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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Neurosci.</journal-id>
<journal-title>Frontiers in Neuroscience</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Neurosci.</abbrev-journal-title>
<issn pub-type="epub">1662-453X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fnins.2022.1008752</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Neuroscience</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Transcriptomic analysis identifies shared biological foundations between ischemic stroke and Alzheimer&#x2019;s disease</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Liu</surname> <given-names>Wenhao</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1760587/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Wan</surname> <given-names>Mengyao</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1800067/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Shi</surname> <given-names>Yinchao</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Yang</surname> <given-names>Xin-Zhuang</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College</institution>, <addr-line>Beijing</addr-line>, <country>China</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College</institution>, <addr-line>Beijing</addr-line>, <country>China</country></aff>
<aff id="aff3"><sup>3</sup><institution>Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College</institution>, <addr-line>Beijing</addr-line>, <country>China</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Anuska V. Andjelkovic, University of Michigan, United States</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Anthony Griswold, University of Miami, United States; Malgorzata Burek, Julius Maximilian University of W&#x00FC;rzburg, Germany</p></fn>
<corresp id="c001">&#x002A;Correspondence: Xin-Zhuang Yang, <email>xinzhuang_yang@163.com</email></corresp>
<fn fn-type="equal" id="fn002"><p><sup>&#x2020;</sup>These authors have contributed equally to this work</p></fn>
<fn fn-type="other" id="fn004"><p>This article was submitted to Neurogenomics, a section of the journal Frontiers in Neuroscience</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>18</day>
<month>11</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>16</volume>
<elocation-id>1008752</elocation-id>
<history>
<date date-type="received">
<day>02</day>
<month>08</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>31</day>
<month>10</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2022 Liu, Wan, Shi and Yang.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Liu, Wan, Shi and Yang</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>Aim</title>
<p>Alzheimer&#x2019;s disease (AD) and ischemic stroke (IS), two major neurological diseases, are suggested to be associated in clinical and pathophysiological levels. Previous studies have provided some insights into the possible genetic mechanisms behind the correlation between AD and IS, but this issue is still not clear. We implemented transcriptomic analysis to detect common hub genes and pathways to help promote the understanding of this issue.</p>
</sec>
<sec>
<title>Materials and methods</title>
<p>Four gene expression profiling datasets (GSE16561, GSE58294, GSE63060, and GSE63061) of peripheral whole blood, which contain 108 IS samples, 284 AD samples, and 285 matched controls, were employed to detect differentially expressed genes (DEGs) for AD and IS, which were further analyzed for shared biological pathways, candidate drugs, and transcription factors. Protein-protein interaction (PPI) network and drug-target interaction analysis were applied to identify hub genes and drug targets, respectively. Result verification was done with other independent datasets (GSE37587, GSE46480, and GSE140829). The difference in proportions of various immune cells in the peripheral blood of AD and IS patients were evaluated using CIBERSORT.</p>
</sec>
<sec>
<title>Results</title>
<p>We identified 74 DEGs and 18 biological processes with statistical significance shared by AD and IS, 9 of which were immune-related pathways. Five hub genes scored high in the topological analysis of the PPI network, and we also found eight drug target genes and candidate drugs which were associated with AD and IS. As for immunological changes, an increase in the proportion of M0 macrophages was found in the peripheral circulation of both AD and IS patients, and <italic>SOD1</italic> expression was significantly correlated with this change.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>Collectively, the common DEGs and shared pathways found in this study suggest a potential shared etiology between AD and IS, behind which immune system, particularly the M0 macrophage elevation, might have important roles. While, the shared hub genes, potential therapeutic gene targets and drugs reported in this study provide promising treatment strategies for AD and IS.</p>
</sec>
</abstract>
<kwd-group>
<kwd>transcriptomic analysis</kwd>
<kwd>ischemic stroke</kwd>
<kwd>Alzheimer&#x2019;s disease</kwd>
<kwd>shared biological dimensions</kwd>
<kwd>immune system</kwd>
</kwd-group>
<contract-num rid="cn001">31900481</contract-num>
<contract-sponsor id="cn001">National Natural Science Foundation of China <named-content content-type="fundref-id">10.13039/501100001809</named-content></contract-sponsor>
<counts>
<fig-count count="7"/>
<table-count count="3"/>
<equation-count count="0"/>
<ref-count count="57"/>
<page-count count="14"/>
<word-count count="6853"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1" sec-type="intro">
<title>Introduction</title>
