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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Bioinform.</journal-id>
<journal-title>Frontiers in Bioinformatics</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Bioinform.</abbrev-journal-title>
<issn pub-type="epub">2673-7647</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">1390607</article-id>
<article-id pub-id-type="doi">10.3389/fbinf.2024.1390607</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Bioinformatics</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>A comprehensive multi-omics analysis reveals unique signatures to predict Alzheimer&#x2019;s disease</article-title>
<alt-title alt-title-type="left-running-head">Vacher et al.</alt-title>
<alt-title alt-title-type="right-running-head">
<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fbinf.2024.1390607">10.3389/fbinf.2024.1390607</ext-link>
</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Vacher</surname>
<given-names>Michael</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2664465/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Canovas</surname>
<given-names>Rodrigo</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Laws</surname>
<given-names>Simon M.</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/195029/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/funding-acquisition/"/>
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<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Doecke</surname>
<given-names>James D.</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/418464/overview"/>
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</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>The Australian eHealth Research Centre</institution>, <institution>CSIRO Health and Biosecurity</institution>, <addr-line>Kensington</addr-line>, <addr-line>WA</addr-line>, <country>Australia</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Centre for Precision Health</institution>, <institution>Edith Cowan University</institution>, <addr-line>Joondalup</addr-line>, <addr-line>WA</addr-line>, <country>Australia</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>The Australian eHealth Research Centre</institution>, <institution>CSIRO Health and Biosecurity</institution>, <addr-line>Parkville</addr-line>, <addr-line>VIC</addr-line>, <country>Australia</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Collaborative Genomics and Translation Group</institution>, <institution>School of Medical and Health Sciences</institution>, <institution>Edith Cowan University</institution>, <addr-line>Joondalup</addr-line>, <addr-line>WA</addr-line>, <country>Australia</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>Curtin Medical School</institution>, <institution>Curtin University</institution>, <addr-line>Bentley</addr-line>, <addr-line>WA</addr-line>, <country>Australia</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>The Australian eHealth Research Centre</institution>, <institution>CSIRO Health and Biosecurity</institution>, <addr-line>Herston</addr-line>, <addr-line>QLD</addr-line>, <country>Australia</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/74339/overview">Dapeng Wang</ext-link>, Imperial College London, United Kingdom</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1200858/overview">Mark Kon</ext-link>, Boston University, United States</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2727955/overview">Ranjith Ramanathan</ext-link>, Oklahoma State University, United States</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Michael Vacher, <email>michael.vacher@csiro.au</email>
</corresp>
</author-notes>
<pub-date pub-type="epub">
<day>19</day>
<month>06</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>4</volume>
<elocation-id>1390607</elocation-id>
<history>
<date date-type="received">
<day>23</day>
<month>02</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>03</day>
<month>06</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2024 Vacher, Canovas, Laws and Doecke.</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Vacher, Canovas, Laws and Doecke</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Complex disorders, such as Alzheimer&#x2019;s disease (AD), result from the combined influence of multiple biological and environmental factors. The integration of high-throughput data from multiple omics platforms can provide system overviews, improving our understanding of complex biological processes underlying human disease. In this study, integrated data from four omics platforms were used to characterise biological signatures of AD.</p>
</sec>
<sec>
<title>Method</title>
<p>The study cohort consists of 455 participants (Control:148, Cases:307) from the Religious Orders Study and Memory and Aging Project (ROSMAP). Genotype (SNP), methylation (CpG), RNA and proteomics data were collected, quality-controlled and pre-processed (SNP &#x3d; 130; CpG &#x3d; 83; RNA &#x3d; 91; Proteomics &#x3d; 119). Using a diagnosis of Mild Cognitive Impairment (MCI)/AD combined as the target phenotype, we first used Partial Least Squares Regression as an unsupervised classification framework to assess the prediction capabilities for each omics dataset individually. We then used a variation of the sparse generalized canonical correlation analysis (sGCCA) to assess predictions of the combined datasets and identify multi-omics signatures characterising each group of participants.</p>
</sec>
<sec>
<title>Results</title>
<p>Analysing datasets individually we found methylation data provided the best predictions with an accuracy of 0.63 (95%CI &#x3d; [0.54&#x2013;0.71]), followed by RNA, 0.61 (95%CI &#x3d; [0.52&#x2013;0.69]), SNP, 0.59 (95%CI &#x3d; [0.51&#x2013;0.68]) and proteomics, 0.58 (95%CI &#x3d; [0.51&#x2013;0.67]). After integration of the four datasets, predictions were dramatically improved with a resulting accuracy of 0.95 (95% CI &#x3d; [0.89&#x2013;0.98]).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The integration of data from multiple platforms is a powerful approach to explore biological systems and better characterise the biological signatures of AD. The results suggest that integrative methods can identify biomarker panels with improved predictive performance compared to individual platforms alone. Further validation in independent cohorts is required to validate and refine the results presented in this study.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Alzheimer disease</kwd>
<kwd>systems biology</kwd>
<kwd>multi omics analysis</kwd>
<kwd>biomarkers prediction</kwd>
<kwd>bioinformatics</kwd>
</kwd-group>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Integrative Bioinformatics</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>Alzheimer&#x2019;s disease (AD) is a complex neurodegenerative disorder, clinically characterized by progressive cognitive decline, memory loss, and impairment in daily functioning. It is the most common cause of dementia worldwide, affecting millions of individuals and posing a significant burden on healthcare systems and society (<xref ref-type="bibr" rid="B6">Brookmeyer et al., 2007</xref>; <xref ref-type="bibr" rid="B19">Nichols et al., 2022</xref>). The aetiology of AD is multifactorial, involving a combination of genetic, environmental, and epigenetic factors (<xref ref-type="bibr" rid="B5">Breijyeh and Karaman, 2020</xref>). Currently, AD diagnosis involves a combination of medical history, physical examinations, neuropsychological tests, and cerebrospinal fluid analysis in some cases. Imaging serves as a supportive tool and helps rule out other causes of cognitive impairment. However, a comprehensive evaluation by a professional is essential for an accurate diagnosis (<xref ref-type="bibr" rid="B23">Rodrigue, 2013</xref>; <xref ref-type="bibr" rid="B9">DeTure and Dickson, 2019</xref>; <xref ref-type="bibr" rid="B21">Porsteinsson et al., 2021</xref>). Given these diagnostic challenges, understanding the underlying biological processes and identifying reliable biomarkers for early detection and accurate diagnosis are crucial for developing effective therapeutic strategies and interventions.</p>
