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{{short description|Cholesterol-transporting protein most notably implicated in Alzheimer's disease}}
{{short description|Cholesterol-transporting protein most notably implicated in Alzheimer's disease}}
{{cs1 config|name-list-style=vanc}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox_gene}}
{{Infobox_gene}}


'''Apolipoprotein E''' ('''Apo-E''') is a protein involved in the metabolism of fats in the body of mammals. A subtype is implicated in the [[Alzheimer's disease]] and [[cardiovascular disease]]s.<ref name="encyclopedia">{{cite book | veditors = Stolerman IP | title = Encyclopedia of Psychopharmacology | date = 2010 | publisher = Springer | location = Berlin | isbn = 978-3540686989 | edition = Online }}</ref> It is encoded in humans by the [[gene]] ''APOE''.
'''Apolipoprotein E''' ('''Apo-E''') is a protein involved in the metabolism of fats in the body of mammals. A subtype is implicated in [[Alzheimer's disease]] and [[cardiovascular disease]]s.<ref name="encyclopedia">{{cite book | veditors = Stolerman IP | title = Encyclopedia of Psychopharmacology | date = 2010 | publisher = Springer | location = Berlin | isbn = 978-3540686989 | edition = Online }}</ref> It is encoded in humans by the [[gene]] ''APOE''.


Apo-E belongs to a family of fat-binding proteins called [[apolipoprotein]]s. In the circulation, it is present as part of several classes of lipoprotein particles, including [[chylomicron remnants]], [[VLDL]], [[Intermediate-density lipoprotein|IDL]], and some [[High-density lipoprotein|HDL]].<ref>{{cite journal | vauthors = Mahley RW, Weisgraber KH, Huang Y | title = Apolipoprotein E: structure determines function, from atherosclerosis to Alzheimer's disease to AIDS | journal = Journal of Lipid Research | volume = 50 | issue = Suppl | pages = S183–S188 | date = April 2009 | pmid = 19106071 | pmc = 2674716 | doi = 10.1194/jlr.R800069-JLR200 |doi-access=free }}</ref> APOE interacts significantly with the [[LDL receptor|low-density lipoprotein receptor (LDLR)]], which is essential for the normal processing ([[catabolism]]) of [[triglyceride]]-rich lipoproteins.<ref name="entrez">{{cite web | title = Entrez Gene: APOE apolipoprotein E| url = https://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=348}}</ref> In peripheral tissues, APOE is primarily produced by the [[liver]] and [[macrophages]], and mediates [[cholesterol]] metabolism. In the [[central nervous system]], Apo-E is mainly produced by [[astrocytes]] and transports [[cholesterol]] to [[neurons]]<ref name="Wang 2020.06.18.159632">{{cite journal | vauthors = Wang H, Kulas JA, Wang C, Holtzman DM, Ferris HA, Hansen SB | title = Regulation of beta-amyloid production in neurons by astrocyte-derived cholesterol | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 118 | issue = 33 | pages = 2020.06.18.159632 | date = August 2021 | pmid = 34385305 | pmc = 8379952 | doi = 10.1073/pnas.2102191118 | s2cid = 220044671 | doi-access = free | bibcode = 2021PNAS..11802191W | biorxiv = 10.1101/2020.06.18.159632 }}</ref> via APOE receptors, which are members of the [[low density lipoprotein receptor gene family]].<ref name="Liu2013"/> Apo-E is the principal cholesterol carrier in the brain.<ref>{{cite journal | vauthors = Puglielli L, Tanzi RE, Kovacs DM | title = Alzheimer's disease: the cholesterol connection | journal = Nature Neuroscience | volume = 6 | issue = 4 | pages = 345–351 | date = April 2003 | pmid = 12658281 | doi = 10.1038/nn0403-345 | s2cid = 5407666 }}</ref> APOE qualifies as a [[checkpoint inhibitor]] of the [[classical complement pathway]] by complex formation with activated [[Complement component 1q|C1q]].<ref>{{cite journal | vauthors = Yin C, Ackermann S, Ma Z, Mohanta SK, Zhang C, Li Y, Nietzsche S, Westermann M, Peng L, Hu D, Bontha SV, Srikakulapu P, Beer M, Megens RT, Steffens S, Hildner M, Halder LD, Eckstein HH, Pelisek J, Herms J, Roeber S, Arzberger T, Borodovsky A, Habenicht L, Binder CJ, Weber C, Zipfel PF, Skerka C, Habenicht AJ | display-authors = 6 | title = ApoE attenuates unresolvable inflammation by complex formation with activated C1q | journal = Nature Medicine | volume = 25 | issue = 3 | pages = 496–506 | date = March 2019 | pmid = 30692699 | pmc = 6420126 | doi = 10.1038/s41591-018-0336-8 }}</ref>
Apo-E belongs to a family of fat-binding proteins called [[apolipoprotein]]s. In the circulation, it is present as part of several classes of lipoprotein particles, including [[chylomicron remnants]], [[VLDL]], [[Intermediate-density lipoprotein|IDL]], and some [[High-density lipoprotein|HDL]].<ref>{{cite journal | vauthors = Mahley RW, Weisgraber KH, Huang Y | title = Apolipoprotein E: structure determines function, from atherosclerosis to Alzheimer's disease to AIDS | journal = Journal of Lipid Research | volume = 50 | issue = Suppl | pages = S183–S188 | date = April 2009 | pmid = 19106071 | pmc = 2674716 | doi = 10.1194/jlr.R800069-JLR200 |doi-access=free }}</ref> Apo-E interacts significantly with the [[LDL receptor|low-density lipoprotein receptor (LDLR)]], which is essential for the normal processing ([[catabolism]]) of [[triglyceride]]-rich lipoproteins.<ref name="entrez">{{cite web | title = Entrez Gene: APOE apolipoprotein E| url = https://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=348}}</ref> In peripheral tissues, Apo-E is primarily produced by the [[liver]] and [[macrophages]], and mediates [[cholesterol]] metabolism. In the [[central nervous system]], Apo-E is mainly produced by [[astrocytes]] and transports [[cholesterol]] to [[neurons]]<ref name="Wang 2020.06.18.159632">{{cite journal | vauthors = Wang H, Kulas JA, Wang C, Holtzman DM, Ferris HA, Hansen SB | title = Regulation of beta-amyloid production in neurons by astrocyte-derived cholesterol | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 118 | issue = 33 | pages = 2020.06.18.159632 | date = August 2021 | pmid = 34385305 | pmc = 8379952 | doi = 10.1073/pnas.2102191118 | s2cid = 220044671 | doi-access = free | bibcode = 2021PNAS..11802191W | biorxiv = 10.1101/2020.06.18.159632 }}</ref> via Apo-E receptors, which are members of the [[low density lipoprotein receptor gene family]].<ref name="Liu2013"/> Apo-E is the principal cholesterol carrier in the brain.<ref>{{cite journal | vauthors = Puglielli L, Tanzi RE, Kovacs DM | title = Alzheimer's disease: the cholesterol connection | journal = Nature Neuroscience | volume = 6 | issue = 4 | pages = 345–351 | date = April 2003 | pmid = 12658281 | doi = 10.1038/nn0403-345 | s2cid = 5407666 }}</ref> Apo-E qualifies as a [[checkpoint inhibitor]] of the [[classical complement pathway]] by complex formation with activated [[Complement component 1q|C1q]].<ref>{{cite journal | vauthors = Yin C, Ackermann S, Ma Z, Mohanta SK, Zhang C, Li Y, Nietzsche S, Westermann M, Peng L, Hu D, Bontha SV, Srikakulapu P, Beer M, Megens RT, Steffens S, Hildner M, Halder LD, Eckstein HH, Pelisek J, Herms J, Roeber S, Arzberger T, Borodovsky A, Habenicht L, Binder CJ, Weber C, Zipfel PF, Skerka C, Habenicht AJ | title = ApoE attenuates unresolvable inflammation by complex formation with activated C1q | journal = Nature Medicine | volume = 25 | issue = 3 | pages = 496–506 | date = March 2019 | pmid = 30692699 | pmc = 6420126 | doi = 10.1038/s41591-018-0336-8 }}</ref>


==Evolution==
==Evolution==
Apolipoproteins are not unique to mammals. Many terrestrial and marine [[vertebrate]]s have versions of them.<ref name="Babin_1997">{{cite journal | vauthors = Babin PJ, Thisse C, Durliat M, Andre M, Akimenko MA, Thisse B | title = Both apolipoprotein E and A-I genes are present in a nonmammalian vertebrate and are highly expressed during embryonic development | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 94 | issue = 16 | pages = 8622–8627 | date = August 1997 | pmid = 9238027 | pmc = 23048 | doi = 10.1073/pnas.94.16.8622 | doi-access = free | bibcode = 1997PNAS...94.8622B }}</ref> It is believed that ''APOE'' arose via gene duplications of [[APOC1]] before the fish-[[Tetrapoda|tetrapod]] split c. 400 million years ago. Proteins similar in function have been found in [[choanoflagellate]]s, suggesting that they are a very old class of proteins predating the dawn of all living animals.<ref name="Huebbe_2017">{{cite journal | vauthors = Huebbe P, Rimbach G | title = Evolution of human apolipoprotein E (APOE) isoforms: Gene structure, protein function and interaction with dietary factors | journal = Ageing Research Reviews | volume = 37 | pages = 146–161 | date = August 2017 | pmid = 28647612 | doi = 10.1016/j.arr.2017.06.002 | s2cid = 3758905 }}</ref>
Apolipoproteins are not unique to mammals. Many terrestrial and marine [[vertebrate]]s have versions of them.<ref name="Babin_1997">{{cite journal | vauthors = Babin PJ, Thisse C, Durliat M, Andre M, Akimenko MA, Thisse B | title = Both apolipoprotein E and A-I genes are present in a nonmammalian vertebrate and are highly expressed during embryonic development | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 94 | issue = 16 | pages = 8622–8627 | date = August 1997 | pmid = 9238027 | pmc = 23048 | doi = 10.1073/pnas.94.16.8622 | doi-access = free | bibcode = 1997PNAS...94.8622B }}</ref> It is believed that ''APOE'' arose via gene duplications of ''[[APOC1]]'' before the fish–[[Tetrapoda|tetrapod]] split ca. 400 million years ago. Proteins similar in function have been found in [[choanoflagellate]]s, suggesting that they are a very old class of proteins predating the dawn of all living animals.<ref name="Huebbe_2017">{{cite journal | vauthors = Huebbe P, Rimbach G | title = Evolution of human apolipoprotein E (APOE) isoforms: Gene structure, protein function and interaction with dietary factors | journal = Ageing Research Reviews | volume = 37 | pages = 146–161 | date = August 2017 | pmid = 28647612 | doi = 10.1016/j.arr.2017.06.002 | s2cid = 3758905 }}</ref>


The three major human alleles (''E4'', ''E3'', ''E2'') arose after the primate-human split around 7.5 million years ago. These alleles are the by-product of non-synonymous mutations which led to changes in functionality. The first allele to emerge was E4. After the primate-human split, there were four amino acid changes in the human lineage, three of which had no effect on protein function (V174L, A18T, A135V). The fourth substitution (T61R) traded a threonine for an arginine altering the protein's functionality. This substitution occurred somewhere in the 6 million year gap between the primate-human split and the Denisovan-human split, since exactly the same substitutions were found in Denisovan ''APOE''.<ref name="McIntosh_2012">{{cite journal | vauthors = McIntosh AM, Bennett C, Dickson D, Anestis SF, Watts DP, Webster TH, Fontenot MB, Bradley BJ | display-authors = 6 | title = The apolipoprotein E (APOE) gene appears functionally monomorphic in chimpanzees (Pan troglodytes) | journal = PLOS ONE | volume = 7 | issue = 10 | pages = e47760 | year = 2012 | pmid = 23112842 | pmc = 3480407 | doi = 10.1371/journal.pone.0047760 | doi-access = free | bibcode = 2012PLoSO...747760M }}</ref>
The three major human alleles (''E4'', ''E3'', ''E2'') arose after the primate–human split around 7.5 million years ago. These alleles are the by-product of non-synonymous mutations which led to changes in functionality. The first allele to emerge was E4. After the primate–human split, there were four amino acid changes in the human lineage, three of which had no effect on protein function (V174L, A18T, A135V). The fourth substitution (T61R) traded a threonine for an arginine altering the protein's functionality. This substitution occurred somewhere in the 6 million year gap between the primate–human split and the [[Denisovan]]–human split, since exactly the same substitutions were found in Denisovan ''APOE''.<ref name="McIntosh_2012">{{cite journal | vauthors = McIntosh AM, Bennett C, Dickson D, Anestis SF, Watts DP, Webster TH, Fontenot MB, Bradley BJ | title = The apolipoprotein E (APOE) gene appears functionally monomorphic in chimpanzees (Pan troglodytes) | journal = PLOS ONE | volume = 7 | issue = 10 | pages = e47760 | year = 2012 | pmid = 23112842 | pmc = 3480407 | doi = 10.1371/journal.pone.0047760 | doi-access = free | bibcode = 2012PLoSO...747760M }}</ref>


About 220,000 years ago, a cysteine to arginine substitution took place at amino acid 112 (Cys112Arg) of the ''APOE4'' gene, and this resulted in the ''E3'' allele. Finally, 80,000 years ago, another arginine to cysteine substitution at amino acid 158 (Arg158Cys) of the ''APOE3'' gene created the ''E2'' allele.<ref name="pmid15101252">{{cite journal | vauthors = Finch CE, Stanford CB | title = Meat-adaptive genes and the evolution of slower aging in humans | journal = The Quarterly Review of Biology | volume = 79 | issue = 1 | pages = 3–50 | date = March 2004 | pmid = 15101252 | doi = 10.1086/381662 | s2cid = 14225962 }}</ref><ref name="Huebbe_2017"/>
About 220,000 years ago, a cysteine to arginine substitution took place at amino acid 112 (Cys112Arg) of the ''APOE4'' gene, and this resulted in the ''E3'' allele. Finally, 80,000 years ago, another arginine to cysteine substitution at amino acid 158 (Arg158Cys) of the ''APOE3'' gene created the ''E2'' allele.<ref name="pmid15101252">{{cite journal | vauthors = Finch CE, Stanford CB | title = Meat-adaptive genes and the evolution of slower aging in humans | journal = The Quarterly Review of Biology | volume = 79 | issue = 1 | pages = 3–50 | date = March 2004 | pmid = 15101252 | doi = 10.1086/381662 | s2cid = 14225962 }}</ref><ref name="Huebbe_2017"/>
Line 17: Line 17:


