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Hobbs NZ, Papoutsi M, Delva A, Kinnunen KM, Nakajima M, Van Laere K, Vandenberghe W, Herath P, Scahill RI. Neuroimaging to Facilitate Clinical Trials in Huntington's Disease: Current Opinion from the EHDN Imaging Working Group. J Huntingtons Dis 2024; 13:163-199. [PMID: 38788082 PMCID: PMC11307036 DOI: 10.3233/jhd-240016] [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] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Neuroimaging is increasingly being included in clinical trials of Huntington's disease (HD) for a wide range of purposes from participant selection and safety monitoring, through to demonstration of disease modification. Selection of the appropriate modality and associated analysis tools requires careful consideration. On behalf of the EHDN Imaging Working Group, we present current opinion on the utility and future prospects for inclusion of neuroimaging in HD trials. Covering the key imaging modalities of structural-, functional- and diffusion- MRI, perfusion imaging, positron emission tomography, magnetic resonance spectroscopy, and magnetoencephalography, we address how neuroimaging can be used in HD trials to: 1) Aid patient selection, enrichment, stratification, and safety monitoring; 2) Demonstrate biodistribution, target engagement, and pharmacodynamics; 3) Provide evidence for disease modification; and 4) Understand brain re-organization following therapy. We also present the challenges of translating research methodology into clinical trial settings, including equipment requirements and cost, standardization of acquisition and analysis, patient burden and invasiveness, and interpretation of results. We conclude, that with appropriate consideration of modality, study design and analysis, imaging has huge potential to facilitate effective clinical trials in HD.
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Affiliation(s)
- Nicola Z. Hobbs
- HD Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Marina Papoutsi
- HD Research Centre, UCL Institute of Neurology, UCL, London, UK
- IXICO plc, London, UK
| | - Aline Delva
- Department of Neurosciences, KU Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Belgium
| | | | | | - Koen Van Laere
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurosciences, KU Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Belgium
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Jia Y, Sun H, Sun L, Wang Y, Xu Q, Liu Y, Chang X, He Y, Guo D, Shi M, Chen GC, Zheng J, Zhang Y, Zhu Z. Mendelian randomization analysis implicates bidirectional associations between brain imaging-derived phenotypes and ischemic stroke. Cereb Cortex 2023; 33:10848-10857. [PMID: 37697910 DOI: 10.1093/cercor/bhad329] [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: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
Brian imaging-derived phenotypes (IDPs) have been suggested to be associated with ischemic stroke, but the causality between them remains unclear. In this bidirectional two-sample Mendelian randomization (MR) study, we explored the potential causal relationship between 461 imaging-derived phenotypes (n = 33,224, UK Biobank) and ischemic stroke (n = 34,217 cases/406,111 controls, Multiancestry Genome-Wide Association Study of Stroke). Forward MR analyses identified five IDPs associated with ischemic stroke, including mean diffusivity (MD) in the right superior fronto-occipital fasciculus (1.22 [95% CI, 1.11-1.34]), MD in the left superior fronto-occipital fasciculus (1.30 [1.17-1.44]), MD in the anterior limb of the right internal capsule (1.36 [1.22-1.51]), MD in the right anterior thalamic radiation (1.17 [1.09-1.26]), and MD in the right superior thalamic radiation (1.23 [1.11-1.35]). In the reverse MR analyses, ischemic stroke was identified to be associated with three IDPs, including high isotropic or free water volume fraction in the body of corpus callosum (beta, 0.189 [95% confidence interval, 0.107-0.271]), orientation dispersion index in the pontine crossing tract (0.175 [0.093-0.257]), and volume of the third ventricle (0.219 [0.138-0.301]). This bidirectional two-sample MR study suggested five predictors and three diagnostic markers for ischemic stroke at the brain-imaging level. Further studies are warranted to replicate our findings and clarify underlying mechanisms.
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Affiliation(s)
- Yiming Jia
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Hongyan Sun
- Department of Medical Imaging, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, China
| | - Lulu Sun
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Yinan Wang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Qingyun Xu
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Yi Liu
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Xinyue Chang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Yu He
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Daoxia Guo
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Jin Zheng
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200433, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Ministry of Education (MOE) Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, China
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Estevez-Fraga C, Elmalem MS, Papoutsi M, Durr A, Rees EM, Hobbs NZ, Roos RAC, Landwehrmeyer B, Leavitt BR, Langbehn DR, Scahill RI, Rees G, Tabrizi SJ, Gregory S. Progressive alterations in white matter microstructure across the timecourse of Huntington's disease. Brain Behav 2023; 13:e2940. [PMID: 36917716 PMCID: PMC10097137 DOI: 10.1002/brb3.2940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Whole-brain longitudinal diffusion studies are crucial to examine changes in structural connectivity in neurodegeneration. Here, we investigated the longitudinal alterations in white matter (WM) microstructure across the timecourse of Huntington's disease (HD). METHODS We examined changes in WM microstructure from premanifest to early manifest disease, using data from two cohorts with different disease burden. The TrackOn-HD study included 67 controls, 67 premanifest, and 10 early manifest HD (baseline and 24-month data); the PADDINGTON study included 33 controls and 49 early manifest HD (baseline and 15-month data). Longitudinal changes in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity from baseline to last study visit were investigated for each cohort using tract-based spatial statistics. An optimized pipeline was employed to generate participant-specific templates to which diffusion tensor imaging maps were registered and change maps were calculated. We examined longitudinal differences between HD expansion-carriers and controls, and correlations with clinical scores, including the composite UHDRS (cUHDRS). RESULTS HD expansion-carriers from TrackOn-HD, with lower disease burden, showed a significant longitudinal decline in FA in the left superior longitudinal fasciculus and an increase in MD across subcortical WM tracts compared to controls, while in manifest HD participants from PADDINGTON, there were significant widespread longitudinal increases in diffusivity compared to controls. Baseline scores in clinical scales including the cUHDRS predicted WM microstructural change in HD expansion-carriers. CONCLUSION The present study showed significant longitudinal changes in WM microstructure across the HD timecourse. Changes were evident in larger WM areas and across more metrics as the disease advanced, suggesting a progressive alteration of WM microstructure with disease evolution.
