Large-scale plasma proteomics can capture molecular changes across the Alzheimer's disease (AD) continuum and provide insight into biological mechanisms associated with AD pathology. We analysed the Bio-Hermes cohort (n = 961), with participants enrolled across 17 sites in the United States from April 2021 to November 2022. Participants were stratified by clinical status and amyloid PET scan-based Core1 biomarker status (CN Core1- , CN Core1+, MCI Core1+, and AD dementia Core1+). We performed differential abundance analyses across biologically defined contrasts, clustered proteins into co-expression networks, and evaluated protein panels to distinguish participants with biologically defined AD from amyloid-negative cognitively normal controls. We also used Mendelian randomization (MR) to assess genetic evidence for potential causal relationships with AD risk. The biologically defined contrast, Core1+ vs. CN Core1-, identified 69 differentially abundant proteins. Across AD stages, eight core proteins were consistently dysregulated from preclinical through prodromal and dementia phases, and three additional proteins emerged at MCI Core1+ and remained altered in AD dementia Core1+. We identified 29 co-expression modules, six of which varied significantly across the AD continuum. Among differential abundance proteins, ACHE ranked highest for distinguishing biologically defined AD from CN Core1-. Stage-specific protein panels improved the discriminatory performance for MCI Core1+ (AUC = 0.850) and AD dementia Core1+ (AUC = 0.856). MR provided genetic evidence consistent with an association between plasma ACHE abundance and AD risk. Plasma proteomics delineated a stage-spanning core signature across the AD continuum. These findings nominate co-expression modules and candidate proteins for further validation in early detection and AD screening.
Zhao, H., Zhu, T., Erabadda, B., Leonenko, G., Maurya, R., Lim, D., Koychev, I., Quinn, T., Mavromati, K., Escott-Price, V., Jiang, S., Nevado-Holgado, A., Winchester, L.
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