===Gene===
===Gene===
The gene, ''APOE'', is mapped to [[chromosome 19 (human)|chromosome 19]] in a [[gene cluster|cluster]] with [[apolipoprotein C1]] (APOC1) and the [[apolipoprotein C2]] (APOC2). The ''APOE'' gene consists of four [[exons]] and three [[introns]], totaling 3597 [[base pair]]s. ''APOE'' is transcriptionally activated by the [[liver X receptor]] (an important regulator of [[cholesterol]], [[fatty acid]], and [[glucose]] [[homeostasis]]) and [[peroxisome proliferator-activated receptor]] γ, [[nuclear receptor]]s that form [[heterodimer]]s with [[retinoid X receptor]]s.<ref name="pmid11172721">{{cite journal | vauthors = Chawla A, Boisvert WA, Lee CH, Laffitte BA, Barak Y, Joseph SB, Liao D, Nagy L, Edwards PA, Curtiss LK, Evans RM, Tontonoz P | display-authors = 6 | title = A PPAR gamma-LXR-ABCA1 pathway in macrophages is involved in cholesterol efflux and atherogenesis | journal = Molecular Cell | volume = 7 | issue = 1 | pages = 161–171 | date = January 2001 | pmid = 11172721 | doi = 10.1016/S1097-2765(01)00164-2 | doi-access = free }}</ref> In [[Melanocyte|melanocytic cells]] ''APOE'' gene expression may be regulated by [[Microphthalmia-associated transcription factor|MITF]].<ref name="pmid19067971">{{cite journal | vauthors = Hoek KS, Schlegel NC, Eichhoff OM, Widmer DS, Praetorius C, Einarsson SO, Valgeirsdottir S, Bergsteinsdottir K, Schepsky A, Dummer R, Steingrimsson E | display-authors = 6 | title = Novel MITF targets identified using a two-step DNA microarray strategy | journal = Pigment Cell & Melanoma Research | volume = 21 | issue = 6 | pages = 665–676 | date = December 2008 | pmid = 19067971 | doi = 10.1111/j.1755-148X.2008.00505.x | s2cid = 24698373 | doi-access = free }}</ref>
The gene, ''APOE'', is mapped to [[chromosome 19 (human)|chromosome 19]] in a [[gene cluster|cluster]] with the [[apolipoprotein C1]] (''APOC1'') gene and the [[apolipoprotein C2]] (''APOC2'') gene. The ''APOE'' gene consists of four [[exons]] and three [[introns]], totaling 3597 [[base pair]]s. ''APOE'' is transcriptionally activated by the [[liver X receptor]] (an important regulator of [[cholesterol]], [[fatty acid]], and [[glucose]] [[homeostasis]]) and [[peroxisome proliferator-activated receptor]] γ, [[nuclear receptor]]s that form [[heterodimer]]s with [[retinoid X receptor]]s.<ref name="pmid11172721">{{cite journal | vauthors = Chawla A, Boisvert WA, Lee CH, Laffitte BA, Barak Y, Joseph SB, Liao D, Nagy L, Edwards PA, Curtiss LK, Evans RM, Tontonoz P | title = A PPAR gamma-LXR-ABCA1 pathway in macrophages is involved in cholesterol efflux and atherogenesis | journal = Molecular Cell | volume = 7 | issue = 1 | pages = 161–171 | date = January 2001 | pmid = 11172721 | doi = 10.1016/S1097-2765(01)00164-2 | doi-access = free }}</ref> In [[Melanocyte|melanocytic cells]] ''APOE'' gene expression may be regulated by [[Microphthalmia-associated transcription factor|MITF]].<ref name="pmid19067971">{{cite journal | vauthors = Hoek KS, Schlegel NC, Eichhoff OM, Widmer DS, Praetorius C, Einarsson SO, Valgeirsdottir S, Bergsteinsdottir K, Schepsky A, Dummer R, Steingrimsson E | title = Novel MITF targets identified using a two-step DNA microarray strategy | journal = Pigment Cell & Melanoma Research | volume = 21 | issue = 6 | pages = 665–676 | date = December 2008 | pmid = 19067971 | doi = 10.1111/j.1755-148X.2008.00505.x | s2cid = 24698373 | doi-access = free }}</ref>


===Protein===
===Protein===
APOE is 299 [[amino acid]]s long and contains multiple [[amphipathic]] [[α-helices]]. According to crystallography studies, a hinge region connects the N- and C-terminal regions of the protein. The N-terminal region ([[Residue (chemistry)#Biochemistry|residues]] 1–167) forms an anti-parallel four-helix bundle such that the non-polar sides face inside the protein. Meanwhile, the C-terminal domain (residues 206–299) contains three α-helices which form a large exposed [[hydrophobic]] surface and interact with those in the N-terminal helix bundle domain through [[hydrogen bond]]s and salt-bridges. The C-terminal region also contains a [[low density lipoprotein receptor]] (LDLR)-binding site.<ref name="pmid25328986">{{cite journal | vauthors = Phillips MC | title = Apolipoprotein E isoforms and lipoprotein metabolism | journal = IUBMB Life | volume = 66 | issue = 9 | pages = 616–623 | date = September 2014 | pmid = 25328986 | doi = 10.1002/iub.1314 | s2cid = 6159310 | doi-access = }}</ref>
Apoe-E is 299 [[amino acid]]s long and contains multiple [[amphipathic]] [[α-helices]]. According to crystallography studies, a hinge region connects the N- and C-terminal regions of the protein. The N-terminal region ([[Residue (chemistry)#Biochemistry|residues]] 1–167) forms an anti-parallel four-helix bundle such that the non-polar sides face inside the protein. Meanwhile, the C-terminal domain (residues 206–299) contains three α-helices which form a large exposed [[hydrophobic]] surface and interact with those in the N-terminal helix bundle domain through [[hydrogen bond]]s and salt-bridges. The C-terminal region also contains a [[low density lipoprotein receptor]] (LDLR)-binding site.<ref name="pmid25328986">{{cite journal | vauthors = Phillips MC | title = Apolipoprotein E isoforms and lipoprotein metabolism | journal = IUBMB Life | volume = 66 | issue = 9 | pages = 616–623 | date = September 2014 | pmid = 25328986 | doi = 10.1002/iub.1314 | s2cid = 6159310 | doi-access = }}</ref>


