A brain immune phenotype independent of Alzheimer's Disease associates with amyloid susceptibility and systemic inflammation

Abstract

Transcriptomic and proteomic studies have consistently demonstrated substantial molecular heterogeneity across patients with Alzheimer's disease (AD) and other neurodegenerative disorders, leading to the proposal of multiple disease subtypes. However, almost all previous studies have focused on heterogeneity within diseased cohorts, whereas comparatively little attention has been paid to the molecular diversity of neurologically healthy individuals. In the present study, we demonstrate that one of the most prominent transcriptomic programs characterized by a strong immune component previously interpreted as an AD-specific immune subtype is in fact a brain phenotype that exists independently of AD yet interacts with AD susceptibility and is selectively associated with amyloid pathology. The transcriptional effect of the immune phenotype exceeds that of AD pathology-induced changes and is accompanied by alterations of brain cellular compositions and a distinct systemic inflammation. Our findings suggest that part of the molecular heterogeneity observed in neurological diseases might arise from pre-existing brain phenotypes rather than representing disease-specific subtypes. These insights support a precision medicine approach for Alzheimer's disease, whereby individuals with an immune phenotype of the brain could be prospectively identified and monitored, enabling the application of targeted preventive strategies before substantial neuropathology and cognitive decline emerge.