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Zerr I, Ladogana A, Mead S, Hermann P, Forloni G, Appleby BS. Creutzfeldt-Jakob disease and other prion diseases. Nat Rev Dis Primers 2024; 10:14. [PMID: 38424082 DOI: 10.1038/s41572-024-00497-y] [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] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
Prion diseases share common clinical and pathological characteristics such as spongiform neuronal degeneration and deposition of an abnormal form of a host-derived protein, termed prion protein. The characteristic features of prion diseases are long incubation times, short clinical courses, extreme resistance of the transmissible agent to degradation and lack of nucleic acid involvement. Sporadic and genetic forms of prion diseases occur worldwide, of which genetic forms are associated with mutations in PRNP. Human to human transmission of these diseases has occurred due to iatrogenic exposure, and zoonotic forms of prion diseases are linked to bovine disease. Significant progress has been made in the diagnosis of these disorders. Clinical tools for diagnosis comprise brain imaging and cerebrospinal fluid tests. Aggregation assays for detection of the abnormally folded prion protein have a clear potential to diagnose the disease in peripherally accessible biofluids. After decades of therapeutic nihilism, new treatment strategies and clinical trials are on the horizon. Although prion diseases are relatively rare disorders, understanding their pathogenesis and mechanisms of prion protein misfolding has significantly enhanced the field in research of neurodegenerative diseases.
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Affiliation(s)
- Inga Zerr
- National Reference Center for CJD Surveillance, Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany.
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Simon Mead
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Peter Hermann
- National Reference Center for CJD Surveillance, Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Gianluigi Forloni
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Brian S Appleby
- Departments of Neurology, Psychiatry and Pathology, Case Western Reserve University, Cleveland, OH, USA
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Qiang Q, Skudder-Hill L, Toyota T, Huang Z, Wei W, Adachi H. CSF 14-3-3β is associated with progressive cognitive decline in Alzheimer's disease. Brain Commun 2023; 5:fcad312. [PMID: 38035365 PMCID: PMC10684297 DOI: 10.1093/braincomms/fcad312] [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: 07/12/2023] [Revised: 09/22/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
Alzheimer's disease is a neurodegenerative disorder characterized pathologically by amyloid-beta plaques, tau tangles and neuronal loss. In clinical practice, the 14-3-3 isoform beta (β) is a biomarker that aids in the diagnosis of sporadic Creutzfeldt-Jakob disease. Recently, a proteomics study found increased CSF 14-3-3β levels in Alzheimer's disease patients, suggesting a potential link between CSF 14-3-3β and Alzheimer's disease. Our present study aimed to further investigate the role of CSF 14-3-3β in Alzheimer's disease by analysing the data of 719 participants with available CSF 14-3-3β measurements from the Alzheimer's Disease Neuroimaging Initiative. Higher CSF 14-3-3β levels were observed in the mild cognitive impairment group compared to the cognitively normal group, with the highest CSF 14-3-3β levels in the Alzheimer's disease dementia group. This study also found significant associations between CSF 14-3-3β levels and CSF biomarkers of p-tau, t-tau, pTau/Aβ42 ratios and GAP-43, as well as other Alzheimer's disease biomarkers such as Aβ-PET. An early increase in CSF 14-3-3β levels was observed prior to Aβ-PET-positive status, and CSF 14-3-3β levels continued to rise after crossing the Aβ-PET positivity threshold before reaching a plateau. The diagnostic accuracy of CSF 14-3-3β (area under the receiver operating characteristic curve = 0.819) was moderate compared to other established Alzheimer's disease biomarkers in distinguishing cognitively normal Aβ pathology-negative individuals from Alzheimer's disease Aβ pathology-positive individuals. Higher baseline CSF 14-3-3β levels were associated with accelerated cognitive decline, reduced hippocampus volumes and declining fluorodeoxyglucose-PET values over a 4-year follow-up period. Patients with mild cognitive impairment and high CSF 14-3-3β levels at baseline had a significantly increased risk [hazard ratio = 2.894 (1.599-5.238), P < 0.001] of progression to Alzheimer's disease dementia during follow-up. These findings indicate that CSF 14-3-3β may be a potential biomarker for Alzheimer's disease and could provide a more comprehensive understanding of the underlying pathological changes of Alzheimer's disease, as well as aid in the diagnosis and monitoring of disease progression.
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Affiliation(s)
- Qiang Qiang
- Department of Neurology, Cognitive Disorders Center, Huadong Hospital, Fudan University, 200040 Shanghai, China
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, 807-8555 Kitakyushu, Japan
| | - Loren Skudder-Hill
- Yuquan Hospital, Tsinghua University School of Clinical Medicine, 100084 Beijing, China
- School of Medicine, University of Auckland, 1023 Auckland, New Zealand
| | - Tomoko Toyota
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, 807-8555 Kitakyushu, Japan
| | - Zhe Huang
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, 807-8555 Kitakyushu, Japan
| | - Wenshi Wei
- Department of Neurology, Cognitive Disorders Center, Huadong Hospital, Fudan University, 200040 Shanghai, China
| | - Hiroaki Adachi
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, 807-8555 Kitakyushu, Japan
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Kitazaki Y, Ikawa M, Hamano T, Sasaki H, Yamaguchi T, Enomoto S, Shirafuji N, Hayashi K, Yamamura O, Tsujikawa T, Okazawa H, Kimura H, Nakamoto Y. Magnetic resonance imaging arterial spin labeling hypoperfusion with diffusion-weighted image hyperintensity is useful for diagnostic imaging of Creutzfeldt-Jakob disease. Front Neurol 2023; 14:1242615. [PMID: 37885479 PMCID: PMC10598551 DOI: 10.3389/fneur.2023.1242615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Background and objectives Magnetic resonance imaging with arterial spin labeling (ASL) perfusion imaging is a noninvasive method for quantifying cerebral blood flow (CBF). We aimed to evaluate the clinical utility of ASL perfusion imaging to aid in the diagnosis of Creutzfeldt-Jakob disease (CJD). Methods This retrospective study enrolled 10 clinically diagnosed with probable sporadic CJD (sCJD) based on the National CJD Research & Surveillance Unit and EuroCJD criteria and 18 healthy controls (HCs). Diffusion-weighted images (DWIs), CBF images obtained from ASL, N-isopropyl-(123I)-p-iodoamphetamine (123IMP)-single-photon emission computed tomography (SPECT) images, and 18F-fluorodeoxyglucose (18FDG)-positron emission tomography (PET) images were analyzed. First, the cortical values obtained using volume-of-interest (VOI) analysis were normalized using the global mean in each modality. The cortical regions were classified into DWI-High (≥ +1 SD) and DWI-Normal (< +1 SD) regions according to the DWI-intensity values. The normalized cortical values were compared between the two regions for each modality. Second, each modality value was defined as ASL hypoperfusion (< -1 SD), SPECT hypoperfusion (< -1 SD), and PET low accumulation (< -1 SD). The overall agreement rate of DWIs with ASL-CBF, SPECT, and PET was calculated. Third, regression analyses between the normalized ASL-CBF values and normalized SPECT or PET values derived from the VOIs were performed using a scatter plot. Results The mean values of ASL-CBF (N = 10), 123IMP-SPECT (N = 8), and 18FDG-PET (N = 3) in DWI-High regions were significantly lower than those in the DWI-Normal regions (p < 0.001 for all); however, HCs (N = 18) showed no significant differences in ASL-CBF between the two regions. The overall agreement rate of DWI (high or normal) with ASL-CBF (hypoperfusion or normal) (81.8%) was similar to that of SPECT (85.2%) and PET (78.5%) in CJD. The regression analysis showed that the normalized ASL-CBF values significantly correlated with the normalized SPECT (r = 0.44, p < 0.001) and PET values (r = 0.46, p < 0.001) in CJD. Discussion Patients with CJD showed ASL hypoperfusion in lesions with DWI hyperintensity, suggesting that ASL-CBF could be beneficial for the diagnostic aid of CJD.
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Affiliation(s)
- Yuki Kitazaki
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
- Department of Advanced Medicine for Community Healthcare, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tadanori Hamano
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- Department of Aging and Dementia (DAD), University of Fukui, Fukui, Japan
- Life Science Innovation Center, University of Fukui, Fukui, Japan
| | - Hirohito Sasaki
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Soichi Enomoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Norimichi Shirafuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kouji Hayashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui, Japan
| | - Osamu Yamamura
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Brunelli S, Giannella E, Bizzaglia M, De Angelis D, Sancesario GM. Secondary neurodegeneration following Stroke: what can blood biomarkers tell us? Front Neurol 2023; 14:1198216. [PMID: 37719764 PMCID: PMC10502514 DOI: 10.3389/fneur.2023.1198216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Stroke is one of the leading causes of death and the primary source of disability in adults, resulting in neuronal necrosis of ischemic areas, and in possible secondary degeneration of regions surrounding or distant to the initial damaged area. Secondary neurodegeneration (SNDG) following stroke has been shown to have different pathogenetic origins including inflammation, neurovascular response and cytotoxicity, but can be associated also to regenerative processes. Aside from focal neuronal loss, ipsilateral and contralateral effects distal to the lesion site, disruptions of global functional connectivity and a transcallosal diaschisis have been reported in the chronic stages after stroke. Furthermore, SNDG can be observed in different areas not directly connected to the primary lesion, such as thalamus, hippocampus, amygdala, substantia nigra, corpus callosum, bilateral inferior fronto-occipital fasciculus and superior longitudinal fasciculus, which can be highlighted by neuroimaging techniques. Although the clinical relevance of SNDG following stroke has not been well understood, the identification of specific biomarkers that reflect the brain response to the damage, is of paramount importance to investigate in vivo the different phases of stroke. Actually, brain-derived markers, particularly neurofilament light chain, tau protein, S100b, in post-stroke patients have yielded promising results. This review focuses on cerebral morphological modifications occurring after a stroke, on associated cellular and molecular changes and on state-of-the-art of biomarkers in acute and chronic phase. Finally, we discuss new perspectives regarding the implementation of blood-based biomarkers in clinical practice to improve the rehabilitation approaches and post stroke recovery.
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Affiliation(s)
- Stefano Brunelli
- NeuroRehabilitation Unit 4, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Emilia Giannella
- Clinical Neurochemistry Unit and Biobank, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mirko Bizzaglia
- Radiology and Diagnostic Imaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
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Kishida H, Ueda N, Tanaka F. The advances in the early and accurate diagnosis of Creutzfeldt-Jakob disease and other prion diseases: where are we today? Expert Rev Neurother 2023; 23:803-817. [PMID: 37581576 DOI: 10.1080/14737175.2023.2246653] [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: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Before the introduction of MRI diffusion-weighted images (DWI), the diagnosis of Creutzfeldt-Jakob disease (CJD) relied upon nonspecific findings including clinical symptoms, EEG abnormalities, and elevated levels of cerebrospinal fluid 14-3-3 protein. Subsequently, the use of DWI has improved diagnostic accuracy, but it sometimes remains difficult to differentiate CJD from encephalitis, epilepsy, and other dementing disorders. The revised diagnostic criteria include real-time quaking-induced conversion (RT-QuIC), detecting small amounts of CJD-specific prion protein, and clinically sensitive DWI. Combining these techniques has further improved diagnostic accuracy, enabling earlier diagnosis. AREAS COVERED Herein, the authors review the recent advances in diagnostic methods and revised diagnostic criteria for sporadic CJD. They also discuss other prion diseases, such as variant CJD and chronic wasting disease, where the emergence of new types is a concern. EXPERT OPINION Despite improvements in diagnostic methods and criteria, some subtypes of prion disease are still difficult to diagnose, and even the diagnosis using the most innovative RT-QuIC test remains a challenge in terms of accuracy and standardization. However, these revised criteria can be adapted to the emergence of new types of prion diseases. It is essential to continue careful surveillance and update information on the latest prion disease phenotypes.
