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Bentivenga GM, Baiardi S, Mastrangelo A, Ruggeri E, Mammana A, Ticca A, Rossi M, Capellari S, Parchi P. Clinical, neuropathological, and molecular characteristics of rapidly progressive dementia with Lewy bodies: a distinct clinicopathological entity? Alzheimers Res Ther 2024; 16:201. [PMID: 39256877 DOI: 10.1186/s13195-024-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND The term rapidly progressive dementia (RPD) with Lewy bodies (rpDLB) is used for DLB patients who develop a rapidly progressive neurological syndrome and have reduced survival. Here, we characterise the clinical, neuropathological, and molecular characteristics of a large rpDLB neuropathological series. METHODS We included all RPD patients with a disease duration < 4 years submitted to our prion disease referral centre between 2003 and 2022 who showed Lewy body pathology (LBP) in limbic or neocortical stages as primary neuropathological diagnosis, had no systemic condition justifying the rapid deterioration and were previously neurologically unimpaired. Clinical features were retrieved and compared with Creutzfeldt-Jakob disease (CJD) and rapidly progressive Alzheimer's disease (rpAD) cohorts. Neuropathological and genetic (whole exome sequencing, APOE genotyping, and C9orf72 repeat expansion analysis) characteristics of rpDLB patients were systematically investigated. We scored semi-quantitatively the LBP load and performed a α-synuclein (αSyn) RT-QuIC seeding amplification assay (SAA) on cerebrospinal fluid (CSF) and tenfold serially diluted brain homogenates from different brain areas in rpDLB patients and typical long-lasting Lewy body disease (LBD) with dementia patients as control group. RESULTS RpDLB patients were older (p = 0.047) and presented more cognitive fluctuations (p = 0.005), visual hallucinations (p = 0.020), neuropsychiatric symptoms (p = 0.006) and seizures (p = 0.032), and fewer cerebellar (p < 0.001) and visual (p = 0.004) signs than CJD ones. Delirium onset was more common than in both CJD (p < 0.001) and rpAD (p = 0.008). Atypical LBD signs (pyramidal, myoclonus, akinetic mutism) were common. All tested patients were positive by CSF αSyn SAA. Concomitant pathologies were common, with only four cases showing relatively "pure" LBP. LBP load and αSyn seeding activity measured through αSyn RT-QuIC SAA were not significantly different between rpDLB patients and typical LBD. We found a likely pathogenic variant in GBA in one patient. CONCLUSIONS Our results indicate that: 1) rpDLB exhibits a distinct clinical signature (2) CSF αSyn SAA is a reliable diagnostic test; 3) rpDLB is a heterogeneous neuropathological entity that can be underlain by both widespread pure LBP, or multiple copathologies 4) rpDLB is likely not sustained by distinct αSyn conformational strains; 5) genetic defects may, at least occasionally, contribute to the poor prognosis in these patients.
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Affiliation(s)
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Edoardo Ruggeri
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Alice Ticca
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy.
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Ingrassia L, Boluda S, Potier MC, Haïk S, Jimenez G, Kar A, Racoceanu D, Delatour B, Stimmer L. Automated deep learning segmentation of neuritic plaques and neurofibrillary tangles in Alzheimer disease brain sections using a proprietary software. J Neuropathol Exp Neurol 2024; 83:752-762. [PMID: 38812098 PMCID: PMC11333827 DOI: 10.1093/jnen/nlae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Neuropathological diagnosis of Alzheimer disease (AD) relies on semiquantitative analysis of phosphorylated tau-positive neurofibrillary tangles (NFTs) and neuritic plaques (NPs), without consideration of lesion heterogeneity in individual cases. We developed a deep learning workflow for automated annotation and segmentation of NPs and NFTs from AT8-immunostained whole slide images (WSIs) of AD brain sections. Fifteen WSIs of frontal cortex from 4 biobanks with varying tissue quality, staining intensity, and scanning formats were analyzed. We established an artificial intelligence (AI)-driven iterative procedure to improve the generation of expert-validated annotation datasets for NPs and NFTs thereby increasing annotation quality by >50%. This strategy yielded an expert-validated annotation database with 5013 NPs and 5143 NFTs. We next trained two U-Net convolutional neural networks for detection and segmentation of NPs or NFTs, achieving high accuracy and consistency (mean Dice similarity coefficient: NPs, 0.77; NFTs, 0.81). The workflow showed high generalization performance across different cases. This study serves as a proof-of-concept for the utilization of proprietary image analysis software (Visiopharm) in the automated deep learning segmentation of NPs and NFTs, demonstrating that AI can significantly improve the annotation quality of complex neuropathological features and enable the creation of highly precise models for identifying these markers in AD brain sections.
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Affiliation(s)
- Lea Ingrassia
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Susana Boluda
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department of Neuropathology Raymond Escourolle, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Marie-Claude Potier
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Stéphane Haïk
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
- AP-HP, Cellule Nationale de Référence des MCJ, Salpêtrière Hospital, Paris, France
| | - Gabriel Jimenez
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Anuradha Kar
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Daniel Racoceanu
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Benoît Delatour
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Lev Stimmer
- Paris Brain Institute (ICM), Centre National de la Recherche Scientifique (CNRS) UMR 7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
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3
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Adams JW, Kirsch D, Calderazzo SM, Tuz-Zahra F, Tripodis Y, Mez J, Alosco ML, Alvarez VE, Huber BR, Kubilus C, Cormier KA, Nicks R, Uretsky M, Nair E, Kuzyk E, Aytan N, Cherry JD, Crary JF, Daneshvar DH, Nowinski CJ, Goldstein LE, Dwyer B, Katz DI, Cantu RC, Stern RA, McKee AC, Stein TD. Substantia Nigra Pathology, Contact Sports Play, and Parkinsonism in Chronic Traumatic Encephalopathy. JAMA Neurol 2024; 81:916-924. [PMID: 39008284 PMCID: PMC11250391 DOI: 10.1001/jamaneurol.2024.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/21/2024] [Indexed: 07/16/2024]
Abstract
Importance Parkinsonism is associated with traumatic brain injury and chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repetitive head impact (RHI) exposure, but the neuropathologic substrates that underlie parkinsonism in individuals with CTE are yet to be defined. Objective To evaluate the frequency of parkinsonism in individuals with CTE and the association of RHI and neuropathologic substrates with parkinsonism in these individuals. Design, Setting, and Participants This cross-sectional study included brain donors with neuropathologically diagnosed CTE without other significant neurodegenerative disease and with information on parkinsonism from the Understanding Neurologic Injury and Traumatic Encephalopathy brain bank between July 2015 and May 2022. Exposure Years of contact sports participation as a proxy for RHI. Main Outcomes and Measures The main outcomes were frequency of parkinsonism in individuals with CTE and associations between (1) RHI with substantia nigra (SN) Lewy bodies (LBs) and neurofibrillary tangles (NFTs); (2) LBs, NFTs, and arteriolosclerosis with SN neuronal loss; and (3) SN neuronal loss, LBs, NFTs, and arteriolosclerosis with parkinsonism, tested by age-adjusted logistic regressions. Results Of 481 male brain donors with neuropathologically diagnosed CTE, parkinsonism occurred frequently in individuals with CTE (119 [24.7%]; 362 [75.3%] did not have parkinsonism). Participants with parkinsonism had a higher mean (SD) age at death (71.5 [13.0] years) than participants without parkinsonism (54.1 [19.3] years) (P < .001) and higher rates of dementia (104 [87.4%] vs 105 [29.0%]), visual hallucinations (45 [37.8%] vs 51 [14.1%]), and probable rapid eye movement sleep behavior disorder (52 [43.7%] vs 58 [16.0%]) (P < .001 for all). Participants with parkinsonism had a more severe CTE stage (eg, stage IV: 35 [29.4%] vs 39 [10.8%]) and nigral pathology than those without parkinsonism (NFTs: 50 of 117 [42.7%] vs 103 of 344 [29.9%]; P = .01; neuronal loss: 61 of 117 [52.1%] vs 59 of 344 [17.1%]; P < .001; and LBs: 28 of 116 [24.1%] vs 20 of 342 [5.8%]; P < .001). Years of contact sports participation were associated with SN NFTs (adjusted odds ratio [AOR], 1.04; 95% CI, 1.00-1.07; P = .03) and neuronal loss (AOR, 1.05; 95% CI, 1.01-1.08; P = .02). Nigral neuronal loss (AOR, 2.61; 95% CI, 1.52-4.47; P < .001) and LBs (AOR, 2.29; 95% CI, 1.15-4.57; P = .02) were associated with parkinsonism. However, SN neuronal loss was associated with SN LBs (AOR, 4.48; 95% CI, 2.25-8.92; P < .001), SN NFTs (AOR, 2.51; 95% CI, 1.52-4.15; P < .001), and arteriolosclerosis (AOR, 2.27; 95% CI, 1.33-3.85; P = .002). In American football players, regression analysis demonstrated that SN NFTs and neuronal loss mediated the association between years of play and parkinsonism in the context of CTE (β, 0.012; 95% CI, 0.001-0.038). Conclusions and Relevance In this cross-sectional study of contact sports athletes with CTE, years of contact sports participation were associated with SN tau pathology and neuronal loss, and these pathologies were associated with parkinsonism. Repetitive head impacts may incite neuropathologic processes that lead to symptoms of parkinsonism in individuals with CTE.
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Affiliation(s)
- Jason W. Adams
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosciences, University of California, San Diego School of Medicine, La Jolla
| | - Daniel Kirsch
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Samantha M. Calderazzo
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Fatima Tuz-Zahra
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Victor E. Alvarez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Caroline Kubilus
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kerry A. Cormier
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Raymond Nicks
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Evan Nair
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Eva Kuzyk
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Nurgul Aytan
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jonathan D. Cherry
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - John F. Crary
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, Massachusetts
| | - Christopher J. Nowinski
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
| | - Lee E. Goldstein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Douglas I. Katz
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
| | - Robert A. Stern
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
| | - Ann C. McKee
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
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Jicha GA, Tucker TC, Arnold SM, Nelson PT. Cancer research provides a model for advancing clinical trials in dementia in the era of disease-modifying Alzheimer's-type dementia therapies. Alzheimers Res Ther 2024; 16:184. [PMID: 39164754 PMCID: PMC11337902 DOI: 10.1186/s13195-024-01532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024]
Abstract
Dementia and cancer are multifactorial, widely-feared, age-associated clinical syndromes that are increasing in prevalence. There have been major breakthroughs in clinical cancer research leading to some effective treatments, whereas the field of dementia has achieved comparatively limited success in clinical research. The lessons of cancer research may help those in the dementia research field in confronting some of the dilemmas faced when the clinical care regimen is not entirely safe or efficacious. Cancer clinical trials have assumed that untreated individuals with cancer are at high risk for morbidity and mortality after primary diagnoses. Thus, patients deserve a choice of clinical interventions, either standard of care or experimental, even if the benefits are not certain and the therapy's side effects are potentially severe. The prognosis for many individuals at risk for dementia carries a correspondingly high level of risk for both mortality and severe morbidity, particularly if one focuses on "health-span" rather than lifespan. Caregivers and patients can be strongly impacted by dementia and the many troubling associated symptoms that often go well beyond amnesia. Polls, surveys, and a literature on "dementia worry" strongly underscore that the public fears dementia. While there are institutional and industry hurdles that complicate enrollment in randomized trials, the gravity of the future morbidity and mortality inherent in a dementia diagnosis may require reconsideration of the current protective stance that limits the freedom of at-risk individuals (either symptomatic or asymptomatic) to participate and potentially benefit from ongoing clinical research. There is also evidence from both cancer and dementia research that individuals enrolled in the placebo arms of clinical trials have unexpectedly good outcomes, indicating that participation in clinical trial can have medical benefits to enrollees. To highlight aspects of cancer clinical research that may inform present and future dementia clinical research, this review highlights three main themes: the risk of side effects should be weighed against the often dire consequences of non-treatment; the desirability of long-term incremental (rather than "magic bullet") clinical advances; and, the eventual importance of combination therapies, reflecting that the dementia clinical syndrome has many underlying biological pathways.
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Affiliation(s)
- Gregory A Jicha
- Department of Neurology, University of Kentucky, Lexington, KY, USA
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA
| | - Thomas C Tucker
- College of Public Health, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Susanne M Arnold
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Peter T Nelson
- Department of Pathology and Laboratory Medicine, University of Kentucky, Rm 575 Lee Todd Bldg, 789 S. Limestone Ave, Lexington, KY, 40536, USA.
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA.
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Shin C, Kim SI, Park SH, Kim JM, Lee JY, Chung SJ, Kim JW, Ahn TB, Park KW, Shin JH, Lee CY, Lee HJ, Kong SH, Suh YS, Kim HJ, Yang HK, Jeon B. Diagnostic accuracy and predictors of alpha-synuclein accumulation in the gastrointestinal tract of Parkinson's disease. NPJ Parkinsons Dis 2024; 10:155. [PMID: 39147801 PMCID: PMC11327357 DOI: 10.1038/s41531-024-00766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024] Open
Abstract
The only characteristic of alpha-synuclein (AS) accumulation in the gastrointestinal (GI) tract of Parkinson's disease (PD) found in pathological studies is the "rostrocaudal gradient," which describes the more frequent presence of AS accumulation in the upper GI tract than in the lower GI tract. This study aimed to determine the diagnostic accuracy and identify predictors of AS accumulation in the GI tract of PD patients. The frequency of AS accumulation in the GI tract was compared between PD patients (N = 97) who underwent radical GI surgery for cancer and individually matched controls (N = 94). We evaluated AS accumulation in the neural structures using phosphorylated AS immunohistochemistry. A multivariable logistic regression analysis was conducted to determine the predictors of AS accumulation in the GI tract of PD patients. The frequency of AS accumulation was significantly higher in PD patients (75.3%) than in controls (8.5%, p-value < 0.001). The sensitivity and specificity of the full-layer evaluation were 75.3% and 91.5%, respectively. When the evaluation was confined to the mucosal/submucosal layer, the sensitivity and specificity were 46.9% and 94.7%, respectively. The rostrocaudal gradient of AS accumulation was found in PD patients. The duration from symptom onset to surgery was significantly longer in PD patients with AS accumulation (4.9 ± 4.9 years) than in PD patients without AS accumulation (1.8 ± 4.1 years, p-value = 0.005). Both disease duration and rostrocaudal gradient independently predicted the presence of AS accumulation in the GI tract of PD patients. Our study suggests PD-related AS accumulation in the GI tract follows a temporally increasing but spatially static progression pattern.
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Affiliation(s)
- Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, 20, Bodeum 7-ro, Sejong-si, Republic of Korea
| | - Seong-Ik Kim
- Department of Pathology, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Republic of Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Kye Won Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
- Pacific Parkinson Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Chan Young Lee
- Department of Neurology, Ewha Womans University Mokdong Hospital, 1071 Annyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Chung-ang University Health Care System Hyundae Hospital, Namyangju-si, Gyeonggi-do, Republic of Korea.
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Leak RK, Clark RN, Abbas M, Xu F, Brodsky JL, Chen J, Hu X, Luk KC. Current insights and assumptions on α-synuclein in Lewy body disease. Acta Neuropathol 2024; 148:18. [PMID: 39141121 PMCID: PMC11324801 DOI: 10.1007/s00401-024-02781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/28/2024] [Accepted: 08/04/2024] [Indexed: 08/15/2024]
Abstract
Lewy body disorders are heterogeneous neurological conditions defined by intracellular inclusions composed of misshapen α-synuclein protein aggregates. Although α-synuclein aggregates are only one component of inclusions and not strictly coupled to neurodegeneration, evidence suggests they seed the propagation of Lewy pathology within and across cells. Genetic mutations, genomic multiplications, and sequence polymorphisms of the gene encoding α-synuclein are also causally linked to Lewy body disease. In nonfamilial cases of Lewy body disease, the disease trigger remains unidentified but may range from industrial/agricultural toxicants and natural sources of poisons to microbial pathogens. Perhaps due to these peripheral exposures, Lewy inclusions appear at early disease stages in brain regions connected with cranial nerves I and X, which interface with inhaled and ingested environmental elements in the nasal or gastrointestinal cavities. Irrespective of its identity, a stealthy disease trigger most likely shifts soluble α-synuclein (directly or indirectly) into insoluble, cross-β-sheet aggregates. Indeed, β-sheet-rich self-replicating α-synuclein multimers reside in patient plasma, cerebrospinal fluid, and other tissues, and can be subjected to α-synuclein seed amplification assays. Thus, clinicians should be able to capitalize on α-synuclein seed amplification assays to stratify patients into potential responders versus non-responders in future clinical trials of α-synuclein targeted therapies. Here, we briefly review the current understanding of α-synuclein in Lewy body disease and speculate on pathophysiological processes underlying the potential transmission of α-synucleinopathy across the neuraxis.
