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Rekik A, Mrabet S, Kacem I, Nasri A, Ben Djebara M, Gargouri A, Gouider R. Eye Movement Abnormalities in Amyotrophic Lateral Sclerosis in a Tunisian Cohort. Neuroophthalmology 2022; 46:227-235. [PMID: 35859634 PMCID: PMC9291663 DOI: 10.1080/01658107.2022.2038638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Few studies have reported abnormal ocular movements in cases of amyotrophic lateral sclerosis (ALS) and their link with other disease features. Our study aimed to describe and analyse eye movement abnormalities in ALS patients. Specifically, we set out to investigate the correlation between non-motor signs and oculomotor impairment in order to understand the pathogenesis of the disease. All ALS patients seen from 2018 to 2020 in the department of Neurology of Razi hospital underwent the recording of saccadic eye movements. Results were compared with healthy controls. Sixty-two patients were included. Altered saccadic eye movements (72.6%) correlated with tongue atrophy and bladder dysfunction. The most common finding was altered smooth pursuit (56.5%), which showed correlation with bladder dysfunction and altered frontal assessment battery (FAB) scores. Prolonged latencies of horizontal saccades (34%) correlated with sensory and extrapyramidal signs. Our study is the first to examine the characteristics of eye movements in a large African cohort of ALS patients and to show correlations with extra-motor clinical signs. Our findings showed extra-motor cortex dysfunction in ALS with greater frequency of eye movement abnormalities in comparison with previous studies. Altered horizontal pursuit, the core abnormality, confirmed the extension of the neurodegenerative process to the frontal and prefrontal cortices. Prolonged horizontal saccade latencies reflect mainly the involvement of the parietal eye field. Anti-saccadic abnormalities were the least common finding and showed, paradoxically, no link with executive dysfunction.
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Affiliation(s)
- Arwa Rekik
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia
| | - Saloua Mrabet
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Imen Kacem
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Amina Nasri
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Mouna Ben Djebara
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Amina Gargouri
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Riadh Gouider
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Manouba, Tunisia,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia,CONTACT Riadh Gouider Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, LR 18SP03, 1, Orangers Street, Manouba, Tunis2010, Tunisia
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Yu M, Zhao X, Wu W, Wang Q, Liu J, Zhang W, Yuan Y, Hong D, Wang Z, Deng J. Widespread Mislocalization of FUS Is Associated With Mitochondrial Abnormalities in Skeletal Muscle in Amyotrophic Lateral Sclerosis With FUS Mutations. J Neuropathol Exp Neurol 2022; 81:172-181. [PMID: 35139534 DOI: 10.1093/jnen/nlac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mutations in the fused in sarcoma (FUS) gene have been reported to be the most common genetic cause of early-onset amyotrophic lateral sclerosis (ALS); cytoplasmic inclusions containing FUS protein are the predominant pathological feature. Recent studies indicated that mutant FUS impaired neuromuscular junctions and induced muscle intrinsic toxicity in cell and animal models. However, the role of FUS in muscle degeneration remains unclear. In this study, we investigated FUS protein distribution in skeletal muscle fibers in ALS-FUS. Our data show that cytoplasmic mislocalized FUS in the unaggregated form represented a remarkable pathological feature in affected muscle fibers in ALS-FUS. Additional studies found that cytoplasmic FUS colocalized with some mitochondria and was associated with mitochondrial swelling and disorganized cristae. RNA sequencing and quantitative real-time polymerase chain reaction analyses indicated downregulation of the key subunits of mitochondrial oxidative phosphorylation complexes in the affected skeletal muscle in ALS-FUS patients. Further immunoblot analysis showed increased levels of FUS, but decreased levels of Cox I (subunit of complex IV) in ALS-FUS patients compared with age-matched controls. This is the first demonstration of the close association of cytoplasmic mislocalized FUS with mitochondrial dysfunction in skeletal muscle, implicating the presence of a cell-autonomous mechanism in muscle degeneration in ALS.
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Affiliation(s)
- Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xutong Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Wu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qingqing Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jing Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Daojun Hong
- Department of Medical Genetics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaoxia Wang
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Jianwen Deng
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
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3
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Dhasmana S, Dhasmana A, Narula AS, Jaggi M, Yallapu MM, Chauhan SC. The panoramic view of amyotrophic lateral sclerosis: A fatal intricate neurological disorder. Life Sci 2022; 288:120156. [PMID: 34801512 DOI: 10.1016/j.lfs.2021.120156] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurological disease affecting both upper and lower motor neurons. In the United States alone, there are 16,000-20,000 established cases of ALS. The early disease diagnosis is challenging due to many overlapping pathophysiologies with other neurological diseases. The etiology of ALS is unknown; however, it is divided into two categories: familial ALS (fALS) which occurs due to gene mutations & contributes to 5-10% of ALS, and sporadic ALS (sALS) which is due to environmental factors & contributes to 90-95% of ALS. There is still no curative treatment for ALS: palliative care and symptomatic treatment are therefore essential components in the management of these patients. In this review, we provide a panoramic view of ALS, which includes epidemiology, risk factors, pathophysiologies, biomarkers, diagnosis, therapeutics (natural, synthetic, gene-based, pharmacological, stem cell, extracellular vesicles, and physical therapy), controversies (in the clinical trials of ALS), the scope of nanomedicine in ALS, and future perspectives.
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Affiliation(s)
- Swati Dhasmana
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA; South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
| | - Anupam Dhasmana
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA; South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
| | - Acharan S Narula
- Narula Research LLC, 107 Boulder Bluff, Chapel Hill, NC 27516, USA
| | - Meena Jaggi
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA; South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
| | - Murali M Yallapu
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA; South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
| | - Subhash C Chauhan
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA; South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA.
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4
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Wo X, Yuan Y, Xu Y, Chen Y, Wang Y, Zhao S, Lin L, Zhong X, Wang Y, Zhong Z, Zhao W. TAR DNA-Binding Protein 43 is Cleaved by the Protease 3C of Enterovirus A71. Virol Sin 2021; 36:95-103. [PMID: 32696397 PMCID: PMC7973337 DOI: 10.1007/s12250-020-00262-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
Enterovirus A71 (EV-A71) is one of the etiological pathogens leading to hand, foot, and mouth disease (HFMD), which can cause severe neurological complications. The neuropathogenesis of EV-A71 infection is not well understood. The mislocalization and aggregation of TAR DNA-binding protein 43 (TDP-43) is the pathological hallmark of amyotrophic lateral sclerosis (ALS). However, whether TDP-43 was impacted by EV-A71 infection is unknown. This study demonstrated that TDP-43 was cleaved during EV-A71 infection. The cleavage of TDP-43 requires EV-A71 replication rather than the activated caspases due to viral infection. TDP-43 is cleaved by viral protease 3C between the residues 331Q and 332S, while mutated TDP-43 (Q331A) was not cleaved. In addition, mutated 3C which lacks the protease activity failed to induce TDP-43 cleavage. We also found that TDP-43 was translocated from the nucleus to the cytoplasm, and the mislocalization of TDP-43 was induced by viral protease 2A rather than 3C. Taken together, we demonstrated that TDP-43 was cleaved by viral protease and translocated to the cytoplasm during EV-A71 infection, implicating the possible involvement of TDP-43 in the pathogenesis of EV-A71infection.
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Affiliation(s)
- Xiaoman Wo
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China
| | - Yuan Yuan
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China
| | - Yong Xu
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China
| | - Yang Chen
- Department of Microbiology, Harbin Medical University, Harbin, 150081, China
| | - Yao Wang
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China
| | - Shuoxuan Zhao
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China
| | - Lexun Lin
- Department of Microbiology, Harbin Medical University, Harbin, 150081, China
| | - Xiaoyan Zhong
- Department of Microbiology, Harbin Medical University, Harbin, 150081, China
| | - Yan Wang
- Department of Microbiology, Harbin Medical University, Harbin, 150081, China
| | - Zhaohua Zhong
- Department of Microbiology, Harbin Medical University, Harbin, 150081, China.
| | - Wenran Zhao
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China.