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Affiliation(s)
- Hitaru Kishida
- Department of Neurology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Naohisa Ueda
- Department of Neurology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Senesi M, Lewis V, Varghese S, Stehmann C, McGlade A, Doecke JD, Ellett L, Sarros S, Fowler CJ, Masters CL, Li QX, Collins SJ. Diagnostic performance of CSF biomarkers in a well-characterized Australian cohort of sporadic Creutzfeldt-Jakob disease. Front Neurol 2023; 14:1072952. [PMID: 36846121 PMCID: PMC9944944 DOI: 10.3389/fneur.2023.1072952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 02/11/2023] Open
Abstract
The most frequently utilized biomarkers to support a pre-mortem clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) include concentrations of the 14-3-3 and total tau (T-tau) proteins, as well as the application of protein amplification techniques, such as the real time quaking-induced conversion (RT-QuIC) assay, in cerebrospinal fluid (CSF). Utilizing CSF from a cohort of neuropathologically confirmed (definite) sCJD (n = 50) and non-CJD controls (n = 48), we established the optimal cutpoints for the fully automated Roche Elecsys® immunoassay for T-tau and the CircuLexTM 14-3-3 Gamma ELISA and compared these to T-tau protein measured using a commercially available assay (INNOTEST hTAU Ag) and 14-3-3 protein detection by western immunoblot (WB). These CSF specimens were also assessed for presence of misfolded prion protein using the RT-QuIC assay. T-tau showed similar diagnostic performance irrespective of the assay utilized, with ~90% sensitivity and specificity. The 14-3-3 protein detection by western blot (WB) has 87.5% sensitivity and 66.7% specificity. The 14-3-3 ELISA demonstrated 81.3% sensitivity and 84.4% specificity. RT-QuIC was the single best performing assay, with a sensitivity of 92.7% and 100% specificity. Our study indicates that a combination of all three CSF biomarkers increases sensitivity and offers the best chance of case detection pre-mortem. Only a single sCJD case in our cohort was negative across the three biomarkers, emphasizing the value of autopsy brain examination on all suspected CJD cases to ensure maximal case ascertainment.
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Affiliation(s)
- Matteo Senesi
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia,Department of Medicine, Royal Melbourne Hospital (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Victoria Lewis
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia,Department of Medicine, Royal Melbourne Hospital (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Shiji Varghese
- National Dementia Diagnostics Laboratory (NDDL), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christiane Stehmann
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Amelia McGlade
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Laura Ellett
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Shannon Sarros
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher J. Fowler
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Colin L. Masters
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia,National Dementia Diagnostics Laboratory (NDDL), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia,The Florey Institute of Neuroscience and Mental Health, Florey Department, The University of Melbourne, Parkville, VIC, Australia
| | - Qiao-Xin Li
- Department of Medicine, Royal Melbourne Hospital (RMH), The University of Melbourne, Parkville, VIC, Australia,The Florey Institute of Neuroscience and Mental Health, Florey Department, The University of Melbourne, Parkville, VIC, Australia,Qiao-Xin Li ✉
| | - Steven J. Collins
- Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia,Department of Medicine, Royal Melbourne Hospital (RMH), The University of Melbourne, Parkville, VIC, Australia,National Dementia Diagnostics Laboratory (NDDL), The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia,*Correspondence: Steven J. Collins ✉
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Kong Y, Chen Z, Shi Q, Zuo Y, Zhang J. Clinical Correlates of Cerebrospinal Fluid 14-3-3 Protein in Non-Prion Rapid Progressive Dementia. J Alzheimers Dis 2023; 91:263-272. [PMID: 36404548 DOI: 10.3233/jad-220718] [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: 11/16/2022]
Abstract
BACKGROUND The 14-3-3 protein in cerebrospinal fluid (CSF) is a suitable biomarker for the diagnosis of Creutzfeldt-Jakob disease (CJD). However, it has also been detected in various non-prion-related rapidly progressive dementia (RPD), which affected its diagnostic performance and clinical utilization. OBJECTIVE To investigate the general disease distribution with positive 14-3-3 result and to evaluate the association between CSF 14-3-3 protein and the clinical features in patients with non-prion RPD. METHODS A total of 150 patients with non-prion RPD were enrolled. The clinical data were collected and CSF 14-3-3 test was performed for all patients. The distribution of various diseases with a positive 14-3-3 result was analyzed and the association of CSF 14-3-3 with clinical features was tested. RESULTS The CSF 14-3-3 protein was detected in 23.3% of non-prion RPD patients, and the most frequent diagnoses were autoimmune encephalitis (22.9%) and neurodegenerative disease (22.9%). CSF 14-3-3 protein was more common in older patients (p = 0.028) and those presenting myoclonus (p = 0.008). In subgroup analysis, the positive 14-3-3 test was more common in neurodegenerative disease with a long time from the symptom onset to CSF 14-3-3 test (p = 0.014). CONCLUSION CSF 14-3-3 protein could be detected in a broad spectrum of non-prion RPD. In particular, patients with autoimmune encephalitis and rapidly progressive neurodegenerative diseases and those with myoclonus have a greater likelihood of a positive 14-3-3 result. These results could help clinicians interpret the results of CSF 14-3-3 protein more reasonably.
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Affiliation(s)
- Yu Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Shi
- State Key Laboratory of Infectious Disease Prevention and Control, NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya Zuo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Matsubayashi T, Sanjo N. Systematic Review of Clinical and Pathophysiological Features of Genetic Creutzfeldt-Jakob Disease Caused by a Val-to-Ile Mutation at Codon 180 in the Prion Protein Gene. Int J Mol Sci 2022; 23:15172. [PMID: 36499498 PMCID: PMC9737045 DOI: 10.3390/ijms232315172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) is a subtype of genetic prion diseases (gPrDs) caused by the accumulation of mutated pathological prion proteins (PrPSc). gCJD has a phenotypic similarity with sporadic CJD (sCJD). In Japan, gCJD with a Val to Ile substitution at codon 180 (V180I-gCJD) is the most frequent gPrD, while the mutation is extremely rare in countries other than Japan and Korea. In this article, we aim to review previously elucidated clinical and biochemical features of V180I-gCJD, expecting to advance the understanding of this unique subtype in gCJD. Compared to classical sCJD, specific clinical features of V180I-gCJD include older age at onset, a relatively slow progression of dementia, and a lower positivity for developing myoclonus, cerebellar, pyramidal signs, and visual disturbance. Diffuse edematous ribboning hyperintensity of the cerebral cortex, without occipital lobes in diffusion-weighted magnetic resonance imaging, is also specific. Laboratory data reveal the low positivity of PrPSc in the cerebrospinal fluid and periodic sharp wave complexes on an electroencephalogram. Most patients with V180I-gCJD have been reported to have no family history, probably due to the older age at onset, and clinical and biochemical features indicate the specific phenotype associated with the prion protein gene mutation.
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Affiliation(s)
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan
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Shir D, Lazar EB, Graff-Radford J, Aksamit AJ, Cutsforth-Gregory JK, Jones DT, Botha H, Ramanan VK, Prusinski C, Porter A, Day GS. Analysis of Clinical Features, Diagnostic Tests, and Biomarkers in Patients With Suspected Creutzfeldt-Jakob Disease, 2014-2021. JAMA Netw Open 2022; 5:e2225098. [PMID: 35921110 PMCID: PMC9350714 DOI: 10.1001/jamanetworkopen.2022.25098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Detection of prion proteins in cerebrospinal fluid (CSF) using real-time quaking-induced conversion (RT-QuIC) assays has transformed the diagnostic approach to sporadic Creutzfeldt-Jakob disease (CJD), facilitating earlier and more complete recognition of affected patients. It is unclear how expanded recognition of affected patients may affect the diagnostic and prognostic relevance of clinical features and diagnostic tests historically associated with CJD. OBJECTIVE To evaluate clinical features and diagnostic testing in patients presenting with CJD and determine the associations of these features with prognosis. DESIGN, SETTING, AND PARTICIPANTS This cohort study incorporated data from electronic medical records of patients with CJD treated at Mayo Clinic Enterprise tertiary care centers in Rochester, Minnesota; Jacksonville, Florida; and Scottsdale, Arizona. Participants included patients with definite or probable CJD assessed from 2014 to 2021. Data were analyzed October 2021 to January 2022. EXPOSURES Dominant presentation, clinical features, and diagnostic tests associated with CJD. MAIN OUTCOMES AND MEASURES The outcomes of interest were the sensitivity and prognostic value of clinical features and accessible diagnostic tests at presentation with possible CJD. RESULTS A total of 115 patients were identified, including 40 patients (35%) with definite CJD. Mean (SD) age at symptom onset was 64.8 (9.4) years, and 68 patients were women (59%). The sensitivity of clinical markers (myoclonus) and tests historically considered in patients with suspected CJD was poor (eg, stereotyped electroencephalography anomalies: 17 of 105 patients [16%]; elevated CSF protein 14-3-3 levels: 54 of 90 patients [60%]). By comparison, biomarkers with good diagnostic sensitivity at presentation included RT-QuIC (66 of 71 patients [93%]), CSF total tau (T-tau) level greater than 1149 pg/mL (81 of 92 patients [88%]), and characteristic signal anomalies on magnetic resonance imaging (88 of 115 patients [77%]). Multivariable linear regression confirmed shorter survival in patients with myoclonus (difference, -125.9 [95% CI, -236.3 to -15.5] days; P = .03), visual or cerebellar signs (difference, -180.2 [95% CI, -282.2 to -78.2] days; P < .001), elevated CSF protein 14-3-3 levels (difference, -193 [95% CI, -304.9 to -82.9] days; P < .001), and elevated T-tau level (difference for every 1000 pg/mL elevation, -9.1 [95% CI, -17.7 to -1.0] days; P = .04). CONCLUSIONS AND RELEVANCE These findings suggest that CSF RT-QuIC, elevated CSF T-tau level, and stereotyped magnetic resonance imaging anomalies were associated with the diagnosis of CJD, while other clinical findings (eg, myoclonus), stereotyped electroencephalography anomalies, and CSF protein 14-3-3 levels offered less diagnostic value. Visual or cerebellar features, myoclonus, and CSF 14-3-3 and T-tau levels may be associated with disease duration, justifying continued inclusion in the evaluation of patients suspected to have CJD.
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Affiliation(s)
- Dror Shir
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Amanda Porter
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
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Cencini F, Catania M, Di Fede G, Rossi G, Khouri Chalouhi K, Manfredi C, Giaccone G, Tiraboschi P, Bersano A, Groppo E, Rosci C, Tancredi L, Campiglio L, De Grado A, Priori A, Scelzo E. SORL1 gene mutation and octapeptide repeat insertion in PRNP gene in a case presenting with rapidly progressive dementia and cerebral amyloid angiopathy. Eur J Neurol 2022; 29:3139-3146. [PMID: 35789031 DOI: 10.1111/ene.15487] [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: 05/12/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) has been associated with a variety of neurodegenerative disorders, included prion diseases (PrDs) and Alzheimer's disease (AD); its pathophysiology is still largely unknown. We report the case of an 80-year-old man with a rapidly progressive dementia and neuroimaging features consistent with CAA carrying two genetic defects in the PRNP and SORL1 genes. METHODS Neurological examination, brain Magnetic Resonance Imaging (MRI), electroencephalogram-electromyography (EEG-EMG) polygraphy and analysis of 14-3-3 and tau proteins, Aβ40 and Aβ42 in the cerebrospinal fluid (CSF) were performed. The patient underwent a detailed genetic study by next generation sequencing analysis. RESULTS The patient presented with progressive cognitive dysfunction, generalized myoclonus and ataxia. About 9 months after symptom onset, he was bed-bound, almost mute and akinetic. Brain MRI was consistent with CAA. CSF analysis showed high levels of t-tau and p-tau, decreased Aβ42, decreased Aβ42/Aβ40 ratio, while 14.3.3 protein was not detected. EEG-EMG polygraphy demonstrated diffuse slowing, frontal theta activity and generalized spikes-waves related to upper limb myoclonus induced by intermittent photic stimulation. Genetic tests revealed the presence of the E270K variant in the SORL1 gene and the presence of a single octapeptide repeat insertion (OPRI) in the coding region of the PRNP gene. CONCLUSIONS The specific pathogenic contribution of the two DNA variations is difficult to determine without neuropathology; among the possible explanations, we discuss the possibility of their link with CAA. Vascular and degenerative pathways actually interact in a synergistic way, and genetic studies may lead to more insight into pathophysiological mechanisms.
