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Sin MK, Cheng Y, Roseman JM, Zamrini E, Ahmed A. Relationships between Late-Life Blood Pressure and Cerebral Microinfarcts in Octogenarians: An Observational Autopsy Study. J Clin Med 2023; 12:6080. [PMID: 37763020 PMCID: PMC10531732 DOI: 10.3390/jcm12186080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Mid-life high blood pressure (BP) is a risk factor for cerebral microinfarcts. Less is known about the relationship between late-life BP and cerebral microinfarcts, the examination of which is the objective of the current study. This case-control study analyzed data from 551 participants (94.6% aged ≥80 years; 58.6% women) in the Adult Changes in Thought (ACT) study who had autopsy data on microinfarcts and four values of systolic and diastolic blood pressure (SBP and DBP) before death. Using the average of four values, SBP was categorized using 10 mmHg intervals; a trend was defined as a ≥10 mmHg rise or fall from the first to fourth values (average gap of 6.5 years). Multivariable-adjusted regression models were used to examine the associations of BP and microinfarcts, adjusting for age, sex, last BP-to-death time, APOE genotype, and antihypertensive medication use. Microinfarcts were present in 274 (49.7%) participants; there were multiple in 51.8% of the participants, and they were located in cortical areas in 40.5%, subcortical areas in 29.6%, and both areas in 29.9% of the participants. All SBP categories (reference of 100-119 mmHg) and both SBP trends were associated with higher odds of both the presence and number of microinfarcts. The magnitude of these associations was numerically greater for subcortical than cortical microinfarcts. Similar associations were observed with DBP. These hypothesis-generating findings provide new information about the overall relationship between BP and cerebral microinfarcts in octogenarians.
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Affiliation(s)
- Mo-Kyung Sin
- College of Nursing, Seattle University, Seattle, WA 98122, USA
| | - Yan Cheng
- Biomedical Informatics Center and School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA; (Y.C.); (A.A.)
| | - Jeffrey M. Roseman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Edward Zamrini
- Biomedical Informatics Center and School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA; (Y.C.); (A.A.)
- Irvine Clinical Research, Irvine, CA 92614, USA
- VA Medical Center, Washington, DC 20242, USA
| | - Ali Ahmed
- Biomedical Informatics Center and School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA; (Y.C.); (A.A.)
- VA Medical Center, Washington, DC 20242, USA
- School of Medicine, Georgetown University, Washington, DC 20057, USA
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Sin MK, Cheng Y, Roseman JM, Zamrini E, Ahmed A. Relationships between Cerebral Vasculopathies and Microinfarcts in a Community-Based Cohort of Older Adults. J Clin Med 2023; 12:3807. [PMID: 37298002 PMCID: PMC10253407 DOI: 10.3390/jcm12113807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Cerebral microinfarcts are associated with cognitive impairment and dementia. Small vessel diseases such as cerebral arteriolosclerosis and cerebral amyloid angiography (CAA) have been found to be associated with microinfarcts. Less is known about the associations of these vasculopathies with the presence, numbers, and location of microinfarcts. These associations were examined in the clinical and autopsy data of 842 participants in the Adult Changes in Thought (ACT) study. Both vasculopathies were categorized by severity (none, mild, moderate, and severe) and region (cortical and subcortical). Odds ratios (OR) and 95% CIs for microinfarcts associated with arteriolosclerosis and CAA adjusted for possible modifying covariates such as age at death, sex, blood pressure, APOE genotype, Braak, and CERAD were estimated. 417 (49.5%) had microinfarcts (cortical, 301; subcortical, 249), 708 (84.1%) had cerebral arteriolosclerosis, 320 (38%) had CAA, and 284 (34%) had both. Ors (95% CI) for any microinfarct were 2.16 (1.46-3.18) and 4.63 (2.90-7.40) for those with moderate (n = 183) and severe (n = 124) arteriolosclerosis, respectively. Respective Ors (95% CI) for the number of microinfarcts were 2.25 (1.54-3.30) and 4.91 (3.18-7.60). Similar associations were observed for cortical and subcortical microinfarcts. Ors (95% Cis) for the number of microinfarcts associated with mild (n = 75), moderate (n = 73), and severe (n = 15) amyloid angiopathy were 0.95 (0.66-1.35), 1.04 (0.71-1.52), and 2.05 (0.94-4.45), respectively. Respective Ors (95% Cis) for cortical microinfarcts were 1.05 (0.71-1.56), 1.50 (0.99-2.27), and 1.69 (0.73-3.91). Respective Ors (95% Cis) for subcortical microinfarcts were 0.84 (0.55-1.28), 0.72 (0.46-1.14), and 0.92 (0.37-2.28). These findings suggest a significant association of cerebral arteriolosclerosis with the presence, number, and location (cortical and subcortical) of microinfarcts, and a weak and non-significant association of CAA with each microinfarct, highlighting the need for future research to better understand the role of small vessel diseases in the pathogenesis of cerebral microinfarcts.
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Affiliation(s)
- Mo-Kyung Sin
- College of Nursing, Seattle University, Seattle, WA 98122, USA
| | - Yan Cheng
- Biomedical Informatics Center, School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA; (Y.C.); (E.Z.); (A.A.)
| | - Jeffrey M. Roseman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Edward Zamrini
- Biomedical Informatics Center, School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA; (Y.C.); (E.Z.); (A.A.)
- Division of Neurology, Irvine Clinical Research, Irvine, CA 92614, USA
- Health and Aging, VA Medical Center, Washington, DC 20060, USA
| | - Ali Ahmed
- Biomedical Informatics Center, School of Medicine & Health Sciences, George Washington University, Washington, DC 20052, USA; (Y.C.); (E.Z.); (A.A.)
