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Lee S, Martinez-Valbuena I, Lang AE, Kovacs GG. Cellular iron deposition patterns predict clinical subtypes of multiple system atrophy. Neurobiol Dis 2024; 197:106535. [PMID: 38761956 DOI: 10.1016/j.nbd.2024.106535] [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: 03/03/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a primary oligodendroglial synucleinopathy, characterized by elevated iron burden in early-affected subcortical nuclei. Although neurotoxic effects of brain iron deposition and its relationship with α-synuclein pathology have been demonstrated, the exact role of iron dysregulation in MSA pathogenesis is unknown. Therefore, advancing the understanding of iron dysregulation at the cellular level is critical, especially in relation to α-synuclein cytopathology. METHODS Iron burden in subcortical and brainstem regions were histologically mapped in human post-mortem brains of 4 MSA-parkinsonian (MSA-P), 4 MSA-cerebellar (MSA-C), and 1 MSA case with both parkinsonian and cerebellar features. We then performed the first cell type-specific evaluation of pathological iron deposition in α-synuclein-affected and -unaffected cells of the globus pallidus, putamen, and the substantia nigra, regions of highest iron concentration, using a combination of iron staining with immunolabelling. Selective regional and cellular vulnerability patterns of iron deposition were compared between disease subtypes. In 7 MSA cases, expression of key iron- and closely related oxygen-homeostatic genes were examined. RESULTS MSA-P and MSA-C showed different patterns of regional iron burden across the pathology-related systems. We identified subcortical microglia to predominantly accumulate iron, which was more distinct in MSA-P. MSA-C showed relatively heterogenous iron accumulation, with greater or similar deposition in astroglia. Iron deposition was also found outside cellular bodies. Cellular iron burden associated with oligodendrocytic, and not neuronal, α-synuclein cytopathology. Gene expression analysis revealed dysregulation of oxygen homeostatic genes, rather than of cellular iron. Importantly, hierarchal cluster analysis revealed the pattern of cellular vulnerability to iron accumulation, distinctly to α-synuclein pathology load in the subtype-related systems, to distinguish MSA subtypes. CONCLUSIONS Our comprehensive evaluation of iron deposition in MSA brains identified distinct regional, and for the first time, cellular distribution of iron deposition in MSA-P and MSA-C and revealed cellular vulnerability patterns to iron deposition as a novel neuropathological characteristic that predicts MSA clinical subtypes. Our findings suggest distinct iron-related pathomechanisms in MSA clinical subtypes that are therefore not a consequence of a uniform down-stream pathway to α-synuclein pathology, and inform current efforts in iron chelation therapies at the disease and cellular-specific levels.
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Affiliation(s)
- Seojin Lee
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5T 0S8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Ivan Martinez-Valbuena
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5T 0S8, Canada; Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Anthony E Lang
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5T 0S8, Canada; Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada; Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5T 0S8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada; Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario M5G 2C4, Canada.
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Kon T, Ichimata S, Di Luca DG, Martinez-Valbuena I, Kim A, Yoshida K, Alruwaita AA, Kleiner G, Strafella AP, Forrest SL, Sato C, Rogaeva E, Fox SH, Lang AE, Kovacs GG. Multiple system atrophy with amyloid-β-predominant Alzheimer's disease neuropathologic change. Brain Commun 2024; 6:fcae141. [PMID: 38712319 PMCID: PMC11073746 DOI: 10.1093/braincomms/fcae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/08/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
Multiple system atrophy is a neurodegenerative disease with α-synuclein pathology predominating in the striatonigral and olivopontocerebellar systems. Mixed pathologies are considered to be of low frequency and mostly comprise primary age-related tauopathy or low levels of Alzheimer's disease-related neuropathologic change. Therefore, the concomitant presence of different misfolded proteins in the same brain region is less likely in multiple system atrophy. During the neuropathological evaluation of 21 consecutive multiple system atrophy cases, we identified four cases exhibiting an unusual discrepancy between high Thal amyloid-β phase and low transentorhinal Braak neurofibrillary tangle stage. We mapped α-synuclein pathology, measured the size and number of glial cytoplasmic inclusions and compared the amyloid-β peptides between multiple system atrophy and Alzheimer's disease. In addition, we performed α-synuclein seeding assay from the affected putamen samples. We performed genetic testing for APOE, MAPT, PSEN1, PSEN2 and APP. We refer to the four multiple system atrophy cases with discrepancy between amyloid-β and tau pathology as 'amyloid-β-predominant Alzheimer's disease neuropathologic change-multiple system atrophy' to distinguish these from multiple system atrophy with primary age-related tauopathy or multiple system atrophy with typical Alzheimer's disease neuropathologic change. As most multiple system atrophy cases with mixed pathologies reported in the literature, these cases did not show a peculiar clinical or MRI profile. Three amyloid-β-predominant Alzheimer's disease neuropathologic change-multiple system atrophy cases were available for genetic testing, and all carried the APOE ɛ4 allele. The extent and severity of neuronal loss and α-synuclein pathology were not different compared with typical multiple system atrophy cases. Analysis of amyloid-β peptides revealed more premature amyloid-β plaques in amyloid-β-predominant Alzheimer's disease neuropathologic change-multiple system atrophy compared with Alzheimer's disease. α-Synuclein seeding amplification assay showed differences in the kinetics in two cases. This study highlights a rare mixed pathology variant of multiple system atrophy in which there is an anatomical meeting point of amyloid-β and α-synuclein, i.e. the striatum or cerebellum. Since biomarkers are entering clinical practice, these cases will be recognized, and the clinicians have to be informed that the prognosis is not necessarily different than in pure multiple system atrophy cases but that the effect of potential α-synuclein-based therapies might be influenced by the co-presence of amyloid-β in regions where α-synuclein also aggregates. We propose that mixed pathologies should be interpreted not only based on differences in the clinical phenotype but also on whether protein depositions regionally overlap, potentially leading to a different response to α-synuclein-targeted therapies.
