Domain mapping of disease mutations reveals pathogenic SORL1 variants in Alzheimer’s disease

Journal article

Background: Protein truncating variants (PTVs) in SORL1 are observed almost exclusively in Alzheimer’s Disease (AD) cases, but the effect of rare SORL1 missense variants is unclear. Methods: To identify high-priority missense variants (HPVs), we applied ‘domain mapping of disease mutations’ for the 637 unique coding SORL1 variants detected in 18,959 AD-cases and 21,893 non-demented controls. Results: In this sample, PTVs and HPVs associated with respectively a 35- and 10-fold increased risk of early onset AD and 17- and 6-fold increased risk of overall AD. The median age at onset (AAO) of PTV- and HPV-carriers was 62 and 64 years, and APOE-genotype contributed to AAO-variability. The median AAO of PTV- and HPV-carriers is ~8–10 years earlier than wild-type SORL1 carriers, matched for APOE-genotype. Specific HPVs are highly penetrant and lead to earlier AAOs than PTVs, suggesting possible dominant negative effects. Conclusion: Our results justify a debate on whether HPV carriers should be considered for clinical counseling.

Authors: Andersen, OM; de Waal, MWJ; Monti, G; Tesi, N; Jensen, AMG

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: Molecular Neurodegeneration
• Volume: 20
• Issue: 1
• Article number: 122
• Publication date: 2025-12-01
• Acceptance date: 2025-10-05
• DOI: 10.1186/s13024-025-00907-z
• EISSN: 1750-1326
• ISSN: 1750-1326
• Language: English
• Keywords: SORL1; Penetrance; Age at onset; SORLA; Genetics; Rare variants; Alzheimer’s disease; Disease risk; Alzforum mutation database; Domain-mapping disease-mutations