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Plasma Proteomic Analysis of APOE ϵ4 Homozygotes Identifies Preclinical Alzheimer's Disease Alterations Potentially Treatable with Semaglutide

Dammer, E. B.; Afshar, S.; Bian, S.; The Global Neurodegeneration Proteomics Consortium (GNPC), ; Levey, A. I.; Fortea, J.; Johnson, E. C. B.

2026-02-17 neurology
10.64898/2026.02.14.26346321 medRxiv
Show abstract

Individuals who carry two copies of the apolipoprotein E {varepsilon}4 (APOE{varepsilon}4) allele are at high risk of developing Alzheimers disease (AD), yet the effects of APOE {varepsilon}4 homozygosity on biological pathways related to AD over the lifespan are unknown. Here we analyzed the plasma proteomes of APOE {varepsilon}4/{varepsilon}4 individuals with and without AD-related cognitive impairment (n=413) and compared them to the proteomes of cognitively unimpaired individuals with APOE {varepsilon}3/{varepsilon}3 genotype (n=2764) from ages 20 to 90. Multiple biological pathways were altered in young adulthood in {varepsilon}4 homozygotes including metabolism and glucagon-like peptide 1/insulin growth factor (GLP-1/IGF), mitochondrial, microtubule, proteostasis, and synaptic pathways. Semaglutide--a GLP-1 receptor agonist--demonstrated reversal effects on metabolic and synaptic pathway alterations in {varepsilon}4 homozygotes at preclinical and clinical AD stages. Targeting metabolic and other pathways for therapeutic intervention in {varepsilon}4/{varepsilon}4 individuals by at least age 50 will likely be the most effective approach to decrease risk for AD in this special population.

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