- Health and Aging, VA Medical Center, Washington, DC 20060, USA
- School of Medicine, Georgetown University, Washington, DC 20057, USA
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Lee CS, Latimer CS, Henriksen JC, Blazes M, Larson EB, Crane PK, Keene CD, Lee AY. Application of deep learning to understand resilience to Alzheimer's disease pathology. Brain Pathol 2021; 31:e12974. [PMID: 34009663 PMCID: PMC8549025 DOI: 10.1111/bpa.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022] Open
Abstract
People who have Alzheimer's disease neuropathologic change (ADNC) typically associated with dementia but not the associated cognitive decline can be considered to be “resilient” to the effects of ADNC. We have previously reported lower neocortical levels of hyperphosphorylated tau (pTau) and less limbic‐predominant age‐related TDP‐43 encephalopathy neuropathologic change (LATE‐NC) in the resilient participants compared to those with dementia and similar ADNC as determined by current NIA‐AA recommendations using traditional semi‐quantitative assessments of amyloid β and pathological tau burden. To better understand differences between AD‐dementia and resilient participants, we developed and applied a deep learning approach to analyze the neuropathology of 14 brain donors from the Adult Changes in Thought study, including seven stringently defined resilient participants and seven age‐matched AD‐dementia controls. We created two novel, fully automated deep learning algorithms to quantify the level of phosphorylated TDP‐43 (pTDP‐43) and pTau in whole slide imaging. The models performed better than traditional techniques for quantifying pTDP‐43 and pTau. The second model was able to segment lesions staining for pTau into neurofibrillary tangles (NFTs) and tau neurites (neuronal processes positive for pTau). Both groups had similar quantities of pTau localizing to neurites, but the pTau burden associated with NFTs in the resilient group was significantly lower compared to the group with dementia. These results validate use of deep learning approaches to quantify clinically relevant microscopic characteristics from neuropathology workups. These results also suggest that the burden of NFTs is more strongly associated with cognitive impairment than the more diffuse neuritic tau commonly seen with tangle pathology and suggest that additional factors may underlie resilience mechanisms defined by traditional means.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Caitlin S Latimer
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Jonathan C Henriksen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Paul K Crane
- Division of General Internal Medicine, Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Barthold D, Gibbons LE, Marcum ZA, Gray SL, Keene CD, Grabowski TJ, Postupna N, Larson EB, Crane PK. Alzheimer's Disease-Related Neuropathology Among Patients with Medication Treated Type 2 Diabetes in a Community-Based Autopsy Cohort. J Alzheimers Dis 2021; 83:1303-1312. [PMID: 34420950 PMCID: PMC8846930 DOI: 10.3233/jad-210059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diabetes is a risk factor for Alzheimer's disease and related dementias (ADRD). Epidemiologic evidence shows an association between diabetes medications and ADRD risk; cell and mouse models show diabetes medication association with AD-related neuropathologic change (ADNC). OBJECTIVE This hypothesis-generating analysis aimed to describe autopsy-measured ADNC for individuals who used diabetes medications. METHODS Descriptive analysis of ADNC for Adult Changes in Thought (ACT) Study autopsy cohort who used diabetes medications, including sulfonylureas, insulin, and biguanides; total N = 118. ADNC included amyloid plaque distribution (Thal phasing), neurofibrillary tangle (NFT) distribution (Braak stage), and cortical neuritic plaque density (CERAD score). We also examined quantitative measures of ADNC using the means of standardized Histelide measures of cortical PHF-tau and Aβ1-42. Adjusted analyses control for age at death, sex, education, APOE genotype, and diabetes complication severity index. RESULTS Adjusted analyses showed no significant association between any drug class and traditional neuropathologic measures compared to nonusers of that class. In adjusted Histelide analyses, any insulin use was associated with lower mean levels of Aβ1-42 (-0.57 (CI: -1.12, -0.02)) compared to nonusers. Five years of sulfonylureas and of biguanides use was associated with lower levels of Aβ1-42 compared to nonusers (-0.15 (CI: -0.28, -0.02), -0.31 (CI: -0.54, -0.07), respectively). CONCLUSION Some evidence exists that diabetes medications are associated with lower levels of Aβ1-42, but not traditional measures of neuropathology. Future studies are needed in larger samples to build understanding of the mechanisms between diabetes, its medications, and ADRD, and to potentially repurpose existing medications for prevention or delay of ADRD.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Laura E. Gibbons
- General Internal Medicine, Data Management and Statistics Core, Alzheimer’s Disease Research Center, University of Washington, Seattle, WA, USA
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Zachary A. Marcum
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Shelly L. Gray
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - C. Dirk Keene
- Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas J. Grabowski
- Department of Radiology and Neurology, UW School of Medicine, Alzheimer’s Disease Research Center, University of Washington, Seattle, WA, USA
| | - Nadia Postupna
- Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
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Shaffer RM, Li G, Adar SD, Dirk Keene C, Latimer CS, Crane PK, Larson EB, Kaufman JD, Carone M, Sheppard L. Fine Particulate Matter and Markers of Alzheimer's Disease Neuropathology at Autopsy in a Community-Based Cohort. J Alzheimers Dis 2021; 79:1761-1773. [PMID: 33459717 PMCID: PMC8061707 DOI: 10.3233/jad-201005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Evidence links fine particulate matter (PM2.5) to Alzheimer's disease (AD), but no community-based prospective cohort studies in older adults have evaluated the association between long-term exposure to PM2.5 and markers of AD neuropathology at autopsy. OBJECTIVE Using a well-established autopsy cohort and new spatiotemporal predictions of air pollution, we evaluated associations of 10-year PM2.5 exposure prior to death with Braak stage, Consortium to Establish a Registry for AD (CERAD) score, and combined AD neuropathologic change (ABC score). METHODS We used autopsy specimens (N = 832) from the Adult Changes in Thought (ACT) study, with enrollment ongoing since 1994. We assigned long-term exposure at residential address based on two-week average concentrations from a newly developed spatiotemporal model. To account for potential selection bias, we conducted inverse probability weighting. Adjusting for covariates with tiered models, we performed ordinal regression for Braak and CERAD and logistic regression for dichotomized ABC score. RESULTS 10-year average (SD) PM2.5 from death across the autopsy cohort was 8.2 (1.9) μg/m3. Average age (SD) at death was 89 (7) years. Each 1μg/m3 increase in 10-year average PM2.5 prior to death was associated with a suggestive increase in the odds of worse neuropathology as indicated by CERAD score (OR: 1.35 (0.90, 1.90)) but a suggestive decreased odds of neuropathology as defined by the ABC score (OR: 0.79 (0.49, 1.19)). There was no association with Braak stage (OR: 0.99 (0.64, 1.47)). CONCLUSION We report inconclusive associations between PM2.5 and AD neuropathology at autopsy among a cohort where 94% of individuals experienced 10-year exposures below the current EPA standard. Prior studies of AD risk factors and AD neuropathology are similarly inconclusive, suggesting alternative mechanistic pathways for disease or residual confounding.
