Abstract The risk of Alzheimer’s disease (AD) in women is about 2 times greater than in men. The estrogen hypothesis is being accepted as the essential sex factor causing the sex difference in AD. Also, the recent meta-analysis using large-scale medical records data indicated estrogen replacement therapy. However, the underlying molecular targets and mechanisms explaining this sex difference in AD disease development remain unclear. In this study, we identified that estrogen treatment can strongly inhibition of neuro-inflammation signaling targets, using the systems pharmacology model; and identified ESR1/ESR2 (the receptors of estrogen) are topologically close to the neuroinflammation biomarker genes using signaling network analysis. Moreover, the estrogen level in women decreased to an extremely lower level than in men after age 55. Pooling together the multiple pieces of evidence, it is concluded that the loss of estrogen unleashing neuro-inflammation increases the women’s risk of Alzheimer’s disease. These analysis results provide novel supporting evidence explaining the potential mechanism of the anti-neuroinflammation role of estrogen causing the sex difference of AD. Medications boosting the direct downstream signaling of ESR1/ESR2, or inhibiting upstream signaling targets of neuroinflammation, like JAK2 inhibitors, on the signaling network can be potentially effective or synergistic combined with estrogen for AD prevention and treatment.

Loss of estrogen unleashing neuro-inflammation increases the risk of Alzheimer’s disease in women