Gene dosage of the apolipoprotein E (APOE) epsilon 4 allele is a major
risk factor for familiar Alzheimer disease (AD) of late onset (after
age 60). Here we studied a large series of 115 AD case subjects and 24
3 controls as well as 150 affected and 197 unaffected members of 66 AD
families. Our data demonstrate a protective effect of the epsilon 2 a
llele, in addition to the dose effect of the epsilon 4 allele in spora
dic AD. Although a substantial proportion (65%) of AD is attributable
to the presence of epsilon 4 alleles, risk of AD is lowest in subjects
with the epsilon 2/epsilon 3 genotype, with an additional 23% of AD a
ttributable to the absence of an epsilon 2 allele. The opposite action
s of the epsilon 2 and epsilon 4 alleles further support the direct in
volvement of APOE in the pathogenesis of AD.