===Polymorphisms===
===Polymorphisms===
Line 51: Line 51:
| ε2 (rs7412-T, rs429358-T)
| ε2 (rs7412-T, rs429358-T)
| 8.4%<ref name="Liu2013">{{cite journal | vauthors = Liu CC, Liu CC, Kanekiyo T, Xu H, Bu G | title = Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy | journal = Nature Reviews. Neurology | volume = 9 | issue = 2 | pages = 106–118 | date = February 2013 | pmid = 23296339 | pmc = 3726719 | doi = 10.1038/nrneurol.2012.263 }}</ref>
| 8.4%<ref name="Liu2013">{{cite journal | vauthors = Liu CC, Liu CC, Kanekiyo T, Xu H, Bu G | title = Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy | journal = Nature Reviews. Neurology | volume = 9 | issue = 2 | pages = 106–118 | date = February 2013 | pmid = 23296339 | pmc = 3726719 | doi = 10.1038/nrneurol.2012.263 }}</ref>
| This variant of the apoprotein binds poorly to cell surface receptors while E3 and E4 bind well.<ref>{{cite journal | vauthors = Weisgraber KH, Innerarity TL, Mahley RW | title = Abnormal lipoprotein receptor-binding activity of the human E apoprotein due to cysteine-arginine interchange at a single site | journal = The Journal of Biological Chemistry | volume = 257 | issue = 5 | pages = 2518–2521 | date = March 1982 | pmid = 6277903 | doi = 10.1016/S0021-9258(18)34954-8 | doi-access = free }}</ref> E2 is associated with both increased and decreased risk for [[atherosclerosis]]. Individuals with an E2/E2 combination may clear dietary fat slowly and be at greater risk for early vascular disease and the [[genetic disorder]] [[type III hyperlipoproteinemia]]—94.4% of people with such disease are E2/E2 but only ~2% of E2/E2 develop it, so other environmental and genetic factors are likely to be involved (such as cholesterol in the diet and age).<ref>{{cite journal | vauthors = Breslow JL, Zannis VI, SanGiacomo TR, Third JL, Tracy T, Glueck CJ | title = Studies of familial type III hyperlipoproteinemia using as a genetic marker the apoE phenotype E2/2 | journal = Journal of Lipid Research | volume = 23 | issue = 8 | pages = 1224–1235 | date = November 1982 | pmid = 7175379 | doi = 10.1016/S0022-2275(20)38060-3 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Feussner G, Feussner V, Hoffmann MM, Lohrmann J, Wieland H, März W | title = Molecular basis of type III hyperlipoproteinemia in Germany | journal = Human Mutation | volume = 11 | issue = 6 | pages = 417–423 | year = 1998 | pmid = 9603433 | doi = 10.1002/(SICI)1098-1004(1998)11:6<417::AID-HUMU1>3.0.CO;2-5 | s2cid = 39103399 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Civeira F, Pocoví M, Cenarro A, Casao E, Vilella E, Joven J, González J, Garcia-Otín AL, Ordovás JM | display-authors = 6 | title = Apo E variants in patients with type III hyperlipoproteinemia | journal = Atherosclerosis | volume = 127 | issue = 2 | pages = 273–282 | date = December 1996 | pmid = 9125318 | doi = 10.1016/S0021-9150(96)05969-2 }}</ref> E2 has also been implicated in [[Parkinson's disease]],<ref>{{cite journal | vauthors = Huang X, Chen PC, Poole C | title = APOE-[epsilon]2 allele associated with higher prevalence of sporadic Parkinson disease | journal = Neurology | volume = 62 | issue = 12 | pages = 2198–2202 | date = June 2004 | pmid = 15210882 | doi = 10.1212/01.wnl.0000130159.28215.6a | s2cid = 10445412 }}</ref> but this finding was not replicated in a larger population association study.<ref>{{cite journal | vauthors = Federoff M, Jimenez-Rolando B, Nalls MA, Singleton AB | title = A large study reveals no association between APOE and Parkinson's disease | journal = Neurobiology of Disease | volume = 46 | issue = 2 | pages = 389–392 | date = May 2012 | pmid = 22349451 | pmc = 3323723 | doi = 10.1016/j.nbd.2012.02.002 }}</ref>
| This variant of the apoprotein binds poorly to cell surface receptors while E3 and E4 bind well.<ref>{{cite journal | vauthors = Weisgraber KH, Innerarity TL, Mahley RW | title = Abnormal lipoprotein receptor-binding activity of the human E apoprotein due to cysteine-arginine interchange at a single site | journal = The Journal of Biological Chemistry | volume = 257 | issue = 5 | pages = 2518–2521 | date = March 1982 | pmid = 6277903 | doi = 10.1016/S0021-9258(18)34954-8 | doi-access = free }}</ref> E2 is associated with both increased and decreased risk for [[atherosclerosis]]. Individuals with an E2/E2 combination may clear dietary fat slowly and be at greater risk for early vascular disease and the [[genetic disorder]] [[type III hyperlipoproteinemia]]—94.4% of people with such disease are E2/E2 but only ~2% of E2/E2 develop it, so other environmental and genetic factors are likely to be involved (such as cholesterol in the diet and age).<ref>{{cite journal | vauthors = Breslow JL, Zannis VI, SanGiacomo TR, Third JL, Tracy T, Glueck CJ | title = Studies of familial type III hyperlipoproteinemia using as a genetic marker the apoE phenotype E2/2 | journal = Journal of Lipid Research | volume = 23 | issue = 8 | pages = 1224–1235 | date = November 1982 | pmid = 7175379 | doi = 10.1016/S0022-2275(20)38060-3 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Feussner G, Feussner V, Hoffmann MM, Lohrmann J, Wieland H, März W | title = Molecular basis of type III hyperlipoproteinemia in Germany | journal = Human Mutation | volume = 11 | issue = 6 | pages = 417–423 | year = 1998 | pmid = 9603433 | doi = 10.1002/(SICI)1098-1004(1998)11:6<417::AID-HUMU1>3.0.CO;2-5 | s2cid = 39103399 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Civeira F, Pocoví M, Cenarro A, Casao E, Vilella E, Joven J, González J, Garcia-Otín AL, Ordovás JM | title = Apo E variants in patients with type III hyperlipoproteinemia | journal = Atherosclerosis | volume = 127 | issue = 2 | pages = 273–282 | date = December 1996 | pmid = 9125318 | doi = 10.1016/S0021-9150(96)05969-2 }}</ref> E2 has also been implicated in [[Parkinson's disease]],<ref>{{cite journal | vauthors = Huang X, Chen PC, Poole C | title = APOE-[epsilon]2 allele associated with higher prevalence of sporadic Parkinson disease | journal = Neurology | volume = 62 | issue = 12 | pages = 2198–2202 | date = June 2004 | pmid = 15210882 | doi = 10.1212/01.wnl.0000130159.28215.6a | s2cid = 10445412 }}</ref> but this finding was not replicated in a larger population association study.<ref>{{cite journal | vauthors = Federoff M, Jimenez-Rolando B, Nalls MA, Singleton AB | title = A large study reveals no association between APOE and Parkinson's disease | journal = Neurobiology of Disease | volume = 46 | issue = 2 | pages = 389–392 | date = May 2012 | pmid = 22349451 | pmc = 3323723 | doi = 10.1016/j.nbd.2012.02.002 }}</ref>
|-
|-
| ε3 (rs7412-C, rs429358-T)
| ε3 (rs7412-C, rs429358-T)
Line 60: Line 60:
| 13.7%<ref name="Liu2013"/>
| 13.7%<ref name="Liu2013"/>
|
|
E4 has been implicated in [[atherosclerosis]],<ref name="Phillips2014">{{cite journal | vauthors = Phillips MC | title = Apolipoprotein E isoforms and lipoprotein metabolism | journal = IUBMB Life | volume = 66 | issue = 9 | pages = 616–623 | date = September 2014 | pmid = 25328986 | doi = 10.1002/iub.1314 | s2cid = 6159310 }}</ref><ref name="Mahley2000">{{cite journal | vauthors = Mahley RW, Rall SC | title = Apolipoprotein E: far more than a lipid transport protein | journal = Annual Review of Genomics and Human Genetics | volume = 1 | pages = 507–537 | date = 2000 | pmid = 11701639 | doi = 10.1146/annurev.genom.1.1.507 | doi-access = free }}</ref> [[Alzheimer's disease]],<ref name="pmid8346443">{{cite journal | vauthors = Corder EH, Saunders AM, Strittmatter WJ, Schmechel DE, Gaskell PC, Small GW, Roses AD, Haines JL, Pericak-Vance MA | display-authors = 6 | title = Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families | journal = Science | volume = 261 | issue = 5123 | pages = 921–923 | date = August 1993 | pmid = 8346443 | doi = 10.1126/science.8346443 | bibcode = 1993Sci...261..921C }}</ref><ref name="pmid8446617">{{cite journal | vauthors = Strittmatter WJ, Saunders AM, Schmechel D, Pericak-Vance M, Enghild J, Salvesen GS, Roses AD | title = Apolipoprotein E: high-avidity binding to beta-amyloid and increased frequency of type 4 allele in late-onset familial Alzheimer disease | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 90 | issue = 5 | pages = 1977–1981 | date = March 1993 | pmid = 8446617 | pmc = 46003 | doi = 10.1073/pnas.90.5.1977 | doi-access = free | bibcode = 1993PNAS...90.1977S }}</ref> impaired [[cognitive function]],<ref>{{cite journal | vauthors = Deary IJ, Whiteman MC, Pattie A, Starr JM, Hayward C, Wright AF, Carothers A, Whalley LJ | display-authors = 6 | title = Cognitive change and the APOE epsilon 4 allele | journal = Nature | volume = 418 | issue = 6901 | pages = 932 | date = August 2002 | pmid = 12198535 | doi = 10.1038/418932a | hdl-access = free | s2cid = 4418270 | hdl = 1842/702 }}</ref><ref name="Cognitive Impairment">{{cite journal | vauthors = Farlow MR, He Y, Tekin S, Xu J, Lane R, Charles HC | title = Impact of APOE in mild cognitive impairment | journal = Neurology | volume = 63 | issue = 10 | pages = 1898–1901 | date = November 2004 | pmid = 15557508 | doi = 10.1212/01.wnl.0000144279.21502.b7 | s2cid = 21131734 }}</ref> reduced [[hippocampal]] volume,<ref>{{cite journal | vauthors = Saeed U, Desmarais P, Masellis M | title = The ''APOE'' ε4 variant and hippocampal atrophy in Alzheimer's disease and Lewy body dementia: a systematic review of magnetic resonance imaging studies and therapeutic relevance | journal = Expert Review of Neurotherapeutics | volume = 21 | issue = 8 | pages = 851–870 | date = August 2021 | pmid = 34311631 | doi = 10.1080/14737175.2021.1956904 | s2cid = 236451232 }}</ref> [[HIV]],<ref>{{cite journal | vauthors = Burt TD, Agan BK, Marconi VC, He W, Kulkarni H, Mold JE, Cavrois M, Huang Y, Mahley RW, Dolan MJ, McCune JM, Ahuja SK | display-authors = 6 | title = Apolipoprotein (apo) E4 enhances HIV-1 cell entry in vitro, and the APOE epsilon4/epsilon4 genotype accelerates HIV disease progression | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 105 | issue = 25 | pages = 8718–8723 | date = June 2008 | pmid = 18562290 | pmc = 2438419 | doi = 10.1073/pnas.0803526105 | doi-access = free }}</ref> faster disease progression in [[multiple sclerosis]],<ref>{{cite journal | vauthors = Chapman J, Vinokurov S, Achiron A, Karussis DM, Mitosek-Szewczyk K, Birnbaum M, Michaelson DM, Korczyn AD | display-authors = 6 | title = APOE genotype is a major predictor of long-term progression of disability in MS | journal = Neurology | volume = 56 | issue = 3 | pages = 312–316 | date = February 2001 | pmid = 11171894 | doi = 10.1212/wnl.56.3.312 | s2cid = 40761206 }}</ref><ref>{{cite journal | vauthors = Schmidt S, Barcellos LF, DeSombre K, Rimmler JB, Lincoln RR, Bucher P, Saunders AM, Lai E, Martin ER, Vance JM, Oksenberg JR, Hauser SL, Pericak-Vance MA, Haines JL | display-authors = 6 | title = Association of polymorphisms in the apolipoprotein E region with susceptibility to and progression of multiple sclerosis | journal = American Journal of Human Genetics | volume = 70 | issue = 3 | pages = 708–717 | date = March 2002 | pmid = 11836653 | pmc = 384947 | doi = 10.1086/339269 }}</ref> unfavorable outcome after [[traumatic brain injury]],<ref>{{cite journal | vauthors = Friedman G, Froom P, Sazbon L, Grinblatt I, Shochina M, Tsenter J, Babaey S, Yehuda B, Groswasser Z | display-authors = 6 | title = Apolipoprotein E-epsilon4 genotype predicts a poor outcome in survivors of traumatic brain injury | journal = Neurology | volume = 52 | issue = 2 | pages = 244–248 | date = January 1999 | pmid = 9932938 | doi = 10.1212/wnl.52.2.244 | s2cid = 131908791 }}</ref> ischemic [[cerebrovascular disease]],<ref>{{cite journal | vauthors = McCarron MO, Delong D, Alberts MJ | title = APOE genotype as a risk factor for ischemic cerebrovascular disease: a meta-analysis | journal = Neurology | volume = 53 | issue = 6 | pages = 1308–1311 | date = October 1999 | pmid = 10522889 | doi = 10.1212/wnl.53.6.1308 | s2cid = 23443430 }}</ref> [[sleep apnea]],<ref>{{cite journal | vauthors = Kadotani H, Kadotani T, Young T, Peppard PE, Finn L, Colrain IM, Murphy GM, Mignot E | display-authors = 6 | title = Association between apolipoprotein E epsilon4 and sleep-disordered breathing in adults | journal = JAMA | volume = 285 | issue = 22 | pages = 2888–2890 | date = June 2001 | pmid = 11401610 | doi = 10.1001/jama.285.22.2888 | doi-access = }}</ref><ref>{{cite journal | vauthors = Gottlieb DJ, DeStefano AL, Foley DJ, Mignot E, Redline S, Givelber RJ, Young T | title = APOE epsilon4 is associated with obstructive sleep apnea/hypopnea: the Sleep Heart Health Study | journal = Neurology | volume = 63 | issue = 4 | pages = 664–668 | date = August 2004 | pmid = 15326239 | doi = 10.1212/01.wnl.0000134671.99649.32 | s2cid = 12280483 }}</ref> both the extension and shortening of [[telomere]]s,<ref name="pmid23418430">{{cite journal | vauthors = Jacobs EG, Kroenke C, Lin J, Epel ES, Kenna HA, Blackburn EH, Rasgon NL | title = Accelerated cell aging in female APOE-ε4 carriers: implications for hormone therapy use | journal = PLOS ONE | volume = 8 | issue = 2 | pages = e54713 | date = February 2013 | pmid = 23418430 | pmc = 3572118 | doi = 10.1371/journal.pone.0054713 | doi-access = free | bibcode = 2013PLoSO...854713J }}</ref><ref name="Wikgren2012">{{cite journal | vauthors = Wikgren M, Karlsson T, Nilbrink T, Nordfjäll K, Hultdin J, Sleegers K, Van Broeckhoven C, Nyberg L, Roos G, Nilsson LG, Adolfsson R, Norrback KF | display-authors = 6 | title = APOE ε4 is associated with longer telomeres, and longer telomeres among ε4 carriers predicts worse episodic memory | journal = Neurobiology of Aging | volume = 33 | issue = 2 | pages = 335–344 | date = February 2012 | pmid = 20395015 | doi = 10.1016/j.neurobiolaging.2010.03.004 | s2cid = 27820056 }}</ref><ref name="Honig2006">{{cite journal | vauthors = Honig LS, Schupf N, Lee JH, Tang MX, Mayeux R | title = Shorter telomeres are associated with mortality in those with APOE epsilon4 and dementia | journal = Annals of Neurology | volume = 60 | issue = 2 | pages = 181–187 | date = August 2006 | pmid = 16807921 | doi = 10.1002/ana.20894 | s2cid = 73120632 }}</ref><ref name="Dhillon2020">{{cite journal | vauthors = Dhillon VS, Deo P, Chua A, Thomas P, Fenech M | title = Shorter Telomere Length in Carriers of APOE-ε4 and High Plasma Concentration of Glucose, Glyoxal and Other Advanced Glycation End Products (AGEs) | journal = The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences | volume = 75 | issue = 10 | pages = 1894–1898 | date = September 2020 | pmid = 31541246 | doi = 10.1093/gerona/glz203 }}</ref> reduced [[neurite]] outgrowth,<ref name="pmid18395206">{{cite journal | vauthors = Raber J | title = AR, apoE, and cognitive function | journal = Hormones and Behavior | volume = 53 | issue = 5 | pages = 706–715 | date = May 2008 | pmid = 18395206 | pmc = 2409114 | doi = 10.1016/j.yhbeh.2008.02.012 }}</ref> and [[COVID-19]].<ref>{{cite journal | vauthors = Kuo CL, Pilling LC, Atkins JL, Masoli JA, Delgado J, Kuchel GA, Melzer D | title = APOE e4 Genotype Predicts Severe COVID-19 in the UK Biobank Community Cohort | journal = The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences | volume = 75 | issue = 11 | pages = 2231–2232 | date = October 2020 | pmid = 32451547 | pmc = 7314139 | doi = 10.1093/gerona/glaa131 | doi-access = free }}</ref> However, E4 has also been associated with enhanced [[vitamin D]] and [[calcium]] status,<ref>{{cite journal | vauthors = Huebbe P, Nebel A, Siegert S, Moehring J, Boesch-Saadatmandi C, Most E, Pallauf J, Egert S, Müller MJ, Schreiber S, Nöthlings U, Rimbach G | display-authors = 6 | title = APOE ε4 is associated with higher vitamin D levels in targeted replacement mice and humans | journal = FASEB Journal | volume = 25 | issue = 9 | pages = 3262–3270 | date = September 2011 | pmid = 21659554 | doi = 10.1096/fj.11-180935 | doi-access = free | s2cid = 22483645 }}</ref> higher [[fecundity]],<ref>{{cite journal | vauthors = Jasienska G, Ellison PT, Galbarczyk A, Jasienski M, Kalemba-Drozdz M, Kapiszewska M, Nenko I, Thune I, Ziomkiewicz A | display-authors = 6 | title = Apolipoprotein E (ApoE) polymorphism is related to differences in potential fertility in women: a case of antagonistic pleiotropy? | journal = Proceedings. Biological Sciences | volume = 282 | issue = 1803 | pages = 20142395 | date = March 2015 | pmid = 25673673 | pmc = 4345437 | doi = 10.1098/rspb.2014.2395 }}</ref> protection against early childhood [[infection]] and [[malnutrition]],<ref>{{cite journal | vauthors = Oriá RB, Patrick PD, Oriá MO, Lorntz B, Thompson MR, Azevedo OG, Lobo RN, Pinkerton RF, Guerrant RL, Lima AA | display-authors = 6 | title = ApoE polymorphisms and diarrheal outcomes in Brazilian shanty town children | journal = Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas | volume = 43 | issue = 3 | pages = 249–256 | date = March 2010 | pmid = 20401432 | pmc = 3057459 | doi = 10.1590/s0100-879x2010007500003 }}</ref> and decreased [[fetal]], [[perinatal]], and [[infant]] mortality.<ref>{{cite journal | vauthors = Becher JC, Keeling JW, Bell J, Wyatt B, McIntosh N | title = Apolipoprotein E e4 and its prevalence in early childhood death due to sudden infant death syndrome or to recognised causes | journal = Early Human Development | volume = 84 | issue = 8 | pages = 549–554 | date = August 2008 | pmid = 18280677 | doi = 10.1016/j.earlhumdev.2008.01.002 }}</ref>
E4 has been implicated in [[atherosclerosis]],<ref name="Phillips2014">{{cite journal | vauthors = Phillips MC | title = Apolipoprotein E isoforms and lipoprotein metabolism | journal = IUBMB Life | volume = 66 | issue = 9 | pages = 616–623 | date = September 2014 | pmid = 25328986 | doi = 10.1002/iub.1314 | s2cid = 6159310 }}</ref><ref name="Mahley2000">{{cite journal | vauthors = Mahley RW, Rall SC | title = Apolipoprotein E: far more than a lipid transport protein | journal = Annual Review of Genomics and Human Genetics | volume = 1 | pages = 507–537 | date = 2000 | pmid = 11701639 | doi = 10.1146/annurev.genom.1.1.507 | doi-access = free }}</ref> [[Alzheimer's disease]],<ref name="pmid8346443">{{cite journal | vauthors = Corder EH, Saunders AM, Strittmatter WJ, Schmechel DE, Gaskell PC, Small GW, Roses AD, Haines JL, Pericak-Vance MA | title = Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families | journal = Science | volume = 261 | issue = 5123 | pages = 921–923 | date = August 1993 | pmid = 8346443 | doi = 10.1126/science.8346443 | bibcode = 1993Sci...261..921C }}</ref><ref name="pmid8446617">{{cite journal | vauthors = Strittmatter WJ, Saunders AM, Schmechel D, Pericak-Vance M, Enghild J, Salvesen GS, Roses AD | title = Apolipoprotein E: high-avidity binding to beta-amyloid and increased frequency of type 4 allele in late-onset familial Alzheimer disease | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 90 | issue = 5 | pages = 1977–1981 | date = March 1993 | pmid = 8446617 | pmc = 46003 | doi = 10.1073/pnas.90.5.1977 | doi-access = free | bibcode = 1993PNAS...90.1977S }}</ref> impaired [[cognitive function]],<ref>{{cite journal | vauthors = Deary IJ, Whiteman MC, Pattie A, Starr JM, Hayward C, Wright AF, Carothers A, Whalley LJ | title = Cognitive change and the APOE epsilon 4 allele | journal = Nature | volume = 418 | issue = 6901 | pages = 932 | date = August 2002 | pmid = 12198535 | doi = 10.1038/418932a | hdl-access = free | s2cid = 4418270 | hdl = 1842/702 }}</ref><ref name="Cognitive Impairment">{{cite journal | vauthors = Farlow MR, He Y, Tekin S, Xu J, Lane R, Charles HC | title = Impact of APOE in mild cognitive impairment | journal = Neurology | volume = 63 | issue = 10 | pages = 1898–1901 | date = November 2004 | pmid = 15557508 | doi = 10.1212/01.wnl.0000144279.21502.b7 | s2cid = 21131734 }}</ref> reduced [[hippocampal]] volume,<ref name="auto">{{cite journal | vauthors = Saeed U, Desmarais P, Masellis M | title = The ''APOE'' ε4 variant and hippocampal atrophy in Alzheimer's disease and Lewy body dementia: a systematic review of magnetic resonance imaging studies and therapeutic relevance | journal = Expert Review of Neurotherapeutics | volume = 21 | issue = 8 | pages = 851–870 | date = August 2021 | pmid = 34311631 | doi = 10.1080/14737175.2021.1956904 | s2cid = 236451232 }}</ref> [[HIV]],<ref>{{cite journal | vauthors = Burt TD, Agan BK, Marconi VC, He W, Kulkarni H, Mold JE, Cavrois M, Huang Y, Mahley RW, Dolan MJ, McCune JM, Ahuja SK | title = Apolipoprotein (apo) E4 enhances HIV-1 cell entry in vitro, and the APOE epsilon4/epsilon4 genotype accelerates HIV disease progression | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 105 | issue = 25 | pages = 8718–8723 | date = June 2008 | pmid = 18562290 | pmc = 2438419 | doi = 10.1073/pnas.0803526105 | doi-access = free }}</ref> faster disease progression in [[multiple sclerosis]],<ref>{{cite journal | vauthors = Chapman J, Vinokurov S, Achiron A, Karussis DM, Mitosek-Szewczyk K, Birnbaum M, Michaelson DM, Korczyn AD | title = APOE genotype is a major predictor of long-term progression of disability in MS | journal = Neurology | volume = 56 | issue = 3 | pages = 312–316 | date = February 2001 | pmid = 11171894 | doi = 10.1212/wnl.56.3.312 | s2cid = 40761206 }}</ref><ref>{{cite journal | vauthors = Schmidt S, Barcellos LF, DeSombre K, Rimmler JB, Lincoln RR, Bucher P, Saunders AM, Lai E, Martin ER, Vance JM, Oksenberg JR, Hauser SL, Pericak-Vance MA, Haines JL | title = Association of polymorphisms in the apolipoprotein E region with susceptibility to and progression of multiple sclerosis | journal = American Journal of Human Genetics | volume = 70 | issue = 3 | pages = 708–717 | date = March 2002 | pmid = 11836653 | pmc = 384947 | doi = 10.1086/339269 }}</ref> unfavorable outcome after [[traumatic brain injury]],<ref>{{cite journal | vauthors = Friedman G, Froom P, Sazbon L, Grinblatt I, Shochina M, Tsenter J, Babaey S, Yehuda B, Groswasser Z | title = Apolipoprotein E-epsilon4 genotype predicts a poor outcome in survivors of traumatic brain injury | journal = Neurology | volume = 52 | issue = 2 | pages = 244–248 | date = January 1999 | pmid = 9932938 | doi = 10.1212/wnl.52.2.244 | s2cid = 131908791 }}</ref> ischemic [[cerebrovascular disease]],<ref>{{cite journal | vauthors = McCarron MO, Delong D, Alberts MJ | title = APOE genotype as a risk factor for ischemic cerebrovascular disease: a meta-analysis | journal = Neurology | volume = 53 | issue = 6 | pages = 1308–1311 | date = October 1999 | pmid = 10522889 | doi = 10.1212/wnl.53.6.1308 | s2cid = 23443430 }}</ref> [[sleep apnea]],<ref>{{cite journal | vauthors = Kadotani H, Kadotani T, Young T, Peppard PE, Finn L, Colrain IM, Murphy GM, Mignot E | title = Association between apolipoprotein E epsilon4 and sleep-disordered breathing in adults | journal = JAMA | volume = 285 | issue = 22 | pages = 2888–2890 | date = June 2001 | pmid = 11401610 | doi = 10.1001/jama.285.22.2888 | doi-access = }}</ref><ref>{{cite journal | vauthors = Gottlieb DJ, DeStefano AL, Foley DJ, Mignot E, Redline S, Givelber RJ, Young T | title = APOE epsilon4 is associated with obstructive sleep apnea/hypopnea: the Sleep Heart Health Study | journal = Neurology | volume = 63 | issue = 4 | pages = 664–668 | date = August 2004 | pmid = 15326239 | doi = 10.1212/01.wnl.0000134671.99649.32 | s2cid = 12280483 }}</ref> both the extension and shortening of [[telomere]]s,<ref name="pmid23418430">{{cite journal | vauthors = Jacobs EG, Kroenke C, Lin J, Epel ES, Kenna HA, Blackburn EH, Rasgon NL | title = Accelerated cell aging in female APOE-ε4 carriers: implications for hormone therapy use | journal = PLOS ONE | volume = 8 | issue = 2 | pages = e54713 | date = February 2013 | pmid = 23418430 | pmc = 3572118 | doi = 10.1371/journal.pone.0054713 | doi-access = free | bibcode = 2013PLoSO...854713J }}</ref><ref name="Wikgren2012">{{cite journal | vauthors = Wikgren M, Karlsson T, Nilbrink T, Nordfjäll K, Hultdin J, Sleegers K, Van Broeckhoven C, Nyberg L, Roos G, Nilsson LG, Adolfsson R, Norrback KF | title = APOE ε4 is associated with longer telomeres, and longer telomeres among ε4 carriers predicts worse episodic memory | journal = Neurobiology of Aging | volume = 33 | issue = 2 | pages = 335–344 | date = February 2012 | pmid = 20395015 | doi = 10.1016/j.neurobiolaging.2010.03.004 | s2cid = 27820056 }}</ref><ref name="Honig2006">{{cite journal | vauthors = Honig LS, Schupf N, Lee JH, Tang MX, Mayeux R | title = Shorter telomeres are associated with mortality in those with APOE epsilon4 and dementia | journal = Annals of Neurology | volume = 60 | issue = 2 | pages = 181–187 | date = August 2006 | pmid = 16807921 | doi = 10.1002/ana.20894 | s2cid = 73120632 }}</ref><ref name="Dhillon2020">{{cite journal | vauthors = Dhillon VS, Deo P, Chua A, Thomas P, Fenech M | title = Shorter Telomere Length in Carriers of APOE-ε4 and High Plasma Concentration of Glucose, Glyoxal and Other Advanced Glycation End Products (AGEs) | journal = The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences | volume = 75 | issue = 10 | pages = 1894–1898 | date = September 2020 | pmid = 31541246 | doi = 10.1093/gerona/glz203 }}</ref> reduced [[neurite]] outgrowth,<ref name="pmid18395206">{{cite journal | vauthors = Raber J | title = AR, apoE, and cognitive function | journal = Hormones and Behavior | volume = 53 | issue = 5 | pages = 706–715 | date = May 2008 | pmid = 18395206 | pmc = 2409114 | doi = 10.1016/j.yhbeh.2008.02.012 }}</ref> and [[COVID-19]].<ref>{{cite journal | vauthors = Kuo CL, Pilling LC, Atkins JL, Masoli JA, Delgado J, Kuchel GA, Melzer D | title = APOE e4 Genotype Predicts Severe COVID-19 in the UK Biobank Community Cohort | journal = The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences | volume = 75 | issue = 11 | pages = 2231–2232 | date = October 2020 | pmid = 32451547 | pmc = 7314139 | doi = 10.1093/gerona/glaa131 | doi-access = free }}</ref> However, E4 has also been associated with enhanced [[vitamin D]] and [[calcium]] status,<ref>{{cite journal | vauthors = Huebbe P, Nebel A, Siegert S, Moehring J, Boesch-Saadatmandi C, Most E, Pallauf J, Egert S, Müller MJ, Schreiber S, Nöthlings U, Rimbach G | title = APOE ε4 is associated with higher vitamin D levels in targeted replacement mice and humans | journal = FASEB Journal | volume = 25 | issue = 9 | pages = 3262–3270 | date = September 2011 | pmid = 21659554 | doi = 10.1096/fj.11-180935 | doi-access = free | s2cid = 22483645 }}</ref> higher [[fecundity]],<ref>{{cite journal | vauthors = Jasienska G, Ellison PT, Galbarczyk A, Jasienski M, Kalemba-Drozdz M, Kapiszewska M, Nenko I, Thune I, Ziomkiewicz A | title = Apolipoprotein E (ApoE) polymorphism is related to differences in potential fertility in women: a case of antagonistic pleiotropy? | journal = Proceedings. Biological Sciences | volume = 282 | issue = 1803 | pages = 20142395 | date = March 2015 | pmid = 25673673 | pmc = 4345437 | doi = 10.1098/rspb.2014.2395 }}</ref> protection against early childhood [[infection]] and [[malnutrition]],<ref>{{cite journal | vauthors = Oriá RB, Patrick PD, Oriá MO, Lorntz B, Thompson MR, Azevedo OG, Lobo RN, Pinkerton RF, Guerrant RL, Lima AA | title = ApoE polymorphisms and diarrheal outcomes in Brazilian shanty town children | journal = Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas | volume = 43 | issue = 3 | pages = 249–256 | date = March 2010 | pmid = 20401432 | pmc = 3057459 | doi = 10.1590/s0100-879x2010007500003 }}</ref> and decreased [[fetal]], [[perinatal]], and [[infant]] mortality.<ref>{{cite journal | vauthors = Becher JC, Keeling JW, Bell J, Wyatt B, McIntosh N | title = Apolipoprotein E e4 and its prevalence in early childhood death due to sudden infant death syndrome or to recognised causes | journal = Early Human Development | volume = 84 | issue = 8 | pages = 549–554 | date = August 2008 | pmid = 18280677 | doi = 10.1016/j.earlhumdev.2008.01.002 }}</ref>
|}
|}
Much remains to be learned about the APOE isoforms, including the interaction of other protective genes.<ref name="Sundermann EE 2016">Sundermann EE, Wang C, Katz M, et al. Cholesteryl ester transfer protein genotype modifies the effect of apolipoprotein ε4 on memory decline in older adults. Neurobiol Aging. 2016;41:200.e7-200.e12. doi:10.1016/j.neurobiolaging.2016.02.006</ref> Indeed, the apolipoprotein ε4 isoform is more protective against cognitive decline than other isoforms in some cases,<ref name="Sundermann EE 2016"/> so caution is advised before making determinant statements about the influence of APOE polymorphisms on cognition, development of Alzheimer's disease, cardiovascular disease, telomere shortening, etc. Many of the studies cited that purport these adverse outcomes are from single studies that have not been replicated and the research is based on unchecked assumptions about this isoform. As of 2007, there was no evidence that APOE polymorphisms influence cognition in younger age groups (other than possible increased episodic memory ability and neural efficiency in younger APOE4 age groups), nor that the APOE4 isoform places individuals at increased risk for any infectious disease.<ref>{{cite journal | vauthors = Mondadori CR, de Quervain DJ, Buchmann A, Mustovic H, Wollmer MA, Schmidt CF, Boesiger P, Hock C, Nitsch RM, Papassotiropoulos A, Henke K | display-authors = 6 | title = Better memory and neural efficiency in young apolipoprotein E epsilon4 carriers | journal = Cerebral Cortex | volume = 17 | issue = 8 | pages = 1934–1947 | date = August 2007 | pmid = 17077159 | doi = 10.1093/cercor/bhl103 | doi-access = free | hdl = 20.500.11850/5720 | hdl-access = free }}</ref>
Much remains to be learned about the APOE isoforms, including the interaction of other protective genes.<ref name="Sundermann EE 2016">Sundermann EE, Wang C, Katz M, et al. Cholesteryl ester transfer protein genotype modifies the effect of apolipoprotein ε4 on memory decline in older adults. Neurobiol Aging. 2016;41:200.e7-200.e12. doi:10.1016/j.neurobiolaging.2016.02.006</ref> Indeed, the apolipoprotein ε4 isoform is more protective against cognitive decline than other isoforms in some cases,<ref name="Sundermann EE 2016"/> so caution is advised before making determinant statements about the influence of APOE polymorphisms on cognition, development of Alzheimer's disease, cardiovascular disease, telomere shortening, etc. Many of the studies cited that purport these adverse outcomes are from single studies that have not been replicated and the research is based on unchecked assumptions about this isoform. As of 2007, there was no evidence that APOE polymorphisms influence cognition in younger age groups (other than possible increased episodic memory ability and neural efficiency in younger APOE4 age groups), nor that the APOE4 isoform places individuals at increased risk for any infectious disease.<ref>{{cite journal | vauthors = Mondadori CR, de Quervain DJ, Buchmann A, Mustovic H, Wollmer MA, Schmidt CF, Boesiger P, Hock C, Nitsch RM, Papassotiropoulos A, Henke K | title = Better memory and neural efficiency in young apolipoprotein E epsilon4 carriers | journal = Cerebral Cortex | volume = 17 | issue = 8 | pages = 1934–1947 | date = August 2007 | pmid = 17077159 | doi = 10.1093/cercor/bhl103 | doi-access = free | hdl = 20.500.11850/5720 | hdl-access = free }}</ref>