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Affiliation(s)
- Tomoya Kon
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Shojiro Ichimata
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Daniel G Di Luca
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Ivan Martinez-Valbuena
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
| | - Ain Kim
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
| | - Koji Yoshida
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Abdullah A Alruwaita
- Edmund J Safra Program in Parkinson’s Disease and Rossy Program in Progressive Supranuclear Palsy, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
- Neurology Department, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Galit Kleiner
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Movement Disorders and Spasticity Management Clinic, Pamela and Paul Austin Centre for Neurology and Behavioral Support, Baycrest Centre for Geriatric Care, Toronto, ON M6A 2E1, Canada
| | - Antonio P Strafella
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Edmund J Safra Program in Parkinson’s Disease and Rossy Program in Progressive Supranuclear Palsy, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Shelley L Forrest
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
- Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, ON M5T 0S8, Canada
- Faculty of Medicine, Health and Human Sciences, Dementia Research Centre, Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
| | - Susan H Fox
- Edmund J Safra Program in Parkinson’s Disease and Rossy Program in Progressive Supranuclear Palsy, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Anthony E Lang
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Edmund J Safra Program in Parkinson’s Disease and Rossy Program in Progressive Supranuclear Palsy, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON M5T 0S8, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Edmund J Safra Program in Parkinson’s Disease and Rossy Program in Progressive Supranuclear Palsy, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
- Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, ON M5T 0S8, Canada
- Faculty of Medicine, Health and Human Sciences, Dementia Research Centre, Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
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Lee S, Kovacs GG. The Irony of Iron: The Element with Diverse Influence on Neurodegenerative Diseases. Int J Mol Sci 2024; 25:4269. [PMID: 38673855 PMCID: PMC11049980 DOI: 10.3390/ijms25084269] [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: 02/29/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Iron accumulation in the brain is a common feature of many neurodegenerative diseases. Its involvement spans across the main proteinopathies involving tau, amyloid-beta, alpha-synuclein, and TDP-43. Accumulating evidence supports the contribution of iron in disease pathologies, but the delineation of its pathogenic role is yet challenged by the complex involvement of iron in multiple neurotoxicity mechanisms and evidence supporting a reciprocal influence between accumulation of iron and protein pathology. Here, we review the major proteinopathy-specific observations supporting four distinct hypotheses: (1) iron deposition is a consequence of protein pathology; (2) iron promotes protein pathology; (3) iron protects from or hinders protein pathology; and (4) deposition of iron and protein pathology contribute parallelly to pathogenesis. Iron is an essential element for physiological brain function, requiring a fine balance of its levels. Understanding of disease-related iron accumulation at a more intricate and systemic level is critical for advancements in iron chelation therapies.
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Affiliation(s)
- Seojin Lee
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON M5T 0S8, Canada;
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON M5T 0S8, Canada;
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Edmond J. Safra Program in Parkinson’s Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
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Han Y, He Z. Concomitant protein pathogenesis in Parkinson's disease and perspective mechanisms. Front Aging Neurosci 2023; 15:1189809. [PMID: 37181621 PMCID: PMC10174460 DOI: 10.3389/fnagi.2023.1189809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Comorbidity is a common phenotype in Parkinson's disease (PD). Patients with PD not only have motor deficit symptoms, but also have heterogeneous non-motor symptoms, including cognitive impairment and emotional changes, which are the featured symptoms observed in patients with Alzheimer's disease (AD), frontotemporal dementia (FTD) and cerebrovascular disease. Moreover, autopsy studies have also confirmed the concomitant protein pathogenesis, such as the co-existences of α-synuclein, amyloid-β and tau pathologies in PD and AD patients' brains. Here, we briefly summarize the recent reports regarding the comorbidity issues in PD from both clinical observations and neuropathological evidences. Furthermore, we provide some discussion about the perspective potential mechanisms underlying such comorbidity phenomenon, with a focus on PD and related neurodegenerative diseases.
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Affiliation(s)
- Yuliang Han
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
- University of the Chinese Academy of Sciences, Beijing, China
| | - Zhuohao He
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
- University of the Chinese Academy of Sciences, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- *Correspondence: Zhuohao He,
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Association between Cognitive Impairment and Hippocampal Subfield Volumes in Multiple System Atrophy. PARKINSON'S DISEASE 2023; 2023:8888255. [PMID: 36923711 PMCID: PMC10010875 DOI: 10.1155/2023/8888255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
This study aimed to explore morphological changes of hippocampal subfields in patients with multiple system atrophy (MSA) with and without cognitive impairment using FreeSurfer-automated segmentation of hippocampal subfield techniques and their relationship with cognitive function. We enrolled 75 patients with MSA classified as cognitively impaired MSA (MSA-CI, n = 40) and cognitively preserved MSA (MSA-CP, n = 35), as well as 68 healthy controls. All participants underwent three-dimensional volume T1-weighted magnetic resonance imaging. The hippocampal subfield volume was measured using FreeSurfer version 7.2 and compared among groups. Regression analyses were performed between the hippocampal subfield volumes and cognitive variables. Compared with healthy controls, the volume of the right cornu ammonis (CA) 2/3 was significantly lower in the MSA-CI group (P=0.029) and that of the left fimbria was significantly higher in the MSA-CP group (P=0.046). Results of linear regression analysis showed that the right CA2/3 volume was significantly correlated with the Frontal Assessment Battery score in patients with MSA (adjusted R 2 = 0.282, β = 0.227, and P=0.041). The hippocampal subfield volume decreased in patients with MSA-CI, even at the early disease stages. Specific structural changes in the hippocampus might be associated with cognitive deficits in MSA.
