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Corbillé AG, Letournel F, Kordower JH, Lee J, Shanes E, Neunlist M, Munoz DG, Derkinderen P, Beach TG. Evaluation of alpha-synuclein immunohistochemical methods for the detection of Lewy-type synucleinopathy in gastrointestinal biopsies. Acta Neuropathol Commun 2016. [PMID: 27044604 DOI: 10.1186/s40478-016-0305-8/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
The observation showing that Lewy type synucleinopathy (LTS), the pathological hallmark of Parkinson's disease (PD), is found in the gut of almost all PD subjects led to a substantial amount of research to develop a diagnostic procedure in living patients based on endoscopically obtained gastrointestinal biopsies. However, the existing studies have provided conflicting results regarding the sensitivity and specificity of gastrointestinal biopsies for the detection of LTS. We therefore undertook a multi-center staining and blinded judging of a common set of slides from colonic biopsies to determine the optimal protocol for the detection of LTS. Four different immunohistochemical methods, developed in four separate expert laboratories, were evaluated for their sensitivity and specificity to detect enteric LTS. Test sets of formalin-fixed, paraffin-embedded sections from biopsies of 9 PD subjects and 3 controls were stained with the 4 methods and graded by 4 different observers. Four types of staining morphology (granular staining in the lamina propria, perivascular/vascular wall staining in the submucosa, lacy-granular pattern in the submucosa and epithelial cell nuclear staining) were variably observed in the slides stained by the 4 methods. Positive alpha-synuclein staining was observed by all 5 judges in most of the slides from control cases, regardless of the staining methods that were used. Moreover, none of the tested method or staining pattern had a specificity and sensitivity more than 80 % regarding to PD. Overall, our study suggest that the tested methods are not adequate for the prediction of PD using gastrointestinal biopsies. Future studies are warranted to test new immunostaining methods.
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Affiliation(s)
- Anne-Gaëlle Corbillé
- Inserm, U913, Nantes, F-44035, France
- Nantes University, Nantes, F-44035, France
- Department of Neurology, CHU Nantes, Nantes, F-44093, France
- CHU Angers, Neurobiology and Neuropathology Laboratory, Angers, F-49033, France
- Université of Angers, UPRES EA3143, Angers, F-49033, France
| | - Franck Letournel
- CHU Angers, Neurobiology and Neuropathology Laboratory, Angers, F-49033, France
- Université of Angers, UPRES EA3143, Angers, F-49033, France
| | - Jeffrey H Kordower
- Department of Center for Brain Repair, Department of Pathology, Rush Medical College, Chicago, IL, USA
| | - John Lee
- Department of Pathology, NorthShore Medical Group, Evanston, IL, 60201, USA
| | - Elisheva Shanes
- Department of Pathology, NorthShore Medical Group, Evanston, IL, 60201, USA
| | - Michel Neunlist
- Inserm, U913, Nantes, F-44035, France
- Nantes University, Nantes, F-44035, France
| | - David G Munoz
- Laboratory Medicine, St. Michael's Hospital, University of Toronto & Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Pascal Derkinderen
- Inserm, U913, Nantes, F-44035, France.
- Nantes University, Nantes, F-44035, France.
- Department of Neurology, CHU Nantes, Nantes, F-44093, France.
- Department of Neurology, CHU Nantes, 44093, Nantes, France.
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105
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Adler CH, Dugger BN, Hentz JG, Hinni ML, Lott DG, Driver-Dunckley E, Mehta S, Serrano G, Sue LI, Duffy A, Intorcia A, Filon J, Pullen J, Walker DG, Beach TG. Peripheral Synucleinopathy in Early Parkinson's Disease: Submandibular Gland Needle Biopsy Findings. Mov Disord 2016; 31:250-6. [PMID: 26799362 DOI: 10.1002/mds.26476] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/16/2015] [Accepted: 10/25/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Finding a peripheral tissue biopsy site to diagnose early PD would be of value for clinical care, biomarker validation, and as research enrollment criteria. Whereas autopsy and advanced PD studies suggest that the submandibular gland is an important biopsy site, there are no studies in early PD. The aim of this study was to determine whether needle biopsy of the submandibular gland reveals Lewy type alpha-synucleinopathy in early PD. METHODS Twenty-five early PD (duration < 5 years) and 10 controls underwent transcutaneous needle core biopsies of the submandibular gland. Tissue was stained for phosphorylated alpha-synuclein, reviewed blind to clinical diagnosis, and only nerve element staining was considered positive. RESULTS Mean (standard deviation) age was 69.5 (8.3) for the PD group, 64.8 (8.0) years for controls, and disease duration 2.6 (1.1) years. Six PD and 1 control subject had inadequate glandular tissue. Positive staining was found in 14 of 19 (74%) PD and 2 of 9 (22%) control subjects. PD-positive and -negative cases did not differ clinically. Adverse events (mainly swelling and bruising) were common (77% of cases), but were minor and transient. CONCLUSIONS Submandibular gland needle biopsies identified phosphorylated alpha-synuclein staining in 74% of early PD subjects. False positives may be true false positives or may represent prodromal PD. If confirmed in larger studies with eventual autopsy confirmation, the potential value of submandibular gland biopsies for early PD may be to aid in clinical trial inclusion/exclusion and eventually serve as a gold standard for biomarker studies short of autopsy confirmation.