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Affiliation(s)
- Rehana K Leak
- Graduate School of Pharmaceutical Sciences, Duquesne University, 418C Mellon Hall, 913 Bluff Street, Pittsburgh, PA, 15219, USA.
| | - Rachel N Clark
- Graduate School of Pharmaceutical Sciences, Duquesne University, 418C Mellon Hall, 913 Bluff Street, Pittsburgh, PA, 15219, USA
| | - Muslim Abbas
- Graduate School of Pharmaceutical Sciences, Duquesne University, 418C Mellon Hall, 913 Bluff Street, Pittsburgh, PA, 15219, USA
| | - Fei Xu
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey L Brodsky
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jun Chen
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA
| | - Xiaoming Hu
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelvin C Luk
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Pennsylvania, PA, USA
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Coughlin DG, MacLeod KR, Middleton JS, Bozoki AC, Galvin JE, Irwin DJ, Lippa CF, Litvan I, Lopez OL, Berman S, Tsuang DW, Zabetian CP, Honig LS, Marder KS, Fleisher JE, Sabbagh M, Wint D, Taylor AS, Bekris L, Leverenz JB, Galasko D. Association of CSF α-Synuclein Seeding Amplification Assay Results With Clinical Features of Possible and Probable Dementia With Lewy Bodies. Neurology 2024; 103:e209656. [PMID: 39013126 PMCID: PMC11238940 DOI: 10.1212/wnl.0000000000209656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/28/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The clinical diagnosis of dementia with Lewy bodies (DLB) depends on identifying significant cognitive decline accompanied by core features of parkinsonism, visual hallucinations, cognitive fluctuations, and REM sleep behavior disorder (RBD). Hyposmia is one of the several supportive features. α-Synuclein seeding amplification assays (αSyn-SAAs) may enhance diagnostic accuracy by detecting pathologic αSyn seeds in CSF. In this study, we examine how different clinical features associate with CSF αSyn-SAA positivity in a large group of clinically diagnosed participants with DLB. METHODS Cross-sectional and longitudinal CSF samples from the multicentered observational cohort study of the DLB Consortium and similar studies within the Parkinson's Disease Biomarker Program, contributed by academic medical centers in the United States, underwent αSyn-SAA testing. Participants included those clinically diagnosed with DLB and 2 control cohorts. Associations between core DLB features and olfaction with αSyn-SAA positivity were evaluated using logistic regression. RESULTS CSF samples from 191 participants diagnosed with DLB (mean age 69.9 ± 6.8, 15% female), 50 age-matched and sex-matched clinical control participants, and 49 younger analytical control participants were analyzed. Seventy-two percent (137/191) of participants with DLB had positive αSyn-SAAs vs 4% of the control groups. Among participants with DLB, those who were αSyn-SAA-positive had lower Montreal Cognitive Assessment scores (18.8 ± 5.7 vs 21.2 ± 5.2, p = 0.01), had worse parkinsonism on the Movement Disorders Society Unified Parkinson's Disease Rating Scale part III (33.8 ± 15.1 vs 25.6 ± 16.4, p = 0.001), were more likely to report RBD (114/133 [86%] vs 33/53 [62%], p < 0.0001), and had worse hyposmia on the University of Pennsylvania Smell Identification Test (UPSIT) (94/105 [90%] below 15th percentile vs 14/44 [32%], p < 0.0001). UPSIT percentile had the highest area under the curve (0.87, 95% CI 0.81-0.94) in predicting αSyn-SAA positivity and participants scoring at or below the 15th percentile of age and sex normative values had 18.3 times higher odds (95% CI 7.52-44.6) of having a positive αSyn-SAA test. Among 82 participants with longitudinal CSF samples, 81 (99%) had the same αSyn-SAA result for initial and follow-up specimens. DISCUSSION A substantial proportion of clinically diagnosed participants with DLB had negative αSyn-SAA results. Hyposmia was the strongest clinical predictor of αSyn-SAA positivity. Hyposmia and αSyn-SAA may have utility in improving the diagnostic assessment of individuals with potential DLB. CLASSIFICATION OF EVIDENCE This study provided Class III evidence that CSF αSyn-SAA distinguishes patients with clinically diagnosed DLB from normal controls.
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Affiliation(s)
- David G Coughlin
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Karen R MacLeod
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - John S Middleton
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Andrea C Bozoki
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - James E Galvin
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - David J Irwin
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Carol F Lippa
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Irene Litvan
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Oscar L Lopez
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Sarah Berman
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Debby W Tsuang
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Cyrus P Zabetian
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Lawrence S Honig
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Karen S Marder
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Jori E Fleisher
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Marwan Sabbagh
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Dylan Wint
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Angela S Taylor
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Lynn Bekris
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - James B Leverenz
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
| | - Douglas Galasko
- From the Department of Neurosciences (D.G.C., I.L., D.G.), University of California San Diego; Clinical Laboratory (K.R.M., J.S.M.), Amprion Inc., La Jolla, CA; Department of Neurology (A.C.B.), University of North Carolina, Chapel Hill, NC; Department of Neurology (J.E.G.), University of Miami, FL; Department of Neurology (D.J.I.), University of Pennsylvania, Philadelphia; Department of Neurology (C.F.L.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (O.L.L., S.B.), University of Pittsburgh, PA; Department of Neurology (D.W.T., C.P.Z.), University of Washington and Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA; Department of Neurology (L.S.H., K.S.M.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (J.E.F.), Rush University, Chicago, IL; Department of Neurology (M.S.), Barrow Neurological Institute, AZ; Department of Neurology (D.W., L.B., J.B.L.), Cleveland Clinic, OH; and Lewy Body Dementia Association (A.S.T.), Lilburn, GA
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Daniels AJ, McDade E, Llibre-Guerra JJ, Xiong C, Perrin RJ, Ibanez L, Supnet-Bell C, Cruchaga C, Goate A, Renton AE, Benzinger TL, Gordon BA, Hassenstab J, Karch C, Popp B, Levey A, Morris J, Buckles V, Allegri RF, Chrem P, Berman SB, Chhatwal JP, Farlow MR, Fox NC, Day GS, Ikeuchi T, Jucker M, Lee JH, Levin J, Lopera F, Takada L, Sosa AL, Martins R, Mori H, Noble JM, Salloway S, Huey E, Rosa-Neto P, Sánchez-Valle R, Schofield PR, Roh JH, Bateman RJ. 15 Years of Longitudinal Genetic, Clinical, Cognitive, Imaging, and Biochemical Measures in DIAN. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.08.24311689. [PMID: 39148846 PMCID: PMC11326320 DOI: 10.1101/2024.08.08.24311689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
This manuscript describes and summarizes the Dominantly Inherited Alzheimer Network Observational Study (DIAN Obs), highlighting the wealth of longitudinal data, samples, and results from this human cohort study of brain aging and a rare monogenic form of Alzheimer's disease (AD). DIAN Obs is an international collaborative longitudinal study initiated in 2008 with support from the National Institute on Aging (NIA), designed to obtain comprehensive and uniform data on brain biology and function in individuals at risk for autosomal dominant AD (ADAD). ADAD gene mutations in the amyloid protein precursor (APP), presenilin 1 (PSEN1), or presenilin 2 (PSEN2) genes are deterministic causes of ADAD, with virtually full penetrance, and a predictable age at symptomatic onset. Data and specimens collected are derived from full clinical assessments, including neurologic and physical examinations, extensive cognitive batteries, structural and functional neuro-imaging, amyloid and tau pathological measures using positron emission tomography (PET), flurordeoxyglucose (FDG) PET, cerebrospinal fluid and blood collection (plasma, serum, and whole blood), extensive genetic and multi-omic analyses, and brain donation upon death. This comprehensive evaluation of the human nervous system is performed longitudinally in both mutation carriers and family non-carriers, providing one of the deepest and broadest evaluations of the human brain across decades and through AD progression. These extensive data sets and samples are available for researchers to address scientific questions on the human brain, aging, and AD.
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Affiliation(s)
- Alisha J. Daniels
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Eric McDade
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | | | - Chengjie Xiong
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Richard J. Perrin
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Laura Ibanez
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | | | - Carlos Cruchaga
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Alison Goate
- Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Alan E. Renton
- Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | - Brian A. Gordon
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Jason Hassenstab
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Celeste Karch
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Brent Popp
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Allan Levey
- Goizueta Alzheimer’s Disease Research Center, Emory University, Atlanta, GA, USA
| | - John Morris
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | - Virginia Buckles
- Washington University School of Medicine, St Louis, St Louis, MO, USA
| | | | - Patricio Chrem
- Institute of Neurological Research FLENI, Buenos Aires, Argentina
| | | | - Jasmeer P. Chhatwal
- Massachusetts General and Brigham & Women’s Hospitals, Harvard Medical School, Boston MA, USA
| | | | - Nick C. Fox
- UK Dementia Research Institute at University College London, London, United Kingdom
- University College London, London, United Kingdom
| | | | - Takeshi Ikeuchi
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Mathias Jucker
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | | | - Johannes Levin
- DZNE, German Center for Neurodegenerative Diseases, Munich, Germany
- Ludwig-Maximilians-Universität München, Munich, Germany
| | | | | | - Ana Luisa Sosa
- Instituto Nacional de Neurologia y Neurocirugla Innn, Mexico City, Mexico
| | - Ralph Martins
- Edith Cowan University, Western Australia, Australia
| | | | - James M. Noble
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, and GH Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Edward Huey
- Brown University, Butler Hospital, Providence, RI, USA
| | - Pedro Rosa-Neto
- Centre de Recherche de L’hopital Douglas and McGill University, Montreal, Quebec
| | - Raquel Sánchez-Valle
- Hospital Clínic de Barcelona. IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Peter R. Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jee Hoon Roh
- Korea University, Korea University Anam Hospital, Seoul, South Korea
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Kon T, Forrest SL, Lee S, Li J, Chasiotis H, Nassir N, Uddin MJ, Lang AE, Kovacs GG. SNCA and TPPP transcripts increase in oligodendroglial cytoplasmic inclusions in multiple system atrophy. Neurobiol Dis 2024; 198:106551. [PMID: 38839023 DOI: 10.1016/j.nbd.2024.106551] [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: 03/07/2024] [Revised: 05/16/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024] Open
Abstract
Multiple system atrophy (MSA) is characterized by glial cytoplasmic inclusions (GCIs) containing aggregated α-synuclein (α-syn) in oligodendrocytes. The origin of α-syn accumulation in GCIs is unclear, in particular whether abnormal α-syn aggregates result from the abnormal elevation of endogenous α-syn expression in MSA or ingested from the neuronal source. Tubulin polymerization promoting protein (TPPP) has been reported to play a crucial role in developing GCI pathology. Here, the total cell body, nucleus, and cytoplasmic area density of SNCA and TPPP transcripts in neurons and oligodendrocytes with and without various α-syn pathologies in the pontine base in autopsy cases of MSA (n = 4) and controls (n = 2) were evaluated using RNAscope with immunofluorescence. Single-nucleus RNA-sequencing data for TPPP was evaluated using control frontal cortex (n = 3). SNCA and TPPP transcripts were present in the nucleus and cytoplasm of oligodendrocytes in both controls and diseased, with higher area density in GCIs and glial nuclear inclusions in MSA. Area densities of SNCA and TPPP transcripts were lower in neurons showing cytoplasmic inclusions in MSA. Indeed, TPPP transcripts were unexpectedly found in neurons, while the anti-TPPP antibody failed to detect immunoreactivity. Single-nucleus RNA-sequencing revealed significant TPPP transcript expression predominantly in oligodendrocytes, but also in excitatory and inhibitory neurons. This study addressed the unclear origin of accumulated α-syn in GCIs, proposing that the elevation of SNCA transcripts may supply templates for misfolded α-syn. In addition, the parallel behavior of TPPP and SNCA transcripts in GCI development highlights their potential synergistic contribution to inclusion formation. In conclusion, this study advances our understanding of MSA pathogenesis, offers insights into the dynamics of SNCA and TPPP transcripts in inclusion formation, and proposes regulating their transcripts for future molecular therapy to MSA.
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Affiliation(s)
- Tomoya Kon
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Shelley L Forrest
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Dementia Research Centre, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
| | - Seojin Lee
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Jun Li
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada.
| | - Helen Chasiotis
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada.
| | - Nasna Nassir
- Centre for Applied and Translational Genomics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Mohammed J Uddin
- Centre for Applied and Translational Genomics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates; GenomeArc Inc, Toronto, ON, Canada.
| | - Anthony E Lang
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Edmund J Safra Program in Parkinson's Disease and Rossy Progressive Supranuclear Palsy Centre, Toronto Western Hospital, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Dementia Research Centre, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Edmund J Safra Program in Parkinson's Disease and Rossy Progressive Supranuclear Palsy Centre, Toronto Western Hospital, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
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10
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Wisse LEM, Spotorno N, Rossi M, Grothe MJ, Mammana A, Tideman P, Baiardi S, Strandberg O, Ticca A, van Westen D, Mattsson-Carlgren N, Palmqvist S, Stomrud E, Parchi P, Hansson O. MRI Signature of α-Synuclein Pathology in Asymptomatic Stages and a Memory Clinic Population. JAMA Neurol 2024:2821935. [PMID: 39068668 DOI: 10.1001/jamaneurol.2024.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Importance The lack of an in vivo measure for α-synuclein (α-syn) pathology until recently has limited thorough characterization of its brain atrophy pattern, especially during early disease stages. Objective To assess the association of state-of-the-art cerebrospinal fluid (CSF) seed amplification assays (SAA) α-syn positivity (SAA α-syn+) with magnetic resonance imaging (MRI) structural measures, across the continuum from clinically unimpaired (CU) to cognitively impaired (CI) individuals, in 3 independent cohorts, and separately in CU and CI individuals, the latter reflecting a memory clinic population. Design, Setting, and Participants Cross-sectional data were used from the Swedish BioFINDER-2 study (inclusion, 2017-2023) as the discovery cohort and the Swedish BioFINDER-1 study (inclusion, 2007-2015) and Alzheimer's Disease Neuroimaging Initiative (ADNI; inclusion 2005-2022) as replication cohorts. All cohorts are from multicenter studies, but the BioFINDER cohorts used 1 MRI scanner. CU and CI individuals fulfilling inclusion criteria and without missing data points in relevant metrics were included in the study. All analyses were performed from 2023 to 2024. Exposures Presence of α-syn pathology, estimated by baseline CSF SAA α-syn. Main Outcomes and Measures The primary outcomes were cross-sectional structural MRI measures either through voxel-based morphometry (VBM) or regions of interest (ROI) including an automated pipeline for cholinergic basal forebrain nuclei CH4/4p (nucleus basalis of Meynert [NBM]) and CH1/2/3. Secondary outcomes were domain-specific cross-sectional cognitive measures. Analyses were adjusted for CSF biomarkers of Alzheimer pathology. Results A total of 2961 participants were included in this study: 1388 (mean [SD] age, 71 [10] years; 702 female [51%]) from the BioFINDER-2 study, 752 (mean [SD] age, 72 [6] years; 406 female [54%]) from the BioFINDER-1 study, and 821 (mean [SD] age, 75 [8] years; 449 male [55%]) from ADNI. In the BioFINDER-2 study, VBM analyses in the whole cohort revealed a specific association between SAA α-syn+ and the cholinergic NBM, even when adjusting for Alzheimer copathology. ROI-based analyses in the BioFINDER-2 study focused on regions involved in the cholinergic system and confirmed that SAA α-syn+ was indeed independently associated with smaller NBM (β = -0.271; 95% CI, -0.399 to -0.142; P <.001) and CH1/2/3 volumes (β = -0.227; 95% CI, -0.377 to -0.076; P =.02). SAA α-syn+ was also independently associated with smaller NBM volumes in the separate CU (β = -0.360; 95% CI, -0.603 to -0.117; P =.03) and CI (β = -0.251; 95% CI, -0.408 to -0.095; P =.02) groups. Overall, the association between SAA α-syn+ and NBM volume was replicated in the BioFINDER-1 study and ADNI cohort. In CI individuals, NBM volumes partially mediated the association of SAA α-syn+ with attention/executive impairments in all cohorts (BioFINDER-2, β = -0.017; proportion-mediated effect, 7%; P =.04; BioFINDER-1, β = -0.096; proportion-mediated effect, 19%; P =.04; ADNI, β = -0.061; proportion-mediated effect, 20%; P =.007). Conclusions and Relevance In this cohort study, SAA α-syn+ was consistently associated with NBM atrophy already during asymptomatic stages. Further, in memory clinic CI populations, SAA α-syn+ was associated with NBM atrophy, which partially mediated α-syn-induced attention/executive impairment.
