Causal Effects of the Plasma Proteome on Vascular Dementia Risk: A Mendelian Randomization Study with Experimental Validation.

Vascular dementia (VaD) is a prevalent form of dementia caused by cerebrovascular disease, leading to cognitive impairment. While various risk factors have been identified, the role of plasma proteins in VaD etiology remains poorly understood. This study employs Mendelian randomization (MR) to investigate the causal relationship between plasma proteins and VaD risk, complemented by experimental validation. We conducted a two-sample MR analysis using summary statistics from genome-wide association studies (GWAS) on plasma proteins and VaD. Plasma protein data were derived from the deCODE Health study, encompassing 35,559 Icelandic participants and genetic associations for 4907 circulating proteins. VaD GWAS data were obtained from the FinnGen biobank, comprising 2717 VaD patients and 393,024 controls. Instrumental variables (IVs) were selected based on genome-wide significance thresholds (P < 5 × 10 for plasma proteins, P < 5 × 10 for VaD). The primary analysis used inverse variance weighting (IVW), supplemented by weighted median, MR-Egger, simple mode, and weighted mode methods. The Sensitivity analyses included heterogeneity tests, horizontal pleiotropy assessments, and leave-one-out analyses. Additionally, a 2-vessel occlusion (2-VO) animal model was used to validate key genes, with gene expression measured by quantitative real-time PCR (qPCR). Our initial MR analysis identified 123 plasma proteins significantly associated with VaD (P < 0.05), of which 12 maintained significance after FDR correction (FDR < 0.05). Importantly, the comprehensive pleiotropy analysis ultimately confirmed robust causal relationships for nine of these proteins with VaD. Among these, MED4 (OR = 1.819, 95% CI: 1.493-2.217, FDR < 0.001), COPS7B (OR = 1.136, 95% CI: 1.076-1.199, FDR < 0.001), CSF3 (OR = 1.262, 95% CI: 1.139-1.398, FDR < 0.001), IL26 (OR = 1.125, 95% CI: 1.066-1.186, FDR < 0.001), NRXN1 (OR = 1.125, 95% CI: 1.066-1.187, FDR < 0.001), LRRTM4 (OR = 1.418, 95% CI: 1.225-1.614, FDR < 0.001), and MAGEA3 (OR = 1.883, 95% CI: 1.403-2.529, FDR < 0.001) were identified as risk factors for VaD, with MED4 showing the strongest association. Conversely, CRYZL1 (OR = 0.387, 95% CI: 0.246-0.609, FDR < 0.001) and TMCC3 (OR = 0.327, 95% CI: 0.191-0.558, FDR < 0.001) were identified as protective factors. The Reverse MR analysis indicated no significant association between VaD and the 9 plasma proteins. In the 2-VO model, MED4 expression was significantly reduced, while NRXN1 expression was elevated compared to the sham group (P < 0.05). This study identifies several plasma proteins with a significant causal relationship with VaD, highlighting MED4 and NRXN1 as potential biomarkers and therapeutic targets. The findings were further validated in an experimental model, providing robust evidence for their roles in VaD pathogenesis. Further research is needed to elucidate the underlying mechanisms and confirm their clinical relevance.