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Affiliation(s)
- Charles H Adler
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph G Hentz
- Department of Biostatistics, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - David G Lott
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - Erika Driver-Dunckley
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shyamal Mehta
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Geidy Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Amy Duffy
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Jessica Filon
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Joel Pullen
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Douglas G Walker
- Banner Sun Health Research Institute, Sun City, Arizona, USA.,Arizona State University, Tempe, Arizona, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
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109
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Sprenger FS, Stefanova N, Gelpi E, Seppi K, Navarro-Otano J, Offner F, Vilas D, Valldeoriola F, Pont-Sunyer C, Aldecoa I, Gaig C, Gines A, Cuatrecasas M, Högl B, Frauscher B, Iranzo A, Wenning GK, Vogel W, Tolosa E, Poewe W. Enteric nervous system α-synuclein immunoreactivity in idiopathic REM sleep behavior disorder. Neurology 2015; 85:1761-8. [PMID: 26475692 PMCID: PMC4653104 DOI: 10.1212/wnl.0000000000002126] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/23/2015] [Indexed: 12/24/2022] Open
Abstract
Objective: To investigate the expression of α-synuclein in colonic biopsies of patients with idiopathic REM sleep behavior disorder (iRBD) and address if α-synuclein immunostaining of tissue obtained via colonic biopsies holds promise as a diagnostic biomarker for prodromal Parkinson disease (PD). Methods: Patients with iRBD, patients with PD, and healthy controls were prospectively recruited to undergo colonic biopsies for comparison of α-synuclein immunoreactivity patterns between the groups by using 2 different antibodies. Results: There was no difference in colonic mucosal and submucosal immunostaining between groups using the 15G7 α-synuclein antibody, which was found in almost all participants enrolled in this study. By contrast, immunostaining for serine 129-phosphorylated α-synuclein (pSyn) in submucosal nerve fibers or ganglia was found in none of 14 controls but was observed in 4 of 17 participants with iRBD and 1 out of 19 patients with PD. Conclusions: The present findings of pSyn immunostaining of colonic biopsies in a substantial proportion of iRBD participants raise the possibility that this tissue marker may be a suitable candidate to study further as a prodromal PD marker in at-risk cohorts.
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Affiliation(s)
- Fabienne S Sprenger
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Nadia Stefanova
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Ellen Gelpi
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Klaus Seppi
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Judith Navarro-Otano
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Felix Offner
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Dolores Vilas
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Francesc Valldeoriola
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Claustre Pont-Sunyer
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Iban Aldecoa
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Carles Gaig
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Angels Gines
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Miriam Cuatrecasas
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Birgit Högl
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Birgit Frauscher
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Alex Iranzo
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Gregor K Wenning
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Wolfgang Vogel
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Eduardo Tolosa
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria
| | - Werner Poewe
- From the Departments of Neurology (F.S.S., N.S., K.S., B.H., B.F., G.K.W., W.P.) and Gastroenterology (W.V.), Medical University of Innsbruck, Austria; Neurological Tissue Bank of the Biobanc-Hospital Clinic de Barcelona (E.G.), IDIBAPS; the Departments of Neurology (J.N.-O., D.V., F.V., C.P.-S., C.G., A.I., E.T.), Pathology (I.A., M.C.), and Gastroenterology (A.G.), Hospital Clinic de Barcelona, Spain; and the Institute of Pathology (F.O.), Academic Teaching Hospital, Feldkirch, Austria.
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