Amyloid-β 42-carrying extracellular vesicles are associated with neurodegeneration and neuroinflammation in Alzheimer's disease

Alzheimers disease (AD) is the most common form of dementia, characterized by progressive amyloid-{beta} (A{beta}) accumulation and neurodegeneration. Extracellular vesicles (EVs) have been implicated in AD pathology, but their relationship to disease progression and the cerebrospinal fluid (CSF) proteome remains poorly understood. In this study, we analysed plasma-derived A{beta}42-containing EVs from participants of the Alzheimers Disease Neuroimaging Initiative (ADNI) and calculated the ratio between the percentage of A{beta}42-positive peripheral EVs and CSF A{beta}42 (rA{beta}42). This ratio was elevated in AD and positively correlated with amyloid pathology as measured by PET. Longitudinal analyses revealed that higher rA{beta}42 values predicted accelerated hippocampal atrophy and cognitive decline, independent of CSF A{beta}42 concentrations. Proteomic profiling of CSF using the SomaScan platform showed that rA{beta}42 was associated with an inflammatory signature characterized by myeloid activation and type II interferon-related signalling pathways. Together, these findings indicate that A{beta}42-carrying EVs reflect an active and inflammatory component of AD pathology and may represent a novel class of biomarkers for disease progression. Understanding the mechanisms that link A{beta}42-positive EVs to neuroinflammatory signalling could open new avenues for pathway-specific diagnostics and therapeutic strategies in AD.