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Affiliation(s)
- Carlos Estevez-Fraga
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Michael S Elmalem
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marina Papoutsi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, Inserm, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Nicola Z Hobbs
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Blair R Leavitt
- Centre for Huntington's Disease at UBC Hospital, Department of Medical Genetics and Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Rachael I Scahill
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Geraint Rees
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah Gregory
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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Lopes C, Ferreira IL, Maranga C, Beatriz M, Mota SI, Sereno J, Castelhano J, Abrunhosa A, Oliveira F, De Rosa M, Hayden M, Laço MN, Januário C, Castelo Branco M, Rego AC. Mitochondrial and redox modifications in early stages of Huntington's disease. Redox Biol 2022; 56:102424. [PMID: 35988447 PMCID: PMC9420526 DOI: 10.1016/j.redox.2022.102424] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 01/30/2023] Open
Abstract
Deficits in mitochondrial function and redox deregulation have been attributed to Huntington's disease (HD), a genetic neurodegenerative disorder largely affecting the striatum. However, whether these changes occur in early stages of the disease and can be detected in vivo is still unclear. In the present study, we analysed changes in mitochondrial function and production of reactive oxygen species (ROS) at early stages and with disease progression. Studies were performed in vivo in human brain by PET using [64Cu]-ATSM and ex vivo in human skin fibroblasts of premanifest and prodromal (Pre-M) and manifest HD carriers. In vivo brain [64Cu]-ATSM PET in YAC128 transgenic mouse and striatal and cortical isolated mitochondria were assessed at presymptomatic (3 month-old, mo) and symptomatic (6–12 mo) stages. Pre-M HD carriers exhibited enhanced whole-brain (with exception of caudate) [64Cu]-ATSM labelling, correlating with CAG repeat number. Fibroblasts from Pre-M showed enhanced basal and maximal respiration, proton leak and increased hydrogen peroxide (H2O2) levels, later progressing in manifest HD. Mitochondria from fibroblasts of Pre-M HD carriers also showed reduced circularity, while higher number of mitochondrial DNA copies correlated with maximal respiratory capacity. In vivo animal PET analysis showed increased accumulation of [64Cu]-ATSM in YAC128 mouse striatum. YAC128 mouse (at 3 months) striatal isolated mitochondria exhibited a rise in basal and maximal mitochondrial respiration and in ATP production, and increased complex II and III activities. YAC128 mouse striatal mitochondria also showed enhanced mitochondrial H2O2 levels and circularity, revealed by brain ultrastructure analysis, and defects in Ca2+ handling, supporting increased striatal susceptibility. Data demonstrate both human and mouse mitochondrial overactivity and altered morphology at early HD stages, facilitating redox unbalance, the latter progressing with manifest disease. Pre-manifest HD carriers and presymptomatic YAC128 mice show increased brain [64Cu]-ATSM labelling. Increased [64Cu]-ATSM brain retention correlates with raised ROS levels in human and mouse samples. Increased [64Cu]-ATSM correlates with enhanced mitochondrial activity and mtDNA copy number. Presymptomatic YAC128 mouse striatal mitochondria show altered morphology and Ca2+ handling.
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Affiliation(s)
- Carla Lopes
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; IIIUC-Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal.
| | - I Luísa Ferreira
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; IIIUC-Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal.
| | - Carina Maranga
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.
| | - Margarida Beatriz
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.
| | - Sandra I Mota
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; IIIUC-Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal.
| | - José Sereno
- ICNAS-Institute of Nuclear Science Applied to Health, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal.
| | - João Castelhano
- ICNAS-Institute of Nuclear Science Applied to Health, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal.
| | - Antero Abrunhosa
- ICNAS-Institute of Nuclear Science Applied to Health, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal.
| | - Francisco Oliveira
- ICNAS-Institute of Nuclear Science Applied to Health, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal.
| | - Maura De Rosa
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.
| | - Michael Hayden
- Center for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
| | - Mário N Laço
- FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Medical Genetics Unit, Pediatric Hospital of Coimbra, Coimbra University Hospital (CHUC), Coimbra, Portugal.
| | | | - Miguel Castelo Branco
- ICNAS-Institute of Nuclear Science Applied to Health, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - A Cristina Rego
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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5
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De Paepe AE, Ara A, Garcia-Gorro C, Martinez-Horta S, Perez-Perez J, Kulisevsky J, Rodriguez-Dechicha N, Vaquer I, Subira S, Calopa M, Muñoz E, Santacruz P, Ruiz-Idiago J, Mareca C, de Diego-Balaguer R, Camara E. Gray Matter Vulnerabilities Predict Longitudinal Development of Apathy in Huntington's Disease. Mov Disord 2021; 36:2162-2172. [PMID: 33998063 DOI: 10.1002/mds.28638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Apathy, a common neuropsychiatric disturbance in Huntington's disease (HD), is subserved by a complex neurobiological network. However, no study has yet employed a whole-brain approach to examine underlying regional vulnerabilities that may precipitate apathy changes over time. OBJECTIVES To identify whole-brain gray matter volume (GMV) vulnerabilities that may predict longitudinal apathy development in HD. METHODS Forty-five HD individuals (31 female) were scanned and evaluated for apathy and other neuropsychiatric features using the short-Problem Behavior Assessment for a maximum total of six longitudinal visits (including baseline). In order to identify regions where changes in GMV may describe changes in apathy, we performed longitudinal voxel-based morphometry (VBM) on those 33 participants with a magnetic resonance imaging (MRI) scan on their second visit at 18 ± 6 months follow-up (78 MRI datasets). We next employed a generalized linear mixed-effects model (N = 45) to elucidate whether initial and specific GMV may predict apathy development over time. RESULTS Utilizing longitudinal VBM, we revealed a relationship between increases in apathy and specific GMV atrophy in the right middle cingulate cortex (MCC). Furthermore, vulnerability in the right MCC volume at baseline successfully predicted the severity and progression of apathy over time. CONCLUSIONS This study highlights that individual differences in apathy in HD may be explained by variability in atrophy and initial vulnerabilities in the right MCC, a region implicated in action-initiation. These findings thus serve to facilitate the prediction of an apathetic profile, permitting targeted, time-sensitive interventions in neurodegenerative disease with potential implications in otherwise healthy populations. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Audrey E De Paepe
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Ara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain.,Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
| | - Clara Garcia-Gorro
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Saül Martinez-Horta
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jesus Perez-Perez
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jaime Kulisevsky
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | | | - Irene Vaquer
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Subira
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.,Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Esteban Muñoz
- European Huntington's Disease Network, Ulm, Germany.,Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain.,IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Celia Mareca
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruth de Diego-Balaguer
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain.,Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain.,European Huntington's Disease Network, Ulm, Germany.,ICREA (Catalan Institute for Research and Advanced Studies), Barcelona, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain.,Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain.,European Huntington's Disease Network, Ulm, Germany
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6
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Mansoor NM, Vanniyasingam T, Malone I, Hobbs NZ, Rees E, Durr A, Roos RAC, Landwehrmeyer B, Tabrizi SJ, Johnson EB, Scahill RI. Validating Automated Segmentation Tools in the Assessment of Caudate Atrophy in Huntington's Disease. Front Neurol 2021; 12:616272. [PMID: 33935934 PMCID: PMC8079754 DOI: 10.3389/fneur.2021.616272] [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: 10/11/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neuroimaging shows considerable promise in generating sensitive and objective outcome measures for therapeutic trials across a range of neurodegenerative conditions. For volumetric measures the current gold standard is manual delineation, which is unfeasible for samples sizes required for large clinical trials. Methods: Using a cohort of early Huntington's disease (HD) patients (n = 46) and controls (n = 35), we compared the performance of four automated segmentation tools (FIRST, FreeSurfer, STEPS, MALP-EM) with manual delineation for generating cross-sectional caudate volume, a region known to be vulnerable in HD. We then examined the effect of each of these baseline regions on the ability to detect change over 15 months using the established longitudinal Caudate Boundary Shift Integral (cBSI) method, an automated longitudinal pipeline requiring a baseline caudate region as an input. Results: All tools, except Freesurfer, generated significantly smaller caudate volumes than the manually derived regions. Jaccard indices showed poorer levels of overlap between each automated segmentation and manual delineation in the HD patients compared with controls. Nevertheless, each method was able to demonstrate significant group differences in volume (p < 0.001). STEPS performed best qualitatively as well as quantitively in the baseline analysis. Caudate atrophy measures generated by the cBSI using automated baseline regions were largely consistent with those derived from a manually segmented baseline, with STEPS providing the most robust cBSI values across both control and HD groups. Conclusions: Atrophy measures from the cBSI were relatively robust to differences in baseline segmentation technique, suggesting that fully automated pipelines could be used to generate outcome measures for clinical trials.