However, the association between the APOE4 allele and Alzheimer's disease has been shown to be weaker in minority groups differently compared to their Caucasian counterparts.<ref name="Liu2013" /> [[Alzheimer's disease in the Hispanic/Latino population|Hispanics/Latinos]] and [[Alzheimer's disease in African Americans|African Americans]] who were homozygous for the APOE4 allele had 2.2 and 5.7 times the odds, respectively of developing Alzheimer's disease.<ref name=":3">{{cite journal | vauthors = Huynh RA, Mohan C | title = Alzheimer's Disease: Biomarkers in the Genome, Blood, and Cerebrospinal Fluid | journal = Frontiers in Neurology | volume = 8 | pages = 102 | date = 2017 | pmid = 28373857 | pmc = 5357660 | doi = 10.3389/fneur.2017.00102 | doi-access = free }}</ref><ref name="Liu2013" /> The APOE4 allele has an even stronger effect in [[Alzheimer's Disease in the East Asian Population|East Asian populations]], with Japanese populations have 33 times the odds compared to other populations.<ref>{{cite journal |last1=Miyashita |first1=Akinori |last2=Kikuchi |first2=Masataka |last3=Hara |first3=Norikazu |last4=Ikeuchi |first4=Takeshi |date=March 2023 |title=Genetics of Alzheimer's disease: an East Asian perspective |journal=Journal of Human Genetics |language=en |volume=68 |issue=3 |pages=115–124 |doi=10.1038/s10038-022-01050-z |pmid=35641666 |pmc=9968656 |issn=1435-232X}}</ref> Caucasians who were homozygous for the allele had 12.5 times the odds.<ref name=":3" /><ref name="Liu2013" />
However, the association between the APOE4 allele and Alzheimer's disease has been shown to be weaker in minority groups differently compared to their Caucasian counterparts.<ref name="Liu2013" /> [[Alzheimer's disease in the Hispanic/Latino population|Hispanics/Latinos]] and [[Alzheimer's disease in African Americans|African Americans]] who were homozygous for the APOE4 allele had 2.2 and 5.7 times the odds, respectively of developing Alzheimer's disease.<ref name=":3">{{cite journal | vauthors = Huynh RA, Mohan C | title = Alzheimer's Disease: Biomarkers in the Genome, Blood, and Cerebrospinal Fluid | journal = Frontiers in Neurology | volume = 8 | pages = 102 | date = 2017 | pmid = 28373857 | pmc = 5357660 | doi = 10.3389/fneur.2017.00102 | doi-access = free }}</ref><ref name="Liu2013" /> The APOE4 allele has an even stronger effect in [[Alzheimer's Disease in the East Asian Population|East Asian populations]], with Japanese populations have 33 times the odds compared to other populations.<ref>{{cite journal | vauthors = Miyashita A, Kikuchi M, Hara N, Ikeuchi T | title = Genetics of Alzheimer's disease: an East Asian perspective | journal = Journal of Human Genetics | volume = 68 | issue = 3 | pages = 115–124 | date = March 2023 | pmid = 35641666 | pmc = 9968656 | doi = 10.1038/s10038-022-01050-z }}</ref> Caucasians who were homozygous for the allele had 12.5 times the odds.<ref name=":3" /><ref name="Liu2013" />