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Affiliation(s)
- Laura E M Wisse
- Department of Clinical Science Lund, Lund University, Lund, Sweden
| | - Nicola Spotorno
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michel J Grothe
- Reina Sofia Alzheimer Center, CIEN Foundation, Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigacion Biomédica en Red Sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pontus Tideman
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Alice Ticca
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Danielle van Westen
- Department of Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden
- Image and Function, Skåne University Hospital, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
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11
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Gal J, Vary C, Gartner CA, Jicha GA, Abner EL, Ortega YS, Choucair I, Wilcock DM, Nelson RS, Nelson PT. Exploratory Mass Spectrometry of Cerebrospinal Fluid from Persons with Autopsy-Confirmed LATE-NC. J Mol Neurosci 2024; 74:65. [PMID: 38987361 DOI: 10.1007/s12031-024-02239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
Common neuropathologies associated with dementia include Alzheimer's disease neuropathologic change (ADNC) and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). Biofluid proteomics provides a window into the pathobiology of dementia and the information from biofluid tests may help guide clinical management. Participants (n = 29) had been autopsied and had antemortem CSF draws in a longitudinal cohort of older adults at the University of Kentucky AD Research Center. Cases were designated as LATE-NC + if they had LATE-NC stage > 1 (n = 9); the remaining 20 cases were designated LATE-NC-. This convenience sample of CSF specimens was analyzed in two separate processes: From one group, aliquots were depleted of highly abundant proteins using affinity spin columns. Tryptic digests of sample proteins were subjected to liquid chromatographic separation and mass spectrometry. Relative quantification was performed using Sciex software. Peptides referent to a total of 949 proteins were identified in the samples depleted of abundant proteins, and 820 different proteins were identified in the non-depleted samples. When the Bonferroni/false-discovery statistical correction was applied to account for having made multiple comparison tests, only 4 proteins showed differential expression (LATE-NC + vs LATE-NC-) in the non-depleted samples (RBP4, MIF, IGHG3, and ITM2B). Post hoc western blots confirmed that RBP4 expression was higher in the LATE-NC + cases at the group level. In summary, an exploratory assessment of proteomes of autopsy-confirmed LATE-NC and non-LATE-NC CSF did not demonstrate a clear-cut proteomic fingerprint that distinguished the two groups. There was, however, an increase in RBP4 protein levels in CSF from LATE-NC cases.
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Affiliation(s)
- Jozsef Gal
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky, Lexington, KY, USA
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Calvin Vary
- Center for Molecular Medicine, MaineHealth Institute for Research, Scarborough, ME, USA
| | - Carlos A Gartner
- Center for Molecular Medicine, MaineHealth Institute for Research, Scarborough, ME, USA
| | - Gregory A Jicha
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Erin L Abner
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA
- School of Public Health, University of Kentucky, Lexington, KY, USA
| | - Yulica S Ortega
- Center for Molecular Medicine, MaineHealth Institute for Research, Scarborough, ME, USA
| | - Ibrahim Choucair
- Department of Pathology and Laboratory Medicine, University of Kentucky, Rm 575 Todd Building, Lexington, KY, 40536, USA
| | - Donna M Wilcock
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA
- University of Indiana, Indianapolis, IN, USA
| | | | - Peter T Nelson
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA.
- Department of Pathology and Laboratory Medicine, University of Kentucky, Rm 575 Todd Building, Lexington, KY, 40536, USA.
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12
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Mastenbroek SE, Vogel JW, Collij LE, Serrano GE, Tremblay C, Young AL, Arce RA, Shill HA, Driver-Dunckley ED, Mehta SH, Belden CM, Atri A, Choudhury P, Barkhof F, Adler CH, Ossenkoppele R, Beach TG, Hansson O. Disease progression modelling reveals heterogeneity in trajectories of Lewy-type α-synuclein pathology. Nat Commun 2024; 15:5133. [PMID: 38879548 PMCID: PMC11180185 DOI: 10.1038/s41467-024-49402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/04/2024] [Indexed: 06/19/2024] Open
Abstract
Lewy body (LB) diseases, characterized by the aggregation of misfolded α-synuclein proteins, exhibit notable clinical heterogeneity. This may be due to variations in accumulation patterns of LB neuropathology. Here we apply a data-driven disease progression model to regional neuropathological LB density scores from 814 brain donors with Lewy pathology. We describe three inferred trajectories of LB pathology that are characterized by differing clinicopathological presentation and longitudinal antemortem clinical progression. Most donors (81.9%) show earliest pathology in the olfactory bulb, followed by accumulation in either limbic (60.8%) or brainstem (21.1%) regions. The remaining donors (18.1%) initially exhibit abnormalities in brainstem regions. Early limbic pathology is associated with Alzheimer's disease-associated characteristics while early brainstem pathology is associated with progressive motor impairment and substantial LB pathology outside of the brain. Our data provides evidence for heterogeneity in the temporal spread of LB pathology, possibly explaining some of the clinical disparities observed in Lewy body disease.
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Affiliation(s)
- Sophie E Mastenbroek
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands.
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Jacob W Vogel
- Department of Clinical Sciences Malmö, Faculty of Medicine, SciLifeLab, Lund University, Lund, Sweden
| | - Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | - Alexandra L Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | - Holly A Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Erika D Driver-Dunckley
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Mayo Clinic, Scottsdale, AZ, USA
| | - Shyamal H Mehta
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, AZ, USA
- Department of Neurology, Center for Mind/Brain Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | | | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
- Institutes of Neurology & Healthcare Engineering, University College London, London, UK
| | - Charles H Adler
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Mayo Clinic, Scottsdale, AZ, USA
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam University Medical Center location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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13
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Ghanem A, Berry DS, Cosentino S, Faust PL, Louis ED. Subjective Sleep Disturbance and Lewy Pathology: Data from a Cohort of Essential Tremor Brain Donors. NEURODEGENER DIS 2024; 24:6-15. [PMID: 38861955 PMCID: PMC11257784 DOI: 10.1159/000539032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Sleep disturbances have been associated with essential tremor (ET). However, their pathophysiological underpinnings remain unknown. In this exploratory study, we examined the association between subjective sleep disturbances and the presence of Lewy pathology (LP) on postmortem brain examination in ET cases. METHODS Fifty-two ET cases enrolled in a prospective, longitudinal study were assessed over an average period of 42 months. Cases completed the Pittsburgh Sleep Quality Index (PSQI), which yields seven component scores (e.g., sleep quality, sleep latency). For each component score, we calculated the difference between the last score and the baseline score. Brains were harvested at death. Each had a complete neuropathological assessment, including extensive α-synuclein immunostaining. We examined the associations between baseline PSQI scores and the change in PSQI scores (last - first), and LP on postmortem brain examination. RESULTS ET cases had a mean baseline age of 87.1 ± 4.8 years. LP was observed in 12 (23.1%) of 52 cases; in 7 of these 12, LP was observed in the locus coeruleus (LC). Change in time needed to fall asleep (last - first sleep latency component score) was associated with presence of LP on postmortem brain examination - greater increase in sleep latency was associated with higher odds of LP (odds ratio = 2.98, p = 0.02). The greatest increase in sleep latency was observed in cases with LP in the LC (p = 0.04). CONCLUSION In ET cases, increases in sleep latency over time could be a marker of underlying LP, especially in the LC.
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Affiliation(s)
- Ali Ghanem
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diane S. Berry
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Phyllis L. Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Elan D. Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Kmiecik MJ, Micheletti S, Coker D, Heilbron K, Shi J, Stagaman K, Filshtein Sonmez T, Fontanillas P, Shringarpure S, Wetzel M, Rowbotham HM, Cannon P, Shelton JF, Hinds DA, Tung JY, Holmes MV, Aslibekyan S, Norcliffe-Kaufmann L. Genetic analysis and natural history of Parkinson's disease due to the LRRK2 G2019S variant. Brain 2024; 147:1996-2008. [PMID: 38804604 PMCID: PMC11146432 DOI: 10.1093/brain/awae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 05/29/2024] Open
Abstract
The LRRK2 G2019S variant is the most common cause of monogenic Parkinson's disease (PD); however, questions remain regarding the penetrance, clinical phenotype and natural history of carriers. We performed a 3.5-year prospective longitudinal online study in a large number of 1286 genotyped LRRK2 G2019S carriers and 109 154 controls, with and without PD, recruited from the 23andMe Research Cohort. We collected self-reported motor and non-motor symptoms every 6 months, as well as demographics, family histories and environmental risk factors. Incident cases of PD (phenoconverters) were identified at follow-up. We determined lifetime risk of PD using accelerated failure time modelling and explored the impact of polygenic risk on penetrance. We also computed the genetic ancestry of all LRRK2 G2019S carriers in the 23andMe database and identified regions of the world where carrier frequencies are highest. We observed that despite a 1 year longer disease duration (P = 0.016), LRRK2 G2019S carriers with PD had similar burden of motor symptoms, yet significantly fewer non-motor symptoms including cognitive difficulties, REM sleep behaviour disorder (RBD) and hyposmia (all P-values ≤ 0.0002). The cumulative incidence of PD in G2019S carriers by age 80 was 49%. G2019S carriers had a 10-fold risk of developing PD versus non-carriers. This rose to a 27-fold risk in G2019S carriers with a PD polygenic risk score in the top 25% versus non-carriers in the bottom 25%. In addition to identifying ancient founding events in people of North African and Ashkenazi descent, our genetic ancestry analyses infer that the G2019S variant was later introduced to Spanish colonial territories in the Americas. Our results suggest LRRK2 G2019S PD appears to be a slowly progressive predominantly motor subtype of PD with a lower prevalence of hyposmia, RBD and cognitive impairment. This suggests that the current prodromal criteria, which are based on idiopathic PD, may lack sensitivity to detect the early phases of LRRK2 PD in G2019S carriers. We show that polygenic burden may contribute to the development of PD in the LRRK2 G2019S carrier population. Collectively, the results should help support screening programmes and candidate enrichment strategies for upcoming trials of LRRK2 inhibitors in early-stage disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Paul Cannon
- 23andMe, Inc., Research, Sunnyvale, CA 94086, USA
| | | | | | - Joyce Y Tung
- 23andMe, Inc., Research, Sunnyvale, CA 94086, USA
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15
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Chatterjee M, Özdemir S, Fritz C, Möbius W, Kleineidam L, Mandelkow E, Biernat J, Doğdu C, Peters O, Cosma NC, Wang X, Schneider LS, Priller J, Spruth E, Kühn AA, Krause P, Klockgether T, Vogt IR, Kimmich O, Spottke A, Hoffmann DC, Fliessbach K, Miklitz C, McCormick C, Weydt P, Falkenburger B, Brandt M, Guenther R, Dinter E, Wiltfang J, Hansen N, Bähr M, Zerr I, Flöel A, Nestor PJ, Düzel E, Glanz W, Incesoy E, Bürger K, Janowitz D, Perneczky R, Rauchmann BS, Hopfner F, Wagemann O, Levin J, Teipel S, Kilimann I, Goerss D, Prudlo J, Gasser T, Brockmann K, Mengel D, Zimmermann M, Synofzik M, Wilke C, Selma-González J, Turon-Sans J, Santos-Santos MA, Alcolea D, Rubio-Guerra S, Fortea J, Carbayo Á, Lleó A, Rojas-García R, Illán-Gala I, Wagner M, Frommann I, Roeske S, Bertram L, Heneka MT, Brosseron F, Ramirez A, Schmid M, Beschorner R, Halle A, Herms J, Neumann M, Barthélemy NR, Bateman RJ, Rizzu P, Heutink P, Dols-Icardo O, Höglinger G, Hermann A, Schneider A. Plasma extracellular vesicle tau and TDP-43 as diagnostic biomarkers in FTD and ALS. Nat Med 2024; 30:1771-1783. [PMID: 38890531 PMCID: PMC11186765 DOI: 10.1038/s41591-024-02937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/21/2024] [Indexed: 06/20/2024]
Abstract
Minimally invasive biomarkers are urgently needed to detect molecular pathology in frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). Here, we show that plasma extracellular vesicles (EVs) contain quantifiable amounts of TDP-43 and full-length tau, which allow the quantification of 3-repeat (3R) and 4-repeat (4R) tau isoforms. Plasma EV TDP-43 levels and EV 3R/4R tau ratios were determined in a cohort of 704 patients, including 37 genetically and 31 neuropathologically proven cases. Diagnostic groups comprised patients with TDP-43 proteinopathy ALS, 4R tauopathy progressive supranuclear palsy, behavior variant FTD (bvFTD) as a group with either tau or TDP-43 pathology, and healthy controls. EV tau ratios were low in progressive supranuclear palsy and high in bvFTD with tau pathology. EV TDP-43 levels were high in ALS and in bvFTD with TDP-43 pathology. Both markers discriminated between the diagnostic groups with area under the curve values >0.9, and between TDP-43 and tau pathology in bvFTD. Both markers strongly correlated with neurodegeneration, and clinical and neuropsychological markers of disease severity. Findings were replicated in an independent validation cohort of 292 patients including 34 genetically confirmed cases. Taken together, the combination of EV TDP-43 levels and EV 3R/4R tau ratios may aid the molecular diagnosis of FTD, FTD spectrum disorders and ALS, providing a potential biomarker to monitor disease progression and target engagement in clinical trials.
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Grants
- R01 AG080470 NIA NIH HHS
- This study was funded by a grant from the German Federal Ministry of Education and Research, BMBF, grant identifier 01KX2230 to AS. AS received funding from the Federal Ministry of Education and Research, BMBF (DESCARTES consortium, grant identifier 01EK2102A, and PREPARE, grant identifier 01GP2213A), Verum Foundation and BMBF/NUM (UTN consortium). A.S. received funding from Cure Alzheimer’s Fund and from Netzwerke NRW iBehave consortium. A.S. is member of the DFG-funded Cluster of Excellence ImmunoSensation2 - EXC2151 – 390873048. A.S. and A.R. were supported by La Fundación Reina Sofía, proyecto “MANOLO BARRÓS”. A.S. received funding by the Target ALS Foundation (TALS).
- MC received funding from Deutsche Demenzhilfe DZNE Innovative Minds Program and the Manfred-Strohscheer-Foundation.
- L.K. received funding from the Hertie Foundation, Hertie Network of Excellence in Clinical Neurosciences and from the JPND grant 01ED2007B (PreAdapt).
- Cure Alzheimer Foundation, Katharina Hard Foundation
- NRW Netzwerke iBehave
- DFG, Neuro-AcSis
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Affiliation(s)
| | - Selcuk Özdemir
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Genetics, Atatürk University, Erzurum, Turkey
| | - Christian Fritz
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Cluster of Excellence 'Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells' (MBExC), University of Göttingen, Göttingen, Germany
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Eckhard Mandelkow
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Jacek Biernat
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Cem Doğdu
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | | | - Xiao Wang
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | | | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich School of Medicine, Munich, Germany
- University of Edinburgh and UK DRI, Edinburgh, UK
| | - Eike Spruth
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Ina R Vogt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Okka Kimmich
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | | | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Carolin Miklitz
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Cornelia McCormick
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Patrick Weydt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Björn Falkenburger
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Moritz Brandt
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - René Guenther
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisabeth Dinter
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Niels Hansen
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Mathias Bähr
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
- Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), University Medical Center Göttingen, Göttingen, Germany
| | - Inga Zerr
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Peter J Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Queensland Brain Institute, University of Queensland and Mater Public Hospital, Brisbane, Queensland, Australia
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Clinic for Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Enise Incesoy
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Magdeburg, Magdeburg, Germany
| | - Katharina Bürger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Boris S Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Neuroradiology, University Hospital LMU, Munich, Germany
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Franziska Hopfner
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Olivia Wagemann
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Stefan Teipel
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Kilimann
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Doreen Goerss
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Johannes Prudlo
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Thomas Gasser
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - David Mengel
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Milan Zimmermann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Carlo Wilke
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Judit Selma-González
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Janina Turon-Sans
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Miguel Angel Santos-Santos
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Sara Rubio-Guerra
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Álvaro Carbayo
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Ricardo Rojas-García
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Ingo Frommann
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lucas Bertram
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Michael T Heneka
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg
- Department of Infectious Diseases and Immunology, University of Massachussetss Medical School, North Worcester, MA, USA
| | | | - Alfredo Ramirez
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry, University of Cologne, Cologne, Germany
- Department of Psychiatry, Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Rudi Beschorner
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Annett Halle
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Jochen Herms
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Manuela Neumann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Nicolas R Barthélemy
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Patrizia Rizzu
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Peter Heutink
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Oriol Dols-Icardo
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Andreas Hermann
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Translational Neurodegeneration Section 'Albrecht Kossel' and Center for Transdisciplinary Neurosciences, University Medical Center Rostock, Rostock, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany.
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16
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Wyman-Chick KA, Chaudhury P, Bayram E, Abdelnour C, Matar E, Chiu SY, Ferreira D, Hamilton CA, Donaghy PC, Rodriguez-Porcel F, Toledo JB, Habich A, Barrett MJ, Patel B, Jaramillo-Jimenez A, Scott GD, Kane JPM. Differentiating Prodromal Dementia with Lewy Bodies from Prodromal Alzheimer's Disease: A Pragmatic Review for Clinicians. Neurol Ther 2024; 13:885-906. [PMID: 38720013 PMCID: PMC11136939 DOI: 10.1007/s40120-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer's disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)-parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.
