ABSTRACT: IMPORTANCE:To provide a comprehensive review of knowledge of the genomics of Alzheimer disease (AD) and DNA amyloid ? 42 (A?42) vaccination as a potential therapy. OBSERVATIONS:Genotype-phenotype correlations of AD are presented to provide a comprehensive appreciation of the spectrum of disease causation. Alzheimer disease is caused in part by the overproduction and lack of clearance of A? protein. Oligomer A?, the most toxic species of A?, causes direct injury to neurons, accompanied by enhanced neuroinflammation, astrocytosis and gliosis, and eventually neuronal loss. The strongest genetic evidence supporting this hypothesis derives from mutations in the amyloid precursor protein (APP) gene. A detrimental APP mutation at the ?-secretase cleavage site linked to early-onset AD found in a Swedish pedigree enhances A? production, in contrast to a beneficial mutation 2 residues away in APP that reduces A? production and protects against the onset of sporadic AD. A number of common variants associated with late-onset AD have been identified including apolipoprotein E, BIN1, ABC7, PICALM, MS4A4E/MS4A6A, CD2Ap, CD33, EPHA1, CLU, CR1, and SORL1. One or 2 copies of the apolipoprotein E ?4 allele are a major risk factor for late-onset AD. With DNA A?42 vaccination, a Th2-type noninflammatory immune response was achieved with a downregulation of A?42-specific effector (Th1, Th17, and Th2) cell responses at later immunization times. DNA A?42 vaccination upregulated T regulator cells (CD4+, CD25+, and FoxP3+) and its cytokine interleukin 10, resulting in downregulation of T effectors. CONCLUSIONS AND RELEVANCE:Mutations in APP and PS-1 and PS-2 genes that are associated with early-onset, autosomal, dominantly inherited AD, in addition to the at-risk gene polymorphisms responsible for late-onset AD, all indicate a direct and early role of A? in the pathogenesis of AD. A translational result of genomic research has been A?-reducing therapies including DNA A?42 vaccination as a promising approach to delay or prevent this disease.
