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Banerjee G, Farmer SF, Hyare H, Jaunmuktane Z, Mead S, Ryan NS, Schott JM, Werring DJ, Rudge P, Collinge J. Iatrogenic Alzheimer's disease in recipients of cadaveric pituitary-derived growth hormone. Nat Med 2024; 30:394-402. [PMID: 38287166 PMCID: PMC10878974 DOI: 10.1038/s41591-023-02729-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024]
Abstract
Alzheimer's disease (AD) is characterized pathologically by amyloid-beta (Aβ) deposition in brain parenchyma and blood vessels (as cerebral amyloid angiopathy (CAA)) and by neurofibrillary tangles of hyperphosphorylated tau. Compelling genetic and biomarker evidence supports Aβ as the root cause of AD. We previously reported human transmission of Aβ pathology and CAA in relatively young adults who had died of iatrogenic Creutzfeldt-Jakob disease (iCJD) after childhood treatment with cadaver-derived pituitary growth hormone (c-hGH) contaminated with both CJD prions and Aβ seeds. This raised the possibility that c-hGH recipients who did not die from iCJD may eventually develop AD. Here we describe recipients who developed dementia and biomarker changes within the phenotypic spectrum of AD, suggesting that AD, like CJD, has environmentally acquired (iatrogenic) forms as well as late-onset sporadic and early-onset inherited forms. Although iatrogenic AD may be rare, and there is no suggestion that Aβ can be transmitted between individuals in activities of daily life, its recognition emphasizes the need to review measures to prevent accidental transmissions via other medical and surgical procedures. As propagating Aβ assemblies may exhibit structural diversity akin to conventional prions, it is possible that therapeutic strategies targeting disease-related assemblies may lead to selection of minor components and development of resistance.
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Affiliation(s)
- Gargi Banerjee
- MRC Prion Unit at UCL and UCL Institute of Prion Diseases, London, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon F Farmer
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Harpreet Hyare
- UCL Queen Square Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon Mead
- MRC Prion Unit at UCL and UCL Institute of Prion Diseases, London, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, London, UK
| | - Natalie S Ryan
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Stroke Service, National Hospital for Neurology and Neurosurgery, London, UK
| | - Peter Rudge
- MRC Prion Unit at UCL and UCL Institute of Prion Diseases, London, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, London, UK
| | - John Collinge
- MRC Prion Unit at UCL and UCL Institute of Prion Diseases, London, UK.
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, London, UK.
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2
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Huntoon K, Anderson SK, Ballman KV, Twohy E, Dooley K, Jiang W, An Y, Li J, von Roemeling C, Qie Y, Ross OA, Cerhan JH, Whitton AC, Greenspoon JN, Parney IF, Ashman JB, Bahary JP, Hadjipanayis C, Urbanic JJ, Farace E, Khuntia D, Laack NN, Brown PD, Roberge D, Kim BYS. Association of circulating markers with cognitive decline after radiation therapy for brain metastasis. Neuro Oncol 2023; 25:1123-1131. [PMID: 36472389 PMCID: PMC10237411 DOI: 10.1093/neuonc/noac262] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A recent phase III trial (NCT01372774) comparing use of stereotactic radiosurgery [SRS] versus whole-brain radiation therapy [WBRT] after surgical resection of a single brain metastasis revealed that declines in cognitive function were more common with WBRT than with SRS. A secondary endpoint in that trial, and the primary objective in this secondary analysis, was to identify baseline biomarkers associated with cognitive impairment after either form of radiotherapy for brain metastasis. Here we report our findings on APOE genotype and serum levels of associated proteins and their association with radiation-induced neurocognitive decline. METHODS In this retrospective analysis of prospectively collected samples from a completed randomized clinical trial, patients provided blood samples every 3 months that were tested by genotyping and enzyme-linked immunosorbent assay, and results were analyzed in association with cognitive impairment. RESULTS The APOE genotype was not associated with neurocognitive impairment at 3 months. However, low serum levels of ApoJ, ApoE, or ApoA protein (all P < .01) and higher amyloid beta (Aβ 1-42) levels (P = .048) at baseline indicated a greater likelihood of neurocognitive decline at 3 months after SRS, whereas lower ApoJ levels were associated with decline after WBRT (P = .014). CONCLUSIONS Patients with these pretreatment serum markers should be counseled about radiation-related neurocognitive decline.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S Keith Anderson
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Karla V Ballman
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, New York, USA
| | - Erin Twohy
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine Dooley
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas,USA
| | - Yi An
- Department of Therapeutic Radiology, Yale-New Haven Hospital, North Haven, Connecticut, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas,USA
| | | | - Yaqing Qie
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Jane H Cerhan
- Department of Psychiatry and Psychology Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony C Whitton
- Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey N Greenspoon
- Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic, Phoenix/Scottsdale, Arizona, USA
| | - Jean-Paul Bahary
- Department of Radiation Oncology, CHUM, Montreal, Quebec, Canada
| | | | - James J Urbanic
- Department of Radiation Oncology, University of California San Diego, Moores Cancer Center, La Jolla, California, USA
| | - Elana Farace
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Deepak Khuntia
- Department of Radiation Oncology, Precision Cancer Specialists and Varian Medical Systems, Palo Alto, California, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Roberge
- Department of Radiation Oncology, CHUM, Montreal, Quebec, Canada
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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3
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Clark A, Barpujari A, Lucke-Wold B, Porche K, Laurent D, Koch M, Decker M. Cerebral amyloid angiopathy: early presentation in a patient with prior neurosurgical interventions. Case report. ROMANIAN NEUROSURGERY 2021; 35:499-502. [PMID: 34992489 PMCID: PMC8730372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) has classically been described as a disease of the elderly. Genetic predisposition has been linked to the APOE e3/e3 allele. Evidence suggests that brain insult in the form of injury, prior surgical intervention, or radiation can exacerbate the clearance of toxic proteins in patients susceptible to CAA. CASE We describe a unique case of CAA in a 30-year-old male who had prior surgical interventions for spina bifida, Chiari malformation, and hydrocephalus as a child. CONCLUSIONS The case is used to teach important components regarding diagnosis, clinical suspicion, and highlight the need for further investigation regarding the emerging role of the glymphatic system and its role in clinical pathology.
