Background: Approximately 25% of the general population carries at least one ε4 allele of the Apolipoprotein E (APOE ε4) with a major role in cardiovascular disease and dementia. Despite a significant increased risk of AD in individuals carrying two APOE ε4 alleles, these individuals currently cannot receive novel anti-amyloid drugs, in the UK, due to concerns about side effects. Research is needed to understand how we can improve resilience, either through vascular or brain resilience, of individuals carrying two APOE ε4 alleles, reducing risk of both dementia and cardiovascular disease. There is good evidence to support diet and metabolomics as modulators of the effect of APOE genotype on dementia and this PhD will focus on identifying resilience factors in the exposome to APOE ε4 using twins with the same APOE ε4 dose, but different cardiovascular and brain outcomes. It aims to identify protective factors and resilience pathways for these highly prevalent chronic conditions.
Specific objectives include:
Objective 1: Investigate the impact of the APOE-ε4 allele on cardiovascular endotypes (atherosclerosis and arteriosclerosis), ‘BrainAge’ MRI imaging, and blood based biomarkers of Alzheimer’s dementia and dementia in TwinsUK.
Objective 2: Identify phenotypic differences in twin pairs positive for APOE-ε4 allele but with different vascular and ‘BrainAge’ phenotypes.
Objective 3: Identify metabolic, and inflammatory exposures which can modulate the resilience of the brain and vasculature to APOE ε4.
Novelty and importance: This PhD will identify and study resilience to known genetic stressors, providing a unique opportunity to uncover novel protective factors and resilience pathways for manipulation in interventions in the prevention of key chronic conditions: cardiovascular disease and dementia. This is important as there is currently limited management available to reduce risk for APOE e4 positive individuals.