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Heterogeneity of Multiple System Atrophy: An Update. Biomedicines 2022; 10:biomedicines10030599. [PMID: 35327402 PMCID: PMC8945102 DOI: 10.3390/biomedicines10030599] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Multiple system atrophy (MSA) is a fatal, rapidly progressing neurodegenerative disease of uncertain etiology, clinically characterized by various combinations of Levodopa unresponsive parkinsonism, cerebellar, autonomic and motor dysfunctions. The morphological hallmark of this α-synucleinopathy is the deposition of aberrant α-synuclein in both glia, mainly oligodendroglia (glial cytoplasmic inclusions /GCIs/) and neurons, associated with glioneuronal degeneration of the striatonigral, olivopontocerebellar and many other neuronal systems. Typical phenotypes are MSA with predominant parkinsonism (MSA-P) and a cerebellar variant (MSA-C) with olivocerebellar atrophy. However, MSA can present with a wider range of clinical and pathological features than previously thought. In addition to rare combined or “mixed” MSA, there is a broad spectrum of atypical MSA variants, such as those with a different age at onset and disease duration, “minimal change” or prodromal forms, MSA variants with Lewy body disease or severe hippocampal pathology, rare forms with an unusual tau pathology or spinal myoclonus, an increasing number of MSA cases with cognitive impairment/dementia, rare familial forms, and questionable conjugal MSA. These variants that do not fit into the current classification of MSA are a major challenge for the diagnosis of this unique proteinopathy. Although the clinical diagnostic accuracy and differential diagnosis of MSA have improved by using combined biomarkers, its distinction from clinically similar extrapyramidal disorders with other pathologies and etiologies may be difficult. These aspects should be taken into consideration when revising the current diagnostic criteria. This appears important given that disease-modifying treatment strategies for this hitherto incurable disorder are under investigation.
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Ando T, Riku Y, Akagi A, Miyahara H, Hirano M, Ikeda T, Yabata H, Koizumi R, Oba C, Morozumi S, Yasui K, Goto A, Katayama T, Sakakibara S, Aiba I, Sakai M, Konagaya M, Mori K, Ito Y, Yuasa H, Nomura M, Porto KJL, Mitsui J, Tsuji S, Mimuro M, Hashizume Y, Katsuno M, Iwasaki Y, Yoshida M. Multiple system atrophy variant with severe hippocampal pathology. Brain Pathol 2021; 32:e13002. [PMID: 34255887 PMCID: PMC8713529 DOI: 10.1111/bpa.13002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022] Open
Abstract
The striatonigral and olivopontocerebellar systems are known to be vulnerable in multiple system atrophy (MSA), showing neuronal loss, astrogliosis, and alpha‐synuclein‐immunoreactive inclusions. MSA patients who displayed abundant neuronal cytoplasmic inclusions (NCIs) in the regions other than the striatonigral or olivopontocerebellar system have occasionally been diagnosed with variants of MSA. In this study, we report clinical and pathologic findings of MSA patients characterized by prominent pathologic involvement of the hippocampus. We assessed 146 consecutively autopsied MSA patients. Semi‐quantitative analysis of anti‐alpha‐synuclein immunohistochemistry revealed that 12 of 146 patients (8.2%) had severe NCIs in two or more of the following areas: the hippocampal granule cells, cornu ammonis areas, parahippocampal gyrus, and amygdala. In contrast, the remaining 134 patients did not show severe NCIs in any of these regions. Patients with severe hippocampal involvement showed a higher representation of women (nine women/three men; Fisher's exact test, p = 0.0324), longer disease duration (13.1 ± 5.9 years; Mann–Whitney U‐test, p = 0.000157), higher prevalence of cognitive impairment (four patients; Fisher's exact test, p = 0.0222), and lower brain weight (1070.3 ± 168.6 g; Mann–Whitney U‐test, p = 0.00911) than other patients. The hippocampal granule cells and cornu ammonis area 1/subiculum almost always showed severe NCIs. The NCIs appeared to be ring‐shaped or neurofibrillary tangle‐like, fibrous configurations. Three of 12 patients also had dense, round‐shaped NCIs that were morphologically similar to pick bodies. The patients with Pick body‐like inclusions showed more severe atrophy of the medial temporal lobes and broader spreading of NCIs than those without. Immunohistochemistry for hyperphosphorylated tau and phosphorylated TDP‐43 revealed minimal aggregations in the hippocampus of the hippocampal MSA patients. Our observations suggest a pathological variant of MSA that is characterized by severe involvement of hippocampal neurons. This phenotype may reinforce the importance of neuronal alpha‐synucleinopathy in the pathogenesis of MSA.