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Leigh N, Simpson J, Eccles FJR. Does a lack of social support and perceived stigma influence the relationship between motor neurone disease-related stress and psychological distress? Br J Health Psychol 2020; 26:289-306. [PMID: 33026136 DOI: 10.1111/bjhp.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/02/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to investigate the mechanisms through which social support and felt stigma influence the relationship between motor neurone disease (MND)-related stress and psychological distress for people with MND. Although a lack of social support has been identified as a significant predictor of psychological distress for individuals with MND, the mechanisms through which this relationship exists have not been assessed, nor have the predictive nature of stigma. Furthermore, the theoretical model specifying the effects of enacted stigma on self-stigma has not been tested in individuals with MND. DESIGN A cross-sectional design utilizing an online survey method was used. It was hypothesized that social support would moderate the relationship between MND-related stress (operationalized as enacted stigma or physical functioning) and psychological distress (operationalized as depression, anxiety, and stress). Furthermore, felt stigma would significantly mediate the relationship between MND-related stress (enacted stigma) and psychological distress. METHODS Individuals with a diagnosis of MND were recruited internationally through social media and through various organizations and support services. Seventy-seven participants completed the online survey. RESULTS Significant correlations were identified between social support, felt, and enacted stigma and psychological distress. Moderation analysis was not significant. However, the mediation analyses identified felt stigma as a significant mediator of the relationship between enacted stigma and psychological distress. A direct relationship between enacted stigma and stress (but not depression and anxiety) was also evident. CONCLUSIONS A comprehensive approach to tackling stigma is important in ameliorating psychological distress for people with MND. Limitations of the current study are discussed, along with implications for clinical practice.
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Affiliation(s)
- Natalie Leigh
- Division of Health Research, Lancaster University, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, UK
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Chaudhuri P, Prajapati KP, Anand BG, Dubey K, Kar K. Amyloid cross-seeding raises new dimensions to understanding of amyloidogenesis mechanism. Ageing Res Rev 2019; 56:100937. [PMID: 31430565 DOI: 10.1016/j.arr.2019.100937] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/21/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Abstract
Hallmarks of most of the amyloid pathologies are surprisingly found to be heterocomponent entities such as inclusions and plaques which contain diverse essential proteins and metabolites. Experimental studies have already revealed the occurrence of coaggregation and cross-seeding during amyloid formation of several proteins and peptides, yielding multicomponent assemblies of amyloid nature. Further, research reports on the co-occurrence of more than one type of amyloid-linked pathologies in the same individual suggest the possible cross-talk among the disease related amyloidogenic protein species during their amyloid growth. In this review paper, we have tried to gain more insight into the process of coaggregation and cross-seeding during amyloid aggregation of proteins, particularly focusing on their relevance to the pathogenesis of the protein misfolding diseases. Revelation of amyloid cross-seeding and coaggregation seems to open new dimensions in our mechanistic understanding of amyloidogenesis and such knowledge may possibly inspire better designing of anti-amyloid therapeutics.
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7
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Kang BH, Kim JI, Lim YM, Kim KK. Abnormal Oculomotor Functions in Amyotrophic Lateral Sclerosis. J Clin Neurol 2018; 14:464-471. [PMID: 30198218 PMCID: PMC6172508 DOI: 10.3988/jcn.2018.14.4.464] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Although traditionally regarded as spared, a range of oculomotor dysfunction has been recognized in amyotrophic lateral sclerosis (ALS) patients. ALS is nowadays considered as a neurodegenerative disorder of a third compartment comprising widespread areas of extra-motor brain including cerebellum. Our objective was to perform an observational study to examine for ocular motor dysfunction in patients with ALS and for any differences between bulbar-onset and spinal-onset patients. METHODS Thirty two ALS patients (bulbar onset: 10, spinal onset: 22) underwent the standardized systemic evaluations using video-oculography. RESULTS Oculomotor dysfunctions such as square wave jerks, saccadic dysmetria, abnormal cogwheeling smooth pursuits and head shaking and positional nystagmus of central origin have been observed in the ALS patients at a relatively early stage. Abnormal smooth pursuits and saccadic dysmetria were increased in the bulbar-onset compared to the spinal-onset (p<0.05). CONCLUSIONS These oculomotor abnormalities may be a marker of neuro-degeneration beyond motor neurons in ALS, especially in bulbar-onset disease. Future longitudinal studies of eye movement abnormalities have provided insights into the distribution and nature of the disease process.
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Affiliation(s)
- Bong Hui Kang
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Neurology, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea
| | - Jae Il Kim
- Department of Neurology, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea
| | - Young Min Lim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kwang Kuk Kim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Cykowski MD, Powell SZ, Appel JW, Arumanayagam AS, Rivera AL, Appel SH. Phosphorylated TDP-43 (pTDP-43) aggregates in the axial skeletal muscle of patients with sporadic and familial amyotrophic lateral sclerosis. Acta Neuropathol Commun 2018; 6:28. [PMID: 29653597 PMCID: PMC5899326 DOI: 10.1186/s40478-018-0528-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023] Open
Abstract
Muscle atrophy with weakness is a core feature of amyotrophic lateral sclerosis (ALS) that has long been attributed to motor neuron loss alone. However, several studies in ALS patients, and more so in animal models, have challenged this assumption with the latter providing direct evidence that muscle can play an active role in the disease. Here, we examined the possible role of cell autonomous pathology in 148 skeletal muscle samples from 57 ALS patients, identifying phosphorylated TAR DNA-binding protein (pTDP-43) inclusions in the muscle fibers of 19 patients (33.3%) and 24 tissue samples (16.2% of specimens). A muscle group-specific difference was identified with pTDP-43 pathology being significantly more common in axial (paraspinous, diaphragm) than appendicular muscles (P = 0.0087). This pathology was not significantly associated with pertinent clinical, genetic (c9ALS) or nervous system pathologic data, suggesting it is not limited to any particular subgroup of ALS patients. Among 25 non-ALS muscle samples, pTDP-43 inclusions were seen only in the autophagy-related disorder inclusion body myositis (IBM) (n = 4), where they were more diffuse than in positive ALS samples (P = 0.007). As in IBM samples, pTDP-43 aggregates in ALS were p62/ sequestosome-1-positive, potentially indicating induction of autophagy. Phospho-TDP-43-positive ALS and IBM samples also showed significant up-regulation of TARDBP and SQSTM1 expression. These findings implicate axial skeletal muscle as an additional site of pTDP-43 pathology in some ALS patients, including sporadic and familial cases, which is deserving of further investigation.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA.
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA.
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Joan W Appel
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Anithachristy S Arumanayagam
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Stanley H Appel
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
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Cykowski MD, Powell SZ, Peterson LE, Appel JW, Rivera AL, Takei H, Chang E, Appel SH. Clinical Significance of TDP-43 Neuropathology in Amyotrophic Lateral Sclerosis. J Neuropathol Exp Neurol 2017; 76:402-413. [PMID: 28521037 PMCID: PMC5901081 DOI: 10.1093/jnen/nlx025] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To determine the significance of TAR DNA binding protein 43 kDa (TDP-43) pathology in amyotrophic lateral sclerosis (ALS), we examined the whole brains and spinal cords of 57 patients (35 men; 22 women; mean age 63.3 years; 15 patients with c9orf72-associated ALS [c9ALS]). TDP-43 pathologic burden was determined relative to symptom onset site, disease duration, progression rate, cognitive status, and c9ALS status. There was a trend for greater TDP-43 pathologic burden in cognitively impaired patients (p = 0.07), though no association with disease duration or progression rate was seen. Shorter disease duration (p = 0.0016), more severe striatal pathology (p = 0.0029), and a trend toward greater whole brain TDP-43 pathology (p = 0.059) were found in c9ALS. Cluster analysis identified “TDP43-limited,” “TDP43-moderate,” and “TDP43-severe” subgroups. The TDP43-limited group contained more cognitively intact (p = 0.005) and lower extremity onset site (p = 0.019) patients, while other subgroups contained more cognitively impaired patients. We conclude that TDP-43 pathologic burden in ALS is associated with cognitive impairment and c9ALS, but not duration of disease or rate of progression. Further, we demonstrate a subgroup of patients with low TDP-43 burden, lower extremity onset, and intact cognition, which requires further investigation.