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Affiliation(s)
- Federica Cencini
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marcella Catania
- Neurology 5 / Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Di Fede
- Neurology 5 / Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giacomina Rossi
- Neurology 5 / Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Chiara Manfredi
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giorgio Giaccone
- Neurology 5 / Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Pietro Tiraboschi
- Neurology 5 / Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisabetta Groppo
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Chiara Rosci
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lucia Tancredi
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Laura Campiglio
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Amedeo De Grado
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alberto Priori
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Emma Scelzo
- III Clinical Neurology Unit, Department of Health Sciences, "Aldo Ravelli" Research Center, University of Milan, Polo Universitario Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
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11
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Hermann P, Zerr I. Rapidly progressive dementias - aetiologies, diagnosis and management. Nat Rev Neurol 2022; 18:363-376. [PMID: 35508635 PMCID: PMC9067549 DOI: 10.1038/s41582-022-00659-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/15/2022]
Abstract
Rapidly progressive dementias (RPDs) are a group of heterogeneous disorders that include immune-mediated, infectious and metabolic encephalopathies, as well as prion diseases and atypically rapid presentations of more common neurodegenerative diseases. Some of these conditions are treatable, and some must be diagnosed promptly because of their potential infectivity. Prion disease is considered to be the prototypical RPD, but over the past two decades, epidemiological reports and the identification of various encephalitis-mediating antibodies have led to a growing recognition of other encephalopathies as potential causes of rapid cognitive decline. Knowledge of RPD aetiologies, syndromes and diagnostic work-up protocols will help clinicians to establish an early, accurate diagnosis, thereby reducing morbidity and mortality, especially in immune-mediated and other potentially reversible dementias. In this Review, we define the syndrome of RPD and shed light on its different aetiologies and on secondary factors that might contribute to rapid cognitive decline. We describe an extended diagnostic procedure in the context of important differential diagnoses, discuss the utility of biomarkers and summarize potential treatment options. In addition, we discuss treatment options such as high-dose steroid therapy in the context of therapy and diagnosis in clinically ambiguous cases. The term ‘rapidly progressive dementia’ (RPD) describes a cognitive disorder with fast progression, leading to dementia within a relatively short time. This Review discusses the wide range of RPD aetiologies, as well as the diagnostic approach and treatment options. Definitions of rapidly progressive dementia (RPD) vary according to the aetiological background and relate to the speed of cognitive decline, time from first symptom to dementia syndrome and/or overall survival. RPD can occur in rapidly progressive neurodegenerative diseases, such as prion diseases, or in primarily slowly progressive diseases as a consequence of intrinsic factors or concomitant pathologies. Besides neurodegenerative diseases, inflammatory (immune-mediated and infectious), vascular, metabolic and neoplastic CNS diseases are important and frequent causes of RPD. To identify treatable causes of RPD, the technical diagnostic work-up must include MRI and analyses of blood and cerebrospinal fluid, and further diagnostics might be indicated in unclear cases. Therapeutic options for many non-neurodegenerative causes of RPD are already available; disease-modifying therapies for neurodegenerative RPDs are an important focus of current research and could become a treatment option in the near future.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Göttingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.
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12
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Altuna M, Ruiz I, Zelaya MV, Mendioroz M. Role of Biomarkers for the Diagnosis of Prion Diseases: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58040473. [PMID: 35454316 PMCID: PMC9030755 DOI: 10.3390/medicina58040473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Prion diseases are progressive and irreversible neurodegenerative disorders with a low incidence (1.5–2 cases per million per year). Genetic (10–15%), acquired (anecdotal) and sporadic (85%) forms of the disease have been described. The clinical spectrum of prion diseases is very varied, although the most common symptoms are rapidly progressive dementia, cerebellar ataxia and myoclonus. Mean life expectancy from the onset of symptoms is 6 months. There are currently diagnostic criteria based on clinical phenotype, as well as neuroimaging biomarkers (magnetic resonance imaging), neurophysiological tests (electroencephalogram and polysomnogram), and cerebrospinal fluid biomarkers (14-3-3 protein and real-time quaking-induced conversion (RT-QuIC)). The sensitivity and specificity of some of these tests (electroencephalogram and 14-3-3 protein) is under debate and the applicability of other tests, such as RT-QuIC, is not universal. However, the usefulness of these biomarkers beyond the most frequent prion disease, sporadic Creutzfeldt–Jakob disease, remains unclear. Therefore, research is being carried out on new, more efficient cerebrospinal fluid biomarkers (total tau, ratio total tau/phosphorylated tau and neurofilament light chain) and potential blood biomarkers (neurofilament light chain, among others) to try to universalize access to early diagnosis in the case of prion diseases.
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Affiliation(s)
- Miren Altuna
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau—Biomedical Research Institute Sant Pau—Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
- Centre of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- CITA-Alzheimer Foundation, 20009 Donostia-San Sebastián, Spain
- Correspondence: ; Tel.: +34-935-56-59-86; Fax: +34-935-56-56-02
| | - Iñigo Ruiz
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau—Biomedical Research Institute Sant Pau—Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - María Victoria Zelaya
- Department of Pathological Anatomy, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
| | - Maite Mendioroz
- Department of Neurology, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
- Neuroepigenetics Laboratory-Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA (Navarra Institute for Health Research), 31006 Pamplona, Spain
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13
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Hermann P, Haller P, Goebel S, Bunck T, Schmidt C, Wiltfang J, Zerr I. Total and Phosphorylated Cerebrospinal Fluid Tau in the Differential Diagnosis of Sporadic Creutzfeldt-Jakob Disease and Rapidly Progressive Alzheimer’s Disease. Viruses 2022; 14:v14020276. [PMID: 35215868 PMCID: PMC8874601 DOI: 10.3390/v14020276] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
Background: CSF total-tau (t-tau) became a standard cerebrospinal fluid biomarker in Alzheimer’s disease (AD). In parallel, extremely elevated levels were observed in Creutzfeldt-Jakob disease (CJD). Therefore, tau is also considered as an alternative CJD biomarker, potentially complicating the interpretation of results. We investigated CSF t-tau and the t-tau/phosphorylated tau181 ratio in the differential diagnosis of sCJD and rapidly-progressive AD (rpAD). In addition, high t-tau concentrations and associated tau-ratios were explored in an unselected laboratory cohort. Methods: Retrospective analyses included n = 310 patients with CJD (n = 205), non-rpAD (n = 65), and rpAD (n = 40). The diagnostic accuracies of biomarkers were calculated and compared. Differential diagnoses were evaluated in patients from a neurochemistry laboratory with CSF t-tau >1250 pg/mL (n = 199 out of 7036). Results: CSF t-tau showed an AUC of 0.942 in the discrimination of sCJD from AD and 0.918 in the discrimination from rpAD. The tau ratio showed significantly higher AUCs (p < 0.001) of 0.992 versus non-rpAD and 0.990 versus rpAD. In the neurochemistry cohort, prion diseases accounted for only 25% of very high CSF t-tau values. High tau-ratios were observed in CJD, but also in non-neurodegenerative diseases. Conclusions: CSF t-tau is a reliable biomarker for sCJD, but false positive results may occur, especially in rpAD and acute encephalopathies. The t-tau/p-tau ratio may improve the diagnostic accuracy in centers where specific biomarkers are not available.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
- Correspondence: ; Tel.: +49-551-39-8955
| | - Philip Haller
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Stefan Goebel
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Timothy Bunck
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Christian Schmidt
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
- Neurosciences and Signaling Group, Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Inga Zerr
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
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14
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Cazzaniga FA, Bistaffa E, De Luca CMG, Bufano G, Indaco A, Giaccone G, Moda F. Sporadic Creutzfeldt-Jakob disease: Real-Time Quaking Induced Conversion (RT-QuIC) assay represents a major diagnostic advance. Eur J Histochem 2021; 65. [PMID: 34657408 PMCID: PMC8529530 DOI: 10.4081/ejh.2021.3298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and fatal neurodegenerative disorder with an incidence of 1.5 to 2 cases per million population/year. The disease is caused by a proteinaceous infectious agent, named prion (or PrPSc), which arises from the conformational conversion of the cellular prion protein (PrPC). Once formed, PrPSc interacts with the normally folded PrPC coercing it to undergo similar structural rearrangement. The disease is highly heterogeneous from a clinical and neuropathological point of view. The origin of this variability lies in the aberrant structures acquired by PrPSc. At least six different sCJD phenotypes have been described and each of them is thought to be caused by a peculiar PrPSc strain. Definitive sCJD diagnosis requires brain analysis with the aim of identifying intracerebral accumulation of PrPSc which currently represents the only reliable biomarker of the disease. Clinical diagnosis of sCJD is very challenging and is based on the combination of several clinical, instrumental and laboratory tests representing surrogate disease biomarkers. Thanks to the advent of the ultrasensitive Real-Time Quaking-Induced Conversion (RT-QuIC) assay, PrPSc was found in several peripheral tissues of sCJD patients, sometimes even before the clinical onset of the disease. This discovery represents an important step forward for the clinical diagnosis of sCJD. In this manuscript, we present an overview of the current applications and future perspectives of RT-QuIC in the field of sCJD diagnosis.
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Affiliation(s)
| | - Edoardo Bistaffa
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan.
| | | | - Giuseppe Bufano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan, Italy.
| | - Antonio Indaco
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan.
| | - Giorgio Giaccone
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan, Italy.
| | - Fabio Moda
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan, Italy.
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15
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Mastrangelo A, Baiardi S, Zenesini C, Poleggi A, Mammana A, Polischi B, Ladogana A, Capellari S, Parchi P. Diagnostic and prognostic performance of CSF α-synuclein in prion disease in the context of rapidly progressive dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12214. [PMID: 34222611 PMCID: PMC8240124 DOI: 10.1002/dad2.12214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Surrogate cerebrospinal fluid (CSF) biomarkers of neurodegeneration still have a central role in the first-line screening of patients with suspected Creutzfeldt-Jakob disease (CJD). Recently, CSF α-synuclein, a marker of synaptic damage, showed a close to optimal performance in distinguishing between CJD and other neurodegenerative dementias. METHODS We evaluated the diagnostic value of CSF α-synuclein in patients with prion disease, non-prion rapidly progressive dementias, and non-neurodegenerative controls. Additionally, we studied its distribution across the different prion disease subtypes and evaluated its association with survival. RESULTS CSF α-synuclein levels were significantly higher in patients with prion disease than in the other groups but showed a lower diagnostic value than CSF total tau or 14-3-3. Moreover, CSF α-synuclein was significantly associated with survival in the whole prion cohort and the most frequent clinicopathological subtypes. DISCUSSION In the clinical setting, CSF α-synuclein does not exceed the diagnostic performance of currently used surrogate markers, but it might constitute a robust prognostic indicator.
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Affiliation(s)
- Andrea Mastrangelo
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES)University of BolognaBolognaItaly
| | - Simone Baiardi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES)University of BolognaBolognaItaly
- IRCCSIstituto delle Scienze Neurologiche di BolognaBolognaItaly
| | | | - Anna Poleggi
- Department of NeuroscienceIstituto Superiore di SanitàRomeItaly
| | - Angela Mammana
- IRCCSIstituto delle Scienze Neurologiche di BolognaBolognaItaly
| | | | - Anna Ladogana
- Department of NeuroscienceIstituto Superiore di SanitàRomeItaly
| | - Sabina Capellari
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES)University of BolognaBolognaItaly
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna (DIBINEM)BolognaItaly
| | - Piero Parchi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES)University of BolognaBolognaItaly
- IRCCSIstituto delle Scienze Neurologiche di BolognaBolognaItaly
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16
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Harrington K, Abbott CC, Quinn D. Psychiatric Presentations of Creutzfeldt-Jakob Disease: A Case Report. J Acad Consult Liaison Psychiatry 2021; 62:248-252. [PMID: 33973526 DOI: 10.1016/j.jaclp.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kelly Harrington
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | | | - Davin Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM.
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17
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Figgie MP, Appleby BS. Clinical Use of Improved Diagnostic Testing for Detection of Prion Disease. Viruses 2021; 13:v13050789. [PMID: 33925126 PMCID: PMC8146465 DOI: 10.3390/v13050789] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Prion diseases are difficult to recognize as many symptoms are shared among other neurologic pathologies and the full spectra of symptoms usually do not appear until late in the disease course. Additionally, many commonly used laboratory markers are non-specific to prion disease. The recent introduction of second-generation real time quaking induced conversion (RT-QuIC) has revolutionized pre-mortem diagnosis of prion disease due to its extremely high sensitivity and specificity. However, RT-QuIC does not provide prognostic data and has decreased diagnostic accuracy in some rarer, atypical prion diseases. The objective of this review is to provide an overview of the current clinical utility of fluid-based biomarkers, neurodiagnostic testing, and brain imaging in the diagnosis of prion disease and to suggest guidelines for their clinical use, with a focus on rarer prion diseases with atypical features. Recent advancements in laboratory-based testing and imaging criteria have shown improved diagnostic accuracy and prognostic potential in prion disease, but because these diagnostic tests are not sensitive in some prion disease subtypes and diagnostic test sensitivities are unknown in the event that CWD transmits to humans, it is important to continue investigations into the clinical utility of various testing modalities.
