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Iaccarino L, Llibre-Guerra JJ, McDade E, Edwards L, Gordon B, Benzinger T, Hassenstab J, Kramer JH, Li Y, Miller BL, Miller Z, Morris JC, Mundada N, Perrin RJ, Rosen HJ, Soleimani-Meigooni D, Strom A, Tsoy E, Wang G, Xiong C, Allegri R, Chrem P, Vazquez S, Berman SB, Chhatwal J, Masters CL, Farlow MR, Jucker M, Levin J, Salloway S, Fox NC, Day GS, Gorno-Tempini ML, Boxer AL, La Joie R, Bateman R, Rabinovici GD. Molecular neuroimaging in dominantly inherited versus sporadic early-onset Alzheimer's disease. Brain Commun 2024; 6:fcae159. [PMID: 38784820 PMCID: PMC11114609 DOI: 10.1093/braincomms/fcae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/14/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Approximately 5% of Alzheimer's disease patients develop symptoms before age 65 (early-onset Alzheimer's disease), with either sporadic (sporadic early-onset Alzheimer's disease) or dominantly inherited (dominantly inherited Alzheimer's disease) presentations. Both sporadic early-onset Alzheimer's disease and dominantly inherited Alzheimer's disease are characterized by brain amyloid-β accumulation, tau tangles, hypometabolism and neurodegeneration, but differences in topography and magnitude of these pathological changes are not fully elucidated. In this study, we directly compared patterns of amyloid-β plaque deposition and glucose hypometabolism in sporadic early-onset Alzheimer's disease and dominantly inherited Alzheimer's disease individuals. Our analysis included 134 symptomatic sporadic early-onset Alzheimer's disease amyloid-Positron Emission Tomography (PET)-positive cases from the University of California, San Francisco, Alzheimer's Disease Research Center (mean ± SD age 59.7 ± 5.6 years), 89 symptomatic dominantly inherited Alzheimer's disease cases (age 45.8 ± 9.3 years) and 102 cognitively unimpaired non-mutation carriers from the Dominantly Inherited Alzheimer Network study (age 44.9 ± 9.2). Each group underwent clinical and cognitive examinations, 11C-labelled Pittsburgh Compound B-PET and structural MRI. 18F-Fluorodeoxyglucose-PET was also available for most participants. Positron Emission Tomography scans from both studies were uniformly processed to obtain a standardized uptake value ratio (PIB50-70 cerebellar grey reference and FDG30-60 pons reference) images. Statistical analyses included pairwise global and voxelwise group comparisons and group-independent component analyses. Analyses were performed also adjusting for covariates including age, sex, Mini-Mental State Examination, apolipoprotein ε4 status and average composite cortical of standardized uptake value ratio. Compared with dominantly inherited Alzheimer's disease, sporadic early-onset Alzheimer's disease participants were older at age of onset (mean ± SD, 54.8 ± 8.2 versus 41.9 ± 8.2, Cohen's d = 1.91), with more years of education (16.4 ± 2.8 versus 13.5 ± 3.2, d = 1) and more likely to be apolipoprotein ε4 carriers (54.6% ε4 versus 28.1%, Cramer's V = 0.26), but similar Mini-Mental State Examination (20.6 ± 6.1 versus 21.2 ± 7.4, d = 0.08). Sporadic early-onset Alzheimer's disease had higher global cortical Pittsburgh Compound B-PET binding (mean ± SD standardized uptake value ratio, 1.92 ± 0.29 versus 1.58 ± 0.44, d = 0.96) and greater global cortical 18F-fluorodeoxyglucose-PET hypometabolism (mean ± SD standardized uptake value ratio, 1.32 ± 0.1 versus 1.39 ± 0.19, d = 0.48) compared with dominantly inherited Alzheimer's disease. Fully adjusted comparisons demonstrated relatively higher Pittsburgh Compound B-PET standardized uptake value ratio in the medial occipital, thalami, basal ganglia and medial/dorsal frontal regions in dominantly inherited Alzheimer's disease versus sporadic early-onset Alzheimer's disease. Sporadic early-onset Alzheimer's disease showed relatively greater 18F-fluorodeoxyglucose-PET hypometabolism in Alzheimer's disease signature temporoparietal regions and caudate nuclei, whereas dominantly inherited Alzheimer's disease showed relatively greater hypometabolism in frontal white matter and pericentral regions. Independent component analyses largely replicated these findings by highlighting common and unique Pittsburgh Compound B-PET and 18F-fluorodeoxyglucose-PET binding patterns. In summary, our findings suggest both common and distinct patterns of amyloid and glucose hypometabolism in sporadic and dominantly inherited early-onset Alzheimer's disease.
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Affiliation(s)
- Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Jorge J Llibre-Guerra
- The Dominantly Inherited Alzheimer Network (DIAN), St Louis, MO 63108, USA
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Eric McDade
- The Dominantly Inherited Alzheimer Network (DIAN), St Louis, MO 63108, USA
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Brian Gordon
- Department of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Tammie Benzinger
- Department of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Jason Hassenstab
- The Dominantly Inherited Alzheimer Network (DIAN), St Louis, MO 63108, USA
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Yan Li
- Department of Biostatistics, Washington University in St Louis, St Louis, MO 63110, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Zachary Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - John C Morris
- The Dominantly Inherited Alzheimer Network (DIAN), St Louis, MO 63108, USA
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Nidhi Mundada
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Richard J Perrin
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - David Soleimani-Meigooni
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Amelia Strom
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Guoqiao Wang
- Department of Biostatistics, Washington University in St Louis, St Louis, MO 63110, USA
| | - Chengjie Xiong
- Department of Biostatistics, Washington University in St Louis, St Louis, MO 63110, USA
| | - Ricardo Allegri
- Department of Cognitive Neurology, Institute for Neurological Research Fleni, Buenos Aires 1428, Argentina
| | - Patricio Chrem
- Department of Cognitive Neurology, Institute for Neurological Research Fleni, Buenos Aires 1428, Argentina
| | - Silvia Vazquez
- Department of Cognitive Neurology, Institute for Neurological Research Fleni, Buenos Aires 1428, Argentina
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jasmeer Chhatwal
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Colin L Masters
- Department of Neuroscience, Florey Institute, The University of Melbourne, Melbourne 3052, Australia
| | - Martin R Farlow
- Neuroscience Center, Indiana University School of Medicine at Indianapolis, Indiana, IN 46202, USA
| | - Mathias Jucker
- DZNE-German Center for Neurodegenerative Diseases, Tübingen 72076, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-University, Munich 80539, Germany
- German Center for Neurodegenerative Diseases, Munich 81377, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich 81377, Germany
| | - Stephen Salloway
- Memory & Aging Program, Butler Hospital, Brown University in Providence, RI 02906, USA
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Institute of Neurology, London WC1N 3BG, UK
| | - Gregory S Day
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL 33224, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Randall Bateman
- The Dominantly Inherited Alzheimer Network (DIAN), St Louis, MO 63108, USA
- Department of Neurology, Washington University in St Louis, St Louis, MO 63108, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
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Joseph‐Mathurin N, Feldman RL, Lu R, Shirzadi Z, Toomer C, Saint Clair JR, Ma Y, McKay NS, Strain JF, Kilgore C, Friedrichsen KA, Chen CD, Gordon BA, Chen G, Hornbeck RC, Massoumzadeh P, McCullough AA, Wang Q, Li Y, Wang G, Keefe SJ, Schultz SA, Cruchaga C, Preboske GM, Jack CR, Llibre‐Guerra JJ, Allegri RF, Ances BM, Berman SB, Brooks WS, Cash DM, Day GS, Fox NC, Fulham M, Ghetti B, Johnson KA, Jucker M, Klunk WE, la Fougère C, Levin J, Niimi Y, Oh H, Perrin RJ, Reischl G, Ringman JM, Saykin AJ, Schofield PR, Su Y, Supnet‐Bell C, Vöglein J, Yakushev I, Brickman AM, Morris JC, McDade E, Xiong C, Bateman RJ, Chhatwal JP, Benzinger TLS. Presenilin-1 mutation position influences amyloidosis, small vessel disease, and dementia with disease stage. Alzheimers Dement 2024; 20:2680-2697. [PMID: 38380882 PMCID: PMC11032566 DOI: 10.1002/alz.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Amyloidosis, including cerebral amyloid angiopathy, and markers of small vessel disease (SVD) vary across dominantly inherited Alzheimer's disease (DIAD) presenilin-1 (PSEN1) mutation carriers. We investigated how mutation position relative to codon 200 (pre-/postcodon 200) influences these pathologic features and dementia at different stages. METHODS Individuals from families with known PSEN1 mutations (n = 393) underwent neuroimaging and clinical assessments. We cross-sectionally evaluated regional Pittsburgh compound B-positron emission tomography uptake, magnetic resonance imaging markers of SVD (diffusion tensor imaging-based white matter injury, white matter hyperintensity volumes, and microhemorrhages), and cognition. RESULTS Postcodon 200 carriers had lower amyloid burden in all regions but worse markers of SVD and worse Clinical Dementia Rating® scores compared to precodon 200 carriers as a function of estimated years to symptom onset. Markers of SVD partially mediated the mutation position effects on clinical measures. DISCUSSION We demonstrated the genotypic variability behind spatiotemporal amyloidosis, SVD, and clinical presentation in DIAD, which may inform patient prognosis and clinical trials. HIGHLIGHTS Mutation position influences Aβ burden, SVD, and dementia. PSEN1 pre-200 group had stronger associations between Aβ burden and disease stage. PSEN1 post-200 group had stronger associations between SVD markers and disease stage. PSEN1 post-200 group had worse dementia score than pre-200 in late disease stage. Diffusion tensor imaging-based SVD markers mediated mutation position effects on dementia in the late stage.
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Lombardi G, Berti V, Ginestroni A, Nacmias B, Sorbi S. The Association Between Positive Amyloid-PET and Cognitive Decline Is Not Always Supportive of Alzheimer's Disease: Suggestions from a Case Report. J Alzheimers Dis Rep 2024; 8:281-288. [PMID: 38405347 PMCID: PMC10894606 DOI: 10.3233/adr-230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Amyloid-β deposition is the pathological hallmark of both cerebral amyloid angiopathy and Alzheimer's disease dementia, clinical conditions that can share cognitive decline and positive Amyloid-PET scan. A case is reported involving an 82-year-old Italian female who presented initially a memory deficit, later transient focal neurologic episodes, and finally two symptomatic lobar intracerebral hemorrhages. In light of these events, MRI and PET imaging findings, acquired before cerebral hemorrhages, are reconsidered and discussed, highlighting the utility of Amyloid-PET in supporting an in vivo diagnosis of cerebral amyloid angiopathy.
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Affiliation(s)
- Gemma Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Valentina Berti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | | | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Mohamed-Mohamed H, García-Morales V, Sánchez Lara EM, González-Acedo A, Pardo-Moreno T, Tovar-Gálvez MI, Melguizo-Rodríguez L, Ramos-Rodríguez JJ. Physiological Mechanisms Inherent to Diabetes Involved in the Development of Dementia: Alzheimer's Disease. Neurol Int 2023; 15:1253-1272. [PMID: 37873836 PMCID: PMC10594452 DOI: 10.3390/neurolint15040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
Type 2 diabetes mellitus (T2D) is a metabolic disease reaching pandemic levels worldwide. In parallel, Alzheimer's disease (AD) and vascular dementia (VaD) are the two leading causes of dementia in an increasingly long-living Western society. Numerous epidemiological studies support the role of T2D as a risk factor for the development of dementia. However, few basic science studies have focused on the possible mechanisms involved in this relationship. On the other hand, this review of the literature also aims to explore the relationship between T2D, AD and VaD. The data found show that there are several alterations in the central nervous system that may be promoting the development of T2D. In addition, there are some mechanisms by which T2D may contribute to the development of neurodegenerative diseases such as AD or VaD.