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Affiliation(s)
- Takashi Ando
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Yuichi Riku
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Mitsuaki Hirano
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshimasa Ikeda
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Yabata
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Shiga University of Medical Science, Ohtsu, Japan
| | - Ryuichi Koizumi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chisato Oba
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Saori Morozumi
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Keizo Yasui
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Atsuko Goto
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
| | - Taiji Katayama
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
| | - Satoko Sakakibara
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
| | - Motoko Sakai
- Department of Neurology, National Hospital Organization Suzuka National Hospital, Suzuka, Japan
| | - Masaaki Konagaya
- Department of Neurology, National Hospital Organization Suzuka National Hospital, Suzuka, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Japan
| | - Yasuhiro Ito
- Department of Neurology, Toyota Memorial Hospital, Toyota, Japan
| | - Hiroyuki Yuasa
- Department of Neurology, Tosei General Hospital, Seto, Japan
| | - Masayo Nomura
- Department of Neurology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan
| | - Kristine Joyce L Porto
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Mitsui
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Tsuji
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maya Mimuro
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Yoshio Hashizume
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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Miki Y, Foti SC, Hansen D, Strand KM, Asi YT, Tsushima E, Jaunmuktane Z, Lees AJ, Warner TT, Quinn N, Ling H, Holton JL. Hippocampal α-synuclein pathology correlates with memory impairment in multiple system atrophy. Brain 2021; 143:1798-1810. [PMID: 32385496 DOI: 10.1093/brain/awaa126] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/06/2020] [Accepted: 03/01/2020] [Indexed: 01/09/2023] Open
Abstract
Recent post-mortem studies reported 22-37% of patients with multiple system atrophy can develop cognitive impairment. With the aim of identifying associations between cognitive impairment including memory impairment and α-synuclein pathology, 148 consecutive patients with pathologically proven multiple system atrophy were reviewed. Among them, 118 (79.7%) were reported to have had normal cognition in life, whereas the remaining 30 (20.3%) developed cognitive impairment. Twelve of them had pure frontal-subcortical dysfunction, defined as the presence of executive dysfunction, impaired processing speed, personality change, disinhibition or stereotypy; six had pure memory impairment; and 12 had both types of impairment. Semi-quantitative analysis of neuronal cytoplasmic inclusions in the hippocampus and parahippocampus revealed a disease duration-related increase in neuronal cytoplasmic inclusions in the dentate gyrus and cornu ammonis regions 1 and 2 of patients with normal cognition. In contrast, such a correlation with disease duration was not found in patients with cognitive impairment. Compared to the patients with normal cognition, patients with memory impairment (pure memory impairment: n = 6; memory impairment + frontal-subcortical dysfunction: n = 12) had more neuronal cytoplasmic inclusions in the dentate gyrus, cornu ammonis regions 1-4 and entorhinal cortex. In the multiple system atrophy mixed pathological subgroup, which equally affects the striatonigral and olivopontocerebellar systems, patients with the same combination of memory impairment developed more neuronal inclusions in the dentate gyrus, cornu ammonis regions 1, 2 and 4, and the subiculum compared to patients with normal cognition. Using patients with normal cognition (n = 18), frontal-subcortical dysfunction (n = 12) and memory impairment + frontal-subcortical dysfunction (n = 18), we further investigated whether neuronal or glial cytoplasmic inclusions in the prefrontal, temporal and cingulate cortices or the underlying white matter might affect cognitive impairment in patients with multiple system atrophy. We also examined topographic correlates of frontal-subcortical dysfunction with other clinical symptoms. Although no differences in neuronal or glial cytoplasmic inclusions were identified between the groups in the regions examined, frontal release signs were found more commonly when patients developed frontal-subcortical dysfunction, indicating the involvement of the frontal-subcortical circuit in the pathogenesis of frontal-subcortical dysfunction. Here, investigating cognitive impairment in the largest number of pathologically proven multiple system atrophy cases described to date, we provide evidence that neuronal cytoplasmic inclusion burden in the hippocampus and parahippocampus is associated with the occurrence of memory impairment in multiple system atrophy. Further investigation is necessary to identify the underlying pathological basis of frontal-subcortical dysfunction in multiple system atrophy.
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Affiliation(s)
- Yasuo Miki
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK.,Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Sandrine C Foti
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Daniela Hansen
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Kate M Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Yasmine T Asi
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Eiki Tsushima
- Department of Comprehensive Rehabilitation Science, Hirosaki University Graduate School of Health Sciences, Hirosaki 036-8564, Japan
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK.,Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Niall Quinn
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Helen Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK.,Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK
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9
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Visanji NP, Lang AE, Kovacs GG. Beyond the synucleinopathies: alpha synuclein as a driving force in neurodegenerative comorbidities. Transl Neurodegener 2019; 8:28. [PMID: 31508228 PMCID: PMC6727368 DOI: 10.1186/s40035-019-0172-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023] Open
Abstract
The fundamental role that alpha-synuclein (aSyn) plays in the pathogenesis of neurodegenerative synucleinopathies, including Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy, is a well-accepted fact. A wealth of experimental evidence has linked this relatively small but ubiquitously expressed protein to a plethora of cytopathologic mechanisms and suggests that aSyn may be capable of seeding the progressive spread of synucleinopathy throughout the brain. Beyond the synucleinopathies, the abnormal deposition of aSyn is frequently seen in a variety of other neurodegenerative proteinopathies including Alzheimer’s disease. In spite of the fact that the frequency of concomitant aSyn pathology in these disorders is such that it can be considered the rule rather than the exception, the potential role that aSyn may have in these disorders has received relatively little attention. In this article we postulate that aSyn may in fact be a key protein in driving the pathogenic processes in neurodegenerative comorbidities. In addition to reviewing the frequency of concomitant deposition of aSyn in the neurodegenerative proteinopathies, we also consider our current understanding of the interaction of aSyn with other neurodegenerative disease-associated proteins, including tau, TDP-43, amyloid-β and prion protein, in the context of neuropathologic studies describing the anatomical sites of potential concomitant pathology. We conclude that a growing body of evidence, encompassing neuropathology studies in human brain, animal models of concomitant proteinopathies and studies employing sophisticated methods of probing protein-protein interaction, cumulatively suggest that aSyn is well positioned to exert a strong influence on the pathogenesis of the neurodegenerative comorbidities. We hope to stimulate research in this emerging field and consider that future studies exploring the contribution of aSyn to the pathogenic processes in neurodegenerative comorbidities may provide critical information pertaining to diagnosis and the development of vital disease modifying treatments for these devastating diseases.
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Affiliation(s)
- Naomi P Visanji
- 1Edmond J. Safra program in Parkinson's disease and the Morton and Gloria Shulman Movement disorders clinic, Toronto Western Hospital, Toronto, Ontario Canada
| | - Anthony E Lang
- 1Edmond J. Safra program in Parkinson's disease and the Morton and Gloria Shulman Movement disorders clinic, Toronto Western Hospital, Toronto, Ontario Canada
| | - Gabor G Kovacs
- 1Edmond J. Safra program in Parkinson's disease and the Morton and Gloria Shulman Movement disorders clinic, Toronto Western Hospital, Toronto, Ontario Canada.,2Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario Canada.,3Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, Ontario Canada
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10
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Kovacs GG. Molecular pathology of neurodegenerative diseases: principles and practice. J Clin Pathol 2019; 72:725-735. [PMID: 31395625 DOI: 10.1136/jclinpath-2019-205952] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022]
Abstract
Neurodegenerative diseases are characterised by selective dysfunction and progressive loss of synapses and neurons associated with pathologically altered proteins that deposit primarily in the human brain and spinal cord. Recent discoveries have identified a spectrum of distinct immunohistochemically and biochemically detectable proteins, which serve as a basis for protein-based disease classification. Diagnostic criteria have been updated and disease staging procedures have been proposed. These are based on novel concepts which recognise that (1) most of these proteins follow a sequential distribution pattern in the brain suggesting a seeding mechanism and cell-to-cell propagation; (2) some of the neurodegeneration-associated proteins can be detected in peripheral organs; and (3) concomitant presence of neurodegeneration-associated proteins is more the rule than the exception. These concepts, together with the fact that the clinical symptoms do not unequivocally reflect the molecular pathological background, place the neuropathological examination at the centre of requirements for an accurate diagnosis. The need for quality control in biomarker development, clinical and neuroimaging studies, and evaluation of therapy trials, as well as an increasing demand for the general public to better understand human brain disorders, underlines the importance for a renaissance of postmortem neuropathological studies at this time. This review summarises recent advances in neuropathological diagnosis and reports novel aspects of relevance for general pathological practice.
