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Picard K, Dolhan K, Watters JJ, Tremblay MÈ. Microglia and Sleep Disorders. ADVANCES IN NEUROBIOLOGY 2024; 37:357-377. [PMID: 39207702 DOI: 10.1007/978-3-031-55529-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Sleep is a physiological state that is essential for maintaining physical and mental health. Sleep disorders and sleep deprivation therefore have many adverse effects, including an increased risk of metabolic diseases and a decline in cognitive function that may be implicated in the long-term development of neurodegenerative diseases. There is increasing evidence that microglia, the resident immune cells of the central nervous system (CNS), are involved in regulating the sleep-wake cycle and the CNS response to sleep alteration and deprivation. In this chapter, we will discuss the involvement of microglia in various sleep disorders, including sleep-disordered breathing, insomnia, narcolepsy, myalgic encephalomyelitis/chronic fatigue syndrome, and idiopathic rapid-eye-movement sleep behavior disorder. We will also explore the impact of acute and chronic sleep deprivation on microglial functions. Moreover, we will look into the potential involvement of microglia in sleep disorders as a comorbidity to Alzheimer's disease and Parkinson's disease.
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Affiliation(s)
- Katherine Picard
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada
- Département de Médecine Moléculaire, Université Laval, Québec, QC, Canada
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Kira Dolhan
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Department of Psychology, University of Victoria, Victoria, BC, Canada
- Department of Biology, University of Victoria, Victoria, BC, Canada
| | - Jyoti J Watters
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI, USA
| | - Marie-Ève Tremblay
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada.
- Département de Médecine Moléculaire, Université Laval, Québec, QC, Canada.
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
- Department of Biochemistry and Molecular Biology, The University of British Columbia, Vancouver, BC, Canada.
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada.
- Institute on Aging and Lifelong Health (IALH), University of Victoria, Victoria, BC, Canada.
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Xie K, Chen Y, Chu M, Cui Y, Chen Z, Zhang J, Liu L, Jing D, Cui C, Liang Z, Ren L, Rosa-Neto P, Ghorayeb I, Zhang Z, Wu L. Specific structuro-metabolic pattern of thalamic subnuclei in fatal familial insomnia: A PET/MRI imaging study. Neuroimage Clin 2022; 34:103026. [PMID: 35504222 PMCID: PMC9065920 DOI: 10.1016/j.nicl.2022.103026] [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] [Received: 01/04/2022] [Revised: 03/31/2022] [Accepted: 04/24/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Dysfunction of the thalamus has been proposed as a core mechanism of fatal familial insomnia. However, detailed metabolic and structural alterations in thalamic subnuclei are not well documented. We aimed to address the multimodal structuro-metabolic pattern at the level of the thalamic nuclei in fatal familial insomnia patients, and investigated the clinical presentation of primary thalamic alterations. MATERIALS AND METHODS Five fatal familial insomnia patients and 10 healthy controls were enrolled in this study. All participants underwent neuropsychological assessments, polysomnography, electroencephalogram, and cerebrospinal fluid tests. MRI and fluorodeoxyglucose PET were acquired on a hybrid PET/MRI system. Structural and metabolic changes were compared using voxel-based morphometry analyses and standardized uptake value ratio analyses, focusing on thalamic subnuclei region of interest analyses. Correlation analysis was conducted between gray matter volume and metabolic decrease ratios, and clinical features. RESULTS The whole-brain analysis showed that gray matter volume decline was confined to the bilateral thalamus and right middle temporal pole in fatal familial insomnia patients, whereas hypometabolism was observed in the bilateral thalamus, basal ganglia, and widespread cortices, mainly in the forebrain. In the regions of interest analysis, gray matter volume and metabolism decreases were prominent in bilateral medial dorsal nuclei, anterior nuclei, and the pulvinar, which is consistent with neuropathological and clinical findings. A positive correlation was found between gray matter volume and metabolic decrease ratios. CONCLUSIONS Our study revealed specific structuro-metabolic pattern of fatal familial insomnia that demonstrated the essential roles of medial dorsal nuclei, anterior nuclei, and pulvinar, which may be a potential biomarker in diagnosis. Also, primary thalamic subnuclei alterations may be correlated with insomnia, neuropsychiatric, and autonomic symptoms sparing primary cortical involvement.