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Affiliation(s)
- Mark P. Figgie
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Brian S. Appleby
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
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18
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Hermann P, Appleby B, Brandel JP, Caughey B, Collins S, Geschwind MD, Green A, Haïk S, Kovacs GG, Ladogana A, Llorens F, Mead S, Nishida N, Pal S, Parchi P, Pocchiari M, Satoh K, Zanusso G, Zerr I. Biomarkers and diagnostic guidelines for sporadic Creutzfeldt-Jakob disease. Lancet Neurol 2021; 20:235-246. [PMID: 33609480 DOI: 10.1016/s1474-4422(20)30477-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022]
Abstract
Sporadic Creutzfeldt-Jakob disease is a fatal neurodegenerative disease caused by misfolded prion proteins (PrPSc). Effective therapeutics are currently not available and accurate diagnosis can be challenging. Clinical diagnostic criteria use a combination of characteristic neuropsychiatric symptoms, CSF proteins 14-3-3, MRI, and EEG. Supportive biomarkers, such as high CSF total tau, could aid the diagnostic process. However, discordant studies have led to controversies about the clinical value of some established surrogate biomarkers. Development and clinical application of disease-specific protein aggregation and amplification assays, such as real-time quaking induced conversion (RT-QuIC), have constituted major breakthroughs for the confident pre-mortem diagnosis of sporadic Creutzfeldt-Jakob disease. Updated criteria for the diagnosis of sporadic Creutzfeldt-Jakob disease, including application of RT-QuIC, should improve early clinical confirmation, surveillance, assessment of PrPSc seeding activity in different tissues, and trial monitoring. Moreover, emerging blood-based, prognostic, and potentially pre-symptomatic biomarker candidates are under investigation.
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Affiliation(s)
- Peter Hermann
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Brian Appleby
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA; Departments of Neurology, Psychiatry, and Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jean-Philippe Brandel
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Steven Collins
- Australian National Creutzfeldt-Jakob disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | - Alison Green
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephane Haïk
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Franc Llorens
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Network Center For Biomedical Research Of Neurodegenerative Diseases, Institute Carlos III, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Simon Mead
- National Prion Clinic, University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Prion Unit at University College London, Institute of Prion Diseases, London, UK
| | - Noriyuki Nishida
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Suvankar Pal
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Piero Parchi
- Istituto di Ricovero e Cura e Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Katsuya Satoh
- Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Inga Zerr
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; German Center for Neurodegenerative Diseases, Göttingen, Germany
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Ojha R, Nepal G, Jamarkattel S, Prasad Gajurel B, Karn R, Rajbhandari R. Sporadic Creutzfeldt-Jakob disease: A case report and review of literature. Clin Case Rep 2020; 8:2240-2244. [PMID: 33235768 PMCID: PMC7669377 DOI: 10.1002/ccr3.3131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/30/2020] [Accepted: 06/12/2020] [Indexed: 01/15/2023] Open
Abstract
Creutzfeldt-Jakob Disease is a rare neurodegenerative disease and earlier diagnosis is usually difficult. Combining clinical features with electroencephalogram, laboratory parameters, and neuroimaging findings will facilitate the diagnosis.
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Affiliation(s)
- Rajeev Ojha
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Gaurav Nepal
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Sujan Jamarkattel
- Department of Internal MedicineLincoln Medical and Mental Health CenterBronxNYUSA
| | | | - Ragesh Karn
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
| | - Reema Rajbhandari
- Department of NeurologyTribhuvan University Teaching HospitalKathmanduNepal
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Ascari LM, Rocha SC, Gonçalves PB, Vieira TCRG, Cordeiro Y. Challenges and Advances in Antemortem Diagnosis of Human Transmissible Spongiform Encephalopathies. Front Bioeng Biotechnol 2020; 8:585896. [PMID: 33195151 PMCID: PMC7606880 DOI: 10.3389/fbioe.2020.585896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
Transmissible spongiform encephalopathies (TSEs), also known as prion diseases, arise from the structural conversion of the monomeric, cellular prion protein (PrPC) into its multimeric scrapie form (PrPSc). These pathologies comprise a group of intractable, rapidly evolving neurodegenerative diseases. Currently, a definitive diagnosis of TSE relies on the detection of PrPSc and/or the identification of pathognomonic histological features in brain tissue samples, which are usually obtained postmortem or, in rare cases, by brain biopsy (antemortem). Over the past two decades, several paraclinical tests for antemortem diagnosis have been developed to preclude the need for brain samples. Some of these alternative methods have been validated and can provide a probable diagnosis when combined with clinical evaluation. Paraclinical tests include in vitro cell-free conversion techniques, such as the real-time quaking-induced conversion (RT-QuIC), as well as immunoassays, electroencephalography (EEG), and brain bioimaging methods, such as magnetic resonance imaging (MRI), whose importance has increased over the years. PrPSc is the main biomarker in TSEs, and the RT-QuIC assay stands out for its ability to detect PrPSc in cerebrospinal fluid (CSF), olfactory mucosa, and dermatome skin samples with high sensitivity and specificity. Other biochemical biomarkers are the proteins 14-3-3, tau, neuron-specific enolase (NSE), astroglial protein S100B, α-synuclein, and neurofilament light chain protein (NFL), but they are not specific for TSEs. This paper reviews the techniques employed for definite diagnosis, as well as the clinical and paraclinical methods for possible and probable diagnosis, both those in use currently and those no longer employed. We also discuss current criteria, challenges, and perspectives for TSE diagnosis. An early and accurate diagnosis may allow earlier implementation of strategies to delay or stop disease progression.
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Affiliation(s)
- Lucas M. Ascari
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephanie C. Rocha
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscila B. Gonçalves
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tuane C. R. G. Vieira
- Institute of Medical Biochemistry Leopoldo de Meis, National Institute of Science and Technology for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yraima Cordeiro
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Younas N, Zafar S, Shafiq M, Noor A, Siegert A, Arora AS, Galkin A, Zafar A, Schmitz M, Stadelmann C, Andreoletti O, Ferrer I, Zerr I. SFPQ and Tau: critical factors contributing to rapid progression of Alzheimer's disease. Acta Neuropathol 2020; 140:317-339. [PMID: 32577828 PMCID: PMC7423812 DOI: 10.1007/s00401-020-02178-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
Dysfunctional RNA-binding proteins (RBPs) have been implicated in several neurodegenerative disorders. Recently, this paradigm of RBPs has been extended to pathophysiology of Alzheimer’s disease (AD). Here, we identified disease subtype specific variations in the RNA-binding proteome (RBPome) of sporadic AD (spAD), rapidly progressive AD (rpAD), and sporadic Creutzfeldt Jakob disease (sCJD), as well as control cases using RNA pull-down assay in combination with proteomics. We show that one of these identified proteins, splicing factor proline and glutamine rich (SFPQ), is downregulated in the post-mortem brains of rapidly progressive AD patients, sCJD patients and 3xTg mice brain at terminal stage of the disease. In contrast, the expression of SFPQ was elevated at early stage of the disease in the 3xTg mice, and in vitro after oxidative stress stimuli. Strikingly, in rpAD patients’ brains SFPQ showed a significant dislocation from the nucleus and cytoplasmic colocalization with TIA-1. Furthermore, in rpAD brain lesions, SFPQ and p-tau showed extranuclear colocalization. Of note, association between SFPQ and tau-oligomers in rpAD brains suggests a possible role of SFPQ in oligomerization and subsequent misfolding of tau protein. In line with the findings from the human brain, our in vitro study showed that SFPQ is recruited into TIA-1-positive stress granules (SGs) after oxidative stress induction, and colocalizes with tau/p-tau in these granules, providing a possible mechanism of SFPQ dislocation through pathological SGs. Furthermore, the expression of human tau in vitro induced significant downregulation of SFPQ, suggesting a causal role of tau in the downregulation of SFPQ. The findings from the current study indicate that the dysregulation and dislocation of SFPQ, the subsequent DNA-related anomalies and aberrant dynamics of SGs in association with pathological tau represents a critical pathway which contributes to rapid progression of AD.
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Affiliation(s)
- Neelam Younas
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Saima Zafar
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Mohsin Shafiq
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Aneeqa Noor
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Anna Siegert
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Amandeep Singh Arora
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Dr, Columbus, OH, 43210, USA
| | - Alexey Galkin
- St. Petersburg Branch, Vavilov Institute of General Genetics, St. Petersburg, Russia
| | - Ayesha Zafar
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- College of Medicine Center for Pharmacogenomics, The Ohio State University, 460 W 12th Avenue, Columbus, OH, 1004 BRT, USA
| | - Mathias Schmitz
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | | | - Olivier Andreoletti
- UMR INRA ENVT 1225- Interactions Hôte Agent Pathogène-École Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Isidre Ferrer
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- CIBERNED, Barcelona, Spain
- Hospitalet de Llobregat, Barcelona, Spain
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen and the German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany.
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Zhang YL, Wu XM, Chen Y, Gu WP, Lu W. Could Sporadic Creutzfeldt-Jakob Disease Be Underdiagnosed in China? Experience From Four Cases. Front Neurol 2020; 11:763. [PMID: 32849219 PMCID: PMC7399133 DOI: 10.3389/fneur.2020.00763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Creutzfeldt-Jakob Disease (CJD) is a rapidly progressive neurodegenerative disease caused by the misfolded version of the cellular prion protein. Here we report four cases of sporadic CJD (sCJD) and describe the diagnostic methods available in order avoid missed or delayed recognition of CJD in China. Case presentation: We report four patients diagnosed with sCJD between March 2018 and December 2019 at Xiangya Hospital and the Second Xiangya Hospital of Central South University. All patients were admitted to the hospital because of a progressive cognitive decline. Although their routine tests and biochemical indicators in the cerebrospinal fluid (CSF), as well as computed tomography (CT) imaging, did not reveal any apparent abnormalities, the presence of “cortical ribboning” was incidentally found on diffusion-weighted imaging (DWI). The patients were subsequently diagnosed with CJD based on positive testing for 14-3-3 protein in their CSF, and the presence of periodic sharp and slow wave complexes (PSWCs) on their electroencephalograms (EEG). Additionally, two of patients was confirmed pathological examination of cerebral biopsies demonstrating neuronal loss, gliosis, and spongiform changes. Conclusions: CJD is a rare disease and is easily misdiagnosed by clinician in China due to a lack of recognition and awareness of CJD. Based on our experience described in this report, enhanced vigilance for CJD is required for patients with rapidly progressive dementia in China and other developing countries. DWI, EEG and detection of 14-3-3 protein in CSF should be performed in order to achieve a timely diagnosis of CJD.
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Affiliation(s)
- Yi-Liu Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Mei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Ping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wen-Ping Gu
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Wei Lu
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Lee SM, Hyeon JW, Kim SJ, Kim H, Noh R, Kim S, Lee YS, Kim SY. Sensitivity and specificity evaluation of multiple neurodegenerative proteins for Creutzfeldt-Jakob disease diagnosis using a deep-learning approach. Prion 2020; 13:141-150. [PMID: 31306078 PMCID: PMC6650195 DOI: 10.1080/19336896.2019.1639482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) can only be confirmed by abnormal protease-resistant prion protein accumulation in post-mortem brain tissue. The relationships between sCJD and cerebrospinal fluid (CSF) proteins such as 14–3-3, tau, and α-synuclein (a-syn) have been investigated for their potential value in pre-mortem diagnosis. Recently, deep-learning (DL) methods have attracted attention in neurodegenerative disease research. We established DL-aided pre-mortem diagnostic methods for CJD using multiple CSF biomarkers to improve their discriminatory sensitivity and specificity. Enzyme-linked immunosorbent assays were performed on phospho-tau (p-tau), total-tau (t-tau), a-syn, and β-amyloid (1–42), and western blot analysis was performed for 14–3-3 protein from CSF samples of 49 sCJD and 256 non-CJD Korean patients, respectively. The deep neural network structure comprised one input, five hidden, and one output layers, with 20, 40, 30, 20 and 12 hidden unit numbers per hidden layer, respectively. The best performing DL model demonstrated 90.38% accuracy, 83.33% sensitivity, and 92.5% specificity for the three-protein combination of t-tau, p-tau, and a-syn, and all other patients in a separate CSF set (n = 15) with other neuronal diseases were correctly predicted to not have CJD. Thus, DL-aided pre-mortem diagnosis may provide a suitable tool for discriminating CJD patients from non-CJD patients.