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Affiliation(s)
- Gabor G Kovacs
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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11
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Jellinger KA. Neuropathology and pathogenesis of extrapyramidal movement disorders: a critical update-I. Hypokinetic-rigid movement disorders. J Neural Transm (Vienna) 2019; 126:933-995. [PMID: 31214855 DOI: 10.1007/s00702-019-02028-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
Extrapyramidal movement disorders include hypokinetic rigid and hyperkinetic or mixed forms, most of them originating from dysfunction of the basal ganglia (BG) and their information circuits. The functional anatomy of the BG, the cortico-BG-thalamocortical, and BG-cerebellar circuit connections are briefly reviewed. Pathophysiologic classification of extrapyramidal movement disorder mechanisms distinguish (1) parkinsonian syndromes, (2) chorea and related syndromes, (3) dystonias, (4) myoclonic syndromes, (5) ballism, (6) tics, and (7) tremor syndromes. Recent genetic and molecular-biologic classifications distinguish (1) synucleinopathies (Parkinson's disease, dementia with Lewy bodies, Parkinson's disease-dementia, and multiple system atrophy); (2) tauopathies (progressive supranuclear palsy, corticobasal degeneration, FTLD-17; Guamian Parkinson-dementia; Pick's disease, and others); (3) polyglutamine disorders (Huntington's disease and related disorders); (4) pantothenate kinase-associated neurodegeneration; (5) Wilson's disease; and (6) other hereditary neurodegenerations without hitherto detected genetic or specific markers. The diversity of phenotypes is related to the deposition of pathologic proteins in distinct cell populations, causing neurodegeneration due to genetic and environmental factors, but there is frequent overlap between various disorders. Their etiopathogenesis is still poorly understood, but is suggested to result from an interaction between genetic and environmental factors. Multiple etiologies and noxious factors (protein mishandling, mitochondrial dysfunction, oxidative stress, excitotoxicity, energy failure, and chronic neuroinflammation) are more likely than a single factor. Current clinical consensus criteria have increased the diagnostic accuracy of most neurodegenerative movement disorders, but for their definite diagnosis, histopathological confirmation is required. We present a timely overview of the neuropathology and pathogenesis of the major extrapyramidal movement disorders in two parts, the first one dedicated to hypokinetic-rigid forms and the second to hyperkinetic disorders.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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12
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Clark IA, Vissel B. Neurodegenerative disease treatments by direct TNF reduction, SB623 cells, maraviroc and irisin and MCC950, from an inflammatory perspective – a Commentary. Expert Rev Neurother 2019; 19:535-543. [DOI: 10.1080/14737175.2019.1618710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- I A Clark
- Research School of Biology, Australian National University, Canberra, Australia
| | - B Vissel
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology, Sydney, Australia
- St. Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
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13
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Forrest SL, Crockford DR, Sizemova A, McCann H, Shepherd CE, McGeachie AB, Affleck AJ, Carew-Jones F, Bartley L, Kwok JB, Kim WS, Jary E, Tan RH, McGinley CV, Piguet O, Hodges JR, Kril JJ, Halliday GM. Coexisting Lewy body disease and clinical parkinsonism in frontotemporal lobar degeneration. Neurology 2019; 92:e2472-e2482. [PMID: 31019099 DOI: 10.1212/wnl.0000000000007530] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of clinically relevant multiple system atrophy (MSA) and Lewy body disease (LBD) pathologies in a large frontotemporal lobar degeneration (FTLD) cohort to determine if concomitant pathologies underlie the heterogeneity of clinical features. METHODS All prospectively followed FTLD-tau and FTLD-TDP cases held by the Sydney Brain Bank (n = 126) were screened for coexisting MSA and LBD (Braak ≥ stage IV) pathology. Relevant clinical (including family history) and genetic associations were determined. RESULTS MSA pathology was not identified in this series. Of the FTLD cohort, 9 cases had coexisting LBD ≥ Braak stage IV and were associated with different FTLD subtypes including Pick disease (n = 2), corticobasal degeneration (n = 2), progressive supranuclear palsy (n = 2), and TDP type A (n = 3). All FTLD-TDP cases with coexisting LBD had mutations in progranulin (n = 2) or an abnormal repeat expansion in C9orf72 (n = 1). All FTLD-tau cases with coexisting LBD were sporadic. The H1H1 MAPT haplotype was found in all cases that could be genotyped (n = 6 of 9). Seven cases presented with a predominant dementia disorder, 3 of which developed parkinsonism. Two cases presented with a movement disorder and developed dementia in their disease course. The age at symptom onset (62 ± 11 years) and disease duration (8 ± 5 years) in FTLD cases with coexisting LBD did not differ from pure FTLD or pure LBD cases in the brain bank. CONCLUSION Coexisting LBD in FTLD comprises a small proportion of cases but has implications for clinical and neuropathologic diagnoses and the identification of biomarkers.
