PREFACEThe vast majority of Alzheimer's disease (AD) cases are late-onset and their development is likely influenced by both genetic and environmental risk factors. A strong genetic risk factor for lateonset AD is the presence of the ε4 allele of the apolipoprotein E (APOE) gene, which encodes a protein with crucial roles in cholesterol metabolism. Mounting evidence demonstrates that apoE4 contributes to AD pathogenesis by modulating the metabolism and aggregation of amyloid-β peptide and by directly regulating brain lipid metabolism and synaptic functions through apoE receptors. Emerging knowledge on the contribution of apoE to the pathophysiology of AD presents new opportunities for AD therapy.
INTRODUCTIONAlzheimer's disease (AD) is the most common cause of dementia in the elderly. Extracellular amyloid plaques and intracellular neurofibrillary tangles are defining lesions in AD 1,2 . Mounting genetic and biochemical data support the hypothesis that amyloid-β(Aβ) accumulation and aggregation in the brain is an early and central event in the pathogenesis of AD 2,3 . Aβ is derived from sequential proteolytic processing of the amyloid precursor protein (APP) by β-and γ-secretases. Mutations associated with early-onset familial AD (FAD) are dominantly inherited and are found in the APP gene itself or in the genes of presenilin 1 (PSEN1) and PSEN2, whose products, together with nicastrin, APH-1 and PEN-2, are essential components of a multi-protein complex that is responsible for γ-secretase activity 4 . A common feature of most FAD mutations is that they increase the generation of Aβ peptides, or increase the proportion of the longer Aβ42 form, which has a higher tendency to aggregate and is more toxic than the shorter Aβ40 3 . Because γ-secretase cleavage of an increasingly recognized panel of substrates is important for synaptic function and neuronal survival, a loss-of-function hypothesis for PSEN mutations in AD pathogenesis has also been proposed 5 .FAD genetics and mouse models have shed light on early-onset AD pathogenesis, but the vast majority of AD cases occur late in life. The ε4 allele of the apolipoprotein E (APOE) gene is a major risk for late-onset AD (LOAD). This risk allele, discovered in 1993 by Strittmatter, Roses and colleagues 6,7 , has been validated in numerous genetic association studies (see AlzGene website at http://www.alzforum.org/res/com/gen/alzgene/default.asp). Although a gene on chromosome 19 had previously been implicated in LOAD risk, the Correspondence to: Guojun Bu, Department of Pediatrics, Washington University School of Medicine, CB 8208, 660 South Euclid Ave, St. Louis, MO 63110, USA, Phone: 314-286-2860, Fax: 314-286-2894 Competing interests statement The author declares no competing financial interest.
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Author ManuscriptNat Rev Neurosci. Author manuscript; available in PMC 2010 July 22.
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript observation that apoE binds to Aβ in the cerebrospinal fluid (CSF) prompted the testing of APOE ...