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Affiliation(s)
- Nina M Mansoor
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tishok Vanniyasingam
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ian Malone
- Department of Neurodegenerative Disease, Dementia Research Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Nicola Z Hobbs
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Elin Rees
- IXICO plc, Griffin Court, Long Lane, London, United Kingdom
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau/Paris Brain Institute AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Eileanoir B Johnson
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachael I Scahill
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
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7
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Reyes A, Bartlett DM, Rankin TJ, Zaenker P, Turner K, Teo WP, Fu SC, Domingos J, Georgiou-Karistianis N, Ziman M, Cruickshank TM. Clinical Determinants of Dual Tasking in People With Premanifest Huntington Disease. Phys Ther 2021; 101:6106263. [PMID: 33482001 DOI: 10.1093/ptj/pzab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/01/2020] [Accepted: 12/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Dual-tasking deficiencies are common in people with Huntington disease (HD) and contribute to reduced functional independence. To date, few studies have investigated the determinants of dual-tasking deficiencies in this population. The reliability of dual-tasking measures has also been poorly investigated in HD. The purpose of this study was to investigate the influence of clinical determinants on dual-tasking performance and to determine the association of disease burden outcomes on dual-tasking performance in individuals with premanifest HD. METHODS Thirty-six individuals with premanifest HD and 28 age- and sex-matched healthy controls were recruited for this study. Participants performed 3 single-task (2 cognitive and 1 motor) and 2 dual-task assessments, comprising motor (postural stability) and cognitive (simple or complex mental arithmetic) components. In addition, participants performed a comprehensive clinical battery comprising motor, cognitive, mood, and sleep assessments as well as lifestyle and disease burden measures. RESULTS Poorer sleep quality was associated with greater cognitive dual-task cost in individuals with premanifest HD. Compared with healthy controls, people with premanifest HD demonstrated an impaired capacity to dual task. Dual-task measures exhibited acceptable test-retest reliability in premanifest HD and healthy control groups. CONCLUSION These results show that dual-tasking measures are sensitive and reliable in individuals with premanifest HD. Furthermore, poor sleep quality is associated with worse cognitive performance on dual tasks, which should be considered by rehabilitation specialists when examining and therapeutically managing dual-tasking problems in individuals with HD and other neurodegenerative populations in the future. IMPACT This study adds important knowledge to the sparse literature on dual-tasking deficiencies in people with HD. When examining and therapeutically managing dual-tasking problems in this and other neurodegenerative populations, rehabilitation specialists should consider that people with premanifest HD may have an impaired capacity to dual task. Clinicians also should assess sleep quality, as poorer sleep quality is associated with worse cognitive performance on dual tasks in these individuals. LAY SUMMARY If you have premanifest HD and poor quality of sleep, you may pay more attention to maintaining postural stability rather than performing arithmetic calculations to reduce the risk of falling.
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Affiliation(s)
- Alvaro Reyes
- Facultad de Ciencias de la Rehabilitacion, Universidad Andres Bello, Santiago, Chile
| | - Danielle M Bartlett
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Timothy J Rankin
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- Centre for Sleep Science, School of Human Sciences, Faculty of Science, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Pauline Zaenker
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Turner
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore
| | - Shih Ching Fu
- School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Josefa Domingos
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Mel Ziman
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- School of Biomedical Science, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Travis M Cruickshank
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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8
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Estevez-Fraga C, Scahill R, Rees G, Tabrizi SJ, Gregory S. Diffusion imaging in Huntington's disease: comprehensive review. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-324377. [PMID: 33033167 PMCID: PMC7803908 DOI: 10.1136/jnnp-2020-324377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022]
Abstract
Huntington's disease (HD) is a monogenic disorder with 100% penetrance. With the advent of genetic testing in adults, disease-related, structural brain changes can be investigated from the earliest, premorbid stages of HD. While examining macrostructural change characterises global neuronal damage, investigating microstructural alterations provides information regarding brain organisation and its underlying biological properties. Diffusion MRI can be used to track the progression of microstructural anomalies in HD decades prior to clinical disease onset, providing a greater understanding of neurodegeneration. Multiple approaches, including voxelwise, region of interest and tractography, have been used in HD cohorts, showing a centrifugal pattern of white matter (WM) degeneration starting from deep brain areas, which is consistent with neuropathological studies. The corpus callosum, longer WM tracts and areas that are more densely connected, in particular the sensorimotor network, also tend to be affected early during premanifest stages. Recent evidence supports the routine inclusion of diffusion analyses within clinical trials principally as an additional measure to improve understanding of treatment effects, while the advent of novel techniques such as multitissue compartment models and connectomics can help characterise the underpinnings of progressive functional decline in HD.