<p>Alzheimer&#x2019;s disease (AD), one of the foremost neurodegenerative diseases, is characterized by memory loss and gradual impairment in language, praxis, and other aspects of cognition, leading to dementia. It is acknowledged that genetic and environmental factors interact with each other during the onset and development of AD (<xref ref-type="bibr" rid="B53">Wicinski et al., 2019</xref>). Ischemic stroke (IS) is a major public health problem with high prevalence and disability and mortality rate (<xref ref-type="bibr" rid="B44">Virani et al., 2020</xref>). The pathogenesis behind is heterogenous, including atherosclerosis, disturbance in blood regulation, genetic disorders, etc. In recent years, numerous studies have explored the loci and genes associated with these two complicated diseases (<xref ref-type="bibr" rid="B27">Lucke-Wold et al., 2015</xref>; <xref ref-type="bibr" rid="B9">Cui et al., 2018</xref>; <xref ref-type="bibr" rid="B46">Wang et al., 2021</xref>). Despite the seemingly different etiopathogenesis, many clinical studies have indicated potential association between AD and IS at multiple levels (<xref ref-type="bibr" rid="B57">Zhou et al., 2015</xref>; <xref ref-type="bibr" rid="B47">Wang et al., 2020</xref>, <xref ref-type="bibr" rid="B46">2021</xref>; <xref ref-type="bibr" rid="B36">Pinho et al., 2021</xref>; <xref ref-type="bibr" rid="B55">Zhang et al., 2021</xref>). Firstly, the coexistence of these two diseases is more frequent than by chance, as a population-based study in 2013 showed that the prevalence of IS was significantly higher in AD patients (<xref ref-type="bibr" rid="B14">Iadecola, 2016</xref>). Besides, AD and IS share some common risk factors such as old age, obesity, hypertension, and stroke is known to advance AD development (<xref ref-type="bibr" rid="B6">Breijyeh and Karaman, 2020</xref>).</p>
<p>Furthermore, with the progress in sequencing technology, increasing research is exploring the genetic and molecular mechanisms behind these diseases. Studies showed that <italic>APOE</italic> &#x03B5;<italic>4</italic>, a verified allele related to AD, increased concomitance of AD and IS, and presented a positive dose-response association with the IS (<xref ref-type="bibr" rid="B20">Khan et al., 2013</xref>). The amyloid-beta (A&#x03B2;) deposition in brain parenchyma and vessels is the pathology for AD and cerebral amyloid angiography, respectively, while the latter is one of the causes for young-onset and recurrent IS (<xref ref-type="bibr" rid="B43">Vijayan and Reddy, 2016</xref>; <xref ref-type="bibr" rid="B10">Dong et al., 2018</xref>). Mutation in genes influencing A&#x03B2; (e.g., <italic>PSEN1</italic>, <italic>APP</italic>) formation could be the causes for both AD and IS (<xref ref-type="bibr" rid="B10">Dong et al., 2018</xref>). The genome-wide association study (GWAS) is suitable for exploring the comprehensive effects of genetic factors behind complicated diseases. <xref ref-type="bibr" rid="B9">Cui et al. (2018)</xref> summarized GWAS datasets and discovered several shared novel functional pathways linking AD and IS, including immune process and signaling transduction. <xref ref-type="bibr" rid="B51">Wei et al. (2019)</xref> found that SNPs previously shown to function in immune system might underlie the common pathogenesis for AD and IS. Our previous studies demonstrated post-IS inflammatory reactions including the differentiation and activation of T cells and mononuclear cells, which were also involved in sporadic AD by previous GWASs (<xref ref-type="bibr" rid="B26">Liu W. et al., 2022</xref>).</p>
<p>Despite the above clinical and genetic evidence, it is still very difficult to clarify the pathogenesis underlying the relationship between IS and AD. A genome-wide transcriptome study (GWTS) could provide new perspectives, identifying more relevant pathways. However, few GTWSs have explored the shared biological pathways and transcriptomic changes between IS and AD. Therefore, we applied analyses on the following aspect, protein-protein interaction (PPI) network, functional pathway enrichment, drug targets, transcript factors, and immune infiltration, based on common differentially expressed genes (DEGs) in IS and AD patients. The sequential workflow of our research is presented in <xref ref-type="fig" rid="F1">Figure 1</xref>.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>Flowchart of the study. Microarray data from whole peripheral blood of patients with Alzheimer&#x2019;s disease (AD) or ischemic stroke (IS) were obtained and analysis for differentially expressed genes (DEGs) between patients and healthy controls was performed. Protein-protein interactions network (PPI&#x2013;Net), drug targets, functional enrichment, and immune infiltration analysis were applied to common DEGs between AD and IS, to explore shared mechanism between these two diseases. Hub genes obtained by PPI-Net analysis and potential drug targets were validated with test dataset of AD and IS.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g001.tif"/>
</fig>
</sec>
<sec id="S2" sec-type="materials|methods">
<title>Materials and methods</title>
<sec id="S2.SS1">
<title>Datasets employed in this study</title>
<p>The microarray datasets used in this study were obtained from the GEO database.<sup><xref ref-type="fn" rid="footnote1">1</xref></sup> The criteria for retrieval were: (A) samples were from human peripheral whole blood samples, (B) gene expression was profiled, (C) datasets contained both patients and healthy people without a history of stroke nor dementia, (D) all IS patients were clinically diagnosed radiographically (with magnetic resonance imaging or computed tomography), (E) all AD patients were diagnosed according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer&#x2019;s Disease and Related Disorders Association criteria. In particular, all the non-IS or non-AD samples included in the datasets were deleted.</p>
