In this study, we integrated human brain snRNA-seq datasets, GWAS summary statistics and WGS from AD and control individuals to identify cell type-specific dysregulated LR pairs and their underlying biological pathways. We identified key known and potential novel dysregulated LR interactions and highlighted vulnerable cell types in AD. Our pathway analyses further prioritized dysregulated LR interactions and related biological pathways supported by genetic association data. Our analysis provides a detailed landscape of cellular communication alterations in AD (Fig. 5), highlighting the power of multi-layered data integration in the study of complex diseases.
Our integrative analysis revealed the critical role of dysregulated astrocytes-to-neurons signaling and related biological functions associated with AD. Our comprehensive bioinformatics analysis highlights that the well-known gene APOE, which encodes the ligand in three dysregulated LR pairs, interacts with receptors encoded by LRP1, LRP4, and SORL1 (Fig. 2a). In addition, LR pairs involving APOE were found to be implicated in top enriched GO terms in our analyses, such as 'endocytic vesicle' and 'negative regulation of amyloid precursor protein catabolic process' (Fig. 4b). These findings underscore the central role of APOE signaling in the interplay between non-neurons and neurons in the pathophysiology of AD [27, 28]. In addition, pleiotrophin, encoded by PTN, is a heparin-binding growth factor that regulates peripheral and central immune responses. We found that PTN-involved LR interactions (PTN-PTPRZ1 and PTN-PTPRB) were downregulated from astrocytes to excitatory and inhibitory neurons. The interactions of PTN with protein tyrosine phosphatase receptor type Z polypeptide 1 (PTPRZ1) and protein tyrosine phosphatase receptor type S polypeptide (PTPRB) may play a role in cell proliferation and regulation, both of which are important in AD [43].
Our analysis underscores the pivotal role of calcium dyshomeostasis in the pathogenesis of AD. Notably, CALM, encoded by CALM1 and CALM3, served as a ligand in 25 downregulated LR pairs between excitatory and inhibitory neurons in AD. These LR pairs displayed alterations between excitatory and inhibitory neurons in our analysis. Among them, ten LR gene pairs (CALM1-GRM5, CALM1-GRM7, CALM1-RYR2, CALM -GRM5, and CALM3-GRM7, CALM3-RYR2, CALM1-CACNA1C, CALM3-CACNA1C, CALM3-EGFR, CALM3-INSR) were prioritized in the pathway analyses. Interestingly, the metabotropic glutamate receptor (GRM) was found to be the receptor in five of these 25 pairs. In general, CALMs interact with GRMs to regulate synaptic plasticity. GRM5 gene is ubiquitously expressed in brain regions implicated in AD phenotypes in mice and in regions linked to memory and learning [53, 54]. Our pathway analyses highlighted biological functions—such as regulation of calcium ion transport, second messenger-mediated signaling, and maintenance of location, which encompass four dysregulated LR pairs, including CALM1-RYR2, CALM3-RYR2, CALM1-CACNA1C, CALM3-CACNA1C (Fig. 4, Additional file 6: Table S5). RYR2 is a receptor to CALM1, and the binding of CALM1 to RYR2 has been shown to limit neuronal loss in AD [55]. Voltage-dependent L-type calcium channel subunit alpha-1C (CACNA1C) interacts with CALM1 and CALM3 to regulate calcium influx, and it can be related to neuronal survival and synaptic efficiency, and is thought to be involved in attention, learning, memory, and stress response [56–59].
Our ligand-target gene analysis revealed the potential regulatory role of ligands encoded by CALM1 and CALM3 on the DEGs in excitatory neurons. The predicted target genes, CIRBP and FTH1, were replicated in the independent dataset. Cold-inducible RNA-binding protein (CIRBP) is a general stress-response protein, which was downregulated in AD in our analysis (Fig. 3b). It has been proposed that CRIBP exerts a protective effect against neuronal amyloid toxicity via antioxidative and antiapoptotic pathways [60]. The dysregulation of ferritin heavy chain 1 (FTH1), on the other hand, is linked with neuronal death and memory impairments through iron dyshomeostasis [61].
