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Objectives To examine associations between PsA and psoriasis vs lifestyle factors and comorbidities by triangulating observational and genetic evidence. Methods We analysed cross-sectional data from the UK Biobank (1836 PsA, 8995 psoriasis, 36 000 controls) to describe the association between psoriatic disease and lifestyle factors (including BMI and smoking) and 15 comorbidities [including diabetes and coronary artery disease (CAD)] using logistic models adjusted for age, sex and lifestyle factors. We applied bidirectional Mendelian randomization (MR) to genome-wide association data (3609 PsA and 7804 psoriasis cases, up to 1.2 million individuals for lifestyle factors and 757 601 for comorbidities) to examine causal direction, using the inverse-variance weighted method. Results BMI was cross-sectionally associated with risk of PsA (OR 1.31 per 5 kg/m2 increase; 95% CI 1.26, 1.37) and psoriasis (OR 1.23; 1.20, 1.26), with consistent MR estimates (PsA OR 1.38; 1.14, 1.67; psoriasis OR 1.36; 1.18, 1.58). In both designs, smoking was more strongly associated with psoriasis than PsA. PsA and psoriasis were cross-sectionally associated with diabetes (OR 1.35 and 1.39, respectively) and CAD (OR 1.56 and 1.38, respective). Genetically predicted glycated haemoglobin (surrogate for diabetes) increased PsA risk (OR 1.18 per 6.7 mmol/mol increase; 1.02, 1.36) but not psoriasis. Genetic liability to PsA (OR 1.05; 1.003, 1.09) and psoriasis (OR 1.03; 1.001, 1.06) were associated with increased risk of CAD. Conclusion Observational and genetic evidence converge to suggest that BMI and glycaemic control are associated with increased psoriatic disease risk, while psoriatic disease is associated with increased CAD risk. Further research is needed to understand the mechanism of these associations.

Plasma biomarkers for Alzheimer’s disease-related pathologies have undergone rapid developments during the past few years, and there are now well-validated blood tests for amyloid and tau pathology, as well as neurodegeneration and astrocytic activation. To define Alzheimer’s disease with biomarkers rather than clinical assessment, we assessed prediction of research-diagnosed disease status using these biomarkers and tested genetic variants associated with the biomarkers that may reflect more accurately the risk of biochemically defined Alzheimer’s disease instead of the risk of dementia. In a cohort of Alzheimer’s disease cases [n = 1439, mean age 68 years (standard deviation = 8.2)] and screened controls [n = 508, mean age 82 years (standard deviation = 6.8)], we measured plasma concentrations of the 40 and 42 amino acid-long amyloid-β (Aβ) fragments (Aβ40 and Aβ42, respectively), tau phosphorylated at amino acid 181 (P-tau181), neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) using state-of-the-art Single molecule array (Simoa) technology. We tested the relationships between the biomarkers and Alzheimer’s disease genetic risk, age at onset and disease duration. We also conducted a genome-wide association study for association of disease risk genes with these biomarkers. The prediction accuracy of Alzheimer’s disease clinical diagnosis by the combination of all biomarkers, APOE and polygenic risk score reached area under receiver operating characteristic curve (AUC) = 0.81, with the most significant contributors being ε4, Aβ40 or Aβ42, GFAP and NfL. All biomarkers were significantly associated with age in cases and controls (P < 4.3 × 10−5). Concentrations of the Aβ-related biomarkers in plasma were significantly lower in cases compared with controls, whereas other biomarker levels were significantly higher in cases. In the case-control genome-wide analyses, APOE-ε4 was associated with all biomarkers (P = 0.011−4.78 × 10−8), except NfL. No novel genome-wide significant single nucleotide polymorphisms were found in the case-control design; however, in a case-only analysis, we found two independent genome-wide significant associations between the Aβ42/Aβ40 ratio and WWOX and COPG2 genes. Disease prediction modelling by the combination of all biomarkers indicates that the variance attributed to P-tau181 is mostly captured by APOE-ε4, whereas Aβ40, Aβ42, GFAP and NfL biomarkers explain additional variation over and above APOE. We identified novel plausible genome wide-significant genes associated with Aβ42/Aβ40 ratio in a sample which is 50 times smaller than current genome-wide association studies in Alzheimer’s disease.