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Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center and Center for Memory and Aging, Department of Neurology, HealthPartners/Park Nicollet, Bloomington, USA.
| | - Parichita Chaudhury
- Cleo Roberts Memory and Movement Center, Banner Sun Health Research Institute, Sun City, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, University of California San Diego, San Diego, USA
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shannon Y Chiu
- Department of Neurology, Mayo Clinic Arizona, Phoenix, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- Department of Radiology, Mayo Clinic Rochester, Rochester, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jon B Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Matthew J Barrett
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, USA
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, USA
- Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, USA
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- School of Medicine, Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Gregory D Scott
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, USA
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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17
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Brody EM, Seo Y, Suh E, Amari N, Hartstone WG, Skrinak RT, Zhang H, Diaz-Ortiz ME, Weintraub D, Tropea TF, Van Deerlin VM, Chen-Plotkin AS. GPNMB Biomarker Levels in GBA1 Carriers with Lewy Body Disorders. Mov Disord 2024; 39:1065-1070. [PMID: 38610104 PMCID: PMC11209810 DOI: 10.1002/mds.29773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The GPNMB single-nucleotide polymorphism rs199347 and GBA1 variants both associate with Lewy body disorder (LBD) risk. GPNMB encodes glycoprotein nonmetastatic melanoma protein B (GPNMB), a biomarker for GBA1-associated Gaucher's disease. OBJECTIVE The aim of this study was to determine whether GPNMB levels (1) differ in LBD with and without GBA1 variants and (2) associate with rs199347 genotype. METHODS We quantified GPNMB levels in plasma and cerebrospinal fluid (CSF) from 124 individuals with LBD with one GBA1 variant (121 plasma, 14 CSF), 631 individuals with LBD without GBA1 variants (626 plasma, 41 CSF), 9 neurologically normal individuals with one GBA1 variant (plasma), and 2 individuals with two GBA1 variants (plasma). We tested for associations between GPNMB levels and rs199347 or GBA1 status. RESULTS GPNMB levels associate with rs199347 genotype in plasma (P = 0.022) and CSF (P = 0.007), but not with GBA1 status. CONCLUSIONS rs199347 is a protein quantitative trait locus for GPNMB. GPNMB levels are unaltered in individuals carrying one GBA1 variant. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eliza M. Brody
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yunji Seo
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - EunRan Suh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noor Amari
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Whitney G. Hartstone
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R. Tyler Skrinak
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hanwen Zhang
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Maria E. Diaz-Ortiz
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel Weintraub
- Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas F. Tropea
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vivianna M. Van Deerlin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alice S. Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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18
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Aslam S, Manfredsson F, Stokes A, Shill H. "Advanced" Parkinson's disease: A review. Parkinsonism Relat Disord 2024; 123:106065. [PMID: 38418318 DOI: 10.1016/j.parkreldis.2024.106065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
There is no consensus driven definition of "advanced" Parkinson's disease (APD) currently. APD has been described in terms of emergence of specific clinical features and clinical milestones of the disease e.g., motor fluctuations, time to increasing falls, emergence of cognitive decline, etc. The pathological burden of disease has been used to characterize various stages of the disease. Imaging markers have been associated with various motor and nonmotor symptoms of advancing disease. In this review, we present an overview of clinical, pathologic, and imaging markers of APD. We also propose a model of disease definition involving longitudinal assessments of these markers as well as quality of life metrics to better understand and predict disease progression in those with Parkinson's disease.
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Affiliation(s)
- Sana Aslam
- Barrow Neurological Institute, Phoenix, AZ, United States.
| | | | - Ashley Stokes
- Barrow Neurological Institute, Phoenix, AZ, United States
| | - Holly Shill
- Barrow Neurological Institute, Phoenix, AZ, United States
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19
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Taghdiri F, Khodadadi M, Sadia N, Mushtaque A, Scott OFT, Hirsch‐Reinhagen V, Tator C, Wennberg R, Kovacs GG, Tartaglia MC. Unusual combinations of neurodegenerative pathologies with chronic traumatic encephalopathy (CTE) complicates clinical prediction of CTE. Eur J Neurol 2024; 31:e16259. [PMID: 38404144 PMCID: PMC11235773 DOI: 10.1111/ene.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND PURPOSE Chronic traumatic encephalopathy (CTE) has gained widespread attention due to its association with multiple concussions and contact sports. However, CTE remains a postmortem diagnosis, and the link between clinical symptoms and CTE pathology is poorly understood. This study aimed to investigate the presence of copathologies and their impact on symptoms in former contact sports athletes. METHODS This was a retrospective case series design of 12 consecutive cases of former contact sports athletes referred for autopsy. Analyses are descriptive and include clinical history as well as the pathological findings of the autopsied brains. RESULTS All participants had a history of multiple concussions, and all but one had documented progressive cognitive, psychiatric, and/or motor symptoms. The results showed that 11 of the 12 participants had evidence of CTE in the brain, but also other copathologies, including different combinations of tauopathies, and other rare entities. CONCLUSIONS The heterogeneity of symptoms after repetitive head injuries and the diverse pathological combinations accompanying CTE complicate the prediction of CTE in clinical practice. It is prudent to consider the possibility of multiple copathologies when clinically assessing patients with repetitive head injuries, especially as they age, and attributing neurological or cognitive symptoms solely to presumptive CTE in elderly patients should be discouraged.
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Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Mozhgan Khodadadi
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Nusrat Sadia
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Asma Mushtaque
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Olivia F. T. Scott
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Veronica Hirsch‐Reinhagen
- Division of NeuropathologyVancouver General HospitalVancouverBritish ColumbiaCanada
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Charles Tator
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Richard Wennberg
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Laboratory Medicine ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders ClinicToronto Western HospitalTorontoOntarioCanada
| | - M. Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
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20
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Liou JJ, Li J, Berardinelli J, Jin H, Santini T, Noh J, Farhat N, Wu M, Aizenstein H, Mettenburg JM, Yong W, Head E, Ikonomovic M, Ibrahim T, Kofler J. Correlating hippocampal and amygdala volumes with neuropathological burden in neurodegenerative diseases using 7T postmortem MRI. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307354. [PMID: 38798514 PMCID: PMC11118630 DOI: 10.1101/2024.05.15.24307354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Numerous research groups worldwide have focused on postmortem imaging to bridge the resolution gap between clinical neuroimaging and neuropathology data. We developed a standardized protocol for brain embedding, imaging, and processing, facilitating alignment between antemortem MRI, postmortem MRI, and pathology to observe brain atrophy and structural damage progression over time. Using 7T postmortem ex vivo MRI, we explore the potential correlation of amygdala and hippocampal atrophy with neuropathological burden in both Down syndrome (DS) and Alzheimer's disease (AD) cohorts. Using 7T postmortem ex vivo MRI scans from 66 cases (12 DS and 54 AD) alongside a subset of antemortem scans (n=17), we correlated manually segmented hippocampal and amygdala volumes, adjusted for age, sex, and ApoE4 status, with pathological indicators such as Thal phase, Braak stage, limbic-predominant age-related TDP-43 encephalopathy (LATE) stage, hippocampal sclerosis (HS), and Lewy body (LB) stage. A significant correlation was observed between postmortem and antemortem volumes for the hippocampus, but a similar trend observed for the amygdala did not reach statistical significance. DS individuals exhibited notably smaller hippocampal and amygdala volumes compared to AD subjects. In DS, lower hippocampal and amygdala volumes correlated with more severe Braak stage, without significant associations with Thal phase. LATE and HS pathologies were uncommon in DS cases but trended toward smaller hippocampal volumes. In AD, lower hippocampal volume associated with dementia duration, advanced Thal phase, Braak stage, LATE stage, and HS presence, whereas reduced amygdala volume correlated mainly with severe LATE stage and HS, but not with Thal or Braak stages. No significant LB correlation was detected in either DS or AD cohorts. Hippocampal volume in AD appears influenced by both AD and LATE pathologies, while amygdala volume seems primarily influenced by LATE. In DS, smaller hippocampal volume, relative to AD, appears primarily influenced by tau pathology.
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21
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Kannarkat GT, Zack R, Skrinak RT, Morley JF, Davila-Rivera R, Arezoumandan S, Dorfmann K, Luk K, Wolk DA, Weintraub D, Tropea TF, Lee EB, Xie SX, Chandrasekaran G, Lee VMY, Irwin D, Akhtar RS, Chen-Plotkin AS. α-Synuclein Conformations in Plasma Distinguish Parkinson's Disease from Dementia with Lewy Bodies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.07.593056. [PMID: 38765963 PMCID: PMC11100683 DOI: 10.1101/2024.05.07.593056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Spread and aggregation of misfolded α-synuclein (aSyn) within the brain is the pathologic hallmark of Lewy body diseases (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies (DLB). While evidence exists for multiple aSyn protein conformations, often termed "strains" for their distinct biological properties, it is unclear whether PD and DLB result from aSyn strain differences, and biomarkers that differentiate PD and DLB are lacking. Moreover, while pathological forms of aSyn have been detected outside the brain ( e.g., in skin, gut, blood), the functional significance of these peripheral aSyn species is unclear. Here, we developed assays using monoclonal antibodies selective for two different aSyn species generated in vitro - termed Strain A and Strain B - and used them to evaluate human brain tissue, cerebrospinal fluid (CSF), and plasma, through immunohistochemistry, enzyme-linked immunoassay, and immunoblotting. Surprisingly, we found that plasma aSyn species detected by these antibodies differentiated individuals with PD vs. DLB in a discovery cohort (UPenn, n=235, AUC 0.83) and a multi-site replication cohort (Parkinson's Disease Biomarker Program, or PDBP, n=200, AUC 0.72). aSyn plasma species detected by the Strain A antibody also predicted rate of cognitive decline in PD. We found no evidence for aSyn strains in CSF, and ability to template aSyn fibrillization differed for species isolated from plasma vs. brain, and in PD vs. DLB. Taken together, our findings suggest that aSyn conformational differences may impact clinical presentation and cortical spread of pathological aSyn. Moreover, the enrichment of these aSyn strains in plasma implicates a non-central nervous system source.
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22
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Sánchez-Juan P, Valeriano-Lorenzo E, Ruiz-González A, Pastor AB, Rodrigo Lara H, López-González F, Zea-Sevilla MA, Valentí M, Frades B, Ruiz P, Saiz L, Burgueño-García I, Calero M, del Ser T, Rábano A. Serum GFAP levels correlate with astrocyte reactivity, post-mortem brain atrophy and neurofibrillary tangles. Brain 2024; 147:1667-1679. [PMID: 38634687 PMCID: PMC11068326 DOI: 10.1093/brain/awae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/28/2023] [Accepted: 01/21/2024] [Indexed: 04/19/2024] Open
Abstract
Glial fibrillary acidic protein (GFAP), a proxy of astrocyte reactivity, has been proposed as biomarker of Alzheimer's disease. However, there is limited information about the correlation between blood biomarkers and post-mortem neuropathology. In a single-centre prospective clinicopathological cohort of 139 dementia patients, for which the time-frame between GFAP level determination and neuropathological assessment was exceptionally short (on average 139 days), we analysed this biomarker, measured at three time points, in relation to proxies of disease progression such as cognitive decline and brain weight. Most importantly, we investigated the use of blood GFAP to detect the neuropathological hallmarks of Alzheimer's disease, while accounting for potential influences of the most frequent brain co-pathologies. The main findings demonstrated an association between serum GFAP level and post-mortem tau pathology (β = 12.85; P < 0.001) that was independent of amyloid deposits (β = 13.23; P = 0.02). A mediation analysis provided additional support for the role of astrocytic activation as a link between amyloid and tau pathology in Alzheimer's disease. Furthermore, a negative correlation was observed between pre-mortem serum GFAP and brain weight at post-mortem (r = -0.35; P < 0.001). This finding, together with evidence of a negative correlation with cognitive assessments (r = -0.27; P = 0.005), supports the role of GFAP as a biomarker for disease monitoring, even in the late phases of Alzheimer's disease. Moreover, the diagnostic performance of GFAP in advanced dementia patients was explored, and its discriminative power (area under the receiver operator characteristic curve at baseline = 0.91) in differentiating neuropathologically-confirmed Alzheimer's disease dementias from non-Alzheimer's disease dementias was determined, despite the challenging scenario of advanced age and frequent co-pathologies in these patients. Independently of Alzheimer's disease, serum GFAP levels were shown to be associated with two other pathologies targeting the temporal lobes-hippocampal sclerosis (β = 3.64; P = 0.03) and argyrophilic grain disease (β = -6.11; P = 0.02). Finally, serum GFAP levels were revealed to be correlated with astrocyte reactivity, using the brain GFAP-immunostained area as a proxy (ρ = 0.21; P = 0.02). Our results contribute to increasing evidence suggesting a role for blood GFAP as an Alzheimer's disease biomarker, and the findings offer mechanistic insights into the relationship between blood GFAP and Alzheimer's disease neuropathology, highlighting its ties with tau burden. Moreover, the data highlighting an independent association between serum GFAP levels and other neuropathological lesions provide information for clinicians to consider when interpreting test results. The longitudinal design and correlation with post-mortem data reinforce the robustness of our findings. However, studies correlating blood biomarkers and neuropathological assessments are still scant, and further research is needed to replicate and validate these results in diverse populations.
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Affiliation(s)
- Pascual Sánchez-Juan
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, 28029 Madrid, Spain
| | | | - Alicia Ruiz-González
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Ana Belén Pastor
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Hector Rodrigo Lara
- Banco de Cerebros de la Región de Murcia, Neuropathology Department, 30120 Murcia, Spain
| | | | | | - Meritxell Valentí
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Belen Frades
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Paloma Ruiz
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Laura Saiz
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Iván Burgueño-García
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Miguel Calero
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, 28029 Madrid, Spain
- Chronic Disease Programme, Instituto de Salud Carlos III, Madrid, Spain
| | - Teodoro del Ser
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
| | - Alberto Rábano
- Alzheimer’s Centre Reina Sofia-CIEN Foundation-ISCIII, Research Platforms, 28031 Madrid, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, 28029 Madrid, Spain
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23
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Kok EH, Paetau A, Martiskainen M, Lyytikäinen LP, Lehtimäki T, Karhunen P, Myllykangas L. Accumulation of Lewy-Related Pathology Starts in Middle Age: The Tampere Sudden Death Study. Ann Neurol 2024; 95:843-848. [PMID: 38501694 DOI: 10.1002/ana.26912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
When effective treatments against neurodegenerative diseases become a reality, it will be important to know the age these pathologies begin to develop. We investigated alpha-synuclein pathology in brain tissue of the Tampere Sudden Death Study-unselected forensic autopsies on individuals living outside hospital institutions in Finland. Of 562 (16-95 years) participants, 42 were positive for Lewy-related pathology (LRP). The youngest LRP case was aged 54 years, and the frequency of LRP in individuals aged ≥50 years was 9%. This forensic autopsy study indicates LRP starts already in middle age and is more common than expected in the ≥50 years-of-age non-hospitalized population. ANN NEUROL 2024;95:843-848.
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Affiliation(s)
- Eloise H Kok
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anders Paetau
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Department of Pathology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Mika Martiskainen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Government Services, Forensic Medicine Unit, Helsinki, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
| | - Pekka Karhunen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
| | - Liisa Myllykangas
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Department of Pathology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
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24
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Shaw JS, Richey LN, Gifford MK, Bray MJC, Esagoff AI, Rosenberg PB, Peters ME. Impact of motor dysfunction on neuropsychiatric symptom profile in patients with autopsy-confirmed Alzheimer's disease. Int Rev Psychiatry 2024; 36:208-218. [PMID: 39255020 DOI: 10.1080/09540261.2024.2361764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/24/2024] [Indexed: 09/11/2024]
Abstract
Motor dysfunction, which includes changes in gait, balance, and/or functional mobility, is a lesser-known feature of Alzheimer's Disease (AD), especially as it relates to the development of neuropsychiatric symptoms (NPS). This study (1) compared rates of NPS between autopsy-confirmed AD patients with and without early-onset motor dysfunction and (2) compared rates of non-AD dementia autopsy pathology (Lewy Body disease, Frontotemporal Lobar degeneration) between these groups. This retrospective longitudinal cohort study utilized National Alzheimer's Coordinating Center (NACC) data. Participants (N = 856) were required to have moderate-to-severe autopsy-confirmed AD, Clinical Dementia Rating-Global scores of ≤1 at their index visit, and NPS and clinician-rated motor data. Early motor dysfunction was associated with significantly higher NPI-Q total scores (T = 4.48, p < .001) and higher odds of delusions (OR [95%CI]: 1.73 [1.02-2.96]), hallucinations (2.45 [1.35-4.56]), depression (1.51 [1.11-2.06]), irritability (1.50 [1.09-2.08]), apathy (1.70 [1.24-2.36]), anxiety (1.38 [1.01-1.90]), nighttime behaviors (1.98 [1.40-2.81]), and appetite/eating problems (1.56 [1.09-2.25]). Early motor dysfunction was also associated with higher Lewy Body disease pathology (1.41 [1.03-1.93]), but not Frontotemporal Lobar degeneration (1.10 [0.71-1.69]), on autopsy. Our results suggest that motor symptoms in early AD are associated with a higher number and severity of NPS, which may be partially explained by comorbid non-AD neuropathology.
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Affiliation(s)
- Jacob S Shaw
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mia K Gifford
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron I Esagoff
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Flønes IH, Toker L, Sandnes DA, Castelli M, Mostafavi S, Lura N, Shadad O, Fernandez-Vizarra E, Painous C, Pérez-Soriano A, Compta Y, Molina-Porcel L, Alves G, Tysnes OB, Dölle C, Nido GS, Tzoulis C. Mitochondrial complex I deficiency stratifies idiopathic Parkinson's disease. Nat Commun 2024; 15:3631. [PMID: 38684731 PMCID: PMC11059185 DOI: 10.1038/s41467-024-47867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
Idiopathic Parkinson's disease (iPD) is believed to have a heterogeneous pathophysiology, but molecular disease subtypes have not been identified. Here, we show that iPD can be stratified according to the severity of neuronal respiratory complex I (CI) deficiency, and identify two emerging disease subtypes with distinct molecular and clinical profiles. The CI deficient (CI-PD) subtype accounts for approximately a fourth of all cases, and is characterized by anatomically widespread neuronal CI deficiency, a distinct cell type-specific gene expression profile, increased load of neuronal mtDNA deletions, and a predilection for non-tremor dominant motor phenotypes. In contrast, the non-CI deficient (nCI-PD) subtype exhibits no evidence of mitochondrial impairment outside the dopaminergic substantia nigra and has a predilection for a tremor dominant phenotype. These findings constitute a step towards resolving the biological heterogeneity of iPD with implications for both mechanistic understanding and treatment strategies.
