Interplay between age, APOE Ɛ4 and the metabolome in plasma and brain in Alzheimer’s disease

Najaf Amin, Jun Liu, William Sproviero, Matthias Arnold, Richa Batra, Bruno Bonnechere, Yu-Jie Chiou, Marco Fernandes, Jan Krumsiek, Danielle Newby, Kwangsik Nho, Jun Pyo Kim, Andrew J. Saykin, Liu Shi, Laura M. Winchester, Yang Yang, Alejo J. Nevado-Holgado, Gabi Kastenmüller, Rima Kaddurah-Daouk*, Cornelia M. van Duijn*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Age and the ε4 variant of the apolipoprotein E gene (APOE ε4) are two major drivers of Alzheimer’s disease (AD). APOE is also the major determinant of longevity. How age and APOE interact in the development of AD is largely unknown. In this study we integrate metabolomics (N = 274,259) and proteomics (N = 54,219) data in plasma from the UK Biobank with the metabolomics (N = 514) and proteomics (N = 618) data in brain from the Religious Orders Study and the Rush Memory and Aging Project (ROSMAP) to understand the interplay of age, APOE ε4 and metabolome in the development of AD. We find that levels of β-hydroxybutyrate (BHBA) and branch-chained amino acids (BCAAs) are dysregulated in plasma and brains of AD patients. APOE ε4 carriers manifest significantly higher plasma concentration of BHBA that is detectable as early as 37 years of age and remains high throughout the studied age range of 37–73 whereas the plasma concentrations of BCAAs decline in APOE ε44 carriers after the age of 58 years. Proteomic signatures of APOE ε4, BHBA and BCAAs suggest downregulation of lysosome, immune and insulin-like growth factor (IGF1) transport/uptake pathways in plasma, and downregulation of the tricarboxylic acid (TCA) cycle, neurexins/neuroligins and clathrin-mediated endocytosis pathways in brain. Our data identifies two major shifts in metabolism occurring decades apart over the age course in AD in APOE ε4 carriers. These include early ketogenesis that manifests around late 30 s and gluconeogenesis, which manifests around the age of 60 years.

Original languageEnglish
Article number460
Pages (from-to)1-15
Number of pages15
JournalTranslational Psychiatry
Volume15
Early online date31 Oct 2025
DOIs
Publication statusPublished - Dec 2025

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