<p>In recent years, the continuous advancements in high-throughput technologies have provided unprecedented opportunities to explore complex disorders at the molecular level. These technological improvements have not only increased the diversity of omics platforms available but also their resolution. While the analysis of single omics platform provides a unique perspective, capturing specific molecular changes associated with a trait of interest, this approach also limits our understanding of the complete molecular landscape underlying complex pathogenesis.</p>
<p>To address this limitation, there has been a growing interest in the integration of data across multiple omics platforms (i.e., &#x201c;multi-omics&#x201d;), to comprehensively explore the interactions and alterations occurring at multiple biological levels. Multi-omics integrations aim to capture a broader view of biological systems and therefore holds great promise in unravelling the complex molecular interplay across biological domains (<xref ref-type="bibr" rid="B13">Ivanisevic and Sewduth, 2023</xref>). This knowledge is essential to enhance our understanding of the underlying mechanisms driving complex disorders such as AD and facilitate the development of personalised and targeted therapies.</p>
<p>In this study, we present an integrated analysis of four omics platforms, including single nucleotide polymorphism (SNP), methylation (CpG), transcriptomic (RNA), and proteomics data, to characterise the biological signatures of AD. Leveraging a well-characterised cohort from the Religious Orders Study and Memory and Aging Project (ROSMAP) (<xref ref-type="bibr" rid="B2">Bennett et al., 2012Bennett et al., 2012</xref>), consisting of individuals categorized as no cognitive impairment (NCI), mild cognitive impairment (MCI), and AD patients, we employed integrative approaches to predict the disease status based on each omics dataset individually. Subsequently, we utilized a variation of the generalized canonical correlation analysis (sGCCA) (<xref ref-type="bibr" rid="B15">Kettenring, 1971</xref>; <xref ref-type="bibr" rid="B26">Tenenhaus et al., 2014</xref>)to integrate the four datasets and identify multi-omics signatures specifically associated with AD participants.</p>
</sec>
<sec sec-type="materials|methods" id="s2">
<title>Materials and methods</title>
<sec id="s2-1">
<title>Participants and clinical characterisation</title>
<p>Data used in the preparation of this article were obtained from the Religious Orders Study and Memory and Aging Project (ROSMAP) (<xref ref-type="bibr" rid="B2">Bennett et al., 2012</xref>). The synapse portal (<ext-link ext-link-type="uri" xlink:href="https://adknowledgeportal.synapse.org/">https://adknowledgeportal.synapse.org/</ext-link>) offers comprehensive list of data, we used four different datasets from this resource, including: proteomics (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn10468856">https://doi.org/10.7303/syn10468856</ext-link>), epigenetics (DNA methylation array, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn3157275">https://doi.org/10.7303/syn3157275</ext-link>), genomic variants (SNP Array, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn3157325">https://doi.org/10.7303/syn3157325</ext-link>) and gene expression (RNAseq from bulk brain, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn3388564">https://doi.org/10.7303/syn3388564</ext-link>). These four datasets were selected as they provided the largest number of overlapping samples (N &#x3d; 455). Participants were divided into two groups, based on their clinical characterisation at death, generating a case/control binary outcome. Specifically, participants were considered &#x201c;<italic>cases</italic>&#x201d; when the most likely clinical diagnosis at the time of death was AD or MCI (Mild Cognitive Impairment) and &#x201c;<italic>control</italic>&#x201d; when diagnosed as NCI (No Cognitive Impairment). The participants&#x2019; data include phenotypic information relevant to AD, such as the Braak stage, which classifies AD progression based on neurofibrillary tangle pathology throughout the brain (<xref ref-type="bibr" rid="B4">Braak and Braak, 1991</xref>; <xref ref-type="bibr" rid="B3">Braak et al., 2006</xref>) and the Consortium to Establish a Registry for Alzheimer&#x2019;s Disease (CERAD) score, a standardized method for assessing the severity of neuritic plaques (<xref ref-type="bibr" rid="B10">Fillenbaum et al., 2008</xref>). Detailed demographics are summarised in <xref ref-type="table" rid="T1">Table 1</xref>.</p>
<table-wrap id="T1" position="float">
<label>TABLE 1</label>
<caption>
<p>Population demographics.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left"/>
<th align="center">Control (N &#x3d; 148)</th>
<th align="center">Case (N &#x3d; 307)</th>
<th align="center">
<italic>p</italic>-value</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td colspan="4" align="left">Sex</td>
</tr>
<tr>
<td align="left">&#x2003;Female</td>
<td align="left">85 (57.4%)</td>
<td align="left">202 (65.8%)</td>
<td rowspan="2" align="center">0.0971</td>
</tr>
<tr>
<td align="left">&#x2003;Male</td>
<td align="left">63 (42.6%)</td>
<td align="left">105 (34.2%)</td>
</tr>
<tr>
<td colspan="4" align="left">Age (years)</td>
</tr>
<tr>
<td align="left">&#x2003;Mean (SD)</td>
<td align="left">82.9 (4.79)</td>
<td align="left">85.4 (4.28)</td>
<td rowspan="2" align="center">&#x3c;0.001</td>
</tr>
<tr>
<td align="left">&#x2003;Median [Min, Max]</td>
<td align="left">84.2 [67.4, 89.7]</td>
<td align="left">86.7 [70.3, 90.0]</td>
</tr>
<tr>
<td colspan="4" align="left">Education (years)</td>
</tr>
<tr>
<td align="left">&#x2003;Mean (SD)</td>
<td align="left">16.4 (3.39)</td>
<td align="left">16.4 (3.47)</td>
<td rowspan="2" align="center">0.973</td>
</tr>
<tr>
<td align="left">&#x2003;Median [Min, Max]</td>
<td align="left">16.0 [10.0, 25.0]</td>
<td align="left">16.0 [5.00, 28.0]</td>
</tr>
<tr>
<td colspan="4" align="left">
<italic>APOE</italic> &#x3b5;4</td>
</tr>
<tr>
<td align="left">&#x2003;Absent</td>
<td align="left">126 (85.1%)</td>
<td align="left">217 (70.7%)</td>
<td rowspan="2" align="center">&#x3c;0.001</td>
</tr>
<tr>
<td align="left">&#x2003;Present</td>
<td align="left">22 (14.9%)</td>
<td align="left">90 (29.3%)</td>
</tr>
<tr>
<td colspan="4" align="left">Braak stage</td>
</tr>
<tr>
<td align="left">&#x2003;I</td>
<td align="left">6 (4.1%)</td>
<td align="left">1 (0.3%)</td>
<td rowspan="6" align="center">&#x3c;0.001</td>
</tr>
<tr>
<td align="left">&#x2003;II</td>
<td align="left">25 (16.9%)</td>
<td align="left">11 (3.6%)</td>
</tr>
<tr>
<td align="left">&#x2003;III</td>
<td align="left">17 (11.5%)</td>
<td align="left">24 (7.8%)</td>
</tr>
<tr>
<td align="left">&#x2003;IV</td>
<td align="left">54 (36.5%)</td>
<td align="left">85 (27.7%)</td>
</tr>
<tr>
<td align="left">&#x2003;V</td>
<td align="left">41 (27.7%)</td>
<td align="left">97 (31.6%)</td>
</tr>
<tr>
<td align="left">&#x2003;VI</td>
<td align="left">5 (3.4%)</td>