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Affiliation(s)
- Himan Mohamed-Mohamed
- Department of Physiology, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
| | - Victoria García-Morales
- Physiology Area, Department of Biomedicine, Biotechnology and Public Health, Faculty of Medicine, University of Cádiz, Pl. Falla, 9, 11003 Cádiz, Spain
| | - Encarnación María Sánchez Lara
- Department of Personalidad, Evaluación y Tratamiento Psicológico, Faculty of Health Sciences (Ceuta), University of Granada, 51001 Ceuta, Spain;
| | - Anabel González-Acedo
- Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Teresa Pardo-Moreno
- Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
| | - María Isabel Tovar-Gálvez
- Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
| | - Lucía Melguizo-Rodríguez
- Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Juan José Ramos-Rodríguez
- Department of Physiology, Faculty of Health Sciences of Ceuta, University of Granada, 51001 Ceuta, Spain
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Martín-Jiménez P, Sánchez-Tornero M, Llamas-Velasco S, Guerrero-Molina MP, González-Sánchez M, Herrero-San Martín A, Blanco-Palmero V, Calleja-Castaño P, Francisco-Gonzalo J, Hilario A, Ramos A, Salvador E, Toldos Ó, Hernández-Lain A, Pérez-Martínez DA, Villarejo-Galende A. Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. Neurologia 2023; 38:550-559. [PMID: 37437655 DOI: 10.1016/j.nrleng.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/31/2020] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels. METHODS We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Affiliation(s)
- P Martín-Jiménez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - M Sánchez-Tornero
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, Spain
| | - S Llamas-Velasco
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - M González-Sánchez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - A Herrero-San Martín
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - V Blanco-Palmero
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Hilario
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Salvador
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ó Toldos
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hernández-Lain
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D A Pérez-Martínez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - A Villarejo-Galende
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
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Cogswell PM, Fan AP. Multimodal comparisons of QSM and PET in neurodegeneration and aging. Neuroimage 2023; 273:120068. [PMID: 37003447 PMCID: PMC10947478 DOI: 10.1016/j.neuroimage.2023.120068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Quantitative susceptibility mapping (QSM) has been used to study susceptibility changes that may occur based on tissue composition and mineral deposition. Iron is a primary contributor to changes in magnetic susceptibility and of particular interest in applications of QSM to neurodegeneration and aging. Iron can contribute to neurodegeneration through inflammatory processes and via interaction with aggregation of disease-related proteins. To better understand the local susceptibility changes observed on QSM, its signal has been studied in association with other imaging metrics such as positron emission tomography (PET). The associations of QSM and PET may provide insight into the pathophysiology of disease processes, such as the role of iron in aging and neurodegeneration, and help to determine the diagnostic utility of QSM as an indirect indicator of disease processes typically evaluated with PET. In this review we discuss the proposed mechanisms and summarize prior studies of the associations of QSM and amyloid PET, tau PET, TSPO PET, FDG-PET, 15O-PET, and F-DOPA PET in evaluation of neurologic diseases with a focus on aging and neurodegeneration.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Audrey P Fan
- Department of Biomedical Engineering and Department of Neurology, University of California, Davis, 1590 Drew Avenue, Davis, CA 95618, USA
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Gokcal E, Horn MJ, Becker JA, Das AS, Schwab K, Biffi A, Rost N, Rosand J, Viswanathan A, Polimeni JR, Johnson KA, Greenberg SM, Gurol ME. Effect of vascular amyloid on white matter disease is mediated by vascular dysfunction in cerebral amyloid angiopathy. J Cereb Blood Flow Metab 2022; 42:1272-1281. [PMID: 35086372 PMCID: PMC9207495 DOI: 10.1177/0271678x221076571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We postulated that vascular dysfunction mediates the relationship between amyloid load and white matter hyperintensities (WMH) in cerebral amyloid angiopathy (CAA). Thirty-eight cognitively healthy patients with CAA (mean age 70 ± 7.1) were evaluated. WMH was quantified and expressed as percent of total intracranial volume (pWMH) using structural MRI. Mean global cortical Distribution Volume Ratio representing Pittsburgh Compound B (PiB) uptake (PiB-DVR) was calculated from PET scans. Time-to-peak [TTP] of blood oxygen level-dependent response to visual stimulation was used as an fMRI measure of vascular dysfunction. Higher PiB-DVR correlated with prolonged TTP (r = 0.373, p = 0.021) and higher pWMH (r = 0.337, p = 0.039). Prolonged TTP also correlated with higher pWMH (r = 0.485, p = 0.002). In a multivariate linear regression model, TTP remained independently associated with pWMH (p = 0.006) while PiB-DVR did not (p = 0.225). In a bootstrapping model, TTP had a significant indirect effect (ab = 0.97, 95% CI: 0.137-2.461), supporting that the association between PiB-DVR and pWMH is mediated by TTP response. There was no longer a direct effect independent of the hypothesized pathway. Our study suggests that the effect of vascular amyloid load on white matter disease is mediated by vascular dysfunction in CAA. Amyloid lowering strategies might prevent pathophysiological processes leading to vascular dysfunction, therefore limiting ischemic brain injury.
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Affiliation(s)
- Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Alex Becker
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Keith A Johnson
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Vemuri P, Decarli CS, Duering M. Imaging Markers of Vascular Brain Health: Quantification, Clinical Implications, and Future Directions. Stroke 2022; 53:416-426. [PMID: 35000423 PMCID: PMC8830603 DOI: 10.1161/strokeaha.120.032611] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cerebrovascular disease (CVD) manifests through a broad spectrum of mechanisms that negatively impact brain and cognitive health. Oftentimes, CVD changes (excluding acute stroke) are insufficiently considered in aging and dementia studies which can lead to an incomplete picture of the etiologies contributing to the burden of cognitive impairment. Our goal with this focused review is 3-fold. First, we provide a research update on the current magnetic resonance imaging methods that can measure CVD lesions as well as early CVD-related brain injury specifically related to small vessel disease. Second, we discuss the clinical implications and relevance of these CVD imaging markers for cognitive decline, incident dementia, and disease progression in Alzheimer disease, and Alzheimer-related dementias. Finally, we present our perspective on the outlook and challenges that remain in the field. With the increased research interest in this area, we believe that reliable CVD imaging biomarkers for aging and dementia studies are on the horizon.
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Affiliation(s)
| | - Charles S. Decarli
- Departments of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, California, USA
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Switzerland
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9
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Michiels L, Dobbels L, Demeestere J, Demaerel P, Van Laere K, Lemmens R. Simplified Edinburgh and modified Boston criteria in relation to amyloid PET for lobar intracerebral hemorrhage. NEUROIMAGE: CLINICAL 2022; 35:103107. [PMID: 35853346 PMCID: PMC9421490 DOI: 10.1016/j.nicl.2022.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022] Open
Abstract
Amyloid PET was positive in 63% of patients with lobar ICH. Simplified Edinburgh criteria and amyloid PET have similar accuracy vs Boston criteria. Simplified Edinburgh and Boston criteria have similar accuracy vs amyloid PET. Amyloid PET could assist in diagnosing CAA.
Background Histopathological evidence of cerebral vascular amyloid β accumulation is the gold standard to diagnose cerebral amyloid angiopathy (CAA). Neuroimaging findings obtained with CT and MRI can suggest the presence of CAA when histopathology is lacking. We explored the role of amyloid PET in patients with lobar intracerebral hemorrhage (ICH) as this may provide molecular evidence for CAA as well. Methods In this retrospective, monocenter analysis, we included consecutive patients with non-traumatic lobar ICH who had undergone amyloid PET. We categorized patients according to amyloid PET status and compared demographics and neuroimaging findings. We calculated sensitivity and specificity of the simplified Edinburgh criteria and amyloid PET with probable modified Boston criteria as reference standard, as well as sensitivity and specificity of the simplified Edinburgh and modified Boston criteria with amyloid PET status as molecular marker for presence or absence of CAA. Results We included 38 patients of whom 24 (63%) were amyloid PET positive. Amyloid PET positive patients were older at presentation (p = 0.004). We observed no difference in prevalence of subarachnoid hemorrhages, fingerlike projections or microbleeds between both groups, but cortical superficial siderosis (p = 0.003) was more frequent in the amyloid PET positive group. In 5 out of 38 patients (13%), the modified Boston criteria were not fulfilled due to young age or concomitant vitamin K antagonist use with INR > 3.0. With the modified Boston criteria as reference standard, there was no difference in sensitivity nor specificity between the simplified Edinburgh criteria and amyloid PET status. With amyloid PET status as reference standard, there was also no difference in sensitivity nor specificity between the simplified Edinburgh and modified Boston criteria. Conclusions Amyloid PET was positive in 63% of lobar ICH patients. Under certain circumstances, patients might not be diagnosed with probable CAA according to the modified Boston criteria and in these cases, amyloid PET may be useful. Accuracy to predict CAA based on amyloid PET status did not differ between the simplified Edinburgh and modified Boston criteria.
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10
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Pivtoraiko VN, Racic T, Abrahamson EE, Villemagne VL, Handen BL, Lott IT, Head E, Ikonomovic MD. Postmortem Neocortical 3H-PiB Binding and Levels of Unmodified and Pyroglutamate Aβ in Down Syndrome and Sporadic Alzheimer's Disease. Front Aging Neurosci 2021; 13:728739. [PMID: 34489686 PMCID: PMC8416541 DOI: 10.3389/fnagi.2021.728739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022] Open
Abstract
Individuals with Down syndrome (DS) have a genetic predisposition for amyloid-β (Aβ) overproduction and earlier onset of Aβ deposits compared to patients with sporadic late-onset Alzheimer’s disease (AD). Positron emission tomography (PET) with Pittsburgh Compound-B (PiB) detects fibrillar Aβ pathology in living people with DS and AD, but its relationship with heterogeneous Aβ forms aggregated within amyloid deposits is not well understood. We performed quantitative in vitro3H-PiB binding assays and enzyme-linked immunosorbent assays of fibrillar (insoluble) unmodified Aβ40 and Aβ42 forms and N-terminus truncated and pyroglutamate-modified AβNpE3-40 and AβNpE3-42 forms in postmortem frontal cortex and precuneus samples from 18 DS cases aged 43–63 years and 17 late-onset AD cases aged 62–99 years. Both diagnostic groups had frequent neocortical neuritic plaques, while the DS group had more severe vascular amyloid pathology (cerebral amyloid angiopathy, CAA). Compared to the AD group, the DS group had higher levels of Aβ40 and AβNpE3-40, while the two groups did not differ by Aβ42 and AβNpE3-42 levels. This resulted in lower ratios of Aβ42/Aβ40 and AβNpE3-42/AβNpE3-40 in the DS group compared to the AD group. Correlations of Aβ42/Aβ40 and AβNpE3-42/AβNpE3-40 ratios with CAA severity were strong in DS cases and weak in AD cases. Pyroglutamate-modified Aβ levels were lower than unmodified Aβ levels in both diagnostic groups, but within group proportions of both pyroglutamate-modified Aβ forms relative to both unmodified Aβ forms were lower in the DS group but not in the AD group. The two diagnostic groups did not differ by 3H-PiB binding levels. These results demonstrate that compared to late-onset AD cases, adult DS individuals with similar severity of neocortical neuritic plaques and greater CAA pathology have a preponderance of both pyroglutamate-modified AβNpE3-40 and unmodified Aβ40 forms. Despite the distinct molecular profile of Aβ forms and greater vascular amyloidosis in DS cases, cortical 3H-PiB binding does not distinguish between diagnostic groups that are at an advanced level of amyloid plaque pathology. This underscores the need for the development of CAA-selective PET radiopharmaceuticals to detect and track the progression of cerebral vascular amyloid deposits in relation to Aβ plaques in individuals with DS.
