[The genetics of Alzheimer's disease.].
The aetiology of Alzheimer's disease (AD) is still unknown, but a small fraction of AD patients have a dominant inherited defect in one of three genes. These patients often develop Alzheimer's disease between 40 to 65 years of age. The majority of patients, however, get the disease after the age of 65 and do not have a gene defect in any of these three genes. Apart from age of onset, no symptomatic or pathological difference exists between AD patients with or without known genetic defect. In patients with AD before the age of 65 a germ-line gene defect in the APP gene ((3-amyloid precursor protein) at chromosome 21q21.2, the PS-1 gene (presenile) at chromosome 14q24.3 and the PS-2 gene at chromosome lq42.1 has been identified. The first mutation was discovered 1991 in the APP gene in a family with early-onset AD. Since then hundreds of families have been screened for mutations in this gene but they have only been found in 10 to 15 families. On the other hand more than 35 different mutations in over 60 unrelated families have been discovered in the PS-1 gene and nearly half of AD patients with familial early-onset AD have mutations in this gene. Patients with mutation in the PS-1 gene often get AD before the age of 50 and even before the age of 40. The third germ line gene defect was discovered 1995 in the PS-2 gene by screening the genome in search for PS-1 gene homology. Two different mutations have been found in PS-2 gene in unrelated families. An increased risk of late-onset AD has been associated with apolipoprotein E (ApoE). ApoE exists in three different isoforms: ApoE2, ApoE3 and ApoE4. Three alleles (e2, e3, and e4) on chromosome 19ql3.2 encode these different kinds of ApoE. Those who are e4 homozygous (B4/E4) have increased risk of late-onset AD, and usually develop symptoms earlier in live than E4 negatives. The same applies to e4 heterozygous (e3/s4 or e2/e4) individuals even though their risk does not increase as much as e4 homozygous. Other chromosome regions have been linked to late-onset AD, an example is a region on chromosome 12. Furthermore mutations in the mitochondrial genes that encode the enzyme cytochrome c oxidase have also recently been shown to be associated with AD.
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