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Affiliation(s)
- Matthew D Cykowski
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Suzanne Z Powell
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Leif E Peterson
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Joan W Appel
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Andreana L Rivera
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Hidehiro Takei
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Ellen Chang
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Stanley H Appel
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
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10
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Grad LI, Rouleau GA, Ravits J, Cashman NR. Clinical Spectrum of Amyotrophic Lateral Sclerosis (ALS). Cold Spring Harb Perspect Med 2017; 7:cshperspect.a024117. [PMID: 28003278 DOI: 10.1101/cshperspect.a024117] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is primarily characterized by progressive loss of motor neurons, although there is marked phenotypic heterogeneity between cases. Typical, or "classical," ALS is associated with simultaneous upper motor neuron (UMN) and lower motor neuron (LMN) involvement at disease onset, whereas atypical forms, such as primary lateral sclerosis and progressive muscular atrophy, have early and predominant involvement in the UMN and LMN, respectively. The varying phenotypes can be so distinctive that they would seem to have differing biology. Because the same phenotypes can have multiple causes, including different gene mutations, there may be multiple molecular mechanisms causing ALS, implying that the disease is a syndrome. Conversely, multiple phenotypes can be caused by a single gene mutation; thus, a single molecular mechanism could be compatible with clinical heterogeneity. The pathogenic mechanism(s) in ALS remain unknown, but active propagation of the pathology neuroanatomically is likely a primary component.
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Affiliation(s)
- Leslie I Grad
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal H3A 2B4, Canada
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
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Guerrero EN, Wang H, Mitra J, Hegde PM, Stowell SE, Liachko NF, Kraemer BC, Garruto RM, Rao KS, Hegde ML. TDP-43/FUS in motor neuron disease: Complexity and challenges. Prog Neurobiol 2016; 145-146:78-97. [PMID: 27693252 PMCID: PMC5101148 DOI: 10.1016/j.pneurobio.2016.09.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/19/2016] [Accepted: 09/20/2016] [Indexed: 01/05/2023]
Abstract
Amyotrophic lateral sclerosis (ALS), a common motor neuron disease affecting two per 100,000 people worldwide, encompasses at least five distinct pathological subtypes, including, ALS-SOD1, ALS-C9orf72, ALS-TDP-43, ALS-FUS and Guam-ALS. The etiology of a major subset of ALS involves toxicity of the TAR DNA-binding protein-43 (TDP-43). A second RNA/DNA binding protein, fused in sarcoma/translocated in liposarcoma (FUS/TLS) has been subsequently associated with about 1% of ALS patients. While mutations in TDP-43 and FUS have been linked to ALS, the key contributing molecular mechanism(s) leading to cell death are still unclear. One unique feature of TDP-43 and FUS pathogenesis in ALS is their nuclear clearance and simultaneous cytoplasmic aggregation in affected motor neurons. Since the discoveries in the last decade implicating TDP-43 and FUS toxicity in ALS, a majority of studies have focused on their cytoplasmic aggregation and disruption of their RNA-binding functions. However, TDP-43 and FUS also bind to DNA, although the significance of their DNA binding in disease-affected neurons has been less investigated. A recent observation of accumulated genomic damage in TDP-43 and FUS-linked ALS and association of FUS with neuronal DNA damage repair pathways indicate a possible role of deregulated DNA binding function of TDP-43 and FUS in ALS. In this review, we discuss the different ALS disease subtypes, crosstalk of etiopathologies in disease progression, available animal models and their limitations, and recent advances in understanding the specific involvement of RNA/DNA binding proteins, TDP-43 and FUS, in motor neuron diseases.
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Affiliation(s)
- Erika N. Guerrero
- Department of Radiation Oncology, Houston Methodist Research Institute, Houston, Texas 77030, USA
- Centre for Neuroscience, Institute for Scientific Research and Technology Services (INDICASAT-AIP), City of Knowledge, Panama
- Department of Biotechnology, Acharya Nagarjuna University, Guntur, India
| | - Haibo Wang
- Department of Radiation Oncology, Houston Methodist Research Institute, Houston, Texas 77030, USA
| | - Joy Mitra
- Department of Radiation Oncology, Houston Methodist Research Institute, Houston, Texas 77030, USA
| | - Pavana M. Hegde
- Department of Radiation Oncology, Houston Methodist Research Institute, Houston, Texas 77030, USA
| | - Sara E. Stowell
- Department of Anthropology, Binghamton University, State University of New York, Binghamton, New York
| | - Nicole F Liachko
- Geriatric Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Brian C. Kraemer
- Geriatric Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Ralph M. Garruto
- Department of Anthropology, Binghamton University, State University of New York, Binghamton, New York
- Department of Biological Sciences, Binghamton University, State University of New York, Binghamton, New York
| | - K. S. Rao
- Centre for Neuroscience, Institute for Scientific Research and Technology Services (INDICASAT-AIP), City of Knowledge, Panama
- Department of Biotechnology, Acharya Nagarjuna University, Guntur, India
| | - Muralidhar L. Hegde
- Department of Radiation Oncology, Houston Methodist Research Institute, Houston, Texas 77030, USA
- Houston Methodist Neurological Institute, Houston, Texas 77030 USA
- Weill Medical College of Cornell University, New York
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Mathis S, Couratier P, Julian A, Vallat JM, Corcia P, Le Masson G. Management and therapeutic perspectives in amyotrophic lateral sclerosis. Expert Rev Neurother 2016; 17:263-276. [DOI: 10.1080/14737175.2016.1227705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Neuro-Muscular Unit and ALS Center, CHU de Bordeaux, groupe hospitalier Pellegrin, Bordeaux, France
| | - Philippe Couratier
- Department of Neurology, ALS center, Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, Limoges, France
| | - Adrien Julian
- Department of Neurology, CHU Poitiers, University of Poitiers, Poitiers, France
| | - Jean-Michel Vallat
- Department and Laboratory of Neurology, Centre de Référence ‘neuropathies périphériques rares’, University Hospital of Limoges, Limoges, France
| | - Philippe Corcia
- Department of Neurology, ALS center, Centre de compétence SLA-fédération Tours-Limoges, CHU de Tours, Tours, France
| | - Gwendal Le Masson
- Department of Neurology, Neuro-Muscular Unit and ALS Center, CHU de Bordeaux, groupe hospitalier Pellegrin, Bordeaux, France
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van Groenestijn AC, Kruitwagen-van Reenen ET, Visser-Meily JMA, van den Berg LH, Schröder CD. Associations between psychological factors and health-related quality of life and global quality of life in patients with ALS: a systematic review. Health Qual Life Outcomes 2016; 14:107. [PMID: 27439463 PMCID: PMC4955215 DOI: 10.1186/s12955-016-0507-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/07/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To systematically identify and appraise evidence on associations between psychological factors (moods, beliefs, personality) and Health-related QoL (HRQoL) and/or global QoL in patients with Amyotrophic Lateral Sclerosis (ALS). METHODS A systematic review was conducted in several online databases (PsycINFO, EMBASE, PubMed and CINAHL) up to October 2015. Articles were included if they reported associations between psychological factors (moods, beliefs and personality) and HRQoL and/or global QoL in an ALS population. The search was limited to empirical studies, published in English, which provided quantitative data. The methodological quality of the included articles was assessed. RESULTS In total, 22 studies were included. Mood was investigated in 14 studies, beliefs in 11 studies and personality in one study. Fifteen different psychological factors were extracted and assessed using 24 different measures. Twelve different QoL measures were used in the selected studies, subdivided into seven different HRQoL measures and five different global QoL measures. Higher levels of anxiety and depression appeared to be related to a poorer HRQoL, whereas a higher level of religiosity seemed to be associated with better global QoL. No conclusive associations were found for confusion-bewilderment (mood), spirituality, mindfulness, coping styles, hopelessness, perception of burden, cognitive appraisal (beliefs), neuroticism, extraversion, openness, agreeableness and conscientiousness (personality), due to insufficient or inconsistent evidence. Religiosity and spirituality appeared to become more positively associated over time. CONCLUSIONS Our results suggest that higher levels of anxiety and depression are related to a poorer HRQoL, whereas higher levels of religiosity appeared to be related to better global QoL. Associations might change during the disease course. This review supports the importance of psychological factors with regard to ALS care. Further research is needed to supplement the available evidence and to investigate how psychological factors can be modified to improve QoL. REVIEW REGISTRATION NUMBER PROSPERO 2015:CRD42015027303.
