Biomarkers

Early identification of individuals at risk for Alzheimer's disease (AD) is critical for effective intervention. Amyloid deposition, a hallmark of AD pathology, offers insights into genetic factors driving disease progression. While the APOE genotype is a major contributor, the role of other risk variants in amyloid deposition and early AD endophenotypes remains unclear. This study aims to (1) identify amyloid polygenic risk scores (PRS) that best predict amyloid burden in Europeans and Hispanics beyond APOE, (2) compare the amyloid PRS with APOE, an AD risk PRS, and a tau PET PRS, and (3) validate these PRSs against AD endophenotypes in non-demented older adults.

Among Europeans, amyloid PRSs were developed using GWAS of amyloid PET, plasma p-tau181, and CSF p-tau181, along with separate PRSs for AD risk and tau PET burden. For Hispanics, amyloid PRSs were derived using GWAS of plasma p-tau181 and the GAUDI method, which incorporates individual-level plasma p-tau181 and local ancestry among admixed population. Multi-ancestry PRSs were constructed using PRS-CSx from GWAS of plasma p-tau181 and AD across ancestries. After parameter tunning, all PRSs were tested in two datasets (515 Hispanics and 1,120 Europeans) using linear and mixed-effects models to evaluate cross-sectional and longitudinal associations with plasma p-tau181, p-tau217, Aβ42, Aβ42/Aβ40, GFAP, NfL, and global cognition.

Among Europeans, the APOE-ε4 allele explains 3.6%-6% of the variance in p-tau181 (β=0.071, 95%CI: 0.034-0.108) and p-tau217 (β=0.127, 95%CI: 0.101-0.152). PRSs derived from amyloid-PET GWAS explain 3%-4% of the variance in p-tau181 (β=0.039, 95%CI:0.018-0.060) and p-tau217 (β=0.036, 95%CI: 0.022-0.051). Among Hispanics, the APOE-ε4 allele explains 1% of the variance in p-tau181 (β=0.057, 95%CI: 0.004-0.109), while GAUDI PRSs explain 1.5% (β=0.032, 95%CI: 0.009-0.054). Among non-demented older adults, in Europeans, amyloid-PET PRSs are associated with plasma Aβ42, Aβ42/Aβ40, GFAP, NfL, and global cognition, while GAUDI PRSs show similar associations in Hispanics. Other PRSs derived from AD or tau GWAS or multi-ancestry PRS show weaker or no associations in both ancestries.

Amyloid PRSs show promise as predictive tools for early AD pathology in asymptomatic individuals among Europeans and Caribbean Hispanics.