Abstract
BACKGROUND: Systemic inflammation and astrogliosis are relevant in Alzheimer’s disease (AD). We evaluated whether peripheral inflammation has synergistic effects with astrogliosis on β‐amyloid (Aβ), vascular, and neurodegeneration markers. METHOD: In the Ginkgo Evaluation of Memory Study, we evaluated the relationship between peripheral inflammation (TNF‐R1, TNF‐R2, IL‐6, IL‐2, CRP and sCD14) and astrogliosis (GFAP ≥196pg/mL) as to Aβ burden (≥20centiloids) and accumulation (centiloids/year), white matter lesion (WML) volume, and neurodegeneration (NfL) across the AD spectrum. Participants underwent PiB‐PET scans between 2009‐2018. GFAP, NfL, and peripheral inflammatory markers were measured in 2009 by immunoassay; their values were standardized within the cohort. We used negative binomial regression models and adjusted for age, sex, education, APOEε4, cystatin C and baseline Aβ status. RESULT: 190 participants were included (mean age: 86±2.8 yrs., 40.8% women, 96.9% White). GFAP was higher among Aβ+ participants; it did not differ by levels of peripheral inflammation. Aβ accumulation was slower among those with high sCD14, particularly among Aβ+. There was a significant negative multiplicative interaction between GFAP and CRP on Aβ accumulation (RR;95%CI:0.61;.38‐.99; p =0.047). WML were larger among GFAP+ individuals. There were significant additive and multiplicative interactions of GFAP with CRP (relative excess risk due to interaction (RERI);95%CI:0.47;0.12‐0.83; p =0.008; RR;95%CI:1.76;1.11‐2.81; p =0.016, respectively), with TNFR1 (RERI;95%CI:0.63;0.29‐0.97; p <.001; RR;95%CI:1.93;1.24‐3.01; p =0.004, respectively), and with TNFR2 (RERI;95%CI:0.52;0.22‐0.82; p =0.001; RR;95%CI:1.82;1.18‐2.82; p =0.006, respectively) on WML. Regarding neurodegeneration, there were significant joint effects of GFAP with CRP, sCD14 and/or TNFR1; and significant additive and/or multiplicative interactions of GFAP with CRP (RERI;95%CI:0.35;0.07‐0.62; p =0.012, RR;95%CI:1.37;1.04‐1.81; p =0.023, respectively) with TNFR1 (RERI;95%CI:0.29;0.08‐0.50; p =.007, RR;95%CI:1.30;1.03‐1.63; p =0.023, respectively) and with TNFR2 (RERI;95%CI:0.22;0.005‐0.45; p =.045). CONCLUSION: In this 85+ population, with expected high levels of inflammation and more co‐pathology; peripheral inflammation (CRP, TNFR1 and/or TNFR2) showed additive/multiplicative synergistic effects with astrogliosis resulting in less amyloid accumulation, greater vascular burden, and more neurodegeneration, particularly in Aβ+ participants. More inflammation may relate with more pathogenesis, bringing participants closer to the amyloid asymptote, slowing Aβ accumulation.