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Affiliation(s)
- Violetta N Pivtoraiko
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tamara Racic
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Eric E Abrahamson
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Victor L Villemagne
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Benjamin L Handen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ira T Lott
- Department of Neurology, UC Irvine School of Medicine, Orange, CA, United States
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, UC Irvine School of Medicine, Orange, CA, United States
| | - Milos D Ikonomovic
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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11
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Shi Y, Jiang Z, Jiang L, Xu J. Integrative analysis of key candidate genes and signaling pathways in acute coronary syndrome related to obstructive sleep apnea by bioinformatics. Sci Rep 2021; 11:14153. [PMID: 34239024 PMCID: PMC8266822 DOI: 10.1038/s41598-021-93789-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Although obstructive sleep apnea (OSA) has been clinically reported to be associated with acute coronary syndrome (ACS), the pathogenesis between the two is unclear. Herein, we analyzed and screened out the prospective molecular marker. To explore the candidate genes, as well as signaling cascades involved in ACS related to OSA, we extracted the integrated differentially expressed genes (DEGs) from the intersection of genes from the Gene Expression Omnibus (GEO) cohorts and text mining, followed by enrichment of the matching cell signal cascade through DAVID analysis. Moreover, the MCODE of Cytoscape software was employed to uncover the protein-protein interaction (PPI) network and the matching hub gene. A total of 17 and 56 integrated human DEGs in unstable angina (UA) and myocardial infarction (MI) group associated with OSAs that met the criteria of |log2 fold change (FC)|≥ 1, adjusted P < 0.05, respectively, were uncovered. After PPI network construction, the top five hub genes associated with UA were extracted, including APP, MAPK3, MMP9, CD40 and CD40LG, whereas those associated with MI were PPARG, MAPK1, MMP9, AGT, and TGFB1. The establishment of the aforementioned candidate key genes, as well as the enriched signaling cascades, provides promising molecular marker for OSA-related ACS, which will to provide a certain predictive value for the occurrence of ACS in OSA patients in the future.
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Affiliation(s)
- Yanxi Shi
- Department of Cardiology, Jiaxing Second Hospital, Jiaxing, China
| | - Zhengye Jiang
- Institute of Neurosurgery, School of Medicine, Xiamen University, Xiamen, China
| | - Liqin Jiang
- Department of Cardiology, Jiaxing Second Hospital, Jiaxing, China
| | - Jianjiang Xu
- Department of Cardiology, Jiaxing Second Hospital, Jiaxing, China.
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12
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Subotic A, McCreary CR, Saad F, Nguyen A, Alvarez-Veronesi A, Zwiers AM, Charlton A, Beaudin AE, Ismail Z, Pike GB, Smith EE. Cortical Thickness and Its Association with Clinical Cognitive and Neuroimaging Markers in Cerebral Amyloid Angiopathy. J Alzheimers Dis 2021; 81:1663-1671. [PMID: 33998545 PMCID: PMC8293635 DOI: 10.3233/jad-210138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) contributes to brain neurodegeneration and cognitive decline, but the relationship between these two processes is incompletely understood. OBJECTIVE The purpose of this study is to examine cortical thickness and its association with cognition and neurodegenerative biomarkers in CAA. METHODS Data were collected from the Functional Assessment of Vascular Reactivity study and the Calgary Normative Study. In total, 48 participants with probable CAA, 72 cognitively normal healthy controls, and 24 participants with mild dementia due to AD were included. Participants underwent an MRI scan, after which global and regional cortical thickness measurements were obtained using FreeSurfer. General linear models, adjusted for age and sex, were used to compare cortical thickness globally and in an AD signature region. RESULTS Global cortical thickness was lower in CAA compared to healthy controls (mean difference (MD) -0.047 mm, 95% confidence interval (CI) -0.088, -0.005, p = 0.03), and lower in AD compared to CAA (MD -0.104 mm, 95% CI -0.165, -0.043, p = 0.001). In the AD signature region, cortical thickness was lower in CAA compared to healthy controls (MD -0.07 mm, 95% CI -0.13 to -0.01, p = 0.02). Within the CAA group, lower cortical thickness was associated with lower memory scores (R2 = 0.10; p = 0.05) and higher white matter hyperintensity volume (R2 = 0.09, p = 0.04). CONCLUSION CAA contributes to neurodegeneration in the form of lower cortical thickness, and this could contribute to cognitive decline. Regional overlap with an AD cortical atrophy signature region suggests that co-existing AD pathology may contribute to lower cortical thickness observed in CAA.
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Affiliation(s)
- Arsenije Subotic
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl R McCreary
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Feryal Saad
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Nguyen
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Ana Alvarez-Veronesi
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Angela M Zwiers
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna Charlton
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrew E Beaudin
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - G Bruce Pike
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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13
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Graff-Radford J, Lesnick T, Rabinstein AA, Gunter JL, Przybelski SA, Noseworthy PA, Preboske GM, Mielke MM, Lowe VJ, Knopman DS, Petersen RC, Kremers WK, Jack CR, Vemuri P, Kantarci K. Cerebral Microbleeds: Relationship to Antithrombotic Medications. Stroke 2021; 52:2347-2355. [PMID: 33966498 DOI: 10.1161/strokeaha.120.031515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Jonathan Graff-Radford
- Department of Neurology (J.G.-R., A.A.R., M.M.M., D.S.K., R.C.P.S), Mayo Clinic, Rochester, MN
| | - Timothy Lesnick
- Department of Health Sciences Research (T.L., S.A.P., M.M.M., W.K.K.), Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- Department of Neurology (J.G.-R., A.A.R., M.M.M., D.S.K., R.C.P.S), Mayo Clinic, Rochester, MN
| | - Jeffrey L Gunter
- Department of Radiology (J.L.G., G.M.P., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- Department of Health Sciences Research (T.L., S.A.P., M.M.M., W.K.K.), Mayo Clinic, Rochester, MN
| | | | - Gregory M Preboske
- Department of Radiology (J.L.G., G.M.P., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Neurology (J.G.-R., A.A.R., M.M.M., D.S.K., R.C.P.S), Mayo Clinic, Rochester, MN.,Department of Health Sciences Research (T.L., S.A.P., M.M.M., W.K.K.), Mayo Clinic, Rochester, MN
| | - Val J Lowe
- Department of Radiology (J.L.G., G.M.P., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- Department of Neurology (J.G.-R., A.A.R., M.M.M., D.S.K., R.C.P.S), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- Department of Neurology (J.G.-R., A.A.R., M.M.M., D.S.K., R.C.P.S), Mayo Clinic, Rochester, MN
| | - Walter K Kremers
- Department of Health Sciences Research (T.L., S.A.P., M.M.M., W.K.K.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- Department of Radiology (J.L.G., G.M.P., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- Department of Radiology (J.L.G., G.M.P., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Kejal Kantarci
- Department of Radiology (J.L.G., G.M.P., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
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14
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Martín-Jiménez P, Sánchez-Tornero M, Llamas-Velasco S, Guerrero-Molina MP, González-Sánchez M, Herrero-San Martín A, Blanco-Palmero V, Calleja-Castaño P, Francisco-Gonzalo J, Hilario A, Ramos A, Salvador E, Toldos Ó, Hernández-Lain A, Pérez-Martínez DA, Villarejo-Galende A. Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. Neurologia 2021; 38:S0213-4853(21)00033-5. [PMID: 33726968 DOI: 10.1016/j.nrl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels. METHODS We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Affiliation(s)
- P Martín-Jiménez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Sánchez-Tornero
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, España
| | - S Llamas-Velasco
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - M P Guerrero-Molina
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M González-Sánchez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - A Herrero-San Martín
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - V Blanco-Palmero
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Francisco-Gonzalo
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Hilario
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Salvador
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - Ó Toldos
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Hernández-Lain
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D A Pérez-Martínez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
| | - A Villarejo-Galende
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
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15
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Angiopatia amiloide cerebrale sporadica. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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He Y, Fu T, Li Y, Xue W, Cui M, Wang L, Niu M, Peng Z, Jia J. Flexible multidentate benzyldiamine derivatives with high affinity for β-amyloid in cerebral amyloid angiopathy. Mol Divers 2020; 25:525-533. [PMID: 32410113 DOI: 10.1007/s11030-020-10098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
Cerebral amyloid angiopathy (CAA) commonly found in the aged is pathologically characterized by β-amyloid (Aβ) deposition in the walls of arteries and capillaries of brain. In this study, four flexible multidentate benzyldiamine derivatives as potential probes for cerebrovascular Aβ deposition were designed and synthesized. In in vitro inhibition assays, the ligands 18-21 displayed high affinities for Aβ aggregates with Ki values of 1.45 ± 0.53 nM, 1.68 ± 0.35 nM, 1.16 ± 0.23 nM and 1.72 ± 0.19 nM, respectively. A significant improvement in the binding affinity over the monomer, compounds 9-12 or benzyldiamine derivatives, demonstrated the applicability of the multidentate approach. The underlying mechanism of these novel Aβ agents was explored by molecular docking technique, which theoretically verified the high affinities of the multidentate benzyldiamine derivatives for Aβ aggregates. Moreover, the molecular masses of the ligands 18-21 are more than 700 Dalton, which are believed to be hardly capable of penetrating blood brain barrier. In this regard, these ligands could be used to distinguish CAA from Alzheimer's disease which is another Aβ-related disorder disease. To convert these ligands to positron emission tomography imaging agents, we attempted to radiosynthesize [18F]18. Though the radiolabeling was not very successful, the preliminary results suggested that these newly proposed multidentate benzyldiamine derivatives may be used as potential Aβ imaging agents in cerebral amyloid angiopathy.