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Affiliation(s)
- Alec Clark
- Medical Student, University of Central Florida, USA
| | | | | | - Ken Porche
- MD, PGY5 Neurosurgery Resident, University of Florida, USA
| | | | - Matthew Koch
- MD, Assistant Professor, Department of Neurosurgery, University of Florida, USA
| | - Matthew Decker
- MD, MBA, MPH, Assistant Professor, Department of Neurosurgery, University of Florida, USA
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4
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Abstract
ABSTRACT Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a rare but increasingly recognized subtype of CAA. CAA-RI consists of two subtypes: inflammatory cerebral amyloid angiopathy and amyloid β (Aβ)-related angiitis. Acute or subacute onset of cognitive decline or behavioral changes is the most common symptom of CAA-RI. Rapid progressive dementia, headache, seizures, or focal neurological deficits, with patchy or confluent hyperintensity on T2 or fluid-attenuated inversion recovery sequences and evidence of strictly lobar microbleeds or cortical superficial siderosis on susceptibility-weighted imaging imply CAA-RI. The gold standard for diagnosis is autopsy or brain biopsy. However, biopsy is invasive; consequently, most clinically diagnosed cases have been based on clinical and radiological data. Other diagnostic indexes include the apolipoprotein E ε4 allele, Aβ and anti-Aβ antibodies in cerebral spinal fluid and amyloid positron emission tomography. Many diseases with similar clinical manifestations should be carefully ruled out. Immunosuppressive therapy is effective both during initial presentation and in relapses. The use of glucocorticoids and immunosuppressants improves prognosis. This article reviews the pathology and pathogenesis, clinical and imaging manifestations, diagnostic criteria, treatment, and prognosis of CAA-RI, and highlights unsolved problems in the existing research.
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Yamada M, Hamaguchi T, Sakai K. Acquired cerebral amyloid angiopathy: An emerging concept. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 168:85-95. [PMID: 31699330 DOI: 10.1016/bs.pmbts.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is commonly found in older people and in patients with Alzheimer's disease (AD) accompanying cerebrovascular disorders and dementia. Early-onset CAA cases generally have been found only in rare genetic forms of CAA. Interestingly, however, CAA-related hemorrhages have been recently reported in younger people who had histories of neurosurgery with or without evidence of cadaveric dura mater grafts in childhood. It has been established in experimental settings that amyloid β-protein (Aβ) pathology can be transmitted inter-individually with Aβ seeds. Incidental Aβ pathology, predominantly Aβ-CAA, has been recognized in recipients of cadaveric dura mater grafts or cadaveric human growth hormone. These findings suggest that transmission of Aβ seeds through dura mater grafts and other contaminated materials could lead to development of CAA. In addition, neurosurgery or brain injury may contribute to cerebrovascular Aβ deposition through the disturbance of vascular Aβ drainage pathways. Thus, a novel concept, "acquired CAA," has emerged.
