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de Sousa DMB, Poupardin R, Villeda SA, Schroer AB, Fröhlich T, Frey V, Staffen W, Mrowetz H, Altendorfer B, Unger MS, Iglseder B, Paulweber B, Trinka E, Cadamuro J, Drerup M, Schallmoser K, Aigner L, Kniewallner KM. The platelet transcriptome and proteome in Alzheimer's disease and aging: an exploratory cross-sectional study. Front Mol Biosci 2023; 10:1196083. [PMID: 37457829 PMCID: PMC10348715 DOI: 10.3389/fmolb.2023.1196083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction: Alzheimer's disease (AD) and aging are associated with platelet hyperactivity. However, the mechanisms underlying abnormal platelet function in AD and aging are yet poorly understood. Methods: To explore the molecular profile of AD and aged platelets, we investigated platelet activation (i.e., CD62P expression), proteome and transcriptome in AD patients, non-demented elderly, and young individuals as controls. Results: AD, aged and young individuals showed similar levels of platelet activation based on CD62P expression. However, AD and aged individuals had a proteomic signature suggestive of increased platelet activation compared with young controls. Transcriptomic profiling suggested the dysregulation of proteolytic machinery involved in regulating platelet function, particularly the ubiquitin-proteasome system in AD and autophagy in aging. The functional implication of these transcriptomic alterations remains unclear and requires further investigation. Discussion: Our data strengthen the evidence of enhanced platelet activation in aging and provide a first glimpse of the platelet transcriptomic changes occurring in AD.
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Affiliation(s)
- Diana M. Bessa de Sousa
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Rodolphe Poupardin
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Experimental and Clinical Cell Therapy Institute, Paracelsus Medical University, Salzburg, Austria
| | - Saul A. Villeda
- Department of Anatomy, University of California San Francisco, San Francisco, CA, United States
| | - Adam B. Schroer
- Department of Anatomy, University of California San Francisco, San Francisco, CA, United States
| | - Thomas Fröhlich
- Laboratory of Functional Genome Analysis (LAFUGA), Gene Center, Ludwig Maximilian University of Munich, Munich, Germany
| | - Vanessa Frey
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Staffen
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Heike Mrowetz
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Michael S. Unger
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine, St. Johanns University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Janne Cadamuro
- Department of Laboratory Medicine, University Hospital SALK, Salzburg, Austria
| | - Martin Drerup
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Katharina Schallmoser
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Department of Transfusion Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Kathrin M. Kniewallner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
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Li TR, Liu FQ. β-Amyloid promotes platelet activation and activated platelets act as bridge between risk factors and Alzheimer's disease. Mech Ageing Dev 2022; 207:111725. [PMID: 35995275 DOI: 10.1016/j.mad.2022.111725] [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: 05/25/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022]
Abstract
Alzheimer's disease (AD) is an evolving challenge that places an enormous burden on families and society. The presence of obvious brain β-amyloid (Aβ) deposition is a premise to diagnose AD, which induces the subsequent tau hyperphosphorylation and neurodegeneration. Platelets are the primary source of circulating amyloid precursor protein (APP). Upon activation, they can secrete significant amounts of Aβ into the blood, which can be actively transported to the brain across the blood-brain barrier and promote amyloid deposition. In this review, we summarized the changes in the platelet APP metabolic pathway in patients with AD and further comprehensively explored the targets and downstream events of Aβ-activated platelets. In addition, we attempted to clarify whether patients with AD are in a state of general platelet activation, with inconsistent results. Considering the increasingly evident bidirectional relationship between AD and vascular events, we speculate that the AD pathology alone seems to be insufficient to induce the general activation of platelets; however, the intervention of third-party factors, such as atherosclerosis, exposes the extracellular matrix and leads to platelet activation, further promoting AD progression. Therefore, we proposed a framework in which the relationship between platelets and AD is indirect and mediated by vascular factors. Therapies targeting platelets and interventions for vascular risk factors are likely to contribute to the prevention and treatment of AD.
