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Mencarelli L, Torso M, Borghi I, Assogna M, Pezzopane V, Bonnì S, Di Lorenzo F, Santarnecchi E, Giove F, Martorana A, Bozzali M, Ridgway GR, Chance SA, Koch G. Macro and micro structural preservation of grey matter integrity after 24 weeks of rTMS in Alzheimer's disease patients: a pilot study. Alzheimers Res Ther 2024; 16:152. [PMID: 38970141 PMCID: PMC11225141 DOI: 10.1186/s13195-024-01501-z] [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: 01/18/2024] [Accepted: 06/12/2024] [Indexed: 07/07/2024]
Abstract
Alzheimer's Disease (AD) is characterized by structural and functional dysfunction involving the Default Mode Network (DMN), for which the Precuneus (PC) is a key node. We proposed a randomized double-blind pilot study to determine neurobiological changes after 24 weeks of PC-rTMS in patients with mild-to-moderate AD. Sixteen patients were randomly assigned to SHAM or PC-rTMS, and received an intensive 2-weeks course with daily rTMS sessions, followed by a maintenance phase in which rTMS has been applied once a week. Before and after the treatment structural and functional MRIs were collected. Our results showed macro- and micro-structural preservation in PC-rTMS compared to SHAM-rTMS group after 24 weeks of treatment, correlated to an increase of functional connectivity (FC) within the PC in the PC-rTMS group. Even if preliminary, these results trigger the possibility of using PC-rTMS to arrest atrophy progression by manipulating distributed network connectivity patterns.
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Affiliation(s)
- Lucia Mencarelli
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy
| | - Mario Torso
- Oxford Brain Diagnostics Ltd, New Rd, Oxford, OX1 1BY, UK
| | - Ilaria Borghi
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari, 46, Ferrara, 44121, Italy
| | - Martina Assogna
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy
| | - Valentina Pezzopane
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy
- Center for Translational Neurophysiology of Speech and Communication, Istituto Italiano di Tecnologia, Via Fossato di Mortara, 19, Ferrara, 44121, Italy
| | - Sonia Bonnì
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy
| | - Francesco Di Lorenzo
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Massachusetts General Hospital & Harvard Medical School, 125 Nashua Street, Boston, MA, 02114- 1107, USA
| | - Federico Giove
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, Rome, 00179, Italy
- MARBILab, Museo Storico della Fisica e Centro Studi e Ricerche Enrico Fermi, Via Panisperna 89 A, Rome, 00184, Italy
| | - Alessandro Martorana
- Department of Systems Medicine, Memory Clinic, University of Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Marco Bozzali
- Neuroscience Department "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
| | | | | | - Giacomo Koch
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, Rome, 00179, Italy.
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari, 46, Ferrara, 44121, Italy.
- Center for Translational Neurophysiology of Speech and Communication, Istituto Italiano di Tecnologia, Via Fossato di Mortara, 19, Ferrara, 44121, Italy.
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Mulay AR, Hwang J, Kim DH. Microphysiological Blood-Brain Barrier Systems for Disease Modeling and Drug Development. Adv Healthc Mater 2024:e2303180. [PMID: 38430211 DOI: 10.1002/adhm.202303180] [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: 09/20/2023] [Revised: 02/22/2024] [Indexed: 03/03/2024]
Abstract
The blood-brain barrier (BBB) is a highly controlled microenvironment that regulates the interactions between cerebral blood and brain tissue. Due to its selectivity, many therapeutics targeting various neurological disorders are not able to penetrate into brain tissue. Pre-clinical studies using animals and other in vitro platforms have not shown the ability to fully replicate the human BBB leading to the failure of a majority of therapeutics in clinical trials. However, recent innovations in vitro and ex vivo modeling called organs-on-chips have shown the potential to create more accurate disease models for improved drug development. These microfluidic platforms induce physiological stressors on cultured cells and are able to generate more physiologically accurate BBBs compared to previous in vitro models. In this review, different approaches to create BBBs-on-chips are explored alongside their application in modeling various neurological disorders and potential therapeutic efficacy. Additionally, organs-on-chips use in BBB drug delivery studies is discussed, and advances in linking brain organs-on-chips onto multiorgan platforms to mimic organ crosstalk are reviewed.
