Apolipoprotein E potently inhibits ferroptosis by blocking ferritinophagy

Background Allelic variation to the APOE gene confers the greatest genetic risk for sporadic Alzheimer’s disease (AD). Independent of genotype, low abundance of apolipoprotein E (apoE), is characteristic of AD CSF, and predicts cognitive decline. The mechanisms underlying the genotype and apoE level risks are uncertain. Recent fluid and imaging biomarker studies have revealed an unexpected link between apoE and brain iron, which also forecasts disease progression, possibly through ferroptosis, an iron‐dependent regulated cell death pathway. Method Ferroptosis was induced in the N27 neuronal cell model of ferroptosis using multiple agents (erastin, RSL3, iron, cysteine depletion). The severity of ferroptosis was measured by several toxicity assays (MTT, LDH) and lipid peroxide probe (C11BODIPY). Iron levels in the temporal inferior cortex was gathered from 608 deceased subjects in the memory and aging project (MAP, Chicago, USA). Iron levels were quantified and analyzed using multiple regression models stratified by APOE genotype. Result We report that apoE is a potent inhibitor of ferroptosis (EC50≈10 nM; N27 neurons). We demonstrate that apoE signals to activate the PI3K/AKT pathway that then inhibits the autophagic degradation of ferritin (ferritinophagy), thus averting iron‐dependent lipid peroxidation. Using postmortem inferior temporal brain cortex tissue from deceased subjects from the Rush Memory and Aging Project (MAP) (N = 608), we found that the association of iron with pathologically confirmed clinical Alzheimer’s disease was stronger among those with the adverse APOE‐ε4 allele. While protection against ferroptosis did not differ between apoE isoforms in vitro, other features of ε4 carriers, such as low abundance of apoE protein and higher levels of polyunsaturated fatty acids (which fuel ferroptosis) could mediate the ε4 allele’s heighted risk of AD. Conclusion We show that apoE protects against ferroptic neurodegeneration through regulating autophagy and identified an increased risk of AD diagnosis associated with the apoE risk allele in a clinical study. These findings support ferroptosis as a putative pathway to explain the major genetic risk associated with late onset AD.