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Affiliation(s)
- Tao-Ran Li
- Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Feng-Qi Liu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Lipid-core nanocapsules containing simvastatin improve the cognitive impairment induced by obesity and hypercholesterolemia in adult rats. Eur J Pharm Sci 2020; 151:105397. [DOI: 10.1016/j.ejps.2020.105397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 01/07/2023]
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Ludhiadch A, Muralidharan A, Balyan R, Munshi A. The molecular basis of platelet biogenesis, activation, aggregation and implications in neurological disorders. Int J Neurosci 2020; 130:1237-1249. [PMID: 32069430 DOI: 10.1080/00207454.2020.1732372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Platelets are anucleated blood constituents, vital for hemostasis and involved in the pathophysiology of several cardiovascular, neurovascular diseases as well as inflammatory processes and metastasis. Over the past few years, the molecular processes that regulate the function of platelets in hemostasis and thrombosis have emerged revealing platelets to be perhaps more complex than may have been expected. The most understood part of platelets is to respond to a blood vessel injury by altering shape, secreting granule contents, and aggregating. These responses, while advantageous for hemostasis, can become detrimental when they root ischemia or infarction. Only a few transcription and signaling factors involved in platelet biogenesis have been identified till date. Platelets encompass an astonishingly complete array of organelles and storage granules including mitochondria, lysosomes, alpha granules, dense granules, a dense tubular system (analogous to the endoplasmic reticulum of nucleated cells); a highly invaginated plasma membrane system known as the open canalicular system (OCS) and large fields of glycogen. Platelets as a model cells to study neurological disorders have been recommended by several researchers since several counterparts exist between platelets and the brain, which make them interesting for studying the neurobiology of various neurological disorders. This review has been compiled with an aim to integrate the latest research on platelet biogenesis, activation and aggregation focusing on the molecular pathways that power and regulate these processes. The dysregulation of important molecular players affecting fluctuating platelet biology and thereby resulting in neurovascular diseases has also been discussed.
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Affiliation(s)
- Abhilash Ludhiadch
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India
| | - Abhishek Muralidharan
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India
| | - Renuka Balyan
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India
| | - Anjana Munshi
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India
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dos Santos GAA, Pardi PC. Biomarkers in Alzheimer's disease: Evaluation of platelets, hemoglobin and vitamin B12. Dement Neuropsychol 2020; 14:35-40. [PMID: 32206196 PMCID: PMC7077854 DOI: 10.1590/1980-57642020dn14-010006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/21/2019] [Indexed: 01/09/2023] Open
Abstract
Currently, the most likely hypotheses as the cause of Alzheimer's disease are deposition of amyloid beta peptide in the cerebral cortex and hyperphosphorylation of Tau protein. The diagnosis of Alzheimer's disease is based on the exclusion of other diseases, behavioral assessments, and blood and imaging tests. Biotechnology has created interesting perspectives for the early detection of Alzheimer's disease through blood analysis, with special attention to platelets, hemoglobin and vitamin B12. OBJECTIVE To evaluate the concentrations of platelets, hemoglobin and vitamin B12 in the blood of older adults with and without dementia of Alzheimer's disease. METHODS A case-control study involving 120 individuals was conducted, seeking to establish a correlation between changes in platelet, hemoglobin and vitamin B12 concentrations in patients with confirmed AD and in individuals in the inclusion group without AD. The study met the established ethical requirements. RESULTS Hemoglobin and platelet levels were statistically lower in patients with AD. The biochemical evaluation in AD patient and healthy groups for vitamin B12 showed a decrease in the levels of this compound in patients with AD. CONCLUSION We demonstrated the feasibility of the use of blood biomarkers as predictive markers for the diagnosis of AD.
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Affiliation(s)
- Gustavo Alves Andrade dos Santos
- Universidade de São Paulo – USP. Faculdade de Medicina de Ribeirão
Preto. Departamento de Anatomia e Cirurgia. Ribeirão Preto, SP, Brazil
- Centro Universitário do Senac – Unidade Tiradentes. Departamento de
Pós-graduação em Farmácia
| | - Paulo Celso Pardi
- Universidade Anhanguera Guarulhos. Departamento de Biomedicina, São
Paulo, SP, Brazil
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Shi Y, Gu L, Alsharif AA, Zhang Z. The Distinction of Amyloid-β Protein Precursor (AβPP) Ratio in Platelet Between Alzheimer's Disease Patients and Controls: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2018; 59:1037-1044. [PMID: 28731441 DOI: 10.3233/jad-170253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To systematically assess the clinical significance of platelet amyloid-β protein precursor (AβPP) ratio between Alzheimer's disease (AD) patients and controls. 14 articles were selected in this analysis by search of databases including PubMed and Web of Science up to December 2016. Random effects models were used to calculate the standardized mean difference (SMD). Subgroup analyses were used to detect the cause of heterogeneity. The result showed a significant drop in platelet AβPP ratio in AD patients compared to controls [SMD: -1.871; 95% CI: (-2.33, -1.41); p < 0.001; I2 = 88.0% ]. Subgroup analysis revealed races or the quality of studies may be the cause of high heterogeneity. This meta-analysis concluded that there is a close association between platelet AβPP ratio and AD. It is necessary to design a sizable sample study to further support that platelet AβPP ratio can be a biomarker of AD.
