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Peripheral blood neuroendocrine hormones are associated with clinical indices of sport-related concussion. Sci Rep 2019; 9:18605. [PMID: 31819094 PMCID: PMC6901546 DOI: 10.1038/s41598-019-54923-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to evaluate the relationship between neuroendocrine hormones and clinical recovery following sport-related concussion (SRC). Ninety-five athletes (n = 56 male, n = 39 female) from a cohort of 11 interuniversity sport teams at a single institution provided blood samples; twenty six athletes with SRC were recruited 2–7 days post-injury, and 69 uninjured athletes recruited prior to the start of their competitive season. Concentrations of seven neuroendocrine hormones were quantitated in either plasma or serum by solid-phase chemiluminescent immunoassay. The Sport Concussion Assessment Tool version 5 (SCAT-5) was used to evaluate symptoms at the time of blood sampling in all athletes. Multivariate partial least squares (PLS) analyses were used to evaluate the relationship between blood hormone concentrations and both (1) time to physician medical clearance and (2) initial symptom burden. A negative relationship was observed between time to medical clearance and both dehydroepiandrosterone sulfate (DHEA-S) and progesterone; a positive relationship was found between time to medical clearance and prolactin. Cognitive, somatic, fatigue and emotion symptom clusters were associated with distinct neuroendocrine signatures. Perturbations to the neuroendocrine system in athletes following SRC may contribute to initial symptom burden and longer recovery times.
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52
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Lesman-Segev OH, La Joie R, Stephens ML, Sonni I, Tsai R, Bourakova V, Visani AV, Edwards L, O'Neil JP, Baker SL, Gardner RC, Janabi M, Chaudhary K, Perry DC, Kramer JH, Miller BL, Jagust WJ, Rabinovici GD. Tau PET and multimodal brain imaging in patients at risk for chronic traumatic encephalopathy. Neuroimage Clin 2019; 24:102025. [PMID: 31670152 PMCID: PMC6831941 DOI: 10.1016/j.nicl.2019.102025] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To characterize individual and group-level neuroimaging findings in patients at risk for Chronic Traumatic Encephalopathy (CTE). METHODS Eleven male patients meeting criteria for Traumatic Encephalopathy Syndrome (TES, median age: 64) underwent neurologic evaluation, 3-Tesla MRI, and PET with [18F]-Flortaucipir (FTP, tau-PET) and [11C]-Pittsburgh compound B (PIB, amyloid-PET). Six patients underwent [18F]-Fluorodeoxyglucose-PET (FDG, glucose metabolism). We assessed imaging findings at the individual patient level, and in group-level comparisons with modality-specific groups of cognitively normal older adults (CN). Tau-PET findings in patients with TES were also compared to a matched group of patients with mild cognitive impairment or dementia due to Alzheimer's disease (AD). RESULTS All patients with TES sustained repetitive head injury participating in impact sports, ten in American football. Three patients met criteria for dementia and eight had mild cognitive impairment. Two patients were amyloid-PET positive and harbored the most severe MRI atrophy, FDG hypometabolism, and FTP-tau PET binding. Among the nine amyloid-negative patients, tau-PET showed either mildly elevated frontotemporal binding, a "dot-like" pattern, or no elevated binding. Medial temporal FTP was mildly elevated in a subset of amyloid-negative patients, but values were considerably lower than in AD. Voxelwise analyses revealed a convergence of imaging abnormalities (higher FTP binding, lower FDG, lower gray matter volumes) in frontotemporal areas in TES compared to controls. CONCLUSIONS Mildly elevated tau-PET binding was observed in a subset of amyloid-negative patients at risk for CTE, in a distribution consistent with CTE pathology stages III-IV. FTP-PET may be useful as a biomarker of tau pathology in CTE but is unlikely to be sensitive to early disease stages.
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Affiliation(s)
- Orit H Lesman-Segev
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States.
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Melanie L Stephens
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Ida Sonni
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Richard Tsai
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Viktoriya Bourakova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Adrienne V Visani
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - James P O'Neil
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Suzanne L Baker
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Raquel C Gardner
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States; San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, United States
| | - Mustafa Janabi
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
| | - Kiran Chaudhary
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - David C Perry
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States
| | - William J Jagust
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States; Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720, United States
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, United States; Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, United States; Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States; Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720, United States
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53
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Netto JP, Iliff J, Stanimirovic D, Krohn KA, Hamilton B, Varallyay C, Gahramanov S, Daldrup-Link H, d'Esterre C, Zlokovic B, Sair H, Lee Y, Taheri S, Jain R, Panigrahy A, Reich DS, Drewes LR, Castillo M, Neuwelt EA. Neurovascular Unit: Basic and Clinical Imaging with Emphasis on Advantages of Ferumoxytol. Neurosurgery 2019; 82:770-780. [PMID: 28973554 DOI: 10.1093/neuros/nyx357] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/27/2017] [Indexed: 12/11/2022] Open
Abstract
Physiological and pathological processes that increase or decrease the central nervous system's need for nutrients and oxygen via changes in local blood supply act primarily at the level of the neurovascular unit (NVU). The NVU consists of endothelial cells, associated blood-brain barrier tight junctions, basal lamina, pericytes, and parenchymal cells, including astrocytes, neurons, and interneurons. Knowledge of the NVU is essential for interpretation of central nervous system physiology and pathology as revealed by conventional and advanced imaging techniques. This article reviews current strategies for interrogating the NVU, focusing on vascular permeability, blood volume, and functional imaging, as assessed by ferumoxytol an iron oxide nanoparticle.
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Affiliation(s)
- Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, Portland, Oregon.,Department of Neuroradiology, Oregon Health & Science University, Portland, Oregon
| | - Jeffrey Iliff
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Danica Stanimirovic
- Human Health Therapeutics Portfolio, National Research Council of Canada, Ottawa, Ontario, Canada
| | - Kenneth A Krohn
- Department of Radiology, University of Washington, Seattle, Washington.,Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Bronwyn Hamilton
- Department of Neuroradiology, Oregon Health & Science University, Portland, Oregon
| | - Csanad Varallyay
- Department of Neurology, Oregon Health & Science University, Portland, Oregon.,Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Seymur Gahramanov
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
| | | | - Christopher d'Esterre
- Department of Radiology, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
| | - Berislav Zlokovic
- Zikha Neurogenetic Institute, University of Southern California, Los Angeles, California
| | - Haris Sair
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Yueh Lee
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Saeid Taheri
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Rajan Jain
- Department of Radiology and Neurosurgery, New York University School of Medicine, New York, New York
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel S Reich
- Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Lester R Drewes
- Department of Biomedical Sciences, University of Minnesota, Duluth, Minnesota
| | - Mauricio Castillo
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon.,Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon.,Portland Veterans Affairs Medical Center, Portland, Oregon
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54
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Katsumoto A, Takeuchi H, Tanaka F. Tau Pathology in Chronic Traumatic Encephalopathy and Alzheimer's Disease: Similarities and Differences. Front Neurol 2019; 10:980. [PMID: 31551922 PMCID: PMC6748163 DOI: 10.3389/fneur.2019.00980] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) has been associated with the development of Alzheimer's disease (AD) because these conditions share common pathological hallmarks: amyloid-β and hyperphosphorylated tau accumulation. However, given recent data it is uncertain if a history of TBI leads to the development of AD. Moreover, chronic traumatic encephalopathy (CTE), caused by repetitive mild TBI and characterized by progressive neurodegeneration with hyperphosphorylated tau, has come to be recognized as distinct from AD. Therefore, it is important to elucidate the clinical outcomes and molecular mechanisms underlying tau pathology following TBI. We summarize the histopathological features and clinical course of TBI in CTE, comparing the tau pathology with that in AD. Following brain injury, diffuse axonal injury, and hyperphosphorylated tau aggregates are observed within a shorter period than in AD. Hyperphosphorylated tau deposition usually begins in the perivascular area of the sulci in the cerebral cortex, then spreads unevenly in the cortex in CTE, while AD shows diffuse distribution of hyperphosphorylated tau in the cortical areas. We also highlight the molecular profile of tau and the implications of tau progression throughout the brain in both diseases. Tau contains phosphorylation sites common to both conditions. In particular, phosphorylation at Thr231 triggers a conformational change to the toxic cis form of tau, which is suggested to drive neurodegeneration. Although the mechanism of rapid tau accumulation remains unknown, the structural diversity of tau might result in these different outcomes. Finally, future perspectives on CTE in terms of tau reduction are discussed.
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Affiliation(s)
- Atsuko Katsumoto
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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55
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Omalu B, Small GW, Bailes J, Ercoli LM, Merrill DA, Wong KP, Huang SC, Satyamurthy N, Hammers JL, Lee J, Fitzsimmons RP, Barrio JR. Postmortem Autopsy-Confirmation of Antemortem [F-18]FDDNP-PET Scans in a Football Player With Chronic Traumatic Encephalopathy. Neurosurgery 2019; 82:237-246. [PMID: 29136240 DOI: 10.1093/neuros/nyx536] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/26/2017] [Indexed: 12/14/2022] Open
Abstract
Currently, only presumptive diagnosis of chronic traumatic encephalopathy (CTE) can be made in living patients. We present a modality that may be instrumental to the definitive diagnosis of CTE in living patients based on brain autopsy confirmation of [F-18]FDDNP-PET findings in an American football player with CTE. [F-18]FDDNP-PET imaging was performed 52 mo before the subject's death. Relative distribution volume parametric images and binding values were determined for cortical and subcortical regions of interest. Upon death, the brain was examined to identify the topographic distribution of neurodegenerative changes. Correlation between neuropathology and [F-18]FDDNP-PET binding patterns was performed using Spearman rank-order correlation. Mood, behavioral, motor, and cognitive changes were consistent with chronic traumatic myeloencephalopathy with a 22-yr lifetime risk exposure to American football. There were tau, amyloid, and TDP-43 neuropathological substrates in the brain with a differential topographically selective distribution. [F-18]FDDNP-PET binding levels correlated with brain tau deposition (rs = 0.59, P = .02), with highest relative distribution volumes in the parasagittal and paraventricular regions of the brain and the brain stem. No correlation with amyloid or TDP-43 deposition was observed. [F-18]FDDNP-PET signals may be consistent with neuropathological patterns of tau deposition in CTE, involving areas that receive the maximal shearing, angular-rotational acceleration-deceleration forces in American football players, consistent with distinctive and differential topographic vulnerability and selectivity of CTE beyond brain cortices, also involving midbrain and limbic areas. Future studies are warranted to determine whether differential and selective [F-18]FDDNP-PET may be useful in establishing a diagnosis of CTE in at-risk patients.