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Affiliation(s)
- Yujia He
- Department of Radiological Medicine and Oncology, College of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Tingting Fu
- School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, People's Republic of China
| | - Yuying Li
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, 100875, People's Republic of China
| | - Weiwei Xue
- School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, People's Republic of China.
| | - Mengchao Cui
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, 100875, People's Republic of China
| | - Liang Wang
- Department of Radiological Medicine and Oncology, College of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Mengda Niu
- Department of Radiological Medicine and Oncology, College of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Zhiping Peng
- Department of Radiological Medicine and Oncology, College of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
| | - Jianhua Jia
- Department of Radiological Medicine and Oncology, College of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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17
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Bermejo-Guerrero L, Sánchez-Tejerina D, Sánchez-Tornero M, Sánchez-Sánchez MDC, Gómez-Grande A, Villarejo-Galende A, Herrero-San Martín AO, González-Sánchez M. Low Amyloid-PET Uptake in Iowa-Type Cerebral Amyloid Angiopathy with Cerebral Venous Thrombosis. J Alzheimers Dis 2019; 72:677-681. [DOI: 10.3233/jad-190800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | - Adolfo Gómez-Grande
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alberto Villarejo-Galende
- Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Group of Neurodegenerative Diseases, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Alejandro Octavio Herrero-San Martín
- Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Group of Neurodegenerative Diseases, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Marta González-Sánchez
- Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Group of Neurodegenerative Diseases, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
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18
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Schultz AP, Kloet RW, Sohrabi HR, van der Weerd L, van Rooden S, Wermer MJH, Moursel LG, Yaqub M, van Berckel BNM, Chatterjee P, Gardener SL, Taddei K, Fagan AM, Benzinger TL, Morris JC, Sperling R, Johnson K, Bateman RJ, Gurol ME, van Buchem MA, Martins R, Chhatwal JP, Greenberg SM. Amyloid imaging of dutch-type hereditary cerebral amyloid angiopathy carriers. Ann Neurol 2019; 86:616-625. [PMID: 31361916 DOI: 10.1002/ana.25560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether amyloid imaging with the positron emission tomography (PET) agent Pittsburgh compound B (PiB) can detect vascular β-amyloid (Aβ) in the essentially pure form of cerebral amyloid angiopathy associated with the Dutch-type hereditary cerebral amyloid angiopathy (D-CAA) mutation. METHODS PiB retention in a cortical composite of frontal, lateral, and retrosplenial regions (FLR) was measured by PiB-PET in 19 D-CAA mutation carriers (M+ ; 13 without neurologic symptoms, 6 with prior lobar intracerebral hemorrhage) and 17 mutation noncarriers (M- ). Progression of PiB retention was analyzed in a subset of 18 serially imaged individuals (10 asymptomatic M+ , 8 M- ). We also analyzed associations between PiB retention and cerebrospinal fluid (CSF) Aβ concentrations in 17 M+ and 11 M- participants who underwent lumbar puncture and compared the findings to PiB-PET and CSF Aβ in 37 autosomal dominant Alzheimer disease (ADAD) mutation carriers. RESULTS D-CAA M+ showed greater age-dependent FLR PiB retention (p < 0.001) than M- , and serially imaged asymptomatic M+ demonstrated greater longitudinal increases (p = 0.004). Among M+ , greater FLR PiB retention associated with reduced CSF concentrations of Aβ40 (r = -0.55, p = 0.021) but not Aβ42 (r = 0.01, p = 0.991). Despite comparably low CSF Aβ40 and Aβ42, PiB retention was substantially less in D-CAA than ADAD (p < 0.001). INTERPRETATION Increased PiB retention in D-CAA and correlation with reduced CSF Aβ40 suggest this compound labels vascular amyloid, although to a lesser degree than amyloid deposits in ADAD. Progression in PiB signal over time suggests amyloid PET as a potential biomarker in trials of candidate agents for this untreatable cause of hemorrhagic stroke. ANN NEUROL 2019;86:616-625.
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Affiliation(s)
- Aaron P Schultz
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Reina W Kloet
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hamid R Sohrabi
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Louise van der Weerd
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sanneke van Rooden
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H Wermer
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Laure Grand Moursel
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine and Department of Neurology (Alzheimer's Center), VU University Medical Center, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine and Department of Neurology (Alzheimer's Center), VU University Medical Center, Amsterdam, the Netherlands
| | - Pratishtha Chatterjee
- Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Samantha L Gardener
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kevin Taddei
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Anne M Fagan
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | - Tammie L Benzinger
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | - John C Morris
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | - Reisa Sperling
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Keith Johnson
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Randall J Bateman
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | | | - M Edip Gurol
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Mark A van Buchem
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ralph Martins
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Jasmeer P Chhatwal
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Steven M Greenberg
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
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19
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Gupta J, Fatima MT, Islam Z, Khan RH, Uversky VN, Salahuddin P. Nanoparticle formulations in the diagnosis and therapy of Alzheimer's disease. Int J Biol Macromol 2019; 130:515-526. [DOI: 10.1016/j.ijbiomac.2019.02.156] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 12/11/2022]
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20
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Preparation of Benzothiazolyl-Decorated Nanoliposomes. Molecules 2019; 24:molecules24081540. [PMID: 31003552 PMCID: PMC6514897 DOI: 10.3390/molecules24081540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/17/2022] Open
Abstract
Amyloid β (Aβ) species are considered as potential targets for the development of diagnostics/therapeutics towards Alzheimer’s disease (AD). Nanoliposomes which are decorated with molecules having high affinity for Aβ species may be considered as potential carriers for AD theragnostics. Herein, benzothiazolyl (BTH) decorated nanoliposomes were prepared for the first time, after synthesis of a lipidic BTH derivative (lipid-BTH). The synthetic pathway included acylation of bis(2-aminophenyl) disulfide with palmitic acid or palmitoyl chloride and subsequent reduction of the oxidized dithiol derivative. The liberated thiols were able to cyclize to the corresponding benzothiazolyl derivatives only after acidification of the reaction mixture. Each step of the procedure was monitored by HPLC analysis in order to identify all the important parameters for the formation of the BTH-group. Finally, the optimal methodology was identified, and was applied for the synthesis of the lipid-BTH derivative. BTH-decorated nanoliposomes were then prepared and characterized for physicochemical properties (size distribution, surface charge, physical stability, and membrane integrity during incubation in presence of buffer and plasma proteins). Pegylated BTH-nanoliposomes were demonstrated to have high integrity in the presence of proteins (in comparison to non-peglated ones) justifying their further exploitation as potential theragnostic systems for AD.
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21
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Cohen AD, Landau SM, Snitz BE, Klunk WE, Blennow K, Zetterberg H. Fluid and PET biomarkers for amyloid pathology in Alzheimer's disease. Mol Cell Neurosci 2018; 97:3-17. [PMID: 30537535 DOI: 10.1016/j.mcn.2018.12.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/05/2018] [Indexed: 02/04/2023] Open
Abstract
Alzheimer's disease (AD) is characterized by amyloid plaques and tau pathology (neurofibrillary tangles and neuropil threads). Amyloid plaques are primarily composed of aggregated and oligomeric β-amyloid (Aβ) peptides ending at position 42 (Aβ42). The development of fluid and PET biomarkers for Alzheimer's disease (AD), has allowed for detection of Aβ pathology in vivo and marks a major advancement in understanding the role of Aβ in Alzheimer's disease (AD). In the recent National Institute on Aging and Alzheimer's Association (NIA-AA) Research Framework, AD is defined by the underlying pathology as measured in patients during life by biomarkers (Jack et al., 2018), while clinical symptoms are used for staging of the disease. Therefore, sensitive, specific and robust biomarkers to identify brain amyloidosis are central in AD research. Here, we discuss fluid and PET biomarkers for Aβ and their application.
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Affiliation(s)
- Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America.
| | - Susan M Landau
- Neurology Helen Wills Neuroscience Institute, University of California, Berkeley, United States of America; Lawrence Berkeley National Laboratory, Molecular Biophysics and Integrated Bioimaging Functional Imaging Department, Life Sciences Division, United States of America
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh School of Medicine, United States of America
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States of America
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Molndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, University College, London, United Kingdom of Great Britain and Northern Ireland
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Molndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, University College, London, United Kingdom of Great Britain and Northern Ireland; Department of Molecular Neuroscience, UCL Institute of Neurology, United Kingdom of Great Britain and Northern Ireland; UK Dementia Research Institute at UCL, United Kingdom of Great Britain and Northern Ireland
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22
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Song J, Peng X, Li L, Yang F, Zhang X, Zhang J, Dai J, Cui M. Al 18F-NODA Benzothiazole Derivatives as Imaging Agents for Cerebrovascular Amyloid in Cerebral Amyloid Angiopathy. ACS OMEGA 2018; 3:13089-13096. [PMID: 30411027 PMCID: PMC6217595 DOI: 10.1021/acsomega.8b01120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
In this study, we synthesized four novel Al18/19F-labeled 2-phenylbenzothiazole derivatives conjugated to 1,4,7-triazacyclononane-1,4-diacetic acid via alkyl linkers and evaluated them as imaging agent targets to amyloid-β (Aβ) plaques deposited in the blood vessels of cerebral amyloid angiopathy (CAA) brain. The four ligands exhibited moderate-to-high binding ability to Aβ1-42 aggregates, of which complex 17 possessing the most potent affinity (K i = 11.3 nM) was selected for further biological evaluations. In vitro fluorescent staining and in vitro autoradiography studies on brain sections from CAA patients proved that this ligand could label Aβ deposits in blood vessels selectively. In biodistribution study, [18F]17 can hardly penetrate the blood-brain barrier (brain2 min = 0.3% ID/g) and displayed a rapid blood washout rate (blood2 min/blood60 min = 25.2), which is favorable as CAA imaging agents. In conclusion, this Al18F-labeled 2-phenylbenzothiazole complex was developed and proved to be a promising CAA positron emission tomography agent.
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Affiliation(s)
- Jia Song
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
| | - Xiaohui Peng
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
| | - Linlin Li
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
| | - Fan Yang
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
| | - Xiaojun Zhang
- Department
of Nuclear Medicine, Chinese PLA General
Hospital, Beijing 100853, P. R. China
| | - Jinming Zhang
- Department
of Nuclear Medicine, Chinese PLA General
Hospital, Beijing 100853, P. R. China
| | - Jiapei Dai
- Wuhan
Institute for Neuroscience and Neuroengineering, South-Central University for Nationalities, Wuhan 430074, P. R. China
| | - Mengchao Cui
- Department
of Nuclear Medicine, Chinese PLA General
Hospital, Beijing 100853, P. R. China
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23
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Rhenium and technetium complexes of thioamide derivatives of pyridylhydrazine that bind to amyloid-β plaques. J Biol Inorg Chem 2018; 23:1139-1151. [PMID: 29982869 DOI: 10.1007/s00775-018-1590-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/22/2018] [Indexed: 01/05/2023]
Abstract
Age-associated deposition of amyloid-β in cerebral blood vessels, a condition referred to as cerebral amyloid angiopathy, can contribute to stroke and dementia. This research aimed to design new radioactive technetium-99 m complexes that bind to amyloid-β plaques that have the potential to assist in diagnosis of cerebral amyloid angiopathy using single-photon-emitted computed tomography (SPECT) imaging. Six new pyridylthiosemicarbazide ligands containing either benzofuran or styrylpyridyl functional groups that are known to selectively bind to amyloid plaques were prepared. Non-radioactive isotopes of technetium are not available so rhenium was used as a surrogate for exploratory chemistry. The new ligands were used to prepare well-defined [Re-oxo]3+ complexes where two pyridylthiosemicarbazide ligands were coordinated to a single metal ion to give bivalent complexes with two amyloid-β targeting functional groups. The interaction of the [Re-oxo]3+ complexes with synthetic amyloid-β1-42 and with amyloid plaques in human brain tissue was investigated. Two ligands were selected to develop methods to prepare their [99mTc-oxo]3+ complexes at the tracer level. These technetium-99 m complexes are likely to be isostructural to their rhenium-oxo analogues.