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Affiliation(s)
- Rachel M. Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Ge Li
- VA Northwest Network Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - C. Dirk Keene
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Caitlin S. Latimer
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Paul K. Crane
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B. Larson
- School of Medicine, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
- Departments of Medicine and Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
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Pontecorvo MJ, Keene CD, Beach TG, Montine TJ, Arora AK, Devous MD, Navitsky M, Kennedy I, Joshi AD, Lu M, Serrano GE, Sue LI, Intorcia AJ, Rose SE, Wilson A, Hellstern L, Coleman N, Flitter M, Aldea P, Fleisher AS, Mintun MA, Siderowf A. Comparison of regional flortaucipir PET with quantitative tau immunohistochemistry in three subjects with Alzheimer's disease pathology: a clinicopathological study. EJNMMI Res 2020; 10:65. [PMID: 32542468 PMCID: PMC7295920 DOI: 10.1186/s13550-020-00653-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/03/2020] [Indexed: 01/16/2023] Open
Abstract
Background The objective of this study was to make a quantitative comparison of flortaucipir PET retention with pathological tau and β-amyloid across a range of brain regions at autopsy. Methods Patients with dementia (two with clinical diagnosis of AD, one undetermined), nearing the end of life, underwent 20-min PET, beginning 80 min after an injection of ~370 mBq flortaucipir [18F]. Neocortical, basal ganglia, and limbic tissue samples were obtained bilaterally from 19 regions at autopsy and subject-specific PET regions of interest corresponding to the 19 sampled target tissue regions in each hemisphere were hand drawn on the PET images. SUVr values were calculated for each region using a cerebellar reference region. Abnormally phosphorylated tau (Ptau) and amyloid-β (Aβ) tissue concentrations were measured for each tissue region with an antibody capture assay (Histelide) using AT8 and H31L21 antibodies respectively. Results The imaging-to-autopsy interval ranged from 4–29 days. All three subjects had intermediate to high levels of AD neuropathologic change at autopsy. Mean cortical SUVr averaged across all three subjects correlated significantly with the Ptau immunoassay (Pearson r = 0.81; p < 0.0001). When Ptau and Aβ1-42 were both included in the model, the Ptau correlation with flortaucipir SUVr was preserved but there was no correlation of Aβ1-42 with flortaucipir. There was also a modest correlation between limbic (hippocampal/entorhinal and amygdala) flortaucipir SUVr and Ptau (Pearson r = 0.52; p < 0.080). There was no significant correlation between SUVr and Ptau in basal ganglia. Conclusions The results of this pilot study support a quantitative relationship between cortical flortaucipir SUVr values and quantitative measures of Ptau at autopsy. Additional research including more cases is needed to confirm the generalizability of these results. Trial registration, NIH Clinicaltrials.gov NCT # 02516046. Registered August 27, 2015. https://clinicaltrials.gov/ct2/show/NCT02516046?term=02516046&draw=2&rank=1
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Affiliation(s)
- Michael J Pontecorvo
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA.
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | | | - Anupa K Arora
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Michael D Devous
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Michael Navitsky
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Ian Kennedy
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Abhinay D Joshi
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA.,Present Address: Medpace Holdings, Inc., Cincinnati, Ohio, USA
| | - Ming Lu
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | - Lucia I Sue
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | - Anthony J Intorcia
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | - Shannon E Rose
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Angela Wilson
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Leanne Hellstern
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Natalie Coleman
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Matthew Flitter
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Patricia Aldea
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Adam S Fleisher
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Mark A Mintun
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Andrew Siderowf
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA.,Present Address: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Gray SL, Anderson ML, Hanlon JT, Dublin S, Walker RL, Hubbard RA, Yu O, Montine TJ, Crane PK, Sonnen JA, Keene CD, Larson EB. Exposure to Strong Anticholinergic Medications and Dementia-Related Neuropathology in a Community-Based Autopsy Cohort. J Alzheimers Dis 2019; 65:607-616. [PMID: 30056417 DOI: 10.3233/jad-171174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anticholinergic medication exposure has been associated with increased risk for dementia. No study has examined the association between anticholinergic medication use and neuropathologic lesions in a community-based sample. OBJECTIVE To examine the relationship between anticholinergic exposure and dementia-related neuropathologic changes. METHODS Within a community-based autopsy cohort (N = 420), we ascertained use of anticholinergic medications over a 10-year period from automated pharmacy data and calculated total standardized daily doses (TSDD). We used modified Poisson regression to calculate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the association between anticholinergic exposure and dementia-associated neuropathology. Inverse probability weighting was used to account for selection into the autopsy cohort. RESULTS Heavy anticholinergic exposure (≥1,096 TSDD) was not associated with greater neuropathologic changes of Alzheimer's disease; the adjusted RRs for heavy use of anticholinergics (≥1,096 TSDD) compared to no use were 1.22 (95% CI 0.81-1.88) for neuritic plaque scores and 0.89 (0.47-1.66) for extent of neurofibrillary degeneration. Moderate (91-1,095 TSDD) and heavy use of anticholinergics was associated with a significantly lower cerebral microinfarct burden compared with no use with adjusted RRs of 0.44 (0.21-0.89) and 0.24 (0.09-0.62), respectively. Anticholinergic exposure was not associated with macroscopic infarcts or atherosclerosis. CONCLUSIONS Use of anticholinergic medications is not associated with Alzheimer's disease-related neuropathologic changes but is associated with lower cerebral microinfarct burden. Further research into biological mechanisms underlying the anticholinergic-dementia link is warranteds.