== Function ==
== Function ==
APOE transports [[lipid]]s, fat-soluble [[vitamins]], and [[cholesterol]] into the [[lymph system]] and then into the blood. It is synthesized principally in the [[liver]], but has also been found in other tissues such as the [[brain]], [[kidney]]s, and [[spleen]].<ref name="cardiogenetics">{{cite book | vauthors = Baars HF, van der Smagt JJ, Doevandans PA | title = Clinical Cardiogenetics | date = 2011 | publisher = Springer | location = London | isbn = 978-1849964715 }}</ref> In the nervous system, non-neuronal cell types, most notably [[Astrocyte|astroglia]] and [[microglia]], are the primary producers of APOE, while neurons preferentially express the receptors for APOE.<ref>{{cite journal | vauthors = Zhang Z, Mu J, Li J, Li W, Song J | title = Aberrant apolipoprotein E expression and cognitive dysfunction in patients with poststroke depression | journal = Genetic Testing and Molecular Biomarkers | volume = 17 | issue = 1 | pages = 47–51 | date = January 2013 | pmid = 23171142 | pmc = 3525887 | doi = 10.1089/gtmb.2012.0253 }}</ref> There are seven currently identified mammalian [[Receptor (biochemistry)|receptor]]s for APOE which belong to the evolutionarily conserved LDLR family.<ref>{{cite journal | vauthors = Rogers JT, Weeber EJ | title = Reelin and apoE actions on signal transduction, synaptic function and memory formation | journal = Neuron Glia Biology | volume = 4 | issue = 3 | pages = 259–270 | date = August 2008 | pmid = 19674510 | doi = 10.1017/S1740925X09990184 }}</ref>
As a component of the lipoprotein lipid transport system, APOE facilitates the transport of [[lipid]]s, fat-soluble [[vitamins]], and [[cholesterol]] via the blood. It interacts with the LDL receptor to facilitate endocytosis of VLDL remnants. It is synthesized principally in the [[liver]], but has also been found in other tissues such as the [[brain]], [[kidney]]s, and [[spleen]].<ref name="cardiogenetics">{{cite book | vauthors = Baars HF, van der Smagt JJ, Doevandans PA | title = Clinical Cardiogenetics | date = 2011 | publisher = Springer | location = London | isbn = 978-1849964715 }}</ref> APOE synthesized in the liver associates with [[High-density lipoprotein|HDL]] which can then distribute it to newly formed [[VLDL]] or [[chylomicron]] particles to facilitate their eventual uptake by the liver.
In the nervous system, non-neuronal cell types, most notably [[Astrocyte|astroglia]] and [[microglia]], are the primary producers of APOE, while neurons preferentially express the receptors for APOE.<ref>{{cite journal | vauthors = Zhang Z, Mu J, Li J, Li W, Song J | title = Aberrant apolipoprotein E expression and cognitive dysfunction in patients with poststroke depression | journal = Genetic Testing and Molecular Biomarkers | volume = 17 | issue = 1 | pages = 47–51 | date = January 2013 | pmid = 23171142 | pmc = 3525887 | doi = 10.1089/gtmb.2012.0253 }}</ref> There are seven currently identified mammalian [[Receptor (biochemistry)|receptor]]s for APOE which belong to the evolutionarily conserved LDLR family.<ref>{{cite journal | vauthors = Rogers JT, Weeber EJ | title = Reelin and apoE actions on signal transduction, synaptic function and memory formation | journal = Neuron Glia Biology | volume = 4 | issue = 3 | pages = 259–270 | date = August 2008 | pmid = 19674510 | doi = 10.1017/S1740925X09990184 }}</ref>


APOE was initially recognized for its importance in lipoprotein [[metabolism]] and [[cardiovascular disease]]. Defects in APOE result in [[familial dysbetalipoproteinemia]] aka type III [[hyperlipoproteinemia]] (HLP III), in which increased plasma [[cholesterol]] and triglycerides are the consequence of impaired clearance of [[chylomicron]], [[VLDL]] and [[LDL]].<ref name="Sacks_2015">{{cite journal | vauthors = Sacks FM | title = The crucial roles of apolipoproteins E and C-III in apoB lipoprotein metabolism in normolipidemia and hypertriglyceridemia | journal = Current Opinion in Lipidology | volume = 26 | issue = 1 | pages = 56–63 | date = February 2015 | pmid = 25551803 | pmc = 4371603 | doi = 10.1097/MOL.0000000000000146 }}</ref><ref name="entrez"/> More recently, it has been studied for its role in several biological processes not directly related to lipoprotein transport, including Alzheimer's disease (AD), [[Immune system|immunoregulation]], and [[cognition]].<ref name="encyclopedia"/> Though the exact mechanisms remain to be elucidated, isoform 4 of APOE, encoded by an APOE allele, has been associated with increased calcium ion levels and apoptosis following mechanical injury.<ref>{{cite journal | vauthors = Jiang L, Zhong J, Dou X, Cheng C, Huang Z, Sun X | title = Effects of ApoE on intracellular calcium levels and apoptosis of neurons after mechanical injury | journal = Neuroscience | volume = 301 | pages = 375–383 | date = August 2015 | pmid = 26073697 | doi = 10.1016/j.neuroscience.2015.06.005 | s2cid = 42716198 }}</ref>
APOE was initially recognized for its importance in lipoprotein [[metabolism]] and [[cardiovascular disease]]. Defects in APOE result in [[familial dysbetalipoproteinemia]] aka type III [[hyperlipoproteinemia]] (HLP III), in which increased plasma [[cholesterol]] and triglycerides are the consequence of impaired clearance of [[chylomicron]], [[VLDL]] and [[LDL]].<ref name="Sacks_2015">{{cite journal | vauthors = Sacks FM | title = The crucial roles of apolipoproteins E and C-III in apoB lipoprotein metabolism in normolipidemia and hypertriglyceridemia | journal = Current Opinion in Lipidology | volume = 26 | issue = 1 | pages = 56–63 | date = February 2015 | pmid = 25551803 | pmc = 4371603 | doi = 10.1097/MOL.0000000000000146 }}</ref><ref name="entrez"/> More recently, it has been studied for its role in several biological processes not directly related to lipoprotein transport, including Alzheimer's disease (AD), [[Immune system|immunoregulation]], and [[cognition]].<ref name="encyclopedia"/> Though the exact mechanisms remain to be elucidated, isoform 4 of APOE, encoded by an APOE allele, has been associated with increased calcium ion levels and apoptosis following mechanical injury.<ref>{{cite journal | vauthors = Jiang L, Zhong J, Dou X, Cheng C, Huang Z, Sun X | title = Effects of ApoE on intracellular calcium levels and apoptosis of neurons after mechanical injury | journal = Neuroscience | volume = 301 | pages = 375–383 | date = August 2015 | pmid = 26073697 | doi = 10.1016/j.neuroscience.2015.06.005 | s2cid = 42716198 }}</ref>


In the field of immune regulation, a growing number of studies point to APOE's interaction with many immunological processes, including suppressing [[T cell]] proliferation, [[macrophage]] functioning regulation, lipid antigen presentation facilitation (by [[CD1]])<ref>{{cite journal | vauthors = van den Elzen P, Garg S, León L, Brigl M, Leadbetter EA, Gumperz JE, Dascher CC, Cheng TY, Sacks FM, Illarionov PA, Besra GS, Kent SC, Moody DB, Brenner MB | display-authors = 6 | title = Apolipoprotein-mediated pathways of lipid antigen presentation | journal = Nature | volume = 437 | issue = 7060 | pages = 906–910 | date = October 2005 | pmid = 16208376 | doi = 10.1038/nature04001 | s2cid = 3109596 | bibcode = 2005Natur.437..906E }}</ref> to [[Natural Killer T cell|natural killer T cell]] as well as modulation of [[inflammation]] and [[oxidation]].<ref name="pmid20182542">{{cite journal | vauthors = Zhang HL, Wu J, Zhu J | title = The role of apolipoprotein E in Guillain-Barré syndrome and experimental autoimmune neuritis | journal = Journal of Biomedicine & Biotechnology | volume = 2010 | pages = 357412 | year = 2010 | pmid = 20182542 | pmc = 2825561 | doi = 10.1155/2010/357412 | doi-access = free }}</ref> APOE is produced by macrophages and APOE secretion has been shown to be restricted to classical monocytes in PBMC, and the secretion of APOE by monocytes is down regulated by inflammatory cytokines and upregulated by TGF-beta.<ref name="pmid24244577">{{cite journal | vauthors = Braesch-Andersen S, Paulie S, Smedman C, Mia S, Kumagai-Braesch M | title = ApoE production in human monocytes and its regulation by inflammatory cytokines | journal = PLOS ONE | volume = 8 | issue = 11 | pages = e79908 | year = 2013 | pmid = 24244577 | pmc = 3828220 | doi = 10.1371/journal.pone.0079908 | doi-access = free | bibcode = 2013PLoSO...879908B }}</ref>
In the field of immune regulation, a growing number of studies point to APOE's interaction with many immunological processes, including suppressing [[T cell]] proliferation, [[macrophage]] functioning regulation, lipid antigen presentation facilitation (by [[CD1]])<ref>{{cite journal | vauthors = van den Elzen P, Garg S, León L, Brigl M, Leadbetter EA, Gumperz JE, Dascher CC, Cheng TY, Sacks FM, Illarionov PA, Besra GS, Kent SC, Moody DB, Brenner MB | title = Apolipoprotein-mediated pathways of lipid antigen presentation | journal = Nature | volume = 437 | issue = 7060 | pages = 906–910 | date = October 2005 | pmid = 16208376 | doi = 10.1038/nature04001 | s2cid = 3109596 | bibcode = 2005Natur.437..906E }}</ref> to [[Natural Killer T cell|natural killer T cell]] as well as modulation of [[inflammation]] and [[oxidation]].<ref name="pmid20182542">{{cite journal | vauthors = Zhang HL, Wu J, Zhu J | title = The role of apolipoprotein E in Guillain-Barré syndrome and experimental autoimmune neuritis | journal = Journal of Biomedicine & Biotechnology | volume = 2010 | pages = 357412 | year = 2010 | pmid = 20182542 | pmc = 2825561 | doi = 10.1155/2010/357412 | doi-access = free }}</ref> APOE is produced by macrophages and APOE secretion has been shown to be restricted to classical monocytes in PBMC, and the secretion of APOE by monocytes is down regulated by inflammatory cytokines and upregulated by TGF-beta.<ref name="pmid24244577">{{cite journal | vauthors = Braesch-Andersen S, Paulie S, Smedman C, Mia S, Kumagai-Braesch M | title = ApoE production in human monocytes and its regulation by inflammatory cytokines | journal = PLOS ONE | volume = 8 | issue = 11 | pages = e79908 | year = 2013 | pmid = 24244577 | pmc = 3828220 | doi = 10.1371/journal.pone.0079908 | doi-access = free | bibcode = 2013PLoSO...879908B }}</ref>