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Affiliation(s)
- Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, Sacramento, California
| | - Gary W Small
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles, California
| | - Julian Bailes
- Department of Neurosurgery, North Shore University Health System and University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - Linda M Ercoli
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles, California
| | - David A Merrill
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles, California
| | - Koon-Pong Wong
- Department of Molecular and Medical Pharmacology, The David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sung-Cheng Huang
- Department of Molecular and Medical Pharmacology, The David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nagichettiar Satyamurthy
- Department of Molecular and Medical Pharmacology, The David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - John Lee
- Department of Pathology, North Shore University Health System and University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | | | - Jorge R Barrio
- Department of Molecular and Medical Pharmacology, The David Geffen School of Medicine, University of California, Los Angeles, California
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56
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Dallmeier JD, Meysami S, Merrill DA, Raji CA. Emerging advances of in vivo detection of chronic traumatic encephalopathy and traumatic brain injury. Br J Radiol 2019; 92:20180925. [PMID: 31287716 PMCID: PMC6732918 DOI: 10.1259/bjr.20180925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder that is of epidemic proportions in contact sports athletes and is linked to subconcussive and concussive repetitive head impacts (RHI). Although postmortem analysis is currently the only confirmatory method to diagnose CTE, there has been progress in early detection techniques of fluid biomarkers as well as in advanced neuroimaging techniques. Specifically, promising new methods of diffusion MRI and radionucleotide PET scans could aid in the early detection of CTE.The authors examine early detection methods focusing on various neuroimaging techniques. Advances in structural and diffusion MRI have demonstrated the ability to measure volumetric and white matter abnormalities associated with CTE. Recent studies using radionucleotides such as flortaucipir and 18F-FDDNP have shown binding patterns that are consistent with the four stages of neurofibrillary tangle (NFT) distribution postmortem. Additional research undertakings focusing on fMRI, MR spectroscopy, susceptibility-weighted imaging, and singlephoton emission CT are also discussed as are advanced MRI methods such as diffusiontensor imaging and arterial spin labeled. Neuroimaging is fast becoming a key instrument in early detection and could prove essential for CTE quantification. This review explores a global approach to in vivo early detection.Limited data of in vivo CTE biomarkers with postmortem confirmation are available. While some data exist, they are limited by selection bias. It is unlikely that a single test will be sufficient to properly diagnosis and distinguish CTE from other neurodegenerative diseases such as Alzheimer disease or Frontotemporal Dementia. However, with a combination of fluid biomarkers, neuroimaging, and genetic testing, early detection may become possible.
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Affiliation(s)
- Julian D. Dallmeier
- Department of Neuroscience, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Somayeh Meysami
- Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David A. Merrill
- Psychiatry and Biobehavioral Sciences and Pacific Brain Health Center, UCLA and Pacific Neuroscience Institute, Los Angeles, California, United States
| | - Cyrus A. Raji
- Radiology, Washington University Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
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57
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Schneider AL, Selvin E, Liang M, Latour L, Turtzo LC, Koton S, Coresh J, Mosley T, Whitlow CT, Zhou Y, Wong DF, Ling G, Gottesman RF. Association of Head Injury with Brain Amyloid Deposition: The ARIC-PET Study. J Neurotrauma 2019; 36:2549-2557. [PMID: 30963804 PMCID: PMC6909743 DOI: 10.1089/neu.2018.6213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Our objective was to examine associations of head injury with total and regional brain amyloid deposition. We performed cross-sectional analyses of 329 non-demented participants (81 with prior head injury) in the Atherosclerosis Risk in Communities-Positron Emission Tomography (ARIC-PET) Study who underwent 18-florbetapir PET imaging in 2012-2014. A history of head injury was defined by self-report or emergency department/hospitalization International Classification of Diseases, Ninth Revision codes. Generalized linear regression models adjusted for demographic, socioeconomic, and dementia/cardiovascular risk factors were used to estimate prevalence ratios (PRs; 95% confidence intervals [CIs]) for elevated (> 1.2) global and regional standard uptake value ratios (SUVRs). Mean age of participants was 76 years, 57% were women, and 43% were black. Head injury was associated with increased prevalence of elevated SUVR >1.2 globally (PR: 1.31; 95% CI: 1.19-1.57), as well as in the orbitofrontal cortex (PR: 1.23); (95% CI: 1.04-1.46), prefrontal cortex (PR: 1.18; 95% CI: 1.00-1.39), superior frontal cortex (PR: 1.24; 95% CI: 1.05-1.48), and posterior cingulate (PR: 1.26; 95% CI: 1.04-1.52). There also was evidence for a dose-response relationship, whereby a history of ≥1 head injury was associated with elevated SUVR >1.2 in the prefrontal cortex and superior frontal cortex compared with persons with a history of one head injury (all, p < 0.05). In conclusion, head injury was associated with increased amyloid deposition globally and in the frontal cortex and posterior cingulate, with suggestion of a dose-response association of head injuries with beta-amyloid deposition. Further work is needed to determine if increased amyloid deposition contributes to dementia in this population.
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Affiliation(s)
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Menglu Liang
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence Latour
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | | | - Silvia Koton
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
- Department of Nursing, Tel Aviv University, Tel Aviv, Israel
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Christopher T. Whitlow
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Yun Zhou
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dean F. Wong
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Geoffrey Ling
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Department of Neurology, Uniformed Services University, Bethesda, Maryland
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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58
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Okonkwo DO, Puffer RC, Minhas DS, Beers SR, Edelman KL, Sharpless J, Laymon CM, Lopresti BJ, Benso S, Puccio AM, Pathak S, Ikonomovic MD, Mettenburg JM, Schneider W, Mathis CA, Mountz JM. [ 18F]FDG, [ 11C]PiB, and [ 18F]AV-1451 PET Imaging of Neurodegeneration in Two Subjects With a History of Repetitive Trauma and Cognitive Decline. Front Neurol 2019; 10:831. [PMID: 31428041 PMCID: PMC6688244 DOI: 10.3389/fneur.2019.00831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Trauma-related neurodegeneration can be difficult to differentiate from multifactorial neurodegenerative syndromes, both clinically and radiographically. We have initiated a protocol for in vivo imaging of patients with suspected TBI-related neurodegeneration utilizing volumetric MRI and PET studies, including [18F]FDG indexing cerebral glucose metabolism, [11C]PiB for Aβ deposition, and [18F]AV-1451 for tau deposition. Objective: To present results from a neuroimaging protocol for in vivo evaluation of TBI-related neurodegeneration in patients with early-onset cognitive decline and a history of TBI. Methods: Patients were enrolled in parallel TBI studies and underwent a comprehensive neuropsychological test battery as well as an imaging protocol of volumetric MRI and PET studies. Findings from two patients were compared with two age-matched control subjects without a history of TBI. Results: Both chronic TBI patients demonstrated cognitive deficits consistent with early-onset dementia on neuropsychological testing, and one patient self-reported a diagnosis of probable early-onset AD. Imaging studies demonstrated significant [18F]AV-1451 uptake in the bilateral occipital lobes, substantial [11C]PiB uptake throughout the cortex in both TBI patients, and abnormally decreased [18F]FDG uptake in the posterior temporoparietal areas of the brain. One TBI patient also had subcortical volume loss. Control subjects demonstrated no appreciable [18F]AV-1451 or [11C]PiB uptake, had normal cortical volumes, and had normal cognition profiles on neuropsychological testing. Conclusions: In the two patients presented, the [11C]PiB and [18F]FDG PET scans demonstrate uptake patterns characteristic of AD. [11C]PiB PET scans showed widespread neocortical uptake with less abnormal uptake in the occipital lobes, whereas there was significant [18F]AV-1451 uptake in both occipital lobes.
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Affiliation(s)
- David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Ross C Puffer
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Davneet S Minhas
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kathryn L Edelman
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Jane Sharpless
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Charles M Laymon
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian J Lopresti
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven Benso
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Ava M Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sudhir Pathak
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Milos D Ikonomovic
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph M Mettenburg
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Walter Schneider
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chester A Mathis
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - James M Mountz
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
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59
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Hirad AA, Bazarian JJ, Merchant-Borna K, Garcea FE, Heilbronner S, Paul D, Hintz EB, van Wijngaarden E, Schifitto G, Wright DW, Espinoza TR, Mahon BZ. A common neural signature of brain injury in concussion and subconcussion. SCIENCE ADVANCES 2019; 5:eaau3460. [PMID: 31457074 PMCID: PMC6685720 DOI: 10.1126/sciadv.aau3460] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
The midbrain is biomechanically susceptible to force loading from repetitive subconcussive head impacts (RSHI), is a site of tauopathy in chronic traumatic encephalopathy (CTE), and regulates functions (e.g., eye movements) often disrupted in concussion. In a prospective longitudinal design, we demonstrate there are reductions in midbrain white matter integrity due to a single season of collegiate football, and that the amount of reduction in midbrain white matter integrity is related to the amount of rotational acceleration to which players' brains are exposed. We then replicate the observation of reduced midbrain white matter integrity in a retrospective cohort of individuals with frank concussion, and further show that variance in white matter integrity is correlated with levels of serum-based tau, a marker of blood-brain barrier disruption. These findings mean that noninvasive structural MRI of the midbrain is a succinct index of both clinically silent white matter injury as well as frank concussion.
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Affiliation(s)
- Adnan A. Hirad
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Clinical and Translational Science, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Kian Merchant-Borna
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Frank E. Garcea
- Center for Visual Sciences, University of Rochester, Rochester, NY 14642, USA
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
| | - Sarah Heilbronner
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - David Paul
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Eric B. Hintz
- Division of Neurosurgery, San Antonio Military Medical Center, San Antonio, TX 78234, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Tamara R. Espinoza
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bradford Z. Mahon
- Center for Visual Sciences, University of Rochester, Rochester, NY 14642, USA
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
- Carnegie Mellon Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Abstract
PURPOSE Caution is warranted when in vitro results of biomarkers labeled with tritium were perfunctorily used to criticize in vivo data and conclusions derived with the same tracers labeled with positron emitters and positron emission tomography (PET). This concept is illustrated herein with the PET utilization of [18F]FDDNP, a biomarker used for in vivo visualization of β-amyloid and tau protein neuroaggregates in humans, later contradicted by in vitro data reported with [3H]FDDNP. In this investigation, we analyze the multiple factors involved in the experimental design of the [3H]FDDNP in vitro study that led to the erroneous interpretation of results. PROCEDURE The present work describes full details on the synthesis, characterization, purity, and kinetics of radiolytic stability of [3H]FDDNP. The optimal in vitro conditions for detecting tau and β-amyloid protein aggregates using macroscopic and microscopic autoradiography with both [18F]FDDNP and [3H]FDDNP are also presented. Macroscopic autoradiography determinations were performed with [3H]FDDNP of verified purity using established methods described previously in the literature. RESULTS The autoradiographic results using phosphate buffered saline (PBS) with less than 1 % EtOH and pure, freshly prepared [3H]FDDNP compared with the earlier reported data using [3H]FDDNP of undetermined purity and PBS in 10 % EtOH demonstrate the critical importance of rigorous experimental design for meaningful in vitro determinations. [18F]FDDNP binding to both amyloid plaques and neurofibrillary tangles was confirmed by amyloid and tau immunohistochemical stains of adjacent tissues. CONCLUSIONS This work illustrates the sensitivity of in vitro techniques to various experimental conditions and underscores that conclusions obtained from translational in vitro to in vivo determinations must always be performed with extreme care to avoid wrong interpretations that can be perpetuated and assumed without further analysis.
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Van Ommeren R, Hazrati LN. Pathological Assessment of Chronic Traumatic Encephalopathy: Review of Concepts and Methodology. Acad Forensic Pathol 2019; 8:555-564. [PMID: 31240059 DOI: 10.1177/1925362118797729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/01/2018] [Indexed: 11/17/2022]
Abstract
Chronic traumatic encephalopathy (CTE) has become a topic of considerable interest in recent years, with wide-ranging implications for athletes, military members, and other groups exposed to frequent concussive or subconcussive head trauma. The condition has been subject to intensive neuropathological characterization by various groups, with assessment methodologies and staging criteria proposed. Clinical characterization of symptoms has also been performed, but has not yet been definitively formalized. While efforts are underway to develop in vivo markers of tauopathies including CTE, these remain experimental at this time, necessitating postmortem analysis for definitive diagnosis. The putative link between development of cognitive and behavioral dysfunction and neuropathological findings of CTE may prompt requests for postmortem assessment in the forensic setting. Here, we review current concepts in CTE research, describe histopathological findings in CTE, and describe methodologies for pathological assessment of CTE which may be useful to the forensic pathologist.