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Keene CD, Wilson AM, Kilgore MD, Bruner LT, Postupna NO, Darvas M. Luminex-based quantification of Alzheimer's disease neuropathologic change in formalin-fixed post-mortem human brain tissue. J Transl Med 2019; 99:1056-1067. [PMID: 30573871 PMCID: PMC6586549 DOI: 10.1038/s41374-018-0165-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 01/16/2023] Open
Abstract
The vast majority of archived research and clinical pathological specimens are stored in the form of formalin fixed, paraffin-embedded (FFPE) tissues, but, unlike fresh frozen tissue samples, highly quantitative measures in FFPE tissues are limited to immunohistochemical and immunofluorescence thresholding image analysis studies, cell counting, and ordinal ranking systems. This poses a significant obstacle for clinical investigations that aim to correlate diagnostic markers of neurodegenerative diseases like Alzheimer's disease (AD) with parameters like age, gender, drug exposures, genotype, disease stage, co-morbidities, or environmental factors. To overcome this limitation, we have developed Luminex-based techniques and protocols for the quantification of amyloid β and hyperphosphorylated Tau in FFPE brain sections. We validated the Luminex assay in FFPE sections from prefrontal cortex, hippocampus, and neostriatum from 30 cases that underwent prior neuropathological diagnostic assessment of AD following the current NIA-AA recommendations for AD: 10 cases diagnosed as not or low, 10 cases as intermediate, and 10 cases as high AD neuropathologic change. Consistent with the neuropathologic assessment, Luminex assay detected high amounts of amyloid beta in the frontal cortex and striatum, and high amounts of hyperphosphorylated Tau in the frontal cortex and hippocampus, of cases with high AD neuropathologic change. This assay can be expanded to detect diverse antigenic targets of interest, as we show here with IBA1 and GFAP. This novel approach supports multiplexed highly quantitative, molecularly specific neuropathology measures to further explore mechanisms of neurodegeneration in AD.
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Affiliation(s)
- C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Angela M Wilson
- Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Mitchell D Kilgore
- Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Lauren T Bruner
- Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Nadia O Postupna
- Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Martin Darvas
- Department of Pathology, University of Washington, Seattle, WA, 98104, USA.
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Patnaik R, Sharma A, Skaper SD, Muresanu DF, Lafuente JV, Castellani RJ, Nozari A, Sharma HS. Histamine H3 Inverse Agonist BF 2649 or Antagonist with Partial H4 Agonist Activity Clobenpropit Reduces Amyloid Beta Peptide-Induced Brain Pathology in Alzheimer's Disease. Mol Neurobiol 2019; 55:312-321. [PMID: 28861757 DOI: 10.1007/s12035-017-0743-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Alzheimer's disease (AD) is one of the leading causes for disability and death affecting millions of people worldwide. Thus, novel therapeutic strategies are needed to reduce brain pathology associated with AD. In view of increasing awareness regarding involvement of histaminergic pathways in AD, we explored the role of one H3 receptor inverse agonist BF 2649 and one selective H3 receptor antagonist with partial H4 agonist activity in amyloid beta peptide (AβP) infusion-induced brain pathology in a rat model. AD-like pathology was produced by administering AβP (1-40) intracerebroventricular (i.c.v.) in the left lateral ventricle (250 ng/10 μl, once daily) for 4 weeks. Control rats received saline. In separate group of rats, either BF 2649 (1 mg/kg, i.p.) or clobenpropit (1 mg/kg, i.p.) was administered once daily for 1 week after 3 weeks of AβP administration. After 30 days, blood-brain barrier (BBB) breakdown, edema formation, neuronal, glial injuries, and AβP deposits were examined in the brain. A significant reduction in AβP deposits along with marked reduction in neuronal or glial reactions was seen in the drug-treated group. The BBB breakdown to Evans blue albumin and radioiodine in the cortex, hippocampus, hypothalamus, and cerebellum was also significantly reduced in these drug-treated groups. Clobenpropit showed superior effects than the BF2649 in reducing brain pathology in AD. Taken together, our observations are the first to show that blockade of H3 and stimulation of H4 receptors are beneficial for the treatment of AD pathology, not reported earlier.
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Affiliation(s)
- Ranjana Patnaik
- School of Biomedical Engineering, Department of Biomaterials, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University Hospital, Uppsala University, SE-75185, Uppsala, Sweden
| | - Aruna Sharma
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University Hospital, Uppsala University, SE-75185, Uppsala, Sweden
- International Experimental Central Nervous System Injury and Repair (IECNSIR), University Hospital, Uppsala University, Frödingsgatan 12, Bldg. 28, SE-75421, Uppsala, Sweden
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Stephen D Skaper
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Largo "E. Meneghetti" 2, 35131, Padua, Italy
| | - Dafin F Muresanu
- "RoNeuro" Institute for Neurological Research and Diagnostic, 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Department of Clinical Neurosciences, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Nanoneurosurgery Group, BioCruces Health Research Institute, 48903, Barakaldo, Bizkaia, Spain
- Faculty of Health Science, Universidad Autónoma de Chile, Santiago de Chile, Chile
| | | | - Ala Nozari
- Anesthesiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Hari S Sharma
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University Hospital, Uppsala University, SE-75185, Uppsala, Sweden.
- International Experimental Central Nervous System Injury and Repair (IECNSIR), University Hospital, Uppsala University, Frödingsgatan 12, Bldg. 28, SE-75421, Uppsala, Sweden.
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.
