A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease

Abstract Copy number variation (CNV) of the amyloid-β precursor protein gene (APP) is a known cause of autosomal dominant Alzheimer disease (ADAD), but de novo genetic variants causing ADAD are rare. We report a mother and daughter with neuropathologically confirmed definite Alzheimer disease (AD) a...

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Main Authors: Emma Ehn, Jesper Eisfeldt, Jose M. Laffita-Mesa, Håkan Thonberg, Jacqueline Schoumans, Anne M. Portaankorva, Matti Viitanen, Anna Lindstrand, Inger Nennesmo, Caroline Graff
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Language:English
Published: Nature Portfolio 2025-01-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-86645-0
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author Emma Ehn
Jesper Eisfeldt
Jose M. Laffita-Mesa
Håkan Thonberg
Jacqueline Schoumans
Anne M. Portaankorva
Matti Viitanen
Anna Lindstrand
Inger Nennesmo
Caroline Graff
author_facet Emma Ehn
Jesper Eisfeldt
Jose M. Laffita-Mesa
Håkan Thonberg
Jacqueline Schoumans
Anne M. Portaankorva
Matti Viitanen
Anna Lindstrand
Inger Nennesmo
Caroline Graff
author_sort Emma Ehn
collection DOAJ
description Abstract Copy number variation (CNV) of the amyloid-β precursor protein gene (APP) is a known cause of autosomal dominant Alzheimer disease (ADAD), but de novo genetic variants causing ADAD are rare. We report a mother and daughter with neuropathologically confirmed definite Alzheimer disease (AD) and extensive cerebral amyloid angiopathy (CAA). Copy number analysis identified an increased number of APP copies and genome sequencing (GS) revealed the underlying complex genomic rearrangement (CGR) including a triplication of APP with two unique breakpoint junctions (BPJs). The mosaic state in the mother had likely occurred de novo. Digital droplet PCR (ddPCR) on 42 different tissues, including 17 different brain regions, showed the derivative chromosome at varying mosaic levels (20–96%) in the mother who had symptom onset at age 58 years. In contrast, the derivative chromosome was present in all analyzed cells in the daughter whose symptom onset was at 34 years. This study reveals the architecture of a de novo CGR causing APP triplication and ADAD with a striking difference in age at onset between the fully heterozygous daughter compared to the mosaic mother. The GS analysis identified the complexity of the CGR illustrating its usefulness in identifying structural variants (SVs) in neurodegenerative disorders.
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spelling doaj-art-2bc3e75a4480464bb22b59f8f0a080ff2025-08-20T02:05:13ZengNature PortfolioScientific Reports2045-23222025-01-0115111410.1038/s41598-025-86645-0A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer diseaseEmma Ehn0Jesper Eisfeldt1Jose M. Laffita-Mesa2Håkan Thonberg3Jacqueline Schoumans4Anne M. Portaankorva5Matti Viitanen6Anna Lindstrand7Inger Nennesmo8Caroline Graff9Division for Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetDepartment for Molecular Medicine and Surgery, Karolinska InstitutetDivision for Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetDepartment for Molecular Medicine and Surgery, Karolinska InstitutetDépartement de Médicine de Laboratoire et Pathologie, Centre Universitaire Hospitalier Vaudois (CHUV)Faculty of Medicine, Clinical Neurosciences, University of HelsinkiDivision for Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetDepartment for Molecular Medicine and Surgery, Karolinska InstitutetDepartment of Oncology-Pathology, Karolinska InstitutetDivision for Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetAbstract Copy number variation (CNV) of the amyloid-β precursor protein gene (APP) is a known cause of autosomal dominant Alzheimer disease (ADAD), but de novo genetic variants causing ADAD are rare. We report a mother and daughter with neuropathologically confirmed definite Alzheimer disease (AD) and extensive cerebral amyloid angiopathy (CAA). Copy number analysis identified an increased number of APP copies and genome sequencing (GS) revealed the underlying complex genomic rearrangement (CGR) including a triplication of APP with two unique breakpoint junctions (BPJs). The mosaic state in the mother had likely occurred de novo. Digital droplet PCR (ddPCR) on 42 different tissues, including 17 different brain regions, showed the derivative chromosome at varying mosaic levels (20–96%) in the mother who had symptom onset at age 58 years. In contrast, the derivative chromosome was present in all analyzed cells in the daughter whose symptom onset was at 34 years. This study reveals the architecture of a de novo CGR causing APP triplication and ADAD with a striking difference in age at onset between the fully heterozygous daughter compared to the mosaic mother. The GS analysis identified the complexity of the CGR illustrating its usefulness in identifying structural variants (SVs) in neurodegenerative disorders.https://doi.org/10.1038/s41598-025-86645-0Autosomal dominant Alzheimer disease (ADAD)Amyloid-β precursor protein gene (APP)Cerebral amyloid angiopathy (CAA)Complex genomic rearrangement (CGR)MosaicismStructural variant (SV).
spellingShingle Emma Ehn
Jesper Eisfeldt
Jose M. Laffita-Mesa
Håkan Thonberg
Jacqueline Schoumans
Anne M. Portaankorva
Matti Viitanen
Anna Lindstrand
Inger Nennesmo
Caroline Graff
A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease
Scientific Reports
Autosomal dominant Alzheimer disease (ADAD)
Amyloid-β precursor protein gene (APP)
Cerebral amyloid angiopathy (CAA)
Complex genomic rearrangement (CGR)
Mosaicism
Structural variant (SV).
title A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease
title_full A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease
title_fullStr A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease
title_full_unstemmed A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease
title_short A de novo, mosaic and complex chromosome 21 rearrangement causes APP triplication and familial autosomal dominant early onset Alzheimer disease
title_sort de novo mosaic and complex chromosome 21 rearrangement causes app triplication and familial autosomal dominant early onset alzheimer disease
topic Autosomal dominant Alzheimer disease (ADAD)
Amyloid-β precursor protein gene (APP)
Cerebral amyloid angiopathy (CAA)
Complex genomic rearrangement (CGR)
Mosaicism
Structural variant (SV).
url https://doi.org/10.1038/s41598-025-86645-0
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