<p>To ensure the consistency and completeness of the datasets, we manually identified relevant literature using keywords filters and applied R programming language (version: 4.1.3) for subsequent analysis. Finally, IS datasets [GSE16561 (<xref ref-type="bibr" rid="B3">Barr et al., 2010</xref>; <xref ref-type="bibr" rid="B33">O&#x2019;Connell et al., 2016</xref>, <xref ref-type="bibr" rid="B34">2017</xref>) and GSE58294 (<xref ref-type="bibr" rid="B40">Stamova et al., 2014</xref>)] and AD datasets [GSE63060 and GSE63061 (<xref ref-type="bibr" rid="B39">Sood et al., 2015</xref>)] were included as training sets and were merged, respectively, and batch effects were corrected using the &#x201C;combat&#x201D; function in the SVA package (version: 3.38.0). Next, we normalized the merged datasets and adjusted for covariates using the &#x201C;Normalizebetweenarrays&#x201D; and &#x201C;removeBatchEffect&#x201D; function in the limma package (version: 3.46.0). To validate hub genes and drug targets, we downloaded GSE140829 (<xref ref-type="bibr" rid="B8">Cooper et al., 2018</xref>) dataset as validation set for AD, and GSE37587 (<xref ref-type="bibr" rid="B4">Barr et al., 2015</xref>), GSE46480 (<xref ref-type="bibr" rid="B15">Issa et al., 2016</xref>) datasets for IS which conformed to the above criteria. <xref ref-type="table" rid="T1">Table 1</xref> summarizes the included datasets.</p>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>All data sets used in this study contain a total of 1,273 samples, among which there were 650 cases and 623 controls.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Data sets (GEO ID)</td>
<td valign="top" align="center" colspan="2">Data<hr/></td>
<td valign="top" align="center">Sample type</td>
<td valign="top" align="center">References</td>
<td valign="top" align="center">Category</td>
<td valign="top" align="center">Phenotype</td>
<td valign="top" align="center">GPL</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="center">Case</td>
<td valign="top" align="center">Control</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">GSE16561</td>
<td valign="top" align="center">39</td>
<td valign="top" align="center">24</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B18">Johnston et al., 2018</xref>; <xref ref-type="bibr" rid="B19">Kaushal et al., 2015</xref>; <xref ref-type="bibr" rid="B20">Khan et al., 2013</xref></td>
<td valign="top" align="center">Train</td>
<td valign="top" align="center">Ischemic stroke</td>
<td valign="top" align="center">GPL570</td>
</tr>
<tr>
<td valign="top" align="left">GSE58294</td>
<td valign="top" align="center">69</td>
<td valign="top" align="center">23</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B21">Lautrup et al., 2019</xref></td>
<td valign="top" align="center">Train</td>
<td valign="top" align="center">Ischemic stroke</td>
<td valign="top" align="center">GPL570</td>
</tr>
<tr>
<td valign="top" align="left">GSE37587</td>
<td valign="top" align="center">68</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B24">Li et al., 2019</xref></td>
<td valign="top" align="center">Test</td>
<td valign="top" align="center">Ischemic stroke</td>
<td valign="top" align="center">GPL6883</td>
</tr>
<tr>
<td valign="top" align="left">GSE46480</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">98</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B15">Issa et al., 2016</xref></td>
<td valign="top" align="center">Test</td>
<td valign="top" align="center">Control</td>
<td valign="top" align="center">GPL570</td>
</tr>
<tr>
<td valign="top" align="left">GSE63060</td>
<td valign="top" align="center">145</td>
<td valign="top" align="center">104</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B22">Lee et al., 2010</xref></td>
<td valign="top" align="center">Train</td>
<td valign="top" align="center">Alzheimer&#x2019;s disease<xref ref-type="table-fn" rid="t1fns1">&#x002A;</xref></td>
<td valign="top" align="center">GPL6947</td>
</tr>
<tr>
<td valign="top" align="left">GSE63061</td>
<td valign="top" align="center">139</td>
<td valign="top" align="center">134</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B22">Lee et al., 2010</xref></td>
<td valign="top" align="center">Train</td>
<td valign="top" align="center">Alzheimer&#x2019;s disease<xref ref-type="table-fn" rid="t1fns1">&#x002A;</xref></td>
<td valign="top" align="center">GPL10558</td>
</tr>
<tr>
<td valign="top" align="left">GSE140829</td>
<td valign="top" align="center">190</td>
<td valign="top" align="center">240</td>
<td valign="top" align="center">Peripheral blood</td>
<td valign="top" align="center"><xref ref-type="bibr" rid="B8">Cooper et al., 2018</xref></td>
<td valign="top" align="center">Test</td>
<td valign="top" align="center">Alzheimer&#x2019;s disease<xref ref-type="table-fn" rid="t1fns1">&#x002A;</xref></td>
<td valign="top" align="center">GPL15988</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>All samples were collected in the peripheral blood tissue.</p></fn>
<fn id="t1fns1"><p>&#x002A;All the MCI samples included in the datasets were deleted, and the Case column only referred to AD samples.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S2.SS2">
<title>Identification of differentially expressed genes and functional annotation</title>
<p>To identify differentially expressed genes (DEGs) in peripheral blood samples from AD/IS patients and controls, we performed differential expression analysis using the limma package (version: 3.46.0), controlling for age. The threshold for screening DEGs was | log<sub>2</sub> FC (fold change)| &#x003E; 0.5 and false discovery rate (FDR) &#x003C; 0.01. Common DEGs for AD and IS were then imported to functional annotation.</p>
<p>Enrichment analysis of Gene Ontology (GO) and Disease Ontology (DO) was performed on common DEGs using the clusterprofiler package (version: 3.18.1). Kyoto Encyclopedia of Genes and Genomes (KEGG)<sup><xref ref-type="fn" rid="footnote2">2</xref></sup> and gene set enrichment analysis (GSEA) were further carried out for common DEGs. The threshold for significance of the above enrichment analysis was set at FDR &#x003C; 0.05. The background used for biological functional enrichment analysis were genes expressed in any samples of AD and IS in training process.</p>
</sec>
<sec id="S2.SS3">
<title>Identification and validation of hub genes and drug targets</title>