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Affiliation(s)
- Carlos Estevez-Fraga
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rachael Scahill
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Geraint Rees
- Wellcome Centre for Neuroimaging, University College London, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah Gregory
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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9
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Nasr S, Rosas HD. Impact of Huntington's Disease on Mental Rotation Performance in Motor Pre-Symptomatic Individuals. J Huntingtons Dis 2020; 8:339-356. [PMID: 31306138 DOI: 10.3233/jhd-190348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a genetic disorder known for affecting motor control. Despite evidence for the impact of HD on visual cortico-striatal loops, evidence for impaired visual perception in early symptomatic HD patients is limited; much less is known about what happens during the HD prodrome. OBJECTIVE The goals of this study were to evaluate perceptual processing in motor pre-manifest HD gene-carriers (Pre-HDs) during a visual mental rotation task. METHODS To achieve this goal, 79 participants including 24 Pre-HD participants and 55 healthy matched controls were scanned using functional MRI as they performed a mental rotation task. Another group of 36 subjects including 15 pre-HDs and 21 healthy age/gender matched controls participated in a control behavioral test of judgment of line orientation outside the scanner. RESULTS We found that, although Pre-HDs (in this stage of disease) did not demonstrate slower response times, their response accuracy was lower than controls. On the fMRI task, controls showed a significant decrease in activity in the occipito-temporal (OT) visual network and increase in activity in the caudo-fronto-parietal (CFP) network with mental rotation load. Interestingly, the amount of mental rotation-related activity decrease in the OT network was reduced in Pre-HDs compared to controls while, the level of CFP response remained unchanged between the two groups. Comparing the link between the evoked BOLD activity within these networks and response accuracy (i.e., behavior), we found that the models fit to data from controls were less accurate in predicting response accuracy of Pre-HDs. CONCLUSION These findings provide some of the earliest functional evidence of impaired visual processing and altered neural processing underlying visual perceptual decision making during the HD prodrome.
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Affiliation(s)
- Shahin Nasr
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Herminia D Rosas
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Boston, MA, USA
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10
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McColgan P, Joubert J, Tabrizi SJ, Rees G. The human motor cortex microcircuit: insights for neurodegenerative disease. Nat Rev Neurosci 2020; 21:401-415. [PMID: 32555340 DOI: 10.1038/s41583-020-0315-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
The human motor cortex comprises a microcircuit of five interconnected layers with different cell types. In this Review, we use a layer-specific and cell-specific approach to integrate physiological accounts of this motor cortex microcircuit with the pathophysiology of neurodegenerative diseases affecting motor functions. In doing so we can begin to link motor microcircuit pathology to specific disease stages and clinical phenotypes. Based on microcircuit physiology, we can make future predictions of axonal loss and microcircuit dysfunction. With recent advances in high-resolution neuroimaging we can then test these predictions in humans in vivo, providing mechanistic insights into neurodegenerative disease.
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Affiliation(s)
- Peter McColgan
- Huntington's Disease Research Centre, UCL Institute of Neurology, University College London, London, UK.
| | - Julie Joubert
- Huntington's Disease Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Research Centre, UCL Institute of Neurology, University College London, London, UK.,Dementia Research Institute at UCL, London, UK
| | - Geraint Rees
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, London, UK.,UCL Institute of Cognitive Neuroscience, University College London, London, UK
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11
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Ross CA, Reilmann R, Cardoso F, McCusker EA, Testa CM, Stout JC, Leavitt BR, Pei Z, Landwehrmeyer B, Martinez A, Levey J, Srajer T, Bang J, Tabrizi SJ. Movement Disorder Society Task Force Viewpoint: Huntington's Disease Diagnostic Categories. Mov Disord Clin Pract 2019; 6:541-546. [PMID: 31538087 PMCID: PMC6749806 DOI: 10.1002/mdc3.12808] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Christopher A. Ross
- Departments of Psychiatry, Neurology, Neuroscience, and Pharmacology and Huntington's Disease CenterJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Ralf Reilmann
- George Huntington Institut, Head, European HD Network (EHDN) Huntington CenterUniversity of MunsterMunsterGermany
| | - Francisco Cardoso
- Department of Neurology in the Movement Disorders Unit, Neurology ServiceInternal Medicine Department of the Federal University of Minas GeraisBelo HorizonteMGBrazil
| | - Elizabeth A. McCusker
- Neurology Department, Huntington Disease ServiceWestmead Hospital and Sydney University Medical SchoolSydneyAustralia
| | | | - Julie C. Stout
- Institute of Cognitive and Clinical Neurosciences, School of Psychological SciencesMonash UniversityVictoriaAustralia
| | - Blair R. Leavitt
- Department of Medical Genetics and Centre for Molecular Medicine and TherapeuticsThe University of British ColumbiaVancouverCanada
| | - Zhong Pei
- The First Affiliated HospitalSun Yat‐Sen UniversityGuangzhouChina
| | | | | | - Jamie Levey
- Cure HD Initiative (CHDI) Management/CHDI FoundationPrincetonNJUSA
- European Huntington's Disease NetworkUniversity Hospital of UlmUlmGermany
| | | | - Jee Bang
- Departments of Neurology and Psychiatry, and Huntington's Disease CenterJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Sarah J. Tabrizi
- Huntington's Disease Centre, University College LondonQueen Square Institute of NeurologyLondonUnited Kingdom
- UK Dementia Research InstituteUniversity College LondonLondonUnited Kingdom
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12
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Zeun P, Scahill RI, Tabrizi SJ, Wild EJ. Fluid and imaging biomarkers for Huntington's disease. Mol Cell Neurosci 2019; 97:67-80. [PMID: 30807825 DOI: 10.1016/j.mcn.2019.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 01/18/2023] Open
Abstract
Huntington's disease is a chronic progressive neurodegenerative condition for which there is no disease-modifying treatment. The known genetic cause of Huntington's disease makes it possible to identify individuals destined to develop the disease and instigate treatments before the onset of symptoms. Multiple trials are already underway that target the cause of HD, yet clinical measures are often insensitive to change over typical clinical trial duration. Robust biomarkers of drug target engagement, disease severity and progression are required to evaluate the efficacy of treatments and concerted efforts are underway to achieve this. Biofluid biomarkers have potential advantages of direct quantification of biological processes at the molecular level, whilst imaging biomarkers can quantify related changes at a structural level in the brain. The most robust biofluid and imaging biomarkers can offer complementary information, providing a more comprehensive evaluation of disease stage and progression to inform clinical trial design and endpoints.