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Perani D, Iaccarino L, Lammertsma AA, Windhorst AD, Edison P, Boellaard R, Hansson O, Nordberg A, Jacobs AH. A new perspective for advanced positron emission tomography-based molecular imaging in neurodegenerative proteinopathies. Alzheimers Dement 2019; 15:1081-1103. [PMID: 31230910 DOI: 10.1016/j.jalz.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/21/2019] [Accepted: 02/20/2019] [Indexed: 12/12/2022]
Abstract
Recent studies in neurodegenerative conditions have increasingly highlighted that the same neuropathology can trigger different clinical phenotypes or, vice-versa, that similar phenotypes can be triggered by different neuropathologies. This evidence has called for the adoption of a pathology spectrum-based approach to study neurodegenerative proteinopathies. These conditions share brain deposition of abnormal protein aggregates, leading to aberrant biochemical, metabolic, functional, and structural changes. Positron emission tomography (PET) is a well-recognized and unique tool for the in vivo assessment of brain neuropathology, and novel PET techniques are emerging for the study of specific protein species. Today, key applications of PET range from early research and clinical diagnostic tools to their use in clinical trials for both participants screening and outcome evaluation. This position article critically reviews the role of distinct PET molecular tracers for different neurodegenerative proteinopathies, highlighting their strengths, weaknesses, and opportunities, with special emphasis on methodological challenges and future applications.
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Affiliation(s)
- Daniela Perani
- Vita-Salute San Raffaele University, Nuclear Medicine Unit San Raffaele Hospital, Division of Neuroscience San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University, Nuclear Medicine Unit San Raffaele Hospital, Division of Neuroscience San Raffaele Scientific Institute, Milan, Italy
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Edison
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK; Neurology Imaging Unit, Imperial College London, London, UK
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research, Stockholm, Sweden
| | - Andreas H Jacobs
- European Institute for Molecular Imaging, University of Münster, Münster, Germany; Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany.
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Spader HS, Dean DC, LaFrance WC, Raukar NP, Cosgrove GR, Eyerly-Webb SA, Ellermeier A, Correia S, Deoni SCL, Rogg J. Prospective study of myelin water fraction changes after mild traumatic brain injury in collegiate contact sports. J Neurosurg 2019; 130:1321-1329. [PMID: 29712487 PMCID: PMC6541528 DOI: 10.3171/2017.12.jns171597] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) in athletes, including concussion, is increasingly being found to have long-term sequelae. Current imaging techniques have not been able to identify early damage caused by mTBI that is predictive of long-term symptoms or chronic traumatic encephalopathy. In this preliminary feasibility study, the authors investigated the use of an emerging magnetic resonance imaging (MRI) technique, multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT), in visualizing acute and chronic white matter changes after mTBI in collegiate football and rugby players. METHODS This study was a nonrandomized, nonblinded prospective trial designed to quantify changes in the myelin water fraction (MWF), used as a surrogate MRI measure of myelin content, in a group of male collegiate football and rugby players, classified here as a contact sport player (CSP) cohort, at the time of mTBI diagnosis and 3 months after injury when the acute symptoms of the injury had resolved. In addition, differences in the MWF between the CSP cohort and a control cohort of noncontact sport players (NCSPs) were quantified. T-tests and a threshold-free cluster enhancement (TFCE) statistical analysis technique were used to identify brain structures with significant changes in the MWF between the CSP and NCSP cohorts and between immediately postinjury and follow-up images obtained in the CSP cohort. RESULTS Brain MR images of 12 right-handed male CSPs were analyzed and compared with brain images of 10 right-handed male NCSPs from the same institution. A comparison of CSP and NCSP baseline images using TFCE showed significantly higher MWFs in the bilateral basal ganglia, anterior and posterior corpora callosa, left corticospinal tract, and left anterior and superior temporal lobe (p < 0.05). At the 3-month follow-up examination, images from the CSP cohort still showed significantly higher MWFs than those identified on baseline images from the NCSP cohort in the bilateral basal ganglia, anterior and posterior corpora callosa, and left anterior temporal lobe, and also in the bilateral corticospinal tracts, parahippocampal gyrus, and bilateral juxtapositional (previously known as supplemental motor) areas (p < 0.05). In the CSP cohort, a t-test comparing the MWF at the time of injury and 3 months later showed a significant increase in the overall MWF at follow-up (p < 0.005). These increases were greatest in the bilateral basal ganglia and deep white matter. MWF decreases were seen in more superficial white matter (p < 0.005). CONCLUSIONS In this preliminary study, MWF was found to be increased in the brains of CSPs compared with the brains of controls, suggesting acute/chronic MWF alterations in CSPs from previous injuries. Increases in the MWF were also demonstrated in the brains of CSPs 3 months after the players sustained an mTBI. The full clinical significance of an increased MWF and whether this reflects axon neuropathology or disorderly remyelination leading to hypermyelination has yet to be determined.
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Affiliation(s)
- Heather S Spader
- 1Division of Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, and
| | - Douglas C Dean
- 2Waisman Center, University of Wisconsin-Madison, Wisconsin
| | - W Curt LaFrance
- 3Division of Neuropsychiatry and Behavioral Neurology
- 4Department of Psychiatry and Human Behavior
- 5Department of Neurology, and
| | | | - G Rees Cosgrove
- 10Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Stephen Correia
- 4Department of Psychiatry and Human Behavior
- 9Providence VA Medical Center, Providence; and
| | - Sean C L Deoni
- 11Advanced Baby Imaging Lab, School of Engineering, Brown University; and
- 12Department of Pediatrics, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; and
| | - Jeffrey Rogg
- 7Department of Diagnostic Imaging, Rhode Island Hospital
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Robinson ME, McKee AC, Salat DH, Rasmusson AM, Radigan LJ, Catana C, Milberg WP, McGlinchey RE. Positron emission tomography of tau in Iraq and Afghanistan Veterans with blast neurotrauma. Neuroimage Clin 2019; 21:101651. [PMID: 30642757 PMCID: PMC6412062 DOI: 10.1016/j.nicl.2019.101651] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/04/2018] [Accepted: 01/01/2019] [Indexed: 12/14/2022]
Abstract
Military personnel are often exposed to multiple instances of various types of head trauma. As a result, there has been increasing concern recently over identifying when head trauma has resulted in a brain injury and what, if any, long-term consequences those brain injuries may have. Efforts to develop equipment to protect soldiers from these long-term consequences will first require understanding the types of head trauma that are likely responsible. In this study, we sought to identify the types of head trauma most likely to lead to the deposition of tau, a protein identified as a likely indicator of long-term negative consequences of brain injury. To define the types of head trauma in a military population, we applied a factor analysis to interviews from a larger cohort of 428 Veterans enrolled in the Translational Research Center for Traumatic Brain Injury and Stress Disorders. Three factors were identified: Blast Exposure, Symptom Duration, and Blunt Concussion. Sixteen male Veterans from this study and one additional male civilian (aged 25-69, mean 35.2 years) underwent simultaneous positron emission tomography/magnetic resonance imaging using a tracer that binds to tau protein, the ligand T807/AV-1451 (Flortaucipir). Standard uptake value ratios to the isthmus of the cingulate were calculated from a 20-minute time frame 70 min post-injection. We found that tracer uptake throughout the brain was associated with Blast Exposure factor beta weights, but not with either Symptom Duration or Blunt Concussion. Associations with uptake were located primarily in the cerebellar, occipital, inferior temporal and frontal regions. The data suggest that in this small, relatively young cohort of Veterans, elevated T807/AV-1451 uptake is associated with exposure to blast neurotrauma. These findings are unanticipated, as they do not match histopathological descriptions of tau pathology associated with head trauma. Continued work will be necessary to understand the nature of the regional T807/AV-1451 uptake and any associations with clinical symptoms.
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Affiliation(s)
- Meghan E Robinson
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, United States; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States.
| | - Ann C McKee
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States; Department of Pathology and Laboratory Medicine, VA Boston Healthcare System, United States; CTE Program, Alzheimer's Disease Center, Boston University School of Medicine, United States; Department of Pathology, Boston University School of Medicine, United States
| | - David H Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, United States; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, United States; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, United States
| | - Ann M Rasmusson
- National Center for PTSD, Women's Health Science Division, Department of Veterans Affairs, VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States
| | - Lauren J Radigan
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, United States
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, United States
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, United States; Geriatric Research Education and Clinical Core, VA Boston Healthcare System, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, United States; Geriatric Research Education and Clinical Core, VA Boston Healthcare System, United States; Department of Psychiatry, Harvard Medical School, United States
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de la Monte SM. The Full Spectrum of Alzheimer's Disease Is Rooted in Metabolic Derangements That Drive Type 3 Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1128:45-83. [PMID: 31062325 PMCID: PMC9996398 DOI: 10.1007/978-981-13-3540-2_4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The standard practice in neuropathology is to diagnose Alzheimer's disease (AD) based on the distribution and abundance of neurofibrillary tangles and Aβ deposits. However, other significant abnormalities including neuroinflammation, gliosis, white matter degeneration, non-Aβ microvascular disease, and insulin-related metabolic dysfunction require further study to understand how they could be targeted to more effectively remediate AD. This review addresses non-Aβ and non-pTau AD-associated pathologies, highlighting their major features, roles in neurodegeneration, and etiopathic links to deficits in brain insulin and insulin-like growth factor signaling and cognitive impairment. The discussion delineates why AD with its most characteristic clinical and pathological phenotypic profiles should be regarded as a brain form of diabetes, i.e., type 3 diabetes, and entertains the hypothesis that type 3 diabetes is just one of the categories of insulin resistance diseases that can occur independently or overlap with one or more of the others, including type 2 diabetes, metabolic syndrome, and nonalcoholic fatty liver disease.
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Affiliation(s)
- Suzanne M de la Monte
- Departments of Neurology, Neuropathology, and Neurosurgery, Rhode Island Hospital, and the Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Pathology and Laboratory Medicine, Providence VA Medical Center, Providence, RI, USA.
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Alosco ML, Stern RA. The long-term consequences of repetitive head impacts: Chronic traumatic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:337-355. [PMID: 31753141 DOI: 10.1016/b978-0-12-804766-8.00018-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI). Although described in boxers for almost a century, scientific and public interest in CTE grew tremendously following a report of postmortem evidence of CTE in the first former professional American football player in 2005. Neuropathologic diagnostic criteria for CTE have been defined, with abnormal perivascular deposition of hyperphosphorylated tau at the sulcal depths as the pathognomonic feature. CTE can currently only be diagnosed postmortem, but clinical research criteria for the in vivo diagnosis of CTE have been proposed. The clinical phenotype of CTE is still ill-defined and there are currently no validated biomarkers to support an in-life diagnosis of "Probable CTE." Many knowledge gaps remain regarding the neuropathologic and clinical make-up of CTE. An increased understanding of CTE is critical given the millions that could potentially be impacted by this disease. This chapter describes the state of the literature on CTE. The historical origins of CTE are first presented, followed by a comprehensive description of the neuropathologic and clinical features. The chapter concludes with discussion on future research directions, emphasizing the importance of diagnosing CTE during life to facilitate development of preventative and intervention strategies.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States; Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States.
