Objective
Autosomal‐dominant familial Alzheimer disease (
AD
) is caused by by variants in presenilin 1 (
PSEN
1
), presenilin 2 (
PSEN
2
), and amyloid precursor protein (
APP
). Previously, we reported a rare
PSEN
2
frameshift variant in an early‐onset
AD
case (
PSEN
2 p.K115Efs*11). In this study, we characterize a second family with the same variant and analyze cellular transcripts from both patient fibroblasts and brain lysates.
Methods
We combined genomic, neuropathological, clinical, and molecular techniques to characterize the
PSEN
2 K115Efs*11 variant in two families.
Results
Neuropathological and clinical evaluation confirmed the
AD
diagnosis in two individuals carrying the
PSEN
2 K115Efs*11 variant. A truncated transcript from the variant allele is detectable in patient fibroblasts while levels of wild‐type
PSEN
2
transcript and protein are reduced compared to controls. Functional studies to assess biological consequences of the variant demonstrated that
PSEN
2 K115Efs*11 fibroblasts secrete less A
β
1–40
compared to controls, indicating abnormal
γ
‐secretase activity. Analysis of
PSEN
2
transcript levels in brain tissue revealed alternatively spliced
PSEN
2
products in patient brain as well as in sporadic
AD
and age‐matched control brain.
Interpretation
These data suggest that
PSEN
2 K115Efs*11 is a likely pathogenic variant associated with
AD
. We uncovered novel
PSEN
2
alternative transcripts in addition to previously reported
PSEN
2
splice isoforms associated with sporadic
AD
. In the context of a frameshift, these alternative transcripts return to the canonical reading frame with potential to generate deleterious protein products. Our findings suggest novel potential mechanisms by which
PSEN
variants may influence
AD
pathogenesis, highlighting the complexity underlying genetic contribution to disease risk.