LRP4 has diverse roles in neuromuscular junctions and in disorders of the nervous system, including Alzheimer’s disease and amyotrophic lateral sclerosis36, STX4 is implicated in synaptic growth and plasticity37, and MMAB, which catalyses the final step in the conversion of cobalamin (vitamin B12) into adenosylcobalamin (biologically active coenzyme B12), all of which have broad implications for brain function, including those in relation to methylmalonic acidaemia38. This evidence concerns the gene LRP4 and early-onset autosomal dominant Alzheimer disease.