Ageing is the greatest global healthcare challenge, as it underlies age-related functional decline and is the primary risk factor for a range of common diseases, including neurodegenerative conditions such as Alzheimer’s disease (AD). However, the molecular mechanisms defining chronological age versus biological age, and how these underlie AD pathogenesis, are not well understood. The objective of this study was to integrate common human genetic variation associated with human lifespan or AD from Genome-Wide Association Studies (GWAS) with co-expression networks altered with age in the central nervous system, to gain insights into the biological processes which connect ageing with AD and lifespan. Initially, we identified common genetic variation in the human population associated with lifespan and AD by performing a gene-based association study using GWAS data. We also identified preserved co-expression networks associated with age in the brains of C57BL/6J mice from bulk and single-cell RNA-sequencing (RNA-seq) data, and in the brains of humans from bulk RNA-seq data. We then intersected the human gene-level common variation with these co-expression networks, representing the different cell types and processes of the brain. We found that genetic variation associated with AD was enriched in both microglial and oligodendrocytic bulk RNA-seq gene networks, which show increased expression with ageing in the human hippocampus, in contrast to synaptic networks which decreased with age. Further, longevity-associated genetic variation was modestly enriched in a single-cell gene network expressed by homeostatic microglia. Finally, we performed a transcriptome-wide association study (TWAS), to identify and confirm new risk genes associated with ageing that show variant-dependent changes in gene expression. In addition to validating known ageing-related genes such as APOE and FOXO3, we found that Caspase 8 (CASP8) and APOC1 show genetic variation associated with longevity. We observed that variants contributing to ageing and AD balance different aspects of microglial function suggesting that ageing-related processes affect multiple cell types in the brain. Specifically, changes in homeostatic microglia are associated with lifespan, and allele-dependent expression changes in age-related genes control microglial activation and myelination influencing the risk of developing AD. We identified putative molecular drivers of these genetic networks, as well as module genes whose expression in relevant human tissues are significantly associated with AD-risk or longevity, and may drive “inflammageing.” Our study also shows allele-dependent expression changes with ageing for genes classically involved in neurodegeneration, including MAPT and HTT, and demonstrates that PSEN1 is a prominent member/hub of an age-dependent expression network. In conclusion, this work provides new insights into cellular processes associated with ageing in the brain, and how these may contribute to the resilience of the brain against ageing or AD-risk. Our findings have important implications for developing markers indicating the physiological age and pre-pathological state of the brain, and provide new targets for therapeutic intervention.

Alzheimer's disease (AD) is a devastating neurodegenerative condition with significant genetic heritability. Several genes have been implicated in the onset of AD with the apolipoprotein E (APOE) gene being the strongest single genetic risk loci. Evidence suggests that the effect of APOE alters with age during disease progression. Here, we aim to investigate the impact of APOE and other variants outside the APOE region on AD risk in younger and older participants. Using data from both the Alzheimer's Disease Neuroimaging Initiative and the UK Biobank, we computed the polygenic risk score of each individual informed by the latest genetic study from the International Genomics of Alzheimer's Project. Our analysis showed that the effect of APOE on the disease risk is greater in younger participants and reduces as participants' age increases. Our findings indicate the increased impact of polygenic risk score as participants' age increases. Therefore, AD in older individuals can potentially be triggered by the cumulative effect of genes which are outside the APOE region., Highlights • Polygenic risk score analysis was used in ADNI and the UK Biobank data sets. • APOE's effect on Alzheimer's disease risk was greater in the younger group (age

Recently, we reported oligoadenylate synthetase 1 (OAS1) contributed to the risk of Alzheimer’s disease, by its enrichment in transcriptional networks expressed by microglia. However, the function of OAS1 within microglia was not known. Using genotyping from 1313 individuals with sporadic Alzheimer’s disease and 1234 control individuals, we confirm the OAS1 variant, rs1131454, is associated with increased risk for Alzheimer’s disease. The same OAS1 locus has been recently associated with severe coronavirus disease 2019 (COVID-19) outcomes, linking risk for both diseases. The single nucleotide polymorphisms rs1131454(A) and rs4766676(T) are associated with Alzheimer’s disease, and rs10735079(A) and rs6489867(T) are associated with severe COVID-19, where the risk alleles are linked with decreased OAS1 expression. Analysing single-cell RNA-sequencing data of myeloid cells from Alzheimer’s disease and COVID-19 patients, we identify co-expression networks containing interferon (IFN)-responsive genes, including OAS1, which are significantly upregulated with age and both diseases. In human induced pluripotent stem cell-derived microglia with lowered OAS1 expression, we show exaggerated production of TNF-α with IFN-γ stimulation, indicating OAS1 is required to limit the pro-inflammatory response of myeloid cells. Collectively, our data support a link between genetic risk for Alzheimer’s disease and susceptibility to critical illness with COVID-19 centred on OAS1, a finding with potential implications for future treatments of Alzheimer’s disease and COVID-19, and development of biomarkers to track disease progression.