<td align="left">83 (27.0%)</td>
</tr>
<tr>
<td colspan="4" align="left">CERAD</td>
</tr>
<tr>
<td align="left">&#x2003;positive</td>
<td align="left">60 (40.5%)</td>
<td align="left">220 (71.7%)</td>
<td rowspan="2" align="center">&#x3c;0.001</td>
</tr>
<tr>
<td align="left">&#x2003;negative</td>
<td align="left">88 (59.5%)</td>
<td align="left">87 (28.3%)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<italic>p</italic> values determined by <italic>t</italic>-test for continuous variable or Chi square for categorical variables. N number, HC, healthy control; MCI, mild cognitive impairment; AD, Alzheimer&#x2019;s disease, <italic>APOE</italic> &#x3b5;4 apolipoprotein &#x3b5;4 allele, CERAD, Consortium to Establish a Registry for Alzheimer&#x2019;s Disease.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="s2-2">
<title>Data preparation and feature reduction</title>
<p>The analyses were restricted to samples present in all four datasets investigated. Each dataset was therefore limited to these samples and was further prepared as follows.</p>
<sec id="s2-2-1">
<title>RNAseq</title>
<p>Samples were extracted using Qiagen&#x2019;s miRNeasy mini kit and the RNase free DNase Set. They were quantified by Nanodrop and quality was evaluated by Agilent Bioanalyzer. The initial dataset consisted of 642 samples and 55,889 transcripts, stored as raw FPKM (Fragments Per Kilobase of transcript per Million mapped reads) values. After removing non-overlapping samples, we discarded lowly expressed transcripts based on the threshold of geometric mean of (FPKM &#x2b; 0.1) &#x3c; 1. FPKM values were then transformed to log2 scale. To further reduce the number of features, we built an elastic net regression model using the case/control phenotype as target variable. The initial data was separated into two subsets (training set &#x3d; 70% [N &#x3d; 318], test set &#x3d; 30% [N &#x3d; 137]) and the model&#x2019;s training was performed using 10-fold cross-validation and averaged the obtained classification error rate across 50 repetitions to identify the optimal parameters (lambda). The trained model was then used to identify and remove transcripts not contributing to the phenotype&#x2019;s prediction (zero coefficient). The final data consisted of 455 samples and 91 transcripts.</p>
</sec>
<sec id="s2-2-2">
<title>Proteomics</title>
<p>Proteomics assay was performed using frozen tissue from dorsolateral prefrontal cortex (DLPFC) on a nano ACQUITY UPLC coupled to TSQ Vantage MS instrument. Samples were prepared using standard protocol described in the original publications (<xref ref-type="bibr" rid="B20">Petyuk et al., 2010</xref>; <xref ref-type="bibr" rid="B1">Andreev et al., 2012</xref>). The initial dataset contained 1,191 samples and 121 proteins. Control probes and samples were removed, resulting in a final set consisting of 455 samples and 119 proteins.</p>
</sec>
<sec id="s2-2-3">
<title>SNP</title>
<p>Two batches of genotype data are available in ROS and MAP studies. The first batch was generated using the Affymetrix GeneChip 6.0 (Affymetrix, Inc., Santa Clara, CA, United States) and contained 1,709 individuals. The second batch used the Illumina HumanOmniExpress (Illumina, Inc., San Diego, CA, United States) on 382 samples. Both batches underwent the same quality control (QC) analysis, as described in (<xref ref-type="bibr" rid="B7">De Jager et al., 2012</xref>). After non-overlapping samples were removed the two sets were merged and the quality controlled. The QC assessment included exclusion of samples with genotype success rate &#x3c;95%, discordance between inferred and reported gender, and excess inter/intra heterozygosity. SNP-level quality control assessment included exclusion of SNPs with Hardy-Weighberg equilibrium (<italic>p</italic> &#x3c; 0.001), MAF &#x3c;0.01, genotype call rate &#x3c;0.95, misshap test &#x3c; 1 &#xd7; 10<sup>&#x2212;9</sup>. Population outliers were identified and removed using Eigenstrat (<xref ref-type="bibr" rid="B22">Price et al., 2006</xref>) with default parameters.</p>
<p>To further reduce the number of SNP, we employed logistic regression models using the case/control status as a binary outcome. Models&#x2019; covariates included education (years), the presence/absence of the <italic>APOE</italic> &#x3b5;4 allele (binary) and the first 3 principal components of a principal component analysis (PCA), to control for potential population structure. Results from the logistic regressions were adjusted for multiple testing using the Benjamin-Hochberg method. SNP with <italic>p</italic>-values below 0.05 were considered significant and selected for the downstream analyses. The final data included 455 samples and 145 SNPs.</p>
</sec>
<sec id="s2-2-4">
<title>Methylation</title>
<p>The initial data contained 741 samples (prefrontal cortex) and 420,132 cpgs, collected using the Illumina HumanMethylation450 BeadChip. Data generation method was described in (<xref ref-type="bibr" rid="B8">De Jager et al., 2014</xref>). To reduce the number of features prior to integration, the same method as for the RNAseq data was used. The dataset was split into two subsets (training set &#x3d; 70% [N &#x3d; 318], test set &#x3d; 30% [N &#x3d; 137]) and used to train an elastic net regression model. Training phase used 10-fold cross-validation and averaged the obtained classification error rate across 50 repetitions to identify the optimal parameters (lambda). The trained model was used to identify and remove probes not contributing to the phenotype&#x2019;s prediction (zero coefficient). The final data consisted of 455 samples and 91 CpGs.</p>
</sec>
</sec>
<sec id="s2-3">
<title>General analytical pipeline</title>
<p>To facilitate comparisons, the same analytical pipeline was used to assess the predictive capabilities of each individual omics dataset and the integrated dataset. First, participants were randomly divided in two groups (training set &#x3d; 70% [N &#x3d; 318], test set &#x3d; 30% [N &#x3d; 137]). An initial model was then built and tuned using the training data only. Two different models were used depending on the type of the dataset (single omics or integrated), as detailed in the following section. In the context of this study, the tuning phases allowed the identification of the optimal number of components as well as the optimal number of features to select in each of these components. These parameters were considered optimal when they provided the smallest Balanced Error Rate (BER). Tuning phases were performed using a 10-fold, 50 repeats procedure, to limit the impact of the randomly allocated folds at each repetition. The models were then trained on the training data only. Finally, the trained models were used to perform predictions on the <italic>test</italic> set (unseen data) and performance metrics were calculated from the resulting confusion matrices.</p>
</sec>
<sec id="s2-4">
<title>Predictions from individual platforms</title>
<p>To perform predictions on individual omics datasets, we used sparse partial least square discriminant analysis (sPLS-DA) (<xref ref-type="bibr" rid="B16">L&#xea; Cao et al., 2011</xref>), as implemented in the mixOmics R package (<xref ref-type="bibr" rid="B24">Rohart et al., 2017</xref>). sPLS-DA is an extension of the traditional PLS approach, combining variable selection and classification in a one-step procedure. We used this method as a classification framework to predict case/control status of samples. The predictions generated from individual datasets were only used for comparison purposes with the multi-omics model.</p>