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Affiliation(s)
- Annerieke C van Groenestijn
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Esther T Kruitwagen-van Reenen
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carin D Schröder
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Nidos A, Kasselimis DS, Simos PG, Rentzos M, Alexakis T, Zalonis I, Zouvelou V, Potagas C, Evdokimidis I, Woolley SC. Frontotemporal Dysfunction in Amyotrophic Lateral Sclerosis: A Discriminant Function Analysis. NEURODEGENER DIS 2015; 16:140-6. [DOI: 10.1159/000381186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022] Open
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Shindo K, Miwa M, Kobayashi F, Nagasaka T, Takiyama Y. Muscle sympathetic nerve activity in frontotemporal lobar degeneration is similar to amyotrophic lateral sclerosis. Clin Auton Res 2015; 26:1-5. [PMID: 26607591 PMCID: PMC4740563 DOI: 10.1007/s10286-015-0321-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/21/2015] [Indexed: 12/13/2022]
Abstract
Purpose To determine whether frontotemporal lobar degeneration (FTLD) is associated with similar cardiovascular autonomic dysfunction to that seen in amyotrophic lateral sclerosis (ALS), we compared cardiovascular parameters between ALS patients and patients with FTLD. Methods In ten patients with FTLD (mean age ± SD: 71.6 ± 4.6 years) and 12 patients with ALS (mean age ± SD: 71.4 ± 4.6 years), MSNA (using microneurography), heart rate (HR), and blood pressure (BP) were recorded simultaneously. Results MSNA was significantly higher in both groups of patients compared with the controls (p < 0.01), while there were no significant differences in MSNA between the patients with FTLD and those with ALS. During head-up tilt, changes in HR, BP, and the frequency of MSNA bursts were smaller in the patients than in controls (p < 0.05 or p < 0.01). Conclusions Patients with FTLD and ALS showed similar dysfunction of HR, BP, and sympathetic outflow to muscles.
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Affiliation(s)
- Kazumasa Shindo
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898, Japan.
| | - Michiaki Miwa
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898, Japan
| | - Fumikazu Kobayashi
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898, Japan
| | - Takamura Nagasaka
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898, Japan
| | - Yoshihisa Takiyama
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898, Japan
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MacNair L, Xiao S, Miletic D, Ghani M, Julien JP, Keith J, Zinman L, Rogaeva E, Robertson J. MTHFSD and DDX58 are novel RNA-binding proteins abnormally regulated in amyotrophic lateral sclerosis. Brain 2015; 139:86-100. [PMID: 26525917 DOI: 10.1093/brain/awv308] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/03/2015] [Indexed: 01/21/2023] Open
Abstract
Tar DNA-binding protein 43 (TDP-43) is an RNA-binding protein normally localized to the nucleus of cells, where it elicits functions related to RNA metabolism such as transcriptional regulation and alternative splicing. In amyotrophic lateral sclerosis, TDP-43 is mislocalized from the nucleus to the cytoplasm of diseased motor neurons, forming ubiquitinated inclusions. Although mutations in the gene encoding TDP-43, TARDBP, are found in amyotrophic lateral sclerosis, these are rare. However, TDP-43 pathology is common to over 95% of amyotrophic lateral sclerosis cases, suggesting that abnormalities of TDP-43 play an active role in disease pathogenesis. It is our hypothesis that a loss of TDP-43 from the nucleus of affected motor neurons in amyotrophic lateral sclerosis will lead to changes in RNA processing and expression. Identifying these changes could uncover molecular pathways that underpin motor neuron degeneration. Here we have used translating ribosome affinity purification coupled with microarray analysis to identify the mRNAs being actively translated in motor neurons of mutant TDP-43(A315T) mice compared to age-matched non-transgenic littermates. No significant changes were found at 5 months (presymptomatic) of age, but at 10 months (symptomatic) the translational profile revealed significant changes in genes involved in RNA metabolic process, immune response and cell cycle regulation. Of 28 differentially expressed genes, seven had a ≥ 2-fold change; four were validated by immunofluorescence labelling of motor neurons in TDP-43(A315T) mice, and two of these were confirmed by immunohistochemistry in amyotrophic lateral sclerosis cases. Both of these identified genes, DDX58 and MTHFSD, are RNA-binding proteins, and we show that TDP-43 binds to their respective mRNAs and we identify MTHFSD as a novel component of stress granules. This discovery-based approach has for the first time revealed translational changes in motor neurons of a TDP-43 mouse model, identifying DDX58 and MTHFSD as two TDP-43 targets that are misregulated in amyotrophic lateral sclerosis.
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Affiliation(s)
- Laura MacNair
- 1 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, M5T 2S8, Canada 2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Shangxi Xiao
- 1 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Denise Miletic
- 1 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Mahdi Ghani
- 1 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Jean-Pierre Julien
- 3 Département de psychiatrie et de neurosciences, Université Laval, Québec G1V 0A6, Canada
| | - Julia Keith
- 2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5S 1A1, Canada 4 Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lorne Zinman
- 4 Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Ekaterina Rogaeva
- 1 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Janice Robertson
- 1 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, M5T 2S8, Canada 2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5S 1A1, Canada
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Shindo K, Tsuchiya M, Ichinose Y, Onohara A, Fukumoto M, Koh K, Takaki R, Yamashiro N, Kobayashi F, Nagasaka T, Takiyama Y. No relation between sympathetic outflow to muscles and respiratory function in amyotrophic lateral sclerosis. J Neurol Sci 2015; 358:66-71. [DOI: 10.1016/j.jns.2015.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/27/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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Pupillo E, Bianchi E, Messina P, Chiveri L, Lunetta C, Corbo M, Filosto M, Lorusso L, Marin B, Mandrioli J, Riva N, Sasanelli F, Tremolizzo L, Beghi E. Extrapyramidal and cognitive signs in amyotrophic lateral sclerosis: A population based cross-sectional study. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:324-30. [DOI: 10.3109/21678421.2015.1040028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cykowski MD, Takei H, Schulz PE, Appel SH, Powell SZ. TDP-43 pathology in the basal forebrain and hypothalamus of patients with amyotrophic lateral sclerosis. Acta Neuropathol Commun 2014; 2:171. [PMID: 25539830 PMCID: PMC4297460 DOI: 10.1186/s40478-014-0171-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis is a neurodegenerative disease characterized clinically by motor symptoms including limb weakness, dysarthria, dysphagia, and respiratory compromise, and pathologically by inclusions of transactive response DNA-binding protein 43 kDa (TDP-43). Patients with amyotrophic lateral sclerosis also may demonstrate non-motor symptoms and signs of autonomic and energy dysfunction as hypermetabolism and weight loss that suggest the possibility of pathology in the forebrain, including hypothalamus. However, this region has received little investigation in amyotrophic lateral sclerosis. In this study, the frequency, topography, and clinical associations of TDP-43 inclusion pathology in the basal forebrain and hypothalamus were examined in 33 patients with amyotrophic lateral sclerosis: 25 men and 8 women; mean age at death of 62.7 years, median disease duration of 3.1 years (range of 1.3 to 9.8 years). Results TDP-43 pathology was present in 11 patients (33.3%), including components in both basal forebrain (n= 10) and hypothalamus (n= 7). This pathology was associated with non-motor system TDP-43 pathology (Χ2= 17.5, p= 0.00003) and bulbar symptoms at onset (Χ2= 4.04, p= 0.044), but not age or disease duration. Furthermore, TDP-43 pathology in the lateral hypothalamic area was associated with reduced body mass index (W= 11, p= 0.023). Conclusions This is the first systematic demonstration of pathologic involvement of the basal forebrain and hypothalamus in amyotrophic lateral sclerosis. Furthermore, the findings suggest that involvement of the basal forebrain and hypothalamus has significant phenotypic associations in amyotrophic lateral sclerosis, including site of symptom onset, as well as deficits in energy metabolism with loss of body mass index.
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THEME 1 IMPROVING DIAGNOSIS, PROGNOSIS AND DISEASE PROGRESSION. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15 Suppl 1:57-67. [DOI: 10.3109/21678421.2014.960174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McCluskey L, Vandriel S, Elman L, Van Deerlin VM, Powers J, Boller A, Wood EM, Woo J, McMillan CT, Rascovsky K, Grossman M. ALS-Plus syndrome: non-pyramidal features in a large ALS cohort. J Neurol Sci 2014; 345:118-24. [PMID: 25086858 PMCID: PMC4177937 DOI: 10.1016/j.jns.2014.07.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/03/2014] [Accepted: 07/10/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Autopsy studies show widespread pathology in amyotrophic lateral sclerosis (ALS), but clinical surveys of multisystem disease in ALS are rare. We investigated ALS-Plus syndrome, an understudied group of patients with clinical features extending beyond pyramidal and neuromuscular systems with or without cognitive/behavioral deficits. METHODS In a large, consecutively-ascertained cohort of 550 patients with ALS, we documented atypical clinical manifestations. Genetic screening for C9orf72 hexanucleotide expansions was performed in 343 patients, and SOD1, TARDBP, and VCP were tested in the subgroup of patients with a family history of ALS. Gray matter and white matter imaging was available in a subgroup of 30 patients. RESULTS Seventy-five (13.6%) patients were identified with ALS-Plus syndrome. We found disorders of ocular motility, cerebellar, extrapyramidal and autonomic functioning. Relative to those without ALS-Plus, cognitive impairment (8.0% vs 2.9%, p=0.029), bulbar-onset (49.3% vs 23.2%, p<0.001), and pathogenic mutations (20.0% vs 8.4%, p=0.015) were more than twice as common in ALS-Plus. Survival was significantly shorter in ALS-Plus (29.66 months vs 42.50 months, p=0.02), regardless of bulbar-onset or mutation status. Imaging revealed significantly greater cerebellar and cerebral disease in ALS-Plus compared to those without ALS-Plus. CONCLUSIONS ALS-Plus syndrome is not uncommon, and the presence of these atypical features is consistent with neuropathological observations that ALS is a multisystem disorder. ALS-Plus syndrome is associated with increased risk for poor survival and the presence of a pathogenic mutation.