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Affiliation(s)
- Paul Zeun
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Rachael I Scahill
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Sarah J Tabrizi
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Edward J Wild
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
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13
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Abstract
In this study we longitudinally investigated the rate of microstructural alterations in the occipital cortex in different stages of Huntington's disease (HD) by applying an automated atlas-based approach to diffusion MRI data. Twenty-two premanifest (preHD), 10 early manifest HD (early HD) and 24 healthy control subjects completed baseline and two year follow-up scans. The preHD group was stratified based on the predicted years to disease onset into a far (preHD-A) and near (preHD-B) to disease onset group. Clinical and behavioral measures were collected per assessment time point. An automated atlas-based DTI analysis approach was used to obtain the mean, axial and radial diffusivities of the occipital cortex. We found that the longitudinal rate of diffusivity change in the superior occipital gyrus (SOG), middle occipital gyrus (MOG), and inferior occipital gyrus (IOG) was significantly higher in early HD compared to both preHD and controls (all p's ≤ 0.005), which can be interpreted as an increased rate of microstructural degeneration. Furthermore, the change rate in the diffusivity of the MOG could significantly discriminate between preHD-B compared to preHD-A and the other groups (all p's ≤ 0.04). Finally, we found an inverse correlation between the Stroop Word Reading task and diffusivities in the SOG and MOG (all p's ≤ 0.01). These findings suggest that measures obtained from the occipital cortex can serve as sensitive longitudinal biomarkers for disease progression in preHD-B and early HD. These could in turn be used to assess potential effects of proposed disease modifying therapies.
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14
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Ciarochi JA, Johnson HJ, Calhoun VD, Liu J, Espinoza FA, Bockholt HJ, Misiura M, Caprihan A, Plis S, Paulsen JS, Turner JA. Concurrent Cross-Sectional and Longitudinal Analyses of Multivariate White Matter Profiles and Clinical Functioning in Pre-Diagnosis Huntington Disease. J Huntingtons Dis 2019; 8:199-219. [PMID: 30932891 DOI: 10.3233/jhd-180332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gray matter (GM) atrophy in the striatum and across the brain is a consistently reported feature of the Huntington Disease (HD) prodrome. More recently, widespread prodromal white matter (WM) degradation has also been detected. However, longitudinal WM studies are limited and conflicting, and most analyses comparing WM and clinical functioning have also been cross-sectional. OBJECTIVE We simultaneously assessed changes in WM and cognitive and motor functioning at various prodromal HD stages. METHODS Data from 1,336 (1,047 prodromal, 289 control) PREDICT-HD participants were analyzed (3,700 sessions). MRI images were used to create GM, WM, and cerebrospinal fluid probability maps. Using source-based morphometry, independent component analysis was applied to WM probability maps to extract covarying spatial patterns and their subject profiles. WM profiles were analyzed in two sets of linear mixed model (LMM) analyses: one to compare WM profiles across groups cross-sectionally and longitudinally, and one to concurrently compare WM profiles and clinical variables cross-sectionally and longitudinally within each group. RESULTS Findings illustrate widespread prodromal changes in GM-adjacent-WM, with premotor, supplementary motor, middle frontal and striatal changes early in the prodrome that subsequently extend sub-gyrally with progression. Motor functioning agreed most with WM until the near-onset prodromal stage, when Stroop interference was the best WM indicator. Across groups, Trail-Making Test part A outperformed other cognitive variables in its similarity to WM, particularly cross-sectionally. CONCLUSIONS Results suggest that distinct regions coincide with cognitive compared to motor functioning. Furthermore, at different prodromal stages, distinct regions appear to align best with clinical functioning. Thus, the informativeness of clinical measures may vary according to the type of data available (cross-sectional or longitudinal) as well as age and CAG-number.
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Affiliation(s)
| | - Hans J Johnson
- Department of Electrical and Computer Engineering, 1402 Seamans Center for the Engineering Arts and Science, The University of Iowa, Iowa City, IA, USA
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM, USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Jingyu Liu
- The Mind Research Network, Albuquerque, NM, USA
| | | | | | - Maria Misiura
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Sergey Plis
- The Mind Research Network, Albuquerque, NM, USA
| | - Jane S Paulsen
- Department of Psychiatry, Iowa Mental Health Clinical Research Center, University of Iowa, IA, USA
- Departments of Neurology and Psychology, University of Iowa, IA, USA
| | - Jessica A Turner
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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15
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Jiskoot LC, Panman JL, Meeter LH, Dopper EGP, Donker Kaat L, Franzen S, van der Ende EL, van Minkelen R, Rombouts SARB, Papma JM, van Swieten JC. Longitudinal multimodal MRI as prognostic and diagnostic biomarker in presymptomatic familial frontotemporal dementia. Brain 2019; 142:193-208. [PMID: 30508042 PMCID: PMC6308313 DOI: 10.1093/brain/awy288] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022] Open
Abstract
Developing and validating sensitive biomarkers for the presymptomatic stage of familial frontotemporal dementia is an important step in early diagnosis and for the design of future therapeutic trials. In the longitudinal Frontotemporal Dementia Risk Cohort, presymptomatic mutation carriers and non-carriers from families with familial frontotemporal dementia due to microtubule-associated protein tau (MAPT) and progranulin (GRN) mutations underwent a clinical assessment and multimodal MRI at baseline, 2-, and 4-year follow-up. Of the cohort of 73 participants, eight mutation carriers (three GRN, five MAPT) developed clinical features of frontotemporal dementia ('converters'). Longitudinal whole-brain measures of white matter integrity (fractional anisotropy) and grey matter volume in these converters (n = 8) were compared with healthy mutation carriers ('non-converters'; n = 35) and non-carriers (n = 30) from the same families. We also assessed the prognostic performance of decline within white matter and grey matter regions of interest by means of receiver operating characteristic analyses followed by stepwise logistic regression. Longitudinal whole-brain analyses demonstrated lower fractional anisotropy values in extensive white matter regions (genu corpus callosum, forceps minor, uncinate fasciculus, and superior longitudinal fasciculus) and smaller grey matter volumes (prefrontal, temporal, cingulate, and insular cortex) over time in converters, present from 2 years before symptom onset. White matter integrity loss of the right uncinate fasciculus and genu corpus callosum provided significant classifiers between converters, non-converters, and non-carriers. Converters' within-individual disease trajectories showed a relatively gradual onset of clinical features in MAPT, whereas GRN mutations had more rapid changes around symptom onset. MAPT converters showed more decline in the uncinate fasciculus than GRN converters, and more decline in the genu corpus callosum in GRN than MAPT converters. Our study confirms the presence of spreading predominant frontotemporal pathology towards symptom onset and highlights the value of multimodal MRI as a prognostic biomarker in familial frontotemporal dementia.
