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Bentivenga GM, Baiardi S, Mastrangelo A, Zenesini C, Mammana A, Polischi B, Capellari S, Parchi P. Diagnostic and prognostic value of cerebrospinal fluid SNAP-25 and neurogranin in Creutzfeldt-Jakob disease in a clinical setting cohort of rapidly progressive dementias. Alzheimers Res Ther 2023; 15:150. [PMID: 37684653 PMCID: PMC10485978 DOI: 10.1186/s13195-023-01300-y] [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: 03/10/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The levels of synaptic markers synaptosomal-associated protein 25 (SNAP-25) and neurogranin (Ng) have been shown to increase early in the cerebrospinal fluid (CSF) of patients with Creutzfeldt-Jakob disease (CJD) and to have prognostic potential. However, no validation studies assessed these biomarkers' diagnostic and prognostic value in a large clinical setting cohort of rapidly progressive dementia. METHODS In this retrospective study, using commercially available immunoassays, we measured the levels of SNAP-25, Ng, 14-3-3, total-tau (t-tau), neurofilament light chain (NfL), and phospho-tau181 (p-tau) in CSF samples from consecutive patients with CJD (n = 220) or non-prion rapidly progressive dementia (np-RPD) (n = 213). We evaluated and compared the diagnostic accuracy of each CSF biomarker and biomarker combination by receiver operating characteristics curve (ROC) analyses, studied SNAP-25 and Ng CSF concentrations distribution across CJD subtypes, and estimated their association with survival using multivariable Cox regression analyses. RESULTS CSF SNAP-25 and Ng levels were higher in CJD than in np-RPD (SNAP-25: 582, 95% CI 240-1250 vs. 115, 95% CI 78-157 pg/ml, p < 0.0001; Ng: 841, 95% CI 411-1473 vs. 390, 95% CI 260-766 pg/ml, p < 0.001). SNAP-25 diagnostic accuracy (AUC 0.902, 95% CI 0.873-0.931) exceeded that of 14-3-3 (AUC 0.853, 95% CI 0.816-0.889), t-tau (AUC 0.878, 95% CI 0.845-0.901), and the t-tau/p-tau ratio (AUC 0.884, 95% CI 0.851-0.916). In contrast, Ng performed worse (AUC 0.697, 95% CI 0.626-0.767) than all other surrogate biomarkers, except for NfL (AUC 0.649, 95% CI 0.593-0.705). SNAP-25 maintained a relatively high diagnostic value even for atypical CJD subtypes (AUC 0.792, 95% CI 0.729-0.854). In Cox regression analyses, SNAP-25 levels were significantly associated with survival in CJD (hazard ratio [HR] 1.71 95% CI 1.40-2.09). Conversely, Ng was associated with survival only in the most rapidly progressive CJD subtypes (sCJD MM(V)1 and gCJD M1) (HR 1.81 95% CI 1.21-2.93). CONCLUSIONS In the clinical setting, CSF SNAP-25 is a viable alternative to t-tau, 14-3-3, and the t-tau/p-tau ratio in discriminating the CJD subtypes from other RPDs. Additionally, SNAP-25 and, to a lesser extent, Ng predict survival in CJD, showing prognostic power in the range of CSF t-tau/14-3-3 and NfL, respectively.
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Affiliation(s)
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Barbara Polischi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy.