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Affiliation(s)
- Shelley L Forrest
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Daniel R Crockford
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Anastasia Sizemova
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Heather McCann
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Claire E Shepherd
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Andrew B McGeachie
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Andrew J Affleck
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Francine Carew-Jones
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Lauren Bartley
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - John B Kwok
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Woojin Scott Kim
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Eve Jary
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Rachel H Tan
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Ciara V McGinley
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Olivier Piguet
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - John R Hodges
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Jillian J Kril
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia
| | - Glenda M Halliday
- From the Discipline of Pathology (S.L.F., D.R.C., A.S., C.V.M., J.J.K.), Central Clinical School (J.B.K., W.S.K., E.J., R.H.T., J.R.H., G.M.H.), Faculty of Medicine and Health, Brain and Mind Centre (J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), and School of Psychology (O.P.), The University of Sydney; Neuroscience Research Australia (H.M., C.E.S., A.B.M., A.J.A., F.C.-J., L.B., J.B.K., W.S.K., E.J., R.H.T., O.P., J.R.H., G.M.H.), Sydney; School of Medical Sciences (C.E.S., A.J.A., F.C.-J., J.B.K., W.S.K., R.H.T., G.M.H.), University of New South Wales; and ARC Centre of Excellence in Cognition and its Disorders (O.P., J.R.H.), Sydney, Australia.
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14
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Deep brain stimulation does not enhance neuroinflammation in multiple system atrophy. Neurobiol Dis 2018; 118:155-160. [PMID: 30026036 DOI: 10.1016/j.nbd.2018.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 01/25/2023] Open
Abstract
Slowly progressive, levodopa-responsive multiple system atrophy (MSA) may be misdiagnosed as Parkinson's disease (PD). Deep brain stimulation (DBS) is mostly ineffective in these patients and may even worsen the clinical course. Here we assessed whether neuropathological differences between patients with MSA who were treated with DBS of the subthalamic nucleus because of a misleading clinical presentation and typical disease cases may explain the more benign disease course of the former, and also the rapid clinical decline after surgery. The post-mortem assessment included the subthalamic nucleus, the globus pallidus, the thalamus and the putamen in five patients with MSA who received DBS and nine typical disease cases. There was no evidence for distinct neuroinflammatory profiles between both groups that could be related to the surgical procedure or that could explain the rapid clinical progression during DBS. Patients who received deep brain stimulation displayed a higher proportion of α-synuclein bearing neuronal cytoplasmic inclusions in the putamen compared with typical cases, while the number of surviving neurons was not different between groups. Our findings suggest that DBS does not induce neuroinflammatory changes in patients with MSA, at least several years after the surgery. We further hypothesize that the peculiar pattern of α-synuclein pathology may contribute to differences in the clinical phenotype, with a greater proportion of neuronal inclusions in the putamen being associated to a milder, "PD-like" phenotype with sustained levodopa response and slower disease progression.
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15
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Maeda N, Honda H, Suzuki SO, Fujii N, Kira JI, Iwaki T. Mitochondrial dysfunction and altered ribostasis in hippocampal neurons with cytoplasmic inclusions of multiple system atrophy. Neuropathology 2018; 38:361-371. [PMID: 29961958 DOI: 10.1111/neup.12482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022]
Abstract
Multiple system atrophy (MSA) is a sporadic adult-onset neurodegenerative disease. It has recently been shown that patients with MSA accompanied by cognitive decline display numerous neuronal cytoplasmic inclusions (NCIs) in the limbic neurons. We examined potential mechanisms underlying the formation of these NCIs by determining of mitochondrial function and statuses of RNA processing by analyzing 12 pathologically confirmed cases of MSA. Among them, four had cognitive impairment Semiquantitative evaluation using immunohistochemistry analyses revealed a significantly greater NCI burden in the hippocampal cornu ammonis 1 (CA1) subfield, subiculum, and amygdala in the cases with cognitive impairments compared with those without cognitive impairment. Immunofluorescent staining revealed that limbic neurons with NCIs often accelerated production of reactive oxygen species (ROS) and degraded mitochondrial quality control. Immunofluorescent staining also revealed that neurons with these NCIs translocated heterogeneous nuclear ribonucleoprotein A1 (HNRNPA1) from the nucleus and aggregated abnormally at the perinuclear rim. Since the NCIs in the hippocampal neurons of MSA with cognitive impairments were more numerous, the neuronal mitochondrial dysfunction and altered ribostasis observed in NCI formation may be involved in the hippocampal degeneration of MSA.
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Affiliation(s)
- Norihisa Maeda
- Department of Neuropathology, Kyushu University, Fukuoka, Japan
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Honda
- Department of Neuropathology, Kyushu University, Fukuoka, Japan
| | | | - Naoki Fujii
- Department of Neurology, Neuro-Muscular Center, National Omuta Hospital, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Iwaki
- Department of Neuropathology, Kyushu University, Fukuoka, Japan
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16
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Koga S, Dickson DW. Recent advances in neuropathology, biomarkers and therapeutic approach of multiple system atrophy. J Neurol Neurosurg Psychiatry 2018; 89:175-184. [PMID: 28860330 DOI: 10.1136/jnnp-2017-315813] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/07/2017] [Accepted: 08/16/2017] [Indexed: 01/20/2023]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterised by a variable combination of autonomic failure, levodopa-unresponsive parkinsonism, cerebellar ataxia and pyramidal symptoms. The pathological hallmark is the oligodendrocytic glial cytoplasmic inclusion (GCI) consisting of α-synuclein; therefore, MSA is included in the category of α-synucleinopathies. MSA has been divided into two clinicopathological subtypes: MSA with predominant parkinsonism and MSA with predominant cerebellar ataxia, which generally correlate with striatonigral degeneration and olivopontocerebellar atrophy, respectively. It is increasingly recognised, however, that clinical and pathological features of MSA are broader than previously considered.In this review, we aim to describe recent advances in neuropathology of MSA from a review of the literature and from information derived from review of nearly 200 definite MSA cases in the Mayo Clinic Brain Bank. In light of these new neuropathological findings, GCIs and neuronal cytoplasmic inclusions play an important role in clinicopathological correlates of MSA. We also focus on clinical diagnostic accuracy and differential diagnosis of MSA as well as candidate biomarkers. We also review some controversial topics in MSA. Cognitive impairment, which has been a non-supporting feature of MSA, is considered from both clinical and pathological perspectives. The cellular origin of α-synuclein in GCI and a 'prion hypothesis' are discussed. Finally, completed and ongoing clinical trials targeting disease modification, including immunotherapy, are summarised.