In our analysis, most intercellular signals mediated by LR pairs were downregulated across six major cell types in AD. Notably, we observed upregulated LR interactions from microglia to astrocytes in the discovery dataset, although this was not replicated in the independent replication dataset. C3 was found altered as a ligand in two different LR pairs, C3-LRP1 and C3-CD81. Both pairs were upregulated in microglia, astrocytes, and OPCs, with microglia as the sender and astrocytes and OPCs as the receivers (Fig. 2c). C3 is a protein that is part of the complement system and part of the immune system; it co-localizes with amyloid plaques in AD. Low-density lipoprotein receptor-related protein 1 (LRP1) is a surface receptor and mediates pathways that interact with astrocytes and pericytes, the last of which is associated with the BBB. LRP1 expression is known to decrease in endothelial cells due to normal aging and in AD. C3 interacts and can bind with low-density LRP1 to regulate immune response and participate in several cellular processes [41, 62–65]. Ligand C3 and receptor CD81 play an inhibitory role in the control of immune responses [49]. We also identified alpha-2-macroglobulin (A2M) as a ligand in the A2M-LRP1 pair, which was upregulated in microglia. A2M interacts with LRP1 to regulate cholesterol metabolism and is considered a potential therapeutic target in AD [62]. Our ligand-target gene analysis from microglia to astrocytes suggests the regulatory potential of ligands encoded by A2M and C3 on the DEGs in the receiver cells (Additional file 1: Fig. S3a, b). Over-representation analysis on genes involved in dysregulated LR pairs and predicted target genes indicated significant enrichment in ‘amyloid-beta clearance’ and functions related to regulation of lipid (Additional file 1: Fig. S3c).
Moreover, two identified pairs, NRXN1-NLGN1 and NRXN1-NLGN3, are related to neurexins (NRXNs) and neuroligins (NLGNs) and their signaling is decreased in AD in a myriad of cell types, including astrocytes, excitatory and inhibitory neurons. NRXNs are cell-surface receptors that bind NLGNs, forming a crucial transsynaptic complex at brain synapses. This transsynaptic complex is vital for efficient neurotransmission and is involved in forming synaptic contacts and functional synaptic structures. Recent reports suggest that NRXNs and NLGNs undergo proteolytic processing by presenilins at synapses, a mechanism implicated in AD, suggesting a potential dysfunction in the NRXN-NLGN pathway in AD pathology [45].
Further, we observed upregulation of other LR pairs, including PSAP-LRP1 and PSAP-GPR37, in astrocytes, microglia, and oligodendrocytes (Fig. 2c, Additional file 2: Table S1). Prosaposin (PSAP) is a highly conserved glycoprotein that is a precursor of saposins; it also serves as a neurotrophic factor and a regulator of lysosomal enzymes. PSAP is known to interact with LRP1 in AD, with the interaction between PSAP and LRP1 being involved in the regulation of amyloid-beta metabolism [66]. The expression of PSAP and its receptor GPR37 is upregulated in the hippocampus of individuals with AD [67–69].
Finally, other LR pairs possibly related to AD involved genes that encode receptors, such as epidermal growth factor receptor (EGFR), insulin receptor (INSR), corticotropin-releasing hormone receptor 1 (CRHR1), and adenylate cyclase-activating polypeptide type I receptor (ADCYAP1R1) (Additional file 1: Fig. S2b, c). In general, they are involved in cell proliferation and differentiation, glucose metabolism, and stress response [70]. In addition, EGFR has been identified as the receptor in two upregulated LR pairs, involving heat shock protein 90 alpha family class A member 1 (HSP90AA1) and neuregulin 3 (NRG3) as the ligands. Both are implicated in cell proliferation and differentiation; NRG3 has been implicated in cognitive impairment [71, 72]. INSR was also found as a gene that encodes the receptor for sorbin and SH3 domain-containing protein 1 (SORBS1), downregulated in astrocytes, excitatory neurons, inhibitory neurons, and oligodendrocytes; the SORBS1-INSR is known to regulate glucose metabolism. Moreover, we found that the GO BP term ‘regulation of cellular and carbohydrate metabolic process’ encompassing SORBS1-INSR was associated with AD (Additional file 6: Table S5).
