Exploring the Genetic Underpinnings of DTI-ALPS: A Genome-Wide Correlation Study and Implications for Brain Health.

Background: Glymphatic system (GS) plays a central role in eliminating metabolic waste from human brain. Diffusion tensor image analysis along the perivascular space (ALPS) has emerged as a non-invasive biomarker for evaluating GS function. While decreased ALPS is consistently linked to impaired GS in various central nervous system (CNS) pathologies, the genetic architectures and neural mechanisms underlying ALPS and its role in maintaining brain health remain unknown.

Methods: A genome-wide association study (GWAS) of ALPS was conducted in 31,579 participants from the UK Biobank. Genetic associations were identified using positional, expression quantitative trait loci (eQTL), and chromatin mapping strategies. Gene set enrichment analysis and Mendelian randomization (MR) were performed to characterize biological pathways and causal relationships between ALPS, brain phenotypes, and neurological disorders.

Results: The GWAS identified 6 unique loci and 175 genes associated with ALPS. Gene enrichment analyses identified significant associations with brain morphogenesis, along with implications for and glymphatic system function and neurodegenerative pathways. Genetic and individual-level correlations linked ALPS to brain volume, cerebrospinal fluid-related imaging phenotypes, and cognitive metrics. MR demonstrated that genetically predicted lower ALPS increased the risk of multiple sclerosis and Alzheimer's disease.

Conclusions: This study elucidates the genetic architecture of ALPS, a biomarker reflecting GS function, and its association with brain health. The findings highlight decreased ALPS as a potential risk factor for neuroinflammatory and neurodegenerative disorders, emphasizing the importance of GS integrity in maintaining neurological health.