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10
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Flanagan ME, Larson EB, Walker RL, Keene CD, Postupna N, Cholerton B, Sonnen JA, Dublin S, Crane PK, Montine TJ. Associations between Use of Specific Analgesics and Concentrations of Amyloid-β 42 or Phospho-Tau in Regions of Human Cerebral Cortex. J Alzheimers Dis 2019; 61:653-662. [PMID: 29226863 DOI: 10.3233/jad-170414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Analgesics are commonly used by older adults, raising the question of whether their use might contribute to dementia risk and neuropathologic changes of Alzheimer's disease (AD). The Adult Changes in Thought (ACT) study is a population-based study of brain aging and incident dementia among people 65 years or older who are community dwelling and not demented at entry. Amyloid-β (Aβ)42 and phospho-tau were quantified using Histelide in regions of cerebral cortex from 420 brain autopsies. Total standard daily doses of prescription opioid and non-aspirin nonsteroidal anti-inflammatory drug (NSAID) exposure during a defined 10-year exposure window were identified using automated pharmacy dispensing data and used to classify people as having no/low, intermediate, or high exposure. People with high NSAID exposure had significantly greater Aβ42 concentration in middle frontal gyrus and superior and middle temporal gyri, but not inferior parietal lobule; no Aβ42 regional concentration was associated with prescription opioid usage. People with high opioid usage had significantly greater concentration of phospho-tau in middle frontal gyrus than people with little-to-no opioid usage. Consistent with our previous studies, findings suggest that high levels of NSAID use in older individuals may promote Aβ42 accumulation in cerebral cortex.
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Affiliation(s)
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Nadia Postupna
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | - Joshua A Sonnen
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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11
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Lee CS, Larson EB, Gibbons LE, Latimer CS, Rose SE, Hellstern LL, Keene CD, Crane PK. Ophthalmology-Based Neuropathology Risk Factors: Diabetic Retinopathy is Associated with Deep Microinfarcts in a Community-Based Autopsy Study. J Alzheimers Dis 2019; 68:647-655. [PMID: 30883356 PMCID: PMC6450649 DOI: 10.3233/jad-181087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aging eye offers unique opportunities to study and understand the aging brain, in particular related to Alzheimer's disease (AD) and dementia. However, little is known about relationships between eye diseases and dementia-related neurodegeneration. OBJECTIVE To determine the potential association between three age-related eye diseases and AD and dementia-related neuropathology. METHODS We reviewed autopsy data from the prospective longitudinal Adult Changes in Thought (ACT) cohort. ICD-9 codes were used to identify diagnoses of diabetic retinopathy, glaucoma, and age-related macular degeneration. Multivariate regression models were used to determine odds ratios (OR) of neuropathology features associated with dementia, including Braak stage, Consortium to Establish a Registry for AD (CERAD score), Lewy bodies, hippocampal sclerosis, and microvascular brain injury, in addition to quantitative paired helical filament (PHF)-tau levels for people with and without each eye condition. We also evaluated interactions between eye conditions and dementia related neuropathologic findings were evaluated. RESULTS 676 autopsies were included. Diabetic retinopathy was significantly associated with increased risk of deep cerebral microinfarcts (OR = 1.91 [95% confidence interval (CI) 1.11, 3.27], p = 0.02). No other significant association or interaction between eye diseases and neuropathology was found. When PHF-tau quantity was evaluated in 124 decedents, the OR for the association between PHF-tau in the occipital cortex and glaucoma was 1.36 (95% CI 0.91, 2.03, p = 0.13). No statistical correction was made for multiple comparisons. CONCLUSION Increased risk of deep cerebral microinfarcts was found in participants diagnosed with diabetic retinopathy. Eye diseases such as glaucoma may increase susceptibility to neurofibrillary tangles in the occipital cortex.
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Affiliation(s)
- Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Laura E. Gibbons
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Caitlin S. Latimer
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Shannon E. Rose
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Leanne L. Hellstern
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - C. Dirk Keene
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Paul K. Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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12
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Edlow BL, Keene CD, Perl DP, Iacono D, Folkerth RD, Stewart W, Mac Donald CL, Augustinack J, Diaz-Arrastia R, Estrada C, Flannery E, Gordon WA, Grabowski TJ, Hansen K, Hoffman J, Kroenke C, Larson EB, Lee P, Mareyam A, McNab JA, McPhee J, Moreau AL, Renz A, Richmire K, Stevens A, Tang CY, Tirrell LS, Trittschuh EH, van der Kouwe A, Varjabedian A, Wald LL, Wu O, Yendiki A, Young L, Zöllei L, Fischl B, Crane PK, Dams-O'Connor K. Multimodal Characterization of the Late Effects of Traumatic Brain Injury: A Methodological Overview of the Late Effects of Traumatic Brain Injury Project. J Neurotrauma 2018; 35:1604-1619. [PMID: 29421973 DOI: 10.1089/neu.2017.5457] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Epidemiological studies suggest that a single moderate-to-severe traumatic brain injury (TBI) is associated with an increased risk of neurodegenerative disease, including Alzheimer's disease (AD) and Parkinson's disease (PD). Histopathological studies describe complex neurodegenerative pathologies in individuals exposed to single moderate-to-severe TBI or repetitive mild TBI, including chronic traumatic encephalopathy (CTE). However, the clinicopathological links between TBI and post-traumatic neurodegenerative diseases such as AD, PD, and CTE remain poorly understood. Here, we describe the methodology of the Late Effects of TBI (LETBI) study, whose goals are to characterize chronic post-traumatic neuropathology and to identify in vivo biomarkers of post-traumatic neurodegeneration. LETBI participants undergo extensive clinical evaluation using National Institutes of Health TBI Common Data Elements, proteomic and genomic analysis, structural and functional magnetic resonance imaging (MRI), and prospective consent for brain donation. Selected brain specimens undergo ultra-high resolution ex vivo MRI and histopathological evaluation including whole-mount analysis. Co-registration of ex vivo and in vivo MRI data enables identification of ex vivo lesions that were present during life. In vivo signatures of postmortem pathology are then correlated with cognitive and behavioral data to characterize the clinical phenotype(s) associated with pathological brain lesions. We illustrate the study methods and demonstrate proof of concept for this approach by reporting results from the first LETBI participant, who despite the presence of multiple in vivo and ex vivo pathoanatomic lesions had normal cognition and was functionally independent until her mid-80s. The LETBI project represents a multidisciplinary effort to characterize post-traumatic neuropathology and identify in vivo signatures of postmortem pathology in a prospective study.
