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A woman with an Alzheimer’s-causing mutation and lots of beta-amyloid buildup (red, above) in her brain remained cognitively healthy for decades.Aaron Schultz
▼ In 2016, a 73-year-old woman from Medellín, Colombia, flew to Boston so researchers could scan her brain, analyze her blood, and pore over her genome. She carried a genetic mutation that had caused many in her family to develop dementia in middle age. But for decades, she had avoided the disease. The researchers now report that another rare mutation—this one in the well-known Alzheimer’s disease risk geneAPOE—may have protected her. They can’t prove this mutation alone staved off disease. But the study draws new attention to the possibility of preventing or treating Alzheimer’s by targetingAPOE—an idea some researchers say has spent too long on the sidelines.
“This case is very special,” says Yadong Huang, a neuroscientist at the Gladstone Institutes in San Francisco, California, who was not involved with the research. “This may open up a very promising new avenue in both research and therapy.”
APOE, the strongest genetic risk factor for Alzheimer’s, has three common forms. A variant calledAPOE2lowers risk of the disease. The most common variant,APOE3, doesn’t influence risk.APOE4raises risk; roughly half of the people with the disease have at least one copy of this variant.
Researchers have long contemplated targetingAPOEwith therapies. A team at Cornell University will soon start a clinical trialthat infuses the protectiveAPOE2gene into the cerebrospinal fluid of people with two copies ofAPOE4.
But mysteries aboutAPOEhave kept it from becoming a front-runner among drug targets. The APOE protein binds and transports fats and is abundant in the brain. But, “It does so many things that it’s confusing,” says Eric Reiman, a neuroscientist at the Banner Alzheimer’s Institute in Phoenix and a co-author on the new paper.APOE4seems to encourage the formation of sticky plaques of the protein beta-amyloid that clogs the brain in Alzheimer’s. But powerful amyloid-busting drugs have largely failed to benefit patients in clinical trials. Some researchers saw no reason to try anAPOE-targeting therapy that seemed to be “just a poor man’s antiamyloid treatment,” Reiman says.
The Colombian woman’s case suggests other waysAPOEcould affect Alzheimer’s risk. The woman participated in (▪ ▪ ▪)
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