Kim Hyun, Devanand Davangere P, Carlson Scott, Goldberg Terry E
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.
Department of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, United States.
Front Aging Neurosci. 2022 Jul 14;14:919712. doi: 10.3389/fnagi.2022.919712. eCollection 2022.
In this review, we comprehensively, qualitatively, and critically synthesized several features of APOE-e2, a known APOE protective variant, including its associations with longevity, cognition, and neuroimaging, and neuropathology, all in humans. If e2's protective effects-and their limits-could be elucidated, it could offer therapeutic windows for Alzheimer's disease (AD) prevention or amelioration. Literature examining e2 within the years 1994-2021 were considered for this review. Studies on human subjects were selectively reviewed and were excluded if observation of e2 was not specified. Effects of e2 were compared with e3 and e4, separately and as a combined non-e2 group. Our examination of existing literature indicated that the most robust protective role of e2 is in longevity and AD neuropathologies, but e2's effect on cognition and other AD imaging markers (brain structure, function, and metabolism) were inconsistent, thus inconclusive. Notably, e2 was associated with greater risk of non-AD proteinopathies and a disadvantageous cerebrovascular profile. We identified multiple methodological shortcomings of the literature on brain function and cognition that could have contributed to inconsistent and potentially misleading findings. We make careful interpretations of existing findings and provide directions for research strategies that could effectively examine the independent and unbiased effect of e2 on AD risk.
在本综述中,我们全面、定性且批判性地综合了载脂蛋白E(APOE)-e2(一种已知的APOE保护性变体)的几个特征,包括其与人类寿命、认知、神经影像学以及神经病理学的关联。如果能够阐明e2的保护作用及其局限性,那么它可能为阿尔茨海默病(AD)的预防或改善提供治疗窗口。本综述纳入了1994年至2021年间研究e2的文献。对人体研究进行了选择性综述,若未明确提及对e2的观察则予以排除。将e2的作用分别与e3和e4以及作为一个合并的非e2组进行了比较。我们对现有文献的研究表明,e2最显著的保护作用体现在寿命和AD神经病理学方面,但e2对认知和其他AD影像学标志物(脑结构、功能和代谢)的影响并不一致,因此尚无定论。值得注意的是,e2与非AD蛋白病的较高风险以及不利的脑血管特征相关。我们发现了关于脑功能和认知的文献存在多个方法学缺陷,这些缺陷可能导致了不一致且可能具有误导性的结果。我们对现有研究结果进行了谨慎解读,并为能够有效检验e2对AD风险的独立且无偏倚影响的研究策略提供了方向。