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Affiliation(s)
- Masahito Yamada
- Department of Neurology & Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
| | - Tsuyoshi Hamaguchi
- Department of Neurology & Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenji Sakai
- Department of Neurology & Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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6
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Huang R, Zhou Y, Hu S, Ren G, Cui F, Zhou PK. Radiotherapy Exposure in Cancer Patients and Subsequent Risk of Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2019; 10:233. [PMID: 30930843 PMCID: PMC6428767 DOI: 10.3389/fneur.2019.00233] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Cancer patients who have undergone radiotherapy may have an increased risk of subsequent stroke. A clear and detailed understanding of this risk has not been established. Methods: A search for research articles published from January 1990 to November 2017 in the English language was conducted. Subsequent stroke risk in cancer survivors was compared using relative risk (RR) and 95% confidence intervals (CI) according to whether or not radiotherapy was given. Results: A total of 12 eligible studies were identified including 57,881 total patients. All studies were retrospective, as no prospective studies were identified. The meta-analysis revealed a higher overall risk of subsequent stroke in cancer survivors/patients given radiotherapy compared to those not given radiotherapy (RR: 2.09, 95% CI: 1.45, 3.16). In addition, compared to patients not given radiotherapy, there was an increased risk of subsequent stroke for radiotherapy treated patients with Hodgkin's lymphoma (RR: 2.81, 95% CI: 0.69, 4.93) or head/neck/brain/nasopharyngeal cancer (RR: 2.16, 95% CI: 1.16, 3.16), for patients younger than 40 years (RR: 3.53, 95% CI: 2.51, 4.97) or aged 40-49 years (RR: 1.23, 95% CI: 1.09, 1.45) and for patients treated in Asia (RR: 1.88, 95% CI: 1.48, 2.29), the United States (RR: 1.62, 95% CI: 1.01, 2.23), or in Europe (RR: 4.11, 95% CI 2.62, 6.45). Conclusions: The available literature indicates an approximate overall doubling of the subsequent stroke risk in cancer patients given radiotherapy. The elevated risk was generally statistically significant according to cancer type, baseline patient age and region or country where treatment was given. Caution is required in interpreting these findings due to the heterogeneity of populations represented and lack of standardization and completeness across published studies. Further, if real, we cannot conclude the extent to which patient, treatment and/or investigational factors are responsible for this apparent elevated risk. An objective and more detailed understanding of the risks of radiotherapy, and how to prevent them, is urgently required. It is the responsibility of all who provide cancer services to ensure that the experience of all their patients is documented and analyzed using quality registries.
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Affiliation(s)
- Ruixue Huang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yao Zhou
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Sai Hu
- Institute for Environmental Medicine and Radiation Health, The College of Public Health, University of South China, Hengyang, China.,Beijing Key Laboratory for Radiobiology, Department of Radiation Biology, Beijing Institute of Radiation Medicine, Academy of Military Medical Sciences, Beijing, China
| | - Guofeng Ren
- Department of Nutrition and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fengmei Cui
- Department of Radiation Medicine, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Ping-Kun Zhou
- Beijing Key Laboratory for Radiobiology, Department of Radiation Biology, Beijing Institute of Radiation Medicine, Academy of Military Medical Sciences, Beijing, China
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7
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The relationship between neurosurgical instruments and disease transmission: Society of British Neurological Surgeons perspective. Acta Neuropathol 2018; 135:969-971. [PMID: 29725821 DOI: 10.1007/s00401-018-1858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
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8
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Ionizing radiation reduces ADAM10 expression in brain microvascular endothelial cells undergoing stress-induced senescence. Aging (Albany NY) 2018; 9:1248-1268. [PMID: 28437250 PMCID: PMC5425125 DOI: 10.18632/aging.101225] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/10/2017] [Indexed: 12/15/2022]
Abstract
Cellular senescence is associated with aging and is considered a potential contributor to age-associated neurodegenerative disease. Exposure to ionizing radiation increases the risk of developing premature neurovascular degeneration and dementia but also induces premature senescence. As cells of the cerebrovascular endothelium are particularly susceptible to radiation and play an important role in brain homeostasis, we investigated radiation-induced senescence in brain microvascular endothelial cells (EC). Using biotinylation to label surface proteins, streptavidin enrichment and proteomic analysis, we analyzed the surface proteome of stress-induced senescent EC in culture. An array of both recognized and novel senescence-associated proteins were identified. Most notably, we identified and validated the novel radiation-stimulated down-regulation of the protease, a disintegrin and metalloprotease 10 (ADAM10). ADAM10 is an important modulator of amyloid beta protein production, accumulation of which is central to the pathologies of Alzheimer's disease and cerebral amyloid angiopathy. Concurrently, we identified and validated increased surface expression of ADAM10 proteolytic targets with roles in neural proliferation and survival, inflammation and immune activation (L1CAM, NEO1, NEST, TLR2, DDX58). ADAM10 may be a key molecule linking radiation, senescence and endothelial dysfunction with increased risk of premature neurodegenerative diseases normally associated with aging.
