DOI: 10.1002/alz.071948 ISSN: 1552-5260

APOE4 impairs myelination via cholesterol dysregulation in oligodendrocytes

Li‐Huei Tsai, Leyla A Akay, Joel Blanchard, Djuna K Von Maydell, Manolis Kellis, David A. A Bennett, Jose Davila
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



APOE4 is the strongest genetic risk factor for late‐onset Alzheimer’s disease (AD), yet the cellular and molecular mechanisms by which APOE4 contributes to AD risk remain largely unknown


We performed single‐nuclear RNAsequencing from the prefrontal cortex (Brodmann’s Area 10) of thirty‐two individuals, 12 APOE3/3 and 12 APOE3/4 carriers each, and one subgroup with 8 APOE4/4 carriers, and validated hypotheses using mouse models and patient‐derived iPSC lines.


Differential expression and pathway analysis revealed that APOE4 is strongly associated with dysregulation of cholesterol homeostasis across multiple cell types, with oligodendrocytes being the most impacted. Strikingly, in human and mouse brains, APOE4 oligodendrocytes contained aberrant intracellular accumulations of cholesterol, whereas in non‐carriers, cholesterol preferentially localized to the oligodendrocyte cell membrane along myelinated neuronal tracts. Mass‐spectrometry‐based lipidomic analysis further revealed that APOE4 oligodendrocytes and APOE4 human post‐mortem brain tissue had elevated levels of cholesteryl esters, associated with intracellular storage of cholesterol as lipid droplets. Cholesterol transport and bioavailability are rate‐limiting steps in axonal myelination. Consistent with this, we discovered both APOE4 human and mouse brains were hypomyelinated relative to non‐carriers. We found that a small molecule known to facilitate cholesterol transport reduced cholesterol accumulation in APOE4 oligodendrocytes, increased axonal myelination, and improved memory in APOE4 mice.


These results provide a transcriptional atlas of cell‐type specific APOE4 effects in the human brain. Our results demonstrate that cholesterol homeostasis in oligodendrocytes is highly dysregulated in APOE4 oligodendrocytes and identify hypomyelination as a key APOE4‐associated phenotype. Collectively, these data establish a functional link between APOE4, cholesterol homeostasis, and myelination that presents new therapeutic opportunities for Alzheimer’s disease.

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