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Singla A, Leineweber B, Monteith S, Oskouian RJ, Tubbs RS. The anatomy of concussion and chronic traumatic encephalopathy: A comprehensive review. Clin Anat 2018; 32:310-318. [DOI: 10.1002/ca.23313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/09/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Amit Singla
- Swedish Neuroscience Institute; Seattle Washington
| | | | | | | | - R. Shane Tubbs
- Seattle Science Foundation; Seattle Washington
- Department of Anatomical Sciences; St. Georges University; St. Georges Grenada
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Lorigan J, Kearney H, Grimes B, Heffernan J, Beausang A, Cryan J, Farrell MA, Brett FM. Evaluation of the specificity of the central diagnostic criterion for chronic traumatic encephalopathy. Ir J Med Sci 2018; 188:993-998. [PMID: 30506345 DOI: 10.1007/s11845-018-1943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/22/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic traumatic encephalopathy (CTE) is a postmortem diagnosis. Consensus postmortem, but not antemortem, diagnostic criteria have been established. A key factor in these criteria is evidence of phosphorylated-tau (p-tau) around sulcal vessels in the cortex. However, this sign has been observed anecdotally in a diverse range of neurodegenerative diseases (NDD). We therefore hypothesise that this criterion may lack specificity. METHODS To test this, we assessed patients with NDD, but no documented history of brain trauma, for sulcal p-tau. Tissue was retrieved from Dublin Brain Bank (known NDD n = 17; control with no diagnosed NDD n = 6; CTE n = 1), and slides were prepared from three sites with a predilection for trauma: superior frontal gyrus, temporal pole, and superior temporal gyrus. We stained the resulting anonymised slides with both hemotoxylin and eosin (H&E) and p-tau. Three neuropathologists, blinded to the clinical history and neuropathological diagnosis in each instance, evaluated each case for sulcal p-tau. We calculated the interrater agreement, using Fleiss's kappa, and the specificity of this neuropathological sign. RESULTS Sulcal p-tau was highly specific to diagnosed CTE cases (specificity 0.98), with moderate interrater agreement (κ = 0.45). CONCLUSION In conclusion, therefore, we observed sulcal p-tau to be a sign highly specific to CTE when compared with NDD cases in the absence of head trauma.
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Affiliation(s)
- Jennifer Lorigan
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - Hugh Kearney
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Bryan Grimes
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Josephine Heffernan
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Alan Beausang
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Michael A Farrell
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Francesca M Brett
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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Long-Term Neuroimaging Findings in American Football Players: Systematic Review. World Neurosurg 2018; 120:e365-e379. [DOI: 10.1016/j.wneu.2018.08.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/11/2018] [Indexed: 01/08/2023]
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Snyder HM, Carare RO, DeKosky ST, de Leon MJ, Dykxhoorn D, Gan L, Gardner R, Hinds SR, Jaffee M, Lamb BT, Landau S, Manley G, McKee A, Perl D, Schneider JA, Weiner M, Wellington C, Yaffe K, Bain L, Pacifico AM, Carrillo MC. Military-related risk factors for dementia. Alzheimers Dement 2018; 14:1651-1662. [PMID: 30415806 PMCID: PMC6281800 DOI: 10.1016/j.jalz.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In recent years, there has been growing discussion to better understand the pathophysiological mechanisms of traumatic brain injury and post-traumatic stress disorder and how they may be linked to an increased risk of neurodegenerative diseases including Alzheimer's disease in veterans. METHODS Building on that discussion, and subsequent to a special issue of Alzheimer's & Dementia published in June 2014, which focused on military risk factors, the Alzheimer's Association convened a continued discussion of the scientific community on December 1, 2016. RESULTS During this meeting, participants presented and evaluated progress made since 2012 and identified outstanding knowledge gaps regarding factors that may impact veterans' risk for later life dementia. DISCUSSION The following is a summary of the invited presentations and moderated discussions of both the review of scientific understanding and identification of gaps to inform further investigations.
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Affiliation(s)
- Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA.
| | - Roxana O Carare
- Clinical Neuroanatomy, Equality and Diversity Lead, University of Southampton, Southampton, United Kingdom
| | - Steven T DeKosky
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Mony J de Leon
- Department of Psychiatry, New York University Medical Center, New York City, NY, USA
| | - Derek Dykxhoorn
- Department of Microbiology and Immunology, Miami University, Miami, FL, USA
| | - Li Gan
- Gladstone Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Raquel Gardner
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Sidney R Hinds
- Blast Injury Research Program Coordinating Office, United States Army Medical Research and Material Command, Frederick, MD, USA
| | - Michael Jaffee
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Bruce T Lamb
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA
| | - Susan Landau
- Helen Willis Neuroscience Institute, University of California, Berkley, Berkley, CA, USA
| | - Geoff Manley
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Ann McKee
- Department of Neurology and Pathology, Boston University, Boston, MA, USA
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, MD, USA
| | - Julie A Schneider
- Neurology Department, Rush University Medical Center, Chicago, IL, USA
| | - Michael Weiner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristine Yaffe
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Bain
- Independent Science Writer, Philadelphia, PA, USA
| | | | - Maria C Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
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Hsu ET, Gangolli M, Su S, Holleran L, Stein TD, Alvarez VE, McKee AC, Schmidt RE, Brody DL. Astrocytic degeneration in chronic traumatic encephalopathy. Acta Neuropathol 2018; 136:955-972. [PMID: 30194648 DOI: 10.1007/s00401-018-1902-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repeated head traumas. Using immunohistochemistry for glial fibrillary acidic protein as a marker, plus automated quantitative analysis, we examined the characteristics and extent of astrogliosis present in stage III and IV CTE, along with Alzheimer's disease (AD), and frontotemporal dementia (FTD) cases. Astrogliosis in CTE patients was more diffuse compared to that of AD and FTD patients, which was concentrated in the sulcal depths. Of 14 patients with CTE, 10 exhibited signs of a degenerating astrocyte pathology, characterized by beaded, broken astrocytic processes. This astrocytic degeneration was typically found to be diffuse throughout the white matter, although two cases demonstrated astrocytic degeneration in the gray matter. The degeneration was also observed in 2 of 3 AD and 2 of 3 FTD brains, with overall similar characteristics across diseases. There was minimal to no astrocytic degeneration in six age-matched controls with no neurodegenerative disease. We found that the extent of the white matter astrocytic degeneration was strongly correlated with the level of overall astrogliosis in both the white and gray matter. However, astrocytic degeneration was not correlated with the overall extent of tau pathology. Specifically, there was no correlation between levels of p-tau in the sulcal depths and astrocytic degeneration in the white matter adjacent to the sulcal depths. Thus, astrocytic degeneration and overall astrogliosis appear to represent distinct pathological features of CTE. Further investigation into these astroglial pathologies could provide new insights into underlying disease mechanisms and represent a potential target for in vivo assessment of CTE as well as other neurodegenerative disorders.
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ten Kate M, Ingala S, Schwarz AJ, Fox NC, Chételat G, van Berckel BNM, Ewers M, Foley C, Gispert JD, Hill D, Irizarry MC, Lammertsma AA, Molinuevo JL, Ritchie C, Scheltens P, Schmidt ME, Visser PJ, Waldman A, Wardlaw J, Haller S, Barkhof F. Secondary prevention of Alzheimer's dementia: neuroimaging contributions. Alzheimers Res Ther 2018; 10:112. [PMID: 30376881 PMCID: PMC6208183 DOI: 10.1186/s13195-018-0438-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Alzheimer's disease (AD), pathological changes may arise up to 20 years before the onset of dementia. This pre-dementia window provides a unique opportunity for secondary prevention. However, exposing non-demented subjects to putative therapies requires reliable biomarkers for subject selection, stratification, and monitoring of treatment. Neuroimaging allows the detection of early pathological changes, and longitudinal imaging can assess the effect of interventions on markers of molecular pathology and rates of neurodegeneration. This is of particular importance in pre-dementia AD trials, where clinical outcomes have a limited ability to detect treatment effects within the typical time frame of a clinical trial. We review available evidence for the use of neuroimaging in clinical trials in pre-dementia AD. We appraise currently available imaging markers for subject selection, stratification, outcome measures, and safety in the context of such populations. MAIN BODY Amyloid positron emission tomography (PET) is a validated in-vivo marker of fibrillar amyloid plaques. It is appropriate for inclusion in trials targeting the amyloid pathway, as well as to monitor treatment target engagement. Amyloid PET, however, has limited ability to stage the disease and does not perform well as a prognostic marker within the time frame of a pre-dementia AD trial. Structural magnetic resonance imaging (MRI), providing markers of neurodegeneration, can improve the identification of subjects at risk of imminent decline and hence play a role in subject inclusion. Atrophy rates (either hippocampal or whole brain), which can be reliably derived from structural MRI, are useful in tracking disease progression and have the potential to serve as outcome measures. MRI can also be used to assess comorbid vascular pathology and define homogeneous groups for inclusion or for subject stratification. Finally, MRI also plays an important role in trial safety monitoring, particularly the identification of amyloid-related imaging abnormalities (ARIA). Tau PET to measure neurofibrillary tangle burden is currently under development. Evidence to support the use of advanced MRI markers such as resting-state functional MRI, arterial spin labelling, and diffusion tensor imaging in pre-dementia AD is preliminary and requires further validation. CONCLUSION We propose a strategy for longitudinal imaging to track early signs of AD including quantitative amyloid PET and yearly multiparametric MRI.
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Affiliation(s)
- Mara ten Kate
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, PO Box 7056, 1007 MB Amsterdam, the Netherlands
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Adam J. Schwarz
- Takeda Pharmaceuticals Comparny, Cambridge, MA USA
- Eli Lilly and Company, Indianapolis, Indiana USA
| | - Nick C. Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Gaël Chételat
- Institut National de la Santé et de la Recherche Médicale, Inserm UMR-S U1237, Université de Caen-Normandie, GIP Cyceron, Caen, France
| | - Bart N. M. van Berckel
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | | | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | | | | | - Adriaan A. Lammertsma
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Craig Ritchie
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, PO Box 7056, 1007 MB Amsterdam, the Netherlands
| | | | - Pieter Jelle Visser
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, PO Box 7056, 1007 MB Amsterdam, the Netherlands
| | - Adam Waldman
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna Wardlaw
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Sven Haller
- Affidea Centre de Diagnostic Radiologique de Carouge, Geneva, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
- Insititutes of Neurology and Healthcare Engineering, University College London, London, UK
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73
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Ge X, Yu J, Huang S, Yin Z, Han Z, Chen F, Wang Z, Zhang J, Lei P. A novel repetitive mild traumatic brain injury mouse model for chronic traumatic encephalopathy research. J Neurosci Methods 2018; 308:162-172. [DOI: 10.1016/j.jneumeth.2018.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022]
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Amorapanth PX, Aluru V, Stone J, Yousefi A, Tang A, Cox S, Bilaloglu S, Lu Y, Rath J, Long C, Im B, Raghavan P. Traumatic brain injury results in altered physiologic, but not subjective responses to emotional stimuli. Brain Inj 2018; 32:1712-1719. [DOI: 10.1080/02699052.2018.1519598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Prin X. Amorapanth
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Viswanath Aluru
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Jennifer Stone
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Arash Yousefi
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Alvin Tang
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Sarah Cox
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Seda Bilaloglu
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Ying Lu
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Joseph Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Coralynn Long
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Brian Im
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
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Lee BG, Leavitt MJ, Bernick CB, Leger GC, Rabinovici G, Banks SJ. A Systematic Review of Positron Emission Tomography of Tau, Amyloid Beta, and Neuroinflammation in Chronic Traumatic Encephalopathy: The Evidence To Date. J Neurotrauma 2018; 35:2015-2024. [PMID: 29609516 PMCID: PMC6421996 DOI: 10.1089/neu.2017.5558] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is associated with pathological changes, yet detecting these changes during life has proven elusive. Positron emission tomography (PET) offers the potential for identifying such pathology. Few studies have been completed to date and their approaches and results have been diverse. It was the objective of this review to systematically examine relevant research using ligands for PET that bind to identified pathology in CTE. We focused on identification of patterns of binding and addressing gaps in knowledge of PET imaging for CTE. A comprehensive literature search was conducted. Data used were published on or before May 22, 2017. As the extant literature is limited, any peer-reviewed article assessing military, contact sports athletes, or professional fighters was considered for inclusion. The main outcomes were regional binding to brain regions identified through control comparisons or through clinical metrics (e.g., standardized uptake volume ratios). A total of 1207 papers were identified for review, of which six met inclusion criteria. Meta-analyses were planned but were deemed inappropriate given the small number of studies identified. Methodological concerns in these initial papers included small sample sizes, lack of a control comparison, use of nonstandard statistical procedures to quantify data, and interpretation of potentially off-target binding areas. Across studies, the hippocampi, amygdalae, and midbrain had reasonably consistent increased uptake. Evidence for increased uptake in cortical regions was less consistent. The evidence suggests that the field of PET imaging in those at risk for CTE remains nascent. As the field evolves to include more stringent studies, ligands for PET may prove an important tool in identifying CTE in vivo.