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Affiliation(s)
- Leo McCluskey
- Department of Neurology, University of Pennsylvania, United States
| | - Shannon Vandriel
- Department of Neurology, University of Pennsylvania, United States
| | - Lauren Elman
- Department of Neurology, University of Pennsylvania, United States
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, United States
| | - John Powers
- Department of Neurology, University of Pennsylvania, United States
| | - Ashley Boller
- Department of Neurology, University of Pennsylvania, United States
| | - Elisabeth McCarty Wood
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, United States
| | - John Woo
- Department of Radiology, University of Pennsylvania, United States
| | - Corey T McMillan
- Department of Neurology, University of Pennsylvania, United States
| | - Katya Rascovsky
- Department of Neurology, University of Pennsylvania, United States
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania, United States.
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Hebron M, Chen W, Miessau MJ, Lonskaya I, Moussa CEH. Parkin reverses TDP-43-induced cell death and failure of amino acid homeostasis. J Neurochem 2013; 129:350-61. [PMID: 24298989 DOI: 10.1111/jnc.12630] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 12/13/2022]
Abstract
The E3 ubiquitin ligase Parkin plays a central role in the pathogenesis of many neurodegenerative diseases. Parkin promotes specific ubiquitination and affects the localization of transactivation response DNA-binding protein 43 (TDP-43), which controls the translation of thousands of mRNAs. Here we tested the effects of lentiviral Parkin and TDP-43 expression on amino acid metabolism in the rat motor cortex using high frequency ¹³C NMR spectroscopy. TDP-43 expression increased glutamate levels, decreased the levels of other amino acids, including glutamine, aspartate, leucine and isoleucine, and impaired mitochondrial tricarboxylic acid cycle. TDP-43 induced lactate accumulation and altered the balance between excitatory (glutamate) and inhibitory (GABA) neurotransmitters. Parkin restored amino acid levels, neurotransmitter balance and tricarboxylic acid cycle metabolism, rescuing neurons from TDP-43-induced apoptotic death. Furthermore, TDP-43 expression led to an increase in 4E-BP levels, perhaps altering translational control and deregulating amino acid synthesis; while Parkin reversed the effects of TDP-43 on the 4E-BP signaling pathway. Taken together, these data suggest that Parkin may affect TDP-43 localization and mitigate its effects on 4E-BP signaling and loss of amino acid homeostasis.
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Affiliation(s)
- Michaeline Hebron
- Department of Neuroscience, Georgetown University Medical Center, Washington, District of Columbia, USA
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Ravits J, Appel S, Baloh RH, Barohn R, Brooks BR, Elman L, Floeter MK, Henderson C, Lomen-Hoerth C, Macklis JD, McCluskey L, Mitsumoto H, Przedborski S, Rothstein J, Trojanowski JQ, van den Berg LH, Ringel S. Deciphering amyotrophic lateral sclerosis: what phenotype, neuropathology and genetics are telling us about pathogenesis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14 Suppl 1:5-18. [PMID: 23678876 DOI: 10.3109/21678421.2013.778548] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is characterized phenotypically by progressive weakness and neuropathologically by loss of motor neurons. Phenotypically, there is marked heterogeneity. Typical ALS has mixed upper motor neuron (UMN) and lower motor neuron (LMN) involvement. Primary lateral sclerosis has predominant UMN involvement. Progressive muscular atrophy has predominant LMN involvement. Bulbar and limb ALS have predominant regional involvement. Frontotemporal dementia has significant cognitive and behavioral involvement. These phenotypes can be so distinctive that they would seem to have differing biology. However, they cannot be distinguished, at least neuropathologically or genetically. In sporadic ALS (SALS), they are mostly characterized by ubiquitinated cytoplasmic inclusions of TDP-43. In familial ALS (FALS), where phenotypes are indistinguishable from SALS and similarly heterogeneous, each mutated gene has its own genetic and molecular signature. Overall, since the same phenotypes can have multiple causes including different gene mutations, there must be multiple molecular mechanisms causing ALS - and ALS is a syndrome. Since, however, multiple phenotypes can be caused by one single gene mutation, a single molecular mechanism can cause heterogeneity. What the mechanisms are remain unknown, but active propagation of the pathology neuroanatomically seems to be a principal component. Leading candidate mechanisms include RNA processing, cell-cell interactions between neurons and non-neuronal neighbors, focal seeding from a misfolded protein that has prion-like propagation, and fatal errors introduced during neurodevelopment of the motor system. If fundamental mechanisms could be identified and understood, ALS therapy could rationally target progression and stop the disease - a goal that seems increasingly achievable.
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Affiliation(s)
- John Ravits
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093, USA.
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Kamada M, Izumi Y, Ayaki T, Nakamura M, Kagawa S, Kudo E, Sako W, Maruyama H, Nishida Y, Kawakami H, Ito H, Kaji R. Clinicopathologic features of autosomal recessive amyotrophic lateral sclerosis associated with optineurin mutation. Neuropathology 2013; 34:64-70. [PMID: 23889540 DOI: 10.1111/neup.12051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/07/2013] [Accepted: 06/12/2013] [Indexed: 12/13/2022]
Abstract
We performed clinicopathological analyses of two amyotrophic lateral sclerosis (ALS) patients with homozygous Q398X optineurin (OPTN) mutation. Clinically, both patients presented signs of upper and lower motor neuron degeneration, but only Patient 1 showed gradual frontal dysfunction and extrapyramidal signs, and temporal lobe and motor cortex atrophy. Neuropathological examination of Patient 1 revealed extensive cortical and spinal motor neuron degeneration and widespread degeneration of the basal ganglia. Bilateral corticospinal tracts exhibited degeneration. Loss of spinal anterior horn cells (AHCs) and gliosis were observed, whereas posterior columns, Clarke's columns, intermediate lateral columns, and the Onuf's nucleus were spared. In the brainstem, moderate neuronal loss and gliosis were noted in the hypoglossal and facial motor nuclei. No Bunina bodies were found in the surviving spinal and brainstem motor neurons. Transactivation response (TAR) DNA-binding protein 43 (TDP-43)-positive neuronal and glial cytoplasmic inclusions were observed throughout the central nervous system. The Golgi apparatus in motor neurons of the brainstem and spinal cord was often fragmented. Immunoreactivity for OPTN was not observed in the brain and spinal cord, consistent with nonsense-mediated mRNA decay of OPTN. The TDP-43 pathology of Q398X was similar to that of an autosomal dominant E478G mutation. This result suggests that the loss-of-function, but not the proteinopathy itself, of OPTN results in TDP-43 deposits in neuronal and glial cytoplasm and Golgi apparatus fragmentation, leading to multisystem neurodegeneration.