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Affiliation(s)
- Brian L Edlow
- 1 Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.,2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - C Dirk Keene
- 3 Department of Pathology, University of Washington , Seattle, Washington
| | - Daniel P Perl
- 4 Brain Tissue Repository and Neuropathology Core, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Department of Pathology, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Diego Iacono
- 4 Brain Tissue Repository and Neuropathology Core, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Department of Pathology, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,6 Department of Neurology, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,7 The Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland
| | - Rebecca D Folkerth
- 8 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,9 City of New York Office of the Chief Medical Examiner and New York University School of Medicine , New York, New York
| | - William Stewart
- 10 Department of Neuropathology, Queen Elizabeth University Hospital and Institute of Neuroscience and Psychology, University of Glasgow , United Kingdom
| | | | - Jean Augustinack
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Ramon Diaz-Arrastia
- 12 Department of Neurology and Center for Brain Injury and Repair, Hospital of the University of Pennsylvania , Philadelphia
| | - Camilo Estrada
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Elissa Flannery
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Wayne A Gordon
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Thomas J Grabowski
- 15 Department of Neurology, University of Washington , Seattle, Washington.,16 Department of Radiology, University of Washington , Seattle, Washington
| | - Kelly Hansen
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Jeanne Hoffman
- 17 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Christopher Kroenke
- 18 Advanced Imaging Research Center, Oregon Health and Science University , Portland, Oregon
| | - Eric B Larson
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Patricia Lee
- 4 Brain Tissue Repository and Neuropathology Core, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,7 The Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland
| | - Azma Mareyam
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Jennifer A McNab
- 19 Department of Radiology, Stanford University , Stanford, California
| | - Jeanne McPhee
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Allison L Moreau
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Anne Renz
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - KatieRose Richmire
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Allison Stevens
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Cheuk Y Tang
- 20 Department of Radiology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Lee S Tirrell
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Emily H Trittschuh
- 21 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,22 Geriatric Research Education and Clinical Center , VA Puget Sound Health Care System, Seattle, Washington
| | - Andre van der Kouwe
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Ani Varjabedian
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Lawrence L Wald
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Ona Wu
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Anastasia Yendiki
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Liza Young
- 16 Department of Radiology, University of Washington , Seattle, Washington
| | - Lilla Zöllei
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Bruce Fischl
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Paul K Crane
- 23 Department of Medicine, University of Washington , Seattle, Washington
| | - Kristen Dams-O'Connor
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,24 Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, New York
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13
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Novel Treatment Strategies Using TiO 2 -Nanowired Delivery of Histaminergic Drugs and Antibodies to Tau With Cerebrolysin for Superior Neuroprotection in the Pathophysiology of Alzheimer's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 137:123-165. [DOI: 10.1016/bs.irn.2017.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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McNeal DW, Brandner DD, Gong X, Postupna NO, Montine TJ, Keene CD, Back SA. Unbiased Stereological Analysis of Reactive Astrogliosis to Estimate Age-Associated Cerebral White Matter Injury. J Neuropathol Exp Neurol 2016; 75:539-54. [PMID: 27142644 PMCID: PMC6250206 DOI: 10.1093/jnen/nlw032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 12/31/2022] Open
Abstract
Cerebral white matter injury (WMI) contributes to cognitive dysfunction associated with pathological aging. Because reactive astrocyte-related factors contribute to remyelination failure after WMI, we sought accurate, cost-effective, and reproducible histopathological approaches for quantification of morphometric features of reactive astrogliosis in aged human white matter in patients with vascular brain injury (VBI). We compared 7 distinct approaches to quantify the features of glial fibrillary acidic protein (GFAP)-labeled astrocytes in the prefrontal white matter of brains from patients with VBI (n = 17, mean age 88.8 years) and controls that did not exhibit VBI (n = 11, mean age 86.6 years). Only modern stereological techniques (ie, optical fractionator and spaceballs) and virtual process thickness measurements demonstrated significant changes in astrocyte number, process length, or proximal process thickness in cases with VBI relative to controls. The widely employed methods of neuropathological scoring, antibody capture assay (histelide), area fraction fractionator, and Cavalieri point counting failed to detect significant differences in GFAP expression between the groups. Unbiased stereological approaches and virtual thickness measurements provided the only sensitive and accurate means to quantify astrocyte reactivity as a surrogate marker of WMI in human brains with VBI.
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Affiliation(s)
- David W McNeal
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK).
| | - Dieter D Brandner
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK)
| | - Xi Gong
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK)
| | - Nadia O Postupna
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK)
| | - Thomas J Montine
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK)
| | - C Dirk Keene
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK)
| | - Stephen A Back
- From the Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (DWM, DDB, XG, SAB); Department of Neurology, Oregon Health & Science University, Portland, Oregon (SAB); and Department of Pathology, University of Washington, Seattle, Washington, District of Columbia (NOP, TJM, CDK)
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15
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Cholerton B, Larson EB, Quinn JF, Zabetian CP, Mata IF, Keene CD, Flanagan M, Crane PK, Grabowski TJ, Montine KS, Montine TJ. Precision Medicine: Clarity for the Complexity of Dementia. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 186:500-6. [PMID: 26724389 DOI: 10.1016/j.ajpath.2015.12.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/08/2015] [Accepted: 12/03/2015] [Indexed: 01/11/2023]
Abstract
Three key elements to precision medicine are stratification by risk, detection of pathophysiological processes as early as possible (even before clinical presentation), and alignment of mechanism of action of intervention(s) with an individual's molecular driver(s) of disease. Used for decades in the management of some rare diseases and now gaining broad currency in cancer care, a precision medicine approach is beginning to be adapted to cognitive impairment and dementia. This review focuses on the application of precision medicine to address the clinical and biological complexity of two common neurodegenerative causes of dementia: Alzheimer disease and Parkinson disease.