==Clinical significance==
==Clinical significance==


===Alzheimer's disease===
===Alzheimer's disease===
As of 2012, the E4 variant was the largest known genetic risk factor for late-onset sporadic [[Alzheimer's disease]] (AD) in a variety of ethnic groups.<ref>{{cite journal | vauthors = Sadigh-Eteghad S, Talebi M, Farhoudi M | title = Association of apolipoprotein E epsilon 4 allele with sporadic late onset Alzheimer's disease. A meta-analysis | journal = Neurosciences | volume = 17 | issue = 4 | pages = 321–326 | date = October 2012 | pmid = 23022896 }}</ref> However, the E4 variant does not correlate with risk in every population. Nigerian people have the highest observed frequency of the ''APOE4'' allele in world populations,<ref name=":0">{{cite journal | vauthors = Sepehrnia B, Kamboh MI, Adams-Campbell LL, Bunker CH, Nwankwo M, Majumder PP, Ferrell RE | title = Genetic studies of human apolipoproteins. X. The effect of the apolipoprotein E polymorphism on quantitative levels of lipoproteins in Nigerian blacks | journal = American Journal of Human Genetics | volume = 45 | issue = 4 | pages = 586–591 | date = October 1989 | pmid = 2491016 | pmc = 1683508 }}</ref> but AD is rare among them.<ref name=":0" /><ref name=":1">{{cite journal | vauthors = Notkola IL, Sulkava R, Pekkanen J, Erkinjuntti T, Ehnholm C, Kivinen P, Tuomilehto J, Nissinen A | display-authors = 6 | title = Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer's disease | journal = Neuroepidemiology | volume = 17 | issue = 1 | pages = 14–20 | date = 1998-01-01 | pmid = 9549720 | doi = 10.1159/000026149 | s2cid = 71543885 }}</ref> This may be due to their low cholesterol levels.<ref name=":0" /><ref name=":1" /><ref>{{cite journal | vauthors = Petanceska SS, DeRosa S, Sharma A, Diaz N, Duff K, Tint SG, Refolo LM, Pappolla M | display-authors = 6 | title = Changes in apolipoprotein E expression in response to dietary and pharmacological modulation of cholesterol | journal = Journal of Molecular Neuroscience | volume = 20 | issue = 3 | pages = 395–406 | date = 2003-01-01 | pmid = 14501024 | doi = 10.1385/JMN:20:3:395 | s2cid = 35969696 }}</ref><ref name=":2">{{cite journal | vauthors = Kivipelto M, Helkala EL, Laakso MP, Hänninen T, Hallikainen M, Alhainen K, Iivonen S, Mannermaa A, Tuomilehto J, Nissinen A, Soininen H | display-authors = 6 | title = Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease | journal = Annals of Internal Medicine | volume = 137 | issue = 3 | pages = 149–155 | date = August 2002 | pmid = 12160362 | doi = 10.7326/0003-4819-137-3-200208060-00006 | s2cid = 23780605 }}</ref> Caucasian and Japanese carriers of two E4 alleles have between 10 and 30 times the risk of developing AD by 75 years of age, as compared to those not carrying any E4 alleles. This may be caused by an interaction with [[amyloid]].<ref name="pmid1625800">{{cite journal | vauthors = Wisniewski T, Frangione B | title = Apolipoprotein E: a pathological chaperone protein in patients with cerebral and systemic amyloid | journal = Neuroscience Letters | volume = 135 | issue = 2 | pages = 235–238 | date = February 1992 | pmid = 1625800 | doi = 10.1016/0304-3940(92)90444-C | s2cid = 8839627 | doi-access = free }}</ref> Alzheimer's disease is characterized by build-ups of aggregates of the [[peptide]] [[beta-amyloid]]. Apolipoprotein E enhances [[proteolytic]] break-down of this peptide, both within and between cells. The [[isoform]] APOE-ε4 is not as effective as the others at promoting these reactions, resulting in increased vulnerability to AD in individuals with that gene variation.<ref name="Neuron">{{cite journal | vauthors = Jiang Q, Lee CY, Mandrekar S, Wilkinson B, Cramer P, Zelcer N, Mann K, Lamb B, Willson TM, Collins JL, Richardson JC, Smith JD, Comery TA, Riddell D, Holtzman DM, Tontonoz P, Landreth GE | display-authors = 6 | title = ApoE promotes the proteolytic degradation of Abeta | journal = Neuron | volume = 58 | issue = 5 | pages = 681–693 | date = June 2008 | pmid = 18549781 | pmc = 2493297 | doi = 10.1016/j.neuron.2008.04.010 }}
As of 2012, the E4 variant was the largest known genetic risk factor for late-onset sporadic [[Alzheimer's disease]] (AD) in a variety of ethnic groups.<ref>{{cite journal | vauthors = Sadigh-Eteghad S, Talebi M, Farhoudi M | title = Association of apolipoprotein E epsilon 4 allele with sporadic late onset Alzheimer's disease. A meta-analysis | journal = Neurosciences | volume = 17 | issue = 4 | pages = 321–326 | date = October 2012 | pmid = 23022896 }}</ref> However, the E4 variant does not correlate with risk in every population. Nigerian people have the highest observed frequency of the ''APOE4'' allele in world populations,<ref name=":0">{{cite journal | vauthors = Sepehrnia B, Kamboh MI, Adams-Campbell LL, Bunker CH, Nwankwo M, Majumder PP, Ferrell RE | title = Genetic studies of human apolipoproteins. X. The effect of the apolipoprotein E polymorphism on quantitative levels of lipoproteins in Nigerian blacks | journal = American Journal of Human Genetics | volume = 45 | issue = 4 | pages = 586–591 | date = October 1989 | pmid = 2491016 | pmc = 1683508 }}</ref> but AD is rare among them.<ref name=":0" /><ref name=":1">{{cite journal | vauthors = Notkola IL, Sulkava R, Pekkanen J, Erkinjuntti T, Ehnholm C, Kivinen P, Tuomilehto J, Nissinen A | title = Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer's disease | journal = Neuroepidemiology | volume = 17 | issue = 1 | pages = 14–20 | date = 1998-01-01 | pmid = 9549720 | doi = 10.1159/000026149 | s2cid = 71543885 }}</ref> This may be due to their low cholesterol levels.<ref name=":0" /><ref name=":1" /><ref>{{cite journal | vauthors = Petanceska SS, DeRosa S, Sharma A, Diaz N, Duff K, Tint SG, Refolo LM, Pappolla M | title = Changes in apolipoprotein E expression in response to dietary and pharmacological modulation of cholesterol | journal = Journal of Molecular Neuroscience | volume = 20 | issue = 3 | pages = 395–406 | date = 2003-01-01 | pmid = 14501024 | doi = 10.1385/JMN:20:3:395 | s2cid = 35969696 }}</ref><ref name=":2">{{cite journal | vauthors = Kivipelto M, Helkala EL, Laakso MP, Hänninen T, Hallikainen M, Alhainen K, Iivonen S, Mannermaa A, Tuomilehto J, Nissinen A, Soininen H | title = Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease | journal = Annals of Internal Medicine | volume = 137 | issue = 3 | pages = 149–155 | date = August 2002 | pmid = 12160362 | doi = 10.7326/0003-4819-137-3-200208060-00006 | s2cid = 23780605 }}</ref> Caucasian and Japanese carriers of two E4 alleles have between 10 and 30 times the risk of developing AD by 75 years of age, as compared to those not carrying any E4 alleles. This may be caused by an interaction with [[amyloid]].<ref name="pmid1625800">{{cite journal | vauthors = Wisniewski T, Frangione B | title = Apolipoprotein E: a pathological chaperone protein in patients with cerebral and systemic amyloid | journal = Neuroscience Letters | volume = 135 | issue = 2 | pages = 235–238 | date = February 1992 | pmid = 1625800 | doi = 10.1016/0304-3940(92)90444-C | s2cid = 8839627 | doi-access = free }}</ref> Alzheimer's disease is characterized by build-ups of aggregates of the [[peptide]] [[beta-amyloid]]. Apolipoprotein E enhances [[proteolytic]] break-down of this peptide, both within and between cells. The [[isoform]] APOE-ε4 is not as effective as the others at promoting these reactions, resulting in increased vulnerability to AD in individuals with that gene variation.<ref name="Neuron">{{cite journal | vauthors = Jiang Q, Lee CY, Mandrekar S, Wilkinson B, Cramer P, Zelcer N, Mann K, Lamb B, Willson TM, Collins JL, Richardson JC, Smith JD, Comery TA, Riddell D, Holtzman DM, Tontonoz P, Landreth GE | title = ApoE promotes the proteolytic degradation of Abeta | journal = Neuron | volume = 58 | issue = 5 | pages = 681–693 | date = June 2008 | pmid = 18549781 | pmc = 2493297 | doi = 10.1016/j.neuron.2008.04.010 }}
*{{lay source |template = cite press release|url = https://www.sciencedaily.com/releases/2008/06/080611135123.htm|title = Mechanism Explains Link Between Apolipoprotein E And Alzheimer's Disease|date = June 13, 2008 |website = ScienceDaily }}</ref>
*{{lay source |template = cite press release|url = https://www.sciencedaily.com/releases/2008/06/080611135123.htm|title = Mechanism Explains Link Between Apolipoprotein E And Alzheimer's Disease|date = June 13, 2008 |website = ScienceDaily }}</ref>


Recently, the amyloid hypothesis of Alzheimer's disease has been questioned, and an article in ''[[Science (journal)|Science]]'' claimed that "Just as removing smoke does not extinguish a fire, reducing amyloid plaques may not affect the course of Alzheimer's disease."<ref>{{cite journal | vauthors = Thambisetty M, Howard R, Glymour MM, Schneider LS | title = Alzheimer's drugs: Does reducing amyloid work? | journal = Science | volume = 374 | issue = 6567 | pages = 544–545 | date = October 2021 | pmid = 34709898 | doi = 10.1126/science.abl8366 | s2cid = 240152869 | bibcode = 2021Sci...374..544T | url = https://discovery.ucl.ac.uk/id/eprint/10140292/ }}</ref> The role that the E4 variant carries can still be fully explained even in the absence of a valid amyloid hypothesis given the fact that [[reelin]] signaling emerges to be one of the key processes involved in Alzheimer's disease<ref name="Relevance of a Novel Circuit-Level">{{cite journal | vauthors = Kovács KA | title = Relevance of a Novel Circuit-Level Model of Episodic Memories to Alzheimer's Disease | journal = International Journal of Molecular Sciences | volume = 23 | issue = 1 | pages = 462 | date = December 2021 | pmid = 35008886 | pmc = 8745479 | doi = 10.3390/ijms23010462 | doi-access = free }}</ref> and the E4 variant is shown to interact with [[ApoER2]], one of the neuronal reelin receptors, thereby obstructing reelin signaling.<ref name="Relevance of a Novel Circuit-Level"/>
Recently, the amyloid hypothesis of Alzheimer's disease has been questioned, and an article in ''[[Science (journal)|Science]]'' claimed that "Just as removing smoke does not extinguish a fire, reducing amyloid plaques may not affect the course of Alzheimer's disease."<ref>{{cite journal | vauthors = Thambisetty M, Howard R, Glymour MM, Schneider LS | title = Alzheimer's drugs: Does reducing amyloid work? | journal = Science | volume = 374 | issue = 6567 | pages = 544–545 | date = October 2021 | pmid = 34709898 | doi = 10.1126/science.abl8366 | s2cid = 240152869 | bibcode = 2021Sci...374..544T | url = https://discovery.ucl.ac.uk/id/eprint/10140292/ }}</ref> The role that the E4 variant carries can still be fully explained even in the absence of a valid amyloid hypothesis given the fact that [[reelin]] signaling emerges to be one of the key processes involved in Alzheimer's disease<ref name="Relevance of a Novel Circuit-Level">{{cite journal | vauthors = Kovács KA | title = Relevance of a Novel Circuit-Level Model of Episodic Memories to Alzheimer's Disease | journal = International Journal of Molecular Sciences | volume = 23 | issue = 1 | pages = 462 | date = December 2021 | pmid = 35008886 | pmc = 8745479 | doi = 10.3390/ijms23010462 | doi-access = free }}</ref> and the E4 variant is shown to interact with [[ApoER2]], one of the neuronal reelin receptors, thereby obstructing reelin signaling.<ref name="Relevance of a Novel Circuit-Level"/>


Although 40–65% of AD patients have at least one copy of the ε4 allele, ''APOE4'' is not a determinant of the disease. At least one-third of patients with AD are ''APOE4'' negative and some ''APOE4'' homozygotes never develop the disease. Yet those with two ε4 alleles have up to 20 times the risk of developing AD.<ref name="HauserRyan2013">{{cite journal | vauthors = Hauser PS, Ryan RO | title = Impact of apolipoprotein E on Alzheimer's disease | journal = Current Alzheimer Research | volume = 10 | issue = 8 | pages = 809–817 | date = October 2013 | pmid = 23919769 | pmc = 3995977 | doi = 10.2174/15672050113109990156 }}</ref> There is also evidence that the ''APOE2'' allele may serve a protective role in AD.<ref name="pmid7920638">{{cite journal | vauthors = Corder EH, Saunders AM, Risch NJ, Strittmatter WJ, Schmechel DE, Gaskell PC, Rimmler JB, Locke PA, Conneally PM, Schmader KE | display-authors = 6 | title = Protective effect of apolipoprotein E type 2 allele for late onset Alzheimer disease | journal = Nature Genetics | volume = 7 | issue = 2 | pages = 180–184 | date = June 1994 | pmid = 7920638 | doi = 10.1038/ng0694-180 | s2cid = 11137478 }}</ref> Thus, the genotype most at risk for Alzheimer's disease and at an earlier age is APOE4,4. Using genotype APOE3,3 as a benchmark (with the persons who have this genotype regarded as having a risk level of 1.0) and for white populations only, individuals with genotype APOE4,4 have an [[odds ratio]] of 14.9 of developing Alzheimer's disease. Individuals with the APOE3,4 genotype face an odds ratio of 3.2, and people with a copy of the 2 allele and the 4 allele (APOE2,4), have an odds ratio of 2.6. Persons with one copy each of the 2 allele and the 3 allele (APOE2,3) have an odds ratio of 0.6. Persons with two copies of the 2 allele (APOE2,2) also have an odds ratio of 0.6.<ref name="Farrer1997">{{cite journal | vauthors = Farrer LA, Cupples LA, Haines JL, Hyman B, Kukull WA, Mayeux R, Myers RH, Pericak-Vance MA, Risch N, van Duijn CM | display-authors = 6 | title = Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium | journal = JAMA | volume = 278 | issue = 16 | pages = 1349–1356 | year = 1997 | pmid = 9343467 | doi = 10.1001/jama.1997.03550160069041 }}</ref>
Although 40–65% of AD patients have at least one copy of the ε4 allele, ''APOE4'' is not a determinant of the disease. At least one-third of patients with AD are ''APOE4'' negative and some ''APOE4'' homozygotes never develop the disease. Yet those with two ε4 alleles have up to 20 times the risk of developing AD.<ref name="HauserRyan2013">{{cite journal | vauthors = Hauser PS, Ryan RO | title = Impact of apolipoprotein E on Alzheimer's disease | journal = Current Alzheimer Research | volume = 10 | issue = 8 | pages = 809–817 | date = October 2013 | pmid = 23919769 | pmc = 3995977 | doi = 10.2174/15672050113109990156 }}</ref> There is also evidence that the ''APOE2'' allele may serve a protective role in AD.<ref name="pmid7920638">{{cite journal | vauthors = Corder EH, Saunders AM, Risch NJ, Strittmatter WJ, Schmechel DE, Gaskell PC, Rimmler JB, Locke PA, Conneally PM, Schmader KE | title = Protective effect of apolipoprotein E type 2 allele for late onset Alzheimer disease | journal = Nature Genetics | volume = 7 | issue = 2 | pages = 180–184 | date = June 1994 | pmid = 7920638 | doi = 10.1038/ng0694-180 | s2cid = 11137478 }}</ref> Thus, the genotype most at risk for Alzheimer's disease and at an earlier age is APOE4,4. Using genotype APOE3,3 as a benchmark (with the persons who have this genotype regarded as having a risk level of 1.0) and for white populations only, individuals with genotype APOE4,4 have an [[odds ratio]] of 14.9 of developing Alzheimer's disease. Individuals with the APOE3,4 genotype face an odds ratio of 3.2, and people with a copy of the 2 allele and the 4 allele (APOE2,4), have an odds ratio of 2.6. Persons with one copy each of the 2 allele and the 3 allele (APOE2,3) have an odds ratio of 0.6. Persons with two copies of the 2 allele (APOE2,2) also have an odds ratio of 0.6.<ref name="Farrer1997">{{cite journal | vauthors = Farrer LA, Cupples LA, Haines JL, Hyman B, Kukull WA, Mayeux R, Myers RH, Pericak-Vance MA, Risch N, van Duijn CM | title = Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium | journal = JAMA | volume = 278 | issue = 16 | pages = 1349–1356 | year = 1997 | pmid = 9343467 | doi = 10.1001/jama.1997.03550160069041 }}</ref>


{| class="wikitable"
{| class="wikitable"
Line 105: Line 107:
While ApoE4 has been found to greatly increase the odds that an individual will develop Alzheimer's, a 2002 study concluded, that in persons with any combination of APOE alleles, high serum total cholesterol and high blood pressure in mid-life are independent risk factors which together can nearly triple the risk that the individual will later develop AD.<ref name=":2" /> Projecting from their data, some researchers have suggested that lowering serum cholesterol levels may reduce a person's risk for Alzheimer's disease, even if they have two ApoE4 alleles, thus reducing the risk from nine or ten times the odds of getting AD down to just two times the odds.<ref name=":2" />
While ApoE4 has been found to greatly increase the odds that an individual will develop Alzheimer's, a 2002 study concluded, that in persons with any combination of APOE alleles, high serum total cholesterol and high blood pressure in mid-life are independent risk factors which together can nearly triple the risk that the individual will later develop AD.<ref name=":2" /> Projecting from their data, some researchers have suggested that lowering serum cholesterol levels may reduce a person's risk for Alzheimer's disease, even if they have two ApoE4 alleles, thus reducing the risk from nine or ten times the odds of getting AD down to just two times the odds.<ref name=":2" />


Women are more likely to develop AD than men across most ages and APOE genotypes. Premorbid women with the ε4 allele have significantly more neurological dysfunction than men.<ref>{{cite journal | vauthors = Damoiseaux JS, Seeley WW, Zhou J, Shirer WR, Coppola G, Karydas A, Rosen HJ, Miller BL, Kramer JH, Greicius MD | display-authors = 6 | title = Gender modulates the APOE ε4 effect in healthy older adults: convergent evidence from functional brain connectivity and spinal fluid tau levels | journal = The Journal of Neuroscience | volume = 32 | issue = 24 | pages = 8254–8262 | date = June 2012 | pmid = 22699906 | pmc = 3394933 | doi = 10.1523/JNEUROSCI.0305-12.2012 }}</ref>
Women are more likely to develop AD than men across most ages and APOE genotypes. Premorbid women with the ε4 allele have significantly more neurological dysfunction than men.<ref>{{cite journal | vauthors = Damoiseaux JS, Seeley WW, Zhou J, Shirer WR, Coppola G, Karydas A, Rosen HJ, Miller BL, Kramer JH, Greicius MD | title = Gender modulates the APOE ε4 effect in healthy older adults: convergent evidence from functional brain connectivity and spinal fluid tau levels | journal = The Journal of Neuroscience | volume = 32 | issue = 24 | pages = 8254–8262 | date = June 2012 | pmid = 22699906 | pmc = 3394933 | doi = 10.1523/JNEUROSCI.0305-12.2012 }}</ref>