<p>Protein function prediction is the key step in biology research and drug discovery. In order to explore the functional interaction between the common DEGs of AD and IS, PPI network analysis was adopted, which was provided by the STRINGdb package (version: 2.6.5) with a confidence score of &#x2265; 0.7 [0,1]. The information of PPI network was further imported into Cytoscape software (version: 3.9.1) for subsequent analyses. We used Cytohubba app<sup><xref ref-type="fn" rid="footnote3">3</xref></sup> in Cytoscape for network topology analysis to detect hub genes, through which eleven circulation methods were used to score and rank all DEGs.</p>
<p>Drug and Drug_link datasets (Release Version: 5.1.9) were downloaded from the DrugBank database.<sup><xref ref-type="fn" rid="footnote4">4</xref></sup> The intersection of the common DEGs and drug target genes (DTGs) was then used to generate genes targeted by drugs and potential drugs that might contribute to phenotypes. Validation datasets were further used to examine the robustness of hub genes and drug targets.</p>
</sec>
<sec id="S2.SS4">
<title>Transcription factors analysis</title>
<p>The common DEGs were imported into Cytospace for network analysis of transcription factors (TFs). RcisTarget package was used to acquire information of TFs and gene targets, and adjusted <italic>P</italic>-value &#x003C; 0.05 was considered significant. Subsequently, we verified the expression levels of these TFs in validation datasets for AD and IS with <italic>t</italic>-test.</p>
</sec>
<sec id="S2.SS5">
<title>Immune cell infiltration evaluation</title>
<p>CIBERSORT tool analyzing immune system (version: 0.1.0) was used to generate immune cell profiles for all samples by estimating relative subsets of RNA transcripts. The CIBERSORT resulted in an expression matrix of 22 immune cells in all samples of the training dataset for AD and IS. We then used <italic>t</italic>-test to analyze the differences in immune cell components between AD/IS patients and healthy controls. Finally, Spearman&#x2019;s correlation analysis was performed between these selected genes (hub genes and drug targets) and significantly differentiated immune cells. The ggplot2 package (version: 3.3.3) and ggpubr package (version: 0.4.0) was used to generate lollipop chart.</p>
</sec>
</sec>
<sec id="S3" sec-type="results">
<title>Results</title>
<sec id="S3.SS1">
<title>Identification of separate and common differentially expressed genes of Alzheimer&#x2019;s disease and ischemic stroke</title>
<p>To identify differentially expressed genes shared by AD and IS, we initially searched the Array Express and NCBI GEO databases for expression data from whole peripheral blood of AD/IS patients and healthy controls. Seven independent studies that met our inclusion criteria were obtained (see Section &#x201C;Materials and methods&#x201D; and <xref ref-type="table" rid="T1">Tables 1</xref>&#x2013;<xref ref-type="table" rid="T3">3</xref>).</p>
<table-wrap position="float" id="T2">
<label>TABLE 2</label>
<caption><p>Clinical characters of the merged IS training data sets.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="center">Total sample, <italic>N</italic> (%)</td>
<td valign="top" align="center">Stroke, <italic>N</italic> = 108 (69.7%),<break/><italic>N</italic> (%)</td>
<td valign="top" align="center">Control, <italic>N</italic> = 47 (30.3%),<break/><italic>N</italic> (%)</td>
<td valign="top" align="center">Statistics/<italic>df</italic></td>
<td valign="top" align="center"><italic>P-</italic>value</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Gender (% female)</td>
<td valign="top" align="center">80 (51.6%)</td>
<td valign="top" align="center">55 (50.9%)</td>
<td valign="top" align="center">25 (53.2%)</td>
<td valign="top" align="center">X<sup>2</sup> 0.0673/1</td>
<td valign="top" align="center">0.7953</td>
</tr>
<tr>
<td valign="top" align="left">Age, years, mean &#x00B1; SD</td>
<td valign="top" align="center">66.7 &#x00B1; 16.86</td>
<td valign="top" align="center">72.6 &#x00B1; 12.09</td>
<td valign="top" align="center">58.9 &#x00B1; 7.51</td>
<td valign="top" align="center">t &#x2212;13.90302/135</td>
<td valign="top" align="center">&#x003C;0.001</td>
</tr>
<tr>
<td valign="top" align="left">Race (% white)</td>
<td valign="top" align="center">126 (81.3%)</td>
<td valign="top" align="center">84 (77.8%)</td>
<td valign="top" align="center">42 (89.3%)</td>
<td valign="top" align="center">X<sup>2</sup> 2.88932/1</td>
<td valign="top" align="center">0.0892</td>
</tr>
<tr>
<td valign="top" align="left">Hypertension</td>
<td valign="top" align="center">93 (60.0%)</td>
<td valign="top" align="center">70 (64.8%)</td>
<td valign="top" align="center">23 (48.9%)</td>
<td valign="top" align="center">X<sup>2</sup> 3.44037/1</td>
<td valign="top" align="center">0.0636</td>
</tr>
<tr>
<td valign="top" align="left">Diabetes</td>
<td valign="top" align="center">30 (19.4%)</td>
<td valign="top" align="center">23 (21.3%)</td>
<td valign="top" align="center">7 (14.9%)</td>
<td valign="top" align="center">X<sup>2</sup> 0.8601/1</td>
<td valign="top" align="center">0.3537</td>
</tr>
<tr>
<td valign="top" align="left">Dyslipidemia</td>
<td valign="top" align="center">52 (33.5%)</td>
<td valign="top" align="center">36 (33.3%)</td>
<td valign="top" align="center">16 (34.0%)</td>
<td valign="top" align="center">X<sup>2</sup> 0.00739/1</td>
<td valign="top" align="center">0.9333</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap position="float" id="T3">
<label>TABLE 3</label>
<caption><p>Clinical characters of the merged AD training data sets.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="center">Total sample, <italic>N</italic> (%)</td>
<td valign="top" align="center">AD, <italic>N</italic> = 284 (55.4%),<break/><italic>N</italic> (%)</td>
<td valign="top" align="center">Control, <italic>N</italic> = 238 (44.6%),<break/><italic>N</italic> (%)</td>
<td valign="top" align="center">Statistics/<italic>df</italic></td>
<td valign="top" align="center"><italic>P-</italic>value</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Gender (% female)</td>
<td valign="top" align="center">327 (62.6%)</td>
<td valign="top" align="center">184 (64.8%)</td>
<td valign="top" align="center">143 (60.1%)</td>
<td valign="top" align="center">X<sup>2</sup> 1.2247/1</td>