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9
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Correa DD, Kryza-Lacombe M, Zhou X, Baser RE, Beattie BJ, Beiene Z, Humm J, DeAngelis LM, Orlow I, Weber W, Osborne J. A pilot study of neuropsychological functions, APOE and amyloid imaging in patients with gliomas. J Neurooncol 2017; 136:613-622. [PMID: 29168082 PMCID: PMC5807139 DOI: 10.1007/s11060-017-2692-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/18/2017] [Indexed: 12/27/2022]
Abstract
Brain tumor patients treated with radiotherapy (RT) often develop cognitive dysfunction, and recent studies suggest that the APOE ε-4 allele may influence cognitive outcome. The ε-4 allele is known to promote beta (β) amyloid deposition in the cortex, and preliminary evidence suggests that RT may be associated with this process. However, it is unknown whether β-amyloid accumulation contributes to treatment neurotoxicity. In this pilot study, we assessed neuropsychological functions and β-amyloid retention using 18F-florbetaben (FBB) PET in a subset of brain tumor patients who participated in our study of APOE polymorphisms and cognitive functions. Twenty glioma patients treated with conformal RT ± chemotherapy participated in the study: 6 were APOE ε-4 carriers and 14 were non-ε-4 carriers. Patients completed a neuropsychological re-evaluation (mean time interval = 5 years, SD = 0.83) and brain MRI and FBB PET scans. Wilcoxon signed-rank test comparisons between prior and current neuropsychological assessments showed a significant decline in attention (Brief Test of Attention, p = 0.018), and a near significant decline in verbal learning (Hopkins Verbal learning Test-Learning, p = 0.07). Comparisons by APOE status showed significant differences over time in attention/working memory (WAIS-III digits forward, p = 0.028 and digits backward, p = 0.032), with a decline among APOE ε-4 carriers. There were no significant differences in any of the FBB PET analyses between APOE ε-4 carriers and non-ε-4 carriers. The findings suggest that glioma patients may experience worsening in attention and executive functions several years after treatment, and that the APOE ε-4 allele may modulate cognitive decline, but independent of increased β-amyloid deposition.
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Affiliation(s)
- D D Correa
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA. .,Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
| | - M Kryza-Lacombe
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - X Zhou
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - R E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - B J Beattie
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Z Beiene
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - J Humm
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - L M DeAngelis
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA.,Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - I Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - W Weber
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - J Osborne
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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10
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Mizejewski GJ. Breast cancer and amyloid bodies: is there a role for amyloidosis in cancer-cell dormancy? BREAST CANCER-TARGETS AND THERAPY 2017; 9:287-291. [PMID: 28490901 PMCID: PMC5413482 DOI: 10.2147/bctt.s131394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Breast cancer and Alzheimer's disease (AD) are major causes of death in older women. Interestingly, breast cancer occurs less frequently in AD patients than in the general population. Amyloidosis, the aggregation of amyloid proteins to form amyloid bodies, plays a central role in the pathogenesis of AD and other human neuropathies by forming intracellular fibrillary proteins. Contrary to popular belief, amyloidosis is a common occurrence in mammalian cells, and has recently been reported to be a natural physiological process in response to environmental stress stimulations (such as pH and temperature extremes, hypoxia, and oxidative stress). Many proteins contain an intrinsic "amyloid-converting motif", which acts in conjunction with a specific noncoding RNA to induce formation of proteinaceous amyloid bodies that are stored in intracellular bundles. In cancer cells such as breast and prostate, the process of amyloidosis induces cells to enter a dormant or resting stage devoid of cell division and proliferation. Therefore, cancer cells undergo growth cessation and enter a dormant stage following amyloidosis in the cell; this is akin to giving the cell AD to cease growth.
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11
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Roongpiboonsopit D, Kuijf HJ, Charidimou A, Xiong L, Vashkevich A, Martinez-Ramirez S, Shih HA, Gill CM, Viswanathan A, Dietrich J. Evolution of cerebral microbleeds after cranial irradiation in medulloblastoma patients. Neurology 2017; 88:789-796. [PMID: 28122904 PMCID: PMC5344076 DOI: 10.1212/wnl.0000000000003631] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/28/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the temporal and spatial pattern of cerebral microbleeds (CMBs) after cranial irradiation in patients with medulloblastoma. METHODS We retrospectively identified patients with medulloblastoma treated with craniospinal irradiation at the Massachusetts General Hospital between 1999 and 2015. Longitudinal MRI including T2*-weighted gradient-recalled echo (GRE) sequences were reviewed, and the prevalence, spatial pattern, and risk factors associated with CMBs were characterized. RESULTS We identified a total of 27 patients; 5 patients were children (median age 6.3 years) and 22 patients were adults (median age 28.8 years). CMBs were found in 67% (18/27) of patients, who were followed for a median of 4.1 years. Patients with CMBs had longer GRE follow-up time compared to those without CMBs (4.9 vs 1.7 years, p = 0.035). The median latency of the appearance of CMBs was 2.79 years (interquartile range 1.76-4.26). The prevalence of CMBs increased with each year from time of radiation therapy, and the cumulative prevalence was highest in patients age <20 years (100% cumulative prevalence, vs 59% in adult patients treated at age ≥20 years). CMBs were mostly found in lobar distribution and predominately in bilateral occipital lobes. Patients using antithrombotic medications developed CMBs at a significantly higher rate (p = 0.041). CONCLUSIONS Our data demonstrate a high prevalence of CMBs following cranial irradiation, progressively increasing with each year from time of radiation therapy.