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Affiliation(s)
- Brenna Cholerton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Eric B Larson
- Group Health Research Institute, Seattle, Washington
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon
| | - Cyrus P Zabetian
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Parkinson's Disease Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Neurology, University of Washington, Seattle, Washington
| | - Ignacio F Mata
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Neurology, University of Washington, Seattle, Washington
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, Washington
| | - Margaret Flanagan
- Department of Pathology, University of Washington, Seattle, Washington
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, Washington
| | - Thomas J Grabowski
- Department of Neurology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington
| | | | - Thomas J Montine
- Department of Pathology, University of Washington, Seattle, Washington.
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16
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Multiplexed In-cell Immunoassay for Same-sample Protein Expression Profiling. Sci Rep 2015; 5:13651. [PMID: 26328896 PMCID: PMC4556981 DOI: 10.1038/srep13651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/03/2015] [Indexed: 12/15/2022] Open
Abstract
In-cell immunoassays have become a valuable tool for protein expression analysis complementary to established assay formats. However, comprehensive molecular characterization of individual specimens has proven challenging and impractical due to, in part, a singleplex nature of reporter enzymes and technical complexity of alternative assay formats. Herein, we describe a simple and robust methodology for multiplexed protein expression profiling on the same intact specimen, employing a well-characterized enzyme alkaline phosphatase for accurate quantification of all targets of interest, while overcoming fundamental limitations of enzyme-based techniques by implementing the DNA-programmed release mechanism for segregation of sub-sets of target-bound reporters. In essence, this methodology converts same-sample multi-target labeling into a set of isolated singleplex measurements performed in a parallel self-consistent fashion. For a proof-of-principle, multiplexed detection of three model proteins was demonstrated on cultured HeLa cells, and two clinically-relevant markers of dementia, β-amyloid and PHF-tau, were profiled in formalin-fixed paraffin embedded brain tissue sections, uncovering correlated increase in abundance of both markers in the “Alzheimer’s disease” cohort. Featuring an analytically powerful yet technically simple and robust methodology, multiplexed in-cell immunoassay is expected to enable insightful same-sample protein profiling studies and become broadly adopted in biomedical research and clinical diagnostics.
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17
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Cerebral cortical Aβ42 and PHF-τ in 325 consecutive brain autopsies stratified by diagnosis, location, and APOE. J Neuropathol Exp Neurol 2015; 74:100-9. [PMID: 25575135 DOI: 10.1097/nen.0000000000000153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We used a novel approach to molecular quantification in standard fixed and embedded tissue to measure amyloid β 42 (Aβ(42)) and paired helical filament-τ (PHF-τ) in frontal, temporal, and parietal cortices from 325 consecutive brain autopsies collected as part of a population-based study of brain aging and incident dementia in the Seattle area. We observed significant effects of APOE ε4 on Aβ(42) levels in both diagnostic groups by disease stage and region. In contrast, we did not observe a significant effect of APOE ε4 on PHF-τ levels by disease stage in any region. Levels of Aβ(42) and PHF-τ in cerebral cortex were correlated more strongly in the Dementia group, and these measures had independent explanatory power for dementia beyond those of standard neuropathologic indices. Associations between Lewy body disease and Aβ(42) or PHF-τ levels and between Aβ(42) levels and microvascular brain injury suggested that these comorbid diseases enhanced the penetrance of Alzheimer disease. Our novel approach brings additional insights into the molecular pathogenesis of common causes of dementia and may serve as a platform for future studies pursuing associations between molecular changes in Alzheimer disease and genetic or environmental risk.
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18
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Abstract
Alzheimer's disease/senile dementia of the Alzheimer type (AD/SDAT) is the most common neuropathologic substrate of dementia. It is characterized by synapse loss (predominantly within neocortex) as well as deposition of certain distinctive lesions (the result of protein misfolding) throughout the brain. The latter include senile plaques, composed mainly of an amyloid (Aβ) core and a neuritic component; neurofibrillary tangles, composed predominantly of hyperphosphorylated tau; and cerebral amyloid angiopathy, a microangiopathy affecting both cerebral cortical capillaries and arterioles and resulting from Aβ deposition within their walls or (in the case of capillaries) immediately adjacent brain parenchyma. In this article, I discuss the hypothesized role these lesions play in causing cerebral dysfunction, as well as CSF and neuroimaging biomarkers (for dementia) that are especially relevant as immunotherapeutic approaches are being developed to remove Aβ from the brain parenchyma. In addition, I address the role of neuropathology in characterizing the sequelae of new AD/SDAT therapies and helping to validate CSF and neuroimaging biomarkers of disease. Comorbidity of AD/SDAT and various types of cerebrovascular disease is a major theme in dementia research, especially as cognitive impairment develops in the oldest old, who are especially vulnerable to ischemic and hemorrhagic brain lesions.