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Barba L, Abu-Rumeileh S, Halbgebauer S, Bellomo G, Paolini Paoletti F, Gaetani L, Oeckl P, Steinacker P, Massa F, Parnetti L, Otto M. CSF Synaptic Biomarkers in AT(N)-Based Subgroups of Lewy Body Disease. Neurology 2023; 101:e50-e62. [PMID: 37188538 PMCID: PMC10351307 DOI: 10.1212/wnl.0000000000207371] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with Lewy body disease (LBD) often show a co-occurring Alzheimer disease (AD) pathology. CSF biomarkers allow the detection in vivo of AD-related pathologic hallmarks included in the amyloid-tau-neurodegeneration (AT(N)) classification system. Here, we aimed to investigate whether CSF biomarkers of synaptic and neuroaxonal damage are correlated with the presence of AD copathology in LBD and can be useful to differentiate patients with LBD with different AT(N) profiles. METHODS We retrospectively measured CSF levels of AD core biomarkers (Aβ42/40 ratio, phosphorylated tau protein, and total tau protein) and of synaptic (β-synuclein, α-synuclein, synaptosomal-associated protein 25 [SNAP-25], and neurogranin) and neuroaxonal proteins (neurofilament light chain [NfL]) in 28 cognitively unimpaired participants with nondegenerative neurologic conditions and 161 participants with a diagnosis of either LBD or AD (at both mild cognitive impairment, AD-MCI, and dementia stages, AD-dem). We compared CSF biomarker levels in clinical and AT(N)-based subgroups. RESULTS CSF β-synuclein, α-synuclein, SNAP-25, neurogranin, and NfL levels did not differ between LBD (n = 101, age 67.2 ± 7.8 years, 27.7% females) and controls (age 64.8 ± 8.6 years, 39.3% females) and were increased in AD (AD-MCI: n = 30, AD-dem: n = 30, age 72.3 ± 6.0 years, 63.3% females) compared with both groups (p < 0.001 for all comparisons). In LBD, we found increased levels of synaptic and neuroaxonal degeneration biomarkers in patients with A+T+ (LBD/A+T+) than with A-T- profiles (LBD/A-T-) (p < 0.01 for all), and β-synuclein showed the highest discriminative accuracy between the 2 groups (area under the curve 0.938, 95% CI 0.884-0.991). CSF β-synuclein (p = 0.0021), α-synuclein (p = 0.0099), and SNAP-25 concentrations (p = 0.013) were also higher in LBD/A+T+ than in LBD/A+T- cases, which had synaptic biomarker levels within the normal range. CSF α-synuclein was significantly decreased only in patients with LBD with T- profiles compared with controls (p = 0.0448). Moreover, LBD/A+T+ and AD cases did not differ in any biomarker level. DISCUSSION LBD/A+T+ and AD cases showed significantly increased CSF levels of synaptic and neuroaxonal biomarkers compared with LBD/A-T- and control subjects. Patients with LBD and AT(N)-based AD copathology showed, thus, a distinct signature of synaptic dysfunction from other LBD cases. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that CSF levels of β-synuclein, α-synuclein, SNAP-25, neurogranin, and NfL are higher in patients with AD than in patients with LBD.
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Affiliation(s)
- Lorenzo Barba
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy.
| | - Samir Abu-Rumeileh
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Steffen Halbgebauer
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Giovanni Bellomo
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Federico Paolini Paoletti
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Lorenzo Gaetani
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Patrick Oeckl
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Petra Steinacker
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Federico Massa
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Lucilla Parnetti
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Markus Otto
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy.
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Paolini Paoletti F, Gaetani L, Bellomo G, Chipi E, Salvadori N, Montanucci C, Mancini A, Filidei M, Nigro P, Simoni S, Tambasco N, Di Filippo M, Parnetti L. CSF neurochemical profile and cognitive changes in Parkinson's disease with mild cognitive impairment. NPJ Parkinsons Dis 2023; 9:68. [PMID: 37095141 PMCID: PMC10126070 DOI: 10.1038/s41531-023-00509-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Pathophysiological substrate(s) and progression of Parkinson's disease (PD) with mild cognitive impairment (PD-MCI) are still matter of debate. Baseline cerebrospinal fluid (CSF) neurochemical profile and cognitive changes after 2 years were investigated in a retrospective series of PD-MCI (n = 48), cognitively normal PD (PD-CN, n = 40), prodromal Alzheimer's disease (MCI-AD, n = 25) and cognitively healthy individuals with other neurological diseases (OND, n = 44). CSF biomarkers reflecting amyloidosis (Aβ42/40 ratio, sAPPα, sAPPβ), tauopathy (p-tau), neurodegeneration (t-tau, NfL, p-NfH), synaptic damage (α-syn, neurogranin) and glial activation (sTREM2, YKL-40) were measured. The great majority (88%) of PD-MCI patients was A-/T-/N-. Among all biomarkers considered, only NfL/p-NfH ratio was significantly higher in PD-MCI vs. PD-CN (p = 0.02). After 2 years, one-third of PD-MCI patients worsened; such worsening was associated with higher baseline levels of NfL, p-tau, and sTREM2. PD-MCI is a heterogeneous entity requiring further investigations on larger, longitudinal cohorts with neuropathological verification.
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Affiliation(s)
- Federico Paolini Paoletti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanni Bellomo
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicola Salvadori
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Montanucci
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea Mancini
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Filidei
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Pasquale Nigro
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simone Simoni
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicola Tambasco
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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