<td valign="top" align="center">0.2684</td>
</tr>
<tr>
<td valign="top" align="left">Age, years, mean &#x00B1; SD</td>
<td valign="top" align="center">70.3 &#x00B1; 13.07</td>
<td valign="top" align="center">69.9 &#x00B1; 13.19</td>
<td valign="top" align="center">70.5 &#x00B1; 12.39</td>
<td valign="top" align="center">t &#x2212;0.678/513</td>
<td valign="top" align="center">0.4981</td>
</tr>
<tr>
<td valign="top" align="left">Race (% white)</td>
<td valign="top" align="center">516 (98.8%)</td>
<td valign="top" align="center">281 (98.9%)</td>
<td valign="top" align="center">235 (98.7%)</td>
<td valign="top" align="center">X<sup>2</sup> 0.0475/1</td>
<td valign="top" align="center">0.8275</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>First, a dataset consisting of 108 IS patients and 47 matched controls was generated by merging two IS datasets: GSE16561 and GSE58294 (<xref ref-type="table" rid="T2">Table 2</xref>). To ensure data consistency, batch effects were controlled and the different subsets were normalized. The evaluation results showed that data pre-processing was effective and reliable (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figures 1</xref>, <xref ref-type="supplementary-material" rid="DS1">2</xref>). Next, differential analysis of gene expression was performed by controlling age, which is significantly different between two groups (<xref ref-type="table" rid="T2">Table 2</xref>). Finally, 537 DEGs for IS and 496 DEGs for AD were identified between patients and healthy controls (see Section &#x201C;Materials and methods&#x201D; and <xref ref-type="fig" rid="F2">Figures 2A,B</xref>), and we found 74 common DEGs between AD and IS (<xref ref-type="fig" rid="F2">Figure 2C</xref>).</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p><bold>(A,B)</bold> Volcano plot demonstrating an overview of the differentially expressed genes in AD and IS. The threshold in the volcano plot was &#x2013;lg(adjusted <italic>P</italic>) &#x003E; 2 and |log<sub>2</sub> fold change| &#x003E; 0.5; red dots indicate significant differentially expressed genes. <bold>(C)</bold> Venn diagram demonstrates the common DEGs of AD and IS. Red, purple, and pink represent significant DEGs of IS, AD, and both AD and IS, respectively.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g002.tif"/>
</fig>
</sec>
<sec id="S3.SS2">
<title>Functional enrichment analysis of common differentially expressed genes</title>
<p>Gene ontology and disease ontology enrichment analysis were performed to identify the biological pathways and diseases associated with the shared DEGs. GO enrichment analysis explored the biological processes, cellular components, and molecular functions. For biological processes, 18 pathways achieved statistical significance, including antigen processing and presentation, T cell differentiation and activation, cell activation involved in immune responses and mononuclear cell differentiation and so on, half of which were noticeably associated with immunological changes. While for cellular components, ribosome, endocytic vesicle, ficolin-1-rich granule, mitochondrial protein-containing complex, and vesicle membrane were involved. The molecular function significantly associated with common DEGs was structural constituent of ribosome. When performing DO analysis, Alzheimer&#x2019;s disease, tauopathy, atherosclerosis, and heart disease were related with common DEGs. More information for GO and DO enrichment analysis is presented in <xref ref-type="fig" rid="F3">Figure 3</xref>.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p><bold>(A)</bold> GO enrichment analysis, where the horizontal axis represents the proportion of DEGs under the GO term. Top 10 pathways with most significant <italic>P</italic>-value were shown and ordered by gene ratio. BP, biological process; CC, cellular component; MF, molecular function. <bold>(B)</bold> DO enrichment analysis. Chord diagram showed the correlation between diseases and common DEGs, with different colors corresponding to different DO terms.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g003.tif"/>
</fig>
<p>Furthermore, the GSEA results demonstrated that the enriched molecular pathways related to DEGs were cellular responses to stress and stimuli, innate immune system, translation, and neutrophil degranulation (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 3</xref>). These results were consistent with those in GO enrichment analysis considering innate immune involvement. These results provide evidence that immune-related biological processes might play important roles in the connection of AD and IS.</p>
</sec>
<sec id="S3.SS3">
<title>Identification of hub genes and drug targets</title>
<p>Through the PPI and network topology analysis for the common DEGs, we explored the hub genes that play indispensable roles in the shared biological mechanisms of AD and IS (<xref ref-type="fig" rid="F4">Figure 4A</xref>). According to the eleven ranking methods provided by CytoHubba app to score these genes in the main PPI module, <italic>RPS3</italic>, <italic>RPS15</italic>, <italic>PSMB6</italic>, <italic>MRPL17</italic>, and <italic>MRPL24</italic> were identified as the hub genes (<xref ref-type="fig" rid="F4">Figure 4B</xref>). These hub genes can be potential biomarkers, which may also provide new therapeutic targets. We further looked into whether there were drugs that can mitigate the process of gene expression differentiation (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 4</xref>). By searching for interactions across three gene sets, DEGs of AD, DEGs of IS and DTGs, eight DEGs interacting with two known drug targets were identified, which were <italic>ANXA1</italic>, <italic>SOD1</italic>, <italic>LDHB</italic>, <italic>CASP1</italic>, <italic>PRDX1</italic>, <italic>CD3D</italic>, <italic>NDUFB3</italic>, and <italic>TXN</italic> (<xref ref-type="fig" rid="F5">Figure 5A</xref>). The top ten drugs targeting these common DEGs were Fostamatinib, Artenimol, Zinc, Stiripentol, NADH, Phenethyl Isothiocyanate, Acetylsalicylic acid, Minocycline, Emricasan, and Amcinonide (<xref ref-type="fig" rid="F5">Figure 5B</xref>). We validated these hub genes and drug targets with GSE37587, GSE46480, GSE140829 datasets, and results showed consistency (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 5</xref>).</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption><p>PPI network of common DEGs shared by AD and IS. <bold>(A)</bold> The circle nodes represent DEGs and edges represent the interactions between nodes. The PPI network has 65 nodes and 564 edges. <bold>(B)</bold> According to the 11 ranking methods provided by CytoHubba app, top 10 genes by at least 6 methods are referred as hub genes. Five hub genes were italicized and bold and the scores from all methods were labeled in table.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g004.tif"/>