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Affiliation(s)
- Lize C Jiskoot
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jessica L Panman
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke H Meeter
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elise G P Dopper
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Laura Donker Kaat
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne Franzen
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rick van Minkelen
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Serge A R B Rombouts
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
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16
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Tang X, Ross CA, Johnson H, Paulsen JS, Younes L, Albin RL, Ratnanather JT, Miller MI. Regional subcortical shape analysis in premanifest Huntington's disease. Hum Brain Mapp 2018; 40:1419-1433. [PMID: 30376191 DOI: 10.1002/hbm.24456] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 11/11/2022] Open
Abstract
Huntington's disease (HD) involves preferential and progressive degeneration of striatum and other subcortical regions as well as regional cortical atrophy. It is caused by a CAG repeat expansion in the Huntingtin gene, and the longer the expansion the earlier the age of onset. Atrophy begins prior to manifest clinical signs and symptoms, and brain atrophy in premanifest expansion carriers can be studied. We employed a diffeomorphometric pipeline to contrast subcortical structures' morphological properties in a control group with three disease groups representing different phases of premanifest HD (far, intermediate, and near to onset) as defined by the length of the CAG expansion and the participant's age (CAG-Age-Product). A total of 1,428 magnetic resonance image scans from 694 participants from the PREDICT-HD cohort were used. We found significant region-specific atrophies in all subcortical structures studied, with the estimated abnormality onset time varying from structure to structure. Heterogeneous shape abnormalities of caudate nuclei were present in premanifest HD participants estimated furthest from onset and putaminal shape abnormalities were present in participants intermediate to onset. Thalamic, hippocampal, and amygdalar shape abnormalities were present in participants nearest to onset. We assessed whether the estimated progression of subcortical pathology in premanifest HD tracked specific pathways. This is plausible for changes in basal ganglia circuits but probably not for changes in hippocampus and amygdala. The regional shape analyses conducted in this study provide useful insights into the effects of HD pathology in subcortical structures.
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Affiliation(s)
- Xiaoying Tang
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Christopher A Ross
- Division of Neurobiology, Departments of Psychiatry, Neurology, Neuroscience and Pharmacology, and Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hans Johnson
- Departments of Neurology and Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jane S Paulsen
- Departments of Neurology and Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Laurent Younes
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland.,Center for Imaging Science, Johns Hopkins University, Baltimore, Maryland.,Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Roger L Albin
- Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan.,Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - J Tilak Ratnanather
- Center for Imaging Science, Johns Hopkins University, Baltimore, Maryland.,Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Michael I Miller
- Center for Imaging Science, Johns Hopkins University, Baltimore, Maryland.,Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
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17
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Structural Magnetic Resonance Imaging in Huntington's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:335-380. [PMID: 30409258 DOI: 10.1016/bs.irn.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder, caused by expansion of the CAG repeat in the huntingtin gene. HD is characterized clinically by progressive motor, cognitive and neuropsychiatric symptoms. There are currently no disease modifying treatments available for HD, and there is a great need for biomarkers to monitor disease progression and identify new targets for therapeutic intervention. Neuroimaging techniques provide a powerful tool for assessing disease pathology and progression in premanifest stages, before the onset of overt motor symptoms. Structural magnetic resonance imaging (MRI) is non-invasive imaging techniques which have been employed to study structural and microstructural changes in premanifest and manifest HD gene carriers. This chapter described structural imaging techniques and analysis methods employed across HD MRI studies. Current evidence for structural MRI abnormalities in HD, and associations between atrophy, structural white matter changes, iron deposition and clinical performance are discussed; together with the use of structural MRI measures as a diagnostic tool, to assess longitudinal changes, and as potential biomarkers and endpoints for clinical trials.
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18
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Pozorski V, Oh JM, Adluru N, Merluzzi AP, Theisen F, Okonkwo O, Barzgari A, Krislov S, Sojkova J, Bendlin BB, Johnson SC, Alexander AL, Gallagher CL. Longitudinal white matter microstructural change in Parkinson's disease. Hum Brain Mapp 2018; 39:4150-4161. [PMID: 29952102 DOI: 10.1002/hbm.24239] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/06/2018] [Accepted: 05/22/2018] [Indexed: 01/06/2023] Open
Abstract
Postmortem studies of Parkinson's disease (PD) suggest that Lewy body pathology accumulates in a predictable topographical sequence, beginning in the olfactory bulb, followed by caudal brainstem, substantia nigra, limbic cortex, and neocortex. Diffusion-weighted imaging (DWI) is sensitive, if not specific, to early disease-related white matter (WM) change in a variety of traumatic and degenerative brain diseases. Although numerous cross-sectional studies have reported DWI differences in cerebral WM in PD, only a few longitudinal studies have investigated whether DWI change exceeds that of normal aging or coincides with regional Lewy body accumulation. This study mapped regional differences in the rate of DWI-based microstructural change between 29 PD patients and 43 age-matched controls over 18 months. Iterative within- and between-subject tensor-based registration was completed on motion- and eddy current-corrected DWI images, then baseline versus follow-up difference maps of fractional anisotropy, mean, radial, and axial diffusivity were analyzed in the Biological Parametric Mapping toolbox for MATLAB. This analysis showed that PD patients had a greater decline in WM integrity in the rostral brainstem, caudal subcortical WM, and cerebellar peduncles, compared with controls. In addition, patients with unilateral clinical signs at baseline experienced a greater rate of WM change over the 18-month study than patients with bilateral signs. These findings suggest that rate of WM microstructural change in PD exceeds that of normal aging and is maximal during early stage disease. In addition, the neuroanatomic locations (rostral brainstem and subcortical WM) of accelerated WM change fit with current theories of topographic disease progression.
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Affiliation(s)
- Vincent Pozorski
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer M Oh
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nagesh Adluru
- Waisman Laboratory for Brain Imaging and Behavior, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andrew P Merluzzi
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Frances Theisen
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ozioma Okonkwo
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amy Barzgari
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephanie Krislov
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jitka Sojkova
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Barbara B Bendlin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sterling C Johnson
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew L Alexander
- Waisman Laboratory for Brain Imaging and Behavior, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Catherine L Gallagher
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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19
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Liu J, Ciarochi J, Calhoun VD, Paulsen JS, Bockholt HJ, Johnson HJ, Long JD, Lin D, Espinoza FA, Misiura MB, Caprihan A, Turner JA. Genetics Modulate Gray Matter Variation Beyond Disease Burden in Prodromal Huntington's Disease. Front Neurol 2018; 9:190. [PMID: 29651271 PMCID: PMC5884935 DOI: 10.3389/fneur.2018.00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Huntington’s disease (HD) is a neurodegenerative disorder caused by an expansion mutation of the cytosine–adenine–guanine (CAG) trinucleotide in the HTT gene. Decline in cognitive and motor functioning during the prodromal phase has been reported, and understanding genetic influences on prodromal disease progression beyond CAG will benefit intervention therapies. From a prodromal HD cohort (N = 715), we extracted gray matter (GM) components through independent component analysis and tested them for associations with cognitive and motor functioning that cannot be accounted for by CAG-induced disease burden (cumulative effects of CAG expansion and age). Furthermore, we examined genetic associations (at the genomic, HD pathway, and candidate region levels) with the GM components that were related to functional decline. After accounting for disease burden, GM in a component containing cuneus, lingual, and middle occipital regions was positively associated with attention and working memory performance, and the effect size was about a tenth of that of disease burden. Prodromal participants with at least one dystonia sign also had significantly lower GM volume in a bilateral inferior parietal component than participants without dystonia, after controlling for the disease burden. Two single-nucleotide polymorphisms (SNPs: rs71358386 in NCOR1 and rs71358386 in ADORA2B) in the HD pathway were significantly associated with GM volume in the cuneus component, with minor alleles being linked to reduced GM volume. Additionally, homozygous minor allele carriers of SNPs in a candidate region of ch15q13.3 had significantly higher GM volume in the inferior parietal component, and one minor allele copy was associated with a total motor score decrease of 0.14 U. Our findings depict an early genetical GM reduction in prodromal HD that occurs irrespective of disease burden and affects regions important for cognitive and motor functioning.