</sec>
<sec id="s2-5">
<title>Prediction from integrated data</title>
<p>To perform predictions on the integrated datasets, we used the DIABLO framework. The implementation of the method is further detailed in (<xref ref-type="bibr" rid="B25">Singh et al., 2019</xref>). Briefly, DIABLO provides a classification framework based on sparse generalized canonical correlation analysis (sGCCA) (<xref ref-type="bibr" rid="B26">Tenenhaus et al., 2014</xref>), a multivariate dimension reduction technique that uses singular value decomposition to identify correlated variables amongst several datasets. More specifically, the method seeks linear combinations of variables (latent components) from each dataset, that are maximally correlated. This method offers the possibility to specify a design matrix, describing how the datasets should be connected (i.e.,: correlation between datasets). In this study, we used a design matrix of 0.1 to maximise the discovery of novel signatures between the datasets.</p>
</sec>
</sec>
<sec sec-type="results" id="s3">
<title>Results</title>
<p>The study cohort consisted of 455 individuals (148 controls, 307 cases); detailed demographic characteristics were reported in <xref ref-type="table" rid="T1">Table 1</xref>. Gender was relatively well-balanced between the two groups, with a slightly larger proportion of females classified as cases (65.8%) compared to the control group (57.4%). As expected, the participants in the case group were significantly older (85.4 &#xb1; 4.28 years) than those classified as controls (82.8 &#xb1; 4.79 years, <italic>p</italic> &#x3d; 2.02e<sup>&#x2212;5</sup>), exhibited more advanced Braak stages (<italic>p &#x3d;</italic> 4.9e<sup>&#x2212;4</sup>) (<xref ref-type="bibr" rid="B4">Braak and Braak, 1991</xref>) and had a higher probability of neuritic plaques accumulation, as reflected by their higher CERAD score (<italic>p</italic> &#x3d; 2.44e<sup>&#x2212;10</sup>) (<xref ref-type="bibr" rid="B10">Fillenbaum et al., 2008</xref>). In addition, there were more carriers of at least one copy of the <italic>APOE</italic> &#x3b5;4 allele in cases compared to the control group (<italic>p</italic> &#x3d; 8.94e<sup>&#x2212;4</sup>).</p>
<sec id="s3-3">
<title>The integrated dataset provided better predictions than the individual platforms</title>
<p>Comparing predictive capabilities (i.e.,: ability to correctly classify samples) between models built from individual datasets, we found that the SNP data provided the best <italic>balanced accuracy</italic> (73%), followed by the RNA data (70%). Predictions made from the methylation dataset alone, yielded a balanced accuracy of 68% and the model built with the proteomics data resulted in a 55% balanced accuracy. Overall, the integrated model provided the best predictive capabilities, showing better performance across all the metrics evaluated and resulting in a balanced accuracy of 90%, <xref ref-type="table" rid="T2">Table 2</xref>. Despite the higher prevalence of cases in the sample set (68%), the integrated model demonstrated a high sensitivity of 0.96, indicating its proficiency in correctly identifying <italic>cases</italic>. Specificity was measured at 0.83, supporting the model&#x2019;s ability to correctly distinguish controls.</p>
<table-wrap id="T2" position="float">
<label>TABLE 2</label>
<caption>
<p>Model performance.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left">Performance metric</th>
<th align="center">SNP</th>
<th align="center">RNA</th>
<th align="center">Proteomics</th>
<th align="center">CpGs</th>
<th align="center">Multi-omics</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Sensitivity</td>
<td align="right">0.76</td>
<td align="right">0.69</td>
<td align="right">0.58</td>
<td align="right">0.73</td>
<td align="right">0.96</td>
</tr>
<tr>
<td align="left">Specificity</td>
<td align="right">0.7</td>
<td align="right">0.7</td>
<td align="right">0.52</td>
<td align="right">0.64</td>
<td align="right">0.83</td>
</tr>
<tr>
<td align="left">Precision</td>
<td align="right">0.85</td>
<td align="right">0.83</td>
<td align="right">0.72</td>
<td align="right">0.81</td>
<td align="right">0.94</td>
</tr>
<tr>
<td align="left">Recall</td>
<td align="right">0.76</td>
<td align="right">0.69</td>
<td align="right">0.58</td>
<td align="right">0.73</td>
<td align="right">0.96</td>
</tr>
<tr>
<td align="left">F1</td>
<td align="right">0.8</td>
<td align="right">0.75</td>
<td align="right">0.64</td>
<td align="right">0.77</td>
<td align="right">0.95</td>
</tr>
<tr>
<td align="left">Accurary</td>
<td align="right">0.59</td>
<td align="right">0.61</td>
<td align="right">0.58</td>
<td align="right">0.63</td>
<td align="right">0.95</td>
</tr>
<tr>
<td align="left">Balanced Accuracy</td>
<td align="right">0.73</td>
<td align="right">0.7</td>
<td align="right">0.55</td>
<td align="right">0.68</td>
<td align="right">0.9</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>The table above shows the performance of the single-omics models (SNP, RNA, proteomics, CpGs) and the multi-omics models. The performance metrics of each model were calculated from the corresponding confusion matrices.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="s3-1">
<title>Top individual contributors of discrimination</title>
<p>The tuning phase of the multi-omics model allowed the identification of the optimal number of features to predict the case group. This corresponded to the set of features producing the best discrimination performance between cases and controls. The optimal feature panel of the integrated model consisted of 62 features, distributed as follows: 5 SNPs, 20 RNA transcripts, 20 CpGs and 17 peptides. The selected features&#x2019; contributions, as reflected by their loading weights, are shown in <xref ref-type="fig" rid="F1">Figure 1</xref> and further detailed in <xref ref-type="sec" rid="s12">Supplementary Table S1</xref>. The most important features identified to separate cases and controls were the <italic>Tau (12e8)</italic> [<italic>MAPT</italic>] peptide, <italic>ENSG00000111181</italic> [<italic>SLC6A12</italic>] transcript, <italic>cg25942596</italic> CpG probe, the rs2903011 variant, the cg06965373 methylation probe, <italic>Tau</italic> [<italic>PHF1</italic>] peptide, <italic>ENSG00000260456</italic> transcript and the <italic>rs1928955</italic> SNP.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Loading plots showing the features&#x2019; weight for the first 2 latent components of multi-omics model. The weights indicate the contribution of each feature to the corresponding latent component, reflecting their importance in the discriminatory process of separating case and control samples. The color of the bars indicates whether a feature is over-represented or expressed in a specific phenotype (case or control).</p>
</caption>
<graphic xlink:href="fbinf-04-1390607-g001.tif"/>
</fig>
</sec>
<sec id="s3-2">
<title>Correlated features across the different datasets</title>
