ImportanceAltered immune signatures are emerging as a central theme in neurodegenerative disease, yet little is known about immune responses in early-onset Alzheimer’s disease (EOAD).ObjectiveTo determine whether an EOAD-specific immune signal can be detected in blood.DesignWe examined single-cell RNA-sequencing (scRNA-seq) data from peripheral blood mononuclear cells (PBMCs) and droplet digital (dd)PCR data from CD4 T cells from participants with EOAD and clinically normal controls.SettingUniversity of California, San Francisco Memory and Aging Center.ParticipantsSamples were collected for the study from 2017 to 2021. Participants with EOAD were diagnosed with AD prior to age 65. Data were last analyzed September 2023.Main Outcomes and MeasuresThe primary analysis (scRNA-seq) examined whether EOAD was associated with altered frequency of any PBMC subsets. Secondary analysis (ddPCR) measured marker gene expression in CD4 T cells.ResultsOver 182,000 individual PBMC transcriptomes were analyzed by scRNA-seq from 16 individuals (mean [SD] age at sample collection, 52.2 [9.6] years; 8 [50.0%] were female; 8 [50.0%] had clinical diagnosis of AD). The relative abundance of PBMC subsets was tested for association with EOAD while controlling for age and sex. Of 19 PBMC clusters, one cluster, representing interferon signaling-associated gene (ISAG)hiT cells, was significantly expanded in EOAD (P= 0.005). A validation cohort consisting of 19 individuals (mean [SD] age at sample collection, 57.7 [4.1] years; 13 [68.4%] were female; 9 [47.4%] had clinical diagnosis of AD) was used for CD4 T cell isolation and ddPCR analysis. Expression ofMX1andIFI6, marker genes for ISAGhiT cells, was significantly elevated in participants with EOAD (P= 0.002 andP= 0.04, respectively). Secondary analyses of independent scRNA-seq datasets from later-onset AD and familial tauopathy indicated that ISAGhiT cells are detected but not elevated in these related diseases.Conclusions and RelevanceISAGhiT cells, which appear primed for antiviral activity, are significantly and specifically expanded in EOAD. Additional research into the role of this rare cell type in neurodegeneration is warranted.Key PointsQuestionIs early-onset Alzheimer’s disease (EOAD) associated with a specific peripheral immune signature?FindingsWe performed single-cell RNA-sequencing of >182,000 peripheral blood mononuclear cells and identified striking expansion of a subset of CD4 T cells termed interferon (IFN) signaling-associated gene (ISAG)hiT cells. We confirmed this finding by isolating CD4 T cells from additional participants with EOAD and measuring increased expression of ISAGhimarker genes.MeaningISAGhicells, which are primed for antiviral response, are expanded in early-but not late-onset AD or primary familial tauopathy, suggesting they may provide unique insight into the immune response to EOAD.