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24
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Weber SA, Patel RK, Lutsep HL. Cerebral amyloid angiopathy: diagnosis and potential therapies. Expert Rev Neurother 2018; 18:503-513. [DOI: 10.1080/14737175.2018.1480938] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Stewart A. Weber
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ranish K. Patel
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Helmi L. Lutsep
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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25
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Charidimou A, Farid K, Tsai HH, Tsai LK, Yen RF, Baron JC. Amyloid-PET burden and regional distribution in cerebral amyloid angiopathy: a systematic review and meta-analysis of biomarker performance. J Neurol Neurosurg Psychiatry 2018; 89:410-417. [PMID: 29070646 DOI: 10.1136/jnnp-2017-316851] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/28/2017] [Accepted: 10/02/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We performed a meta-analysis to synthesise current evidence on amyloid-positron emission tomography (PET) burden and presumed preferential occipital distribution in sporadic cerebral amyloid angiopathy (CAA). METHODS In a PubMed systematic search, we identified case-control studies with extractable data on global and occipital-to-global amyloid-PET uptake in symptomatic patients with CAA (per Boston criteria) versus control groups (healthy participants or patients with non-CAA deep intracerebral haemorrhage) and patients with Alzheimer's disease. To circumvent PET studies' methodological variation, we generated and used 'fold change', that is, ratio of mean amyloid uptake (global and occipital-to-global) of CAA relative to comparison groups. Amyloid-PET uptake biomarker performance was then quantified by random-effects meta-analysis on the ratios of the means. A ratio >1 indicates that amyloid-PET uptake (global or occipital/global) is higher in CAA than comparison groups, and a ratio <1 indicates the reverse. RESULTS Seven studies, including 106 patients with CAA (>90% with probable CAA) and 138 controls (96 healthy elderly, 42 deep intracerebral haemorrhage controls) and 72 patients with Alzheimer's disease, were included. Global amyloid-PET ratio between patients with CAA and controls was above 1, with an average effect size of 1.18 (95% CI 1.08 to 1.28; p<0.0001). Occipital-to-global amyloid-PET uptake ratio did not differ between patients with CAA versus patients with deep intracerebral haemorrhage or healthy controls. By contrast, occipital-to-global amyloid-PET uptake ratio was above 1 in patients with CAA versus those with Alzheimer's disease, with an average ratio of 1.10 (95% CI 1.03 to 1.19; p=0.009) and high statistical heterogeneity. CONCLUSIONS Our analysis provides exploratory actionable data on the overall effect sizes and strength of amyloid-PET burden and distribution in patients with CAA, useful for future larger studies.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Group, Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karim Farid
- Department of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Rouh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Jean-Claude Baron
- Department of Neurology, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
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26
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Charidimou A, Boulouis G, Gurol ME, Ayata C, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 2017; 140:1829-1850. [PMID: 28334869 DOI: 10.1093/brain/awx047] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/17/2017] [Indexed: 12/27/2022] Open
Abstract
Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian J Bacskai
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Matthew P Frosch
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA.,C.S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.,Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
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27
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Charidimou A, Farid K, Baron JC. Amyloid-PET in sporadic cerebral amyloid angiopathy: A diagnostic accuracy meta-analysis. Neurology 2017; 89:1490-1498. [PMID: 28855406 DOI: 10.1212/wnl.0000000000004539] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To perform a meta-analysis synthesizing evidence of the value and accuracy of amyloid-PET in diagnosing patients with sporadic cerebral amyloid angiopathy (CAA). METHODS In a PubMed systematic literature search, we identified all case-control studies with extractable data relevant for the sensitivity and specificity of amyloid-PET positivity in symptomatic patients with CAA (cases) vs healthy participants or patients with spontaneous deep intracerebral hemorrhage (ICH) (control groups). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy. RESULTS Seven studies, including 106 patients with CAA (>90% with probable CAA) and 151 controls, were eligible and included in the meta-analysis. The studies were of moderate to high quality and varied in several methodological aspects, including definition of PET-positive and PET-negative cases and relevant cutoffs. The sensitivity of amyloid-PET for CAA diagnosis ranged from 60% to 91% and the specificity from 56% to 90%. The overall pooled sensitivity was 79% (95% confidence interval [CI] 62-89) and specificity was 78% (95% CI 67-86) for CAA diagnosis. A predefined subgroup analysis of studies restricted to symptomatic patients presenting with lobar ICH CAA (n = 58 vs 86 controls) resulted in 79% sensitivity (95% CI 61-90%) and 84% specificity (95% CI 65-93%). In prespecified bivariate diagnostic accuracy meta-analysis of 2 studies using 18F-florbetapir-PET, the sensitivity for CAA-ICH diagnosis was 90% (95% CI 76-100%) and specificity was 88% (95% CI 74-100%). CONCLUSIONS Amyloid-PET appears to have moderate to good diagnostic accuracy in differentiating patients with probable CAA from cognitively normal healthy controls or patients with deep ICH. Given that amyloid-PET labels both cerebrovascular and parenchymal amyloid, a negative scan might be useful to rule out CAA in the appropriate clinical setting.
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Affiliation(s)
- Andreas Charidimou
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France.
| | - Karim Farid
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France
| | - Jean-Claude Baron
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France
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28
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Farid K, Charidimou A, Baron JC. Amyloid positron emission tomography in sporadic cerebral amyloid angiopathy: A systematic critical update. NEUROIMAGE-CLINICAL 2017; 15:247-263. [PMID: 28560150 PMCID: PMC5435601 DOI: 10.1016/j.nicl.2017.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 01/07/2023]
Abstract
Sporadic cerebral amyloid angiopathy (CAA) is a very common small vessel disease of the brain, showing preferential and progressive amyloid-βdeposition in the wall of small arterioles and capillaries of the leptomeninges and cerebral cortex. CAA now encompasses not only a specific cerebrovascular pathological trait, but also different clinical syndromes - including spontaneous lobar intracerebral haemorrhage (ICH), dementia and ‘amyloid spells’ - an expanding spectrum of brain parenchymal MRI lesions and a set of diagnostic criteria – the Boston criteria, which have resulted in increasingly detecting CAA during life. Although currently available validated diagnostic criteria perform well in multiple lobar ICH, a formal diagnosis is currently lacking unless a brain biopsy is performed. This is partly because in practice CAA MRI biomarkers provide only indirect evidence for the disease. An accurate diagnosis of CAA in different clinical settings would have substantial impact for ICH risk stratification and antithrombotic drug use in elderly people, but also for sample homogeneity in drug trials. It has recently been demonstrated that vascular (in addition to parenchymal) amyloid-βdeposition can be detected and quantified in vivo by positron emission tomography (PET) amyloid tracers. This non-invasive approach has the potential to provide a molecular signature of CAA, and could in turn have major clinical impact. However, several issues around amyloid-PET in CAA remain unsettled and hence its diagnostic utility is limited. In this article we systematically review and critically appraise the published literature on amyloid-PET (PiB and other tracers) in sporadic CAA. We focus on two key areas: (a) the diagnostic utility of amyloid-PET in CAA and (b) the use of amyloid-PET as a window to understand pathophysiological mechanism of the disease. Key issues around amyloid-PET imaging in CAA, including relevant technical aspects are also covered in depth. A total of six small-scale studies have addressed (or reported data useful to address) the diagnostic utility of late-phase amyloid PET imaging in CAA, and one additional study dealt with early PiB images as a proxy of brain perfusion. Across these studies, amyloid PET imaging has definite diagnostic utility (currently tested only in probable CAA): it helps rule out CAA if negative, whether compared to healthy controls or to hypertensive deep ICH controls. If positive, however, differentiation from underlying incipient Alzheimer's disease (AD) can be challenging and so far, no approach (regional values, ratios, visual assessment) seems sufficient and specific enough, although early PiB data seem to hold promise. Based on the available evidence reviewed, we suggest a tentative diagnostic flow algorithm for amyloid-PET use in the clinical setting of suspected CAA, combining early- and late-phase PiB-PET images. We also identified ten mechanistic amyloid-PET studies providing early but promising proof-of-concept data on CAA pathophysiology and its various manifestations including key MRI lesions, cognitive impairment and large scale brain alterations. Key open questions that should be addressed in future studies of amyloid-PET imaging in CAA are identified and highlighted. CAA is a major cause of brain haemorrhage and cognitive impairment in aged subjects. Without brain biopsy, its current diagnosis largely relies on indirect MRI markers. Amyloid PET may provide a non-invasive molecular signature to formally diagnose CAA. Based on our review, amyloid PET has excellent sensitivity but specificity is unclear. Amyloid PET is also useful to investigate mechanisms underlying CAA manifestations.
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Affiliation(s)
- Karim Farid
- Department of Nuclear Medicine, Martinique University Hospital, Fort-de-France, Martinique
| | - Andreas Charidimou
- Massachusetts General Hospital, Department of Neurology, Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Jean-Claude Baron
- U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France.
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Raman MR, Kantarci K, Murray ME, Jack CR, Vemuri P. Imaging markers of cerebrovascular pathologies: Pathophysiology, clinical presentation, and risk factors. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 5:5-14. [PMID: 28054023 PMCID: PMC5198884 DOI: 10.1016/j.dadm.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebrovascular pathologies (CVPs) are common pathologies associated with age-related cognitive decline along with Alzheimer disease pathologies. The impact of CVP on the prevalence of dementia is increasingly being recognized. The goal of this review is to improve our understanding of the pathophysiological underpinnings and the multimodal magnetic resonance imaging and positron emission tomography imaging changes that are associated with the hallmarks of CVP. This knowledge will facilitate the development of early detection, intervention, and prevention strategies that may contribute to lowering the risk of dementia. In this review, we will first discuss currently known risk factors of CVPs including cardiovascular, lifestyle, genetic, sex differences, and head injury. Next, we will focus on the pathophysiology of CVPs and their impact on neurodegeneration and downstream cognitive impairment. Specifically, we will discuss three of the most common cerebrovascular lesions seen on MRI: white-matter hyperintensity, microbleeds, and infarcts. Finally, we will discuss the unanswered open questions in this field.
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Affiliation(s)
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Charidimou A, Pantoni L, Love S. The concept of sporadic cerebral small vessel disease: A road map on key definitions and current concepts. Int J Stroke 2016; 11:6-18. [PMID: 26763016 DOI: 10.1177/1747493015607485] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sporadic cerebral small vessel disease is considered to be among the most common known neuropathological processes and has an important role in stroke, cognitive impairment, and functional loss in elderly persons. The term is now commonly used to describe a range of neuroimaging, neuropathological, and associated clinical features, the pathogenesis of which is largely unclear but that are thought to arise from disease affecting the perforating cerebral arterioles, capillaries, and venules. Modern neuroimaging has revolutionized our understanding of the consequences of small vessels disease on the brain parenchyma, even though small arteries, arterioles, capillaries, and venules are difficult to be directly visualized with current techniques used in clinical practice. In this short review, we focus on histopathological and neuroimaging perspectives, basic definitions, and recent advances in the field.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, USA UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Leonardo Pantoni
- NEUROFARBA Department, University of Florence and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Seth Love
- Dementia Research Group, Institute of Clinical Neurosciences, University of Bristol, Learning & Research Level 2, Southmead Hospital, Bristol, UK
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Gurol ME, Becker JA, Fotiadis P, Riley G, Schwab K, Johnson KA, Greenberg SM. Florbetapir-PET to diagnose cerebral amyloid angiopathy: A prospective study. Neurology 2016; 87:2043-2049. [PMID: 27605173 DOI: 10.1212/wnl.0000000000003197] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/27/2016] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE We hypothesized that florbetapir, a Food and Drug Administration-approved PET tracer, could distinguish cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) from hypertensive ICH (HTN-ICH). METHODS We prospectively enrolled survivors of primary ICH related to probable CAA (per Boston Criteria, n = 10) and HTN-ICH (n = 9) without dementia. All patients underwent florbetapir-PET and multimodal MRI, and patients with CAA had additional Pittsburgh compound B (PiB) PET. Amyloid burden was assessed quantitatively (standard uptake value ratio [SUVR]) and visually classified as positive or negative. RESULTS The CAA and HTN-ICH groups had similar age (66.9 vs 67.1), sex, and leukoaraiosis volumes (31 vs 30 mL, all p > 0.8). Florbetapir uptake and PiB retention strongly correlated in patients with CAA both globally within cerebral cortex (r = 0.96, p < 0.001) and regionally in lobar cortices (all r > 0.8, all p ≤ 0.01). Mean global cortical florbetapir uptake was substantially higher in CAA than HTN-ICH (SUVR: 1.41 ± 0.17 vs 1.15 ± 0.08, p = 0.001), as was mean occipital SUVR (1.44 ± 0.12 vs 1.17 ± 0.08, p < 0.001), even after correcting for global SUVR (p = 0.03). Visual rating for positive/negative florbetapir demonstrated perfect interrater agreement (k = 1) and was positive for all 10 patients with CAA vs 1 of 9 HTN-ICH patients (sensitivity 100%, specificity 89%). CONCLUSIONS Florbetapir appears to label vascular amyloid in patients with CAA-related ICH. The approved florbetapir binary visual reading method can have diagnostic value in appropriate clinical settings. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that florbetapir-PET provides a sensitivity of 100% (95% confidence interval [CI] 66%-100%) and specificity of 89% (95% CI 51%-99%) for determination of probable CAA among cognitively normal patients.
