Neuronal APOE4 reduction with an APOE-I3-targeting ASO protects against neurodegeneration and neuroinflammation in an Alzheimer's disease mouse model

Apolipoprotein E4 (APOE4) is the strongest genetic risk factor for late-onset Alzheimers disease (AD). Within the central nervous system (CNS), APOE is produced by a variety of cell types, with differential roles in AD pathogenesis. Studies have shown that APOE4 produced by neurons plays a central role in promoting the development of major AD pathologies, including p-tau accumulation, neuroinflammation, and neurodegeneration, highlighting its role as an upstream initiating factor that affects other cell types and downstream AD-related pathologies. Here, we demonstrate that antisense oligonucleotides (ASOs) targeting APOE-I3, a neuron-specific splicing variant of APOE mRNA, effectively reduce APOE expression in neurons in vitro and in vivo. Treating PS19 tauopathy mice expressing APOE4 with this APOE-I3-targeting ASO reduces neuronal APOE4, rescues neurodegeneration, and diminishes neuroinflammation. Strikingly, the extent of neuronal APOE4 reduction predicts the efficacy of rescuing neurodegeneration. Single nucleus RNA-sequencing demonstrated that APOE-I3-targeting ASO treatment decreases disease associated neuronal and glial subtypes and increases a disease-protective microglial subtype. These findings suggest that preferential knockdown of neuronal APOE4 with an APOE-I3-targeting ASO protects against key hallmarks of AD pathology, elucidating a potential therapeutic approach for treating APOE4-driven AD.