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Affiliation(s)
- Yachen Shi
- Department of Neurology, Affiliated ZhongDaHospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
| | - Lihua Gu
- Department of Neurology, Affiliated ZhongDaHospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
| | - Abdul Azeez Alsharif
- Department of Neurology, Affiliated ZhongDaHospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
| | - Zhijun Zhang
- Department of Neurology, Affiliated ZhongDaHospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
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Avila-Vazquez MF, Altamirano-Bustamante NF, Altamirano-Bustamante MM. Amyloid Biomarkers in Conformational Diseases at Face Value: A Systematic Review. Molecules 2017; 23:molecules23010079. [PMID: 29286329 PMCID: PMC6017595 DOI: 10.3390/molecules23010079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Conformational diseases represent a new aspect of proteomic medicine where diagnostic and therapeutic paradigms are evolving. In this context, the early biomarkers for target cell failure (neurons, β-cells, etc.) represent a challenge to translational medicine and play a multidimensional role as biomarkers and potential therapeutic targets. This systematic review, which follows the PICO and Prisma methods, analyses this new-fangled multidimensionality, its strengths and limitations, and presents the future possibilities it opens up. The nuclear diagnosis methods are immunoassays: ELISA, immunodot, western blot, etc., while the therapeutic approach is focused on pharmaco- and molecular chaperones.
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Affiliation(s)
- Maria Fernanda Avila-Vazquez
- Unidad de Investigación en Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Mexico City 06720, Mexico.
- Health Department, Universidad Iberoamericana, Mexico City 01219, Mexico.
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Abstract
Although serotonin neurotransmission has been implicated in several neurodevelopmental and psychological disorders, the factors that drive dysfunction of the serotonin system are poorly understood. Current research regarding the serotonin system revolves around its dysfunction in neuropsychiatric disorders, but there is no database collating genetic mutations that result in serotonin abnormalities. To bridge this gap, we developed a list of genes in mice that, when perturbed, result in altered levels of serotonin either in brain or blood. Due to the intrinsic limitations of search, the current list should be considered a preliminary subset of all relevant cases. Nevertheless, it offered an opportunity to gain insight into what types of genes have the potential to impact serotonin by using gene ontology (GO). This analysis found that genes associated with monoamine metabolism were more often associated with increases in brain serotonin than decreases. Speculatively, this could be because several pathways (and therefore many genes) are responsible for the clearance and metabolism of serotonin whereas only one pathway (and therefore fewer genes) is directly involved in the synthesis of serotonin. Another contributor could be cross talk between monoamine systems such as dopamine. In contrast, genes that were associated with decreases in brain serotonin were more likely linked to a developmental process. Sensitivity of serotonin neurons to developmental perturbations could be due to their complicated neuroanatomy or possibly they may be negatively regulated by dysfunction of their innervation targets. Thus, these observations suggest hypotheses regarding the mechanisms underlying the vulnerability of brain serotonin neurotransmission.