Genome-wide association studies of late-onset Alzheimer’s disease (AD) have highlighted the importance of variants associated with genes expressed by the innate immune system in determining risk for AD. Recently, we and others have shown that genes associated with variants that confer risk for AD are significantly enriched in transcriptional networks expressed by amyloid-responsive microglia. This allowed us to predict new risk genes for AD, including the interferon-responsive oligoadenylate synthetase 1 (OAS1). However, the function ofOAS1within microglia and its genetic pathway are not known. Using genotyping from 1,313 individuals with sporadic AD and 1,234 control individuals, we confirm that theOAS1variant, rs1131454, is associated with increased risk for AD and decreasedOAS1expression. Moreover, we note that the same locus was recently associated with critical illness in response to COVID-19, linking variants that are associated with AD and a severe response to COVID-19. By analysing single-cell RNA-sequencing (scRNA-seq) data of isolated microglia fromAPPNL-G-Fknock-in and wild-type C57BL/6J mice, we identify a transcriptional network that is significantly upregulated with age and amyloid deposition, and contains the mouse orthologueOas1a, providing evidence thatOas1aplays an age-dependent function in the innate immune system. We identify a similar interferon-related transcriptional network containingOAS1by analysing scRNA-seq data from human microglia isolated from individuals with AD. Finally, using human iPSC-derived microglial cells (h-iPSC-Mg), we see thatOAS1is required to limit the pro-inflammatory response of microglia. When stimulated with interferon-gamma (IFN-γ), we note that cells with lowerOAS1expression show an exaggerated pro-inflammatory response, with increased expression and secretion of TNF-α. Collectively, our data support a link between genetic risk for AD and susceptibility to critical illness with COVID-19 centred onOAS1and interferon signalling, a finding with potential implications for future treatments of both AD and COVID-19, and the development of biomarkers to track disease progression.

Genome-wide association studies of late-onset Alzheimer’s disease risk have previously identified genes primarily expressed in microglia that form a transcriptional network. Using transgenic mouse models of amyloid deposition, we previously showed that many of the mouse orthologues of these risk genes are co-expressed and associated with amyloid pathology. In this new study, we generate an improved RNA-seq-derived network that is expressed in amyloid-responsive mouse microglia and we statistically compare this with gene-level variation in previous human Alzheimer’s disease genome-wide association studies to predict at least four new risk genes for the disease (OAS1, LAPTM5, ITGAM/CD11b and LILRB4). Of the mouse orthologues of these genes Oas1a is likely to respond directly to amyloid at the transcriptional level, similarly to established risk gene Trem2, because the increase in Oas1a and Trem2 transcripts in response to amyloid deposition in transgenic mice is significantly higher than both the increase of the average microglial transcript and the increase in microglial number. In contrast, the mouse orthologues of LAPTM5, ITGAM/CD11b and LILRB4 (Laptm5, Itgam/CD11b and Lilra5) show increased transcripts in the presence of amyloid plaques similar in magnitude to the increase of the average microglial transcript and the increase in microglia number, except that Laptm5 and Lilra5 transcripts increase significantly quicker than the average microglial transcript as the plaque load becomes dense. This work suggests that genetic variability in the microglial response to amyloid deposition is a major determinant for Alzheimer’s disease risk, and identification of these genes may help to predict the risk of developing Alzheimer’s disease. These findings also provide further insights into the mechanisms underlying Alzheimer’s disease for potential drug discovery.

