ABSTRACT
Sex and age are the primary risk factors for Alzheimer’s disease (AD), the most common form of dementia. After
decades of failed clinical trials for the treatment of Alzheimer’s disease (AD), there is an urgent need for creative
approaches to uncover new therapeutic targets. While women experience a greater prevalence, more severe
neuropathology, and greater cognitive decline with AD, men diagnosed with AD progress more quickly to death.
However, little is known about the mechanisms (whether hormonal or sex chromosomal) driving the sex-biased
response to AD pathology with brain aging. Our long-term goal is to identify the underlying mechanisms
governing the sex-biased response to AD. Recent GWAS studies have identified several AD risk loci in genes
exclusively expressed by microglia, shifting the field to explore potential causative roles of microglia in AD. As
well, microglia show profound phenotypic sex differences with aging and AD. We hypothesize that sex
differences in microglial responsivity contribute mechanistically to the sex-biased disease progression seen in
AD. Although the onset of AD correlates to the menopausal transition in women, hormone replacement therapies
(HRT) have generated mixed results. The formerly under-appreciated role of sex chromosomal contributions has
recently come to the forefront in AD research, with a special emphasis on X-encoded histone modifiers. The
objective of this study is to determine if sex chromosome complement (XX v. XY), independent of sex hormones,
alters pathological progression and microglial activational profiles in AD and test the hypothesis that X-encoded
lysine-specific demethylase Kdm6a contributes to the sexually divergent microglial response to AD. Our specific
aims will test the following hypotheses: (Aim 1) sex chromosome complement alters survival and pathological
progression (plaques/tangles, microgliosis) of AD; (Aim 2) sex chromosomally regulated differences in
heterogeneous microglial cell responses to aging and AD are driven, in part, by alterations in histone
modifications (H3K27me3); (Aim 3) microglial X-encoded Kdm6a expression is sufficient to cause sexually-
divergent microglial response to AD through genome-wide, targeted removal of repressive H3K27me3. The
paired phenotypic and multi-omic data generated in these studies will facilitate the identification of sex-
differentially regulated genomic programs that confer protection or risk to the progression of AD in both sexes in
order to prioritize targets for small molecule or epigenome editing for therapeutic intervention in AD. The research
plan is innovative because we investigate sex differences in AD through the lens of sex chromosomes and utilize
ground-breaking transcriptomic, epigenomic, and analytical techniques to gain a previously unattainable
resolution of microglia heterogeneity.