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Atypical multiple system atrophy is a new subtype of frontotemporal lobar degeneration: frontotemporal lobar degeneration associated with α-synuclein. Acta Neuropathol 2015; 130:93-105. [PMID: 25962793 DOI: 10.1007/s00401-015-1442-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
Multiple system atrophy (MSA) is a sporadic neurodegenerative disease clinically characterized by cerebellar signs, parkinsonism, and autonomic dysfunction. Pathologically, MSA is an α-synucleinopathy affecting striatonigral and olivopontocerebellar systems, while neocortical and limbic involvement is usually minimal. In this study, we describe four patients with atypical MSA with clinical features consistent with frontotemporal dementia (FTD), including two with corticobasal syndrome, one with progressive non-fluent aphasia, and one with behavioral variant FTD. None had autonomic dysfunction. All had frontotemporal atrophy and severe limbic α-synuclein neuronal pathology. The neuronal inclusions were heterogeneous, but included Pick body-like inclusions. The latter were strongly associated with neuronal loss in the hippocampus and amygdala. Unlike typical Pick bodies, the neuronal inclusions were positive on Gallyas silver stain and negative on tau immunohistochemistry. In comparison to 34 typical MSA cases, atypical MSA had significantly more neuronal inclusions in anteromedial temporal lobe and limbic structures. While uncommon, our findings suggest that MSA may present clinically and pathologically as a frontotemporal lobar degeneration (FTLD). We suggest that this may represent a novel subtype of FTLD associated with α-synuclein (FTLD-synuclein).
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Kiely AP, Asi YT, Kara E, Limousin P, Ling H, Lewis P, Proukakis C, Quinn N, Lees AJ, Hardy J, Revesz T, Houlden H, Holton JL. α-Synucleinopathy associated with G51D SNCA mutation: a link between Parkinson's disease and multiple system atrophy? Acta Neuropathol 2013; 125:753-69. [PMID: 23404372 PMCID: PMC3681325 DOI: 10.1007/s00401-013-1096-7] [Citation(s) in RCA: 327] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/01/2013] [Indexed: 12/15/2022]
Abstract
We report a British family with young-onset Parkinson's disease (PD) and a G51D SNCA mutation that segregates with the disease. Family history was consistent with autosomal dominant inheritance as both the father and sister of the proband developed levodopa-responsive parkinsonism with onset in their late thirties. Clinical features show similarity to those seen in families with SNCA triplication and to cases of A53T SNCA mutation. Post-mortem brain examination of the proband revealed atrophy affecting frontal and temporal lobes in addition to the caudate, putamen, globus pallidus and amygdala. There was severe loss of pigmentation in the substantia nigra and pallor of the locus coeruleus. Neuronal loss was most marked in frontal and temporal cortices, hippocampal CA2/3 subregions, substantia nigra, locus coeruleus and dorsal motor nucleus of the vagus. The cellular pathology included widespread and frequent neuronal α-synuclein immunoreactive inclusions of variable morphology and oligodendroglial inclusions similar to the glial cytoplasmic inclusions of multiple system atrophy (MSA). Both inclusion types were ubiquitin and p62 positive and were labelled with phosphorylation-dependent anti-α-synuclein antibodies In addition, TDP-43 immunoreactive inclusions were observed in limbic regions and in the striatum. Together the data show clinical and neuropathological similarities to both the A53T SNCA mutation and multiplication cases. The cellular neuropathological features of this case share some characteristics of both PD and MSA with additional unique striatal and neocortical pathology. Greater understanding of the disease mechanism underlying the G51D mutation could aid in understanding of α-synuclein biology and its impact on disease phenotype.
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Affiliation(s)
- Aoife P. Kiely
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Yasmine T. Asi
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Eleanna Kara
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, UK
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Helen Ling
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Patrick Lewis
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
- School of Pharmacy, University of Reading, Whiteknights, Reading, UK
| | - Christos Proukakis
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Niall Quinn
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Andrew J. Lees
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - John Hardy
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Tamas Revesz
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Janice L. Holton
- Queen Square Brain Bank, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
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