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Affiliation(s)
- Masaki Kamada
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan; Department of Neurological Intractable Disease Research, Kagawa University School of Medicine, Kagawa, Japan
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Lee EB, Russ J, Jung H, Elman LB, Chahine LM, Kremens D, Miller BL, Coslett HB, Trojanowski JQ, Van Deerlin VM, McCluskey LF. Topography of FUS pathology distinguishes late-onset BIBD from aFTLD-U. Acta Neuropathol Commun 2013; 1:1-11. [PMID: 24027631 PMCID: PMC3767453 DOI: 10.1186/2051-5960-1-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Multiple neurodegenerative diseases are characterized by the abnormal accumulation of FUS protein including various subtypes of frontotemporal lobar degeneration with FUS inclusions (FTLD-FUS). These subtypes include atypical frontotemporal lobar degeneration with ubiquitin-positive inclusions (aFTLD-U), basophilic inclusion body disease (BIBD) and neuronal intermediate filament inclusion disease (NIFID). Despite considerable overlap, certain pathologic features including differences in inclusion morphology, the subcellular localization of inclusions, and the relative paucity of subcortical FUS pathology in aFTLD-U indicate that these three entities represent related but distinct diseases. In this study, we report the clinical and pathologic features of three cases of aFTLD-U and two cases of late-onset BIBD with an emphasis on the anatomic distribution of FUS inclusions. Results The aFTLD-U cases demonstrated FUS inclusions in cerebral cortex, subcortical grey matter and brainstem with a predilection for anterior forebrain and rostral brainstem. In contrast, the distribution of FUS pathology in late-onset BIBD cases demonstrated a predilection for pyramidal and extrapyramidal motor regions with relative sparing of cerebral cortex and limbic regions. Conclusions The topography of FUS pathology in these cases demonstrate the diversity of sporadic FUS inclusion body diseases and raises the possibility that late-onset motor neuron disease with BIBD neuropathology may exhibit unique clinical and pathologic features.
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Hebron ML, Lonskaya I, Sharpe K, Weerasinghe PPK, Algarzae NK, Shekoyan AR, Moussa CEH. Parkin ubiquitinates Tar-DNA binding protein-43 (TDP-43) and promotes its cytosolic accumulation via interaction with histone deacetylase 6 (HDAC6). J Biol Chem 2013; 288:4103-15. [PMID: 23258539 PMCID: PMC3567661 DOI: 10.1074/jbc.m112.419945] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The importance of E3 ubiquitin ligases, involved in the degradation of misfolded proteins or promotion of protein-protein interaction, is increasingly recognized in neurodegeneration. TDP-43 is a predominantly nuclear protein, which regulates the transcription of thousands of genes and binds to mRNA of the E3 ubiquitin ligase Parkin to regulate its expression. Wild type and mutated TDP-43 are detected in ubiquitinated forms within the cytosol in several neurodegenerative diseases. We elucidated the mechanisms of TDP-43 interaction with Parkin using transgenic A315T mutant TDP-43 (TDP43-Tg) mice, lentiviral wild type TDP-43, and Parkin gene transfer rat models. TDP-43 expression increased Parkin mRNA and protein levels. Lentiviral TDP-43 increased the levels of nuclear and cytosolic protein, whereas Parkin co-expression mediated Lys-48 and Lys-63-linked ubiquitin to TDP-43 and led to cytosolic co-localization of Parkin with ubiquitinated TDP-43. Parkin and TDP-43 formed a multiprotein complex with HDAC6, perhaps to mediate TDP-43 translocation. In conclusion, Parkin ubiquitinates TDP-43 and facilitates its cytosolic accumulation through a multiprotein complex with HDAC6.
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Affiliation(s)
- Michaeline L. Hebron
- From the Department of Neuroscience, Georgetown University Medical Center, Washington, D. C. 20007
| | - Irina Lonskaya
- From the Department of Neuroscience, Georgetown University Medical Center, Washington, D. C. 20007
| | - Kaydee Sharpe
- From the Department of Neuroscience, Georgetown University Medical Center, Washington, D. C. 20007
| | | | - Norah K. Algarzae
- From the Department of Neuroscience, Georgetown University Medical Center, Washington, D. C. 20007
| | - Ashot R. Shekoyan
- From the Department of Neuroscience, Georgetown University Medical Center, Washington, D. C. 20007
| | - Charbel E.-H. Moussa
- From the Department of Neuroscience, Georgetown University Medical Center, Washington, D. C. 20007, To whom correspondence should be addressed: Laboratory for Dementia and Parkinsonism, Dept. of Neuroscience, Georgetown University School of Medicine, 3970 Reservoir Rd., NW, TRB, Rm. WP09B, Washington, D. C. 20057. Tel.: 202-687-7328; Fax: 202-687-0617; E-mail:
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Anderson TJ, MacAskill MR. Eye movements in patients with neurodegenerative disorders. Nat Rev Neurol 2013; 9:74-85. [DOI: 10.1038/nrneurol.2012.273] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Achi EY, Rudnicki SA. ALS and Frontotemporal Dysfunction: A Review. Neurol Res Int 2012; 2012:806306. [PMID: 22919484 PMCID: PMC3423946 DOI: 10.1155/2012/806306] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/19/2012] [Indexed: 12/11/2022] Open
Abstract
Though once believed to be a disease that was limited to the motor system, it is now apparent that amyotrophic lateral sclerosis (ALS) may be associated with cognitive changes in some patients. Changes are consistent with frontotemporal dysfunction, and may range from mild abnormalities only recognized with formal neuropsychological testing, to profound frontotemporal dementia (FTD). Executive function, behavior, and language are the most likely areas to be involved. Screening helpful in detecting abnormalities includes verbal or categorical fluency, behavioral inventories filled out by the caregiver, and evaluation for the presence of depression and pseudobulbar affect. Patients with cognitive dysfunction have shortened survival and may be less compliant with recommendations regarding use of feeding tubes and noninvasive ventilation. Evolving knowledge of genetic and pathological links between ALS and FTD has allowed us to better understand the overlapping spectrum of ALS and FTD.
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Affiliation(s)
| | - Stacy A. Rudnicki
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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31
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Herman AM, Khandelwal PJ, Rebeck GW, Moussa CEH. Wild type TDP-43 induces neuro-inflammation and alters APP metabolism in lentiviral gene transfer models. Exp Neurol 2012; 235:297-305. [PMID: 22402344 DOI: 10.1016/j.expneurol.2012.02.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/13/2012] [Accepted: 02/19/2012] [Indexed: 12/12/2022]
Abstract
The transactivation DNA-binding protein (TDP-43) pathology is associated with fronto-temporal lobar dementia (FTLD) with ubiquitinated inclusions and some cases of Alzheimer's disease (AD). Proteolytic fragments of β-amyloid precursor protein (βAPP) are detected in AD as well as the cerebrospinal fluid (CSF) from FTLD and Amyotrophic Lateral Sclerosis (ALS) patients, suggesting alteration in APP processing. Because of the overlap in TDP-43 pathology between FTLD and AD, we sought to determine whether there is a relationship between TDP-43 and APP metabolism. We generated gene transfer models using lentiviral delivery of human TDP-43 and Aβ(1-42) into the rat primary motor cortex and examined their role 2 weeks post-injection. Expression of TDP-43 and/or Aβ(1-42) increase pro-inflammatory markers, including Interleukin (IL)-6, tumor necrosis factor (TNF-α), glial neurofibrillary proteins (GFAP) and ionized calcium binding adaptor molecule 1 (IBA-1). Lentiviral Aβ(1-42) up-regulates endogenous TDP-43 and promotes its phosphorylation, aggregation and cleavage into 35 kDa fragments. Inversely, lentiviral TDP-43 expression increases the levels and activity of β-secretase (BACE), accelerating production of APP C-terminal fragments (C99) and Aβ(1-40). Here we show that TDP-43 up-regulates APP metabolism and suggest a mechanistic link between TDP-43 and BACE.
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Affiliation(s)
- Alexander M Herman
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20007, USA
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32
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Yang W, Strong MJ. Widespread neuronal and glial hyperphosphorylated tau deposition in ALS with cognitive impairment. ACTA ACUST UNITED AC 2012; 13:178-93. [PMID: 22214313 DOI: 10.3109/17482968.2011.622405] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although the biological basis of frontotemporal syndromes associated with amyotrophic lateral sclerosis (ALS) is considered to be altered metabolism of TDP-43, in ALS with cognitive impairment (ALSci) the metabolism of tau protein is also altered. This includes neuronal hyperphosphorylation (pThr(175)). Using novel polyclonal phospho-tau antibodies (pSer(208, 210), pThr(217) and pThr(175)) and antibodies directed against PHF tau (pSer(202)), TDP-43 or ubiquitin, we characterized tau deposition in ALS and ALSci. In ALS, we observed pThr(175) tau immunoreactive intraneuronal and neuritic aggregates throughout the amygdala and entorhinal cortex. In ALSci, this extended to the anterior cingulate gyrus, superior frontal cortex and substantia nigra. The pThr(217) antibody detected widespread astrocytic tau deposition, including punctuate or fibrillary aggregates, or intensely immunoreactive tufted astrocytes in the superior frontal cortex, anterior cingulate gyrus, entorhinal cortex, amygdala and basal ganglia of ALS. In ALSci, a similar but more widely distributed pThr(217) pathology was observed. There was no correlation between the extent of pathological tau deposition and TDP-43 pathology, although nuclear TDP-43 immunoreactivity was absent in neurons with tau pathology. In conclusion, ALSci is unique in possessing both tau and TDP-43 pathology. The presence of widespread astrocytic tau pathology suggests that ALSci may initially be characterized by astrocytic pathology.