</fig>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption><p><bold>(A)</bold> Table represents target genes, corresponding proteins, and their potential drugs. <bold>(B)</bold> Bar plot demonstrates potential drugs, of which the horizontal axis represents the number of gene targets of the drug.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g005.tif"/>
</fig>
</sec>
<sec id="S3.SS4">
<title>Identification of regulatory transcript factors</title>
<p>Based on the RcisTarget package, we found ten possible TFs regulating the expression of these common DEGs (<xref ref-type="fig" rid="F6">Figure 6A</xref>), 5 TFs of which were differentially expressed in the peripheral blood of AD and IS patients (<xref ref-type="fig" rid="F6">Figure 6B</xref>). Among these TFs, <italic>FOS</italic> expression was up-regulation, while <italic>PRDM4</italic>, <italic>HSF2</italic>, <italic>HOXB2</italic>, and <italic>ETS1</italic> were down-regulation.</p>
<fig id="F6" position="float">
<label>FIGURE 6</label>
<caption><p>Transcription factors (TFs) regulatory network and their gene expression profiles in AD/IS. <bold>(A)</bold> TFs regulatory network. TFs were marked in purple, and the hub genes were marked in blue. <bold>(B)</bold> The gene expression level of TFs in AD and IS datasets. The comparison of gene expression between patients and controls was applied with <italic>t</italic>-test. <italic>P</italic>-value &#x003C; 0.05 was considered statistically significant. AD, Alzheimer&#x2019;s disease; IS, ischemic stroke. &#x002A;<italic>P</italic> &#x003C; 0.05; &#x002A;&#x002A;<italic>P</italic> &#x003C; 0.01; &#x002A;&#x002A;&#x002A;&#x002A;<italic>P</italic> &#x003C; 0.0001.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g006.tif"/>
</fig>
</sec>
<sec id="S3.SS5">
<title>Immune changes</title>
<p>Given the enrichment of the common DEGs on immune-related pathways, we applied the CIBERSORT classification algorithm on gene expression profiles to demonstrate changes of the immune system in AD and IS. The proportions of M2-type macrophages, M0-type macrophages, eosinophils, regulatory T cells, gamma-delta T cells, and CD4<sup>+</sup> memory resting T cells, and CD4<sup>+</sup> naive T cells were significantly different between AD patients and healthy controls (<xref ref-type="fig" rid="F7">Figure 7A</xref>). Meanwhile, the proportions of M0-type macrophages and CD4<sup>+</sup> naive T cells were also significantly different in IS cohort (<xref ref-type="fig" rid="F7">Figure 7B</xref>), of which, M0-type macrophages were increased in AD and IS patients, and CD4<sup>+</sup> naive T cells were increased in AD patients but decreased in IS patients.</p>
<fig id="F7" position="float">
<label>FIGURE 7</label>
<caption><p><bold>(A,B)</bold> Violin diagram showing the proportion of immune cells obtained using the CIBERSORT. &#x002A;<italic>P</italic> &#x003C; 0.05; &#x002A;&#x002A;&#x002A;<italic>P</italic> &#x003C; 0.001; &#x002A;&#x002A;&#x002A;&#x002A;<italic>P</italic> &#x003C; 0.0001. <bold>(C)</bold> Correlation between hub genes and drug target genes, and M0 macrophages. The red dashed lines represent +0.3 and &#x2013;0.3.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnins-16-1008752-g007.tif"/>
</fig>
<p>Correlation analysis indicated a close relationship between hub genes, DTGs and M0-type macrophages (<xref ref-type="fig" rid="F7">Figure 7C</xref>). <italic>NUP88</italic>, <italic>CLNS1A</italic>, <italic>GTF2A2</italic>, <italic>ANXA1</italic>, <italic>SOD1</italic>, <italic>PRDX1</italic>, and <italic>CD3D</italic> were negatively correlated with M0-type macrophages in AD patients (r &#x003C; &#x2212;0.3, <italic>P</italic> &#x003C; 0.001), while <italic>GTF2H5</italic>, <italic>SOD1</italic>, and <italic>LDHB</italic> were negatively correlated with M0-type macrophages in the IS patients (r &#x003C; &#x2212;0.3, <italic>P</italic> &#x003C; 0.001). Our analysis showed that <italic>SOD1</italic> was associated with the change of M0-type macrophages in both AD and IS patients.</p>
</sec>
</sec>
<sec id="S4" sec-type="discussion">
<title>Discussion</title>
<p>Although large-scale GWASs of AD and IS have identified a set of risk loci and pleiotropic genes with genome-wide significance (<xref ref-type="bibr" rid="B28">Malik et al., 2018</xref>; <xref ref-type="bibr" rid="B16">Jansen et al., 2019</xref>), no shared genetic determinants between AD and IS have been reported (<xref ref-type="bibr" rid="B42">Traylor et al., 2016</xref>). Previous pathway-based association tests using large-scale GWAS summary datasets for AD and IS have found come common biological pathways shared by AD and IS (<xref ref-type="bibr" rid="B9">Cui et al., 2018</xref>). In this study, we analyzed the peripheral blood transcriptome of AD and IS patients using gene expression profile datasets from GEO (training datasets for IS: GSE16561 and GSE58294, for AD: GSE63060 and GSE63061; validation datasets for IS: GSE37587 and GSE46480, for AD: GSE140829) to search for supportive evidence for their relevance.</p>