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Affiliation(s)
- Richard C. Tenpenny
- Department of Anesthesiology, Perioperative, and Pain
Medicine, Boston Children’s Hospital and Department of Anesthesia,
Harvard Medical School, 300 Longwood
Avenue, Boston, Massachusetts 02115, United States
| | - Kathryn G. Commons
- Department of Anesthesiology, Perioperative, and Pain
Medicine, Boston Children’s Hospital and Department of Anesthesia,
Harvard Medical School, 300 Longwood
Avenue, Boston, Massachusetts 02115, United States
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Canobbio I, Visconte C, Oliviero B, Guidetti G, Zarà M, Pula G, Torti M. Increased platelet adhesion and thrombus formation in a mouse model of Alzheimer's disease. Cell Signal 2016; 28:1863-1871. [PMID: 27593518 DOI: 10.1016/j.cellsig.2016.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/01/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Vascular dysfunctions and Alzheimer's disease show significant similarities and overlaps. Cardiovascular risk factors (hypercholesterolemia, hypertension, obesity, atherosclerosis and diabetes) increase the risk of vascular dementia and Alzheimer's disease. Conversely, Alzheimer's patients have considerably increased predisposition of ischemic and hemorrhagic strokes. Platelets are major players in haemostasis and thrombosis and are involved in inflammation. We have investigated morphology and function of platelets in 3xTg-AD animals, a consolidate murine model for Alzheimer's disease. Platelets from aged 3xTg-AD mice are normal in number and glycoprotein expression, but adhere more avidly on matrices such as fibrillar collagen, von Willebrand factor, fibrinogen and amyloid peptides compared to platelets from age-matching wild type mice. 3xTg-AD washed platelets adherent to collagen also show increased phosphorylation of selected signaling proteins, including tyrosine kinase Pyk2, PI3 kinase effector Akt, p38MAP kinase and myosin light chain kinase, and increased ability to form thrombi under shear. In contrast, aggregation and integrin αIIbβ3 activation induced by several agonists in 3xTg-AD mice are similar to wild type platelets. These results demonstrated that Alzheimer's mutations result in a significant hyper-activated state of circulating platelets, evident with the progression of the disease.
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Affiliation(s)
- Ilaria Canobbio
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy.
| | - Caterina Visconte
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy
| | - Barbara Oliviero
- Research Laboratories, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianni Guidetti
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy
| | - Marta Zarà
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy
| | - Giordano Pula
- Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, United Kingdom
| | - Mauro Torti
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy
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Lim NS, Swanson CR, Cherng HR, Unger TL, Xie SX, Weintraub D, Marek K, Stern MB, Siderowf A, Trojanowski JQ, Chen-Plotkin AS. Plasma EGF and cognitive decline in Parkinson's disease and Alzheimer's disease. Ann Clin Transl Neurol 2016; 3:346-55. [PMID: 27231704 PMCID: PMC4863747 DOI: 10.1002/acn3.299] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 01/17/2023] Open
Abstract
Objective Cognitive decline occurs in multiple neurodegenerative diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD). Shared underlying mechanisms may exist and manifest as shared biomarker signatures. Previously, we nominated plasma epidermal growth factor (EGF) as a biomarker predicting cognitive decline in patients with established PD. Here, we investigate EGF as a predictive biomarker in prodromal PD, as well as AD. Methods A cohort of PD patients (n = 236) was recruited to replicate our finding that low baseline EGF levels predict future cognitive decline. Additionally, plasma EGF and cognitive outcome measures were obtained from individuals with normal cognition (NC, n = 58), amnestic mild cognitive impairment (AD‐MCI, n = 396), and Alzheimer's disease (AD, n = 112) in the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort to investigate whether low EGF levels correlate with cognitive status and outcome in AD‐MCI and AD. Third, plasma EGF and cognitive measures were evaluated in the high‐risk asymptomatic Parkinson's Associated Risk Study (PARS) cohort (n = 165) to investigate the association of EGF and cognitive performance in a PD prodromal context. Results In both PD and AD‐MCI, low baseline plasma EGF predicted poorer long‐term cognitive outcomes. In asymptomatic individuals at highest risk for developing PD from the PARS cohort, low baseline plasma EGF associated with poorer performance in the visuospatial domain but not in other cognitive domains. Interpretation Low plasma EGF at baseline predicts cognitive decline in both AD and PD. Evidence for this signal may exist in prodromal stages of both diseases.
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Affiliation(s)
- Nicholas S Lim
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Christine R Swanson
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Hua-Ren Cherng
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Travis L Unger
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Daniel Weintraub
- Department of Psychiatry Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Ken Marek
- Parkinson's Associated Risk Study New Haven, CT USA; Institute for Neurodegenerative Disorders New Haven Connecticut
| | - Matthew B Stern
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania; Parkinson's Associated Risk Study New Haven, CT USA
| | | | | | | | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Alice S Chen-Plotkin
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
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