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Affiliation(s)
- Bern G. Lee
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
- University of Nevada, Las Vegas, Las Vegas, Nevada
| | - MacKenzie J. Leavitt
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
| | - Charles B. Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
| | - Gabriel C. Leger
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
| | - Gil Rabinovici
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Sarah J. Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
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Alzheimer's Dementia due to Suspected CTE from Subconcussive Head Impact. Case Rep Neurol Med 2018; 2018:7890269. [PMID: 30155327 PMCID: PMC6091421 DOI: 10.1155/2018/7890269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/24/2018] [Indexed: 01/11/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) has been receiving increasing attention due to press coverage of professional football players. The devastating sequelae of CTE compel us to aim for early diagnosis and treatment. However, by current standards, CTE is challenging to diagnose. Clear clinical diagnostic criteria for CTE have not been established. Only recently, pathological diagnostic criteria have been recognized, but postmortem diagnosis is too late. Reliable biomarkers are not available. By imaging criteria, cavum septum pellucidum has been the only consistent identifiable MRI finding. Because of the imprecise nature of diagnosis based on clinical suspicion, physicians must become cognizant of the broad spectrum of presentations of CTE. With this awareness, appropriate workup can be initiated. CTE can present with early symptoms of emotional changes or late symptoms with memory decline and dementia. Here we present an unusual case of a patient with Alzheimer's disease secondary to suspected CTE that stems from subconcussive head impacts presenting with severe memory and MRI changes. Clinicians should be aware of this presentation and consider CTE in their differential diagnoses while undergoing workup of memory disorders.
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Costello DM, Kaye AH, O'Brien TJ, Shultz SR. Sport related concussion - Potential for biomarkers to improve acute management. J Clin Neurosci 2018; 56:1-6. [PMID: 30055944 DOI: 10.1016/j.jocn.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/08/2018] [Indexed: 12/14/2022]
Abstract
Sport-related concussion is a common form of mild traumatic brain injury that is now recognised as a serious health issue. Growing evidence suggests concussion may result in long-term and severe neurological disabilities. Recent research into the diagnosis and management of concussion may provide new approaches to concussion management that limit the potential long-term adverse effects of concussion. This paper summarises the problem of sport-related concussion and reviews key factors (sex, age, genetics) that may modify concussion outcomes. Current sport-related concussion tools are described. Analysis of emerging methods of acute concussion diagnosis using objective fluid and neuroimaging biomarkers is provided. These new concussion biomarkers have the potential to change management of sport-related concussion.
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Affiliation(s)
- Daniel M Costello
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia.
| | - Andrew H Kaye
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia
| | - Terence J O'Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia; Departments of Neuroscience and Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC, 3004, Australia
| | - Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia; Departments of Neuroscience and Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC, 3004, Australia
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78
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Raji CA, Henderson TA. PET and Single-Photon Emission Computed Tomography in Brain Concussion. Neuroimaging Clin N Am 2018; 28:67-82. [PMID: 29157854 DOI: 10.1016/j.nic.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.
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Affiliation(s)
- Cyrus A Raji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, UCSF China Basin, 185 Berry Street, Suite 350, San Francisco, CA 94158, USA
| | - Theodore A Henderson
- The Synaptic Space Inc, Neuro-Laser Foundation, Neuro-Luminance Brain Health Centers Inc, Dr. Theodore Henderson Inc, 3979 East Arapahoe Road, Suite 200, Centennial, CO 80122, USA.
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Tharmaratnam T, Iskandar MA, Tabobondung TC, Tobbia I, Gopee-Ramanan P, Tabobondung TA. Chronic Traumatic Encephalopathy in Professional American Football Players: Where Are We Now? Front Neurol 2018; 9:445. [PMID: 29971037 PMCID: PMC6018081 DOI: 10.3389/fneur.2018.00445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022] Open
Abstract
Repetitive head trauma provides a favorable milieu for the onset of inflammatory and neurodegenerative processes. The result of long-lasting head trauma is chronic traumatic encephalopathy (CTE), a disease process well-recognized in boxers, military personnel, and more recently, in American football players. CTE is a chronic neurodegenerative disease with hallmarks of hyperphosphorylated tau (p-tau) aggregates and intercellular lesions of neurofibrillary tangles. The criteria for CTE diagnosis requires at least 1-2 focal perivascular lesions of p-tau in the cerebral cortex, at the depth of the sulci. These pathognomonic lesions aggregate within neurons and glial cells such as astrocytes, and cell processes within the vicinity of small blood vessels. CTE presents in a distinct topographical distribution pattern compared to other tauopathies such as AD and other age-related astrogliopathies. CTE also has an insidious onset, years after repetitive head trauma. The disease course of CTE is characterized by cognitive dysfunction, behavioral changes, and can progress to altered motor function with parkinsonian-like manifestations in later stages. This short review aims to summarize CTE in professional football, epidemiology, diagnosis based on neuroanatomical abnormalities, cognitive degeneration, and adverse mental health effects, as well as gaps in the literature and future directions in diagnostics, therapeutics, and preventive measures.
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Affiliation(s)
- Tharmegan Tharmaratnam
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Al Muharraq, Bahrain
| | - Mina A. Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tyler C. Tabobondung
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Brantford General Hospital, Hamilton, ON, Canada
| | - Iqdam Tobbia
- Department of Pathology and Clinical Microbiology, School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Adliya, Bahrain
| | - Prasaanthan Gopee-Ramanan
- Hamilton Health Sciences Centre, Department of Radiology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Taylor A. Tabobondung
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON, Canada
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80
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Gill J, Mustapic M, Diaz-Arrastia R, Lange R, Gulyani S, Diehl T, Motamedi V, Osier N, Stern RA, Kapogiannis D. Higher exosomal tau, amyloid-beta 42 and IL-10 are associated with mild TBIs and chronic symptoms in military personnel. Brain Inj 2018; 32:1277-1284. [PMID: 29913077 DOI: 10.1080/02699052.2018.1471738] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Identify biomarkers in peripheral blood that relate to chronic post-concussive and behavioural symptoms following traumatic brain injuries (TBIs) to ultimately improve clinical management. RESEARCH DESIGN We compared military personnel with mild TBIs (mTBIs) (n = 42) to those without TBIs (n = 22) in concentrations of tau, amyloid-beta (Aβ42) and cytokines (tumour necrosis factor alpha (TNFα, interleukin (IL)-6 and -10) in neuronal-derived exosomes from the peripheral blood. We utilized nanosight technology coupled with ultra-sensitivity immunoassay methods. We also examined the impact of post-concussive and behavioural symptoms including depression and post-traumatic stress disorder (PTSD) on these neuronal-derived markers. RESULTS We report that concentrations of exosomal tau (F1, 62 = 10.50), Aβ42 (F1, 61 = 5.32) and IL-10 (F1, 59 = 4.32) were elevated in the mTBI group compared to the controls. Within the mTBI group, regression models show that post-concussive symptoms were most related to exosomal tau elevations, whereas exosomal IL-10 levels were related to PTSD symptoms. CONCLUSIONS These findings suggest that chronic post-concussive symptoms following an mTBI relate to altered exosomal activity, and that greater tau pathology may underlie chronic post-concussive symptoms that develop following mTBIs. It also suggests that central inflammatory activity contributes to PTSD symptoms following an mTBI, providing necessary insights into the role of inflammation in chronic PTSD symptoms.
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Affiliation(s)
- Jessica Gill
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Maja Mustapic
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Ramon Diaz-Arrastia
- c Department of Neurology, School of Medicine , University of Pennsylvania , Philadelphia , PA , United States
| | - Rael Lange
- d Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , United States
| | - Seema Gulyani
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Tom Diehl
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Vida Motamedi
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Nicole Osier
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Robert A Stern
- e Neurosurgery, and Anatomy & Neurobiology , Boston University, Boston University Alzheimer's Disease and CTE Center , Boston , MA , United States
| | - Dimitrios Kapogiannis
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
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81
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Agoston D, Arun P, Bellgowan P, Broglio S, Cantu R, Cook D, da Silva UO, Dickstein D, Elder G, Fudge E, Gandy S, Gill J, Glenn JF, Gupta RK, Hinds S, Hoffman S, Lattimore T, Lin A, Lu KP, Maroon J, Okonkwo D, Perl D, Robinson M, Rosen C, Smith D. Military Blast Injury and Chronic Neurodegeneration: Research Presentations from the 2015 International State-of-the-Science Meeting. J Neurotrauma 2018; 34:S6-S17. [PMID: 28937955 DOI: 10.1089/neu.2017.5220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Blast-related traumatic brain injury (TBI) is a signature injury of recent military conflicts, leading to increased Department of Defense (DoD) interest in its potential long-term effects, such as chronic traumatic encephalopathy (CTE). The DoD Blast Injury Research Program Coordinating Office convened the 2015 International State-of-the-Science Meeting to discuss the existing evidence regarding a causal relationship between TBI and CTE. Over the course of the meeting, experts across government, academia, and the sports community presented cutting edge research on the unique pathological characteristics of blast-related TBI, blast-related neurodegenerative mechanisms, risk factors for CTE, potential biomarkers for CTE, and treatment strategies for chronic neurodegeneration. The current paper summarizes these presentations. Although many advances have been made to address these topics, more research is needed to establish the existence of links between the long-term effects of single or multiple blast-related TBI and CTE.
