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. 2022 Sep 9;17(9):e0274350.
doi: 10.1371/journal.pone.0274350. eCollection 2022.

Association between inflammatory biomarkers and cognitive aging

Affiliations

Association between inflammatory biomarkers and cognitive aging

Yuan Fang et al. PLoS One. .

Abstract

Inflammatory cytokines and chemokines related to the innate and adaptive immune system have been linked to neuroinflammation in Alzheimer's Disease, dementia, and cognitive disorders. We examined the association of 11 plasma proteins (CD14, CD163, CD5L, CD56, CD40L, CXCL16, SDF1, DPP4, SGP130, sRAGE, and MPO) related to immune and inflammatory responses with measures of cognitive function, brain MRI and dementia risk. We identified Framingham Heart Study Offspring participants who underwent neuropsychological testing (n = 2358) or brain MRI (n = 2100) within five years of the seventh examination where a blood sample for quantifying the protein biomarkers was obtained; and who were followed for 10 years for incident all-cause dementia (n = 1616). We investigated the association of inflammatory biomarkers with neuropsychological test performance and brain MRI volumes using linear mixed effect models accounting for family relationships. We further used Cox proportional hazards models to examine the association with incident dementia. False discovery rate p-values were used to account for multiple testing. Participants included in the neuropsychological test and MRI samples were on average 61 years old and 54% female. Participants from the incident dementia sample (average 68 years old at baseline) included 124 participants with incident dementia. In addition to CD14, which has an established association, we found significant associations between higher levels of CD40L and myeloperoxidase (MPO) with executive dysfunction. Higher CD5L levels were significantly associated with smaller total brain volumes (TCBV), whereas higher levels of sRAGE were associated with larger TCBV. Associations persisted after adjustment for APOE ε4 carrier status and additional cardiovascular risk factors. None of the studied inflammatory biomarkers were significantly associated with risk of incident all-cause dementia. Higher circulating levels of soluble CD40L and MPO, markers of immune cell activation, were associated with poorer performance on neuropsychological tests, while higher CD5L, a key regulator of inflammation, was associated with smaller total brain volumes. Higher circulating soluble RAGE, a decoy receptor for the proinflammatory RAGE/AGE pathway, was associated with larger total brain volume. If confirmed in other studies, this data indicates the involvement of an activated immune system in abnormal brain aging.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study sample for the incident dementia, neuropsychological testing and the brain MRI outcomes.
The biomarkers were collected from the Offspring cohort examination 7(1998–2001). One from each of 4 pairs of Monozygotic (mz) twins with biomarkers measurements were excluded. Participants with prevalent dementia or stroke, participants diagnosed with chronic leukemia or lymphoma prior to exam 7, and participants who reported use of glucocorticoid medication at exam 7 were excluded from all study samples. A 10-year follow-up window was applied in the study for incident dementia, AD or MCI. The closest neuropsychological testing battery and brain MRI scan within five years of the examination was used.
Fig 2
Fig 2. Effect estimates and FDR value for the associations of protein biomarkers with neuropsychological testing scores.
Effect estimates are in colors and FDR value (if ≤0.1) are labeled as numbers. Both protein biomarker predictors and cognitive outcomes were rank normalized to mean 0 and SD 1. Each color block shows the estimated effect for each pair of associations investigated in the primary analyses using linear mixed effect models adjusting for the covariates from Model 1(age, sex, education level, time distance between exam 7 and the neuropsychological testing, and retest indicator). FDR are shown for associations where FDR ≤ 0.1.
Fig 3
Fig 3. Effect estimates and FDR value for the associations of protein biomarkers with brain MRI measures.
Effect estimates are in colors and FDR value (if ≤0.1) are labeled as numbers. Protein biomarker predictors were rank normalized to mean 0 and SD 1. Total and regional brain volumes and WMH volume were as percentage of TCV, WMH was also log transformed. Each color block shows the estimated effect for each pair of associations investigated in the primary analyses using linear mixed effect models adjusting for the covariates from Model 1 (age, age2, sex, age-sex interaction, and time distance between exam 7 and the MRI scan).
Fig 4
Fig 4. HR of incident dementia per SD unit higher protein biomarkers, stratified by APOE ε4 carrier.
Each color highlights the results from analyses using Cox proportional hazard regression models adjusting for Model 1 covariates (age, sex, and education level) in the carriers versus non-carriers subgroup. Points are effect estimates while lines indicate the 95% CI. APOE ε4 carrier status interaction FDR are also listed.

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