BACKGROUND: Alzheimer's disease (AD) is a progressive neurodegenerative disorder that disproportionately affects women. However, the molecular mechanisms underlying sex differences in AD remain poorly understood. METHODS: In this study, we curated 3,302,741 single-nucleus or single-cell profiles from 603 samples (296 female and 307 male samples; 339 AD and 264 normal) across 10 cohorts to investigate sex-specific differences in the brain of individuals with and without AD. Focusing on six major cell types, we applied non-negative matrix factorization at the sample level to identify cell type -specific meta-programs (MPs). These MPs consist of mutually exclusive and functionally orthogonal gene set, representing different functional states of brain cells. Using these MPs, we characterized cellular states (CSs) across four sex-disease groups. We then examined sex differences in both AD and normal brains at the level of cellular states, with emphasis on metabolism, cell-cell communication, senescence, and disease relevance. RESULTS: Metabolic profiling revealed that inflammatory homeostasis is maintained through distinct metabolic pathways in males and females. Cell-cell communication analysis showed that the same cellular state interaction network is linked to AD pathology through sex-biased ligand-receptor pairs. Disease association analyses further indicated that polygenic risk for AD is not uniformly distributed across cell states, but instead shows sex-biased enrichment in specific neuronal and glial circuits. Senescence analysis suggested that males and females exhibit distinct CS-specific signatures of cellular senescence in AD. Additionally, we identified oligodendrocytes MP13 and excitatory neuron MP1 as sex-biased meta-programs. CONCLUSIONS: Overall, our study identified sex-biased MPs across six major cell types and revealed that females displayed greater vulnerability to Aβ and tau pathology, while males carry a higher genetic risk burdens. These findings highlight cellular state heterogeneity underlying sex differences in AD.
Wu et al. (2026) studied this question.