<p>Through a comprehensive analysis, we revealed a total of 74 common DEGs shared by AD and IS. To ensure the biological meaning of the common DEGs, we randomly selected 600 genes from the expressed gene sets of AD and IS separately and repeated for 1,000 times (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 6</xref>). The number of overlapped genes between AD and IS ranged from 6 to 32, obviously less than 74 (<italic>t</italic>-test, <italic>P</italic>-value &#x003C; 0.001). GO and DO enrichment and GSEA analysis were further conducted for these common DEGs. For biological processes, the top GO terms were associated with immune system changes, such as T cell differentiation and activation, cell activation involved in immune responses, and mononuclear cell differentiation. For cellular components, ribosome, endocytic vesicle, ficolin-1-rich granule, mitochondrial protein-containing complex, and vesicle membrane were the top results. The structural constituent of ribosome is the only GO term which was affected by the common DEGs in molecular function experiment. The diseases enriched by DO analysis were mainly Alzheimer&#x2019;s disease, tauopathy, atherosclerosis, and heart diseases. The results of GSEA suggested that cellular responses to stress and stimuli, innate immune System, translation, and neutrophil degranulation were the most significantly enriched pathways.</p>
<p>Therefore, the crucial mechanisms behind the correlation between AD and IS might focus on the immune system. As is known to all, a wide variety of immune cells exist in the brain and dysregulation of the innate immune system contribute to the onset and development of many neurological diseases, AD and IS included (<xref ref-type="bibr" rid="B30">Mastorakos and McGavern, 2019</xref>; <xref ref-type="bibr" rid="B31">Mezey et al., 2021</xref>). These results conform to previous studies. <xref ref-type="bibr" rid="B9">Cui et al. (2018)</xref> identified immunological processes in the shared biological pathways between AD and IS based on large-scale GWAS summary data. Other studies have also demonstrated the essential roles of immune system in AD and IS. Furthermore, we used CIBERSORT classification algorithm to conduct an immune cell enrichment analysis based on the merged datasets. We found that M0-type macrophages were both upregulated in AD and IS patients, however, CD4+ naive T cells were upregulated in AD patients but down-regulated in IS patient. Our results agree with those of <xref ref-type="bibr" rid="B25">Liu C. et al. (2022)</xref> and <xref ref-type="bibr" rid="B49">Wang X. et al. (2022)</xref>, which showed that resting CD4 T memory cells were significantly down-regulated whereas M0 macrophages were significantly up-regulated in IS. This indicated a putative relationship between immune system and IS. Recent studies have elucidated that M2 macrophages, CD4 naive T cells, regulatory T cells, eosinophils, gamma delta T cells, resting mast cells, M0 macrophages and activated CD4 memory T cells are closely correlated with AD, which further verified our discovery. Correlation analyses confirmed a strong relationship between hub genes, DTGs, and M0-type macrophages. This study identified a common gene, <italic>SOD1</italic> to be negatively correlated with M0-type macrophages in AD and IS patients, suggesting its potential role in the shared immune changes of AD and IS.</p>
<p>Further PPI network analysis was constructed to identify the most significant clusters of DEGs and understand the biological characteristics of the proteins. Here, we identified five hub genes based on topological measures that might suggest common pathogenesis behind AD and IS. Both <italic>RPS3</italic> and <italic>RPS15</italic> encode a ribosomal protein, which is part of the 40S subunit. RPS3 induces neuronal apoptosis by interacting with the E2F1 TF and inducing the expression of pro-apoptotic proteins BCL2L11/BIM and HRK/Dp5 (<xref ref-type="bibr" rid="B22">Lee et al., 2010</xref>), while the phosphorylation of <italic>RPS15</italic> is related to LRRK2 neurodegeneration and neurotoxicity (<xref ref-type="bibr" rid="B29">Martin et al., 2014</xref>). <xref ref-type="bibr" rid="B54">Wu et al. (2022)</xref> suggested that RPS3 and RPS15 may be potential targets and treatment for early diagnosis of AIS. <italic>PSMB6</italic>, also known as 20S proteasome subunit beta-1, codes for the &#x03B2;1 core catalytic subunit of the proteasome (<xref ref-type="bibr" rid="B45">Vriend and Marzban, 2017</xref>). A study showed that PSMB6 was a critical regulator of circadian rhythm, which may also have a direct or indirect effect on neurodegenerative diseases (<xref ref-type="bibr" rid="B5">Beker and Kili&#x00C7;, 2020</xref>). Mitochondrial ribosomal protein large 17 (MRPL17) and Mitochondrial ribosomal protein large 24 (MRPL24) are one of the 82 protein components of mitochondrial ribosomes, playing an essential role in the mitochondrial translation process, but their relationship with neurodegenerative diseases is currently unclear (<xref ref-type="bibr" rid="B32">Nottia et al., 2020</xref>). In addition, we found 10 possible TFs regulating the expression of these genes. By further verification, we found that five TFs are differentially expressed in AD and IS, including FOS, PRDM4, HSF2, HOXB2, and ETS1. They coordinately participated in the regulation of two hub genes (<italic>PSMB6</italic>, <italic>RPL17</italic>).</p>