Genetic analysis of late-onset Alzheimer’s disease risk has previously identified a network of largely microglial genes that form a transcriptional network. In transgenic mouse models of amyloid deposition we have previously shown that the expression of many of the mouse orthologs of these genes are co-ordinately up-regulated by amyloid deposition. Here we investigate whether systematic analysis of other members of this mouse amyloid-responsive network predicts other Alzheimer’s risk loci. This statistical comparison of the mouse amyloid-response network with Alzheimer’s disease genome-wide association studies identifies 5 other genetic risk loci for the disease (OAS1, CXCL10, LAPTM5, ITGAM and LILRB4). This work suggests that genetic variability in the microglial response to amyloid deposition is a major determinant for Alzheimer’s risk.One Sentence SummaryIdentification of 5 new risk loci for Alzheimer’s by statistical comparison of mouse Aβ microglial response with gene-based SNPs from human GWAS

Objectives To compare the prevalence and incidence of chronic co-morbidities in people with inflammatory rheumatic and musculoskeletal diseases (iRMDs), and to determine whether the prevalent co-morbidities are associated with physical activity levels in people with iRMDs and in those without iRMDs. Methods Participants were recruited to the UK Biobank; a population-based cohort. Data were collected about demographics, physical activity, iRMDs (RA, PsA, AS, SLE) and other chronic conditions, including angina, myocardial infarction, stroke, hypertension, pulmonary disease, diabetes and depression. The standardized prevalence of co-morbidities in people with iRMDs was calculated. Cox regression was used to determine the relationship between the presence of an iRMD and an incident co-morbidity. The relationship between the presence (versus absence) of a (co-)morbidity and physical activity level (low, moderate, high) in people with iRMDs and in those without was assessed using multinomial logistic regression. Results A total of 488 991 participants were included. The estimated prevalence of each co-morbidity was increased in participants with an iRMD, compared with in those without, particularly for stroke in participants with SLE (standardized morbidity ratio (95% CI), 4.9 (3.6, 6.6). Compared with people with no iRMD and no morbidity, the odds ratios (95% CI) for moderate physical activity were decreased for: no iRMD and morbidity, 0.87 (0.85, 0.89); iRMD and no co-morbidity, 0.71 (0.64, 0.80); and iRMD and co-morbidity, 0.58 (0.54, 0.63). Conclusion Having a (co-)morbidity is associated with reduced physical activity in the general population, and to a greater extent in participants with an iRMD. Optimal management of both iRMDs and co-morbidities may help to reduce their impact on physical activity.

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with the presence of psoriasis. Lifestyle factors such as body mass index (BMI), smoking and alcohol consumption have been reported to contribute to the risk of both diseases. These risk factors also contribute to cardiovascular disease (CVD) which is a major cause of morbidity and mortality in patients with psoriasis and PsA. Objectives To compare lifestyle factors between individuals with PsA, psoriasis and a control group and to assess the association between these inflammatory diseases and CVD outcomes utilising the UK Biobank resource. Methods UK Biobank recruited 502,664 people aged 40–70 years in the UK between 2006 and 2010. Data on lifestyle, sociodemographics, health and medical history were collected at the assessment visit by questionnaire and interview by research nurse. Participants were asked if they have ever been diagnosed by a physician with a disease. Lifestyle factors including alcohol (current or past drinker) and smoking status (ever or never) were recorded and height and weight measured to calculate BMI. In this cross-sectional study, the frequency of these factors was compared between PsA, psoriasis and healthy controls using logistic or linear regression analyses depending on the outcome, adjusting for age and gender. Comparison between disease groups was performed by linear combinations of coefficients post estimation. Three CVD outcomes: heart attack, angina and hypertension, were tested for association with disease group using logistic regression including BMI, smoking, alcohol, age and sex as covariates. Odds ratios (OR) and β coefficients are reported with 95% confidence intervals (CI). Results 862 people with PsA, 4,761 with psoriasis and 465,371 control participants were included in the study (Table). Compared to the control group; both the PsA and psoriasis groups had higher BMI (β 1.43 (95% CI 1.11:1.75) and 0.72 (0.58:0.85) respectively), the psoriasis group smoked more (OR 1.63 (1.54:1.72)) and patients with PsA were less likely to be current drinkers (OR 0.68 (0.55:0.85)). Compared to patients with psoriasis, patients with PsA had higher BMI (β 0.69 (0.32:1.06)) and were less likely to be ever smokers and current drinkers (OR 0.70 (0.61:0.81) and 0.65 (0.51:0.83), respectively). Finally, hypertension was more prevalent in PsA compared to the control and psoriasis cohorts (OR 1.71 (1.48:1.97) and 1.55 (1.33:1.82), respectively). Conclusions Using a large population based cohort we show that self-reported CVD outcomes, in particular hypertension, are significantly higher in PsA compared to psoriasis independently of known CVD risk factors. The results contribute to our understanding of the lower quality of life reported by patients with PsA. Disclosure of Interest None declared