Alternative splicing in a presenilin 2 variant associated with Alzheimer disease

Objective Autosomal‐dominant familial Alzheimer disease ( AD ) is caused by by variants in presenilin 1 ( PSEN 1 ), presenilin 2 ( PSEN 2 ), and amyloid precursor protein ( APP ). Previously, we reported a rare PSEN 2 frameshift variant in an early‐onset AD case ( PSEN 2 p.K115Efs*11). In this study, we characterize a second family with the same variant and analyze cellular transcripts from both patient fibroblasts and brain lysates. Methods We combined genomic, neuropathological, clinical, and molecular techniques to characterize the PSEN 2 K115Efs*11 variant in two families. Results Neuropathological and clinical evaluation confirmed the AD diagnosis in two individuals carrying the PSEN 2 K115Efs*11 variant. A truncated transcript from the variant allele is detectable in patient fibroblasts while levels of wild‐type PSEN 2 transcript and protein are reduced compared to controls. Functional studies to assess biological consequences of the variant demonstrated that PSEN 2 K115Efs*11 fibroblasts secrete less A β 1–40 compared to controls, indicating abnormal γ ‐secretase activity. Analysis of PSEN 2 transcript levels in brain tissue revealed alternatively spliced PSEN 2 products in patient brain as well as in sporadic AD and age‐matched control brain. Interpretation These data suggest that PSEN 2 K115Efs*11 is a likely pathogenic variant associated with AD . We uncovered novel PSEN 2 alternative transcripts in addition to previously reported PSEN 2 splice isoforms associated with sporadic AD . In the context of a frameshift, these alternative transcripts return to the canonical reading frame with potential to generate deleterious protein products. Our findings suggest novel potential mechanisms by which PSEN variants may influence AD pathogenesis, highlighting the complexity underlying genetic contribution to disease risk.