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Affiliation(s)
- Sol Moe Lee
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea.,b Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences , Seoul National University , Seoul , South Korea
| | - Jae Wook Hyeon
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Soo-Jin Kim
- b Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences , Seoul National University , Seoul , South Korea
| | - Heebal Kim
- b Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences , Seoul National University , Seoul , South Korea
| | - Ran Noh
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Seonghan Kim
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Yeong Seon Lee
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Su Yeon Kim
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
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24
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Cerebrospinal fluid non-phosphorylated tau in the differential diagnosis of Creutzfeldt–Jakob disease: a comparative prospective study with 14-3-3. J Neurol 2019; 267:543-550. [DOI: 10.1007/s00415-019-09610-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
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Clinical Laboratory Tests Used To Aid in Diagnosis of Human Prion Disease. J Clin Microbiol 2019; 57:JCM.00769-19. [PMID: 31366689 DOI: 10.1128/jcm.00769-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Prion diseases are a group of rapidly progressive and always fatal neurodegenerative disorders caused by misfolded prion protein in the brain. Although autopsy remains the gold-standard diagnostic tool, antemortem laboratory testing can be performed to aid in the diagnosis of prion disease. This review is meant to help laboratory directors and physicians in their interpretation of test results. Laboratory assays to detect both nonspecific biomarkers of prion disease and prion-specific biomarkers can be used. The levels of nonspecific biomarkers in cerebrospinal fluid (CSF) are elevated when rapid neurodegeneration is occurring in the patient, and these markers include 14-3-3, tau, neuron-specific enolase, S100B, and alpha-synuclein. These markers have various sensitivities and specificities but are overall limited, as the levels of any of these analytes can be elevated in nonprion disease that is causing rapid damage of brain tissue. Prion-specific assays used in clinical laboratory testing are currently limited to two options. The first option is second-generation real-time quaking-induced conversion (RT-QuIC) performed on CSF, and the second option is Western blotting of a brain biopsy specimen used to detect protease-resistant prion protein. Although both tests have exquisite specificity, RT-QuIC has a sensitivity of 92 to 97.2% in symptomatic individuals, compared to the brain biopsy Western blot sensitivity of 20 to 60%. RT-QuIC was added to the Centers for Disease Control and Prevention's diagnostic criteria for prion disease in 2018. Other caveats of laboratory testing need to be considered, as sporadic, genetic, and acquired forms of prion disease have different clinical and laboratory presentations, and these caveats are discussed. Laboratory testing plays an important role in the diagnosis of prion disease, which is often challenging to diagnose.
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Abstract
BACKGROUND Published approaches to the evaluation and management of patients with rapidly progressive dementia (RPD) have been largely informed by experience at academic hospitals and national centers specializing in the diagnosis of Creutzfeldt-Jakob disease. Whether these approaches can be applied to patients assessed within lower-acuity outpatient settings is unknown. METHODS A total of 96 patients with suspected RPD were assessed within the Washington University School of Medicine (Saint Louis, MO) outpatient memory clinic from February 2006 to February 2016. Consensus etiologic diagnoses were established following independent review of clinical data by 2 dementia specialists. RESULTS In total, 67/90 (70%) patients manifested with faster-than-expected cognitive decline leading to dementia within 2 years of symptom onset. Female sex (42/67, 63%), median patient age (68.3 y; range, 45.4 to 89.6), and years of education (12 y; range, 6 to 14) were consistent with clinic demographics. Atypical presentations of common neurodegenerative dementing illnesses accounted for 90% (60/67) of RPD cases. Older age predicted a higher odds of amnestic Alzheimer disease dementia (OR, 2.1 per decade; 95% CI, 1.1-3.8; P=0.02). Parkinsonism (OR, 6.9; 95% CI, 1.6-30.5; P=0.01) or cortical visual dysfunction (OR, 10.8; 95% CI, 1.7-69.4; P=0.01) predicted higher odds of another neurodegenerative cause of RPD, including sporadic Creutzfeldt-Jakob disease. CONCLUSIONS AND RELEVANCE The clinical environment influences the prevalence of RPD causes. The clinical evaluation should be adapted to promote detection of common causes of RPD, specific to the practice setting.
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Abstract
Prions diseases are uniformly fatal neurodegenerative diseases that occur in sporadic, genetic, and acquired forms. Acquired prion diseases, caused by infectious transmission, are least common. Most prion diseases are not infectious, but occur spontaneously through misfolding of normal prion proteins or genetic mutations in the prion protein gene. Although most prion diseases are not caused by infection, they can be transmitted accidentally. Certain infection control protocols should be applied when handling central nervous system and other high-risk tissues. New diagnostic methods are improving premortem and earlier diagnosis. Treatment trials have not shown improved survival, but therapies may be available soon.
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Affiliation(s)
- Boon Lead Tee
- Global Brain Health Institute, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94518, USA; Department of Neurology, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Zhong Yang Road, Hualien City, Hualien County 97002, Taiwan
| | - Erika Mariana Longoria Ibarrola
- Global Brain Health Institute, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94518, USA; Dementia Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Av. Insurgentes Sur 3877, Col. La Fama, Del. Tlalpan, Ciudad de México. C.P. 14269, Mexico
| | - Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158, USA.
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Yeo IJ, Lee CK, Han SB, Yun J, Hong JT. Roles of chitinase 3-like 1 in the development of cancer, neurodegenerative diseases, and inflammatory diseases. Pharmacol Ther 2019; 203:107394. [PMID: 31356910 DOI: 10.1016/j.pharmthera.2019.107394] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
Chitinase 3-like 1 (CHI3L1) is a secreted glycoprotein that mediates inflammation, macrophage polarization, apoptosis, and carcinogenesis. The expression of CHI3L1 is strongly increased by various inflammatory and immunological conditions, including rheumatoid arthritis, multiple sclerosis, Alzheimer's disease, and several cancers. However, its physiological and pathophysiological roles in the development of cancer and neurodegenerative and inflammatory diseases remain unclear. Several studies have reported that CHI3L1 promotes cancer proliferation, inflammatory cytokine production, and microglial activation, and that multiple receptors, such as advanced glycation end product, syndecan-1/αVβ3, and IL-13Rα2, are involved. In addition, the pro-inflammatory action of CHI3L1 may be mediated via the protein kinase B and phosphoinositide-3 signaling pathways and responses to various pro-inflammatory cytokines, including tumor necrosis factor-α, interleukin-1β, interleukin-6, and interferon-γ. Therefore, CHI3L1 could contribute to a vast array of inflammatory diseases. In this article, we review recent findings regarding the roles of CHI3L1 and suggest therapeutic approaches targeting CHI3L1 in the development of cancers, neurodegenerative diseases, and inflammatory diseases.
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Affiliation(s)
- In Jun Yeo
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31, Osongsaengmyeong 1-ro, Osong-eup, Cheongju-si, Chungbuk 28160, Republic of Korea
| | - Chong-Kil Lee
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31, Osongsaengmyeong 1-ro, Osong-eup, Cheongju-si, Chungbuk 28160, Republic of Korea
| | - Sang-Bae Han
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31, Osongsaengmyeong 1-ro, Osong-eup, Cheongju-si, Chungbuk 28160, Republic of Korea
| | - Jaesuk Yun
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31, Osongsaengmyeong 1-ro, Osong-eup, Cheongju-si, Chungbuk 28160, Republic of Korea.
| | - Jin Tae Hong
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31, Osongsaengmyeong 1-ro, Osong-eup, Cheongju-si, Chungbuk 28160, Republic of Korea.
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Lehmann S, Paquet C, Malaplate-Armand C, Magnin E, Schraen S, Quillard-Muraine M, Bousiges O, Delaby C, Dumurgier J, Hugon J, Sablonnière B, Blanc F, Wallon D, Gabelle A, Laplanche JL, Bouaziz-Amar E, Peoc'h K. Diagnosis associated with Tau higher than 1200 pg/mL: Insights from the clinical and laboratory practice. Clin Chim Acta 2019; 495:451-456. [PMID: 31051163 DOI: 10.1016/j.cca.2019.04.081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 01/25/2023]
Abstract
CONTEXT Cerebrospinal fluid (CSF) biomarkers are valuable tools for the diagnosis of neurological diseases. We aimed to investigate within a retrospective multicentric study the final diagnosis associated with very high CSF Tau levels and to identify patterns of biomarkers that would differentiate them in clinical practice, to help clinical biologists into physicians' counseling. PATIENTS AND METHODS Within the national multicentric network ePLM, we included 1743 patients from January 1, 2008, to December 31, 2013, with CSF biomarkers assayed by the same Innotest assays (protein Tau, phospho-Tau [pTau], and Aβ 1-42). We identified 205 patients with protein Tau concentration higher than 1200 pg/mL and final diagnosis. RESULTS Among those patients, 105 (51.2%) were suffering from Alzheimer's disease, 37 (18%) from sporadic Creuztfeldt-Jakob disease, and 63 (30.7%) from other neurological diseases including paraneoplastic/ central nervous system tumor, frontotemporal dementia, other diagnoses, amyloid angiopathy, Lewy body dementia, and infections of the central nervous system. Phospho-Tau, Aβ1-42 and Aβ1-42/pTau values differed significantly between the three groups of patients (p < .001). An Aβ1-42/pTau ratio between 4.7 and 9.7 was suggestive of other neurological diseases (threshold in AD: 8.3). CSF 14-3-3 was useful to discriminate Alzheimer's disease from Creuztfeldt-Jakob disease in case of Aβ1-42 concentrations <550 pg/mL or pTau>60 pg/mL. CONCLUSION This work emphasizes the interest of a well-thought-out interpretation of CSF biomarkers in neurological diseases, particularly in the case of high Tau protein concentrations in the CSF.
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Affiliation(s)
- S Lehmann
- CHU de Montpellier and Université de Montpellier, IRMB, CRB, Laboratoire de Biochimie et Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - C Paquet
- Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal APHP, INSERM U942, Université Paris Diderot, France
| | - C Malaplate-Armand
- Laboratoire de Biochimie et Biologie Moléculaire, UF Oncologie - Endocrinologie - Neurobiologie, Hôpital Central, Centre Hospitalier Universitaire, Nancy, France
| | - E Magnin
- Centre Mémoire Ressources Recherche Besançon Franche-Comté, Departement of Neurology, CHU Besançon, Besançon, France
| | - S Schraen
- Univ.Lille, Inserm, CHU-Lille, UMR-S1172 and Neurobiology Unit, Centre de Biologie-Pathologie, Lille, France
| | | | - O Bousiges
- Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital de Hautepierre, Hôpitaux Universitaire de Strasbourg, Strasbourg, France; Laboratoire de Neurosciences cognitives et Adaptatives (LNCA), UMR7364 Unistra/CNRS, Strasbourg, France
| | - C Delaby
- CHU de Montpellier and Université de Montpellier, IRMB, CRB, Laboratoire de Biochimie et Protéomique Clinique, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - J Dumurgier
- Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal APHP, INSERM U942, Université Paris Diderot, France
| | - J Hugon
- Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal APHP, INSERM U942, Université Paris Diderot, France
| | - B Sablonnière
- Centre Mémoire Ressources Recherche Besançon Franche-Comté, Departement of Neurology, CHU Besançon, Besançon, France
| | - F Blanc
- 2ICube laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS-Neurocrypto, University of Strasbourg and CNRS, Strasbourg, France
| | - D Wallon
- Inserm U1079, University of Rouen, Department of Neurology, France
| | - A Gabelle
- Centre Mémoire Ressources Recherche, CHU de Montpellier, Hôpital Gui de Chauliac, Montpellier, Université Montpellier, Montpellier, France
| | - J L Laplanche
- Service de Biochimie et Biologie moléculaire, GH Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
| | - E Bouaziz-Amar
- Service de Biochimie et Biologie moléculaire, GH Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
| | - K Peoc'h
- Service de Biochimie et Biologie moléculaire, GH Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France; APHP, HUPNVS, Hôpital Beaujon, Biochimie clinique, Clichy, France; Université Paris Diderot, France.
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30
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Paolini Paoletti F, Di Gregorio M, Calabresi P, Parnetti L. Drug-induced Creutzfeldt-Jakob disease-like syndrome: early CSF analysis as useful tool for differential diagnosis. BMJ Case Rep 2018; 11:11/1/e224314. [PMID: 30567187 DOI: 10.1136/bcr-2018-224314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 78-year-old man who showed a subacute onset of severe cognitive impairment, ataxia, tremor, stimulus sensitive myoclonus and hypophonia. Since a few weeks, he received a treatment with a combination of tricyclic antidepressants for mood disorder. The clinical picture mimicked Creutzfeldt-Jakob disease (CJD), but we could rule out this diagnosis by means of cerebrospinal fluid (CSF) analysis, which showed normal level of tau protein and Aβ1-42, being also negative for CSF 14-3-3 protein. A complete clinical recovery was observed after the discontinuation of antidepressants. So far, some cases of drug-induced CJD-like syndrome have been described. In our experience, early CSF analysis shows high diagnostic usefulness in order to exclude CJD.
