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<p>The ε4 allele of apolipoprotein E (APOE4) is the strongest genetic risk factor for Alzheimer’s disease (AD), increasing AD risk about fourfold in ~ 34 million American and ~ 75 million European females. APOE4 carriers exhibit cerebral metabolic deficits decades before clinical onset. We previously demonstrated that ketogenic diet (KD), a low-carbohydrate, high-fat diet promoting ketone metabolism, confers cognitive benefits in aged C57BL/6 mice, and in the PS1/APP mouse model of early-onset AD. Here, we evaluated the effects of KD in a humanized APOE4 AD mouse model. KD significantly improved composite cognitive performance and spatial working memory, with pronounced effects in females. Synaptic plasticity, measured via long-term potentiation (LTP), was likewise enhanced exclusively in females. Transcriptomic and protein analyses revealed KD-induced activation of CREB pathway, marked by increased phosphorylation of ERK and CREB in female brains. Moreover, KD selectively reduced pro-inflammatory cytokine levels in females. These findings demonstrate sex-specific neuroprotective effects of KD in APOE4 mice and suggest its potential therapeutic role in mitigating AD risk in APOE4-positive women.</p> Graphical Abstract <p></p>

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A ketogenic diet improves memory in females in the APOE4 mouse model of Alzheimer’s disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月24日

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  • Jacopo Di Lucente,
  • Jennifer M. Rutkowsky,
  • Alfredo Errico Provenzano,
  • Giuseppe Persico,
  • Zeyu Zhou,
  • Lee-Way Jin,
  • Jon J. Ramsey,
  • Claire B. Montgomery,
  • Kyoungmi Kim,
  • Marco Giorgio,
  • Izumi Maezawa,
  • Gino A. Cortopassi

摘要

The ε4 allele of apolipoprotein E (APOE4) is the strongest genetic risk factor for Alzheimer’s disease (AD), increasing AD risk about fourfold in ~ 34 million American and ~ 75 million European females. APOE4 carriers exhibit cerebral metabolic deficits decades before clinical onset. We previously demonstrated that ketogenic diet (KD), a low-carbohydrate, high-fat diet promoting ketone metabolism, confers cognitive benefits in aged C57BL/6 mice, and in the PS1/APP mouse model of early-onset AD. Here, we evaluated the effects of KD in a humanized APOE4 AD mouse model. KD significantly improved composite cognitive performance and spatial working memory, with pronounced effects in females. Synaptic plasticity, measured via long-term potentiation (LTP), was likewise enhanced exclusively in females. Transcriptomic and protein analyses revealed KD-induced activation of CREB pathway, marked by increased phosphorylation of ERK and CREB in female brains. Moreover, KD selectively reduced pro-inflammatory cytokine levels in females. These findings demonstrate sex-specific neuroprotective effects of KD in APOE4 mice and suggest its potential therapeutic role in mitigating AD risk in APOE4-positive women.

Graphical Abstract