<p>We next detected the candidate drugs for AD and IS based on the intersection across three gene sets, DEGs_AD, DEGs_IS, and DTGs. Here, we identified eight DEGs, including <italic>ANXA1</italic>, <italic>SOD1</italic>, <italic>LDHB</italic>, <italic>CASP1</italic>, <italic>PRDX1</italic>, <italic>CD3D</italic>, <italic>NDUFB3</italic>, and <italic>TXN</italic>. Overwhelming evidence has confirmed the protective role of ANXA1 in neuronal apoptosis during cerebral ischemia (<xref ref-type="bibr" rid="B56">Zhao et al., 2015</xref>; <xref ref-type="bibr" rid="B24">Li et al., 2019</xref>). Recently, Miriam Ries et al. discovered that ANXA1 could restore cerebrovascular integrity and reduce amyloid-&#x03B2; and tau. Moreover, ANXA1 has been reported to have therapeutic potential in ischemia-reperfusion injury (<xref ref-type="bibr" rid="B1">Ansari et al., 2018</xref>) and protecting against the breakdown of the blood-brain barrier in AD (<xref ref-type="bibr" rid="B35">Park et al., 2017</xref>). <italic>SOD1</italic> has previously been reported to correlate with neurodegenerative diseases, such as amyotrophic lateral sclerosis (<xref ref-type="bibr" rid="B37">Renton et al., 2014</xref>) and AD (<xref ref-type="bibr" rid="B2">Bader et al., 2020</xref>). Many studies have demonstrated that <italic>CASP1</italic> may be a therapeutic target against cognitive impairment and inflammation in AD (<xref ref-type="bibr" rid="B19">Kaushal et al., 2015</xref>; <xref ref-type="bibr" rid="B13">Gu et al., 2021</xref>; <xref ref-type="bibr" rid="B12">Flores et al., 2022</xref>). In addition, the inhibition of <italic>CASP1</italic> has proven to relieve cerebral ischemia in a murine model by targeting the canonical inflammasome pathway of pyroptosis that is important for neuronal death in acute IS (<xref ref-type="bibr" rid="B23">Li et al., 2020</xref>). Drugs targeting these genes include Fostamatinib, Artenimol, NADH, Phenethyl Isothiocyanate, Acetylsalicylic acid, Minocycline, Emricasan, and Amcinonide. The recent study has confirmed NADH can not only improve cellular energy metabolism after IS, but also can inhibit oxidative stress by decomposing into NAD<sup>+</sup>, protect mitochondrial function, and reduce cerebral ischemia-reperfusion injury (<xref ref-type="bibr" rid="B48">Wang X. X. et al., 2022</xref>). As the NAD<sup>+</sup> donor, NADH further appeared as a protective agent for AD because of the indispensable role of NAD<sup>+</sup> depletion and impairment of NAD<sup>+</sup>-dependent pathways in AD pathophysiology (<xref ref-type="bibr" rid="B21">Lautrup et al., 2019</xref>). Acetylsalicylic acid, also known as aspirin, an anti-inflammatory medication, has been verified to be useful in prevention cognitive deterioration due to its anti-thrombotic and anti-inflammatory properties. It has shown promising performances for treating IS and AD in multiple pre-clinical and clinical trials (<xref ref-type="bibr" rid="B50">Wang et al., 2013</xref>; <xref ref-type="bibr" rid="B18">Johnston et al., 2018</xref>, <xref ref-type="bibr" rid="B17">2020</xref>; <xref ref-type="bibr" rid="B52">Weng et al., 2021</xref>). Minocycline, an antibiotic, has been proven to have neuroprotective effects in AD and IS. Studies have reported that Minocycline could not only mitigate Alzheimer&#x2019;s-like pathology and improve cognition, but also exhibit similar promise in the treatment of IS when administered alone or in combination with thrombolyticse (<xref ref-type="bibr" rid="B7">Campbell et al., 2011</xref>; <xref ref-type="bibr" rid="B11">Fagan et al., 2011</xref>). Emricasan is a caspase inhibitor and is currently used for several liver diseases in clinical trials (<xref ref-type="bibr" rid="B38">Shiffman et al., 2010</xref>). The findings of <xref ref-type="bibr" rid="B41">Tian et al. (2018)</xref> firstly lay a basis for the use of emricasan to treat IS.</p>
<p>This study has the following limitations. Firstly, this study was conducted basing on bioinformatic and correlational analyses, and differences in microarray platforms, blood collection, and RNA extraction methods, statistical methods could produce potential bias for the results. Besides, the size of the datasets used in this study might not be large enough to generate very powerful results. More large cohorts of AD, IS patients are needed, and future cellular or animal experiments are expected to provide convincing proofs for our results. Therefore, the above findings should be taken with carefulness. Nevertheless, this study provides new insights into the shared pathogenesis behind AD and IS, suggesting the important role of immune changes and several promising genes for the onset and development of these two diseases.</p>
</sec>
<sec id="S5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/<xref ref-type="supplementary-material" rid="DS1">Supplementary material</xref>.</p>
</sec>
<sec id="S6">
<title>Author contributions</title>
<p>WL: methodology, software, investigation, visualization, and writing&#x2014;original draft. MW: methodology, validation, and writing&#x2014;review and editing. YS: investigation and data curation. X-ZY: writing&#x2014;review and editing, supervision, project administration, and funding acquisition. All authors contributed to the article and approved the submitted version.</p>
</sec>
</body>
<back>
<sec id="S7" sec-type="funding-information">
<title>Funding</title>
<p>This work was supported by the National Natural Science Foundation of China (31900481).</p>
</sec>
<sec id="S8" sec-type="COI-statement">
<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 id="S9" sec-type="disclaimer">
<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="S10" sec-type="supplementary-material">
<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/fnins.2022.1008752/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fnins.2022.1008752/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Data_Sheet_1.docx" id="DS1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document" xmlns:xlink="http://www.w3.org/1999/xlink"/>
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<fn-group>
<fn id="footnote1"><label>1</label><p><ext-link ext-link-type="uri" xlink:href="http://www.ncbi.nlm.nih.gov/geo/">http://www.ncbi.nlm.nih.gov/geo/</ext-link></p></fn>
<fn id="footnote2"><label>2</label><p><ext-link ext-link-type="uri" xlink:href="http://www.genome.jp/kegg/">http://www.genome.jp/kegg/</ext-link></p></fn>
<fn id="footnote3"><label>3</label><p><ext-link ext-link-type="uri" xlink:href="https://apps.cytoscape.org/apps/cytohubba">https://apps.cytoscape.org/apps/cytohubba</ext-link></p></fn>
<fn id="footnote4"><label>4</label><p><ext-link ext-link-type="uri" xlink:href="https://go.drugbank.com/releases/latest">https://go.drugbank.com/releases/latest</ext-link></p></fn>
</fn-group>
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