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Affiliation(s)
| | - Maria Di Gregorio
- Section of Neurology, Department of Medicine, Universita degli Studi di Perugia, Perugia, Italy
| | - Paolo Calabresi
- Section of Neurology, Department of Medicine, Universita degli Studi di Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Department of Medicine, Section of Neurology - Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Perugia, Italy
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Abstract
INTRODUCTION Rapidly progressive dementia is a syndrome caused by numerous disease entities. Accurate diagnosis is crucial as substantial proportion of these diseases is highly treatable. Others might implicate specific hygienic problems. Still, differential diagnosis remains challenging because of a huge overlap of clinical presentations. Areas covered: The paper reviews PubMed-listed research articles with a focus on diagnosis and treatment of diseases showing rapid cognitive decline such as inflammatory diseases, rapidly progressive neurodegenerative diseases, toxic-metabolic encephalopathies and prion diseases. The literature was interpreted in the light of experience in clinically differentiating rapid progressing dementia in the framework of Creutzfeldt-Jakob-Disease (CJD) surveillance activities. An overview of relevant differential diagnoses and diagnostic pitfalls as well as therapeutic protocols is presented. Expert commentary: Over the last years, more and more neurologic disorders causing cognitive symptoms, in particular various types of immune-mediated diseases have been discovered. To identify treatable conditions and to enhance knowledge of differential diagnosis and epidemiology, we suggest an extended diagnostic work up in cases with rapidly progressing dementia. Besides standard methods, this should include the search for neoplasia as well as atypical encephalitis. High-dose steroid therapy should be considered in certain clinical situations even when no evidence for inflammation is present.
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Affiliation(s)
- Inga Zerr
- a Clinical Dementia Center and National TSE Reference Center, Department of Neurology , Goettingen University Medical Center , Goettingen , Germany
| | - Peter Hermann
- a Clinical Dementia Center and National TSE Reference Center, Department of Neurology , Goettingen University Medical Center , Goettingen , Germany
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Gushue D, Herbst A, Sim V, McKenzie D, Aiken JM. 14-3-3 and enolase abundances in the CSF of Prion diseased rats. Prion 2018; 12:253-260. [PMID: 30149773 PMCID: PMC6277185 DOI: 10.1080/19336896.2018.1513317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is characterized by an extended asymptomatic preclinical phase followed by rapid neurodegeneration. There are no effective treatments. CJD diagnosis is initially suspected based upon the clinical presentation of the disease and the exclusion of other etiologies. Neurologic symptoms are assessed in combination with results from cerebrospinal fluid (CSF) biomarker abundances, electroencephalography (EEG), magnetic resonance imaging (MRI), and in some countries, real-time quaking-induced conversion (RT-QuIC). Inconsistencies in sensitivities and specificities of prion disease biomarker abundance in CSF have been described, which can affect diagnostic certainty, but the utility of biomarkers for prognosis has not been fully explored. The clinical presentation of CJD is variable, and factors such as prion protein polymorphic variants, prion strain, and other genetic or environmental contributions may affect the disease progression, confounding the appearance or abundance of biomarkers in the CSF. These same factors may also affect the appearance or abundance of biomarkers, further confounding diagnosis. In this study, we controlled for many of these variables through the analysis of serial samples of CSF from prion-infected and control rats. Prion disease in laboratory rodents follows a defined disease course as the infection route and time, prion strain, genotype, and environmental conditions are all controlled. We measured the relative abundance of 14-3-3 and neuron-specific enolase (NSE) in CSF during the course of prion infection in rats. Even when disease-related, environmental and genetic variables were controlled, CSF 14-3-3 and NSE abundances were variable. Our study emphasizes the considerable diagnostic and prognostic limitations of these prion biomarkers.
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Affiliation(s)
- Danielle Gushue
- a Department of Agricultural, Food and Nutritional Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Allen Herbst
- a Department of Agricultural, Food and Nutritional Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Valerie Sim
- b Department of Medicine - Division of Neurology, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Debbie McKenzie
- c Department of Biological Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Judd M Aiken
- a Department of Agricultural, Food and Nutritional Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
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Li QX, Varghese S, Sarros S, Stehmann C, Doecke JD, Fowler CJ, Masters CL, Collins SJ. CSF Tau supplements 14-3-3 protein detection for sporadic Creutzfeldt-Jakob disease diagnosis while transitioning to next generation diagnostics. J Clin Neurosci 2018; 50:292-293. [PMID: 29422367 DOI: 10.1016/j.jocn.2018.01.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/05/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
Abstract
The pre-mortem clinical diagnosis of Creutzfeldt-Jakob disease (CJD) is supported by biomarkers, especially cerebrospinal fluid (CSF) 14-3-3 and total tau (Tau) protein levels. These CSF biomarkers have proven the most useful prior to transitioning to powerful next generation diagnostics employing protein amplification techniques such as the real time quaking-induced conversion (RT-QuIC) assay. To enhance national diagnostic capacity while transitioning to RT-QuIC assays an optimized CSF Tau cutoff was determined and shown to usefully supplement 14-3-3 protein detection.
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Affiliation(s)
- Qiao-Xin Li
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia
| | - Shiji Varghese
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia
| | - Shannon Sarros
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; ANCJDR, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia
| | - Christiane Stehmann
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; ANCJDR, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia
| | - James D Doecke
- CSIRO Health and Biosecurity, Brisbane, QLD 4029, Australia
| | - Christopher J Fowler
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia
| | - Colin L Masters
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; ANCJDR, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia
| | - Steven J Collins
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; ANCJDR, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville 3010, Australia.
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34
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Bizzi A, Peoc'h K. Amended diagnostic protocol increases the early diagnosis of sporadic Creutzfeldt-Jakob disease. Neurology 2018; 91:155-156. [PMID: 29934422 DOI: 10.1212/wnl.0000000000005871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alberto Bizzi
- From Neuroradiology (A.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Laboratoire de Biochimie Clinique (K.P.), APHP, HUPNVS, Hôpital Beaujon, Clichy and Université Paris Diderot, UFR de Médecine Xavier Bichat, Paris, France.
| | - Katell Peoc'h
- From Neuroradiology (A.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Laboratoire de Biochimie Clinique (K.P.), APHP, HUPNVS, Hôpital Beaujon, Clichy and Université Paris Diderot, UFR de Médecine Xavier Bichat, Paris, France
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35
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Gastaldi M, Zardini E, Leante R, Ruggieri M, Costa G, Cocco E, De Luca G, Cataldo I, Biagioli T, Ballerini C, Castellazzi M, Fainardi E, Pettini P, Zaffaroni M, Giunti D, Capello E, Bernardi G, Ciusani E, Giannotta C, Nobile-Orazio E, Bazzigaluppi E, Passerini G, Bedin R, Sola P, Brivio R, Cavaletti G, Sala A, Bertolotto A, Desina G, Leone MA, Mariotto S, Ferrari S, Paternoster A, Giavarina D, Lolli F, Franciotta D. Cerebrospinal fluid analysis and the determination of oligoclonal bands. Neurol Sci 2018; 38:217-224. [PMID: 29030765 DOI: 10.1007/s10072-017-3034-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This document presents the guidelines for the cerebrospinal fluid (CSF) analysis and the determination of oligoclonal bands (OCBs) as pivotal tests in neuroinflammatory pathologies of the central nervous system. The guidelines have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Essential clinical information on the pathologies in which the CSF analysis is indicated, and, particularly, on those characterized by the presence of OCBs in the intrathecal compartment, indications and limits of CSF analysis and OCB determination, instructions for result interpretation, and agreed laboratory protocols (Appendix) are reported for the communicative community of neurologists and clinical pathologists.
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Affiliation(s)
- Matteo Gastaldi
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Elisabetta Zardini
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | | - Clara Ballerini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | | | - Enrico Fainardi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Paola Pettini
- Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | | | - Debora Giunti
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | - Elisabetta Capello
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | | | | | | | | | | | | | - Roberta Bedin
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Patrizia Sola
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Guido Cavaletti
- Expersimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
| | | | | | - Gaetano Desina
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Maurizio A Leone
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | | | - Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy.
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36
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Lewczuk P, Riederer P, O’Bryant SE, Verbeek MM, Dubois B, Visser PJ, Jellinger KA, Engelborghs S, Ramirez A, Parnetti L, Jack CR, Teunissen CE, Hampel H, Lleó A, Jessen F, Glodzik L, de Leon MJ, Fagan AM, Molinuevo JL, Jansen WJ, Winblad B, Shaw LM, Andreasson U, Otto M, Mollenhauer B, Wiltfang J, Turner MR, Zerr I, Handels R, Thompson AG, Johansson G, Ermann N, Trojanowski JQ, Karaca I, Wagner H, Oeckl P, van Waalwijk van Doorn L, Bjerke M, Kapogiannis D, Kuiperij HB, Farotti L, Li Y, Gordon BA, Epelbaum S, Vos SJB, Klijn CJM, Van Nostrand WE, Minguillon C, Schmitz M, Gallo C, Mato AL, Thibaut F, Lista S, Alcolea D, Zetterberg H, Blennow K, Kornhuber J, Riederer P, Gallo C, Kapogiannis D, Mato AL, Thibaut F. Cerebrospinal fluid and blood biomarkers for neurodegenerative dementias: An update of the Consensus of the Task Force on Biological Markers in Psychiatry of the World Federation of Societies of Biological Psychiatry. World J Biol Psychiatry 2018; 19:244-328. [PMID: 29076399 PMCID: PMC5916324 DOI: 10.1080/15622975.2017.1375556] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the 12 years since the publication of the first Consensus Paper of the WFSBP on biomarkers of neurodegenerative dementias, enormous advancement has taken place in the field, and the Task Force takes now the opportunity to extend and update the original paper. New concepts of Alzheimer's disease (AD) and the conceptual interactions between AD and dementia due to AD were developed, resulting in two sets for diagnostic/research criteria. Procedures for pre-analytical sample handling, biobanking, analyses and post-analytical interpretation of the results were intensively studied and optimised. A global quality control project was introduced to evaluate and monitor the inter-centre variability in measurements with the goal of harmonisation of results. Contexts of use and how to approach candidate biomarkers in biological specimens other than cerebrospinal fluid (CSF), e.g. blood, were precisely defined. Important development was achieved in neuroimaging techniques, including studies comparing amyloid-β positron emission tomography results to fluid-based modalities. Similarly, development in research laboratory technologies, such as ultra-sensitive methods, raises our hopes to further improve analytical and diagnostic accuracy of classic and novel candidate biomarkers. Synergistically, advancement in clinical trials of anti-dementia therapies energises and motivates the efforts to find and optimise the most reliable early diagnostic modalities. Finally, the first studies were published addressing the potential of cost-effectiveness of the biomarkers-based diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, and Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Peter Riederer
- Center of Mental Health, Clinic and Policlinic of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Sid E. O’Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Marcel M. Verbeek
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer center, Nijmegen, The Netherlands
| | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Salpêtrièrie Hospital, INSERM UMR-S 975 (ICM), Paris 6 University, Paris, France
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Alzheimer Centre, Amsterdam Neuroscience VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Alfredo Ramirez
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Lucilla Parnetti
- Section of Neurology, Center for Memory Disturbances, Lab of Clinical Neurochemistry, University of Perugia, Perugia, Italy
| | | | - Charlotte E. Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harald Hampel
- AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, Paris, France
| | - Alberto Lleó
- Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Disorders (DZNE), Bonn, Germany
| | - Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Mony J. de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Anne M. Fagan
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - José Luis Molinuevo
- Barcelonabeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Willemijn J. Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Bengt Winblad
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulf Andreasson
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center Göttingen, Department of Neurology, Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry & Psychotherapy, University of Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Martin R. Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Inga Zerr
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Clinical Dementia Centre, Department of Neurology, University Medical School, Göttingen, Germany
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | | | - Gunilla Johansson
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden
| | - Natalia Ermann
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ilker Karaca
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Holger Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Patrick Oeckl
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Linda van Waalwijk van Doorn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer center, Nijmegen, The Netherlands
| | - Maria Bjerke
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
| | - Dimitrios Kapogiannis
- Laboratory of Neurosciences, National Institute on Aging/National Institutes of Health (NIA/NIH), Baltimore, MD, USA
| | - H. Bea Kuiperij
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer center, Nijmegen, The Netherlands
| | - Lucia Farotti
- Section of Neurology, Center for Memory Disturbances, Lab of Clinical Neurochemistry, University of Perugia, Perugia, Italy
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Brian A. Gordon
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Stéphane Epelbaum
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Salpêtrièrie Hospital, INSERM UMR-S 975 (ICM), Paris 6 University, Paris, France
| | - Stephanie J. B. Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | | | - Carolina Minguillon
- Barcelonabeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Matthias Schmitz
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Clinical Dementia Centre, Department of Neurology, University Medical School, Göttingen, Germany
| | - Carla Gallo
- Departamento de Ciencias Celulares y Moleculares/Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrea Lopez Mato
- Chair of Psychoneuroimmunoendocrinology, Maimonides University, Buenos Aires, Argentina
| | - Florence Thibaut
- Department of Psychiatry, University Hospital Cochin-Site Tarnier 89 rue d’Assas, INSERM 894, Faculty of Medicine Paris Descartes, Paris, France
| | - Simone Lista
- AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière (ICM), Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital Pitié-Salpêtrière, Boulevard de l’hôpital, Paris, France
| | - Daniel Alcolea
- Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau - Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Spain
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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37
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Ermann N, Lewczuk P, Schmitz M, Lange P, Knipper T, Goebel S, Kornhuber J, Zerr I, Llorens F. CSF nonphosphorylated Tau as a biomarker for the discrimination of AD from CJD. Ann Clin Transl Neurol 2018; 5:883-887. [PMID: 30009207 PMCID: PMC6043772 DOI: 10.1002/acn3.584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/27/2018] [Indexed: 11/22/2022] Open
Abstract
Creutzfeldt–Jakob disease and Alzheimer's disease are characterized by the presence of elevated total‐Tau cerebrospinal fluid concentrations while the presence of hyperphosphorylated Tau forms in the cerebrospinal fluid is rather a hallmark of Alzheimer's disease. Here we aimed to investigate potential contribution of nonphospho‐Tau epitopes (non‐P‐Tau) in the discrimination between both diseases. Non‐P‐Tau cerebrospinal fluid concentration was highly increased in Creutzfeldt–Jakob disease (n = 57, 3683 ± 3599 pg/mL) compared to Alzheimer's disease (n = 41, 148 ± 219 pg/mL) and neurological controls (n = 56, 62 ± 40 pg/mL), and significantly improved the proportion of correctly classified patients (99%) compared to that achieved by total‐Tau (90%), P‐Tau (62%) and 14‐3‐3 (91%).