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Affiliation(s)
- Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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17
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Abstract
Multiple system atrophy (MSA) is an orphan, fatal, adult-onset neurodegenerative disorder of uncertain etiology that is clinically characterized by various combinations of parkinsonism, cerebellar, autonomic, and motor dysfunction. MSA is an α-synucleinopathy with specific glioneuronal degeneration involving striatonigral, olivopontocerebellar, and autonomic nervous systems but also other parts of the central and peripheral nervous systems. The major clinical variants correlate with the morphologic phenotypes of striatonigral degeneration (MSA-P) and olivopontocerebellar atrophy (MSA-C). While our knowledge of the molecular pathogenesis of this devastating disease is still incomplete, updated consensus criteria and combined fluid and imaging biomarkers have increased its diagnostic accuracy. The neuropathologic hallmark of this unique proteinopathy is the deposition of aberrant α-synuclein in both glia (mainly oligodendroglia) and neurons forming glial and neuronal cytoplasmic inclusions that cause cell dysfunction and demise. In addition, there is widespread demyelination, the pathogenesis of which is not fully understood. The pathogenesis of MSA is characterized by propagation of misfolded α-synuclein from neurons to oligodendroglia and cell-to-cell spreading in a "prion-like" manner, oxidative stress, proteasomal and mitochondrial dysfunction, dysregulation of myelin lipids, decreased neurotrophic factors, neuroinflammation, and energy failure. The combination of these mechanisms finally results in a system-specific pattern of neurodegeneration and a multisystem involvement that are specific for MSA. Despite several pharmacological approaches in MSA models, addressing these pathogenic mechanisms, no effective neuroprotective nor disease-modifying therapeutic strategies are currently available. Multidisciplinary research to elucidate the genetic and molecular background of the deleterious cycle of noxious processes, to develop reliable biomarkers and targets for effective treatment of this hitherto incurable disorder is urgently needed.
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18
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Xu Z, Arbizu J, Pavese N. PET Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:3-36. [DOI: 10.1016/bs.irn.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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19
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Kovacs GG, Kwong LK, Grossman M, Irwin DJ, Lee EB, Robinson JL, Suh E, Van Deerlin VM, Lee VM, Trojanowski JQ. Tauopathy with hippocampal 4-repeat tau immunoreactive spherical inclusions: a report of three cases. Brain Pathol 2017; 28:274-283. [PMID: 28019685 DOI: 10.1111/bpa.12482] [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: 10/20/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022] Open
Abstract
Tauopathies are a major group of neurodegenerative proteinopathies characterized by the accumulation of abnormal and hyperphosphorylated tau proteins in the brain. Tau pathology is characterized as 3R (repeat) or 4R predominant or mixed 3R and 4R type. Here we report three cases lacking mutations in the microtubule associated protein tau (MAPT) gene with unusual tau pathology. The age at onset and duration of illness, respectively, were 63 and 20 years (male), 67 and 5 years (female) and 72 and 20 years (female). The clinical presentation was compatible with a diagnosis of progressive supranuclear palsy (PSP) in two subjects and with cognitive decline in all three subjects. Common neuropathological features included neuronal loss in the hippocampus and dentate gyrus associated with spherical basophilic Pick body-like inclusions showing 4R tau immunoreactivity, which was supported by the detection of predominantly 4R tau species by Western blot examination. In addition, accumulation of tau immunoreactive argyrophilic astrocytes in the hippocampus and amygdala and oligodendroglial coiled bodies in the hippocampal white matter were observed. These morphologies appeared in combination with Alzheimer disease-related pathology and subcortical tau pathology compatible with PSP. Together with a single case report in the literature, our observations on these three cases expand the spectrum of previously described tauopathies. We suggest that this tauopathy variant with hippocampal 4R tau immunoreactive spherical inclusions might contribute to the cognitive deficits in the patients reported here. The precise definition of the clinicopathological relevance of these unusual tau pathologies merits further study.
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Affiliation(s)
- Gabor G Kovacs
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Linda K Kwong
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
| | - John L Robinson
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
| | - Eunran Suh
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
| | - Vivianna M Van Deerlin
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
| | - Virginia M Lee
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Institute on Aging and Department of Pathology & Laboratory Medicine, Philadelphia, PA
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20
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Abstract
In 2017, it is two hundred years since James Parkinson provided the first complete clinical description of the disease named after him, fifty years since the introduction of high-dose D,L-DOPA treatment and twenty years since α-synuclein aggregation came to the fore. In 1998, multiple system atrophy joined Parkinson's disease and dementia with Lewy bodies as the third major synucleinopathy. Here we review our work, which led to the identification of α-synuclein in Lewy bodies, Lewy neurites and Papp-Lantos bodies, as well as what has happened since. Some of the experiments described were carried out in collaboration with ML Schmidt, JQ Trojanowski and VMY Lee.