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Affiliation(s)
- M Edip Gurol
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - J Alex Becker
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Grace Riley
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristin Schwab
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Keith A Johnson
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
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Fotiadis P, van Rooden S, van der Grond J, Schultz A, Martinez-Ramirez S, Auriel E, Reijmer Y, van Opstal AM, Ayres A, Schwab KM, Hedden T, Rosand J, Viswanathan A, Wermer M, Terwindt G, Sperling RA, Polimeni JR, Johnson KA, van Buchem MA, Greenberg SM, Gurol ME. Cortical atrophy in patients with cerebral amyloid angiopathy: a case-control study. Lancet Neurol 2016; 15:811-819. [PMID: 27180034 PMCID: PMC5248657 DOI: 10.1016/s1474-4422(16)30030-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Loss of cortical grey matter is a diagnostic marker of many neurodegenerative diseases, and is a key mediator of cognitive impairment. We postulated that cerebral amyloid angiopathy (CAA), characterised by cortical vascular amyloid deposits, is associated with cortical tissue loss independent of parenchymal Alzheimer's disease pathology. We tested this hypothesis in patients with hereditary cerebral haemorrhage with amyloidosis-Dutch type (HCHWA-D), a monogenetic disease with minimal or no concomitant Alzheimer's disease pathology, as well as in patients with sporadic CAA and healthy and Alzheimer's disease controls. METHODS In this observational case-control study, we included six groups of participants: patients diagnosed with HCHWA-D using genetic testing; healthy controls age-matched to the HCHWA-D group; patients with probable sporadic CAA without dementia; two independent cohorts of healthy controls age-matched to the CAA group; and patients with Alzheimer's disease age-matched to the CAA group. De-identified (but unmasked) demographic, clinical, radiological, and genetic data were collected at Massachusetts General Hospital (Boston, MA, USA), at Leiden University (Leiden, Netherlands), and at sites contributing to Alzheimer's Disease Neuroimaging Initiative (ADNI). The primary outcome measure was cortical thickness. The correlations between cortical thickness and structural lesions, and blood-oxygen-level-dependent time-to-peak (BOLD-TTP; a physiological measure of vascular dysfunction) were analysed to understand the potential mechanistic link between vascular amyloid and cortical thickness. The radiological variables of interest were quantified using previously validated computer-assisted tools, and all results were visually reviewed to ensure their accuracy. RESULTS Between March 15, 2006, and Dec 1, 2014, we recruited 369 individuals (26 patients with HCHWA-D and 28 age-matched, healthy controls; 63 patients with sporadic CAA without dementia; two healthy control cohorts with 63 and 126 individuals; and 63 patients with Alzheimer's disease). The 26 patients with HCHWA-D had thinner cortices (2·31 mm [SD 0·18]) than the 28 healthy controls (mean difference -0·112 mm, 95% CI -0·190 to -0·034, p=0·006). The 63 patients with sporadic CAA without dementia had thinner cortices (2·17 mm [SD 0·11]) than the two healthy control cohorts (n=63, mean difference -0·14 mm, 95% CI -0·17 to -0·10, p<0·0001; and n=126, -0·10, -0·13 to -0·06, p<0·0001). All differences remained independent in multivariable analyses. The 63 patients with Alzheimer's disease displayed more severe atrophy than the patients with sporadic CAA (2·1 mm [SD 0·14], difference 0·07 mm, 95% CI 0·11 to 0·02, p=0·005). We found strong associations between cortical thickness and vascular dysfunction in the patients with HCHWA-D (ρ=-0·58, p=0·003) or sporadic CAA (r=-0·4, p=0·015), but not in controls. Vascular dysfunction was identified as a mediator of the effect of hereditary CAA on cortical atrophy, accounting for 63% of the total effect. INTERPRETATION The appearance of cortical thinning in patients with HCHWA-D indicates that vascular amyloid is an independent contributor to cortical atrophy. These results were reproduced in patients with the more common sporadic CAA. Our findings also suggest that CAA-related cortical atrophy is at least partly mediated by vascular dysfunction. Our results also support the view that small vessel diseases such as CAA can cause cortical atrophy even in the absence of Alzheimer's disease, a conclusion that can help radiologists, neurologists, and other clinicians who diagnose these common geriatric conditions. FUNDING National Institutes of Health.
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Affiliation(s)
- Panagiotis Fotiadis
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aaron Schultz
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | | | - Eitan Auriel
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Yael Reijmer
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Anna M. van Opstal
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alison Ayres
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin M. Schwab
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | | | - Trey Hedden
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jonathan Rosand
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Marieke Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gisela Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Reisa A. Sperling
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jonathan R. Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Keith A. Johnson
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven M. Greenberg
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - M. Edip Gurol
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Zha Z, Song J, Choi SR, Wu Z, Ploessl K, Smith M, Kung H. 68Ga-Bivalent Polypegylated Styrylpyridine Conjugates for Imaging Aβ Plaques in Cerebral Amyloid Angiopathy. Bioconjug Chem 2016; 27:1314-23. [DOI: 10.1021/acs.bioconjchem.6b00127] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Zhihao Zha
- Beijing
Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
- Department
of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Jin Song
- Beijing
Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
- Department
of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Seok Rye Choi
- Five Eleven Pharma Inc., Philadelphia, Pennsylvania 19104, United States
- Department
of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Zehui Wu
- Beijing
Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
- Department
of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Karl Ploessl
- Five Eleven Pharma Inc., Philadelphia, Pennsylvania 19104, United States
- Department
of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Megan Smith
- Five Eleven Pharma Inc., Philadelphia, Pennsylvania 19104, United States
| | - Hank Kung
- Beijing
Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
- Five Eleven Pharma Inc., Philadelphia, Pennsylvania 19104, United States
- Department
of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
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Strømland Ø, Jakubec M, Furse S, Halskau Ø. Detection of misfolded protein aggregates from a clinical perspective. J Clin Transl Res 2016; 2:11-26. [PMID: 30873457 PMCID: PMC6410640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022] Open
Abstract
Neurodegenerative Protein Misfolding Diseases (PMDs), such as Alzheimer's (AD), Parkinson's (PD) and prion diseases, are generally difficult to diagnose before irreversible damage to the central nervous system damage has occurred. Detection of the misfolded proteins that ultimately lead to these conditions offers a means for providing early detection and diagnosis of this class of disease. In this review, we discuss recent developments surrounding protein misfolding diseases with emphasis on the cytotoxic oligomers implicated in their aetiology. We also discuss the relationship of misfolded proteins with biological membranes. Finally, we discuss how far techniques for providing early diagnoses for PMDs have advanced and describe promising clinical approaches. We conclude that antibodies with specificity towards oligomeric species of AD and PD and lectins with specificity for particular glycosylation, show promise. However, it is not clear which approach may yield a reliable clinical test first. Relevance for patients: Individuals suffering from protein misfolding diseases will likely benefit form earlier, less- or even non-invasive diagnosis techniques. The current state and possible future directions for these are subject of this review.
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Gurol ME. Molecular Neuroimaging in Vascular Cognitive Impairment. Stroke 2016; 47:1146-52. [PMID: 26883497 DOI: 10.1161/strokeaha.115.007958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022]
Affiliation(s)
- M Edip Gurol
- From the Department of Neurology, Massachusetts General Hospital, Boston.
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36
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Kase CS, Shoamanesh A, Greenberg SM, Caplan LR. Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Farid K, Hong YT, Aigbirhio FI, Fryer TD, Menon DK, Warburton EA, Baron JC. Early-Phase 11C-PiB PET in Amyloid Angiopathy-Related Symptomatic Cerebral Hemorrhage: Potential Diagnostic Value? PLoS One 2015; 10:e0139926. [PMID: 26439113 PMCID: PMC4595277 DOI: 10.1371/journal.pone.0139926] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/19/2015] [Indexed: 01/06/2023] Open
Abstract
Although late-phase (>35min post-administration) 11C-PiB-PET has good sensitivity in cerebral amyloid angiopathy (CAA), its specificity is poor due to frequently high uptake in healthy aged subjects. By detecting perfusion-like abnormalities, early-phase 11C-PiB-PET might add diagnostic value. Early-frame (1-6min) 11C-PiB-PET was obtained in 11 non-demented patients with probable CAA-related symptomatic lobar intracerebral haemorrhage (70±7yrs), 9 age-matched healthy controls (HCs) and 10 HCs <55yrs. There was a significant decrease in early-phase atrophy-corrected whole-cortex SUV relative to cerebellar vermis (SUVR) in the CAA vs age-matched HC group. None of the age-matched controls fell below the lower 95% confidence limit derived from the young HCs, while 6/11 CAA patients did (sensitivity = 55%, specificity = 100%). Combining both early- and late-phase 11C-PiB data did not change the sensitivity and specificity of late-phase PiB, but combined early- and late-phase positivity entails a very high suspicion of underlying Aβ-related clinical disorder, i.e., CAA or Alzheimer disease (AD). In order to clarify this ambiguity, we then show that the occipital/posterior cingulate ratio is markedly lower in CAA than in AD (N = 7). These pilot data suggest that early-phase 11C-PiB-PET may not only add to late-phase PiB-PET with respect to the unclear situation of late-phase positivity, but also help differentiate CAA from AD.
