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Rossi C, Campese N, Colosimo C. Emerging Symptomatic Treatment of Chronic Traumatic Encephalopathy (CTE): a narrative review. Expert Opin Pharmacother 2023; 24:1415-1425. [PMID: 37300418 DOI: 10.1080/14656566.2023.2224501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Chronic traumatic encephalopathy (CTE) is an emergent neurodegenerative tauopathy well characterized pathologically but with limited consensus about clinical criteria. The clinical features include cognitive, behavioral, and motor symptoms such as parkinsonism, gait, balance disorder, and bulbar impairment. Their recognition derives from retrospective studies in pathologically confirmed CTE patients. This is one of the main reasons for the lack of specific pharmacological studies targeting symptoms or pathologic pathways of this disease. AREAS COVERED In this narrative review, we overview the possible symptomatic treatment options for CTE, based on pathological similarities with other neurodegenerative diseases that may share common pathological pathways with CTE. The PubMed database was screened for articles addressing the symptomatic treatment of CTE and Traumatic Encephalopathy Syndrome (TES). Additional references were retrieved by reference cross-check and retained if pertinent to the subject. The clinicaltrials.gov database was screened for ongoing trials on the treatment of CTE. EXPERT OPINION The similarities with the other tauopathies allow us, in the absence of disease-specific evidence, to translate some knowledge from these neurodegenerative disorders to CTE's symptomatic treatment, but any conclusion should be drawn cautiously and a patient-tailored strategy should be always preferred balancing the risks and benefits of each treatment.
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Affiliation(s)
- Carlo Rossi
- Neurology Unit, F. Lotti Hospital of Pontedera. Azienda Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy
| | - Nicole Campese
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carlo Colosimo
- Department of Neurology, S. Maria University Hospital, Terni, Italy
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Butler T, Chiang GC, Niogi SN, Wang XH, Skudin C, Tanzi E, Wickramasuriya N, Spiegel J, Maloney T, Pahlajani S, Zhou L, Morim S, Rusinek H, Normandin M, Dyke JP, Fung EK, Li Y, Glodzik L, Razlighi QR, Shah SA, de Leon M. Tau PET following acute TBI: Off-target binding to blood products, tauopathy, or both? FRONTIERS IN NEUROIMAGING 2022; 1:958558. [PMID: 36876118 PMCID: PMC9979975 DOI: 10.3389/fnimg.2022.958558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Repeated mild Traumatic Brain Injury (TBI) is a risk factor for Chronic Traumatic Encephalopathy (CTE), characterized pathologically by neurofibrillary tau deposition in the depths of brain sulci and surrounding blood vessels. The mechanism by which TBI leads to CTE remains unknown but has been posited to relate to axonal shear injury leading to release and possibly deposition of tau at the time of injury. As part of an IRB-approved study designed to learn how processes occurring acutely after TBI may predict later proteinopathy and neurodegeneration, we performed tau PET using 18F-MK6240 and MRI within 14 days of complicated mild TBI in three subjects. PET radiotracer accumulation was apparent in regions of traumatic hemorrhage in all subjects, with prominent intraparenchymal PET signal in one young subject with a history of repeated sports-related concussions. These results are consistent with off-target tracer binding to blood products as well as possible on-target binding to chronically and/or acutely-deposited neurofibrillary tau. Both explanations are highly relevant to applying tau PET to understanding TBI and CTE. Additional study is needed to assess the potential utility of tau PET in understanding how processes occurring acutely after TBI, such as release and deposition of tau and blood from damaged axons and blood vessels, may relate to development CTE years later.
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Affiliation(s)
- Tracy Butler
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Gloria C Chiang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Sumit Narayan Niogi
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Xiuyuan Hugh Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Carly Skudin
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Emily Tanzi
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | | | - Jonathan Spiegel
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Thomas Maloney
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Liangdong Zhou
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Simon Morim
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Henry Rusinek
- New York University Grossman School of Medicine, New York, NY, United States
| | - Marc Normandin
- Department of Radiology Harvard Medical School, Boston, MA, United States
| | - Jonathan P Dyke
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Edward K Fung
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Yi Li
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Lidia Glodzik
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | | | - Sudhin A Shah
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Mony de Leon
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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