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Affiliation(s)
- Duangnapa Roongpiboonsopit
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Hugo J Kuijf
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Andreas Charidimou
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Li Xiong
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Anastasia Vashkevich
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Sergi Martinez-Ramirez
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Helen A Shih
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Corey M Gill
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Anand Viswanathan
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Jorg Dietrich
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
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Danve A, Grafe M, Deodhar A. Amyloid Beta-Related Angiitis—A Case Report and Comprehensive Review of Literature of 94 Cases. Semin Arthritis Rheum 2014; 44:86-92. [DOI: 10.1016/j.semarthrit.2014.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/27/2014] [Accepted: 02/07/2014] [Indexed: 11/30/2022]
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Correa DD, Satagopan J, Baser RE, Cheung K, Richards E, Lin M, Karimi S, Lyo J, DeAngelis LM, Orlow I. APOE polymorphisms and cognitive functions in patients with brain tumors. Neurology 2014; 83:320-7. [PMID: 24944262 DOI: 10.1212/wnl.0000000000000617] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The goal of this study was to assess whether the APOE ε4 allele and other APOE single nucleotide polymorphisms (SNPs) influence neuropsychological and neuroimaging outcomes in patients with brain tumors. METHODS Two hundred eleven patients with brain tumors participated in the study. All patients completed standardized neuropsychological tests and provided a blood sample for APOE genotyping. Ratings of white matter abnormalities were performed on MRI scans. Patients were classified into 2 groups based on the presence (n = 50) or absence (n = 161) of at least one APOE ε4 allele. Additional APOE SNPs were genotyped in a subset of 150 patients. RESULTS Patients with at least one APOE ε4 allele had significantly lower scores in verbal learning and delayed recall, and marginally significant lower scores in executive function, in comparison to noncarriers of an ε4 allele. Patients with at least one ε4 allele and history of cigarette smoking had significantly higher scores in working memory and verbal learning than ε4 carriers who never smoked. Nine additional APOE SNPs were significantly associated with attention and executive and memory abilities. There were no significant differences between ε4 carriers and noncarriers on the extent of white matter abnormalities on MRI. CONCLUSIONS The findings suggest that patients with brain tumors who are carriers of the APOE ε4 allele may have increased vulnerability to developing memory and executive dysfunction, and that additional SNPs in the APOE gene may be associated with cognitive outcome.
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Affiliation(s)
- Denise D Correa
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY.
| | - Jaya Satagopan
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Raymond E Baser
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Kenneth Cheung
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Elizabeth Richards
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Michael Lin
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Sasan Karimi
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - John Lyo
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Lisa M DeAngelis
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Irene Orlow
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
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Rowe CC, Ellis KA, Rimajova M, Bourgeat P, Pike KE, Jones G, Fripp J, Tochon-Danguy H, Morandeau L, O'Keefe G, Price R, Raniga P, Robins P, Acosta O, Lenzo N, Szoeke C, Salvado O, Head R, Martins R, Masters CL, Ames D, Villemagne VL. Amyloid imaging results from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging. Neurobiol Aging 2010; 31:1275-83. [PMID: 20472326 DOI: 10.1016/j.neurobiolaging.2010.04.007] [Citation(s) in RCA: 711] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/01/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
The Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging, a participant of the worldwide Alzheimer's Disease Neuroimaging Initiative (ADNI), performed (11)C-Pittsburgh Compound B (PiB) scans in 177 healthy controls (HC), 57 mild cognitive impairment (MCI) subjects, and 53 mild Alzheimer's disease (AD) patients. High PiB binding was present in 33% of HC (49% in ApoE-epsilon4 carriers vs 21% in noncarriers) and increased with age, most strongly in epsilon4 carriers. 18% of HC aged 60-69 had high PiB binding rising to 65% in those over 80 years. Subjective memory complaint was only associated with elevated PiB binding in epsilon4 carriers. There was no correlation with cognition in HC or MCI. PiB binding in AD was unrelated to age, hippocampal volume or memory. Beta-amyloid (Abeta) deposition seems almost inevitable with advanced age, amyloid burden is similar at all ages in AD, and secondary factors or downstream events appear to play a more direct role than total beta amyloid burden in hippocampal atrophy and cognitive decline.
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Affiliation(s)
- Christopher C Rowe
- Austin Health, Department of Nuclear Medicine and Centre for PET, Heidelberg, Victoria, Australia.
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15
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Goodenowe DB, Cook LL, Liu J, Lu Y, Jayasinghe DA, Ahiahonu PWK, Heath D, Yamazaki Y, Flax J, Krenitsky KF, Sparks DL, Lerner A, Friedland RP, Kudo T, Kamino K, Morihara T, Takeda M, Wood PL. Peripheral ethanolamine plasmalogen deficiency: a logical causative factor in Alzheimer's disease and dementia. J Lipid Res 2007; 48:2485-98. [PMID: 17664527 DOI: 10.1194/jlr.p700023-jlr200] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although dementia of the Alzheimer's type (DAT) is the most common form of dementia, the severity of dementia is only weakly correlated with DAT pathology. In contrast, postmortem measurements of cholinergic function and membrane ethanolamine plasmalogen (PlsEtn) content in the cortex and hippocampus correlate with the severity of dementia in DAT. Currently, the largest risk factor for DAT is age. Because the synthesis of PlsEtn occurs via a single nonredundant peroxisomal pathway that has been shown to decrease with age and PlsEtn is decreased in the DAT brain, we investigated potential relationships between serum PlsEtn levels, dementia severity, and DAT pathology. In total, serum PlsEtn levels were measured in five independent population collections comprising >400 clinically demented and >350 nondemented subjects. Circulating PlsEtn levels were observed to be significantly decreased in serum from clinically and pathologically diagnosed DAT subjects at all stages of dementia, and the severity of this decrease correlated with the severity of dementia. Furthermore, a linear regression model predicted that serum PlsEtn levels decrease years before clinical symptoms. The putative roles that PlsEtn biochemistry play in the etiology of cholinergic degeneration, amyloid accumulation, and dementia are discussed.