<p>Looking at cross-correlations between omics datasets, we found that the strongest correlations occurred between the <italic>Tau (12e8)</italic> peptide and three RNA transcripts, <italic>ENSG00000111181</italic> [<italic>SLC6A12</italic>] (r &#x3d; 0.69), <italic>ENSG00000107623</italic> [<italic>GDF10</italic>] (r &#x3d; &#x2212;0.58) and <italic>ENSG00000173588</italic> [<italic>CCDC41</italic>] (r &#x3d; &#x2212;0.57). Counting the number of correlated features in each dataset, we found that the proteomics and RNA datasets were the most highly correlated datasets with 66 and 52 correlated features (absolute Pearson correlation&#x2265;0.5), respectively. At the feature level, the three most correlated variables were the <italic>ELMO1</italic> peptide, ENSG00000166863 [TAC3] RNA transcript and the <italic>Tau (12e8)</italic> peptide, with a total of 14, 10 and 9 correlations (abs(r)&#x2265;0.5), respectively. The heatmap presented in <xref ref-type="fig" rid="F2">Figure 2</xref> depicts the relationships between variables, within and across the four omics datasets.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>Correlation heatmap. The values shown approximate the Pearson correlation coefficients, calculated as the sum of the correlations between the original variables and each latent component in the sPLS-DA model. These values indicate how features relate to each other, reflecting their potential interactions. To facilitate the visualization of intra- and inter-omics correlations, the heatmap is divided into four panels, both vertically and horizontally, representing the four types of omics data integrated in the model. Only features with at least one correlation with an absolute coefficient above 0.5 are displayed. The bar plot at the top shows the number of these correlations for each feature, indicating their level of connectivity with other features.</p>
</caption>
<graphic xlink:href="fbinf-04-1390607-g002.tif"/>
</fig>
</sec>
</sec>
<sec sec-type="discussion" id="s4">
<title>Discussion</title>
<p>Continuous technological improvements along with the development of large initiatives such as the ROS and MAP cohorts have dramatically increased the availability of multi-omics data. In this study we used a well-establish framework, DIABLO (<xref ref-type="bibr" rid="B25">Singh et al., 2019</xref>), to integrate multiple omics datasets and identify molecular signatures specific to AD cases and healthy control.</p>
<p>This framework uses a multivariate dimension reduction technique (Singular Value Decomposition) to maximise the correlated information between omics datasets. As such, it can be used to fulfill two functions: 1) as a discovery framework, to identify relevant biomarkers associated with a specific phenotype and 2) as a predictive framework. Therefore, this type of integrative approach can help achieve a more comprehensive understanding of molecular changes contributing to disease development as well as guide the development of predictive models. In the case of AD, clinical diagnosis is commonly derived from formal neuropsychiatric assessments to evaluate cognition, and a definite diagnosis can only be made post-mortem, with an autopsy revealing the presence of tau tangles and amyloid plaques. Therefore, non-invasive predictive models offer the promise of vastly improving disease detection by providing earlier intervention opportunities.</p>
<p>The results in this study demonstrated that we could extract multi-omics signatures to separate cases (MCI/AD) from controls (NCI). The signatures included features across the four types of omics data investigated, highlighting the tight inter-relationships and possible interactions existing between the biological layers. Amongst the major contributors in predictions, we could retrieve biomarkers known to be involved in key neurodevelopmental processes such as Tau related peptides, transcripts related to solute carrier (<italic>SLC6A12</italic>) and Growth and Differentiation Factor 10 (<italic>GDF10</italic>). The <italic>SLC6A12</italic> gene, for example, is a neurotransmitter transporter which has recently been screened as a hub gene, showing high expression in AD patients (<xref ref-type="bibr" rid="B28">Zou et al., 2023</xref>) studies have shown <italic>GDF10</italic> had an important role in supporting neuronal survival (<xref ref-type="bibr" rid="B18">Li et al., 2010</xref>) and reducing neuroinflammation (<xref ref-type="bibr" rid="B17">Li et al., 2015</xref>).</p>
<p>While supporting evidence exist for some of the main features identified, a number of key contributors identified correspond to biomarkers with unknown functions. Interestingly, most of these uncharacterised features were identified from the integrated dataset but were not detected when looking at individual omics, suggesting a synergistic role across the biological layers. Their limited effect, in isolation, could also explain the lack of annotation associated with these features.</p>
<p>The framework used in this study can allow for both discovery and classification/prediction; however, it is important to note that a compromise needs to be achieved between these two tasks. As further elaborated in <xref ref-type="bibr" rid="B25">Singh et al. (2019)</xref>, the weightings defined in the design matrix plays an important role in the model&#x2019;s abilities and functions. In the context of this study, we opted for a design with small weights (0.1), in order to maximise classification accuracy. This design resulted in models with highly predictive signatures but with a limited ability to extract the correlation structure from the datasets. A design matrix with larger weight values could facilitate further exploration of the interactions and relationships among the datasets, providing a more global perspective of the system and help reveal the complex mechanisms at play.</p>
<p>While the presented study provides valuable insights is essential to acknowledge its limitations. Each omic dataset was individually pre-processed and subject to a preliminary feature selection, in order to maintain a reasonable computational runtime for the integrated model. Although this approach effectively prevented the introduction of non-informative features in the model, it may, however, introduce biases and potentially limit the discovery of multi-omics signatures, especially those with a purely synergetic role.</p>
<p>Moreover, the model considered only features from the four datasets presented and did not account for the potential effects of other covariates. Incorporating additional metadata, for example, &#x2018;age,&#x2019; which is a major risk factor for AD (<xref ref-type="bibr" rid="B11">Guerreiro and Bras, 2015</xref>; <xref ref-type="bibr" rid="B12">Hou et al., 2019</xref>), or imaging data could significantly enhance the model&#x2019;s predictive power. Incorporating imaging data could be particularly beneficial, as it can provide valuable insights into structural and functional brain changes associated with AD and is a central tool for accurate diagnosis (<xref ref-type="bibr" rid="B14">Johnson et al., 2012</xref>; <xref ref-type="bibr" rid="B27">van Oostveen and de Lange, 2021</xref>). Future research could explore the incorporation of extra covariates by creating a synthetic dataset as an additional omics layer within the framework. While this endeavour was beyond the scope of the current study, it represents a promising avenue for further investigation. Finally, the relationships between the different biological layers could be further refined. The connectivity and directionality of the underlying biological networks are extremely complex and dynamic. While the use of an arbitrary design matrix to model these interactions can provide useful insights, as demonstrated in this study, novel solutions are needed to better consider the relationships between the integrated biological data.</p>