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Affiliation(s)
- Denes Agoston
- 1 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Peethambaran Arun
- 2 Walter Reed Army Institute of Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Patrick Bellgowan
- 3 National Institute of Neurological Disorders and Stroke , Bethesda, Maryland
| | | | - Robert Cantu
- 5 Boston University School of Medicine , Boston, Massachusetts
| | - David Cook
- 6 VA Puget Sound Health Care System , Seattle, Washington
| | | | - Dara Dickstein
- 8 Icahn School of Medicine at Mount Sinai , New York, New York
| | - Gregory Elder
- 9 James J. Peters VA Medical Center , Bronx, New York
| | - Elizabeth Fudge
- 10 Office of the Assistant Secretary of Defense , Health Affairs, Falls Church, Virginia
| | - Sam Gandy
- 8 Icahn School of Medicine at Mount Sinai , New York, New York.,11 James J. Peters VA Medical Center , Bronx, New York
| | - Jessica Gill
- 12 National Institutes of Health , Bethesda, Maryland
| | - John F Glenn
- 13 US Army Medical Research and Materiel Command , Fort Detrik, Maryland
| | - Raj K Gupta
- 13 US Army Medical Research and Materiel Command , Fort Detrik, Maryland
| | - Sidney Hinds
- 14 Defense and Veterans Brain Injury Center , Rockville, Maryland
| | | | - Theresa Lattimore
- 10 Office of the Assistant Secretary of Defense , Health Affairs, Falls Church, Virginia
| | - Alexander Lin
- 16 Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Kun Ping Lu
- 17 Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
| | - Joseph Maroon
- 18 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - David Okonkwo
- 18 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Daniel Perl
- 1 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | | | - Charles Rosen
- 20 Department of Neurosurgery, West Virginia University , Morgantown, West Virginia
| | - Douglas Smith
- 21 University of Pennsylvania , Philadelphia, Pennsylvania
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82
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Aldag M, Armstrong RC, Bandak F, Bellgowan PSF, Bentley T, Biggerstaff S, Caravelli K, Cmarik J, Crowder A, DeGraba TJ, Dittmer TA, Ellenbogen RG, Greene C, Gupta RK, Hicks R, Hoffman S, Latta RC, Leggieri MJ, Marion D, Mazzoli R, McCrea M, O'Donnell J, Packer M, Petro JB, Rasmussen TE, Sammons-Jackson W, Shoge R, Tepe V, Tremaine LA, Zheng J. The Biological Basis of Chronic Traumatic Encephalopathy following Blast Injury: A Literature Review. J Neurotrauma 2018; 34:S26-S43. [PMID: 28937953 DOI: 10.1089/neu.2017.5218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The United States Department of Defense Blast Injury Research Program Coordinating Office organized the 2015 International State-of-the-Science meeting to explore links between blast-related head injury and the development of chronic traumatic encephalopathy (CTE). Before the meeting, the planning committee examined articles published between 2005 and October 2015 and prepared this literature review, which summarized broadly CTE research and addressed questions about the pathophysiological basis of CTE and its relationship to blast- and nonblast-related head injury. It served to inform participants objectively and help focus meeting discussion on identifying knowledge gaps and priority research areas. CTE is described generally as a progressive neurodegenerative disorder affecting persons exposed to head injury. Affected individuals have been participants primarily in contact sports and military personnel, some of whom were exposed to blast. The symptomatology of CTE overlaps with Alzheimer's disease and includes neurological and cognitive deficits, psychiatric and behavioral problems, and dementia. There are no validated diagnostic criteria, and neuropathological evidence of CTE has come exclusively from autopsy examination of subjects with histories of exposure to head injury. The perivascular accumulation of hyperphosphorylated tau (p-tau) at the depths of cortical sulci is thought to be unique to CTE and has been proposed as a diagnostic requirement, although the contribution of p-tau and other reported pathologies to the development of clinical symptoms of CTE are unknown. The literature on CTE is limited and is focused predominantly on head injuries unrelated to blast exposure (e.g., football players and boxers). In addition, comparative analyses of clinical case reports has been challenging because of small case numbers, selection biases, methodological differences, and lack of matched controls, particularly for blast-exposed individuals. Consequently, the existing literature is not sufficient to determine whether the development of CTE is associated with head injury frequency (e.g., single vs. multiple exposures) or head injury type (e.g., impact, nonimpact, blast-related). Moreover, the incidence and prevalence of CTE in at-risk populations is unknown. Future research priorities should include identifying additional risk factors, pursuing population-based longitudinal studies, and developing the ability to detect and diagnose CTE in living persons using validated criteria.
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Affiliation(s)
- Matt Aldag
- 1 Booz Allen Hamilton , McLean, Virginia
| | - Regina C Armstrong
- 2 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Faris Bandak
- 3 Defense Advanced Research Projects Agency , Arlington, Virginia
| | | | | | - Sean Biggerstaff
- 6 Office of the Assistant Secretary of Defense , Health Affairs, Falls Church, Virginia
| | | | - Joan Cmarik
- 7 Office of the Principal Assistant for Acquisition, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Alicia Crowder
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | | | | | - Richard G Ellenbogen
- 10 Departments of Neurological Surgery and Global Health Medicine, University of Washington , Seattle, Washington
| | - Colin Greene
- 11 Joint Trauma Analysis and Prevention of Injuries in Combat Program, Frederick, Maryland
| | - Raj K Gupta
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | | | | | | | - Michael J Leggieri
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Donald Marion
- 16 Defense and Veterans Brain Injury Center , Silver Spring, Maryland
| | | | | | | | - Mark Packer
- 20 Hearing Center of Excellence , Lackland, Texas
| | - James B Petro
- 21 Office of the Assistant Secretary of Defense, Research and Engineering, Arlington, Virginia
| | - Todd E Rasmussen
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Wendy Sammons-Jackson
- 22 Office of the Principal Assistant for Research and Technology , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Richard Shoge
- 23 Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command , Fort Detrick, Maryland
| | | | | | - James Zheng
- 25 Program Executive Office Soldier , Fort Belvoir, Virginia
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Sorby-Adams AJ, Vink R, Turner RJ. Large animal models of stroke and traumatic brain injury as translational tools. Am J Physiol Regul Integr Comp Physiol 2018. [PMID: 29537289 DOI: 10.1152/ajpregu.00163.2017] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute central nervous system injury, encompassing traumatic brain injury (TBI) and stroke, accounts for a significant burden of morbidity and mortality worldwide. Studies in animal models have greatly enhanced our understanding of the complex pathophysiology that underlies TBI and stroke and enabled the preclinical screening of over 1,000 novel therapeutic agents. Despite this, the translation of novel therapeutics from experimental models to clinical therapies has been extremely poor. One potential explanation for this poor clinical translation is the choice of experimental model, given that the majority of preclinical TBI and ischemic stroke studies have been conducted in small animals, such as rodents, which have small lissencephalic brains. However, the use of large animal species such as nonhuman primates, sheep, and pigs, which have large gyrencephalic human-like brains, may provide an avenue to improve clinical translation due to similarities in neuroanatomical structure when compared with widely adopted rodent models. This purpose of this review is to provide an overview of large animal models of TBI and ischemic stroke, including the surgical considerations, key benefits, and limitations of each approach.
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Affiliation(s)
- Annabel J Sorby-Adams
- Adelaide Medical School and Adelaide Centre for Neuroscience Research, The University of Adelaide , Adelaide, South Australia
| | - Robert Vink
- Sansom Institute for Health Research, University of South Australia , Adelaide, South Australia
| | - Renée J Turner
- Adelaide Medical School and Adelaide Centre for Neuroscience Research, The University of Adelaide , Adelaide, South Australia
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84
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Structural imaging of mild traumatic brain injury may not be enough: overview of functional and metabolic imaging of mild traumatic brain injury. Brain Imaging Behav 2018; 11:591-610. [PMID: 28194558 DOI: 10.1007/s11682-017-9684-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A majority of patients with traumatic brain injury (TBI) present as mild injury with no findings on conventional clinical imaging methods. Due to this difficulty of imaging assessment on mild TBI patients, there has been much emphasis on the development of diffusion imaging modalities such as diffusion tensor imaging (DTI). However, basic science research in TBI shows that many of the functional and metabolic abnormalities in TBI may be present even in the absence of structural damage. Moreover, structural damage may be present at a microscopic and molecular level that is not detectable by structural imaging modality. The use of functional and metabolic imaging modalities can provide information on pathological changes in mild TBI patients that may not be detected by structural imaging. Although there are various differences in protocols of positron emission tomography (PET), single photon emission computed tomography (SPECT), functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and magnetoencephalography (MEG) methods, these may be important modalities to be used in conjunction with structural imaging in the future in order to detect and understand the pathophysiology of mild TBI. In this review, studies of mild TBI patients using these modalities that detect functional and metabolic state of the brain are discussed. Each modality's advantages and disadvantages are compared, and potential future applications of using combined modalities are explored.
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85
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Di Battista AP, Rhind SG, Baker AJ, Jetly R, Debad JD, Richards D, Hutchison MG. An investigation of neuroinjury biomarkers after sport-related concussion: from the subacute phase to clinical recovery. Brain Inj 2018; 32:575-582. [PMID: 29420083 DOI: 10.1080/02699052.2018.1432892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To characterise a panel of neuroinjury-related blood biomarkers after sport-related concussion (SRC). We hypothesised significant differences in biomarker profiles between athletes with SRC and healthy controls at both subacute and medical clearance time points. METHODS Thirty-eight interuniversity athletes were recruited over two athletic seasons (n = 19 SRC; n = 19 healthy matched-control). High-sensitivity immunoassay was used to evaluate 11 blood analytes at both the subacute phase after SRC and at medical clearance. RESULTS Univariate analysis identified elevated circulating peroxiredoxin-6 (PRDX-6) in athletes with SRC compared to healthy controls at the subacute time point. Multivariate analyses yielded similar results in the subacute phase, but identified both PRDX-6 and T-tau as significant contributors to class separation between athletes with SRC and controls at medical clearance. CONCLUSIONS Our results are consistent with the increasing recognition that physiological recovery after SRC extends beyond clinical recovery. Blood biomarkers appear to be useful in elucidating the biology of brain restitution after SRC. However, their implementation requires mindfulness of factors such as academic stress, exercise, and injury heterogeneity.
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Affiliation(s)
- Alex P Di Battista
- a Institute of Medical Science, University of Toronto , Toronto , ON , Canada.,b Defence Research and Development Canada, Toronto Research Centre , Toronto , ON , Canada
| | - Shawn G Rhind
- b Defence Research and Development Canada, Toronto Research Centre , Toronto , ON , Canada.,c Faculty of Kinesiology & Physical Education , University of Toronto , Toronto , ON , Canada
| | - Andrew J Baker
- a Institute of Medical Science, University of Toronto , Toronto , ON , Canada.,d Departments of Critical Care , Anesthesia and Surgery, St. Michael's Hospital, University of Toronto , Toronto ON , Canada.,e Neuroscience Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital , Toronto , ON , Canada
| | - Rakesh Jetly
- f Directorate of Mental Health , Canadian Forces Health Services , Ottawa , ON Canada.,g Department of Psychiatry , University of Ottawa , Ottawa , ON , Canada
| | - Jeff D Debad
- h Meso Scale Diagnostics, LLC ., Rockville , MD , USA
| | - Doug Richards
- c Faculty of Kinesiology & Physical Education , University of Toronto , Toronto , ON , Canada
| | - Michael G Hutchison
- c Faculty of Kinesiology & Physical Education , University of Toronto , Toronto , ON , Canada.,e Neuroscience Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital , Toronto , ON , Canada
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86
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Lejbman N, Olivera A, Heinzelmann M, Feng R, Yun S, Kim HS, Gill J. Active duty service members who sustain a traumatic brain injury have chronically elevated peripheral concentrations of Aβ40 and lower ratios of Aβ42/40. Brain Inj 2018; 30:1436-1441. [PMID: 27834544 PMCID: PMC5152557 DOI: 10.1080/02699052.2016.1219054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Primary objective: Excessive accumulation of amyloid beta (Aβ) and tau have been observed in older individuals with chronic neurological symptoms related to a traumatic brain injury (TBI), yet little is known about the possible role of Aβ in younger active duty service members following a TBI. The purpose of the study was to determine if Aβ 40 or 42 related to sustaining a TBI or to chronic neurological symptoms in a young cohort of military personnel. Research design: This was a cross-sectional study of active duty service members who reported sustaining a TBI and provided self-report of neurological and psychological symptoms and provided blood. Methods and procedures: An ultrasensitive single-molecule enzyme-linked immunosorbent assay was used to compare concentrations of Aβ in active duty service members with (TBI+; n = 53) and without (TBI–; n = 18) a history of TBI. Self-report and medical history were used to measure TBI occurrence and approximate the number of total TBIs and the severity of TBIs sustained during deployment. Main outcomes and results: This study reports that TBI is associated with higher concentrations of Aβ40 (F1,68 = 6.948, p = 0.009) and a lower ratio of Aβ42/Aβ40 (F1,62 = 5.671, p = 0.020). These differences remained significant after controlling for co-morbid symptoms of post-traumatic stress disorder and depression. Conclusions: These findings suggest that alterations in Aβ relate to TBIs and may contribute to chronic neurological symptoms.