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Correa DD, DeAngelis LM, Shi W, Thaler HT, Lin M, Abrey LE. Cognitive functions in low-grade gliomas: disease and treatment effects. J Neurooncol 2006; 81:175-84. [PMID: 16850104 DOI: 10.1007/s11060-006-9212-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 06/08/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of radiotherapy and chemotherapy in the treatment of low-grade gliomas (LGG) is controversial regarding their effect on survival and the development of neurotoxicity. The few published studies examining adverse treatment effects on cognition revealed conflicting results. OBJECTIVE To assess cognitive functioning in LGG patients who received conformal radiation therapy (RT), chemotherapy, or no treatment. DESIGN 40 LGG patients participated in the study; 16 patients had RT +/- chemotherapy, and 24 patients had no treatment. All patients underwent a neuropsychological evaluation. APOE genotype was obtained in 36 patients who were classified in two groups based on the presence or absence of at least one apolipoprotein E small je, Ukrainian-4 (APOE small je, Ukrainian-4) allele. RESULTS Treated LGG patients had lower scores than untreated patients on several cognitive domains; patients who completed treatment at intervals greater than 3 years and had long disease duration had significantly lower scores on the Non-Verbal Memory domain. Antiepileptic polytherapy, treatment history, and disease duration jointly contributed to low Psychomotor domain scores. 62% of treated patients showed white matter confluence on MRI, whereas only 9% of the untreated patients had such changes. Preliminary comparisons between APOE small je, Ukrainian-4 carriers (n = 9) and non-carriers (n = 27) on cognitive domain scores revealed no statistically significant differences, but APOE small je, Ukrainian-4 carriers had lower mean scores on the Verbal Memory domain than did non-small je, Ukrainian-4 carriers. CONCLUSIONS RT +/- chemotherapy, disease duration, and antiepileptic treatment contributed to mild cognitive difficulties in LGG patients.
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Affiliation(s)
- Denise D Correa
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Yamaguchi H. Illustration of dynamic changes in Alzheimer pathology: From mild cognitive impairment to terminal stage. Neuropathology 2005; 25:285-7. [PMID: 16382776 DOI: 10.1111/j.1440-1789.2005.00629.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is quite important to examine the neuropathology of large numbers of brains from non-demented as well as demented subjects to elucidate the pathogenesis of dementia. Such a study, "power neuropathology" reveals the temporal profile of the disease, and results in the development of the treatment and the prevention of dementia.
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Affiliation(s)
- Haruyasu Yamaguchi
- Gunma University School of Health Sciences, 3-39-15 Showa-machi, Maebashi 371-8514, Japan.
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Chaney MO, Baudry J, Esh C, Childress J, Luehrs DC, Kokjohn TA, Roher AE. A beta, aging, and Alzheimer's disease: a tale, models, and hypotheses. Neurol Res 2003; 25:581-9. [PMID: 14503011 DOI: 10.1179/016164103101202011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this paper we explore the potential functional role of the A beta peptides in the context of Alzheimer's disease (AD). We begin by defining the morphology of the amyloid deposits in relation to surrounding glial cells and, more importantly, in relation to the brain vasculature. Amyloid accumulation in the brain's microvasculature causes disturbances in the blood-brain barrier (BBB), and in larger arteries, impairment in control of regional cerebral blood flow due to myocyte degeneration. We postulate that the deposition of vascular amyloid may represent a hydrophobic protein plaster to seal leaks in the BBB, occasionally observed in aging and catastrophically common in AD. The vasoconstrictive activity of A beta may also be related to leaky vessels whereby decreasing the arterial diameter may also help to control breaches in the BBB. The admission of plasma neurotoxic proteins into the brain may be controlled by activation of microglia elicited by soluble A beta peptides creating a subtle, but permanent brain inflammatory reaction. We also delve into the influence that cholesterol metabolism may have in membrane topology and A beta production, and the close correlations that exist between cardiovascular disease and AD. Finally, we speculate about the possibility of a peripheral source of A beta that may, by crossing the BBB, contribute to the vascular and parenchymal deposits of A beta in the AD brain.