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Affiliation(s)
- Irene H Flønes
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
- K.G. Jebsen Center for Translational Research in Parkinson's disease, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Lilah Toker
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
- K.G. Jebsen Center for Translational Research in Parkinson's disease, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Dagny Ann Sandnes
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Martina Castelli
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Sepideh Mostafavi
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Njål Lura
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Omnia Shadad
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Erika Fernandez-Vizarra
- MRC-Mitochondrial Biology Unit, University of Cambridge, Hills Road, Cambridge, CB2 0XY, UK
- Veneto Institute of Molecular Medicine, 35131, Padova, Italy
| | - Cèlia Painous
- Parkinson's disease & Movement Disorders Unit, Neurology Service, Hospital Clínic I Universitari de Barcelona; IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (Maria de Maeztu excellence centre), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alexandra Pérez-Soriano
- Parkinson's disease & Movement Disorders Unit, Neurology Service, Hospital Clínic I Universitari de Barcelona; IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (Maria de Maeztu excellence centre), Universitat de Barcelona, Barcelona, Catalonia, Spain
- UParkinson - Sinapsi Neurología, Centre Mèdic Teknon Grup Hospitalari Quirón Salud, Barcelona, Spain
| | - Yaroslau Compta
- Parkinson's disease & Movement Disorders Unit, Neurology Service, Hospital Clínic I Universitari de Barcelona; IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (Maria de Maeztu excellence centre), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Molina-Porcel
- Alzheimer's disease and other cognitive disorders unit. Neurology Service, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Neurological Tissue Bank, Biobanc-Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Guido Alves
- The Norwegian Centre for Movement Disorders and Department of Neurology, Stavanger University Hospital, Pb 8100, 4068, Stavanger, Norway
- Department of Mathematics and Natural Sciences, University of Stavanger, 4062, Stavanger, Norway
| | - Ole-Bjørn Tysnes
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Christian Dölle
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
- K.G. Jebsen Center for Translational Research in Parkinson's disease, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Gonzalo S Nido
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
- K.G. Jebsen Center for Translational Research in Parkinson's disease, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Charalampos Tzoulis
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway.
- K.G. Jebsen Center for Translational Research in Parkinson's disease, University of Bergen, Pb 7804, 5020, Bergen, Norway.
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26
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O’Shea DM, Arkhipenko A, Galasko D, Goldman JG, Sheikh ZH, Petrides G, Toledo JB, Galvin JE. Practical use of DAT SPECT imaging in diagnosing dementia with Lewy bodies: a US perspective of current guidelines and future directions. Front Neurol 2024; 15:1395413. [PMID: 38711561 PMCID: PMC11073567 DOI: 10.3389/fneur.2024.1395413] [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: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
Background Diagnosing Dementia with Lewy Bodies (DLB) remains a challenge in clinical practice. The use of 123I-ioflupane (DaTscan™) SPECT imaging, which detects reduced dopamine transporter (DAT) uptake-a key biomarker in DLB diagnosis-could improve diagnostic accuracy. However, DAT imaging is underutilized despite its potential, contributing to delays and suboptimal patient management. Methods This review evaluates DLB diagnostic practices and challenges faced within the U.S. by synthesizing information from current literature, consensus guidelines, expert opinions, and recent updates on DaTscan FDA filings. It contrasts DAT SPECT with alternative biomarkers, provides recommendations for when DAT SPECT imaging may be indicated and discusses the potential of emerging biomarkers in enhancing diagnostic approaches. Results The radiopharmaceutical 123I-ioflupane for SPECT imaging was initially approved in Europe (2000) and later in the US (2011) for Parkinsonism/Essential Tremor. Its application was extended in 2022 to include the diagnosis of DLB. DaTscan's diagnostic efficacy for DLB, with its sensitivity, specificity, and predictive values, confirms its clinical utility. However, US implementation faces challenges such as insurance barriers, costs, access issues, and regional availability disparities. Conclusion 123I-ioflupane SPECT Imaging is indicated for DLB diagnosis and differential diagnosis of Alzheimer's Disease, particularly in uncertain cases. Addressing diagnostic obstacles and enhancing physician-patient education could improve and expedite DLB diagnosis. Collaborative efforts among neurologists, geriatric psychiatrists, psychologists, and memory clinic staff are key to increasing diagnostic accuracy and care in DLB management.
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Affiliation(s)
- Deirdre M. O’Shea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Coral Gables, FL, United States
| | | | - Douglas Galasko
- Department of Neurosciences, UC San Diego, San Diego, CA, United States
| | - Jennifer G. Goldman
- JPG Enterprises LLC, Chicago, IL, United States
- Barrow Neurological Institute, Phoenix, AZ, United States
| | | | - George Petrides
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jon B. Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Coral Gables, FL, United States
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27
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Fu B, Brock EE, Andrews R, Breiter JC, Tian R, Toomey CE, Lachica J, Lashley T, Ryten M, Wood NW, Vendruscolo M, Gandhi S, Weiss LE, Beckwith JS, Lee SF. RASP: Optimal Single Puncta Detection in Complex Cellular Backgrounds. J Phys Chem B 2024; 128:3585-3597. [PMID: 38593280 PMCID: PMC11033865 DOI: 10.1021/acs.jpcb.4c00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Super-resolution and single-molecule microscopies have been increasingly applied to complex biological systems. A major challenge of these approaches is that fluorescent puncta must be detected in the low signal, high noise, heterogeneous background environments of cells and tissue. We present RASP, Radiality Analysis of Single Puncta, a bioimaging-segmentation method that solves this problem. RASP removes false-positive puncta that other analysis methods detect and detects features over a broad range of spatial scales: from single proteins to complex cell phenotypes. RASP outperforms the state-of-the-art methods in precision and speed using image gradients to separate Gaussian-shaped objects from the background. We demonstrate RASP's power by showing that it can extract spatial correlations between microglia, neurons, and α-synuclein oligomers in the human brain. This sensitive, computationally efficient approach enables fluorescent puncta and cellular features to be distinguished in cellular and tissue environments, with sensitivity down to the level of the single protein. Python and MATLAB codes, enabling users to perform this RASP analysis on their own data, are provided as Supporting Information and links to third-party repositories.
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Affiliation(s)
- Bin Fu
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
| | - Emma E. Brock
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
| | - Rebecca Andrews
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
| | - Jonathan C. Breiter
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- Centre
for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - Ru Tian
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- Centre
for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - Christina E. Toomey
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- The
Queen Square Brain Bank for Neurological Disorders, Department of
Clinical and Movement Neuroscience, UCL
Queen Square Institute of Neurology, London WC1N 3BG, U.K.
- Department
of Neurodegenerative Diseases, UCL Queen
Square Institute of Neurology, London WC1N 3BG, U.K.
| | - Joanne Lachica
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- The
Queen Square Brain Bank for Neurological Disorders, Department of
Clinical and Movement Neuroscience, UCL
Queen Square Institute of Neurology, London WC1N 3BG, U.K.
- The
Francis Crick Institute, King’s Cross, London NW1 1AT, U.K.
| | - Tammaryn Lashley
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- The
Queen Square Brain Bank for Neurological Disorders, Department of
Clinical and Movement Neuroscience, UCL
Queen Square Institute of Neurology, London WC1N 3BG, U.K.
- Department
of Neurodegenerative Diseases, UCL Queen
Square Institute of Neurology, London WC1N 3BG, U.K.
| | - Mina Ryten
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- Great
Ormond Street Institute of Child Health, University College London, London WC1E 6BT, U.K.
- UK
Dementia Research Institute at the University of Cambridge, Cambridge CB2 0AH, U.K.
- Department
of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, U.K.
| | - Nicholas W. Wood
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- Department
of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, U.K.
| | - Michele Vendruscolo
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- Centre
for Misfolding Diseases, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K.
| | - Sonia Gandhi
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
- Department
of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, U.K.
- The
Francis Crick Institute, King’s Cross, London NW1 1AT, U.K.
| | - Lucien E. Weiss
- Department of Engineering Physics, Polytechnique
Montréal, Montréal, Québec H3T 1J4, Canada
| | - Joseph S. Beckwith
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
| | - Steven F. Lee
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield
Road, Cambridge CB2 1EW, U.K.
- Aligning
Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, Maryland 20815, United States
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Jaisa-Aad M, Muñoz-Castro C, Healey MA, Hyman BT, Serrano-Pozo A. Characterization of monoamine oxidase-B (MAO-B) as a biomarker of reactive astrogliosis in Alzheimer's disease and related dementias. Acta Neuropathol 2024; 147:66. [PMID: 38568475 PMCID: PMC10991006 DOI: 10.1007/s00401-024-02712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/03/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
Reactive astrogliosis accompanies the two neuropathological hallmarks of Alzheimer's disease (AD)-Aβ plaques and neurofibrillary tangles-and parallels neurodegeneration in AD and AD-related dementias (ADRD). Thus, there is growing interest in developing imaging and fluid biomarkers of reactive astrogliosis for AD/ADRD diagnosis and prognostication. Monoamine oxidase-B (MAO-B) is emerging as a target for PET imaging radiotracers of reactive astrogliosis. However, a thorough characterization of MAO-B expression in postmortem control and AD/ADRD brains is lacking. We sought to: (1) identify the primary cell type(s) expressing MAO-B in control and AD brains; (2) quantify MAO-B immunoreactivity in multiple brain regions of control and AD donors as a proxy for PET radiotracer uptake; (3) correlate MAO-B level with local AD neuropathological changes, reactive glia, and cortical atrophy; (4) determine whether the MAOB rs1799836 SNP genotype impacts MAO-B expression level; (5) compare MAO-B immunoreactivity across AD/ADRD, including Lewy body diseases (LBD) and frontotemporal lobar degenerations with tau (FTLD-Tau) and TDP-43 (FTLD-TDP). We found that MAO-B is mainly expressed by subpial and perivascular cortical astrocytes as well as by fibrous white matter astrocytes in control brains, whereas in AD brains, MAO-B is significantly upregulated by both cortical reactive astrocytes and white matter astrocytes across temporal, frontal, and occipital lobes. By contrast, MAO-B expression level was unchanged and lowest in cerebellum. Cortical MAO-B expression was independently associated with cortical atrophy and local measures of reactive astrocytes and microglia, and significantly increased in reactive astrocytes surrounding Thioflavin-S+ dense-core Aβ plaques. MAO-B expression was not affected by the MAOB rs1799836 SNP genotype. MAO-B expression was also significantly increased in the frontal cortex and white matter of donors with corticobasal degeneration, Pick's disease, and FTLD-TDP, but not in LBD or progressive supranuclear palsy. These findings support ongoing efforts to develop MAO-B-based PET radiotracers to image reactive astrogliosis in AD/ADRD.
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Affiliation(s)
- Methasit Jaisa-Aad
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
- MassGeneral Institute for Neurodegenerative Disease, 114 16th St., Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Clara Muñoz-Castro
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
- MassGeneral Institute for Neurodegenerative Disease, 114 16th St., Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Molly A Healey
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
- MassGeneral Institute for Neurodegenerative Disease, 114 16th St., Charlestown, MA, 02129, USA
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
- MassGeneral Institute for Neurodegenerative Disease, 114 16th St., Charlestown, MA, 02129, USA
- Massachusetts Alzheimer's Disease Research Center, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Alberto Serrano-Pozo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- MassGeneral Institute for Neurodegenerative Disease, 114 16th St., Charlestown, MA, 02129, USA.
- Massachusetts Alzheimer's Disease Research Center, Charlestown, MA, 02129, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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29
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Mu L, Chen J, Li J, Nyirenda T, Hegland KW, Beach TG. Mechanisms of Swallowing, Speech and Voice Disorders in Parkinson's Disease: Literature Review with Our First Evidence for the Periperal Nervous System Involvement. Dysphagia 2024:10.1007/s00455-024-10693-3. [PMID: 38498201 DOI: 10.1007/s00455-024-10693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The majority of patients with Parkinson's disease (PD) develop swallowing, speech, and voice (SSV) disorders. Importantly, swallowing difficulty or dysphagia and related aspiration are life-threatening conditions for PD patients. Although PD treatments have significant therapeutic effects on limb motor function, their effects on SSV disorders are less impressive. A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. PD was long considered to be a central nervous system disorder caused by the death of dopaminergic neurons in the basal ganglia. Aggregates of phosphorylated α-synuclein (PAS) underlie PD pathology. SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. The pharynx, larynx, and tongue play a critical role in performing upper airway (UA) motor tasks and their dysfunction results in disordered SSV. This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.
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Affiliation(s)
- Liancai Mu
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA.
- Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA.
| | - Jingming Chen
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Jing Li
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Themba Nyirenda
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Karen Wheeler Hegland
- Upper Airway Dysfunction Laboratory, M.A. Program in Communication Sciences & Disorders, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, 1225 Center Dr., Gainesville, FL, 32611, USA
| | - Thomas G Beach
- Director of Neuroscience, Director of Brain and Body Donation Program, Banner Sun Health Research Institute, 10515 West Santa Fe Dr, Sun City, AZ, 85351, USA
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30
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Walton RL, Koga S, Beasley AI, White LJ, Griesacker T, Murray ME, Kasanuki K, Hou X, Fiesel FC, Springer W, Uitti RJ, Fields JA, Botha H, Ramanan VK, Kantarci K, Lowe VJ, Jack CR, Ertekin-Taner N, Savica R, Graff-Radford J, Petersen RC, Parisi JE, Reichard RR, Graff-Radford NR, Ferman TJ, Boeve BF, Wszolek ZK, Dickson DW, Ross OA, Heckman MG. Role of GBA variants in Lewy body disease neuropathology. Acta Neuropathol 2024; 147:54. [PMID: 38472443 PMCID: PMC11049671 DOI: 10.1007/s00401-024-02699-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 03/14/2024]
Abstract
Rare and common GBA variants are risk factors for both Parkinson's disease (PD) and dementia with Lewy bodies (DLB). However, the degree to which GBA variants are associated with neuropathological features in Lewy body disease (LBD) is unknown. Herein, we assessed 943 LBD cases and examined associations of 15 different neuropathological outcomes with common and rare GBA variants. Neuropathological outcomes included LBD subtype, presence of a high likelihood of clinical DLB (per consensus guidelines), LB counts in five cortical regions, tyrosine hydroxylase immunoreactivity in the dorsolateral and ventromedial putamen, ventrolateral substantia nigra neuronal loss, Braak neurofibrillary tangle (NFT) stage, Thal amyloid phase, phospho-ubiquitin (pS65-Ub) level, TDP-43 pathology, and vascular disease. Sequencing of GBA exons revealed a total of 42 different variants (4 common [MAF > 0.5%], 38 rare [MAF < 0.5%]) in our series, and 165 cases (17.5%) had a copy of the minor allele for ≥ 1 variant. In analysis of common variants, p.L483P was associated with a lower Braak NFT stage (OR = 0.10, P < 0.001). In gene-burden analysis, presence of the minor allele for any GBA variant was associated with increased odds of a high likelihood of DLB (OR = 2.00, P < 0.001), a lower Braak NFT stage (OR = 0.48, P < 0.001), a lower Thal amyloid phase (OR = 0.55, P < 0.001), and a lower pS65-Ub level (β: -0.37, P < 0.001). Subgroup analysis revealed that GBA variants were most common in LBD cases with a combination of transitional/diffuse LBD and Braak NFT stage 0-II or Thal amyloid phase 0-1, and correspondingly that the aforementioned associations of GBA gene-burden with a decreased Braak NFT stage and Thal amyloid phase were observed only in transitional or diffuse LBD cases. Our results indicate that in LBD, GBA variants occur most frequently in cases with greater LB pathology and low AD pathology, further informing disease-risk associations of GBA in PD, PD dementia, and DLB.