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Affiliation(s)
| | - Ross Jakes
- MRC Laboratory of Molecular Biology, Cambridge, UK
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21
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Koga S, Parks A, Uitti RJ, van Gerpen JA, Cheshire WP, Wszolek ZK, Dickson DW. Profile of cognitive impairment and underlying pathology in multiple system atrophy. Mov Disord 2016; 32:405-413. [PMID: 27859650 DOI: 10.1002/mds.26874] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The objectives of this study were to elucidate any potential association between α-synuclein pathology and cognitive impairment and to determine the profile of cognitive impairment in multiple system atrophy (MSA) patients. To do this, we analyzed the clinical and pathologic features in autopsy-confirmed MSA patients. METHODS We retrospectively reviewed medical records, including neuropsychological test data, in 102 patients with autopsy-confirmed MSA in the Mayo Clinic brain bank. The burden of glial cytoplasmic inclusions and neuronal cytoplasmic inclusions were semiquantitatively scored in the limbic regions and middle frontal gyrus. We also assessed concurrent pathologies potentially causing dementia including Alzheimer's disease, hippocampal sclerosis, and cerebrovascular pathology. RESULTS Of 102 patients, 33 (32%) were documented to have cognitive impairment. Those that received objective testing, deficits primarily in processing speed and attention/executive functions were identified, which suggests a frontal-subcortical pattern of dysfunction. Of these 33 patients with cognitive impairment, 8 patients had concurrent pathologies of dementia. MSA patients with cognitive impairment had a greater burden of neuronal cytoplasmic inclusions in the dentate gyrus than patients without cognitive impairment, both including and excluding patients with concurrent pathologies of dementia. CONCLUSIONS The cognitive deficits observed in this study were more evident on neuropsychological assessment than with cognitive screens. Based on these findings, we recommend that clinicians consider more in-depth neuropsychological assessments if patients with MSA present with cognitive complaints. Although we did not identify the correlation between cognitive deficits and responsible neuroanatomical regions, a greater burden of neuronal cytoplasmic inclusions in the limbic regions was associated with cognitive impairment in MSA. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Adam Parks
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jay A van Gerpen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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22
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Jellinger KA, Wenning GK. Multiple system atrophy: pathogenic mechanisms and biomarkers. J Neural Transm (Vienna) 2016; 123:555-72. [PMID: 27098666 DOI: 10.1007/s00702-016-1545-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/31/2016] [Indexed: 12/13/2022]
Abstract
Multiple system atrophy (MSA) is a unique proteinopathy that differs from other α-synucleinopathies since the pathological process resulting from accumulation of aberrant α-synuclein (αSyn) involves the oligodendroglia rather than neurons, although both pathologies affect multiple parts of the brain, spinal cord, autonomic and peripheral nervous system. Both the etiology and pathogenesis of MSA are unknown, although animal models have provided insight into the basic molecular changes of this disorder. Accumulation of aberrant αSyn in oligodendroglial cells and preceded by relocation of p25α protein from myelin to oligodendroglia results in the formation of insoluble glial cytoplasmic inclusions that cause cell dysfunction and demise. These changes are associated with proteasomal, mitochondrial and lipid transport dysfunction, oxidative stress, reduced trophic transport, neuroinflammation and other noxious factors. Their complex interaction induces dysfunction of the oligodendroglial-myelin-axon-neuron complex, resulting in the system-specific pattern of neurodegeneration characterizing MSA as a synucleinopathy with oligodendroglio-neuronopathy. Propagation of modified toxic αSyn species from neurons to oligodendroglia by "prion-like" transfer and its spreading associated with neuronal pathways result in a multi-system involvement. No reliable biomarkers are currently available for the clinical diagnosis and prognosis of MSA. Multidisciplinary research to elucidate the genetic and molecular background of the deleterious cycle of noxious processes, to develop reliable diagnostic biomarkers and to deliver targets for effective treatment of this hitherto incurable disorder is urgently needed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
| | - Gregor K Wenning
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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23
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Homma T, Mochizuki Y, Komori T, Isozaki E. Frequent globular neuronal cytoplasmic inclusions in the medial temporal region as a possible characteristic feature in multiple system atrophy with dementia. Neuropathology 2016; 36:421-431. [DOI: 10.1111/neup.12289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/03/2016] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Taku Homma
- Department of Pathology; Tokyo Metropolitan Neurological Hospital; Fuchu Tokyo Japan
- Department of Pathology; Nihon University School of Medicine; Itabashi Tokyo Japan
| | - Yoko Mochizuki
- Department of Pathology; Tokyo Metropolitan Neurological Hospital; Fuchu Tokyo Japan
- Department of Neurology; Tokyo Metropolitan Kita Medical and Rehabilitation Centre for the Disabled; Kita-ku Tokyo Japan
| | - Takashi Komori
- Department of Pathology; Tokyo Metropolitan Neurological Hospital; Fuchu Tokyo Japan
| | - Eiji Isozaki
- Department of Neurology; Tokyo Metropolitan Neurological Hospital, Tokyo Metropolitan Neurological Hospital; Fuchu-shi Tokyo Japan
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24
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Kovacs GG. Molecular Pathological Classification of Neurodegenerative Diseases: Turning towards Precision Medicine. Int J Mol Sci 2016; 17:ijms17020189. [PMID: 26848654 PMCID: PMC4783923 DOI: 10.3390/ijms17020189] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 02/06/2023] Open
Abstract
Neurodegenerative diseases (NDDs) are characterized by selective dysfunction and loss of neurons associated with pathologically altered proteins that deposit in the human brain but also in peripheral organs. These proteins and their biochemical modifications can be potentially targeted for therapy or used as biomarkers. Despite a plethora of modifications demonstrated for different neurodegeneration-related proteins, such as amyloid-β, prion protein, tau, α-synuclein, TAR DNA-binding protein 43 (TDP-43), or fused in sarcoma protein (FUS), molecular classification of NDDs relies on detailed morphological evaluation of protein deposits, their distribution in the brain, and their correlation to clinical symptoms together with specific genetic alterations. A further facet of the neuropathology-based classification is the fact that many protein deposits show a hierarchical involvement of brain regions. This has been shown for Alzheimer and Parkinson disease and some forms of tauopathies and TDP-43 proteinopathies. The present paper aims to summarize current molecular classification of NDDs, focusing on the most relevant biochemical and morphological aspects. Since the combination of proteinopathies is frequent, definition of novel clusters of patients with NDDs needs to be considered in the era of precision medicine. Optimally, neuropathological categorizing of NDDs should be translated into in vivo detectable biomarkers to support better prediction of prognosis and stratification of patients for therapy trials.
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Affiliation(s)
- Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, AKH 4J, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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