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Genomics link obesity and type 2 diabetes to Alzheimer's disease to unveil novel biological insights

Cunha, C.; Garcia-Urena, M.; Sanz Martlnez, R.; J. Romero-Lado, M.; Axisa, P.-P.; Fernandez, M. V.; Andreassen, O. A.; Sims, R.; Tsolaki, M.; Sleegers, K.; Hiltunen, M.; Nicolas, G.; Sanchez-Juan, P.; Ingelsson, M.; Giedraitis, V.; Ghidoni, R.; Holstege, H.; van Duijn, C.; van der Lee, S.; Ramirez, A.; Bellenguez, C.; Lambert, J.-C.; Frikke-Schmidt, R.; EADB, ; O. Kilpeläinen, T.; J. F. Loos, R.

2026-02-12 genetic and genomic medicine
10.64898/2026.02.10.26344393 medRxiv
Show abstract

Body mass index (BMI), type 2 diabetes (T2D) and associated cardiometabolic features modify Alzheimers disease (AD) risk, yet shared mechanisms remain poorly understood. Using sex- and age-stratified genotyping data for BMI and T2D, we investigate how these traits converge on shared genetic pathways to AD risk. Employing multi-trait, machine learning and single-cell transcriptomics, we identify sex-specific cardiometabolic liability linked to higher BMI-associated risk in women and T2D-driven risk in men. Variant-level analyses reveal AD risk associates with genetically-driven hypotension and hypoglycaemia. We identify 35 putative effector genes in seven independent loci colocalizing between BMI/T2D and AD, mapping to peripheral immune and metabolic tissues and cell-types. Pathway enrichment identifies druggable targets in calcium and potassium channel signaling. Across 81 approved drugs modulating shared risk genes, levosimendan - a calcium sensitizer for heart failure - inhibits tau oligomerization and emerges as a repurposing candidate. These findings elucidate sex-specific cardiometabolic drivers of AD, identify actionable biological pathways, and reveal drug candidates for AD prevention and treatment.

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