<p>The study demonstrates the effectiveness of integrating multiple data sources to identify robust biomarker panels and facilitate the molecular diagnostic of a complex disease such as AD. Moreover, the results presented in this study provide valuable insights on key biological pathways in AD pathogenesis, which could help identifying potential therapeutic targets. Further validations in independent cohorts are necessary to confirm the robustness and generalisability of the identified signatures. The implications of this research extend beyond AD, as the integration of multi-omics data can be applied to other complex disorders, contributing to the advancement of precision medicine and personalised approaches to disease management.</p>
</sec>
<sec sec-type="conclusion" id="s5">
<title>Conclusion</title>
<p>The availability of high-dimensional multi-omics data has offered unprecedented resources for predictive studies. Although there are still significant contributions to be made before omics-based diagnoses becomes utilised in a clinical practice, this work demonstrates the effectiveness of integrating multiple omics for predictive purposes, compared to relying on a single source of data. The highly predictive molecular signatures identified can help improve our understanding of the key molecular mechanisms driving disease development.</p>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="s6">
<title>Data availability statement</title>
<p>Publicly available datasets were analyzed in this study. This data can be found here: <ext-link ext-link-type="uri" xlink:href="https://adknowledgeportal.synapse.org/">https://adknowledgeportal.synapse.org/</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn10468856">https://doi.org/10.7303/syn10468856</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn3157275">https://doi.org/10.7303/syn3157275</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn3157325">https://doi.org/10.7303/syn3157325</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.7303/syn3388564">https://doi.org/10.7303/syn3388564</ext-link>.</p>
</sec>
<sec id="s7">
<title>Ethics statement</title>
<p>The studies involving humans were approved by the Data from ROSMAP were obtained under data use agreement with Rush University Medical Center (RUMC). ROS and MAP were approved by an Institutional Review Board of RUMC. All participants gave written informed consent, signed an Anatomic Gift Act, and signed a repository consent allowing their data to be shared. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants&#x2019; legal guardians/next of kin in accordance with the national legislation and institutional requirements.</p>
</sec>
<sec id="s8">
<title>Author contributions</title>
<p>MV: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Writing&#x2013;original draft, Writing&#x2013;review and editing. RC: Data curation, Writing&#x2013;original draft, Writing&#x2013;review and editing. SL: Funding acquisition, Writing&#x2013;original draft, Writing&#x2013;review and editing. JD: Data curation, Funding acquisition, Writing&#x2013;original draft, Writing&#x2013;review and editing.</p>
</sec>
<sec sec-type="funding-information" id="s9">
<title>Funding</title>
<p>The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Data collection was supported through funding by NIA grants P30AG10161 (ROS), R01AG15819 (ROSMAP; genomics and RNAseq), R01AG17917 (MAP), R01AG30146, R01AG36042 (5hC methylation), R01AG36836 (RNAseq), U01AG46161(proteomics), the Illinois Department of Public Health (ROSMAP), and the Translational Genomics Research Institute (genomic).</p>
</sec>
<ack>
<p>The results published here are in whole or in part based on data obtained from the AD Knowledge Portal (<ext-link ext-link-type="uri" xlink:href="https://adknowledgeportal.org">https://adknowledgeportal.org</ext-link>). Study data were provided by the Rush Alzheimer&#x2019;s Disease Center, Rush University Medical Center, Chicago. Additional phenotypic data can be requested at <ext-link ext-link-type="uri" xlink:href="http://www.radc.rush.edu">www.radc.rush.edu</ext-link>. Genotype data: <ext-link ext-link-type="uri" xlink:href="http://doi:10.1038/mp.2017.20">doi:10.1038/mp.2017.20</ext-link>. DNA methylation: <ext-link ext-link-type="uri" xlink:href="http://doi:10.1038/nn.3786">doi:10.1038/nn.3786</ext-link>. RNAseq: <ext-link ext-link-type="uri" xlink:href="http://doi:10.1038/s41593-018-0154-9">doi:10.1038/s41593-018-0154-9</ext-link>.</p>
</ack>
<sec sec-type="COI-statement" id="s10">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s11">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s12">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fbinf.2024.1390607/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fbinf.2024.1390607/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="Table1.XLSX" id="SM1" mimetype="application/XLSX" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Andreev</surname>
<given-names>V. P.</given-names>
</name>
<name>
<surname>Petyuk</surname>
<given-names>V. A.</given-names>
</name>
<name>
<surname>Brewer</surname>
<given-names>H. M.</given-names>
</name>
<name>
<surname>Karpievitch</surname>
<given-names>Y. V.</given-names>
</name>
<name>
<surname>Xie</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Clarke</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2012</year>). <article-title>Label-free quantitative LC&#x2013;MS proteomics of Alzheimer&#x2019;s disease and normally aged human brains</article-title>. <source>J. Proteome Res.</source> <volume>11</volume>, <fpage>3053</fpage>&#x2013;<lpage>3067</lpage>. <pub-id pub-id-type="doi">10.1021/pr3001546</pub-id>
</citation>
</ref>
<ref id="B2">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bennett</surname>
<given-names>D. A.</given-names>
</name>
<name>
<surname>Schneider</surname>
<given-names>J. A.</given-names>
</name>
<name>
<surname>Arvanitakis</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Wilson</surname>
<given-names>R. S.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Overview and findings from the religious orders study</article-title>. <source>Curr. Alzheimer Res.</source> <volume>9</volume>, <fpage>628</fpage>&#x2013;<lpage>645</lpage>. <pub-id pub-id-type="doi">10.2174/156720512801322573</pub-id>
</citation>
</ref>
<ref id="B3">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Braak</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Alafuzoff</surname>
<given-names>I.</given-names>
</name>
<name>
<surname>Arzberger</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Kretzschmar</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Del Tredici</surname>
<given-names>K.</given-names>
</name>
</person-group> (<year>2006</year>). <article-title>Staging of Alzheimer disease-associated neurofibrillary pathology using paraffin sections and immunocytochemistry</article-title>. <source>Acta Neuropathol. Berl.</source> <volume>112</volume>, <fpage>389</fpage>&#x2013;<lpage>404</lpage>. <pub-id pub-id-type="doi">10.1007/s00401-006-0127-z</pub-id>
</citation>
</ref>
<ref id="B4">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Braak</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Braak</surname>
<given-names>E.</given-names>
</name>
</person-group> (<year>1991</year>). <article-title>Neuropathological stageing of Alzheimer-related changes</article-title>. <source>Acta Neuropathol. Berl.</source> <volume>82</volume>, <fpage>239</fpage>&#x2013;<lpage>259</lpage>. <pub-id pub-id-type="doi">10.1007/bf00308809</pub-id>
</citation>
</ref>
<ref id="B5">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Breijyeh</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Karaman</surname>
<given-names>R.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Comprehensive review on Alzheimer&#x2019;s disease: causes and treatment</article-title>. <source>Molecules</source> <volume>25</volume>, <fpage>5789</fpage>. <pub-id pub-id-type="doi">10.3390/molecules25245789</pub-id>