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Affiliation(s)
- Karim Farid
- APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris, France
- Dept of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies
| | - Young T. Hong
- Wolfson Brain Imaging Centre, Dept of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Franklin I. Aigbirhio
- Wolfson Brain Imaging Centre, Dept of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Tim D. Fryer
- Wolfson Brain Imaging Centre, Dept of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - David K. Menon
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth A. Warburton
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Stroke Unit, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Jean-Claude Baron
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- INSERM U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
- * E-mail:
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Gregg NM, Kim AE, Gurol ME, Lopez OL, Aizenstein HJ, Price JC, Mathis CA, James JA, Snitz BE, Cohen AD, Kamboh MI, Minhas D, Weissfeld LA, Tamburo EL, Klunk WE. Incidental Cerebral Microbleeds and Cerebral Blood Flow in Elderly Individuals. JAMA Neurol 2015; 72:1021-8. [PMID: 26167811 PMCID: PMC4724412 DOI: 10.1001/jamaneurol.2015.1359] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cerebral microbleeds (CMBs) are collections of blood breakdown products that are a common incidental finding in magnetic resonance imaging of elderly individuals. Cerebral microbleeds are associated with cognitive deficits, but the mechanism is unclear. Studies show that individuals with CMBs related to symptomatic cerebral amyloid angiopathy have abnormal vascular reactivity and cerebral blood flow (CBF), but, to our knowledge, abnormalities in cerebral blood flow have not been reported for healthy individuals with incidental CMBs. OBJECTIVE To evaluate the association of incidental CMBs with resting-state CBF, cerebral metabolism, cerebrovascular disease, β-amyloid (Aβ), and cognition. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of 55 cognitively normal individuals with a mean (SD) age of 86.8 (2.7) years was conducted from May 1, 2010, to May 1, 2013, in an academic medical center in Pittsburgh; data analysis was performed between June 10, 2013, and April 9, 2015. INTERVENTIONS 3-Tesla magnetic resonance imaging was performed with susceptibility-weighted imaging or gradient-recalled echo to assess CMBs, arterial spin labeling for CBF, and T1- and T2-weighted imaging for atrophy, white matter hyperintensities, and infarcts. Positron emission tomography was conducted with fluorodeoxyglucose to measure cerebral metabolism and Pittsburgh compound B for fibrillar Aβ. Neuropsychological evaluation, including the Clinical Dementia Rating scale, was performed. MAIN OUTCOMES AND MEASURES Magnetic resonance images were rated for the presence and location of CMBs. Lobar CMBs were subclassified as cortical or subcortical. Measurements of CBF, metabolism, and Aβ were compared with the presence and number of CMBs with voxelwise and region-of-interest analyses. RESULTS The presence of cortical CMBs was associated with significantly reduced CBF in multiple regions on voxelwise and region-of-interest analyses (percentage difference in global CBF, -25.3%; P = .0003), with the largest reductions in the parietal cortex (-37.6%; P < .0001) and precuneus (-31.8%; P = .0006). Participants with any CMBs showed a nonsignificant trend toward reduced CBF. Participants with cortical CMBs had a significant association with greater prevalence of infarcts (24% vs 6%; P = .047) and demonstrated a trend to greater prevalence of deficits demonstrated on the Clinical Dementia Rating scale (45% vs 19%; P = .12). There was no difference in cortical amyloid (measured by Pittsburgh compound B positron emission tomography) between participants with and without CMBs (P = .60). CONCLUSIONS AND RELEVANCE In cognitively normal elderly individuals, incidental CMBs in cortical locations are associated with widespread reductions in resting-state CBF. Chronic hypoperfusion may put these people at risk for neuronal injury and neurodegeneration. Our results suggest that resting-state CBF is a marker of CMB-related small-vessel disease.
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Affiliation(s)
- Nicholas M Gregg
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Albert E Kim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston3Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie C Price
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chester A Mathis
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeffrey A James
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M Ilyas Kamboh
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Davneet Minhas
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa A Weissfeld
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erica L Tamburo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
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Sweeney MD, Sagare AP, Zlokovic BV. Cerebrospinal fluid biomarkers of neurovascular dysfunction in mild dementia and Alzheimer's disease. J Cereb Blood Flow Metab 2015; 35:1055-68. [PMID: 25899298 PMCID: PMC4640280 DOI: 10.1038/jcbfm.2015.76] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 02/06/2023]
Abstract
Alzheimer's disease (AD) is the most common form of age-related dementias. In addition to genetics, environment, and lifestyle, growing evidence supports vascular contributions to dementias including dementia because of AD. Alzheimer's disease affects multiple cell types within the neurovascular unit (NVU), including brain vascular cells (endothelial cells, pericytes, and vascular smooth muscle cells), glial cells (astrocytes and microglia), and neurons. Thus, identifying and integrating biomarkers of the NVU cell-specific responses and injury with established AD biomarkers, amyloid-β (Aβ) and tau, has a potential to contribute to better understanding of the disease process in dementias including AD. Here, we discuss the existing literature on cerebrospinal fluid biomarkers of the NVU cell-specific responses during early stages of dementia and AD. We suggest that the clinical usefulness of established AD biomarkers, Aβ and tau, could be further improved by developing an algorithm that will incorporate biomarkers of the NVU cell-specific responses and injury. Such biomarker algorithm could aid in early detection and intervention as well as identify novel treatment targets to delay disease onset, slow progression, and/or prevent AD.
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Affiliation(s)
- Melanie D Sweeney
- Department of Physiology and Biophysics, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abhay P Sagare
- Department of Physiology and Biophysics, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Berislav V Zlokovic
- Department of Physiology and Biophysics, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Jia J, Cui M, Dai J, Liu B. 99mTc(CO)3-Labeled Benzothiazole Derivatives Preferentially Bind Cerebrovascular Amyloid: Potential Use as Imaging Agents for Cerebral Amyloid Angiopathy. Mol Pharm 2015; 12:2937-46. [PMID: 26065726 DOI: 10.1021/acs.molpharmaceut.5b00209] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is a disorder affecting the elderly that is characterized by amyloid-β (Aβ) deposition in blood vessel walls of the brain. A series of 99mTc(CO)3-labeled benzothiazole derivatives as potential SPECT imaging probes for cerebrovascular Aβ deposition is reported. Rhenium surrogate displayed high affinities to Aβ aggregates with Ki values ranging from 106 to 42 nM, and they strongly stained Aβ deposits in transgenic mice (Tg) and Alzheimer's disease (AD) patients. In vitro autoradiography on brain sections of Tg and AD patients confirmed that [99mTc]24 possessed sufficient affinity for Aβ plaques, and [99mTc]24 could only label Aβ deposition in blood vessels but not Aβ plaques in the parenchyma of the brain of AD patients. Moreover, [99mTc]24 possessed favorable initial uptake (1.21% ID/g) and fast blood washout (blood2 min/blood60 min=23) in normal mice. These preliminary results suggest that [99mTc]24 may be used as an Aβ imaging probe for the detection of CAA.
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Affiliation(s)
- Jianhua Jia
- †Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
| | - Mengchao Cui
- †Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
| | - Jiapei Dai
- ‡Wuhan Institute for Neuroscience and Neuroengineering, South-Central University for Nationalities, Wuhan 430074, P. R. China
| | - Boli Liu
- †Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, P. R. China
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Blennow K, Mattsson N, Schöll M, Hansson O, Zetterberg H. Amyloid biomarkers in Alzheimer's disease. Trends Pharmacol Sci 2015; 36:297-309. [PMID: 25840462 DOI: 10.1016/j.tips.2015.03.002] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023]
Abstract
Aggregation of amyloid-β (Aβ) into oligomers, fibrils, and plaques is central in the molecular pathogenesis of Alzheimer's disease (AD), and is the main focus of AD drug development. Biomarkers to monitor Aβ metabolism and aggregation directly in patients are important for further detailed study of the involvement of Aβ in disease pathogenesis and to monitor the biochemical effect of drugs targeting Aβ in clinical trials. Furthermore, if anti-Aβ disease-modifying drugs prove to be effective clinically, amyloid biomarkers will be of special value in the clinic to identify patients with brain amyloid deposition at risk for progression to AD dementia, to enable initiation of treatment before neurodegeneration is too severe, and to monitor drug effects on Aβ metabolism or pathology to guide dosage. Two types of amyloid biomarker have been developed: Aβ-binding ligands for use in positron emission tomography (PET) and assays to measure Aβ42 in cerebrospinal fluid (CSF). In this review, we present the rationales behind these biomarkers and compare their ability to measure Aβ plaque load in the brain. We also review possible shortcomings and the need of standardization of both biomarkers, as well as their implementation in the clinic.
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Affiliation(s)
- Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; The Torsten Söderberg Professorship at the Royal Swedish Academy of Sciences.
| | - Niklas Mattsson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Michael Schöll
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA; Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Hansson
- Department of Clinical Sciences, Lund University, Lund, Sweden; Clinical Memory Research unit, Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; UCL Institute of Neurology, Queen Square, London, UK
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Esiri M, Chance S, Joachim C, Warden D, Smallwood A, Sloan C, Christie S, Wilcock G, Smith AD. Cerebral amyloid angiopathy, subcortical white matter disease and dementia: literature review and study in OPTIMA. Brain Pathol 2015; 25:51-62. [PMID: 25521177 PMCID: PMC8028928 DOI: 10.1111/bpa.12221] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/08/2014] [Indexed: 12/23/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is of increasing clinical and research interest as the ability to detect it and its consequences by neuroimaging in living subjects has advanced. There is also increasing interest in understanding its possible role in the development of intracerebral hemorrhage, Alzheimer's disease (AD) and vascular dementia. In this article, the literature on this subject is reviewed and novel findings relating CAA to subcortical white matter damage in 224 subjects in the Oxford project to Investigate Memory and Ageing (OPTIMA) are reported. The relationship between CAA and subcortical tissue damage in the OPTIMA subjects was found to be critically dependent on ApoE genotype, there being a positive relationship between measures of CAA and subcortical small vessel disease in ApoEε4 carriers and a significant negative relationship in ApoEε2 carriers. These findings draw attention, as have many other studies, to the importance of ApoE genotype as a major risk factor not only for dementia but also for damage to blood vessels in the aging brain.
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Affiliation(s)
- Margaret Esiri
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Steven Chance
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Catharine Joachim
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Donald Warden
- Department of PharmacologyUniversity of OxfordOxfordUK
| | | | - Carolyn Sloan
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Sharon Christie
- Nuffield Department of Clinical NeurosciencesOPTIMAUniversity of OxfordOxfordUK
| | - Gordon Wilcock
- Nuffield Department of Clinical NeurosciencesOPTIMAUniversity of OxfordOxfordUK
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Raman MR, Wiste HJ, Senjem ML, Ward CP, Jack CR, Kantarci K. Spontaneous amyloid-related imaging abnormalities in a cognitively normal adult. Neurology 2014; 83:1771-2. [PMID: 25367059 DOI: 10.1212/wnl.0000000000000957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Attems J, Jellinger KA. The overlap between vascular disease and Alzheimer's disease--lessons from pathology. BMC Med 2014; 12:206. [PMID: 25385447 PMCID: PMC4226890 DOI: 10.1186/s12916-014-0206-2] [Citation(s) in RCA: 458] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022] Open
Abstract
Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer's disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.
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Affiliation(s)
- Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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45
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Reijmer YD, Fotiadis P, Martinez-Ramirez S, Salat DH, Schultz A, Shoamanesh A, Ayres AM, Vashkevich A, Rosas D, Schwab K, Leemans A, Biessels GJ, Rosand J, Johnson KA, Viswanathan A, Gurol ME, Greenberg SM. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy. Brain 2014; 138:179-88. [PMID: 25367025 DOI: 10.1093/brain/awu316] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cerebral amyloid angiopathy is a common form of small-vessel disease and an important risk factor for cognitive impairment. The mechanisms linking small-vessel disease to cognitive impairment are not well understood. We hypothesized that in patients with cerebral amyloid angiopathy, multiple small spatially distributed lesions affect cognition through disruption of brain connectivity. We therefore compared the structural brain network in patients with cerebral amyloid angiopathy to healthy control subjects and examined the relationship between markers of cerebral amyloid angiopathy-related brain injury, network efficiency, and potential clinical consequences. Structural brain networks were reconstructed from diffusion-weighted magnetic resonance imaging in 38 non-demented patients with probable cerebral amyloid angiopathy (69 ± 10 years) and 29 similar aged control participants. The efficiency of the brain network was characterized using graph theory and brain amyloid deposition was quantified by Pittsburgh compound B retention on positron emission tomography imaging. Global efficiency of the brain network was reduced in patients compared to controls (0.187 ± 0.018 and 0.201 ± 0.015, respectively, P < 0.001). Network disturbances were most pronounced in the occipital, parietal, and posterior temporal lobes. Among patients, lower global network efficiency was related to higher cortical amyloid load (r = -0.52; P = 0.004), and to magnetic resonance imaging markers of small-vessel disease including increased white matter hyperintensity volume (P < 0.001), lower total brain volume (P = 0.02), and number of microbleeds (trend P = 0.06). Lower global network efficiency was also related to worse performance on tests of processing speed (r = 0.58, P < 0.001), executive functioning (r = 0.54, P = 0.001), gait velocity (r = 0.41, P = 0.02), but not memory. Correlations with cognition were independent of age, sex, education level, and other magnetic resonance imaging markers of small-vessel disease. These findings suggest that reduced structural brain network efficiency might mediate the relationship between advanced cerebral amyloid angiopathy and neurologic dysfunction and that such large-scale brain network measures may represent useful outcome markers for tracking disease progression.
