A haptoglobin (HP) structural variant alters the effect of APOE alleles on Alzheimer's disease

Background: Haptoglobin (HP) is an antioxidant of apolipoprotein E (APOE), and previous reports have shownHP binds with APOE and amyloid beta (A ss) to aid its clearance. A common structural variant of the HP gene distinguishes it into two alleles: HP1 and HP2. Methods: HP genotypes were imputed in 29 cohorts from the Alzheimer's Disease Genetics Consortium (N = 20,512). Associations between the HP polymorphism and Alzheimer's disease (AD) risk and age of onset through APOE interactions were investigated using regression models. Results: The HP polymorphism significantly impacts AD risk in European-descent individuals (and in meta-analysis with African-descent individuals) by modifying both thprotective effect of APOE e2 and the detrimental effect of APOE e4. The effect is particularly significant among APOE e4 carriers. Discussion: The effect modification of APOE by HP suggests adjustment and/or stratification by HP genotype is warranted when APOE risk is considered. Our findings also provided directions for further investigations on potential mechanisms behind this association.e