</citation>
</ref>
<ref id="B6">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brookmeyer</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Johnson</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Ziegler-Graham</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Arrighi</surname>
<given-names>H. M.</given-names>
</name>
</person-group> (<year>2007</year>). <article-title>Forecasting the global burden of Alzheimer&#x2019;s disease</article-title>. <source>Alzheimers Dement.</source> <volume>3</volume>, <fpage>186</fpage>&#x2013;<lpage>191</lpage>. <pub-id pub-id-type="doi">10.1016/j.jalz.2007.04.381</pub-id>
</citation>
</ref>
<ref id="B7">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>De Jager</surname>
<given-names>P. L.</given-names>
</name>
<name>
<surname>Shulman</surname>
<given-names>J. M.</given-names>
</name>
<name>
<surname>Chibnik</surname>
<given-names>L. B.</given-names>
</name>
<name>
<surname>Keenan</surname>
<given-names>B. T.</given-names>
</name>
<name>
<surname>Raj</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Wilson</surname>
<given-names>R. S.</given-names>
</name>
<etal/>
</person-group> (<year>2012</year>). <article-title>A genome-wide scan for common variants affecting the rate of age-related cognitive decline</article-title>. <source>Neurobiol. Aging</source> <volume>33</volume>, <fpage>1017.e1</fpage>&#x2013;<lpage>1017.e15</lpage>. <pub-id pub-id-type="doi">10.1016/j.neurobiolaging.2011.09.033</pub-id>
</citation>
</ref>
<ref id="B8">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>De Jager</surname>
<given-names>P. L.</given-names>
</name>
<name>
<surname>Srivastava</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Lunnon</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Burgess</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Schalkwyk</surname>
<given-names>L. C.</given-names>
</name>
<name>
<surname>Yu</surname>
<given-names>L.</given-names>
</name>
<etal/>
</person-group> (<year>2014</year>). <article-title>Alzheimer&#x2019;s disease: early alterations in brain DNA methylation at ANK1, BIN1, RHBDF2 and other loci</article-title>. <source>Nat. Neurosci.</source> <volume>17</volume>, <fpage>1156</fpage>&#x2013;<lpage>1163</lpage>. <pub-id pub-id-type="doi">10.1038/nn.3786</pub-id>
</citation>
</ref>
<ref id="B9">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>DeTure</surname>
<given-names>M. A.</given-names>
</name>
<name>
<surname>Dickson</surname>
<given-names>D. W.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>The neuropathological diagnosis of Alzheimer&#x2019;s disease</article-title>. <source>Mol. Neurodegener.</source> <volume>14</volume>, <fpage>32</fpage>. <pub-id pub-id-type="doi">10.1186/s13024-019-0333-5</pub-id>
</citation>
</ref>
<ref id="B10">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fillenbaum</surname>
<given-names>G. G.</given-names>
</name>
<name>
<surname>van Belle</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Morris</surname>
<given-names>J. C.</given-names>
</name>
<name>
<surname>Mohs</surname>
<given-names>R. C.</given-names>
</name>
<name>
<surname>Mirra</surname>
<given-names>S. S.</given-names>
</name>
<name>
<surname>Davis</surname>
<given-names>P. C.</given-names>
</name>
<etal/>
</person-group> (<year>2008</year>). <article-title>Consortium to establish a Registry for Alzheimer&#x27;s disease (CERAD): the first twenty years</article-title>. <source>Alzheimers Dement. J. Alzheimers Assoc.</source> <volume>4</volume>, <fpage>96</fpage>&#x2013;<lpage>109</lpage>. <pub-id pub-id-type="doi">10.1016/j.jalz.2007.08.005</pub-id>
</citation>
</ref>
<ref id="B11">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Guerreiro</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Bras</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>The age factor in Alzheimer&#x2019;s disease</article-title>. <source>Genome Med.</source> <volume>7</volume>, <fpage>106</fpage>. <pub-id pub-id-type="doi">10.1186/s13073-015-0232-5</pub-id>
</citation>
</ref>
<ref id="B12">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hou</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Dan</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Babbar</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Wei</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Hasselbalch</surname>
<given-names>S. G.</given-names>
</name>
<name>
<surname>Croteau</surname>
<given-names>D. L.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Ageing as a risk factor for neurodegenerative disease</article-title>. <source>Nat. Rev. Neurol.</source> <volume>15</volume>, <fpage>565</fpage>&#x2013;<lpage>581</lpage>. <pub-id pub-id-type="doi">10.1038/s41582-019-0244-7</pub-id>
</citation>
</ref>
<ref id="B13">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ivanisevic</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Sewduth</surname>
<given-names>R. N.</given-names>
</name>
</person-group> (<year>2023</year>). <article-title>Multi-omics integration for the design of novel therapies and the identification of novel biomarkers</article-title>. <source>Proteomes</source> <volume>11</volume>, <fpage>34</fpage>. <pub-id pub-id-type="doi">10.3390/proteomes11040034</pub-id>
</citation>
</ref>
<ref id="B14">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Johnson</surname>
<given-names>K. A.</given-names>
</name>
<name>
<surname>Fox</surname>
<given-names>N. C.</given-names>
</name>
<name>
<surname>Sperling</surname>
<given-names>R. A.</given-names>
</name>
<name>
<surname>Klunk</surname>
<given-names>W. E.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Brain imaging in alzheimer disease</article-title>. <source>Cold Spring Harb. Perspect. Med.</source> <volume>2</volume>, <fpage>a006213</fpage>. <pub-id pub-id-type="doi">10.1101/cshperspect.a006213</pub-id>
</citation>
</ref>
<ref id="B15">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kettenring</surname>
<given-names>J. R.</given-names>
</name>
</person-group> (<year>1971</year>). <article-title>Canonical analysis of several sets of variables</article-title>. <source>Biometrika</source> <volume>58</volume>, <fpage>433</fpage>&#x2013;<lpage>451</lpage>. <pub-id pub-id-type="doi">10.1093/biomet/58.3.433</pub-id>
</citation>
</ref>
<ref id="B16">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>L&#xea; Cao</surname>
<given-names>K.-A.</given-names>
</name>
<name>
<surname>Boitard</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Besse</surname>
<given-names>P.</given-names>
</name>
</person-group> (<year>2011</year>). <article-title>Sparse PLS discriminant analysis: biologically relevant feature selection and graphical displays for multiclass problems</article-title>. <source>BMC Bioinforma.</source> <volume>12</volume>, <fpage>253</fpage>. <pub-id pub-id-type="doi">10.1186/1471-2105-12-253</pub-id>
</citation>
</ref>
<ref id="B17">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Nie</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Yin</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Benowitz</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Tung</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Vinters</surname>
<given-names>H.</given-names>
</name>
<etal/>
</person-group> (<year>2015</year>). <article-title>GDF10 is a signal for axonal sprouting and functional recovery after stroke</article-title>. <source>Nat. Neurosci.</source> <volume>18</volume>, <fpage>1737</fpage>&#x2013;<lpage>1745</lpage>. <pub-id pub-id-type="doi">10.1038/nn.4146</pub-id>