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Affiliation(s)
- Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Launia J White
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | | | | | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Xu Hou
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Julie A Fields
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Kejal Kantarci
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Clifford R Jack
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Nilufer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joseph E Parisi
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ross Reichard
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
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López A, López-Muñoz S, Caballero G, Castrejon N, Rojo L, Vidal-Robau N, Muñoz A, Ortiz E, Rodrigo M, García A, Cuatrecasas M, Ribalta T, Aldecoa I. Flanagan's condensed protocol for neurodegenerative diseases. Implementation in a clinical autopsy setting with partial supervision of a neuropathologist. Virchows Arch 2024:10.1007/s00428-024-03781-0. [PMID: 38472413 DOI: 10.1007/s00428-024-03781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
The Condensed Protocol (CP) was originally developed for the evaluation of Alzheimer's Disease (AD) and other neurodegenerative diseases as a workable alternative to the complex and costly established autopsy guidelines. The study objective is to examine the degree of implementation of the CP in the pathology department of a third level university hospital in a period of 5 years. Clinical autopsies performed between 2016 and 2021 on patients aged 65 years or over and did not require a specific neuropathological examination were reviewed. Histological screening and staging of neurodegenerative diseases was performed using the original immunohistochemical stains. Out of 255 autopsies, 204 met the inclusion criteria and 190 could be reviewed. The CP was applied to 99 cases; histological signs of neurodegenerative disease were observed in 92. Sampling errors were detected in 59 cases. Immunohistochemical studies were performed in 68 cases. The diseases identified were: 31 cases of AD (12 low grade; 19 intermediate), 18 amyloid angiopathy, 15 primary age-related tauopathy, 6 argyrophilic grain disease, 3 progressive supranuclear palsy, 1 Lewy body disease (of 22 cases), and 2 limbic-predominant age TDP43 encephalopathy (of 5 cases). In 30 out of 83 cases, there was more severe vascular pathology in complete sections of frontal cortex and lentiform nucleus. The CP allows reliable detection and staging of AD and related neurodegenerative diseases in clinical autopsies. However, supervision by a neuropathologist seems necessary for a fully successful implementation of the CP in a clinical hospital setting.
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Affiliation(s)
- Aitana López
- Graduate Student. Medical School Casanova Campus, University of Barcelona, Barcelona, Spain
| | - Samuel López-Muñoz
- Pathology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Gabriela Caballero
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Natalia Castrejon
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Leonardo Rojo
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Nuria Vidal-Robau
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Abel Muñoz
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Estrella Ortiz
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Maite Rodrigo
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Adriana García
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Teresa Ribalta
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain.
- Neurological Tissue Bank of the Biobank-FCRB/IDIBAPS, Hospital Clinic - University of Barcelona, Barcelona, Spain.
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Wada T, Doi H, Okubo M, Tada M, Ueda N, Suzuki H, Tominaga W, Koike H, Komiya H, Kubota S, Hashiguchi S, Nakamura H, Takahashi K, Kunii M, Tanaka K, Miyaji Y, Higashiyama Y, Koshimizu E, Miyatake S, Katsuno M, Fujii S, Takahashi H, Matsumoto N, Takeuchi H, Tanaka F. RNA Foci in Two bi-Allelic RFC1 Expansion Carriers. Ann Neurol 2024; 95:607-613. [PMID: 38062616 DOI: 10.1002/ana.26848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
Cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) is a late-onset, autosomal recessive neurodegenerative disorder caused by biallelic AAGGG/ACAGG repeat expansion (AAGGG-exp/ACAGG-exp) in RFC1. The recent identification of patients with CANVAS exhibiting compound heterozygosity for AAGGG-exp and truncating variants supports the loss-of-function of RFC1 in CANVAS patients. We investigated the pathological changes in 2 autopsied patients with CANVAS harboring biallelic ACAGG-exp and AAGGG-exp. RNA fluorescence in situ hybridization of the 2 patients revealed CCTGT- and CCCTT-containing RNA foci, respectively, in neuronal nuclei of tissues with neuronal loss. Our findings suggest that RNA toxicity may be involved in the pathogenesis of CANVAS. ANN NEUROL 2024;95:607-613.
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Affiliation(s)
- Taishi Wada
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaki Okubo
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mikiko Tada
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naohisa Ueda
- Department of Neurology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hidefumi Suzuki
- Department of Molecular Biology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Wakana Tominaga
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyasu Komiya
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shun Kubota
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shunta Hashiguchi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Haruko Nakamura
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keita Takahashi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Misako Kunii
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kenichi Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yosuke Miyaji
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuichi Higashiyama
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Clinical Genetics Department, Yokohama City University Hospital, Yokohama, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Fujii
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Japan
| | - Hidehisa Takahashi
- Department of Molecular Biology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Arezoumandan S, Cousins KA, Ohm DT, Lowe M, Chen M, Gee J, Phillips JS, McMillan CT, Luk KC, Deik A, Spindler MA, Tropea TF, Weintraub D, Wolk DA, Grossman M, Lee V, Chen‐Plotkin AS, Lee EB, Irwin DJ. Tau maturation in the clinicopathological spectrum of Lewy body and Alzheimer's disease. Ann Clin Transl Neurol 2024; 11:673-685. [PMID: 38263854 PMCID: PMC10963284 DOI: 10.1002/acn3.51988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Alzheimer's disease neuropathologic change and alpha-synucleinopathy commonly co-exist and contribute to the clinical heterogeneity of dementia. Here, we examined tau epitopes marking various stages of tangle maturation to test the hypotheses that tau maturation is more strongly associated with beta-amyloid compared to alpha-synuclein, and within the context of mixed pathology, mature tau is linked to Alzheimer's disease clinical phenotype and negatively associated with Lewy body dementia. METHODS We used digital histology to measure percent area-occupied by pathology in cortical regions among individuals with pure Alzheimer's disease neuropathologic change, pure alpha-synucleinopathy, and a co-pathology group with both Alzheimer's and alpha-synuclein pathologic diagnoses. Multiple tau monoclonal antibodies were used to detect early (AT8, MC1) and mature (TauC3) epitopes of tangle progression. We used linear/logistic regression to compare groups and test the association between pathologies and clinical features. RESULTS There were lower levels of tau pathology (β = 1.86-2.96, p < 0.001) across all tau antibodies in the co-pathology group compared to the pure Alzheimer's pathology group. Among individuals with alpha-synucleinopathy, higher alpha-synuclein was associated with greater early tau (AT8 β = 1.37, p < 0.001; MC1 β = 1.2, p < 0.001) but not mature tau (TauC3 p = 0.18), whereas mature tau was associated with beta-amyloid (β = 0.21, p = 0.01). Finally, lower tau, particularly TauC3 pathology, was associated with lower frequency of both core clinical features and categorical clinical diagnosis of dementia with Lewy bodies. INTERPRETATION Mature tau may be more closely related to beta-amyloidosis than alpha-synucleinopathy, and pathophysiological processes of tangle maturation may influence the clinical features of dementia in mixed Lewy-Alzheimer's pathology.
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Affiliation(s)
- Sanaz Arezoumandan
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Daniel T. Ohm
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - MaKayla Lowe
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Min Chen
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James Gee
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jeffrey S. Phillips
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Corey T. McMillan
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kelvin C. Luk
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andres Deik
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Thomas F. Tropea
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel Weintraub
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David A. Wolk
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Murray Grossman
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia Lee
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Edward B. Lee
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David J. Irwin
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Alexander A, Alvarez VE, Huber BR, Alosco ML, Mez J, Tripodis Y, Nicks R, Katz DI, Dwyer B, Daneshvar DH, Martin B, Palmisano J, Goldstein LE, Crary JF, Nowinski C, Cantu RC, Kowall NW, Stern RA, Delalle I, McKee AC, Stein TD. Cortical-sparing chronic traumatic encephalopathy (CSCTE): a distinct subtype of CTE. Acta Neuropathol 2024; 147:45. [PMID: 38407651 PMCID: PMC11348287 DOI: 10.1007/s00401-024-02690-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repetitive head impacts (RHI) and pathologically defined as neuronal phosphorylated tau aggregates around small blood vessels and concentrated at sulcal depths. Cross-sectional studies suggest that tau inclusions follow a stereotyped pattern that begins in the neocortex in low stage disease, followed by involvement of the medial temporal lobe and subcortical regions with significant neocortical burden in high stage CTE. Here, we define a subset of brain donors with high stage CTE and with a low overall cortical burden of tau inclusions (mean semiquantitative value ≤1) and classify them as cortical-sparing CTE (CSCTE). Of 620 brain donors with pathologically diagnosed CTE, 66 (11%) met criteria for CSCTE. Compared to typical high stage CTE, those with CSCTE had a similar age at death and years of contact sports participation and were less likely to carry apolipoprotein ε4 (p < 0.05). CSCTE had less overall tau pathology severity, but a proportional increase of disease burden in medial temporal lobe and brainstem regions compared to the neocortex (p's < 0.001). CSCTE also had lower prevalence of comorbid neurodegenerative disease. Clinically, CSCTE participants were less likely to have dementia (p = 0.023) and had less severe cognitive difficulties (as reported by informants using the Functional Activities Questionnaire (FAQ); p < 0.001, meta-cognitional index T score; p = 0.002 and Cognitive Difficulties Scale (CDS); p < 0.001,) but had an earlier onset age of behavioral (p = 0.006) and Parkinsonian motor (p = 0.013) symptoms when compared to typical high stage CTE. Other comorbid tauopathies likely contributed in part to these differences: when cases with concurrent Alzheimer dementia or frontal temporal lobar degeneration with tau pathology were excluded, differences were largely retained, but only remained significant for FAQ (p = 0.042), meta-cognition index T score (p = 0.014) and age of Parkinsonian motor symptom onset (p = 0.046). Overall, CSCTE appears to be a distinct subtype of high stage CTE with relatively greater involvement of subcortical and brainstem regions and less severe cognitive symptoms.
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Affiliation(s)
- Abigail Alexander
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Douglas I Katz
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence and Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Nowinski
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Ivana Delalle
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA.
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- , 150 S. Huntington Avenue, Boston, MA, 02130, USA.
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Kon T, Lee S, Martinez-Valbuena I, Yoshida K, Tanikawa S, Lang AE, Kovacs GG. Molecular Behavior of α-Synuclein Is Associated with Membrane Transport, Lipid Metabolism, and Ubiquitin-Proteasome Pathways in Lewy Body Disease. Int J Mol Sci 2024; 25:2676. [PMID: 38473923 DOI: 10.3390/ijms25052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Lewy body diseases (LBDs) feature α-synuclein (α-syn)-containing Lewy bodies, with misfolded α-syn potentially propagating as seeds. Using a seeding amplification assay, we previously reported distinct α-syn seeding in LBD cases based on the area under seeding curves. This study revealed that LBD cases showing different α-syn seeding kinetics have distinct proteomics profiles, emphasizing disruptions in mitochondria and lipid metabolism in high-seeder cases. Though the mechanisms underlying LBD development are intricate, the factors influencing α-syn seeding activity remain elusive. To address this and complement our previous findings, we conducted targeted transcriptome analyses in the substantia nigra using the nanoString nCounter assay together with histopathological evaluations in high (n = 4) and low (n = 3) nigral α-syn seeders. Neuropathological findings (particularly the substantia nigra) were consistent between these groups and were characterized by neocortical LBD associated with Alzheimer's disease neuropathologic change. Among the 1811 genes assessed, we identified the top 20 upregulated and downregulated genes and pathways in α-syn high seeders compared with low seeders. Notably, alterations were observed in genes and pathways related to transmembrane transporters, lipid metabolism, and the ubiquitin-proteasome system in the high α-syn seeders. In conclusion, our findings suggest that the molecular behavior of α-syn is the driving force in the neurodegenerative process affecting the substantia nigra through these identified pathways. These insights highlight their potential as therapeutic targets for attenuating LBD progression.
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Affiliation(s)
- Tomoya Kon
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
- Department of Neurology, Hirosaki University Graduate School of Medicine, 5 Zaifu, Hirosaki 036-8562, Japan
| | - Seojin Lee
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Ivan Martinez-Valbuena
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
| | - Koji Yoshida
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Satoshi Tanikawa
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
| | - Anthony E Lang
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
- Edmond J Safra Program in Parkinson's Disease and Rossy Progressive Supranuclear Palsy Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
- Edmond J Safra Program in Parkinson's Disease and Rossy Progressive Supranuclear Palsy Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
- Krembil Brain Institute, University of Toronto, 60 Leonard Ave., Toronto, ON M5T 0S8, Canada
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Cholerton B, Latimer CS, Crane PK, Corrada MM, Gibbons LE, Larson EB, Kawas CH, Keene CD, Montine TJ. Neuropathologic Burden and Dementia in Nonagenarians and Centenarians: Comparison of 2 Community-Based Cohorts. Neurology 2024; 102:e208060. [PMID: 38175995 PMCID: PMC11097771 DOI: 10.1212/wnl.0000000000208060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to compare 2 large clinicopathologic cohorts of participants aged 90+ and to determine whether the association between neuropathologic burden and dementia in these older groups differs substantially from those seen in younger-old adults. METHODS Autopsied participants from The 90+ Study and Adult Changes in Thought (ACT) Study community-based cohort studies were evaluated for dementia-associated neuropathologic changes. Associations between neuropathologic variables and dementia were assessed using logistic or linear regression, and the weighted population attributable fraction (PAF) per type of neuropathologic change was estimated. RESULTS The 90+ Study participants (n = 414) were older (mean age at death = 97.7 years) and had higher amyloid/tau burden than ACT <90 (n = 418) (mean age at death = 83.5 years) and ACT 90+ (n = 401) (mean age at death = 94.2 years) participants. The ACT 90+ cohort had significantly higher rates of limbic-predominant age-related TDP-43 encephalopathy (LATE-NC), microvascular brain injury (μVBI), and total neuropathologic burden. Independent associations between individual neuropathologic lesions and odds of dementia were similar between all 3 groups, with the exception of μVBI, which was associated with increased dementia risk in the ACT <90 group only (odds ratio 1.5, 95% CI 1.2-1.8, p < 0.001). Weighted PAF scores indicated that eliminating μVBI, although more prevalent in ACT 90+ participants, would have little effect on dementia. Conversely, eliminating μVBI in ACT <90 could theoretically reduce dementia at a similar rate to that of AD neuropathologic change (weighted PAF = 6.1%, 95% CI 3.8-8.4, p = 0.001). Furthermore, reducing LATE-NC in The 90+ Study could potentially reduce dementia to a greater degree (weighted PAF = 5.1%, 95% CI 3.0-7.3, p = 0.001) than either ACT cohort (weighted PAFs = 1.69, 95% CI 0.4-2.7). DISCUSSION Our results suggest that specific neuropathologic features may differ in their effect on dementia among nonagenarians and centenarians from cohorts with different selection criteria and study design. Furthermore, microvascular lesions seem to have a more significant effect on dementia in younger compared with older participants. The results from this study demonstrate that different populations may require distinct dementia interventions, underscoring the need for disease-specific biomarkers.
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Affiliation(s)
- Brenna Cholerton
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Caitlin S Latimer
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Paul K Crane
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Maria M Corrada
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Laura E Gibbons
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Eric B Larson
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Claudia H Kawas
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - C Dirk Keene
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Thomas J Montine
- From the Department of Pathology (B.C., T.J.M.), Stanford University School of Medicine, CA; Departments of Laboratory Medicine and Pathology (C.S.L., C.D.K.), Medicine (P.K.C.), and General Internal Medicine (L.E.G., E.B.L.), University of Washington, Seattle; Departments of Neurology (M.M.C., C.H.K.), Epidemiology (M.M.C.), and Neurobiology & Behavior (C.H.K.), University of California, Irvine; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
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Kaleta M, Hényková E, Menšíková K, Friedecký D, Kvasnička A, Klíčová K, Koníčková D, Strnad M, Kaňovský P, Novák O. Patients with Neurodegenerative Proteinopathies Exhibit Altered Tryptophan Metabolism in the Serum and Cerebrospinal Fluid. ACS Chem Neurosci 2024; 15:582-592. [PMID: 38194490 PMCID: PMC10853934 DOI: 10.1021/acschemneuro.3c00611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
Some pathological conditions affecting the human body can also disrupt metabolic pathways and thus alter the overall metabolic profile. Knowledge of metabolic disturbances in specific diseases could thus enable the differential diagnosis of otherwise similar conditions. This work therefore aimed to comprehensively characterize changes in tryptophan metabolism in selected neurodegenerative diseases. Levels of 18 tryptophan-related neuroactive substances were determined by high throughput and sensitive ultrahigh-performance liquid chromatography-tandem mass spectrometry in time-linked blood serum and cerebrospinal fluid samples from 100 age-matched participants belonging to five cohorts: healthy volunteers (n = 21) and patients with Lewy body disease (Parkinson's disease and dementia with Lewy bodies; n = 31), four-repeat tauopathy (progressive supranuclear palsy and corticobasal syndrome; n = 10), multiple system atrophy (n = 13), and Alzheimer's disease (n = 25). Although these conditions have different pathologies and clinical symptoms, the discovery of new biomarkers is still important. The most statistically significant differences (with p-values of ≤0.05 to ≤0.0001) between the study cohorts were observed for three tryptophan metabolites: l-kynurenine in cerebrospinal fluid and 3-hydroxy-l-kynurenine and 5-hydroxy-l-tryptophan in blood serum. This led to the discovery of distinctive correlation patterns between the profiled cerebrospinal fluid and serum metabolites that could provide a basis for the differential diagnosis of neurodegenerative tauopathies and synucleinopathies. However, further large-scale studies are needed to determine the direct involvement of these metabolites in the studied neuropathologies, their response to medication, and their potential therapeutic relevance.