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Affiliation(s)
- Harry V Vinters
- Department of Pathology and Laboratory Medicine (Neuropathology), UCLA Medical Center, Los Angeles, California 90095-1732;
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19
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Nabar NR, Yuan F, Lin X, Wang L, Bai G, Mayl J, Li Y, Zhou SF, Wang J, Cai J, Cao C. Cell therapy: a safe and efficacious therapeutic treatment for Alzheimer's disease in APP+PS1 mice. PLoS One 2012; 7:e49468. [PMID: 23226497 PMCID: PMC3513317 DOI: 10.1371/journal.pone.0049468] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/09/2012] [Indexed: 01/10/2023] Open
Abstract
Previously, our lab was the first to report the use of antigen-sensitized dendritic cells as a vaccine against Alzheimer's disease (AD). In preparation of this vaccine, we sensitized the isolated dendritic cells ex vivo with Aβ peptide, and administered these sensitized dendritic cells as a therapeutic agent. This form of cell therapy has had success in preventing and/or slowing the rate of cognitive decline when administered prior to the appearance of Aβ plaques in PDAPP mice, but has not been tested in 2 × Tg models. Herein, we test the efficacy and safety of this vaccine in halting and reversing Alzheimer's pathology in 9-month-old APP + PS1 mice. The results showed that administration of this vaccine elicits a long-lasting antibody titer, which correlated well with a reduction of Aβ burden upon histological analysis. Cognitive function in transgenic responders to the vaccine was rescued to levels similar to those found in non-transgenic mice, indicating that the vaccine is capable of providing therapeutic benefit in APP+PS1 mice when administered after the onset of AD pathology. The vaccine also shows indications of circumventing past safety problems observed in AD immunotherapy, as Th1 pro-inflammatory cytokines were not elevated after long-term vaccine administration. Moreover, microhemorrhaging and T-cell infiltration into the brain are not observed in any of the treated subjects. All in all, this vaccine has many advantages over contemporary vaccines against Alzheimer's disease, and may lead to a viable treatment for the disease in the future.
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Affiliation(s)
- Neel R. Nabar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, Florida, United States of America
- USF-Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, Florida, United States of America
| | - Fang Yuan
- Chinese People Liberty Army General Hospital, Beijing, China
- Third Military Medical University, Chongqing, China
| | - Xiaoyang Lin
- USF-Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, Florida, United States of America
| | - Li Wang
- USF-Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, Florida, United States of America
| | - Ge Bai
- Department of Chemistry, University of South Florida, Tampa, Florida, United States of America
| | - Jonathan Mayl
- USF-Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, Florida, United States of America
| | - Yaqiong Li
- Department of Chemistry, University of South Florida, Tampa, Florida, United States of America
| | - Shu-Feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, Florida, United States of America
| | | | - Jianfeng Cai
- Department of Chemistry, University of South Florida, Tampa, Florida, United States of America
| | - Chuanhai Cao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, Florida, United States of America
- USF-Health Byrd Alzheimer’s Institute, University of South Florida, Tampa, Florida, United States of America
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Luo Z, Li J, Nabar NR, Lin X, Bai G, Cai J, Zhou SF, Cao C, Wang J. Efficacy of a therapeutic vaccine using mutated β-amyloid sensitized dendritic cells in Alzheimer's mice. J Neuroimmune Pharmacol 2012; 7:640-55. [PMID: 22684353 DOI: 10.1007/s11481-012-9371-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/17/2012] [Indexed: 01/12/2023]
Abstract
Despite FDA suspension of Elan's AN-1792 amyloid beta (Aβ) vaccine in phase IIb clinical trials, the implications of this study are the guiding principles for contemporary anti-Aβ immunotherapy against Alzheimer's disease (AD). AN-1792 showed promising results with regards to Aβ clearance and cognitive function improvement, but also exhibited an increased risk of Th1 mediated meningoencephalitis. As such, vaccine development has continued with an emphasis on eliciting a notable anti-Aβ antibody titer, while avoiding the unwanted Th1 pro-inflammatory response. Previously, we published the first report of an Aβ sensitized dendritic cell vaccine as a therapeutic treatment for AD in BALB/c mice. Our vaccine elicited an anti-Aβ titer, with indications that a Th1 response was not present. This study is the first to investigate the efficacy and safety of our dendritic cell vaccine for the prevention of AD in transgenic mouse models (PDAPP) for AD. We also used Immunohistochemistry to characterize the involvement of LXR, ABCA1, and CD45 in order to gain insight into the potential mechanisms through which this vaccine may provide benefit. The results indicate that (1) the use of mutant Aβ1-42 sensitized dendritic cell vaccine results in durable antibody production, (2) the vaccine provides significant benefits with regards to cognitive function without the global (Th1) inflammation seen in prior Aβ vaccines, (3) histological studies showed an overall decrease in Aβ burden, with an increase in LXR, ABCA1, and CD45, and (4) the beneficial results of our DC vaccine may be due to the LXR/ABCA1 pathway. In the future, mutant Aβ sensitized dendritic cell vaccines could be an efficacious and safe method for the prevention or treatment of AD that circumvents problems associated with traditional anti-Aβ vaccines.
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Affiliation(s)
- Zhongqiu Luo
- Department of Neurosurgery, Tianjin First Center Hospital, Tianjin, China
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Jellinger KA. Interaction between pathogenic proteins in neurodegenerative disorders. J Cell Mol Med 2012; 16:1166-83. [PMID: 22176890 PMCID: PMC3823071 DOI: 10.1111/j.1582-4934.2011.01507.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/16/2011] [Indexed: 12/21/2022] Open
Abstract
The misfolding and progressive aggregation of specific proteins in selective regions of the nervous system is a seminal occurrence in many neurodegenerative disorders, and the interaction between pathological/toxic proteins to cause neurodegeneration is a hot topic of current neuroscience research. Despite clinical, genetic and experimental differences, increasing evidence indicates considerable overlap between synucleinopathies, tauopathies and other protein-misfolding diseases. Inclusions, often characteristic hallmarks of these disorders, suggest interactions of pathological proteins enganging common downstream pathways. Novel findings that have shifted our understanding in the role of pathologic proteins in the pathogenesis of Alzheimer, Parkinson, Huntington and prion diseases, have confirmed correlations/overlaps between these and other neurodegenerative disorders. Emerging evidence, in addition to synergistic effects of tau protein, amyloid-β, α-synuclein and other pathologic proteins, suggests that prion-like induction and spreading, involving secreted proteins, are major pathogenic mechanisms in various neurodegenerative diseases, depending on genetic backgrounds and environmental factors. The elucidation of the basic molecular mechanisms underlying the interaction and spreading of pathogenic proteins, suggesting a dualism or triad of neurodegeneration in protein-misfolding disorders, is a major challenge for modern neuroscience, to provide a deeper insight into their pathogenesis as a basis of effective diagnosis and treatment.
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