</citation>
</ref>
<ref id="B18">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Overman</surname>
<given-names>J. J.</given-names>
</name>
<name>
<surname>Katsman</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Kozlov</surname>
<given-names>S. V.</given-names>
</name>
<name>
<surname>Donnelly</surname>
<given-names>C. J.</given-names>
</name>
<name>
<surname>Twiss</surname>
<given-names>J. L.</given-names>
</name>
<etal/>
</person-group> (<year>2010</year>). <article-title>An age-related sprouting transcriptome provides molecular control of axonal sprouting after stroke</article-title>. <source>Nat. Neurosci.</source> <volume>13</volume>, <fpage>1496</fpage>&#x2013;<lpage>1504</lpage>. <pub-id pub-id-type="doi">10.1038/nn.2674</pub-id>
</citation>
</ref>
<ref id="B19">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nichols</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>Steinmetz</surname>
<given-names>J. D.</given-names>
</name>
<name>
<surname>Vollset</surname>
<given-names>S. E.</given-names>
</name>
<name>
<surname>Fukutaki</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Chalek</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Abd-Allah</surname>
<given-names>F.</given-names>
</name>
<etal/>
</person-group> (<year>2022</year>). <article-title>Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019</article-title>. <source>Lancet Public Health</source> <volume>7</volume>, <fpage>e105</fpage>&#x2013;<lpage>e125</lpage>. <pub-id pub-id-type="doi">10.1016/s2468-2667(21)00249-8</pub-id>
</citation>
</ref>
<ref id="B20">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Petyuk</surname>
<given-names>V. A.</given-names>
</name>
<name>
<surname>Qian</surname>
<given-names>W.-J.</given-names>
</name>
<name>
<surname>Smith</surname>
<given-names>R. D.</given-names>
</name>
<name>
<surname>Smith</surname>
<given-names>D. J.</given-names>
</name>
</person-group> (<year>2010</year>). <article-title>Mapping protein abundance patterns in the brain using voxelation combined with liquid chromatography and mass spectrometry</article-title>. <source>Methods San. Diego Calif.</source> <volume>50</volume>, <fpage>77</fpage>&#x2013;<lpage>84</lpage>. <pub-id pub-id-type="doi">10.1016/j.ymeth.2009.07.009</pub-id>
</citation>
</ref>
<ref id="B21">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Porsteinsson</surname>
<given-names>A. P.</given-names>
</name>
<name>
<surname>Isaacson</surname>
<given-names>R. S.</given-names>
</name>
<name>
<surname>Knox</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Sabbagh</surname>
<given-names>M. N.</given-names>
</name>
<name>
<surname>Rubino</surname>
<given-names>I.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Diagnosis of early Alzheimer&#x2019;s disease: clinical practice in 2021</article-title>. <source>J. Prev. Alzheimers Dis.</source> <volume>8</volume>, <fpage>371</fpage>&#x2013;<lpage>386</lpage>. <pub-id pub-id-type="doi">10.14283/jpad.2021.23</pub-id>
</citation>
</ref>
<ref id="B22">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Price</surname>
<given-names>A. L.</given-names>
</name>
<name>
<surname>Patterson</surname>
<given-names>N. J.</given-names>
</name>
<name>
<surname>Plenge</surname>
<given-names>R. M.</given-names>
</name>
<name>
<surname>Weinblatt</surname>
<given-names>M. E.</given-names>
</name>
<name>
<surname>Shadick</surname>
<given-names>N. A.</given-names>
</name>
<name>
<surname>Reich</surname>
<given-names>D.</given-names>
</name>
</person-group> (<year>2006</year>). <article-title>Principal components analysis corrects for stratification in genome-wide association studies</article-title>. <source>Nat. Genet.</source> <volume>38</volume>, <fpage>904</fpage>&#x2013;<lpage>909</lpage>. <pub-id pub-id-type="doi">10.1038/ng1847</pub-id>
</citation>
</ref>
<ref id="B23">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rodrigue</surname>
<given-names>K. M.</given-names>
</name>
</person-group> (<year>2013</year>). <article-title>Contribution of cerebrovascular Health to the diagnosis of alzheimer disease</article-title>. <source>JAMA Neurol.</source> <volume>70</volume>, <fpage>438</fpage>&#x2013;<lpage>439</lpage>. <pub-id pub-id-type="doi">10.1001/jamaneurol.2013.1862</pub-id>
</citation>
</ref>
<ref id="B24">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rohart</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Gautier</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Singh</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Cao</surname>
<given-names>K.-A. L.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>mixOmics: an R package for omics feature selection and multiple data integration</article-title>. <source>PLOS Comput. Biol.</source> <volume>13</volume>, <fpage>e1005752</fpage>. <pub-id pub-id-type="doi">10.1371/journal.pcbi.1005752</pub-id>
</citation>
</ref>
<ref id="B25">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Singh</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Shannon</surname>
<given-names>C. P.</given-names>
</name>
<name>
<surname>Gautier</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Rohart</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Vacher</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Tebbutt</surname>
<given-names>S. J.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>DIABLO: an integrative approach for identifying key molecular drivers from multi-omics assays</article-title>. <source>Bioinformatics</source> <volume>35</volume>, <fpage>3055</fpage>&#x2013;<lpage>3062</lpage>. <pub-id pub-id-type="doi">10.1093/bioinformatics/bty1054</pub-id>
</citation>
</ref>
<ref id="B26">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tenenhaus</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Philippe</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Guillemot</surname>
<given-names>V.</given-names>
</name>
<name>
<surname>Le Cao</surname>
<given-names>K.-A.</given-names>
</name>
<name>
<surname>Grill</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Frouin</surname>
<given-names>V.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>Variable selection for generalized canonical correlation analysis</article-title>. <source>Biostat. Oxf Engl.</source> <volume>15</volume>, <fpage>569</fpage>&#x2013;<lpage>583</lpage>. <pub-id pub-id-type="doi">10.1093/biostatistics/kxu001</pub-id>
</citation>
</ref>
<ref id="B27">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>van Oostveen</surname>
<given-names>W. M.</given-names>
</name>
<name>
<surname>de Lange</surname>
<given-names>E. C. M.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Imaging techniques in Alzheimer&#x2019;s disease: a review of applications in early diagnosis and longitudinal monitoring</article-title>. <source>Int. J. Mol. Sci.</source> <volume>22</volume>, <fpage>2110</fpage>. <pub-id pub-id-type="doi">10.3390/ijms22042110</pub-id>
</citation>
</ref>
<ref id="B28">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zou</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Su</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Pan</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Zou</surname>
<given-names>C.</given-names>
</name>
<etal/>
</person-group> (<year>2023</year>). <article-title>Exploration of novel biomarkers in Alzheimer&#x2019;s disease based on four diagnostic models</article-title>. <source>Front. Aging Neurosci.</source> <volume>15</volume>, <fpage>1079433</fpage>. <pub-id pub-id-type="doi">10.3389/fnagi.2023.1079433</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>