Anti-CMV IgG Seropositivity is Associated with Plasma Biomarker Evidence of Amyloid-β Accumulation

Article type: Research Article

Authors: Parker, Daniel C.^{a; b; *} | Whitson, Heather E.^{a; b; c} | Smith, Patrick J.^d | Kraus, Virginia B.^{b; e; f; g} | Huebner, Janet L.^{e; f} | North, Rebecca^b | Kraus, William E.^{b; e; f; h} | Cohen, Harvey Jay^{a; b; f} | Huffman, Kim M.^{b; e; g}

Affiliations: [a] Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA | [b] Duke University Center for the Study of Aging and Human Development, Durham, NC, USA | [c] Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC, USA | [d] Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA | [e] Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA | [f] Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA | [g] Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, USA | [h] Division of Cardiology, Duke University School of Medicine, Durham, NC, USA

Correspondence: [*] Correspondence to: Daniel Parker, MD, Box 3003, Duke University Medical Center, Durham, NC 27710, USA. Tel.:+1 919 660 7692; E-mail: daniel.parker@duke.edu.

Abstract: Background:Some human studies have identified infection with cytomegalovirus (CMV), a member of the alpha herpesvirus family, as a risk factor for Alzheimer’s disease and related dementias (ADRD). To our knowledge, no studies have evaluated associations of CMV seropositivity with plasma biomarkers of ADRD risk in middle-aged adults. Objective:In participants recruited for an exercise study, we evaluated cross-sectional associations of CMV seropositivity with: Aβ42/Aβ40 ratio, a low ratio suggestive of central nervous system Aβ accumulation; glial fibrillary acidic protein (GFAP), a measure of neuroinflammation; and neurofilament light (NfL), a measure of neurodegeneration. Methods:Anti-CMV IgG was quantified by ELISA. Plasma ADRD biomarkers were quantified using the ultrasensitive SIMOA assay. We used linear regression to evaluate associations of CMV seropositivity with the ADRD biomarkers, adjusting for age, sex, and race (n = 303; Age = 55.7±9.2 years). For ADRD biomarkers significantly associated with CMV seropositivity, we evaluated continuous associations of anti-CMV IgG levels with the ADRD biomarkers, excluding CMV seronegative participants. Results:53% of participants were CMV seropositive. CMV seropositivity was associated with a lesser Aβ42/Aβ40 ratio (β=–3.02e–03 95% CI [–5.97e–03, –7.18e–05]; p = 0.045). In CMV seropositive participants, greater anti-CMV IgG levels were associated with a lesser Aβ42/Aβ40 ratio (β=–4.85e–05 95% CI[–8.45e–05, –1.25e–05]; p = 0.009). CMV seropositivity was not associated with plasma GFAP or NfL in adjusted analyses. Conclusions:CMV seropositivity was associated with a lesser plasma Aβ42/Aβ40 ratio. This association may be direct and causally related to CMV neuro-cytotoxicity or may be indirect and mediated by inflammatory factors resulting from CMV infection burden and/or the immune response.

Keywords: Alzheimer’s disease and related dementias, biomarkers, cytomegalovirus, herpesviruses

DOI: 10.3233/JAD-230220

Journal: Journal of Alzheimer's Disease, vol. 98, no. 2, pp. 593-600, 2024