''APOE-ε4'' increases the risk not only for AD but also for dementia in pure alpha-synucleinopathies.<ref>{{cite journal | vauthors = Tsuang D, Leverenz JB, Lopez OL, Hamilton RL, Bennett DA, Schneider JA, Buchman AS, Larson EB, Crane PK, Kaye JA, Kramer P, Woltjer R, Trojanowski JQ, Weintraub D, Chen-Plotkin AS, Irwin DJ, Rick J, Schellenberg GD, Watson GS, Kukull W, Nelson PT, Jicha GA, Neltner JH, Galasko D, Masliah E, Quinn JF, Chung KA, Yearout D, Mata IF, Wan JY, Edwards KL, Montine TJ, Zabetian CP | display-authors = 6 | title = APOE ε4 increases risk for dementia in pure synucleinopathies | journal = JAMA Neurology | volume = 70 | issue = 2 | pages = 223–228 | date = February 2013 | pmid = 23407718 | pmc = 3580799 | doi = 10.1001/jamaneurol.2013.600 }}</ref> The influence of ''APOE''-ε4 on hippocampal atrophy was suggested to be more predominant early in the course of AD at milder stages prior to more widespread neurodegeneration.<ref>{{cite journal |last1=Saeed |first1=Usman |last2=Desmarais |first2=Philippe |last3=Masellis |first3=Mario |date=2021-08-03 |title=The APOE ε4 variant and hippocampal atrophy in Alzheimer's disease and Lewy body dementia: a systematic review of magnetic resonance imaging studies and therapeutic relevance |url=https://www.tandfonline.com/doi/full/10.1080/14737175.2021.1956904 |journal=Expert Review of Neurotherapeutics |language=en |volume=21 |issue=8 |pages=851–870 |doi=10.1080/14737175.2021.1956904 |pmid=34311631 |s2cid=236451232 |issn=1473-7175}}</ref>
''APOE-ε4'' increases the risk not only for AD but also for dementia in pure alpha-synucleinopathies.<ref>{{cite journal | vauthors = Tsuang D, Leverenz JB, Lopez OL, Hamilton RL, Bennett DA, Schneider JA, Buchman AS, Larson EB, Crane PK, Kaye JA, Kramer P, Woltjer R, Trojanowski JQ, Weintraub D, Chen-Plotkin AS, Irwin DJ, Rick J, Schellenberg GD, Watson GS, Kukull W, Nelson PT, Jicha GA, Neltner JH, Galasko D, Masliah E, Quinn JF, Chung KA, Yearout D, Mata IF, Wan JY, Edwards KL, Montine TJ, Zabetian CP | title = APOE ε4 increases risk for dementia in pure synucleinopathies | journal = JAMA Neurology | volume = 70 | issue = 2 | pages = 223–228 | date = February 2013 | pmid = 23407718 | pmc = 3580799 | doi = 10.1001/jamaneurol.2013.600 }}</ref> The influence of ''APOE''-ε4 on hippocampal atrophy was suggested to be more predominant early in the course of AD at milder stages prior to more widespread neurodegeneration.<ref name="auto"/>


===Atherosclerosis===
===Atherosclerosis===
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* {{cite journal | vauthors = Ashford JW | title = APOE genotype effects on Alzheimer's disease onset and epidemiology | journal = Journal of Molecular Neuroscience | volume = 23 | issue = 3 | pages = 157–165 | year = 2004 | pmid = 15181244 | doi = 10.1385/JMN:23:3:157 | s2cid = 14864342 }}
* {{cite journal | vauthors = Ashford JW | title = APOE genotype effects on Alzheimer's disease onset and epidemiology | journal = Journal of Molecular Neuroscience | volume = 23 | issue = 3 | pages = 157–165 | year = 2004 | pmid = 15181244 | doi = 10.1385/JMN:23:3:157 | s2cid = 14864342 }}
* {{cite journal | vauthors = Beffert U, Danik M, Krzywkowski P, Ramassamy C, Berrada F, Poirier J | title = The neurobiology of apolipoproteins and their receptors in the CNS and Alzheimer's disease | journal = Brain Research. Brain Research Reviews | volume = 27 | issue = 2 | pages = 119–142 | date = July 1998 | pmid = 9622609 | doi = 10.1016/S0165-0173(98)00008-3 | s2cid = 28731779 }}
* {{cite journal | vauthors = Beffert U, Danik M, Krzywkowski P, Ramassamy C, Berrada F, Poirier J | title = The neurobiology of apolipoproteins and their receptors in the CNS and Alzheimer's disease | journal = Brain Research. Brain Research Reviews | volume = 27 | issue = 2 | pages = 119–142 | date = July 1998 | pmid = 9622609 | doi = 10.1016/S0165-0173(98)00008-3 | s2cid = 28731779 }}
* {{cite journal | vauthors = Bennet AM, Di Angelantonio E, Ye Z, Wensley F, Dahlin A, Ahlbom A, Keavney B, Collins R, Wiman B, de Faire U, Danesh J | display-authors = 6 | title = Association of apolipoprotein E genotypes with lipid levels and coronary risk | journal = JAMA | volume = 298 | issue = 11 | pages = 1300–1311 | date = September 2007 | pmid = 17878422 | doi = 10.1001/jama.298.11.1300 }}
* {{cite journal | vauthors = Bennet AM, Di Angelantonio E, Ye Z, Wensley F, Dahlin A, Ahlbom A, Keavney B, Collins R, Wiman B, de Faire U, Danesh J | title = Association of apolipoprotein E genotypes with lipid levels and coronary risk | journal = JAMA | volume = 298 | issue = 11 | pages = 1300–1311 | date = September 2007 | pmid = 17878422 | doi = 10.1001/jama.298.11.1300 }}
* {{cite journal | vauthors = Bocksch L, Stephens T, Lucas A, Singh B | title = Apolipoprotein E: possible therapeutic target for atherosclerosis | journal = Current Drug Targets - Cardiovascular & Hematological Disorders | volume = 1 | issue = 2 | pages = 93–106 | date = December 2001 | pmid = 12769659 | doi = 10.2174/1568006013337944 }}
* {{cite journal | vauthors = Bocksch L, Stephens T, Lucas A, Singh B | title = Apolipoprotein E: possible therapeutic target for atherosclerosis | journal = Current Drug Targets. Cardiovascular & Hematological Disorders | volume = 1 | issue = 2 | pages = 93–106 | date = December 2001 | pmid = 12769659 | doi = 10.2174/1568006013337944 }}
* {{cite journal | vauthors = de Knijff P, van den Maagdenberg AM, Frants RR, Havekes LM | title = Genetic heterogeneity of apolipoprotein E and its influence on plasma lipid and lipoprotein levels | journal = Human Mutation | volume = 4 | issue = 3 | pages = 178–194 | year = 1995 | pmid = 7833947 | doi = 10.1002/humu.1380040303 | s2cid = 41959843 | doi-access = free }}
* {{cite journal | vauthors = de Knijff P, van den Maagdenberg AM, Frants RR, Havekes LM | title = Genetic heterogeneity of apolipoprotein E and its influence on plasma lipid and lipoprotein levels | journal = Human Mutation | volume = 4 | issue = 3 | pages = 178–194 | year = 1995 | pmid = 7833947 | doi = 10.1002/humu.1380040303 | s2cid = 41959843 | doi-access = free }}
* {{cite journal | vauthors = Gunzburg MJ, Perugini MA, Howlett GJ | title = Structural basis for the recognition and cross-linking of amyloid fibrils by human apolipoprotein E | journal = The Journal of Biological Chemistry | volume = 282 | issue = 49 | pages = 35831–35841 | date = December 2007 | pmid = 17916554 | doi = 10.1074/jbc.M706425200 | doi-access = free }}
* {{cite journal | vauthors = Gunzburg MJ, Perugini MA, Howlett GJ | title = Structural basis for the recognition and cross-linking of amyloid fibrils by human apolipoprotein E | journal = The Journal of Biological Chemistry | volume = 282 | issue = 49 | pages = 35831–35841 | date = December 2007 | pmid = 17916554 | doi = 10.1074/jbc.M706425200 | doi-access = free }}
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* {{cite journal | vauthors = Mahley RW | title = Apolipoprotein E: cholesterol transport protein with expanding role in cell biology | journal = Science | volume = 240 | issue = 4852 | pages = 622–630 | date = April 1988 | pmid = 3283935 | doi = 10.1126/science.3283935 | bibcode = 1988Sci...240..622M }}
* {{cite journal | vauthors = Mahley RW | title = Apolipoprotein E: cholesterol transport protein with expanding role in cell biology | journal = Science | volume = 240 | issue = 4852 | pages = 622–630 | date = April 1988 | pmid = 3283935 | doi = 10.1126/science.3283935 | bibcode = 1988Sci...240..622M }}
* {{cite journal | vauthors = Masterman T, Hillert J | title = The telltale scan: APOE epsilon4 in multiple sclerosis | journal = The Lancet. Neurology | volume = 3 | issue = 6 | pages = 331 | date = June 2004 | pmid = 15157846 | doi = 10.1016/S1474-4422(04)00763-X | s2cid = 54404547 }}
* {{cite journal | vauthors = Masterman T, Hillert J | title = The telltale scan: APOE epsilon4 in multiple sclerosis | journal = The Lancet. Neurology | volume = 3 | issue = 6 | pages = 331 | date = June 2004 | pmid = 15157846 | doi = 10.1016/S1474-4422(04)00763-X | s2cid = 54404547 }}
* {{cite journal | vauthors = Moriyama K, Sasaki J, Matsunaga A, Arakawa F, Takada Y, Araki K, Kaneko S, Arakawa K | display-authors = 6 | title = Apolipoprotein E1 Lys-146----Glu with type III hyperlipoproteinemia | journal = Biochimica et Biophysica Acta | volume = 1128 | issue = 1 | pages = 58–64 | date = September 1992 | pmid = 1356443 | doi = 10.1016/0005-2760(92)90257-V }}
* {{cite journal | vauthors = Moriyama K, Sasaki J, Matsunaga A, Arakawa F, Takada Y, Araki K, Kaneko S, Arakawa K | title = Apolipoprotein E1 Lys-146----Glu with type III hyperlipoproteinemia | journal = Biochimica et Biophysica Acta | volume = 1128 | issue = 1 | pages = 58–64 | date = September 1992 | pmid = 1356443 | doi = 10.1016/0005-2760(92)90257-V }}
* {{cite journal | vauthors = Parasuraman R, Greenwood PM, Sunderland T | title = The apolipoprotein E gene, attention, and brain function | journal = Neuropsychology | volume = 16 | issue = 2 | pages = 254–274 | date = April 2002 | pmid = 11949718 | pmc = 1350934 | doi = 10.1037/0894-4105.16.2.254 }}
* {{cite journal | vauthors = Parasuraman R, Greenwood PM, Sunderland T | title = The apolipoprotein E gene, attention, and brain function | journal = Neuropsychology | volume = 16 | issue = 2 | pages = 254–274 | date = April 2002 | pmid = 11949718 | pmc = 1350934 | doi = 10.1037/0894-4105.16.2.254 }}
* {{cite journal | vauthors = Raber J | title = Role of apolipoprotein E in anxiety | journal = Neural Plasticity | volume = 2007 | pages = 91236 | year = 2007 | pmid = 17710250 | pmc = 1940061 | doi = 10.1155/2007/91236 | doi-access = free }}
* {{cite journal | vauthors = Raber J | title = Role of apolipoprotein E in anxiety | journal = Neural Plasticity | volume = 2007 | pages = 91236 | year = 2007 | pmid = 17710250 | pmc = 1940061 | doi = 10.1155/2007/91236 | doi-access = free }}
* {{cite journal | vauthors = Roses AD, Einstein G, Gilbert J, Goedert M, Han SH, Huang D, Hulette C, Masliah E, Pericak-Vance MA, Saunders AM, Schmechel DE, Strittmatter WJ, Weisgraber KH, Xi PT | display-authors = 6 | title = Morphological, biochemical, and genetic support for an apolipoprotein E effect on microtubular metabolism | journal = Annals of the New York Academy of Sciences | volume = 777 | issue = 1 | pages = 146–157 | date = January 1996 | pmid = 8624078 | doi = 10.1111/j.1749-6632.1996.tb34413.x | s2cid = 9145181 | bibcode = 1996NYASA.777..146R }}
* {{cite journal | vauthors = Roses AD, Einstein G, Gilbert J, Goedert M, Han SH, Huang D, Hulette C, Masliah E, Pericak-Vance MA, Saunders AM, Schmechel DE, Strittmatter WJ, Weisgraber KH, Xi PT | title = Morphological, biochemical, and genetic support for an apolipoprotein E effect on microtubular metabolism | journal = Annals of the New York Academy of Sciences | volume = 777 | issue = 1 | pages = 146–157 | date = January 1996 | pmid = 8624078 | doi = 10.1111/j.1749-6632.1996.tb34413.x | s2cid = 9145181 | bibcode = 1996NYASA.777..146R }}
* {{cite journal | vauthors = Strittmatter WJ, Roses AD | title = Apolipoprotein E and Alzheimer disease | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 92 | issue = 11 | pages = 4725–4727 | date = May 1995 | pmid = 7761390 | pmc = 41779 | doi = 10.1073/pnas.92.11.4725 | doi-access = free | bibcode = 1995PNAS...92.4725S }}
* {{cite journal | vauthors = Strittmatter WJ, Roses AD | title = Apolipoprotein E and Alzheimer disease | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 92 | issue = 11 | pages = 4725–4727 | date = May 1995 | pmid = 7761390 | pmc = 41779 | doi = 10.1073/pnas.92.11.4725 | doi-access = free | bibcode = 1995PNAS...92.4725S }}
* {{cite journal | vauthors = Utermann G, Pruin N, Steinmetz A | title = Polymorphism of apolipoprotein E. III. Effect of a single polymorphic gene locus on plasma lipid levels in man | journal = Clinical Genetics | volume = 15 | issue = 1 | pages = 63–72 | date = January 1979 | pmid = 759055 | doi = 10.1111/j.1399-0004.1979.tb02028.x | s2cid = 34127430 }}
* {{cite journal | vauthors = Utermann G, Pruin N, Steinmetz A | title = Polymorphism of apolipoprotein E. III. Effect of a single polymorphic gene locus on plasma lipid levels in man | journal = Clinical Genetics | volume = 15 | issue = 1 | pages = 63–72 | date = January 1979 | pmid = 759055 | doi = 10.1111/j.1399-0004.1979.tb02028.x | s2cid = 34127430 }}

Latest revision as of 08:57, 18 October 2024

APOE
Available structures
PDBOrtholog search: PDBe RCSB
Identifiers
AliasesAPOE, AD2, APO-E, LDLCQ5, LPG, apolipoprotein E, ApoE4
External IDsOMIM: 107741; MGI: 88057; HomoloGene: 30951; GeneCards: APOE; OMA:APOE - orthologs
Orthologs
SpeciesHumanMouse
Entrez
Ensembl
UniProt
RefSeq (mRNA)

NM_001302691
NM_000041
NM_001302688
NM_001302689
NM_001302690

NM_009696
NM_001305819
NM_001305843
NM_001305844

RefSeq (protein)

NP_000032
NP_001289617
NP_001289618
NP_001289619
NP_001289620

NP_001292748
NP_001292772
NP_001292773
NP_033826

Location (UCSC)Chr 19: 44.91 – 44.91 MbChr 7: 19.43 – 19.43 Mb
PubMed search[3][4]
Wikidata
View/Edit HumanView/Edit Mouse

Apolipoprotein E (Apo-E) is a protein involved in the metabolism of fats in the body of mammals. A subtype is implicated in Alzheimer's disease and cardiovascular diseases.[5] It is encoded in humans by the gene APOE.