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Affiliation(s)
- Jingyu Liu
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute (LBERI), Albuquerque, NM, United States.,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, United States
| | - Jennifer Ciarochi
- Department of Psychology, Georgia State University, Atlanta, GA, United States.,Department of Neuroscience, Georgia State University, Atlanta, GA, United States
| | - Vince D Calhoun
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute (LBERI), Albuquerque, NM, United States.,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, United States
| | - Jane S Paulsen
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Department of Neurology, University of Iowa, Iowa City, IA, United States.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - H Jeremy Bockholt
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Department of Neurology, University of Iowa, Iowa City, IA, United States.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Hans J Johnson
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States
| | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Department of Biostatistics, University of Iowa, Iowa City, IA, United States
| | - Dongdong Lin
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute (LBERI), Albuquerque, NM, United States
| | - Flor A Espinoza
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute (LBERI), Albuquerque, NM, United States
| | - Maria B Misiura
- Department of Psychology, Georgia State University, Atlanta, GA, United States.,Department of Neuroscience, Georgia State University, Atlanta, GA, United States
| | - Arvind Caprihan
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute (LBERI), Albuquerque, NM, United States
| | - Jessica A Turner
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute (LBERI), Albuquerque, NM, United States.,Department of Psychology, Georgia State University, Atlanta, GA, United States.,Department of Neuroscience, Georgia State University, Atlanta, GA, United States
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20
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Arnerić SP, Kern VD, Stephenson DT. Regulatory-accepted drug development tools are needed to accelerate innovative CNS disease treatments. Biochem Pharmacol 2018; 151:291-306. [PMID: 29410157 DOI: 10.1016/j.bcp.2018.01.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/26/2018] [Indexed: 02/07/2023]
Abstract
Central Nervous System (CNS) diseases represent one of the most challenging therapeutic areas for successful drug approvals. Developing quantitative biomarkers as Drug Development Tools (DDTs) can catalyze the path to innovative treatments, and improve the chances of drug approvals. Drug development and healthcare management requires sensitive, reliable, validated, and regulatory accepted biomarkers and endpoints. This review highlights the regulatory paths and considerations for developing DDTs required to advance biomarker and endpoint use in clinical development (e.g., consensus CDISC [Clinical Data Interchange Standards Consortium] data standards, precompetitive sharing of anonymized patient-level data, and continual alignment with regulators). Summarized is the current landscape of biomarkers in a range of CNS diseases including Alzheimer disease, Parkinson Disease, Amyotrophic Lateral Sclerosis, Autism Spectrum Disorders, Depression, Huntington's disease, Multiple Sclerosis and Traumatic Brain Injury. Advancing DDTs for these devastating diseases that are both validated and qualified will require an integrated, cross-consortium approach to accelerate the delivery of innovative CNS therapeutics.
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Affiliation(s)
- Stephen P Arnerić
- Critical Path for Alzheimer's Disease, Crititcal Path Institute, United States.
| | - Volker D Kern
- Critical Path for Alzheimer's Disease, Crititcal Path Institute, United States
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21
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Wu D, Faria AV, Younes L, Mori S, Brown T, Johnson H, Paulsen JS, Ross CA, Miller MI. Mapping the order and pattern of brain structural MRI changes using change-point analysis in premanifest Huntington's disease. Hum Brain Mapp 2017; 38:5035-5050. [PMID: 28657159 PMCID: PMC5766002 DOI: 10.1002/hbm.23713] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023] Open
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder that progressively affects motor, cognitive, and emotional functions. Structural MRI studies have demonstrated brain atrophy beginning many years prior to clinical onset ("premanifest" period), but the order and pattern of brain structural changes have not been fully characterized. In this study, we investigated brain regional volumes and diffusion tensor imaging (DTI) measurements in premanifest HD, and we aim to determine (1) the extent of MRI changes in a large number of structures across the brain by atlas-based analysis, and (2) the initiation points of structural MRI changes in these brain regions. We adopted a novel multivariate linear regression model to detect the inflection points at which the MRI changes begin (namely, "change-points"), with respect to the CAG-age product (CAP, an indicator of extent of exposure to the effects of CAG repeat expansion). We used approximately 300 T1-weighted and DTI data from premanifest HD and control subjects in the PREDICT-HD study, with atlas-based whole brain segmentation and change-point analysis. The results indicated a distinct topology of structural MRI changes: the change-points of the volumetric measurements suggested a central-to-peripheral pattern of atrophy from the striatum to the deep white matter; and the change points of DTI measurements indicated the earliest changes in mean diffusivity in the deep white matter and posterior white matter. While interpretation needs to be cautious given the cross-sectional nature of the data, these findings suggest a spatial and temporal pattern of spread of structural changes within the HD brain. Hum Brain Mapp 38:5035-5050, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dan Wu
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Andreia V. Faria
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Laurent Younes
- Center for Imaging Science, Johns Hopkins UniversityBaltimoreMaryland
- Institute for Computational Medicine, Johns Hopkins UniversityBaltimoreMaryland
- Department of Applied Mathematics and StatisticsJohns Hopkins UniversityBaltimoreMaryland
| | - Susumu Mori
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger InstituteBaltimoreMaryland
| | - Timothy Brown
- Center for Imaging Science, Johns Hopkins UniversityBaltimoreMaryland
| | - Hans Johnson
- Department of Electrical and Computer EngineeringUniversity of IowaIowa CityIowa
| | - Jane S. Paulsen
- Departments of Psychiatry, Neurology, Psychology and NeurosciencesUniversity of IowaIowa CityIowa
| | - Christopher A. Ross
- Division of Neurobiology, Departments of Psychiatry, Neurology, Neuroscience and Pharmacology, and Program in Cellular and Molecular MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Michael I. Miller
- Center for Imaging Science, Johns Hopkins UniversityBaltimoreMaryland
- Institute for Computational Medicine, Johns Hopkins UniversityBaltimoreMaryland
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMaryland
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22
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McColgan P, Seunarine KK, Gregory S, Razi A, Papoutsi M, Long JD, Mills JA, Johnson E, Durr A, Roos RA, Leavitt BR, Stout JC, Scahill RI, Clark CA, Rees G, Tabrizi SJ. Topological length of white matter connections predicts their rate of atrophy in premanifest Huntington's disease. JCI Insight 2017; 2:92641. [PMID: 28422761 PMCID: PMC5396531 DOI: 10.1172/jci.insight.92641] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/16/2017] [Indexed: 12/11/2022] Open
Abstract
We lack a mechanistic explanation for the stereotyped pattern of white matter loss seen in Huntington’s disease (HD). While the earliest white matter changes are seen around the striatum, within the corpus callosum, and in the posterior white matter tracts, the order in which these changes occur and why these white matter connections are specifically vulnerable is unclear. Here, we use diffusion tractography in a longitudinal cohort of individuals yet to develop clinical symptoms of HD to identify a hierarchy of vulnerability, where the topological length of white matter connections between a brain area and its neighbors predicts the rate of atrophy over 24 months. This demonstrates a new principle underlying neurodegeneration in HD, whereby brain connections with the greatest topological length are the first to suffer damage that can account for the stereotyped pattern of white matter loss observed in premanifest HD. Diffusion tractography in a longitudinal cohort demonstrates that topological length of white matter connections can account for white matter loss patterns in premanifest Huntington’s disease.