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Affiliation(s)
- Michal Kaleta
- Laboratory
of Growth Regulators, Institute of Experimental
Botany of the Czech Academy of Sciences & Palacky University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Eva Hényková
- Laboratory
of Growth Regulators, Institute of Experimental
Botany of the Czech Academy of Sciences & Palacky University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Kateřina Menšíková
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - David Friedecký
- Laboratory
for Inherited Metabolic Disorders, Department of Clinical Biochemistry,
University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Zdravotníků 248/7, 779 00 Olomouc, Czech Republic
| | - Aleš Kvasnička
- Laboratory
for Inherited Metabolic Disorders, Department of Clinical Biochemistry,
University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Zdravotníků 248/7, 779 00 Olomouc, Czech Republic
| | - Kateřina Klíčová
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Dorota Koníčková
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Miroslav Strnad
- Laboratory
of Growth Regulators, Institute of Experimental
Botany of the Czech Academy of Sciences & Palacky University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Petr Kaňovský
- Department
of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Department
of Neurology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Ondřej Novák
- Laboratory
of Growth Regulators, Institute of Experimental
Botany of the Czech Academy of Sciences & Palacky University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
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Carreras Mascaro A, Grochowska MM, Boumeester V, Dits NFJ, Bilgiҫ EN, Breedveld GJ, Vergouw L, de Jong FJ, van Royen ME, Bonifati V, Mandemakers W. LRP10 and α-synuclein transmission in Lewy body diseases. Cell Mol Life Sci 2024; 81:75. [PMID: 38315424 PMCID: PMC10844361 DOI: 10.1007/s00018-024-05135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/13/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
Autosomal dominant variants in LRP10 have been identified in patients with Lewy body diseases (LBDs), including Parkinson's disease (PD), Parkinson's disease-dementia (PDD), and dementia with Lewy bodies (DLB). Nevertheless, there is little mechanistic insight into the role of LRP10 in disease pathogenesis. In the brains of control individuals, LRP10 is typically expressed in non-neuronal cells like astrocytes and neurovasculature, but in idiopathic and genetic cases of PD, PDD, and DLB, it is also present in α-synuclein-positive neuronal Lewy bodies. These observations raise the questions of what leads to the accumulation of LRP10 in Lewy bodies and whether a possible interaction between LRP10 and α-synuclein plays a role in disease pathogenesis. Here, we demonstrate that wild-type LRP10 is secreted via extracellular vesicles (EVs) and can be internalised via clathrin-dependent endocytosis. Additionally, we show that LRP10 secretion is highly sensitive to autophagy inhibition, which induces the formation of atypical LRP10 vesicular structures in neurons in human-induced pluripotent stem cells (iPSC)-derived brain organoids. Furthermore, we show that LRP10 overexpression leads to a strong induction of monomeric α-synuclein secretion, together with time-dependent, stress-sensitive changes in intracellular α-synuclein levels. Interestingly, patient-derived astrocytes carrying the c.1424 + 5G > A LRP10 variant secrete aberrant high-molecular-weight species of LRP10 in EV-free media fractions. Finally, we show that this truncated patient-derived LRP10 protein species (LRP10splice) binds to wild-type LRP10, reduces LRP10 wild-type levels, and antagonises the effect of LRP10 on α-synuclein levels and distribution. Together, this work provides initial evidence for a possible functional role of LRP10 in LBDs by modulating intra- and extracellular α-synuclein levels, and pathogenic mechanisms linked to the disease-associated c.1424 + 5G > A LRP10 variant, pointing towards potentially important disease mechanisms in LBDs.
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Affiliation(s)
- Ana Carreras Mascaro
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martyna M Grochowska
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Valerie Boumeester
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natasja F J Dits
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ece Naz Bilgiҫ
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Guido J Breedveld
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Leonie Vergouw
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martin E van Royen
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincenzo Bonifati
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wim Mandemakers
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Chung M, Carter EK, Veire AM, Dammer EB, Chang J, Duong DM, Raj N, Bassell GJ, Glass JD, Gendron TF, Nelson PT, Levey AI, Seyfried NT, McEachin ZT. Cryptic exon inclusion is a molecular signature of LATE-NC in aging brains. Acta Neuropathol 2024; 147:29. [PMID: 38308693 PMCID: PMC10838224 DOI: 10.1007/s00401-023-02671-0] [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: 10/16/2023] [Revised: 11/30/2023] [Accepted: 12/17/2023] [Indexed: 02/05/2024]
Abstract
The aggregation, mislocalization, and phosphorylation of TDP-43 are pathologic hallmarks of several neurodegenerative diseases and provide a defining criterion for the neuropathologic diagnosis of Limbic-predominant Age-related TDP-43 Encephalopathy (LATE). LATE neuropathologic changes (LATE-NC) are often comorbid with other neurodegenerative pathologies including Alzheimer's disease neuropathologic changes (ADNC). We examined whether TDP-43 regulated cryptic exons accumulate in the hippocampus of neuropathologically confirmed LATE-NC cases. We found that several cryptic RNAs are robustly expressed in LATE-NC cases with or without comorbid ADNC and correlate with pTDP-43 abundance; however, the accumulation of cryptic RNAs is more robust in LATE-NC with comorbid ADNC. Additionally, cryptic RNAs can robustly distinguish LATE-NC from healthy controls and AD cases. These findings expand our current understanding and provide novel potential biomarkers for LATE pathogenesis.
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Affiliation(s)
- Mingee Chung
- Department of Cell Biology, Emory University, Atlanta, GA, 30322, USA
- Laboratory for Translational Cell Biology, Emory University, Atlanta, GA, 30322, USA
| | - E Kathleen Carter
- Department of Biochemistry, Emory University, Atlanta, GA, 30322, USA
| | - Austin M Veire
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Eric B Dammer
- Department of Biochemistry, Emory University, Atlanta, GA, 30322, USA
| | - Jianjun Chang
- Department of Cell Biology, Emory University, Atlanta, GA, 30322, USA
| | - Duc M Duong
- Department of Biochemistry, Emory University, Atlanta, GA, 30322, USA
| | - Nisha Raj
- Department of Cell Biology, Emory University, Atlanta, GA, 30322, USA
- Laboratory for Translational Cell Biology, Emory University, Atlanta, GA, 30322, USA
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Gary J Bassell
- Department of Cell Biology, Emory University, Atlanta, GA, 30322, USA
- Laboratory for Translational Cell Biology, Emory University, Atlanta, GA, 30322, USA
- Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, 30322, USA
| | - Jonathan D Glass
- Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, 30322, USA
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Peter T Nelson
- Department of Pathology and Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, 40536, USA
| | - Allan I Levey
- Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, 30322, USA.
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA.
| | - Nicholas T Seyfried
- Department of Biochemistry, Emory University, Atlanta, GA, 30322, USA.
- Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, 30322, USA.
| | - Zachary T McEachin
- Department of Cell Biology, Emory University, Atlanta, GA, 30322, USA.
- Laboratory for Translational Cell Biology, Emory University, Atlanta, GA, 30322, USA.
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA.
- Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, 30322, USA.
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Katsumata Y, Wu X, Aung KZ, Gauthreaux K, Mock C, Forrest SL, Kovacs GG, Nelson PT. Pathologic correlates of aging-related tau astrogliopathy: ARTAG is associated with LATE-NC and cerebrovascular pathologies, but not with ADNC. Neurobiol Dis 2024; 191:106412. [PMID: 38244935 PMCID: PMC10892903 DOI: 10.1016/j.nbd.2024.106412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
Age-related tau astrogliopathy (ARTAG) is detectable in the brains of over one-third of autopsied persons beyond age 80, but the pathoetiology of ARTAG is poorly understood. Insights can be gained by analyzing risk factors and comorbid pathologies. Here we addressed the question of which prevalent co-pathologies are observed with increased frequency in brains with ARTAG. The study sample was the National Alzheimer's Coordinating Center (NACC) data set, derived from multiple Alzheimer's disease research centers (ADRCs) in the United States. Data from persons with unusual conditions (e.g. frontotemporal dementia) were excluded leaving 504 individual autopsied research participants, clustering from 20 different ADRCs, autopsied since 2020; ARTAG was reported in 222 (44.0%) of included participants. As has been shown previously, ARTAG was increasingly frequent with older age and in males. The presence and severity of other common subtypes of pathology that were previously linked to dementia were analyzed, stratifying for the presence of ARTAG. In logistical regression-based statistical models that included age and sex as covariates, ARTAG was relatively more likely to be found in brains with limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC), and in brains with comorbid cerebrovascular pathology (arteriolosclerosis and/or brain infarcts). However, ARTAG was not associated with severe Alzheimer's disease neuropathologic change (ADNC), or primary age-related tauopathy (PART). In a subset analysis of 167 participants with neurocognitive testing data, there was a marginal trend for ARTAG pathology to be associated with cognitive impairment as assessed with MMSE scores (P = 0.07, adjusting for age, sex, interval between final clinic visit and death, and ADNC severity). A limitation of the study was that there were missing data about ARTAG pathologies, with incomplete operationalization of ARTAG according to anatomic region and pathologic subtypes (e.g., thorn-shaped or granular-fuzzy astrocytes). In summary, ARTAG was not associated with ADNC, whereas prior observations about ARTAG occurring with increased frequency in aging, males, and brains with LATE-NC were replicated. It remains to be determined whether the increased frequency of ARTAG in brains with comorbid cerebrovascular pathology is related to local infarctions or neuroinflammatory signaling, or with some other set of correlated factors including blood-brain barrier dysfunction.
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Affiliation(s)
- Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Biostatistics, University of Kentucky, Lexington, KY 40506, United States of America
| | - Xian Wu
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Biostatistics, University of Kentucky, Lexington, KY 40506, United States of America
| | - Khine Zin Aung
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Biostatistics, University of Kentucky, Lexington, KY 40506, United States of America
| | - Kathryn Gauthreaux
- National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA 98105, United States of America
| | - Charles Mock
- National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA 98105, United States of America
| | - Shelley L Forrest
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Canada
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, United States of America; Department of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States of America.
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Samudra N, Lerner H, Yack L, Walsh CM, Kirsch HE, Kudo K, Yballa C, La Joie R, Gorno‐Tempini ML, Spina S, Seeley WW, Neylan TC, Miller BL, Rabinovici GD, Boxer A, Grinberg LT, Rankin KP, Nagarajan SS, Ranasinghe KG. Spatiotemporal characteristics of neurophysiological changes in patients with four-repeat tauopathies. Ann Clin Transl Neurol 2024; 11:525-535. [PMID: 38226843 PMCID: PMC10863921 DOI: 10.1002/acn3.51974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), are the most common four-repeat tauopathies (4RT), and both frequently occur with varying degree of Alzheimer's disease (AD) copathology. Intriguingly, patients with 4RT and patients with AD are at opposite ends of the wakefulness spectrum-AD showing reduced wakefulness and excessive sleepiness whereas 4RT showing decreased homeostatic sleep. The neural mechanisms underlying these distinct phenotypes in the comorbid condition of 4RT and AD are unknown. The objective of the current study was to define the alpha oscillatory spectrum, which is prominent in the awake resting-state in the human brain, in patients with primary 4RT, and how it is modified in comorbid AD-pathology. METHOD In an autopsy-confirmed case series of 4R-tauopathy patients (n = 10), whose primary neuropathological diagnosis was either PSP (n = 7) or CBD (n = 3), using high spatiotemporal resolution magnetoencephalography (MEG), we quantified the spectral power density within alpha-band (8-12 Hz) and examined how this pattern was modified in increasing AD-copathology. For each patient, their regional alpha power was compared to an age-matched normative control cohort (n = 35). RESULT Patients with 4RT showed increased alpha power but in the presence of AD-copathology alpha power was reduced. CONCLUSIONS Alpha power increase in PSP-tauopathy and reduction in the presence of AD-tauopathy is consistent with the observation that neurons activating wakefulness-promoting systems are preserved in PSP but degenerated in AD. These results highlight the selectively vulnerable impacts in 4RT versus AD-tauopathy that may have translational significance on disease-modifying therapies for specific proteinopathies.
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Affiliation(s)
- Niyatee Samudra
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Hannah Lerner
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Leslie Yack
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
- Department of PsychiatrySan Francisco Veterans Affairs, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Christine M. Walsh
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Heidi E. Kirsch
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCalifornia94143USA
- Epilepsy Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kiwamu Kudo
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCalifornia94143USA
- Medical Imaging Business CenterRicoh CompanyKanazawaJapan
| | - Claire Yballa
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Renaud La Joie
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Maria L. Gorno‐Tempini
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Salvatore Spina
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - William W. Seeley
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Thomas C. Neylan
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
- Department of PsychiatrySan Francisco Veterans Affairs, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCalifornia94143USA
| | - Adam Boxer
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Lea T. Grinberg
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
- Department of PathologyUniversity of CaliforniaSan FranciscoCalifornia94158USA
- Department of PathologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Katherine P. Rankin
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCalifornia94143USA
| | - Kamalini G. Ranasinghe
- Memory and Aging Center, Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCalifornia94158USA
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Saltiel N, Tripodis Y, Menzin T, Olaniyan A, Baucom Z, Yhang E, Palmisano JN, Martin B, Uretsky M, Nair E, Abdolmohammadi B, Shah A, Nicks R, Nowinski C, Cantu RC, Daneshvar DH, Dwyer B, Katz DI, Stern RA, Alvarez V, Huber B, Boyle PA, Schneider JA, Mez J, McKee A, Alosco ML, Stein TD. Relative Contributions of Mixed Pathologies to Cognitive and Functional Symptoms in Brain Donors Exposed to Repetitive Head Impacts. Ann Neurol 2024; 95:314-324. [PMID: 37921042 PMCID: PMC10842014 DOI: 10.1002/ana.26823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Exposure to repetitive head impacts (RHI) is associated with later-life cognitive symptoms and neuropathologies, including chronic traumatic encephalopathy (CTE). Cognitive decline in community cohorts is often due to multiple pathologies; however, the frequency and contributions of these pathologies to cognitive impairment in people exposed to RHI are unknown. Here, we examined the relative contributions of 13 neuropathologies to cognitive symptoms and dementia in RHI-exposed brain donors. METHODS Neuropathologists examined brain tissue from 571 RHI-exposed donors and assessed for the presence of 13 neuropathologies, including CTE, Alzheimer disease (AD), Lewy body disease (LBD), and transactive response DNA-binding protein 43 (TDP-43) inclusions. Cognitive status was assessed by presence of dementia, Functional Activities Questionnaire, and Cognitive Difficulties Scale. Spearman rho was calculated to assess intercorrelation of pathologies. Additionally, frequencies of pathological co-occurrence were compared to a simulated distribution assuming no intercorrelation. Logistic and linear regressions tested associations between neuropathologies and dementia status and cognitive scale scores. RESULTS The sample age range was 18-97 years (median = 65.0, interquartile range = 46.0-76.0). Of the donors, 77.2% had at least one moderate-severe neurodegenerative or cerebrovascular pathology. Stage III-IV CTE was the most common neurodegenerative disease (43.1%), followed by TDP-43 pathology, AD, and hippocampal sclerosis. Neuropathologies were intercorrelated, and there were fewer unique combinations than expected if pathologies were independent (p < 0.001). The greatest contributors to dementia were AD, neocortical LBD, hippocampal sclerosis, cerebral amyloid angiopathy, and CTE. INTERPRETATION In this sample of RHI-exposed brain donors with wide-ranging ages, multiple neuropathologies were common and correlated. Mixed neuropathologies, including CTE, underlie cognitive impairment in contact sport athletes. ANN NEUROL 2024;95:314-324.
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Affiliation(s)
- Nicole Saltiel
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Talia Menzin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Aliyah Olaniyan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Zach Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Eukyung Yhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N. Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Evan Nair
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | - Raymond Nicks
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | | | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Daniel H. Daneshvar
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Brigid Dwyer
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Douglas I. Katz
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor Alvarez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- National Center for PTSD, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Bertrand Huber
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ann McKee
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Höglinger GU, Adler CH, Berg D, Klein C, Outeiro TF, Poewe W, Postuma R, Stoessl AJ, Lang AE. A biological classification of Parkinson's disease: the SynNeurGe research diagnostic criteria. Lancet Neurol 2024; 23:191-204. [PMID: 38267191 DOI: 10.1016/s1474-4422(23)00404-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 01/26/2024]
Abstract
With the hope that disease-modifying treatments could target the molecular basis of Parkinson's disease, even before the onset of symptoms, we propose a biologically based classification. Our classification acknowledges the complexity and heterogeneity of the disease by use of a three-component system (SynNeurGe): presence or absence of pathological α-synuclein (S) in tissues or CSF; evidence of underlying neurodegeneration (N) defined by neuroimaging procedures; and documentation of pathogenic gene variants (G) that cause or strongly predispose to Parkinson's disease. These three components are linked to a clinical component (C), defined either by a single high-specificity clinical feature or by multiple lower-specificity clinical features. The use of a biological classification will enable advances in both basic and clinical research, and move the field closer to the precision medicine required to develop disease-modifying therapies. We emphasise the initial application of these criteria exclusively for research. We acknowledge its ethical implications, its limitations, and the need for prospective validation in future studies.
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Affiliation(s)
- Günter U Höglinger
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) and German Center for Neurodegenerative Diseases, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Daniela Berg
- Christian Albrechts University and University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lüebeck, Germany
| | - Tiago F Outeiro
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Werner Poewe
- Medical University Innsbruck, Innsbruck, Austria
| | - Ronald Postuma
- Department of Neurology, McGill University, Montreal Neurological Institute, Montreal, QC, Canada
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre and Parkinson's Foundation Centre of Excellence, University of British Columbia, BC, Canada
| | - Anthony E Lang
- University Health Network's Krembil Brain Institute, Edmond J Safra Program in Parkinson's Disease and the Rossy PSP Centre, Toronto Western Hospital, Toronto, ON, Canada.