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Affiliation(s)
- Natasha Lejbman
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA
| | - Anlys Olivera
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA
| | - Morgan Heinzelmann
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA
| | - Rebekah Feng
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA
| | - Sijung Yun
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA.,b Yotta Biomed, LLC , Bethesda , MD , USA
| | - Hyung-Suk Kim
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA
| | - Jessica Gill
- a National Institute of Nursing Research, National Institutes of Health , Bethesda , MD , USA
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87
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Chen ST, Siddarth P, Merrill DA, Martinez J, Emerson ND, Liu J, Wong KP, Satyamurthy N, Giza CC, Huang SC, Fitzsimmons RP, Bailes J, Omalu B, Barrio JR, Small GW. FDDNP-PET Tau Brain Protein Binding Patterns in Military Personnel with Suspected Chronic Traumatic Encephalopathy1. J Alzheimers Dis 2018; 65:79-88. [PMID: 30040711 PMCID: PMC6728605 DOI: 10.3233/jad-171152] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Our group has shown that in vivo tau brain binding patterns from FDDNP-PET scans in retired professional football players with suspected chronic traumatic encephalopathy differ from those of tau and amyloid aggregate binding observed in Alzheimer's disease (AD) patients and cognitively-intact controls. OBJECTIVE To compare these findings with those from military personnel with histories of mild traumatic brain injury(mTBI). METHODS FDDNP-PET brain scans were compared among 7 military personnel and 15 retired players with mTBI histories and cognitive and/or mood symptoms, 24 AD patients, and 28 cognitively-intact controls. Nonparametric ANCOVAs with Tukey-Kramer adjusted post-hoc comparisons were used to test for significant differences in regional FDDNP binding among subject groups. RESULTS FDDNP brain binding was higher in military personnel compared to controls in the amygdala, midbrain, thalamus, pons, frontal and anterior and posterior cingulate regions (p < 0.01-0.0001). Binding patterns in the military personnel were similar to those of the players except for the amygdala and striatum (binding higher in players; p = 0.02-0.003). Compared with the AD group, the military personnel showed higher binding in the midbrain (p = 0.0008) and pons (p = 0.002) and lower binding in the medial temporal, lateral temporal, and parietal regions (all p = 0.02). CONCLUSION This first study of in vivo tau and amyloid brain signals in military personnel with histories of mTBI shows binding patterns similar to those of retired football players and distinct from the binding patterns in AD and normal aging, suggesting the potential value of FDDNP-PET for early detection and treatment monitoring in varied at-risk populations.
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Affiliation(s)
- Stephen T. Chen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Prabha Siddarth
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - David A. Merrill
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline Martinez
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Natacha D. Emerson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jie Liu
- Department of Medical and Molecular Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Koon-Pong Wong
- Department of Medical and Molecular Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nagichettiar Satyamurthy
- Department of Medical and Molecular Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher C. Giza
- Department of Neurosurgery at the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sung-Cheng Huang
- Department of Medical and Molecular Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Julian Bailes
- Department of Neurosurgery, North Shore University Health System and University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Jorge R. Barrio
- Department of Medical and Molecular Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gary W. Small
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
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88
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Cao KJ, Yang J. Translational opportunities for amyloid-targeting fluorophores. Chem Commun (Camb) 2018; 54:9107-9118. [DOI: 10.1039/c8cc03619e] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Amyloid-targeting fluorophores have become increasingly useful as clinical tools to aid in the early-stage detection and diagnoses of amyloid-associated neurodegenerative disorders.
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Affiliation(s)
- Kevin J. Cao
- Department of Chemistry and Biochemistry, University of California
- La Jolla
- USA
| | - Jerry Yang
- Department of Chemistry and Biochemistry, University of California
- La Jolla
- USA
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89
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Lin A, Charney M, Shenton ME, Koerte IK. Chronic traumatic encephalopathy: neuroimaging biomarkers. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:309-322. [PMID: 30482359 DOI: 10.1016/b978-0-444-63954-7.00029-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Neuroimaging provides promising biomarkers for the diagnosis of CTE and may also help elucidate pathophysiologic changes that occur with chronic sports-related brain injury. To describe the use of neuroimaging as presumed biomarkers of CTE, this chapter focuses on only those studies that report the chronic stages of sports-related brain injury, as opposed to previous chapters that described neuroimaging in the context of acute and subacute injury. Studies using positron emission tomography and magnetic resonance imaging and spectroscopy will be discussed for contact/collision sports such as American football, boxing, mixed martial arts, rugby, and soccer, in which repetitive head impacts are common.
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Affiliation(s)
- Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Molly Charney
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; VA Boston Healthcare System, Boston, MA, United States
| | - Inga Katharina Koerte
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
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90
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D'Ascanio S, Alosco ML, Stern RA. Chronic traumatic encephalopathy: clinical presentation and in vivo diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:281-296. [PMID: 30482356 DOI: 10.1016/b978-0-444-63954-7.00027-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Exposure to repetitive head impacts from contact sport participation (e.g., American football, boxing, soccer) is associated with the neurodegenerative disorder known as chronic traumatic encephalopathy (CTE). The neuropathology of CTE is becoming well defined, and diagnostic criteria have been developed and are being refined. The critical next step in this emerging field is the diagnosis of CTE during life. The objective of this chapter is to describe what is currently known about the clinical presentation and in vivo diagnosis of CTE. This chapter reviews studies in which clinical manifestation of CTE was examined through retrospective telephone interviews with informants of individuals whose brains were donated and were diagnosed with CTE through neuropathologic examination. In vivo research examining the long-term neurobehavioral consequences of repetitive head impacts is also reviewed, followed by a comparison of the existing provisional clinical diagnostic criteria for CTE, as well as preliminary research on possible fluid and neuroimaging biomarkers. An illustrative case study of CTE is presented, and the chapter concludes with a discussion of gaps in knowledge and future directions.
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Affiliation(s)
- Steven D'Ascanio
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States.
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91
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Kneynsberg A, Combs B, Christensen K, Morfini G, Kanaan NM. Axonal Degeneration in Tauopathies: Disease Relevance and Underlying Mechanisms. Front Neurosci 2017; 11:572. [PMID: 29089864 PMCID: PMC5651019 DOI: 10.3389/fnins.2017.00572] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022] Open
Abstract
Tauopathies are a diverse group of diseases featuring progressive dying-back neurodegeneration of specific neuronal populations in association with accumulation of abnormal forms of the microtubule-associated protein tau. It is well-established that the clinical symptoms characteristic of tauopathies correlate with deficits in synaptic function and neuritic connectivity early in the course of disease, but mechanisms underlying these critical pathogenic events are not fully understood. Biochemical in vitro evidence fueled the widespread notion that microtubule stabilization represents tau's primary biological role and that the marked atrophy of neurites observed in tauopathies results from loss of microtubule stability. However, this notion contrasts with the mild phenotype associated with tau deletion. Instead, an analysis of cellular hallmarks common to different tauopathies, including aberrant patterns of protein phosphorylation and early degeneration of axons, suggests that alterations in kinase-based signaling pathways and deficits in axonal transport (AT) associated with such alterations contribute to the loss of neuronal connectivity triggered by pathogenic forms of tau. Here, we review a body of literature providing evidence that axonal pathology represents an early and common pathogenic event among human tauopathies. Observations of axonal degeneration in animal models of specific tauopathies are discussed and similarities to human disease highlighted. Finally, we discuss potential mechanistic pathways other than microtubule destabilization by which disease-related forms of tau may promote axonopathy.
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Affiliation(s)
- Andrew Kneynsberg
- Neuroscience Program, Michigan State University, East Lansing, MI, United States.,Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Benjamin Combs
- Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Kyle Christensen
- Neuroscience Program, Michigan State University, East Lansing, MI, United States.,Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Gerardo Morfini
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States
| | - Nicholas M Kanaan
- Neuroscience Program, Michigan State University, East Lansing, MI, United States.,Department of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States.,Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, United States
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92
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Abstract
Purpose/Aim: Animal models of traumatic brain injury (TBI) provide powerful tools to study TBI in a controlled, rigorous and cost-efficient manner. The mostly used animals in TBI studies so far are rodents. However, compared with rodents, large animals (e.g. swine, rabbit, sheep, ferret, etc.) show great advantages in modeling TBI due to the similarity of their brains to human brain. The aim of our review was to summarize the development and progress of common large animal TBI models in past 30 years. MATERIALS AND METHODS Mixed published articles and books associated with large animal models of TBI were researched and summarized. RESULTS We majorly sumed up current common large animal models of TBI, including discussion on the available research methodologies in previous studies, several potential therapies in large animal trials of TBI as well as advantages and disadvantages of these models. CONCLUSIONS Large animal models of TBI play crucial role in determining the underlying mechanisms and screening putative therapeutic targets of TBI.
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Affiliation(s)
- Jun-Xi Dai
- a Department of Neurosurgery, Shanghai Ninth People's Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yan-Bin Ma
- a Department of Neurosurgery, Shanghai Ninth People's Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Nan-Yang Le
- a Department of Neurosurgery, Shanghai Ninth People's Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jun Cao
- a Department of Neurosurgery, Shanghai Ninth People's Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yang Wang
- b Department of Emergency , Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
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93
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Rejc L, Šmid L, Kepe V, Podlipnik Č, Golobič A, Bresjanac M, Barrio JR, Petrič A, Košmrlj J. Design, Syntheses, and in Vitro Evaluation of New Fluorine-18 Radiolabeled Tau-Labeling Molecular Probes. J Med Chem 2017; 60:8741-8757. [DOI: 10.1021/acs.jmedchem.7b00764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Luka Rejc
- Faculty
of Chemistry and Chemical Technology, University of Ljubljana, Večna
pot 113, SI-1000 Ljubljana, Slovenia
| | - Lojze Šmid
- Faculty
of Medicine, Institute of Pathological Physiology, University of Ljubljana, Zaloška 4, SI-1001 Ljubljana, Slovenia
| | - Vladimir Kepe
- Department
of Molecular and Medical Pharmacology, The David Geffen School of
Medicine, University of California, Los Angeles, California 90095, United States
| | - Črtomir Podlipnik
- Faculty
of Chemistry and Chemical Technology, University of Ljubljana, Večna
pot 113, SI-1000 Ljubljana, Slovenia
| | - Amalija Golobič
- Faculty
of Chemistry and Chemical Technology, University of Ljubljana, Večna
pot 113, SI-1000 Ljubljana, Slovenia
| | - Mara Bresjanac
- Faculty
of Medicine, Institute of Pathological Physiology, University of Ljubljana, Zaloška 4, SI-1001 Ljubljana, Slovenia
| | - Jorge R. Barrio
- Department
of Molecular and Medical Pharmacology, The David Geffen School of
Medicine, University of California, Los Angeles, California 90095, United States
| | - Andrej Petrič
- Faculty
of Chemistry and Chemical Technology, University of Ljubljana, Večna
pot 113, SI-1000 Ljubljana, Slovenia
- EN-FIST Centre of Excellence, Trg Osvobodilne fronte 13, SI-1000 Ljubljana, Slovenia
| | - Janez Košmrlj
- Faculty
of Chemistry and Chemical Technology, University of Ljubljana, Večna
pot 113, SI-1000 Ljubljana, Slovenia
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94
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Cummings J. Disease modification and Neuroprotection in neurodegenerative disorders. Transl Neurodegener 2017; 6:25. [PMID: 29021896 PMCID: PMC5613313 DOI: 10.1186/s40035-017-0096-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/29/2017] [Indexed: 12/19/2022] Open
Abstract
Background Disease modifying therapies (DMTs) are urgently needed for neurodegenerative diseases (NDD) such as Alzheimer’s disease (AD) and many other disorders characterized by protein aggregation and neurodegeneration. Despite advances in understanding the neurobiology of NDD, there are no approved DMTs. Discussion Defining disease-modification is critical to drug-development programs. A DMT is an intervention that produces an enduring change in the trajectory of clinical decline of an NDD by impacting the disease processes leading to nerve cell death. A DMT is neuroprotective, and neuroprotection will result in disease modification. Disease modification can be demonstrated in clinical trials by a drug-placebo difference in clinical outcomes supported by a drug-placebo difference on biomarkers reflective of the fundamental pathophysiology of the NDD. Alternatively, disease modification can be supported by findings on a staggered start or delayed withdrawal clinical trial design. Collecting multiple biomarkers is necessary to support a comprehensive view of disease modification. Conclusion Disease modification is established by demonstrating an enduring change in the clinical trajectory of an NDD based on intervention in the fundamental pathophysiology of the disease leading to nerve cell death. Supporting data are collected in clinical trials. Effectively defining a DMT will assist in NDD drug development programs.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106 USA
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95
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The chronic and evolving neurological consequences of traumatic brain injury. Lancet Neurol 2017; 16:813-825. [PMID: 28920887 DOI: 10.1016/s1474-4422(17)30279-x] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. With respect to neurodegeneration after TBI, post-mortem studies on the long-term neuropathology after injury have identified complex persisting and evolving abnormalities best described as polypathology, which includes chronic traumatic encephalopathy. Despite growing awareness of the lifelong consequences of TBI, substantial gaps in research exist. Improvements are therefore needed in understanding chronic pathologies and their implications for survivors of TBI, which could inform long-term health management in this sizeable patient population.