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Affiliation(s)
- Peter McColgan
- Huntington's Disease Centre, Department of Neurodegenerative Disease
| | - Kiran K Seunarine
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom
| | - Sarah Gregory
- Huntington's Disease Centre, Department of Neurodegenerative Disease
| | - Adeel Razi
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom.,Department of Electronic Engineering, NED University of Engineering and Technology, Karachi, Pakistan
| | - Marina Papoutsi
- Huntington's Disease Centre, Department of Neurodegenerative Disease
| | - Jeffrey D Long
- Department of Psychiatry.,Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | | | - Eileanoir Johnson
- Huntington's Disease Centre, Department of Neurodegenerative Disease
| | - Alexandra Durr
- APHP Department of Genetics, University Hospital Pitié-Salpêtrière, and ICM (Brain and Spine Institute) INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Paris VI UMR_S1127, Paris, France
| | - Raymund Ac Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver British Columbia, Canada
| | - Julie C Stout
- School of Psychological Sciences, Monash University, Australia
| | - Rachael I Scahill
- Huntington's Disease Centre, Department of Neurodegenerative Disease
| | - Chris A Clark
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom
| | - Geraint Rees
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
| | - Sarah J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease.,National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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- The Track-On HD Investigators are detailed in the Supplemental Acknowledgments
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23
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Shaffer JJ, Ghayoor A, Long JD, Kim RE, Lourens S, O'Donnell LJ, Westin C, Rathi Y, Magnotta V, Paulsen JS, Johnson HJ. Longitudinal diffusion changes in prodromal and early HD: Evidence of white-matter tract deterioration. Hum Brain Mapp 2017; 38:1460-1477. [PMID: 28045213 PMCID: PMC5400101 DOI: 10.1002/hbm.23465] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/11/2016] [Accepted: 11/03/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Huntington's disease (HD) is a genetic neurodegenerative disorder that primarily affects striatal neurons. Striatal volume loss is present years before clinical diagnosis; however, white matter degradation may also occur prior to diagnosis. Diffusion-weighted imaging (DWI) can measure microstructural changes associated with degeneration that precede macrostructural changes. DWI derived measures enhance understanding of degeneration in prodromal HD (pre-HD). METHODS As part of the PREDICT-HD study, N = 191 pre-HD individuals and 70 healthy controls underwent two or more (baseline and 1-5 year follow-up) DWI, with n = 649 total sessions. Images were processed using cutting-edge DWI analysis methods for large multicenter studies. Diffusion tensor imaging (DTI) metrics were computed in selected tracts connecting the primary motor, primary somato-sensory, and premotor areas of the cortex with the subcortical caudate and putamen. Pre-HD participants were divided into three CAG-Age Product (CAP) score groups reflecting clinical diagnosis probability (low, medium, or high probabilities). Baseline and longitudinal group differences were examined using linear mixed models. RESULTS Cross-sectional and longitudinal differences in DTI measures were present in all three CAP groups compared with controls. The high CAP group was most affected. CONCLUSIONS This is the largest longitudinal DWI study of pre-HD to date. Findings showed DTI differences, consistent with white matter degeneration, were present up to a decade before predicted HD diagnosis. Our findings indicate a unique role for disrupted connectivity between the premotor area and the putamen, which may be closely tied to the onset of motor symptoms in HD. Hum Brain Mapp 38:1460-1477, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Ali Ghayoor
- Department of Electrical and Computer EngineeringUniversity of IowaIowa CityIowa
| | - Jeffrey D. Long
- Department of PsychiatryUniversity of IowaIowa CityIowa
- Department of BiostatisticsUniversity of IowaIowa CityIowa
| | | | - Spencer Lourens
- Department of BiostatisticsIndiana University School of MedicineIndianapolisIndiana
| | - Lauren J. O'Donnell
- Department of RadiologyBrigham and Women's Hospital Harvard Medical SchoolBostonMassachusetts
| | - Carl‐Fredrik Westin
- Department of RadiologyBrigham and Women's Hospital Harvard Medical SchoolBostonMassachusetts
| | - Yogesh Rathi
- Department of RadiologyBrigham and Women's Hospital Harvard Medical SchoolBostonMassachusetts
| | - Vincent Magnotta
- Department of RadiologyUniversity of IowaIowa CityIowa
- Department of PsychiatryUniversity of IowaIowa CityIowa
- Biomedical EngineeringUniversity of IowaIowa CityIowa
| | - Jane S. Paulsen
- Department of PsychiatryUniversity of IowaIowa CityIowa
- Department of Neurology, Carver College of MedicineUniversity of IowaIowa CityIowa
- Neuroscience, Carver College of MedicineUniversity of IowaIowa CityIowa
| | - Hans J. Johnson
- Department of Electrical and Computer EngineeringUniversity of IowaIowa CityIowa
- Department of PsychiatryUniversity of IowaIowa CityIowa
- Biomedical EngineeringUniversity of IowaIowa CityIowa
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