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Affiliation(s)
- Yael D Reijmer
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Panagiotis Fotiadis
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sergi Martinez-Ramirez
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H Salat
- 2 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron Schultz
- 2 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Ashkan Shoamanesh
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison M Ayres
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anastasia Vashkevich
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Rosas
- 3 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin Schwab
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Leemans
- 4 Image Sciences Institute, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Biessels
- 5 Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jonathan Rosand
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- 3 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 6 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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46
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Ringman JM, Sachs MC, Zhou Y, Monsell SE, Saver JL, Vinters HV. Clinical predictors of severe cerebral amyloid angiopathy and influence of APOE genotype in persons with pathologically verified Alzheimer disease. JAMA Neurol 2014; 71:878-83. [PMID: 24797962 DOI: 10.1001/jamaneurol.2014.681] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Although cerebral amyloid angiopathy (CAA) has important clinical implications, our understanding of it and ability to diagnose it are limited. OBJECTIVE To determine pathological correlates and clinical factors identifiable during life that predict the presence of severe CAA in persons with pathologically confirmed Alzheimer disease (AD). DESIGN, SETTING, AND PARTICIPANTS We compared demographic and clinical variables at the earliest visit during life at which participants were found to have cognitive impairment and compared pathological variables between persons ultimately found to have no or severe CAA at autopsy using logistic regression. Analyses were repeated separately for carriers and noncarriers of the APOE ε4 allele. Data were obtained from the Uniform Data Set, which comprises longitudinal clinical assessments performed in the Alzheimer's Disease Centers funded by the National Institute on Aging. Participants included 193 persons with AD and severe CAA and 232 persons with AD and no CAA. All participants had cognitive impairment and met National Institute on Aging-Reagan Institute neuropathological criteria for AD. MAIN OUTCOMES AND MEASURES Prevalence of demographic characteristics and the APOE ε4 allele and odds ratios (ORs) of clinical variables for the prediction of severe CAA. RESULTS Persons with severe CAA compared with those without CAA were more likely to carry an APOE ε4 allele (64.9% vs 42.8%, respectively; P < .001), to be Hispanic (6.8% vs 1.3%, respectively; P = .003), to have had a transient ischemic attack (12.5% vs 6.1%, respectively; OR = 2.1; 95% CI, 1.0-4.4), and to have lower degrees of diffuse amyloid plaque pathology (mean [SD] Consortium to Establish a Registry for Alzheimer's Disease score, 1.2 [0.5] vs 1.4 [0.8], respectively; P = .01). Those with CAA compared with those without CAA more commonly had intracerebral hemorrhage (9.3% vs 3.5%, respectively; P = .01), cortical microinfarcts (20.7% vs 12.9%, respectively; P = .03), and subcortical leukoencephalopathy (20.5% vs 12.1%, respectively; P = .02). Noncarriers of the APOE ε4 allele with severe CAA compared with those without CAA had a higher prevalence of stroke (11.1% vs 3.9%, respectively; OR = 3.8; 95% CI, 1.0-14.6) and hypercholesterolemia (50.0% vs 32.7%, respectively; OR = 2.3; 95% CI, 1.1-4.7). CONCLUSIONS AND RELEVANCE Being Hispanic and having had a transient ischemic attack-like episode were predictors of CAA in persons with AD. Less diffuse parenchymal amyloid pathology in persons with severe CAA suggests a difference in β-amyloid trafficking.
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Affiliation(s)
- John M Ringman
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles2Mary S. Easton Center for Alzheimer's Disease Research, University of California, Los Angeles
| | - Michael C Sachs
- National Alzheimer's Coordinating Center, University of Washington, Seattle
| | - Yan Zhou
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles2Mary S. Easton Center for Alzheimer's Disease Research, University of California, Los Angeles
| | - Sarah E Monsell
- National Alzheimer's Coordinating Center, University of Washington, Seattle
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
| | - Harry V Vinters
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles2Mary S. Easton Center for Alzheimer's Disease Research, University of California, Los Angeles4Division of Neuropathology, Department of Pathology and Laborator
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47
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Cerebral microbleeds and macrobleeds: should they influence our recommendations for antithrombotic therapies? Curr Cardiol Rep 2014; 15:425. [PMID: 24122195 DOI: 10.1007/s11886-013-0425-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Intracerebral hemorrhage (ICH, or macrobleeds) and cerebral microbleeds-smaller foci of hemosiderin deposits commonly detected by magnetic resonance imaging of older adults with or without ICH-are both associated with an increased risk of future ICH. These hemorrhagic pathologies also share risk factors with ischemic thromboembolic conditions that may require antithrombotic therapy, requiring specialists in cardiology, internal medicine, and neurology to weigh the benefits vs hemorrhagic risks of antithrombotics in individual patients. This paper will review recent advances in our understanding of hemorrhage prone cerebrovascular pathologies with a particular emphasis on use of these markers in decision making for antithrombotic use.
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48
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Baron JC, Farid K, Dolan E, Turc G, Marrapu ST, O'Brien E, Aigbirhio FI, Fryer TD, Menon DK, Warburton EA, Hong YT. Diagnostic utility of amyloid PET in cerebral amyloid angiopathy-related symptomatic intracerebral hemorrhage. J Cereb Blood Flow Metab 2014; 34:753-8. [PMID: 24619277 PMCID: PMC4013776 DOI: 10.1038/jcbfm.2014.43] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/11/2014] [Indexed: 11/09/2022]
Abstract
By detecting β-amyloid (Aβ) in the wall of cortical arterioles, amyloid positron emission tomography (PET) imaging might help diagnose cerebral amyloid angiopathy (CAA) in patients with lobar intracerebral hemorrhage (l-ICH). No previous study has directly assessed the diagnostic value of (11)C-Pittsburgh compound B (PiB) PET in probable CAA-related l-ICH against healthy controls (HCs). (11)C-PiB-PET and magnetic resonance imaging (MRI) including T2* were obtained in 11 nondemented patients fulfilling the Boston criteria for probable CAA-related symptomatic l-ICH (sl-ICH) and 20 HCs without cognitive complaints or impairment. After optimal spatial normalization, cerebral spinal fluid (CSF)-corrected PiB distribution volume ratios (DVRs) were obtained. There was no significant difference in whole cortex or regional DVRs between CAA patients and age-matched HCs. The whole cortex DVR was above the 95% confidence limit in 4/9 HCs and 10/11 CAA patients (sensitivity=91%, specificity=55%). Region/frontal or occipital ratios did not have better discriminative value. Similar but less accurate results were found using visual analysis. In patients with sl-ICH, (11)C-PiB-PET has low specificity for CAA due to the frequent occurrence of high (11)C-PiB uptake in the healthy elderly reflecting incipient Alzheimer's disease (AD), which might also be present in suspected CAA. However, a negative PiB scan rules out CAA with excellent sensitivity, which has clinical implications for prognostication and selection of candidates for drug trials.
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Affiliation(s)
- Jean-Claude Baron
- 1] Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK [2] INSERM U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
| | - Karim Farid
- APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris, France
| | - Eamon Dolan
- Stroke Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Guillaume Turc
- INSERM U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
| | - Siva T Marrapu
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Eoin O'Brien
- Stroke Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Young T Hong
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
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Greenberg SM, Al-Shahi Salman R, Biessels GJ, van Buchem M, Cordonnier C, Lee JM, Montaner J, Schneider JA, Smith EE, Vernooij M, Werring DJ. Outcome markers for clinical trials in cerebral amyloid angiopathy. Lancet Neurol 2014; 13:419-28. [PMID: 24581702 PMCID: PMC4085787 DOI: 10.1016/s1474-4422(14)70003-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Efforts are underway for early-phase trials of candidate treatments for cerebral amyloid angiopathy, an untreatable cause of haemorrhagic stroke and vascular cognitive impairment. A major barrier to these trials is the absence of consensus on measurement of treatment effectiveness. A range of potential outcome markers for cerebral amyloid angiopathy can be measured against the ideal criteria of being clinically meaningful, closely representative of biological progression, efficient for small or short trials, reliably measurable, and cost effective. In practice, outcomes tend either to have high clinical salience but low statistical efficiency, and thus more applicability for late-phase studies, or greater statistical efficiency but more limited clinical meaning. The most statistically efficient markers might be those that are potentially reversible with treatment, although their clinical significance remains unproven. Many of the candidate outcomes for cerebral amyloid angiopathy trials are probably applicable also to other small-vessel brain diseases.
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Affiliation(s)
- Steven M Greenberg
- Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Geert Jan Biessels
- Brain Centre Rudolf Magnus, University Medical Center of Utrecht, Utrecht, Netherlands
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Charlotte Cordonnier
- Department of Neurology, Universite Lille Nord de France EA 1046, Lille University Hospital, Lille, France
| | - Jin-Moo Lee
- Department of Neurology, Department of Radiology, and Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO, USA
| | - Joan Montaner
- Department of Neurology, Vall d'Hebron University Hospital and Research Institute, Autonomus University of Barcelona, Barcelona, Spain
| | - Julie A Schneider
- Department of Pathology and Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Meike Vernooij
- Department of Radiology and Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
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50
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Sakurai K, Tokumaru AM, Nakatsuka T, Murayama S, Hasebe S, Imabayashi E, Kanemaru K, Takao M, Hatsuta H, Ishii K, Saito Y, Shibamoto Y, Matsukawa N, Chikui E, Terada H. Imaging spectrum of sporadic cerebral amyloid angiopathy: multifaceted features of a single pathological condition. Insights Imaging 2014; 5:375-85. [PMID: 24519790 PMCID: PMC4035487 DOI: 10.1007/s13244-014-0312-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 12/23/2013] [Accepted: 01/13/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Sporadic cerebral amyloid angiopathy (CAA) is common cause of cerebrovascular disorders that predominantly affect elderly patients. When symptomatic, cortical-subcortical intracerebral haemorrhage (ICH) in the elderly is the most well-known manifestation of CAA. Furthermore, the clinical presentation varies from a sudden neurological deficit to seizures, transient symptoms and acute progressive cognitive decline. Despite its clinical importance, this multifaceted nature poses a diagnostic challenge for radiologists. The aims of this study were to expound the characteristics of neuroimaging modalities, which cover a wide spectrum of CAA-related imaging findings, and to review the various abnormal findings for which CAA could be responsible. CONCLUSIONS Radiologically, in addition to typical ICH, CAA leads to various types of abnormal findings, including microbleed, subarachnoid haemorrhage, superficial siderosis, microinfarction, reversible oedema, and irreversible leukoaraiosis. Taking into consideration the clinical importance of CAA-related disorders such as haemorrhagic risks and treatable oedema, it is necessary for radiologists to understand the wide spectrum of CAA-related imaging findings. TEACHING POINTS • To describe the characteristics of imaging modalities and findings of CAA-related disorders. • MRI, especially gradient echo sequences, provides the useful information of CAA-related haemosiderin depositions. • To understand the wide spectrum of CAA-related neuroimaging and clinical features is important.
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Affiliation(s)
- Keita Sakurai
- Department of Diagnostic Radiology, Tokyo Metropolitan Medical Centre of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan,
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