Our drug target analysis revealed existing and potentially novel therapeutic targets of dysregulated LR pairs in AD. Regarding EGFR, erlotinib, gefitinib, and osimertinib were found as potential drugs for repurposing. Both erlotinib and osimertinib are used to treat lung and pancreatic cancers and can cross the BBB (Table 1). They are tyrosine kinase inhibitors that work by blocking the kinase activity of EGFR, which is involved in cell growth and survival [73]. Erlotinib and gefitinib also have antioxidant properties [74]. It has been hypothesized that both drugs may enhance axon regeneration after neurodegeneration [51]. In addition, receptor ALK (in the PTN-ALK LR interaction) was targeted by four potential repurposable drugs that cross the BBB, including alectinib, ceritinib, entrectinib, and lorlatinib (Table 1). Similar to erlotinib and osimertinib, they are also currently used to treat lung cancer. Alectinib, ceritinib, entrectinib, and lorlatinib are also tyrosine kinase inhibitors with ALK-rearrangement. Ceritinib, alectinib and entrectinib are second-generation ALK inhibitors [75]; lorlatinib is a third-generation inhibitor [76, 77]. Moreover, two drugs that target the HSP90AA1 receptor were identified, amlexanox and cromoglicate (also called cromolyn). Both have anti-inflammatory properties, with cromolyn specifically reducing neuroinflammation. Cromolyn has been proposed as a new therapeutic target for AD [78]. Cromolyn has been shown to reduce levels of amyloid beta by promoting microglial phagocytosis [79, 80]. It also reduces the secretion of inflammatory cytokines by the microglia [81], reducing neuroinflammation in neural cells. The root of Rauwolfia serpentina, currently a discovery agent, targets the receptor CACNA1C. This compound has acetylcholinesterase (AChE) inhibitory activities, a mechanism that has been proposed to treat AD [82] and has shown neuroprotective activity.
Recently, brain insulin resistance has been found to play a role in normal memory processes and insulin irregularities may contribute to cognitive and brain changes associated with AD [83]. Metformin and insulin target the INSR and appeared as potentially repurposable drugs in our analyses. Evidence from clinical studies has demonstrated that metformin use contributes to a lower risk of developing AD and better cognitive performance [84]. Intranasally administered insulin is assumed to trigger improvements in synaptic plasticity, regional glucose uptake, and alleviations of AD neuropathology. Pilot clinical trials of intranasal insulin administration in individuals with mild cognitive impairment or AD indicate that acute and prolonged intranasal insulin administration can enhance memory performance [85].
While our integrative study used multiple, large-scale datasets, there were several limitations. First, our inference of dysregulated LR interaction was primarily dependent on the completeness of snRNA-seq datasets, cell type annotation, and the reliability of the LR dataset. Despite employing one of the most comprehensive snRNA-seq datasets of AD and controls currently available [8], we limited our analysis to six major cell types due to a relatively low cell count of pericytes and endothelial cells. We also performed replication analysis to ensure the reliability of the analysis. However, more complex intercellular signals could be unveiled in rare cell types or subclasses of major cell types with the employment of larger snRNA-seq datasets. Second, inadequate annotation of intercellular signaling pathways and intracellular regulatory networks may impede our pathway analyses of dysregulated LR pairs in AD. To address this point, we utilized comprehensive GO gene sets to evaluate the biological functions influenced by dysregulated LR signals in AD. Third, our cell-cell communication analysis was limited to the PFC region. Considering that AD pathology affects multiple brain regions, including the entorhinal cortex and hippocampus, further investigations across multiple brain regions are necessary for a more in-depth understanding of region-specific dysregulated intercellular signals in AD. Finally, rigorous laboratory experimental validation, which we did not perform because it was outside the scope of this study, will further validate the causal relationships between identified dysregulated intercellular interactions and disease progression.