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Affiliation(s)
- Natalia Ermann
- Department of Psychiatry and Psychotherapy Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen Germany
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen Germany.,Department of Neurodegeneration Diagnostics Medical University of Białystok Białystok Poland.,Department of Biochemical Diagnostics University Hospital of Białystok Białystok Poland
| | - Matthias Schmitz
- Clinical Dementia Center Department of Neurology University Medical School Göttingen Germany.,German Center for Neurodegenerative Diseases (DZNE) Göttingen Germany
| | - Peter Lange
- Clinical Dementia Center Department of Neurology University Medical School Göttingen Germany
| | - Tobias Knipper
- Clinical Dementia Center Department of Neurology University Medical School Göttingen Germany
| | - Stefan Goebel
- Clinical Dementia Center Department of Neurology University Medical School Göttingen Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen Germany
| | - Inga Zerr
- Clinical Dementia Center Department of Neurology University Medical School Göttingen Germany.,German Center for Neurodegenerative Diseases (DZNE) Göttingen Germany
| | - Franc Llorens
- Clinical Dementia Center Department of Neurology University Medical School Göttingen Germany.,Network Center for Biomedical Research in Neurodegenerative Diseases Barcelona (CIBERNED) Institute Carlos III Ministry of Health Bellvitge Spain
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Abu-Rumeileh S, Capellari S, Parchi P. Rapidly Progressive Alzheimer’s Disease: Contributions to Clinical-Pathological Definition and Diagnosis. J Alzheimers Dis 2018; 63:887-897. [DOI: 10.3233/jad-171181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Piero Parchi
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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Torres Herrán GE, Ortega Heredia AD, Burbano BM, Serrano-Dueñas M, Ortiz Yepez MA, Barrera Madera RA, Masabanda Campaña LA, Baño Jiménez GD, Santos Saltos DM, Correa Díaz EP. Case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito. BMC Neurol 2018; 18:55. [PMID: 29703169 PMCID: PMC5921541 DOI: 10.1186/s12883-018-1061-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Creutzfeldt-Jakob disease is a rare and fatal neurodegenerative disorder that affects mammals and humans. The prevalence of this disease in the United States is 0.5 to 1 per million inhabitants. So far in Ecuador, we do not know what the prevalence or incidence is, and only one case report has been written. CASE PRESENTATION We present a case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito. The average age of symptom onset in our patients was 58.8 years. The male to female ratio was 1:1. Two patients began with cognitive/behavioral symptoms, while 4 patients began with focal neurological signs; 1 case with ataxia, 2 with gait disorders and 1 with vertigo and headache. All of the patients had the clinical features established by the World Health Organization. In addition, the entire cohort was positive for the 14-3-3 protein in cerebrospinal fluid, and had high signal abnormalities in caudate and putamen nucleus in DWI and FLAIR IRM. Only in one case, did we reach a definitive diagnosis through a pathological study. All other cases had a probable diagnosis. In this series of cases, 6 out of 6 patients died. The average time from the onset of the symptoms to death in this cohort was 13 months. CONCLUSION This is the first report of a series of cases of Creutzfeldt-Jakob disease in Quito. Although definitive diagnosis must be histopathological, there are ancillary tests currently available that have allowed us to obtain a diagnosis of the disease.
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Affiliation(s)
| | | | | | - Marcos Serrano-Dueñas
- Facultad de Medicina de la Pontifica Universidad Católica del Ecuador, Avenida 12 de Octubre y Vicente Ramón Roca, Quito, Ecuador
| | | | | | - Luis Alfredo Masabanda Campaña
- Hospital Carlos Andrade Marín, Av. 18 de Septiembre y Ayacucho, Quito, Ecuador.,Universidad Central del Ecuador, Calle Iquique y Sodiro, Quito, Ecuador
| | - Guillermo David Baño Jiménez
- Hospital Carlos Andrade Marín, Av. 18 de Septiembre y Ayacucho, Quito, Ecuador.,Universidad Central del Ecuador, Calle Iquique y Sodiro, Quito, Ecuador
| | - Denny Maritza Santos Saltos
- Hospital Carlos Andrade Marín, Av. 18 de Septiembre y Ayacucho, Quito, Ecuador.,Universidad Central del Ecuador, Calle Iquique y Sodiro, Quito, Ecuador
| | - Edgar Patricio Correa Díaz
- Hospital Carlos Andrade Marín, Av. 18 de Septiembre y Ayacucho, Quito, Ecuador. .,Universidad Central del Ecuador, Calle Iquique y Sodiro, Quito, Ecuador.
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Abu Rumeileh S, Lattanzio F, Stanzani Maserati M, Rizzi R, Capellari S, Parchi P. Diagnostic Accuracy of a Combined Analysis of Cerebrospinal Fluid t-PrP, t-tau, p-tau, and Aβ42 in the Differential Diagnosis of Creutzfeldt-Jakob Disease from Alzheimer's Disease with Emphasis on Atypical Disease Variants. J Alzheimers Dis 2018; 55:1471-1480. [PMID: 27886009 PMCID: PMC5181677 DOI: 10.3233/jad-160740] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
According to recent studies, the determination of cerebrospinal fluid (CSF) total tau (t-tau)/phosphorylated tau (p-tau) ratio and total prion protein (t-PrP) levels significantly improves the accuracy of the diagnosis of Alzheimer’s disease (AD) in atypical cases with clinical or laboratory features mimicking Creutzfeldt-Jakob disease (CJD). However, this has neither been validated nor tested in series including atypical CJD variants. Furthermore, the added diagnostic value of amyloid-β (Aβ)42 remains unclear. To address these issues, we measured t-PrP, 14-3-3, t-tau, p-tau, and Aβ42 CSF levels in 45 typical and 44 atypical/rapidly progressive AD patients, 54 typical and 54 atypical CJD patients, and 33 controls. CJD patients showed significantly lower CSF t-PrP levels than controls and AD patients. Furthermore, atypical CJD was associated with lower t-PrP levels in comparison to typical CJD. T-tau, 14-3-3, or t-PrP alone yielded, respectively, 80.6, 63.0, and 73.0% sensitivity and 75.3, 92.1, and 75% specificity in distinguishing AD from CJD. On receiver operating characteristic (ROC) curve analyses of biomarker combinations, the (t-tau×Aβ42)/(p-tau×t-PrP) ratio achieved the best accuracy, with 98.1% sensitivity and 97.7% specificity overall, and 96.2% sensitivity and 95.5% specificity for the “atypical” disease groups. Our results show that the combined analysis of CSF t-PrP, t-tau, p-tau, and Aβ42 is clinically useful in the differential diagnosis between CJD and AD. Furthermore, the finding of reduced CSF t-PrP levels in CJD patients suggest that, likewise Aβ42 in AD, CSF t-PrP levels reflect the extent of PrPc conversion into abnormal PrP (PrPSc) and the burden of PrPSc deposition in CJD.
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Affiliation(s)
- Samir Abu Rumeileh
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Lattanzio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Romana Rizzi
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
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Biomarkers in cerebrospinal fluid for synucleinopathies, tauopathies, and other neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2018; 146:99-113. [DOI: 10.1016/b978-0-12-804279-3.00007-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zerr I, Zafar S, Schmitz M, Llorens F. Cerebrospinal fluid in Creutzfeldt–Jakob disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 146:115-124. [DOI: 10.1016/b978-0-12-804279-3.00008-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fragoso DC, Gonçalves Filho ALDM, Pacheco FT, Barros BR, Aguiar Littig I, Nunes RH, Maia Júnior ACM, da Rocha AJ. Imaging of Creutzfeldt-Jakob Disease: Imaging Patterns and Their Differential Diagnosis. Radiographics 2017; 37:234-257. [PMID: 28076012 DOI: 10.1148/rg.2017160075] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) remains a challenge because of the large variability of the clinical scenario, especially in its early stages, which may mimic several reversible or treatable disorders. The molecular basis of prion disease, as well as its brain propagation and the pathogenesis of the illness, have become better understood in recent decades. Several reports have listed recognizable clinical features and paraclinical tests to supplement the replicable diagnostic criteria in vivo. Nevertheless, we lack specific data about the differential diagnosis of CJD at imaging, mainly regarding those disorders evolving with similar clinical features (mimicking disorders). This review provides an update on the neuroimaging patterns of sCJD, emphasizing the relevance of magnetic resonance (MR) imaging, summarizing the clinical scenario and molecular basis of the disease, and highlighting clinical, genetic, and imaging correlations in different subtypes of prion diseases. A long list of differential diagnoses produces a comprehensive pictorial review, with the aim of enabling radiologists to identify typical and atypical patterns of sCJD. This review reinforces distinguishable imaging findings and confirms diffusion-weighted imaging (DWI) features as pivotal in the diagnostic workup of sCJD, as these findings enable radiologists to reliably recognize this rare but invariably lethal disease. A probable diagnosis is justified when expected MR imaging patterns are demonstrated and CJD-mimicking disorders are confidently ruled out. ©RSNA, 2017.
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Affiliation(s)
- Diego Cardoso Fragoso
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Augusto Lio da Mota Gonçalves Filho
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Felipe Torres Pacheco
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Bernardo Rodi Barros
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Ingrid Aguiar Littig
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Renato Hoffmann Nunes
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Antônio Carlos Martins Maia Júnior
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
| | - Antonio J da Rocha
- From the Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, Sao Paulo-SP 01221-020, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., B.R.B., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.); and Division of Neuroradiology, Fleury Medicina e Saúde, Sao Paulo, Brazil (D.C.F., A.L.d.M.G.F., F.T.P., I.A.L., R.H.N., A.C.M.M.J., A.J.d.R.)
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Kovacs GG, Andreasson U, Liman V, Regelsberger G, Lutz MI, Danics K, Keller E, Zetterberg H, Blennow K. Plasma and cerebrospinal fluid tau and neurofilament concentrations in rapidly progressive neurological syndromes: a neuropathology-based cohort. Eur J Neurol 2017; 24:1326-e77. [PMID: 28816001 DOI: 10.1111/ene.13389] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/27/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Cerebrospinal fluid (CSF) tau and neurofilament light chain (NF-L) proteins have proved to be reliable biomarkers for neuronal damage; however, there is a strong need for blood-based tests. METHODS The present study included 132 autopsy cases with rapidly progressive neurological syndromes, including Alzheimer disease (AD) (21), sporadic (65) and genetic (21) Creutzfeldt-Jakob disease (CJD), 25 cases with vascular, neoplastic and inflammatory alterations, and additionally 18 healthy control individuals. CSF tau and NF-L concentrations were measured by enzyme-linked immunosorbent assay. Plasma tau and NF-L concentrations were measured using ultra-sensitive single molecule array technology. RESULTS Plasma and CSF tau (R = 0.59, P < 0.001) and NF-L (R = 0.69, P < 0.001) levels correlated significantly (Spearman test). Plasma tau and NF-L levels were significantly higher in all disease groups compared to healthy controls (P < 0.001). Receiver operating characteristic curves were used and area under the curve values for comparisons with controls were 0.82 (AD), 0.94 (sporadic CJD), 0.92 (genetic CJD) and 0.83 (other neurological disorders) for plasma tau and 0.99, 0.99, 1.00 and 0.96 for plasma NF-L, respectively. Molecular subtyping of sporadic CJD showed a strong effect (linear logistic regression) on plasma tau (P < 0.001) but not NF-L levels (P = 0.19). CONCLUSION Plasma tau and NF-L concentrations are strongly increased in CJD and show similar diagnostic performance to the corresponding CSF measure. Molecular subtypes of sporadic CJD show different levels of plasma tau. Although not disease-specific, these findings support the use of plasma tau and NF-L as tools to identify, or to rule out, neurodegeneration.
