Carrying Two APOE4 Genes Signals ‘Virtually’ Inevitable Alzheimer’s Pathology

Carrying Two APOE4 Genes Signals ‘Virtually’ Inevitable Alzheimer’s Pathology
Although only about 20 percent of the human population carries ApoE4, it accounts for an estimated 40 to 65 percent of Alzheimer's disease (AD) cases. (Kateryna Kon/Shutterstock)
Amie Dahnke
5/7/2024
Updated:
5/7/2024
0:00

A new study suggests that having two copies of the APOE4 gene variant, known to increase the risk of Alzheimer’s disease, is more than a risk factor—it is strongly linked to developing the mind-robbing condition.

“Now we know that virtually all individuals with this duplicated gene develop Alzheimer’s biology,” Dr. Juan Fortea, director of the Memory Unit of the Neurology Service at the Santa Pau Hospital in Barcelona and a lead author of the study, said in a press release.
The discovery could pave the way for earlier diagnoses and more targeted prevention strategies and treatments for people carrying two copies of the gene variant.

Driver of Alzheimer’s Onset

Approximately 2-3 percent of the population carries two copies of the APOE4 gene, according to Dr. Fortea.

The research team evaluated clinical data, pathological changes, and biomarkers in individuals with two APOE4 alleles. Their database included 3,297 brain donors, 273 individuals with dual APOE4 genes, and clinical/biomarker data from 10,000 people, including 519 with the dual APOE4 variant.

The analysis revealed that virtually all individuals with two APOE4 genes had elevated Alzheimer’s biomarker levels by age 55 compared to those with the APOE3 gene.

The findings, published in Nature Medicine, indicate that by age 65, over 95 percent of people with two APOE4 alleles (APOE4 homozygotes) exhibited abnormal levels of amyloid in their cerebrospinal fluid, a key early pathological marker of Alzheimer’s disease. Also, 75 percent of these individuals had positive amyloid PET scans, a test to detect beta-amyloid in the brain, helping to confirm an Alzheimer’s diagnosis more accurately.
“The data clearly show that having two copies of the APOE4 gene not only increases the risk, but also anticipates the onset of Alzheimer’s, reinforcing the need for specific preventive strategies,” Dr. Alberto Lleó, director of the Memory Unit in the Neurology Department at the Hospital of Sant Pau, said in a statement.

Treatment Options Limited

While medication options to manage Alzheimer’s symptoms or to treat the condition exist, they are typically prescribed after a person has already been diagnosed.

Immunotherapy is another treatment approach, as it targets the amyloid proteins that form plaques in the brain, thought to cause the associated cognitive impairment.

Alzheimer’s was the fifth leading cause of death among people aged 65 and above in 2021 in the U.S., Globally, Alzheimer’s disease and other forms of dementia ranked as the seventh leading cause of death in 2019, according to the World Health Organization. Memory problems are often one of the earliest warning signs of the disease.

Certain lifestyle risk factors can increase a person’s likelihood of developing Alzheimer’s disease, according to the U.S. Centers for Disease Control and Prevention. They include poor diet, smoking, excessive drinking, inadequate sleep, and lack of exercise.

Amie Dahnke is a freelance writer and editor residing in California. She has covered community journalism and health care news for nearly a decade, winning a California Newspaper Publishers Award for her work.