Reviewer #2 (Public Review):
The authors' manuscript has several strengths. First, the authors consider multiple relevant levels of biology including genomics, transcriptomics, structural and functional neuroimaging, cognitive neuroscience, and psychological/environmental factors. Such an approach is often necessary to deconvolute the complexities of psychiatric phenotypes. The authors have taken careful steps to think about potential confounds (e.g., ancestry for PRS) and to try to define their phenotypes (e.g., psychological resilience and biological aging) as best as they can, given the data they have access to from the ABCD study. The manuscript is well written overall.
My main concerns relate to core assumptions and techniques that underlie the premise of the study. First, while there is comorbidity between AD and MDD, a causal relationship between the two (in either direction) is not established. Though MDD often predates AD, this is to be expected given MDD's high lifetime prevalence (15-20% of the general population) and typical age of onset before age 65. Because AD typically presents late in life (>65 years of age), MDD will, by definition, usually predate AD. While new onset, late life MDD is often the first presenting symptom of AD/Parkinson's disease and other neurodegenerative conditions, it is also not clear that this is the same disorder as idiopathic MDD.
To this point, two genetic tools can help us determine the biological relationship between MDD/AD, genetic correlation and Mendelian Randomization. Using the data from the MDD PRS used in this analysis, the Supplementary Table 3 from the Howard et al. 2019 paper (https://doi.org/10.1038/s41593-018-0326-7) reveals a genetic correlation of -0.041 between the two. This indicates essentially no strong relationship between the MDD/AD (perhaps even a slightly inverse relationship). Mendelian Randomization studies in addition to the Howard et al paper (https://doi.org/10.1212/WNL.0000000000010463) find no causal role for MDD towards AD and vice versa. Thus, their comorbidity is likely mediated by additional factors. Additionally, while stress contributes to AD pathophysiology, AD is strongly genetic and, given its late onset, it is unclear how genetic risk for AD would meaningfully impact the psychological resilience of a 9 to 10-year-old.
My second concern is regarding the statement "adolescents at genetic risk for AD/MDD" when describing the sample. Per Howard et al 2019 out-of-sample prediction testing, the MDD PRS used by the authors explains between 1.5-3.2% of the phenotypic variance in MDD when used on a sample such as ABCD. MDD PRS is in its infancy and cannot reliably be used to identify individuals at high risk of MDD given that even individuals in the top 10th percentile of MDD PRS have an odds ratio for depression of only ~2.4. We would expect 90 or so individuals in this cohort to fall into this group leaving significant concerns about statistical power and the potential for false positive discoveries. While the AD PRS is significantly further along compared to MDD because of AD's simpler genetic architecture, the same concerns apply as, outside of APOE, the AD PRS does not capture the majority of phenotypic variance in AD.
The authors state that they wish to examine the effects of perinatal adversity directly/indirectly on biological aging and then assess the potential effects of biological aging on resilience. The authors use of pubertal age as a measure of accelerated aging is understandable given the data available, though not ideal. There are well validated measures of biological age such as Horvath's epigenetic clock. While advanced pubertal age is technically a form of accelerated aging, the majority of pubertal age as a phenotype is not likely to be explained by perinatal adversity. Rather, a combination of unmeasured variables including genetic variation, dietary factors, environmental exposures (endocrine disrupting chemicals), and obesity that play a substantial role in determining pubertal age. Childhood stress has been shown to have relatively small effects on pubertal age (d = -0.1) (10.1037/bul0000270).
Lastly, the authors employ the use of an as of yet unpublished technique to map neurotransmitters density to structural data from neuroimaging studies. While this technique is certainly interesting, its face validity is not clear given that many of the receptor-disease associations reported in the original preprint do not line up with what we know about the biology of these disorders from strong human genetics data or current FDA approved treatments. Moreover, the authors mention "Excitation/Inhibition" imbalance but the technique used appears to only include glutamate data from one receptor type, mGluR5. This may not be an adequate measure of E/I imbalance, despite there being a statistically significant finding.
Measuring both transcriptional output from GWAS loci and gene expression correlates from MRI data is a noisy and challenging prospect. Indeed, recent research has shown poor correlation between gene expression and neurotransmitter receptor density.(https://doi.org/10.1016/j.neuroimage.2022.119671).
Thus, fundamental aspects of this manuscript including the use of MDD PRS to identify "at risk" individuals, the unclear link between AD and adolescent psychological resilience, the use of prepubertal age as a measure of biological age, and the limited conclusions that can be drawn from the gene expression and receptor density technique limits confidence in the results as presented.