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Affiliation(s)
- G G Kovacs
- Institute of Neurology, Medical University of Vienna, Vienna, Austria.,Prion Disease and Neuropathology Reference Center, Semmelweis University, Budapest, Hungary
| | - U Andreasson
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - V Liman
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - G Regelsberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - M I Lutz
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - K Danics
- Prion Disease and Neuropathology Reference Center, Semmelweis University, Budapest, Hungary.,Department of Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - E Keller
- Prion Disease and Neuropathology Reference Center, Semmelweis University, Budapest, Hungary.,Department of Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - H Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - K Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
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Hayashi Y, Iwasaki Y, Yoshikura N, Asano T, Mimuro M, Kimura A, Satoh K, Kitamoto T, Yoshida M, Inuzuka T. An autopsy-verified case of steroid-responsive encephalopathy with convulsion and a false-positive result from the real-time quaking-induced conversion assay. Prion 2017; 11:284-292. [PMID: 28749249 DOI: 10.1080/19336896.2017.1345416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We report an autopsy-verified case of steroid-responsive encephalopathy with convulsion and a false-positive result from the real-time quaking-induced conversion (RT-QUIC) assay. A 61-year-old Japanese man presented with acute onset of consciousness disturbance, and convulsions, but without a past medical or family history of progressive dementia, epilepsy, or prion disease. Brain diffusion and fluid-attenuated inverted recovery MR images revealed edematous cortical hyper-intensity, which diminished after the acute phase. Steroid pulse therapy was partially effective, although he continued to have dementia with myoclonus and psychiatric symptoms, despite resolution of the consciousness disturbance. Cerebrospinal fluid (CSF) analysis revealed a normal cell count, with significantly elevated levels of 14-3-3 protein and total tau protein. In addition, prion protein in the CSF was slowly amplified by the RT-QUIC assay. PRNP gene analysis revealed methionine homozygosity at codon 129 without mutation. The patient died of sudden cardiac arrest at 3 months after the onset of symptoms. The positive result from the RT-QUIC assay led us to suspect involvement of prion disease, although a postmortem assessment revealed that he had pathological changes after convulsion, and no prion disease. This case indicates that convulsion may cause false-positive RT-QUIC results, and that a postmortem evaluation remains the gold standard for diagnosing similar cases.
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Affiliation(s)
- Yuichi Hayashi
- a Department of Neurology and Geriatrics , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Yasushi Iwasaki
- b Department of Neuropathology , Institute for Medical Science of Aging, Aichi Medical University , Nagakute , Japan
| | - Nobuaki Yoshikura
- a Department of Neurology and Geriatrics , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Takahiko Asano
- c Department of Radiology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Maya Mimuro
- b Department of Neuropathology , Institute for Medical Science of Aging, Aichi Medical University , Nagakute , Japan
| | - Akio Kimura
- a Department of Neurology and Geriatrics , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Katsuya Satoh
- d Department of Locomotive Rehabilitation Sciences , Nagasaki University Graduate School of Medicine , Nagasaki , Japan
| | - Tetsuyuki Kitamoto
- e Division of CJD Science and Technology, Department of Prion Research , Center for Translational and Advanced Animal Research on Human Diseases, Tohoku University School of Medicine , Sendai , Japan
| | - Mari Yoshida
- b Department of Neuropathology , Institute for Medical Science of Aging, Aichi Medical University , Nagakute , Japan
| | - Takashi Inuzuka
- a Department of Neurology and Geriatrics , Gifu University Graduate School of Medicine , Gifu , Japan
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Abstract
The most definitive classification systems for dementia are based on the underlying pathology which, in turn, is categorized largely according to the observed accumulation of abnormal protein aggregates in neurons and glia. These aggregates perturb molecular processes, cellular functions and, ultimately, cell survival, with ensuing disruption of large-scale neural networks subserving cognitive, behavioural and sensorimotor functions. The functional domains affected and the evolution of deficits in these domains over time serve as footprints that the clinician can trace back with various levels of certainty to the underlying neuropathology. The process of phenotyping and syndromic classification has substantially improved over decades of careful clinicopathological correlation, and through the discovery of in vivo biomarkers of disease. Here, we present an overview of the salient features of the most common dementia subtypes - Alzheimer disease, vascular dementia, frontotemporal dementia and related syndromes, Lewy body dementias, and prion diseases - with an emphasis on neuropathology, relevant epidemiology, risk factors, and signature signs and symptoms.
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McFerrin MB, Chi X, Cutter G, Yacoubian TA. Dysregulation of 14-3-3 proteins in neurodegenerative diseases with Lewy body or Alzheimer pathology. Ann Clin Transl Neurol 2017; 4:466-477. [PMID: 28695147 PMCID: PMC5497531 DOI: 10.1002/acn3.421] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 01/28/2023] Open
Abstract
Objective The highly conserved 14‐3‐3 proteins interact with key players involved in Parkinson's disease (PD) and other neurodegenerative disorders. We recently demonstrated that 14‐3‐3 phosphorylation is increased in PD models and that increased 14‐3‐3 phosphorylation reduces the neuroprotective effects of 14‐3‐3 proteins. Here, we investigated whether 14‐3‐3 phosphorylation is altered in postmortem brains from control, PD, Alzheimer's Disease (AD), Alzheimer's with Lewy Bodies (ADLB), Dementia with Lewy Bodies (DLB), and Progressive Supranuclear Palsy (PSP) subjects at three conserved sites: serine 58 (S58), serine 185 (S185), and serine 232 (S232). Methods S58, S185, and S232 phosphorylation was measured by western blot analysis of Triton X‐100 soluble and insoluble fractions from postmortem temporal cortex. Results The ratio of soluble phospho‐S232 to insoluble phospho‐S232 was reduced by 32%, 60%, 37%, and 52% in PD, AD, ADLB, and DLB, respectively. S185 and S58 phosphorylation were mildly elevated in the soluble fraction in DLB. We also noted a dramatic reduction in soluble pan 14‐3‐3 levels by ~35% in AD, ADLB, and DLB. Lower ratios of soluble to insoluble S232 phosphorylation (pointing to higher insoluble pS232) correlated with lower soluble pan 14‐3‐3 levels, suggesting that S232 phosphorylation may promote insolubilization of 14‐3‐3s. The phospho‐S232 ratio and soluble pan 14‐3‐3 levels correlated with clinical and pathological severity. Interpretation These data reveal dysregulation of 14‐3‐3 proteins in neurodegeneration associated with Lewy body or Alzheimer pathology. S232 phosphorylation may drive insolubilization of 14‐3‐3s and thus contribute to the pathophysiology in neurodegenerative disorders associated with Lewy body or Alzheimer pathology.
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Affiliation(s)
- Michael B McFerrin
- Department of Neurology Center for Neurodegeneration and Experimental Therapeutics University of Alabama at Birmingham Birmingham Alabama
| | - Xiaofei Chi
- Department of Biostatics University of Alabama at Birmingham Birmingham Alabama.,Present address: Department of Biostatistics University of Arkansas for Medical Sciences Little Rock Arkansas
| | - Gary Cutter
- Department of Biostatics University of Alabama at Birmingham Birmingham Alabama
| | - Talene A Yacoubian
- Department of Neurology Center for Neurodegeneration and Experimental Therapeutics University of Alabama at Birmingham Birmingham Alabama
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Detection of CSF 14-3-3 Protein in Sporadic Creutzfeldt-Jakob Disease Patients Using a New Automated Capillary Western Assay. Mol Neurobiol 2017; 55:3537-3545. [DOI: 10.1007/s12035-017-0607-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
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Prion-specific and surrogate CSF biomarkers in Creutzfeldt-Jakob disease: diagnostic accuracy in relation to molecular subtypes and analysis of neuropathological correlates of p-tau and Aβ42 levels. Acta Neuropathol 2017; 133:559-578. [PMID: 28205010 PMCID: PMC5348556 DOI: 10.1007/s00401-017-1683-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 01/28/2023]
Abstract
The differential diagnosis of Creutzfeldt-Jakob disease (CJD) from other, sometimes treatable, neurological disorders is challenging, owing to the wide phenotypic heterogeneity of the disease. Real-time quaking-induced prion conversion (RT-QuIC) is a novel ultrasensitive in vitro assay, which, at variance with surrogate neurodegenerative biomarker assays, specifically targets the pathological prion protein (PrPSc). In the studies conducted to date in CJD, cerebrospinal fluid (CSF) RT-QuIC showed good diagnostic sensitivity (82–96%) and virtually full specificity. In the present study, we investigated the diagnostic value of both prion RT-QuIC and surrogate protein markers in a large patient population with suspected CJD and then evaluated the influence on CSF findings of the CJD type, and the associated amyloid-β (Aβ) and tau neuropathology. RT-QuIC showed an overall diagnostic sensitivity of 82.1% and a specificity of 99.4%. However, sensitivity was lower in CJD types linked to abnormal prion protein (PrPSc) type 2 (VV2, MV2K and MM2C) than in typical CJD (MM1). Among surrogate proteins markers (14-3-3, total (t)-tau, and t-tau/phosphorylated (p)-tau ratio) t-tau performed best in terms of both specificity and sensitivity for all sCJD types. Sporadic CJD VV2 and MV2K types demonstrated higher CSF levels of p-tau when compared to other sCJD types and this positively correlated with the amount of tiny tau deposits in brain areas showing spongiform change. CJD patients showed moderately reduced median Aβ42 CSF levels, with 38% of cases having significantly decreased protein levels in the absence of Aβ brain deposits. Our results: (1) support the use of both RT-QuIC and t-tau assays as first line laboratory investigations for the clinical diagnosis of CJD; (2) demonstrate a secondary tauopathy in CJD subtypes VV2 and MV2K, correlating with increased p-tau levels in the CSF and (3) provide novel insight into the issue of the accuracy of CSF p-tau and Aβ42 as markers of brain tauopathy and β-amyloidosis.
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Llorens F, Kruse N, Karch A, Schmitz M, Zafar S, Gotzmann N, Sun T, Köchy S, Knipper T, Cramm M, Golanska E, Sikorska B, Liberski PP, Sánchez-Valle R, Fischer A, Mollenhauer B, Zerr I. Validation of α-Synuclein as a CSF Biomarker for Sporadic Creutzfeldt-Jakob Disease. Mol Neurobiol 2017; 55:2249-2257. [PMID: 28321768 PMCID: PMC5840235 DOI: 10.1007/s12035-017-0479-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/02/2017] [Indexed: 01/15/2023]
Abstract
The analysis of cerebrospinal fluid (CSF) biomarkers gains importance in the differential diagnosis of prion diseases. However, no single diagnostic tool or combination of them can unequivocally confirm prion disease diagnosis. Electrochemiluminescence (ECL)-based immunoassays have demonstrated to achieve high diagnostic accuracy in a variety of sample types due to their high sensitivity and dynamic range. Quantification of CSF α-synuclein (a-syn) by an in-house ECL-based ELISA assay has been recently reported as an excellent approach for the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD), the most prevalent form of human prion disease. In the present study, we validated a commercially available ECL-based a-syn ELISA platform as a diagnostic test for correct classification of sCJD cases. CSF a-syn was analysed in 203 sCJD cases with definite diagnosis and in 445 non-CJD cases. We investigated reproducibility and stability of CSF a-syn and made recommendations for its analysis in the sCJD diagnostic workup. A sensitivity of 98% and a specificity of 97% were achieved when using an optimal cut-off of 820 pg/mL a-syn. Moreover, we were able to show a negative correlation between a-syn levels and disease duration suggesting that CSF a-syn may be a good prognostic marker for sCJD patients. The present study validates the use of a-syn as a CSF biomarker of sCJD and establishes the clinical and pre-analytical parameters for its use in differential diagnosis in clinical routine. Additionally, the current test presents some advantages compared to other diagnostic approaches: it is fast, economic, requires minimal amount of CSF and a-syn levels are stable along disease progression.
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Affiliation(s)
- Franc Llorens
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.
| | - Niels Kruse
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Matthias Schmitz
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Saima Zafar
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Nadine Gotzmann
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Ting Sun
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Silja Köchy
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Tobias Knipper
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Maria Cramm
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Ewa Golanska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Pawel P Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Raquel Sánchez-Valle
- Creutzfeldt-Jakob disease unit. Alzheimer's disease and other cognitive disorders unit. Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andre Fischer
- German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Brit Mollenhauer
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Paracelsus-Elena Klinik, Center for Parkinsonism and Movement Disorders, Kassel, Germany.,Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Inga Zerr
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
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