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Affiliation(s)
- Wencheng Yang
- Robarts Research Institute, The University of Western Ontario, Canada
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Espay AJ, Spina S, Houghton DJ, Murrell JR, de Courten-Myers GM, Ghetti B, Litvan I. Rapidly progressive atypical parkinsonism associated with frontotemporal lobar degeneration and motor neuron disease. J Neurol Neurosurg Psychiatry 2011; 82:751-3. [PMID: 20587488 PMCID: PMC4449730 DOI: 10.1136/jnnp.2009.201608] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report the rare but distinct clinical and neuropathological phenotype of non-familial, rapidly progressive parkinsonism and dementia associated with frontotemporal lobar degeneration with motor neuron disease (FTLD-MND). METHODS Subjects included two 70-year-old women presenting with rapidly progressive severe postural instability, axial-predominant parkinsonism, oculomotor dysfunction and frontal-predominant dementia with language impairment and pseudobulbar palsy. One had diffuse weakness without signs of lower motor neuron disease. Post-mortem evaluations included immunohistochemistry with antiphospho-TAR DNA-binding protein 43 (TDP-43) and genetic analysis of the TARDBP and PGRN genes. RESULTS Subjects died within 14 months from symptom onset. TDP-43-positive neuronal intracytoplasmic inclusions were prominent in the primary motor cortex, granule cell layer of the hippocampus, and several cranial and spinal cord nuclei. TDP-43 globular glial inclusions (GGI) were identified in one case. There were no mutations in PGRN or TARDBP genes. CONCLUSIONS FTLD-MND due to TDP-43-proteinopathy should be considered in patients with rapidly progressive parkinsonism and dementia phenotype, especially when aphasia and/or weakness are also present.
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Affiliation(s)
- Alberto J Espay
- Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
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Fujioka S, Wszolek ZK. Clinical aspects of familial forms of frontotemporal dementia associated with parkinsonism. J Mol Neurosci 2011; 45:359-65. [PMID: 21656039 DOI: 10.1007/s12031-011-9568-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/29/2011] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia is the second most common dementia among people under the age of 65. Fifty percent of affected patients have an associated family history. Several pathogenic genes have been identified for frontotemporal dementia associated with parkinsonism, including microtubule-associated protein tau, progranulin, and chromatin modifying protein 2B, and fused in sarcoma. It has also been reported that frontotemporal dementia associated with parkinsonism can be linked to chromosome 9p. In addition, there are families with frontotemporal dementia associated with a parkinsonian phenotype but unknown genetic status. Some of these kindreds have been diagnosed clinically as familial progressive supranuclear palsy, hereditary diffuse leukoencephalopathy with axonal spheroids, "overlap" syndrome, and others. Clinical presentation of frontotemporal dementia associated with parkinsonism is variable at age of symptomatic disease onset, disease duration, symptoms, and their occurrence during the disease course. Clinically, it is often difficult to sort out the different genetic forms of frontotemporal dementia associated with parkinsonism. However, with available clinical genetic testing for known genes, the precise diagnosis can be accomplished in some cases.
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Affiliation(s)
- Shinsuke Fujioka
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Cannaday Bldg 2-E, Jacksonville, FL 32224, USA
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35
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Piguet O. Eating disturbance in behavioural-variant frontotemporal dementia. J Mol Neurosci 2011; 45:589-93. [PMID: 21584651 DOI: 10.1007/s12031-011-9547-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/06/2011] [Indexed: 12/13/2022]
Abstract
Behavioural-variant frontotemporal dementia (bvFTD) is a progressive neurodegenerative brain disorder, clinically characterised by changes in cognition, personality and behaviour. Marked disturbances in eating behaviour, such as overeating and preference for sweet foods, are also commonly reported. This paper reviews the current literature on eating abnormalities in bvFTD, their clinical characteristics and biological correlates, and the contribution of hypothalamus to eating regulation. Existing literature shows that disturbance in an orbitofrontal-insular-striatal brain network underlies the emergence of eating disturbance in bvFTD. In addition, recent evidence indicates that degeneration and consequent dysregulation within the hypothalamus relates to significant feeding disturbance in this disease. These findings could provide a basis for the development of therapeutic models in bvFTD.
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Affiliation(s)
- Olivier Piguet
- Neuroscience Research Australia, Barker St, Randwick, Sydney, NSW, 2031, Australia.
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36
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Rusina R, Kovacs GG, Fiala J, Hort J, Ridzoň P, Holmerová I, Ströbel T, Matěj R. FTLD-TDP with motor neuron disease, visuospatial impairment and a progressive supranuclear palsy-like syndrome: broadening the clinical phenotype of TDP-43 proteinopathies. A report of three cases. BMC Neurol 2011; 11:50. [PMID: 21569259 PMCID: PMC3112085 DOI: 10.1186/1471-2377-11-50] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 05/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Frontotemporal lobar degeneration with ubiquitin and TDP-43 positive neuronal inclusions represents a novel entity (FTLD-TDP) that may be associated with motor neuron disease (FTLD-MND); involvement of extrapyramidal and other systems has also been reported. Case presentation We present three cases with similar clinical symptoms, including Parkinsonism, supranuclear gaze palsy, visuospatial impairment and a behavioral variant of frontotemporal dementia, associated with either clinically possible or definite MND. Neuropathological examination revealed hallmarks of FTLD-TDP with major involvement of subcortical and, in particular, mesencephalic structures. These cases differed in onset and progression of clinical manifestations as well as distribution of histopathological changes in the brain and spinal cord. Two cases were sporadic, whereas the third case had a pathological variation in the progranulin gene 102 delC. Conclusions Association of a "progressive supranuclear palsy-like" syndrome with marked visuospatial impairment, motor neuron disease and early behavioral disturbances may represent a clinically distinct phenotype of FTLD-TDP. Our observations further support the concept that TDP-43 proteinopathies represent a spectrum of disorders, where preferential localization of pathogenetic inclusions and neuronal cell loss defines clinical phenotypes ranging from frontotemporal dementia with or without motor neuron disease, to corticobasal syndrome and to a progressive supranuclear palsy-like syndrome.
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Affiliation(s)
- Robert Rusina
- Department of Neurology, Thomayer Teaching Hospital and Institute for Postgraduate Education in Medicine, Prague, Czech Republic.
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37
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Geser F, Stein B, Partain M, Elman LB, McCluskey LF, Xie SX, Van Deerlin VM, Kwong LK, Lee VMY, Trojanowski JQ. Motor neuron disease clinically limited to the lower motor neuron is a diffuse TDP-43 proteinopathy. Acta Neuropathol 2011; 121:509-17. [PMID: 21225272 DOI: 10.1007/s00401-011-0797-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 12/20/2010] [Accepted: 12/21/2010] [Indexed: 12/12/2022]
Abstract
Motor neuron disease (MND) may present as an isolated lower motor neuron (LMN) disorder. Although the significance of pathological 43 kDa transactive responsive sequence DNA binding protein (TDP-43) for amyotrophic lateral sclerosis (ALS) was appreciated only recently, the topographical distribution of TDP-43 pathology in MND clinically isolated to the LMN versus normal controls (COs) is only incompletely described. Therefore, we performed longitudinal clinical evaluation and retrospective chart review of autopsied patients diagnosed with isolated LMN disease. Cases with a disease duration over 4 years were designated as progressive muscular atrophy (PMA), and those with a more rapid course as MND/LMN. Immunohistochemistry was employed to identify neuronal and glial TDP-43 pathology in the central nervous system (CNS) in patients and COs. We examined 19 subjects including six patients (i.e., four with MND/LMN and two with PMA) and 13 COs. All patients showed significant TDP-43 linked degeneration of LMNs, and five cases showed a lesser degree of motor cortex degeneration. Additional brain areas were affected in varying degrees, ranging from predominantly brainstem pathology to significant involvement of the whole CNS including neocortical and limbic areas. Pathological TDP-43 was present only rarely in the CO group. We conclude that MND limited to the LMN and PMA is part of a disease continuum that includes ALS and FTLD-TDP, all of which are characterized by widespread TDP-43 pathology. Hence, we suggest that the next revision of the El Escorial criteria for the diagnosis of ALS include MND patients with disease clinically limited to the LMN and PMA as variants of ALS, which like classical ALS, are TDP-43 proteinopathies.