Apo-E belongs to a family of fat-binding proteins called apolipoproteins. In the circulation, it is present as part of several classes of lipoprotein particles, including chylomicron remnants, VLDL, IDL, and some HDL.[6] Apo-E interacts significantly with the low-density lipoprotein receptor (LDLR), which is essential for the normal processing (catabolism) of triglyceride-rich lipoproteins.[7] In peripheral tissues, Apo-E is primarily produced by the liver and macrophages, and mediates cholesterol metabolism. In the central nervous system, Apo-E is mainly produced by astrocytes and transports cholesterol to neurons[8] via Apo-E receptors, which are members of the low density lipoprotein receptor gene family.[9] Apo-E is the principal cholesterol carrier in the brain.[10] Apo-E qualifies as a checkpoint inhibitor of the classical complement pathway by complex formation with activated C1q.[11]

Evolution

[edit]

Apolipoproteins are not unique to mammals. Many terrestrial and marine vertebrates have versions of them.[12] It is believed that APOE arose via gene duplications of APOC1 before the fish–tetrapod split ca. 400 million years ago. Proteins similar in function have been found in choanoflagellates, suggesting that they are a very old class of proteins predating the dawn of all living animals.[13]

The three major human alleles (E4, E3, E2) arose after the primate–human split around 7.5 million years ago. These alleles are the by-product of non-synonymous mutations which led to changes in functionality. The first allele to emerge was E4. After the primate–human split, there were four amino acid changes in the human lineage, three of which had no effect on protein function (V174L, A18T, A135V). The fourth substitution (T61R) traded a threonine for an arginine altering the protein's functionality. This substitution occurred somewhere in the 6 million year gap between the primate–human split and the Denisovan–human split, since exactly the same substitutions were found in Denisovan APOE.[14]

About 220,000 years ago, a cysteine to arginine substitution took place at amino acid 112 (Cys112Arg) of the APOE4 gene, and this resulted in the E3 allele. Finally, 80,000 years ago, another arginine to cysteine substitution at amino acid 158 (Arg158Cys) of the APOE3 gene created the E2 allele.[15][13]

Structure

[edit]

Gene

[edit]

The gene, APOE, is mapped to chromosome 19 in a cluster with the apolipoprotein C1 (APOC1) gene and the apolipoprotein C2 (APOC2) gene. The APOE gene consists of four exons and three introns, totaling 3597 base pairs. APOE is transcriptionally activated by the liver X receptor (an important regulator of cholesterol, fatty acid, and glucose homeostasis) and peroxisome proliferator-activated receptor γ, nuclear receptors that form heterodimers with retinoid X receptors.[16] In melanocytic cells APOE gene expression may be regulated by MITF.[17]

Protein

[edit]

Apoe-E is 299 amino acids long and contains multiple amphipathic α-helices. According to crystallography studies, a hinge region connects the N- and C-terminal regions of the protein. The N-terminal region (residues 1–167) forms an anti-parallel four-helix bundle such that the non-polar sides face inside the protein. Meanwhile, the C-terminal domain (residues 206–299) contains three α-helices which form a large exposed hydrophobic surface and interact with those in the N-terminal helix bundle domain through hydrogen bonds and salt-bridges. The C-terminal region also contains a low density lipoprotein receptor (LDLR)-binding site.[18]

Polymorphisms

[edit]
SNP: rs429358
GeneApoE
Chromosome19
External databases
EnsemblHuman SNPView
dbSNP429358
HapMap429358
SNPedia429358

APOE is polymorphic,[19][20] with three major alleles (epsilon 2, epsilon 3, and epsilon 4): APOE-ε2 (cys112, cys158), APOE-ε3 (cys112, arg158), and APOE-ε4 (arg112, arg158).[5][21][22] Although these allelic forms differ from each other by only one or two amino acids at positions 112 and 158,[23][24][25] these differences alter APOE structure and function.

There are several low-frequency polymorphisms of APOE. APOE5 comes in two subtypes E5f and E5s, based on migration rates. APOE5 E5f and APOE7 combined were found in 2.8% of Japanese males.[26][unreliable medical source] APOE7 is a mutation of APOE3 with two lysine residues replacing glutamic acid residues at positions 244 and 245.[27]

Polymorphism Worldwide allele frequency Disease relevance
ε2 (rs7412-T, rs429358-T) 8.4%[9] This variant of the apoprotein binds poorly to cell surface receptors while E3 and E4 bind well.[28] E2 is associated with both increased and decreased risk for atherosclerosis. Individuals with an E2/E2 combination may clear dietary fat slowly and be at greater risk for early vascular disease and the genetic disorder type III hyperlipoproteinemia—94.4% of people with such disease are E2/E2 but only ~2% of E2/E2 develop it, so other environmental and genetic factors are likely to be involved (such as cholesterol in the diet and age).[29][30][31] E2 has also been implicated in Parkinson's disease,[32] but this finding was not replicated in a larger population association study.[33]
ε3 (rs7412-C, rs429358-T) 77.9%[9] This variant is considered the "neutral" APOE genotype.
ε4 (rs7412-C, rs429358-C) 13.7%[9]

E4 has been implicated in atherosclerosis,[34][35] Alzheimer's disease,[36][37] impaired cognitive function,[38][39] reduced hippocampal volume,[40] HIV,[41] faster disease progression in multiple sclerosis,[42][43] unfavorable outcome after traumatic brain injury,[44] ischemic cerebrovascular disease,[45] sleep apnea,[46][47] both the extension and shortening of telomeres,[48][49][50][51] reduced neurite outgrowth,[52] and COVID-19.[53] However, E4 has also been associated with enhanced vitamin D and calcium status,[54] higher fecundity,[55] protection against early childhood infection and malnutrition,[56] and decreased fetal, perinatal, and infant mortality.[57]

Much remains to be learned about the APOE isoforms, including the interaction of other protective genes.[58] Indeed, the apolipoprotein ε4 isoform is more protective against cognitive decline than other isoforms in some cases,[58] so caution is advised before making determinant statements about the influence of APOE polymorphisms on cognition, development of Alzheimer's disease, cardiovascular disease, telomere shortening, etc. Many of the studies cited that purport these adverse outcomes are from single studies that have not been replicated and the research is based on unchecked assumptions about this isoform. As of 2007, there was no evidence that APOE polymorphisms influence cognition in younger age groups (other than possible increased episodic memory ability and neural efficiency in younger APOE4 age groups), nor that the APOE4 isoform places individuals at increased risk for any infectious disease.[59]

However, the association between the APOE4 allele and Alzheimer's disease has been shown to be weaker in minority groups differently compared to their Caucasian counterparts.[9] Hispanics/Latinos and African Americans who were homozygous for the APOE4 allele had 2.2 and 5.7 times the odds, respectively of developing Alzheimer's disease.[60][9] The APOE4 allele has an even stronger effect in East Asian populations, with Japanese populations have 33 times the odds compared to other populations.[61] Caucasians who were homozygous for the allele had 12.5 times the odds.[60][9]

Function

[edit]

As a component of the lipoprotein lipid transport system, APOE facilitates the transport of lipids, fat-soluble vitamins, and cholesterol via the blood. It interacts with the LDL receptor to facilitate endocytosis of VLDL remnants. It is synthesized principally in the liver, but has also been found in other tissues such as the brain, kidneys, and spleen.[21] APOE synthesized in the liver associates with HDL which can then distribute it to newly formed VLDL or chylomicron particles to facilitate their eventual uptake by the liver.

In the nervous system, non-neuronal cell types, most notably astroglia and microglia, are the primary producers of APOE, while neurons preferentially express the receptors for APOE.[62] There are seven currently identified mammalian receptors for APOE which belong to the evolutionarily conserved LDLR family.[63]

APOE was initially recognized for its importance in lipoprotein metabolism and cardiovascular disease. Defects in APOE result in familial dysbetalipoproteinemia aka type III hyperlipoproteinemia (HLP III), in which increased plasma cholesterol and triglycerides are the consequence of impaired clearance of chylomicron, VLDL and LDL.[64][7] More recently, it has been studied for its role in several biological processes not directly related to lipoprotein transport, including Alzheimer's disease (AD), immunoregulation, and cognition.[5] Though the exact mechanisms remain to be elucidated, isoform 4 of APOE, encoded by an APOE allele, has been associated with increased calcium ion levels and apoptosis following mechanical injury.[65]

In the field of immune regulation, a growing number of studies point to APOE's interaction with many immunological processes, including suppressing T cell proliferation, macrophage functioning regulation, lipid antigen presentation facilitation (by CD1)[66] to natural killer T cell as well as modulation of inflammation and oxidation.[67] APOE is produced by macrophages and APOE secretion has been shown to be restricted to classical monocytes in PBMC, and the secretion of APOE by monocytes is down regulated by inflammatory cytokines and upregulated by TGF-beta.[68]

Clinical significance

[edit]

Alzheimer's disease

[edit]

As of 2012, the E4 variant was the largest known genetic risk factor for late-onset sporadic Alzheimer's disease (AD) in a variety of ethnic groups.[69] However, the E4 variant does not correlate with risk in every population. Nigerian people have the highest observed frequency of the APOE4 allele in world populations,[70] but AD is rare among them.[70][71] This may be due to their low cholesterol levels.[70][71][72][73] Caucasian and Japanese carriers of two E4 alleles have between 10 and 30 times the risk of developing AD by 75 years of age, as compared to those not carrying any E4 alleles. This may be caused by an interaction with amyloid.[74] Alzheimer's disease is characterized by build-ups of aggregates of the peptide beta-amyloid. Apolipoprotein E enhances proteolytic break-down of this peptide, both within and between cells. The isoform APOE-ε4 is not as effective as the others at promoting these reactions, resulting in increased vulnerability to AD in individuals with that gene variation.[75]

Recently, the amyloid hypothesis of Alzheimer's disease has been questioned, and an article in Science claimed that "Just as removing smoke does not extinguish a fire, reducing amyloid plaques may not affect the course of Alzheimer's disease."[76] The role that the E4 variant carries can still be fully explained even in the absence of a valid amyloid hypothesis given the fact that reelin signaling emerges to be one of the key processes involved in Alzheimer's disease[77] and the E4 variant is shown to interact with ApoER2, one of the neuronal reelin receptors, thereby obstructing reelin signaling.[77]

Although 40–65% of AD patients have at least one copy of the ε4 allele, APOE4 is not a determinant of the disease. At least one-third of patients with AD are APOE4 negative and some APOE4 homozygotes never develop the disease. Yet those with two ε4 alleles have up to 20 times the risk of developing AD.[78] There is also evidence that the APOE2 allele may serve a protective role in AD.[79] Thus, the genotype most at risk for Alzheimer's disease and at an earlier age is APOE4,4. Using genotype APOE3,3 as a benchmark (with the persons who have this genotype regarded as having a risk level of 1.0) and for white populations only, individuals with genotype APOE4,4 have an odds ratio of 14.9 of developing Alzheimer's disease. Individuals with the APOE3,4 genotype face an odds ratio of 3.2, and people with a copy of the 2 allele and the 4 allele (APOE2,4), have an odds ratio of 2.6. Persons with one copy each of the 2 allele and the 3 allele (APOE2,3) have an odds ratio of 0.6. Persons with two copies of the 2 allele (APOE2,2) also have an odds ratio of 0.6.[80]

Estimated worldwide human allele frequencies of APOE in Caucasian population[80]
Allele ε2 ε3 ε4
General frequency 8.4% 77.9% 13.7%
AD frequency 3.9% 59.4% 36.7%

While ApoE4 has been found to greatly increase the odds that an individual will develop Alzheimer's, a 2002 study concluded, that in persons with any combination of APOE alleles, high serum total cholesterol and high blood pressure in mid-life are independent risk factors which together can nearly triple the risk that the individual will later develop AD.[73] Projecting from their data, some researchers have suggested that lowering serum cholesterol levels may reduce a person's risk for Alzheimer's disease, even if they have two ApoE4 alleles, thus reducing the risk from nine or ten times the odds of getting AD down to just two times the odds.[73]

Women are more likely to develop AD than men across most ages and APOE genotypes. Premorbid women with the ε4 allele have significantly more neurological dysfunction than men.[81]

APOE-ε4 increases the risk not only for AD but also for dementia in pure alpha-synucleinopathies.[82] The influence of APOE-ε4 on hippocampal atrophy was suggested to be more predominant early in the course of AD at milder stages prior to more widespread neurodegeneration.[40]

Atherosclerosis

[edit]

Knockout mice that lack the apolipoprotein-E gene (APOE−/−) develop extreme hypercholesterolemia when fed a high-fat diet.[83]

Malaria

[edit]

APOE−/− knockout mice show marked attenuation of cerebral malaria and increased survival, as well as decreased sequestration of parasites and T cells within the brain, likely due to protection of the blood–brain barrier.[84] Human studies have shown that the APOE2 polymorphism correlates with earlier infection, and APOE3/4 polymorphisms increase likelihood of severe malaria.[85]

Lyme disease

[edit]

Borrelia burgdorferi, the causative agent of Lyme disease, is a host-adapted pathogen that acquires environmental cholesterol to form glycolipids for use in cell membrane maintenance. In one experiment in 2015, mice engineered with apoE deficiency were infected with Borrelia spirochetes. The knockout mice suffered from an increased spirochete burden in joints, as well as inflamed ankles, when compared with wild-type mice. This study suggests that apoE deficiency (and potentially other hyperlipidemias) may be a risk factor in the pathogenicity of Lyme disease.

Interactions

[edit]

Interactive pathway map

[edit]

Click on genes, proteins and metabolites below to link to respective articles. [§ 1]

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Statin_Pathway_WP430go to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to articlego to article
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  1. ^ The interactive pathway map can be edited at WikiPathways: "Statin_Pathway_WP430".

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