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Affiliation(s)
- Atharva R Mulay
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Jihyun Hwang
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Deok-Ho Kim
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Center for Microphysiological Systems, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, 21218, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, 21205, USA
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Plantone D, Pardini M, Righi D, Manco C, Colombo BM, De Stefano N. The Role of TNF-α in Alzheimer's Disease: A Narrative Review. Cells 2023; 13:54. [PMID: 38201258 PMCID: PMC10778385 DOI: 10.3390/cells13010054] [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: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
This review analyzes the role of TNF-α and its increase in biological fluids in mild cognitive impairment, and Alzheimer's disease (AD). The potential inhibition of TNF-α with pharmacological strategies paves the way for preventing AD and improving cognitive function in people at risk for dementia. We conducted a narrative review to characterize the evidence in relation to the involvement of TNF-α in AD and its possible therapeutic inhibition. Several studies report that patients with RA and systemic inflammatory diseases treated with TNF-α blocking agents reduce the probability of emerging dementia compared with the general population. Animal model studies also showed interesting results and are discussed. An increasing amount of basic scientific data and clinical studies underscore the importance of inflammatory processes and subsequent glial activation in the pathogenesis of AD. TNF-α targeted therapy is a biologically plausible approach for cognition preservation and further trials are necessary to investigate the potential benefits of therapy in populations at risk of developing AD.
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Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100 Siena, Italy; (D.R.); (C.M.); (N.D.S.)
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, L.go P. Daneo 3, 16132 Genova, Italy;
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy;
| | - Delia Righi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100 Siena, Italy; (D.R.); (C.M.); (N.D.S.)
| | - Carlo Manco
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100 Siena, Italy; (D.R.); (C.M.); (N.D.S.)
| | - Barbara Maria Colombo
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy;
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100 Siena, Italy; (D.R.); (C.M.); (N.D.S.)
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Kantor AB, Akassoglou K, Stavenhagen JB. Fibrin-Targeting Immunotherapy for Dementia. J Prev Alzheimers Dis 2023; 10:647-660. [PMID: 37874085 PMCID: PMC11227370 DOI: 10.14283/jpad.2023.105] [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: 10/25/2023]
Abstract
Blood-brain barrier (BBB) disruption is an early event in the development of Alzheimer's disease. It precedes extracellular deposition of amyloid-β in senile plaques and blood vessel walls, the intracellular accumulation of neurofibrillary tangles containing phosphorylated tau protein, microglial activation, and neuronal cell death. BBB disruption allows the coagulation protein fibrinogen to leak from the blood into the brain, where it is converted by thrombin cleavage into fibrin and deposits in the parenchyma and CNS vessels. Fibrinogen cleavage by thrombin exposes a cryptic epitope termed P2 which can bind CD11b and CD11c on microglia, macrophages and dendritic cells and trigger an inflammatory response toxic to neurons. Indeed, genetic and pharmacological evidence demonstrates a causal role for fibrin in innate immune cell activation and the development of neurodegenerative diseases. The P2 inflammatory epitope is spatially and compositionally distinct from the coagulation epitope on fibrin. Mouse monoclonal antibody 5B8, which targets the P2 epitope without interfering with the clotting process, has been shown to reduce neurodegeneration and neuroinflammation in animal models of Alzheimer's disease and multiple sclerosis. The selectivity and efficacy of this anti-human fibrin-P2 antibody in animal models supports the development of a monoclonal antibody drug targeting fibrin P2 for the treatment of neurodegenerative diseases. THN391 is a humanized, affinity-matured antibody which has a 100-fold greater affinity for fibrin P2 and improved development properties compared to the parental 5B8 antibody. It is currently in a Phase 1 clinical trial.
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Affiliation(s)
- A B Kantor
- Jeffrey Stavenhagen, PhD, Therini Bio, Inc, Sacramento, CA, USA,
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