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96
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Mahar I, Alosco ML, McKee AC. Psychiatric phenotypes in chronic traumatic encephalopathy. Neurosci Biobehav Rev 2017; 83:622-630. [PMID: 28888534 DOI: 10.1016/j.neubiorev.2017.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder involving cognitive, motor, and psychiatrically-relevant symptoms resulting from repetitive head impacts. Psychiatric phenotypes of CTE, including depression and suicidality, present particular challenges for CTE research, given that the diagnosis requires postmortem neuropathological examination. The pathognomonic lesion of CTE is the perivascular accumulation of hyperphosphorylated tau (ptau) protein at the depths of cortical sulci. These lesions are found in the earliest disease stages, and with advancing pathological severity, ptau deposition occurs in widespread brain regions in a four-stage scheme of severity. We review the psychiatric phenotypes of individuals neuropathologically diagnosed with CTE, and suggest that earlier CTE stages hold particular interest for psychiatric CTE research. In the early CTE stages, there is ptau pathology in frontal cortex and axonal loss in the frontal white matter, followed by progressive ptau neurofibrillary degeneration in the amygdala and hippocampus. Neuropathological changes in the frontal and medial temporal lobes may underlie psychiatric phenotypes. Additional insight into the association between CTE pathology and psychiatric sequelae may come from advancements in in vivo methods of CTE detection. Further epidemiological, clinical, and postmortem studies are needed to validate the nature of psychiatric sequelae in CTE.
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Affiliation(s)
- Ian Mahar
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Dept. of Pathology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston, MA, USA.
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97
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Abstract
There is a long history linking traumatic brain injury (TBI) with the development of dementia. Despite significant reservations, such as recall bias or concluding causality for TBI, a summary of recent research points to several conclusions on the TBI-dementia relationship. 1) Increasing severity of a single moderate-to-severe TBI increases the risk of subsequent Alzheimer's disease (AD), the most common type of dementia. 2) Repetitive, often subconcussive, mild TBIs increases the risk for chronic traumatic encephalopathy (CTE), a degenerative neuropathology. 3) TBI may be a risk factor for other neurodegenerative disorders that can be associated with dementia. 4) TBI appears to lower the age of onset of TBI-related neurocognitive syndromes, potentially adding "TBI cognitive-behavioral features". The literature further indicates several specific risk factors for TBI-associated dementia: 5) any blast or blunt physical force to the head as long as there is violent head displacement; 6) decreased cognitive and/or neuronal reserve and the related variable of older age at TBI; and 7) the presence of apolipoprotein E ɛ4 alleles, a genetic risk factor for AD. Finally, there are neuropathological features relating TBI with neurocognitive syndromes: 8) acute TBI results in amyloid pathology and other neurodegenerative proteinopathies; 9) CTE shares features with neurodegenerative dementias; and 10) TBI results in white matter tract and neural network disruptions. Although further research is needed, these ten findings suggest that dose-dependent effects of violent head displacement in vulnerable brains predispose to dementia; among several potential mechanisms is the propagation of abnormal proteins along damaged white matter networks.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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98
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Di Pietro V, Lazzarino G, Amorini AM, Signoretti S, Hill LJ, Porto E, Tavazzi B, Lazzarino G, Belli A. Fusion or Fission: The Destiny of Mitochondria In Traumatic Brain Injury of Different Severities. Sci Rep 2017; 7:9189. [PMID: 28835707 PMCID: PMC5569027 DOI: 10.1038/s41598-017-09587-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022] Open
Abstract
Mitochondrial dynamics are regulated by a complex system of proteins representing the mitochondrial quality control (MQC). MQC balances antagonistic forces of fusion and fission determining mitochondrial and cell fates. In several neurological disorders, dysfunctional mitochondria show significant changes in gene and protein expression of the MQC and contribute to the pathophysiological mechanisms of cell damage. In this study, we evaluated the main gene and protein expression involved in the MQC in rats receiving traumatic brain injury (TBI) of different severities. At 6, 24, 48 and 120 hours after mild TBI (mTBI) or severe TBI (sTBI), gene and protein expressions of fusion and fission were measured in brain tissue homogenates. Compared to intact brain controls, results showed that genes and proteins inducing fusion or fission were upregulated and downregulated, respectively, in mTBI, but downregulated and upregulated, respectively, in sTBI. In particular, OPA1, regulating inner membrane dynamics, cristae remodelling, oxidative phosphorylation, was post-translationally cleaved generating differential amounts of long and short OPA1 in mTBI and sTBI. Corroborated by data referring to citrate synthase, these results confirm the transitory (mTBI) or permanent (sTBI) mitochondrial dysfunction, enhancing MQC importance to maintain cell functions and indicating in OPA1 an attractive potential therapeutic target for TBI.
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Affiliation(s)
- Valentina Di Pietro
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Edgbaston, B15 2TH, Birmingham, UK
| | - Giacomo Lazzarino
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Largo F. Vito 1, 00168, Rome, Italy
| | - Angela Maria Amorini
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Largo F. Vito 1, 00168, Rome, Italy
| | - Stefano Signoretti
- Division of Neurosurgery, Department of Neurosciences Head and Neck Surgery, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Lisa J Hill
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Edgbaston, B15 2TH, Birmingham, UK
| | - Edoardo Porto
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Barbara Tavazzi
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Largo F. Vito 1, 00168, Rome, Italy.
| | - Giuseppe Lazzarino
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Viale A. Doria 6, 95125, Catania, Italy.
| | - Antonio Belli
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Edgbaston, B15 2TH, Birmingham, UK
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99
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Oliver JM, Jones MT, Anzalone AJ, Kirk KM, Gable DA, Repshas JT, Johnson TA, Höglund K, Blennow K, Zetterberg H. A Season of American Football Is Not Associated with Changes in Plasma Tau. J Neurotrauma 2017; 34:3295-3300. [PMID: 28614998 DOI: 10.1089/neu.2017.5064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
American football athletes are routinely exposed to sub-concussive impacts over the course of the season. This study sought to examine the effect of a season of American football on plasma tau, a potential marker of axonal damage. Nineteen National Collegiate Athletic Association (NCAA) football athletes underwent serial blood sampling over the course of the 2014-2015 season at those times in which the number and magnitude of head impacts likely changed. Non-contact sport controls (NCAA men's swim athletes; n = 19) provided a single plasma sample for comparison. No significant differences were observed between control swim athletes and football athletes following a period of non-contact (p = 0.569) or a period of contact (p = 0.076). Football athletes categorized as starters (n = 11) had higher tau concentrations than non-starters (n = 8) following a period of non-contact (p = 0.039) and contact (p = 0.036), but not higher than swimmers (p = 1.000 and p = 1.000, respectively). No difference was noted over the course of the season in football athletes, irrespective of starter status. Despite routine head impacts common to the sport of American football, no changes were observed over the course of the season in football athletes, irrespective of starter status. Further, no difference was observed between football athletes and non-contact control swim athletes following a period of non-contact or contact. These data suggest that plasma tau is not sensitive enough to detect damage associated with repetitive sub-concussive impacts sustained by collegiate-level football athletes.
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Affiliation(s)
- Jonathan M Oliver
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - Margaret T Jones
- 2 Division of Health and Human Performance, George Mason University , Manassas, Virginia
| | - Anthony J Anzalone
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - K Michele Kirk
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas.,3 Department of Sport Medicine, Texas Christian University , Fort Worth, Texas.,4 Department of Sport Medicine, John Peter Smith Hospital , Fort Worth, Texas
| | - David A Gable
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas.,3 Department of Sport Medicine, Texas Christian University , Fort Worth, Texas
| | - Justin T Repshas
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - Torie A Johnson
- 1 Sports Concussion Research Group, Department of KinesiologyMedicine, Texas Christian University , Fort Worth, Texas
| | - Kina Höglund
- 5 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg , Mölndal, Sweden
| | - Kaj Blennow
- 5 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg , Mölndal, Sweden
| | - Henrik Zetterberg
- 5 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg , Mölndal, Sweden .,6 Department of Molecular Neuroscience, UCL Institute of Neurology , Queen Square, London, United Kingdom
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100
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Mathis CA, Lopresti BJ, Ikonomovic MD, Klunk WE. Small-molecule PET Tracers for Imaging Proteinopathies. Semin Nucl Med 2017; 47:553-575. [PMID: 28826526 DOI: 10.1053/j.semnuclmed.2017.06.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this chapter, we provide a review of the challenges and advances in developing successful PET imaging agents for 3 major types of aggregated amyloid proteins: amyloid-beta (Aβ), tau, and alpha-synuclein (α-syn). These 3 amyloids are involved in the pathogenesis of a variety of neurodegenerative diseases, referred to as proteinopathies or proteopathies, that include Alzheimer disease, Lewy body dementias, multiple system atrophy, and frontotemporal dementias, among others. In the Introduction section, we briefly discuss the history of amyloid in neurodegenerative diseases and describe why progress in developing effective imaging agents has been hampered by the failure of crystallography to provide definitive ligand-protein interactions for rational radioligand design efforts. Instead, the field has relied on largely serendipitous, trial-and-error methods to achieve useful and specific PET amyloid imaging tracers for Aβ, tau, and α-syn deposits. Because many of the proteopathies involve more than 1 amyloid protein, it is important to develop selective PET tracers for the different amyloids to help assess the relative contribution of each to total amyloid burden. We use Pittsburgh compound B to illustrate some of the critical steps in developing a potent and selective Aβ PET imaging agent. Other selective Aβ and tau PET imaging compounds have followed similar pathways in their developmental processes. Success for selective α-syn PET imaging agents has not been realized yet, but work is ongoing in multiple laboratories throughout the world. In the tau sections, we provide background regarding 3-repeat (3R) and 4-repeat (4R) tau proteins and how they can affect the binding of tau radioligands in different tauopathies. We review the ongoing efforts to assess the properties of tau ligands, which are useful in 3R, 4R, or combined 3R-4R tauopathies. Finally, we describe in the α-syn sections recent attempts to develop selective tracers to image α-synucleinopathies.
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Affiliation(s)
- Chester A Mathis
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Brian J Lopresti
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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