Al zheimer Disease (AD [MIM 104300]) is a common,complex genetic disorder with a prevalence rate of 5% to 10% and an incidence that increases exponentially after the age of 65 years. A majority of AD cases manifest as sporadic late onset form (LOAD [MIM 606626]), typically with onset above the age of 65 years.Clinical manifestations of the disease are associated with alterations in some or all of the following neurotransmitter networks: the forebrain cholinergic system, noradrenergic system, and telencephalon somatostatinergic system. 1 In addition, the interaction of cholesterol metabolism, inflammatory processes, and APOE has been implicated in contributing to the pathogenesis and/or progression of the disease.Because evidence of genomic variation in association with LOAD is increasingly emerging in both mutational and Background: Although some genes associated with increased risk of Alzheimer Disease (AD) have been identified, few data exist related to gene/gene and gene/environment risk of AD. The purpose of this pilot study was to explore gene/gene and gene/environment associations in AD and to obtain data for sample size estimates for larger, more definitive studies of AD.
Methods:The effect of gene/gene and gene/environment interaction related to late onset Alzheimer Disease (LOAD) was investigated in 153 subjects with LOAD and 302 gender matched controls enrolled in the Personalized Medicine Research Project, a population-based bio-repository. Genetic risk factors examined included APOE, ACE, OLR1, and CYP46 genes, and environmental factors included smoking, total cholesterol, LDL, HDL, triglycerides, C-reactive protein, blood pressure, statin use, and body mass index.
Results:The mean age of the cases was 78.2 years and the mean age of the controls was 87.2 years. APOE4 was significantly associated with LOAD (OR=3.55, 95%CL=1.70, 7.45). Cases were significantly more likely to have ever smoked cigarettes during their life (49.3% versus 38.4%, p=0.03). The highest recorded blood pressure and pulse pressure measurements were significantly higher in the controls than the cases (all P<0.005). Although not statistically significant in this pilot study, the relationship of the following factors was associated in opposite directions with LOAD based on the presence of an APOE4 allele: obesity at the age of 50, ACE, OLR1, and CYP46.
Conclusions:These pilot data suggest that gene/gene and gene/environment interactions may be important in LOAD, with APOE, a known risk factor for LOAD, affecting the relationship of ACE and OLR1 to LOAD. Replication with a larger sample size and in other racial/ethnic groups is warranted and the allele and risk factor frequencies will assist in choosing an appropriate sample size for a definitive study.