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44
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Bayram E, Coughlin DG, Rajmohan R, Litvan I. Sex differences for clinical correlates of substantia nigra neuron loss in people with Lewy body pathology. Biol Sex Differ 2024; 15:8. [PMID: 38243325 PMCID: PMC10797801 DOI: 10.1186/s13293-024-00583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Lewy body dementia (LBD) phenotype is associated with the presence and degree of Lewy body, Alzheimer's pathologies, and substantia nigra neuron loss. Nigral neuron loss is associated with parkinsonism in LBD, and females with LBD are less likely than males to have parkinsonism. As sex differences were reported for clinical correlates of Lewy body and Alzheimer's pathologies, we aimed to investigate whether there are also sex differences for correlates of nigral neuron loss. METHODS Data were obtained from the National Alzheimer's Coordinating Center for females (n = 159) and males (n = 263) with brainstem, limbic, and neocortical Lewy body pathology. Sex differences for the nigral neuron loss' association with Lewy body pathology staging and core clinical LBD features (cognitive fluctuations, visual hallucinations, rapid eye movement sleep behavior disorder, parkinsonism) during follow-up were analyzed with generalized linear models adjusting for age and Alzheimer's pathology staging. Whether any of the core clinical features at the time of dementia onset can predict underlying nigral neuron loss for females and males were also analyzed with generalized linear models. RESULTS Compared to males, females died older and had higher levels of Braak tau staging, but had similar levels of Lewy body pathology staging and nigral neuron loss. Females were less likely than males to have a clinical Lewy body disease diagnosis during follow-up. More advanced Lewy body pathology staging was associated with more nigral neuron loss, more so for males than females. More nigral neuron loss was associated with parkinsonism and clinical LBD diagnosis during follow-up, more so for males than females. Across the subgroup with dementia (40 females, 58 males), core LBD features at first visit with dementia were not associated with nigral neuron loss. CONCLUSIONS Nigral neuron loss' association with Lewy body pathology staging and core LBD features can differ by sex. Compared to males, females with Lewy body pathology have a higher risk of underdiagnosis. There is a need to elucidate the mechanisms underlying sex differences for pathology and clinicopathological correlations to advance diagnostic and therapeutic efforts in LBD.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, Parkinson and other Movement Disorders Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0886, USA.
| | - David G Coughlin
- Department of Neurosciences, Parkinson and other Movement Disorders Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0886, USA
| | - Ravi Rajmohan
- Department of Neurology, University of California Irvine, 1001 Health Sciences Road, Irvine, CA, 92697-3950, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and other Movement Disorders Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0886, USA
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45
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Bentivenga GM, Mammana A, Baiardi S, Rossi M, Ticca A, Magliocchetti F, Mastrangelo A, Poleggi A, Ladogana A, Capellari S, Parchi P. Performance of a seed amplification assay for misfolded alpha-synuclein in cerebrospinal fluid and brain tissue in relation to Lewy body disease stage and pathology burden. Acta Neuropathol 2024; 147:18. [PMID: 38240849 PMCID: PMC10799141 DOI: 10.1007/s00401-023-02663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2024]
Abstract
The development of in vitro seed amplification assays (SAA) detecting misfolded alpha-synuclein (αSyn) in cerebrospinal fluid (CSF) and other tissues has provided a pathology-specific biomarker for Lewy body disease (LBD). However, αSyn SAA diagnostic performance in early pathological stages or low Lewy body (LB) pathology load has only been assessed in small cohorts. Moreover, the relationship between SAA kinetic parameters, the number of αSyn brain seeds and the LB pathology burden assessed by immunohistochemistry has never been systematically investigated. We tested 269 antemortem CSF samples and 138 serially diluted brain homogenates from patients with and without neuropathological evidence of LBD in different stages by the αSyn Real-Time Quaking-Induced Conversion (RT-QuIC) SAA. Moreover, we looked for LB pathology by αSyn immunohistochemistry in a consecutive series of 604 Creutzfeldt-Jakob disease (CJD)-affected brains. αSyn CSF RT-QuIC showed 100% sensitivity in detecting LBD in limbic and neocortical stages. The assay sensitivity was significantly lower in patients in early stages (37.5% in Braak 1 and 2, 73.3% in Braak 3) or with focal pathology (50% in amygdala-predominant). The average number of CSF RT-QuIC positive replicates significantly correlated with LBD stage. Brain homogenate RT-QuIC showed higher sensitivity than immunohistochemistry for the detection of misfolded αSyn. In the latter, the kinetic parameter lag phase (time to reach the positive threshold) strongly correlated with the αSyn seed concentration in serial dilution experiments. Finally, incidental LBD prevalence was 8% in the CJD cohort. The present results indicate that (a) CSF RT-QuIC has high specificity and sufficient sensitivity to detect all patients with LB pathology at Braak stages > 3 and most of those at stage 3; (b) brain deposition of misfolded αSyn precedes the formation of LB and Lewy neurites; (c) αSyn SAA provides "quantitative" information regarding the LB pathology burden, with the lag phase and the number of positive replicates being the most promising variables to be used in the clinical setting.
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Affiliation(s)
| | - Angela Mammana
- IRCCS, Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcello Rossi
- IRCCS, Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alice Ticca
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Poleggi
- Department of Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Ladogana
- Department of Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS, Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
- IRCCS, Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
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46
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Wiseman JA, Murray HC, Faull RLMF, Dragunow M, Turner CP, Dieriks BV, Curtis MA. Aggregate-prone brain regions in Parkinson's disease are rich in unique N-terminus α-synuclein conformers with high proteolysis susceptibility. NPJ Parkinsons Dis 2024; 10:1. [PMID: 38167744 PMCID: PMC10762179 DOI: 10.1038/s41531-023-00614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
In Parkinson's disease (PD), and other α-synucleinopathies, α-synuclein (α-Syn) aggregates form a myriad of conformational and truncational variants. Most antibodies used to detect and quantify α-Syn in the human brain target epitopes within the C-terminus (residues 96-140) of the 140 amino acid protein and may fail to capture the diversity of α-Syn variants present in PD. We sought to investigate the heterogeneity of α-Syn conformations and aggregation states in the PD human brain by labelling with multiple antibodies that detect epitopes along the entire length of α-Syn. We used multiplex immunohistochemistry to simultaneously immunolabel tissue sections with antibodies mapping the three structural domains of α-Syn. Discrete epitope-specific immunoreactivities were visualised and quantified in the olfactory bulb, medulla, substantia nigra, hippocampus, entorhinal cortex, middle temporal gyrus, and middle frontal gyrus of ten PD cases, and the middle temporal gyrus of 23 PD, and 24 neurologically normal cases. Distinct Lewy neurite and Lewy body aggregate morphologies were detected across all interrogated regions/cases. Lewy neurites were the most prominent in the olfactory bulb and hippocampus, while the substantia nigra, medulla and cortical regions showed a mixture of Lewy neurites and Lewy bodies. Importantly, unique N-terminus immunoreactivity revealed previously uncharacterised populations of (1) perinuclear, (2) glial (microglial and astrocytic), and (3) neuronal lysosomal α-Syn aggregates. These epitope-specific N-terminus immunoreactive aggregate populations were susceptible to proteolysis via time-dependent proteinase K digestion, suggesting a less stable oligomeric aggregation state. Our identification of unique N-terminus immunoreactive α-Syn aggregates adds to the emerging paradigm that α-Syn pathology is more abundant and complex in human brains with PD than previously realised. Our findings highlight that labelling multiple regions of the α-Syn protein is necessary to investigate the full spectrum of α-Syn pathology and prompt further investigation into the functional role of these N-terminus polymorphs.
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Affiliation(s)
- James A Wiseman
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
- Centre for Brain Research, University of Auckland, Auckland, 1023, New Zealand.
| | - Helen C Murray
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, 1023, New Zealand
| | - Richard L M F Faull
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, 1023, New Zealand
| | - Michael Dragunow
- Centre for Brain Research, University of Auckland, Auckland, 1023, New Zealand
- Department of Pharmacology, University of Auckland, Auckland, 1023, New Zealand
| | - Clinton P Turner
- LabPlus, Department of Anatomical Pathology, Te Whatu Ora, Auckland, New Zealand
| | - Birger Victor Dieriks
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, 1023, New Zealand
| | - Maurice A Curtis
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
- Centre for Brain Research, University of Auckland, Auckland, 1023, New Zealand.
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47
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Zhai W, Zhao A, Wei C, Xu Y, Cui X, Zhang Y, Meng L, Sun L. Undetected Association Between Fatty Acids and Dementia with Lewy Bodies: A Bidirectional Two-Sample Mendelian Randomization Study. J Alzheimers Dis 2024; 100:1083-1097. [PMID: 38995791 DOI: 10.3233/jad-240267] [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] [Indexed: 07/14/2024]
Abstract
Background Although observational studies indicated connections between fatty acids (FAs) and Alzheimer's disease and dementia, uncertainty persists regarding how these relationships extend to dementia with Lewy bodies (DLB). Objective To explore the potential causal relationships between FAs and the development of DLB, thus clarifying these associations using genetic instruments to infer causality. Methods We applied a two-sample Mendelian randomization (MR) and multivariable Mendelian randomization (MVMR) approach. Genetic data were obtained from a DLB cohort, comprising 2,591 cases and 4,027 controls of European descent. Eight FAs, including linoleic acid, docosahexaenoic acid, monounsaturated fatty acid, omega-3 fatty acid, omega-6 fatty acid, polyunsaturated fatty acid, saturated fatty acid, and total fatty acid, were procured from a comprehensive GWAS of metabolic biomarkers of UK Biobank, conducted by Nightingale Health in 2020 (met-d), involving 114,999 individuals. Our analysis included inverse-variance weighted, MR-Egger, weighted-median, simple mode, and weighted-mode MR estimates. Cochran's Q-statistics, MR-PRESSO, and MR-Egger intercept test were used to quantify the heterogeneity and horizontal pleiotropy of instrumental variables. Results Only linoleic acid showed a significant genetic association with the risk of developing DLB in the univariate MR. The odds ratio for linoleic acid was 1.337 with a 95% confidence interval of 1.019-1.756 (pIVW = 0.036). Results from the MVMR showed that no FAs were associated with the incidence of DLB. Conclusions The results did not support the hypothesis that FAs could reduce the risk of developing DLB. However, elucidating the relationship between FAs and DLB risk holds potential implications for informing dietary recommendations and therapeutic approaches in DLB.
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Affiliation(s)
- Weijie Zhai
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Anguo Zhao
- Department of Urology, The Fourth Affiliated Hospital of Soochow University Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, China
| | - Chunxiao Wei
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yanjiao Xu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Xinran Cui
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yan Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lingjie Meng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
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48
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Walker L, Attems J. Prevalence of Concomitant Pathologies in Parkinson's Disease: Implications for Prognosis, Diagnosis, and Insights into Common Pathogenic Mechanisms. JOURNAL OF PARKINSON'S DISEASE 2024; 14:35-52. [PMID: 38143370 PMCID: PMC10836576 DOI: 10.3233/jpd-230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/26/2023]
Abstract
Pathologies characteristic of Alzheimer's disease (i.e., hyperphosphorylated tau and amyloid-β (Aβ) plaques), cardiovascular disease, and limbic predominant TDP-43 encephalopathy (LATE) often co-exist in patients with Parkinson's disease (PD), in addition to Lewy body pathology (α-synuclein). Numerous studies point to a putative synergistic relationship between hyperphosphorylation tau, Aβ, cardiovascular lesions, and TDP-43 with α-synuclein, which may alter the stereotypical pattern of pathological progression and accelerate cognitive decline. Here we discuss the prevalence and relationships between common concomitant pathologies observed in PD. In addition, we highlight shared genetic risk factors and developing biomarkers that may provide better diagnostic accuracy for patients with PD that have co-existing pathologies. The tremendous heterogeneity observed across the PD spectrum is most likely caused by the complex interplay between pathogenic, genetic, and environmental factors, and increasing our understanding of how these relate to idiopathic PD will drive research into finding accurate diagnostic tools and disease modifying therapies.
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Affiliation(s)
- Lauren Walker
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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49
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Ichimata S, Yoshida K, Li J, Rogaeva E, Lang AE, Kovacs GG. The molecular spectrum of amyloid-beta (Aβ) in neurodegenerative diseases beyond Alzheimer's disease. Brain Pathol 2024; 34:e13210. [PMID: 37652560 PMCID: PMC10711260 DOI: 10.1111/bpa.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
This study investigated the molecular spectrum of amyloid-beta (Aβ) in neurodegenerative diseases beyond Alzheimer's disease (AD). We analyzed Aβ deposition in the temporal cortex and striatum in 116 autopsies, including Lewy body disease (LBD; N = 51), multiple system atrophy (MSA; N = 10), frontotemporal lobar degeneration-TDP-43 (FTLD-TDP; N = 16), and progressive supranuclear palsy (PSP; N = 39). The LBD group exhibited the most Aβ deposition in the temporal cortex and striatum (90/76%, respectively), followed by PSP (69/28%), FTLD-TDP (50/25%), and the MSA group (50/10%). We conducted immunohistochemical analysis using antibodies targeting eight Aβ epitopes in the LBD and PSP groups. Immunohistochemical findings were evaluated semi-quantitatively and quantitatively using digital pathology. Females with LBD exhibited significantly more severe Aβ deposition, particularly Aβ42 and Aβ43 , along with significantly more severe tau pathology. Furthermore, a quantitative analysis of all Aβ peptides in the LBD group revealed an association with the APOE-ε4 genotypes. No significant differences were observed between males and females in the PSP group. Finally, we compared striatal Aβ deposition in cases with LBD (N = 15), AD without α-synuclein pathology (N = 6), and PSP (N = 5). There were no differences in the pan-Aβ antibody (6F/3D)-immunolabeled deposition burden among the three groups, but the deposition burden of peptides with high aggregation capacity, especially Aβ43 , was significantly higher in the AD and LBD groups than in the PSP group. Furthermore, considerable heterogeneity was observed in the composition of Aβ peptides on a case-by-case basis in the AD and LBD groups, whereas it was relatively uniform in the PSP group. Cluster analysis further supported these findings. Our data suggest that the type of concomitant proteinopathies influences the spectrum of Aβ deposition, impacted also by sex and APOE genotypes.
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Affiliation(s)
- Shojiro Ichimata
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Department of Legal Medicine, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Koji Yoshida
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Department of Legal Medicine, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Jun Li
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Anthony E. Lang
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Edmond J Safra Program in Parkinson's Disease and Rossy Program in Progressive Supranuclear PalsyToronto Western HospitalTorontoOntarioCanada
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Edmond J Safra Program in Parkinson's Disease and Rossy Program in Progressive Supranuclear PalsyToronto Western HospitalTorontoOntarioCanada
- Laboratory Medicine Program and Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
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50
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Mastenbroek SE, Vogel JW, Collij LE, Serrano GE, Tremblay C, Young AL, Arce RA, Shill HA, Driver-Dunckley ED, Mehta SH, Belden CM, Atri A, Choudhury P, Barkhof F, Adler CH, Ossenkoppele R, Beach TG, Hansson O. Disease progression modelling reveals heterogeneity in trajectories of Lewy-type α-synuclein pathology. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.05.569878. [PMID: 38106128 PMCID: PMC10723322 DOI: 10.1101/2023.12.05.569878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Lewy body (LB) disorders, characterized by the aggregation of misfolded α-synuclein proteins, exhibit notable clinical heterogeneity. This may be due to variations in accumulation patterns of LB neuropathology. By applying data-driven disease progression modelling to regional neuropathological LB density scores from 814 brain donors, we describe three inferred trajectories of LB pathology that were characterized by differing clinicopathological presentation and longitudinal antemortem clinical progression. Most donors (81.9%) showed earliest pathology in the olfactory bulb, followed by accumulation in either limbic (60.8%) or brainstem (21.1%) regions. The remaining donors (18.1%) exhibited the first abnormalities in brainstem regions. Early limbic pathology was associated with Alzheimer's disease-associated characteristics. Meanwhile, brainstem-first pathology was associated with progressive motor impairment and substantial LB pathology outside of the brain. Our data provides evidence for heterogeneity in the temporal spread of LB pathology, possibly explaining some of the clinical disparities observed in LBDs.
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Affiliation(s)
- Sophie E. Mastenbroek
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jacob W. Vogel
- Department of Clinical Sciences Malmö, Faculty of Medicine, SciLifLab, Lund University, Lund, Sweden
| | - Lyduine E. Collij
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Geidy E. Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Cecilia Tremblay
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Alexandra L. Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Richard A. Arce
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Holly A. Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, United States of America
| | - Erika D. Driver-Dunckley
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Shyamal H. Mehta
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Christine M. Belden
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
- Department of Neurology, Center for Mind/Brain Medicine, Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Parichita Choudhury
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, the Netherlands
- Institutes of Neurology & Healthcare Engineering, University College London, London, United Kingdom
| | - Charles H. Adler
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
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