INTRODUCTION: Alzheimer's disease (AD) disproportionately affects women, but the underlying mechanisms are not fully understood. We compare sex-specific molecular changes across AD with and without dementia at single-cell resolution. METHODS: We performed sex-stratified single-nucleus transcriptomic analysis of human AD to dissect sex-specific differences in dementia progression, using the SEA-AD cohort for discovery and the ROSMAP and NBB datasets, together with 5xFAD mouse models, for validation. Donors were classified as no-dementia controls, no-dementia AD, or dementia AD, followed by donor-level pathway analysis, de novo microglial clustering, communication modeling, and cytokine-response enrichment RESULTS: Females with AD dementia showed enhanced inflammatory pathway activity across glial, neuronal and vascular-associated cell types, with the strongest enrichment in microglia. This female-biased program centered on IL6-JAK-STAT3 signaling and increased STAT3 expression in microglia and astrocytes. These results were validated in the ROSMAP and NBB datasets and conserved in the 5xFAD mouse model. Microglial clustering resolved 18 states and revealed sex-divergent disease remodeling, including female-specific expansion of redox-reactive and CD163+ macrophage-primed states. Cell:cell communication analysis identified female-biased TGF{beta}/GRN signaling, male-biased CD99 signaling, and dementia-associated SPP1-integrin communication with the vasculature. Microglial cytokine-response analysis identified IL-2 response as a dementia-associated signature in both sexes, alongside a female-biased IL-17/interferon response and a male-biased IL-7 response. DISCUSSION: These findings identify a disease-emergent, female-biased STAT3-centered neuroinflammatory program in human and mouse AD, linking sex-specific microglial remodeling to cytokine responsiveness and glial-vascular communication. The results suggest that sex-specific changes in neuroinflammation pathways in microglia and other cell types are associated with progression to dementia.
Abdelfattah, N. H., Kang, R., Jimenez, D., Villapol, S. H., Toledo, J., Hohman, T., Jung, S. Y., Yun, K.
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