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Affiliation(s)
- Michael O Chaney
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
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Yamaguchi H, Sugihara S, Ogawa A, Oshima N, Ihara Y. Alzheimer beta amyloid deposition enhanced by apoE epsilon4 gene precedes neurofibrillary pathology in the frontal association cortex of nondemented senior subjects. J Neuropathol Exp Neurol 2001; 60:731-9. [PMID: 11444802 DOI: 10.1093/jnen/60.7.731] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To clarify how Alzheimer disease pathology develops in the brains of nondemented subjects, we examined the interrelations among the amounts and morphology of Abeta deposition, neurofibrillary pathology, and apolipoprotein E (ApoE) genotype in the frontal association cortex of 101 autopsy brains from patients aged between 40 to 83. Senile plaque density correlated well with the logarithmic data of insoluble Abeta measured by enzyme immunoassay (EIA). The amounts of Abeta42-ETA increased dramatically in the late preclinical stage, whereas the AP42+ plaque density increased in the early preclinical stage. Neurofibrillary pathology appeared only in the areas with severe Abeta deposition and in subjects aged over 70. The ApoE epsilon4 allele enhanced the Abeta3 deposition in presenile subjects. Plaque-associated glial Abeta was prominent in subjects with mild to moderate Abeta deposition. The morphology of cerebral Abeta deposition changed from diffuse plaques with small amounts of Abeta in each plaque in the early preclinical stage to primitive/neuritic plaques with larger amounts of Abeta in each plaque in the late preclinical stage. Our findings suggest that the prevention of Abeta deposition in the late preclinical stage can be a rational therapeutic target, especially in elderly people with ApoE epsilon4 allele.
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Affiliation(s)
- H Yamaguchi
- Gunma University School of Health Sciences, Maebashi, Japan
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Prominent cerebral amyloid angiopathy in transgenic mice overexpressing the london mutant of human APP in neurons. THE AMERICAN JOURNAL OF PATHOLOGY 2000; 157:1283-98. [PMID: 11021833 PMCID: PMC1850171 DOI: 10.1016/s0002-9440(10)64644-5] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Deposition of amyloid beta-peptide (Abeta) in cerebral vessel walls (cerebral amyloid angiopathy, CAA) is very frequent in Alzheimer's disease and occurs also as a sporadic disorder. Here, we describe significant CAA in addition to amyloid plaques, in aging APP/Ld transgenic mice overexpressing the London mutant of human amyloid precursor protein (APP) exclusively in neurons. The number of amyloid-bearing vessels increased with age, from approximately 10 to >50 per coronal brain section in APP/Ld transgenic mice, aged 13 to 24 months. Vascular amyloid was preferentially deposited in arterioles and ranged from small focal to large circumferential depositions. Ultrastructural analysis allowed us to identify specific features contributing to weakening of the vessel wall and aneurysm formation, ie, disruption of the external elastic lamina, thinning of the internal elastic lamina, interruption of the smooth muscle layer, and loss of smooth muscle cells. Biochemically, the much lower Abeta42:Abeta40 ratio evident in vascular relative to plaque amyloid, demonstrated that in blood vessel walls Abeta40 was the more abundant amyloid peptide. The exclusive neuronal origin of transgenic APP, the high levels of Abeta in cerebrospinal fluid compared to plasma, and the specific neuroanatomical localization of vascular amyloid strongly suggest specific drainage pathways, rather than local production or blood uptake of Abeta as the primary mechanism underlying CAA. The demonstration in APP/Ld mice of rare vascular amyloid deposits that immunostained only for Abeta42, suggests that, similar to senile plaque formation, Abeta42 may be the first amyloid to be deposited in the vessel walls and that it entraps the more soluble Abeta40. Its ability to diffuse for larger distances along perivascular drainage pathways would also explain the abundance of Abeta40 in vascular amyloid. Consistent with this hypothesis, incorporation of mutant presenilin-1 in APP/Ld mice, which resulted in selectively higher levels of Abeta42, caused an increase in CAA and senile plaques. This mouse model will be useful in further elucidating the pathogenesis of CAA and Alzheimer's disease, and will allow testing of diagnostic and therapeutic strategies.
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Cadavid D, Mena H, Koeller K, Frommelt RA. Cerebral beta amyloid angiopathy is a risk factor for cerebral ischemic infarction. A case control study in human brain biopsies. J Neuropathol Exp Neurol 2000; 59:768-73. [PMID: 11005257 DOI: 10.1093/jnen/59.9.768] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is conspicuous for its association with Alzheimer disease (AD) and as a cause of lobar hemorrhages in the elderly, but its role in cerebral infarction is less clear. There is evidence that CAA may also be a risk factor for ischemic infarction in AD. To further investigate CAA as a risk factor for infarction, we studied 108 cases of recent cerebral or cerebellar infarction diagnosed in tissue samples obtained from surgical material. There were 69 males and 39 females with a mean age of 52 yr (range 1-86). The majority of biopsies were obtained from the frontal and parietal lobes. Radiological studies demonstrated a lesion confined to a vascular distribution in 12 of the 17 (71%) cases examined. Microscopic sections stained with hematoxylin and eosin revealed complete, organizing infarction in 107 cases with areas of coagulative necrosis, anoxic-ischemic neuronal injury, inflammation, macrophages, vascular proliferation, gliosis, and swollen axons. One case showed an incomplete infarct. Most cases also exhibited a minor hemorrhagic component with hemosiderin and hematoidin pigments. CAA, defined as amyloid deposition in the walls of leptomeningeal and parenchymal arteries, was found by immunohistochemical stains for beta amyloid in 14 (13%) cases of complete cerebral infarct. Cortical beta amyloid plaques were found by immunohistochemistry in 19 (17%) cases. Cerebral or cerebellar tissues containing cortex and leptomeninges obtained from 136 patients with a mean age of 52 yr (range 1-85) during surgical procedures for diagnosis of primary or metastatic neoplasms and demyelinating lesions were used as age-matched controls. In this control group, CAA was found in 5 (3.7%) and beta amyloid plaques in 19 (14%). The results indicate that CAA, but not beta amyloid plaque formation, is significantly more common in patients with ischemic cerebral infarction than in age-matched controls with nonvascular lesions (odds ratio 3.8; 95% confidence interval 1.3-10.9; p < 0.01). Our results indicate that CAA is a risk factor for ischemic cerebral infarction in the population studied.