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Yu-Wai-Man C, Petheram K, Davidson AW, Williams T, Griffiths PG. A Supranuclear Disorder of Ocular Motility as a Rare Initial Presentation of Motor Neurone Disease. Neuroophthalmology 2011; 35:38-39. [DOI: 10.3109/01658107.2010.518333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/31/2010] [Accepted: 07/21/2010] [Indexed: 11/13/2022] Open
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Gilbert RMW, Fahn S, Mitsumoto H, Rowland LP. Parkinsonism and motor neuron diseases: Twenty-seven patients with diverse overlap syndromes. Mov Disord 2010; 25:1868-75. [DOI: 10.1002/mds.23200] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Chen-Plotkin AS, Lee VMY, Trojanowski JQ. TAR DNA-binding protein 43 in neurodegenerative disease. Nat Rev Neurol 2010; 6:211-20. [PMID: 20234357 DOI: 10.1038/nrneurol.2010.18] [Citation(s) in RCA: 338] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 2006, TAR DNA-binding protein 43 (TDP-43), a highly conserved nuclear protein, was identified as the major disease protein in amyotrophic lateral sclerosis (ALS) and in the most common variant of frontotemporal lobar degeneration (FTLD), FTLD-U, which is characterized by cytoplasmic inclusions that stain positive for ubiquitin but negative for tau and alpha-synuclein. Since then, rapid advances have been made in our understanding of the physiological function of TDP-43 and the role of this protein in neurodegeneration. These advances link ALS and FTLD-U (now designated FTLD-TDP) to a shared mechanism of disease. In this Review, we summarize the current evidence regarding the normal function of TDP-43 and the TDP-43 pathology observed in FTLD-TDP, ALS, and other neurodegenerative diseases wherein TDP-43 pathology co-occurs with other disease-specific lesions (for example, with amyloid plaques and neurofibrillary tangles in Alzheimer disease). Moreover, we discuss the accumulating data that support our view that FTLD-TDP and ALS represent two ends of a spectrum of primary TDP-43 proteinopathies. Finally, we comment on the importance of recent advances in TDP-43-related research to neurological practice, including the new opportunities to develop better diagnostics and disease-modifying therapies for ALS, FTLD-TDP, and related disorders exhibiting TDP-43 pathology.
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Affiliation(s)
- Alice S Chen-Plotkin
- Department of Neurology, University of Pennsylvania School of Medicine, 3600 Spruce Street, Philadelphia, PA 19104-4283, USA
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Geser F, Lee VMY, Trojanowski JQ. Amyotrophic lateral sclerosis and frontotemporal lobar degeneration: a spectrum of TDP-43 proteinopathies. Neuropathology 2010; 30:103-12. [PMID: 20102519 DOI: 10.1111/j.1440-1789.2009.01091.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
It is now established that pathological transactive response DNA-binding protein with a Mr of 43 kD (TDP-43) on sodium dodecyl sulfate-polyacrylamide gel electrophoresis is the major disease protein in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) with ubiquitin-positive inclusions (now known as FTLD-TDP). In fact, the discovery of pathological TDP-43 solidified the idea that these disorders are multi-system diseases and this led to the concept of a TDP-43 proteinopathy as a spectrum of disorders comprised of different clinical and pathological entities extending from ALS to ALS with cognitive impairment/dementia and FTLD-TDP without or with motor neuron disease (FTLD-MND). These align along a broad disease continuum sharing similar pathogenetic mechanisms linked to pathological TDP-43. We here review salient findings in the development of a concept of TDP-43 proteinopathy as a novel group of neurodegenerative diseases similar in concept to alpha-synucleinopathies and tauopathies.
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Affiliation(s)
- Felix Geser
- The Institute on Aging, Center for Neurodegenerative Disease Research and the Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Pennsylvania 19104-4283, USA
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Josephs KA, Stroh A, Dugger B, Dickson DW. Evaluation of subcortical pathology and clinical correlations in FTLD-U subtypes. Acta Neuropathol 2009; 118:349-58. [PMID: 19455346 DOI: 10.1007/s00401-009-0547-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 05/06/2009] [Accepted: 05/06/2009] [Indexed: 01/10/2023]
Abstract
Frontotemporal lobar degeneration (FTLD) can be classified as tau-positive (FTLD-tau) and tau-negative FTLD. The most common form of tau-negative FTLD is associated with neuronal inclusions that are composed of TAR DNA-binding protein 43 (TDP-43) (FTLD-TDP). Recent evidence suggests that FTLD-TDP can be further subdivided into at least three major histologic variants based on patterns of TDP-43 immunoreactive neuronal cytoplasmic inclusions (NCI) and dystrophic neurites (DN) in neocortex and hippocampus. The aim of this study was to extend the histologic analysis to other brain regions and to determine if there were distinct clinical and pathologic characteristics of the FTLD-TDP subtypes. Thirty-nine FTLD-TDP cases were analyzed (Mackenzie type 1 n = 24, Mackenzie type 2 n = 9, Mackenzie type 3 n = 6). There was a highly significant association between clinical syndrome and FTLD-TDP subtype, with progressive non-fluent aphasia associated with type 1, semantic dementia with type 2, and behavioral variant frontotemporal dementia with types 1, 2 and 3. Semi-quantitative analysis of NCI and DN demonstrated different patterns of involvement in cortical, subcortical and brainstem areas that were characteristic for each of the three types of FTLD-TDP. Type 1 had a mixture of NCI and DN, as well as intranuclear inclusions in most cases and TDP-43 pathology at all levels of the neuraxis, but less in brainstem than supratentorial structures. Type 2 cases were characterized by predominance of long, thick DN in the cortex, as well as numerous NCI in hippocampus, amygdala and basal ganglia, but virtually no NCI and only sparse DN in diencephalon and brainstem. Type 3 had a paucity of DN at all levels of the neuraxis and significantly more NCI in the hypoglossal nucleus than the other types. These findings extend previously described clinicopathological associations of FTLD-TDP subtypes and support the notion that FTLD-TDP subtypes may be distinct clinicopathologic disorders.
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43
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Simmons Z. What's in the Literature? J Clin Neuromuscul Dis 2009; 10:202-207. [PMID: 19494733 DOI: 10.1097/cnd.0b013e3181a7b35f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Peripheral neuropathies are among the most common disorders seen by neuromuscular specialists. Several of the articles in this issue's review focus on diagnosis, treatment, and prognosis of disorders of peripheral nerve, including some which address important issues relating to chronic inflammatory demyelinating polyneuropathy. Motor neuron diseases continue to be somewhat disproportionately represented, likely due to the devastating nature of amyotrophic lateral sclerosis. The TAR DNA-binding protein-43 (TDP-43) story as outlined in 2 of the articles is fascinating, particularly with regard to etiopathogenesis, whereas other articles focus on epidemiology, diagnosis, treatment, and symptom management, including some insights into Kennedy disease. Myotonic dystrophy and other muscle diseases are presented with some welcome news on treatment and management.
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Amyotrophic lateral sclerosis, frontotemporal dementia and beyond: the TDP-43 diseases. J Neurol 2009; 256:1205-14. [PMID: 19271105 DOI: 10.1007/s00415-009-5069-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 02/09/2009] [Indexed: 12/12/2022]
Abstract
Ever since the significance of pathological 43-kDa transactivating responsive sequence DNA-binding protein (TDP-43) for human disease has been recognized in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration with ubiquitin positive inclusions (FTLD-U), a number of publications have emerged reporting on this pathology in a variety of neurodegenerative diseases. Given the heterogeneous and, in part, conflicting nature of the recent findings, we here review pathological TDP-43 and its relationship to human disease with a special focus on ALS and FTLD-U. To this end, we propose a classification scheme in which pathological TDP-43 is the major disease defining pathology in one group, or is present in addition to other neurodegenerative hallmark pathologies in a second category. We conclude that the TDP-43 proteinopathies represent a novel class of neurodegenerative disorders akin to alpha-synucleinopathies and tauopathies, with the concept of ALS and FTLD-U to be widened to a broad clinico-pathological multisystem disease, i.e., TDP-43 proteinopathy.
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