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Affiliation(s)
- D Cadavid
- Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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23
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Yamaguchi H. Polymorphism in senile dementia of the Alzheimer type from a viewpoint of senile plaque formation. Neuropathology 1998. [DOI: 10.1111/j.1440-1789.1998.tb00085.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sugihara S, Saunders AM, Ogawa A, Nakazato Y, Saido TC, Yamaguchi H. Characteristics of cerebral ? amyloid deposition in four non-demented patients in their forties with a high apolipoprotein E ?4 allele frequency. Neuropathology 1997. [DOI: 10.1111/j.1440-1789.1997.tb00061.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kalaria RN. Cerebrovascular degeneration is related to amyloid-beta protein deposition in Alzheimer's disease. Ann N Y Acad Sci 1997; 826:263-71. [PMID: 9329698 DOI: 10.1111/j.1749-6632.1997.tb48478.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Current evidence is not inconsistent with the suggestion that cerebrovascular functions decline during normal aging with pronounced effects in both sporadic and familial Alzheimer's disease (AD). The primary causes of these changes remain unknown. It is possible that amyloid beta (A beta) protein is involved in the degeneration of both the larger penetrating vessels as well as the cerebral capillaries that represent the blood-brain barrier (BBB). A beta-induced endothelial changes could also alter muscular tone, resulting not only in increased expression of vascular amyloid precursor protein (APP) and production of A beta, but also in oxidative injury. We used immunochemical methods to examine the status of the perfusing cerebral vessels and the microvascular endothelium in relation to deposition of A beta in AD and non-AD aging control subjects. Double-immunostaining with antibodies to vascular markers revealed marked loss of smooth muscle in larger vessels and absence or attenuation of the endothelium in capillary profiles that still appeared to retain their basement membranes. These vascular changes were predominantly restricted to neocortical regions abundant in A beta deposits. Quantitative studies showed that the microvascular abnormalities were correlated to A beta deposition rather than neurofibrillary tangles or neuronal numbers. Our studies suggest that A beta, irrespective of its origin within vascular myocytes or brain parenchyma, is responsible not only for cerebral amyloid angiopathy, but also for the degeneration of the cerebral microvasculature, which may profoundly affect brain perfusion and BBB functions.
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Affiliation(s)
- R N Kalaria
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio 44106, USA
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Yamaguchi H, Ishiguro K, Sugihara S, Nakazato Y, Kawarabayashi T, Sun X, Hirai S. Presence of apolipoprotein E on extracellular neurofibrillary tangles and on meningeal blood vessels precedes the Alzheimer beta-amyloid deposition. Acta Neuropathol 1994; 88:413-9. [PMID: 7847069 DOI: 10.1007/bf00389492] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The localization of apolipoprotein E (ApoE) has been examined immunohistochemically in the autopsied brains of middle-aged and old-aged control subjects, with and without amyloid beta protein (A beta) deposits, and of Alzheimer's disease patients. Senile plaques were consistently labeled with ApoE antiserum even in the very early stage of senile plaque formation seen in the fifth decade. In the cerebellar molecular layer, small dots of ApoE immunoreactivity, which were prominent in the Alzheimer's disease subjects, were observed in addition to immunoreactivity in diffuse plaques. ApoE antisera labeled all of the extracellular neurofibrillary tangles (NFT), whereas only a small minority of extracellular NFT were positive for A beta. A punctate pattern of ApoE immunoreactivity was seen at the media of the meningeal vessels lacking amyloid, when senile plaques were present in the nearby cortex. In the early stage of amyloid angiopathy, the distribution of ApoE immunoreactivity was much more extensive than that of A beta positivity. These findings suggest that ApoE accumulates in the early stage of senile plaque formation and, furthermore, that ApoE accumulation precedes A beta deposition in extracellular NFT and amyloid angiopathy.
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Affiliation(s)
- H Yamaguchi
- College of Medical Care and Technology, Gunma University, Japan
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