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Affiliation(s)
- Kexin Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Min Chu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yue Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Li Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Department of Neurology, Shenyang Fifth People Hospital, Shenyang, Liaoning 110023, China
| | - Donglai Jing
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Department of Neurology, Rongcheng People's Hospital, Baoding, Hebei 071700, China
| | - Chunlei Cui
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhigang Liang
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Pedro Rosa-Neto
- McGill University Research Centre for Studies in Aging, Montreal, QC H3G 1Y6, Canada
| | - Imad Ghorayeb
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, F-33076 Bordeaux, France; CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, F-33076 Bordeaux, France; Département de Neurophysiologie Clinique, Pôle Neurosciences Cliniques, CHU de Bordeaux, F-33076 Bordeaux, France
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China.
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Clinical Research Center for Geriatric Diseases, Beijing 100053, China.
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Zhang J, Chu M, Tian Z, Xie K, Cui Y, Liu L, Meng J, Yan H, Ji YM, Jiang Z, Xia TX, Wang D, Wang X, Zhao Y, Ye H, Li J, Wang L, Wu L. Clinical profile of fatal familial insomnia: phenotypic variation in 129 polymorphisms and geographical regions. J Neurol Neurosurg Psychiatry 2022; 93:291-297. [PMID: 34667102 PMCID: PMC8862016 DOI: 10.1136/jnnp-2021-327247] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Elucidate the core clinical and genetic characteristics and identify the phenotypic variation between different regions and genotypes of fatal familial insomnia (FFI). METHODS A worldwide large sample of FFI patients from our case series and literature review diagnosed by genetic testing were collected. The prevalence of clinical symptoms and genetic profile were obtained, and then the phenotypic comparison between Asians versus non-Asians and 129Met/Met versus 129Met/Val were conducted. RESULTS In total, 131 cases were identified. The age of onset was 47.51±12.53 (range 17-76) years, 106 patients died and disease duration was 13.20±9.04 (range 2-48) months. Insomnia (87.0%) and rapidly progressive dementia (RPD; 83.2%) occurred with the highest frequency. Hypertension (33.6%) was considered to be an objective indicator of autonomic dysfunction. Genotype frequency at codon 129 was Met/Met (84.7%) and Met/Val (15.3%), and allele frequency was Met (92.4%) and Val (7.6%).129 Met was a risk factor (OR: 3.728, 95% CI: 2.194 to 6.333, p=0.000) for FFI in the non-Asian population. Comparison of Asians and non-Asians revealed clinical symptoms and genetic background to show some differences (p<0.05). In the comparison of 129 polymorphisms, a longer disease duration was found in the 129 MV group, with alleviation of some clinical symptoms (p<0.05). After considering survival probability, significant differences in survival time between genotypes remained (p<0.0001). CONCLUSIONS Insomnia, RPD and hypertension are representative key clinical presentations of FFI. Phenotypic variations in genotypes and geographic regions were documented. Prion protein gene 129 Met was considered to be a risk factor for FFI in the non-Asian population, and 129 polymorphisms could modify survival duration.
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Affiliation(s)
- Jing Zhang
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Min Chu
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - ZiChen Tian
- Department of Biology, Carleton College, Northfield, Minnesota, USA
| | - KeXin Xie
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Yue Cui
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Li Liu
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - JiaLi Meng
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - HaiHan Yan
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Yang-Mingyue Ji
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Zhuyi Jiang
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Tian-Xinyu Xia
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Dongxin Wang
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Xin Wang
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Beijing Huairou Hospital of Traditional Chinese Medicine, Beijing, People's Republic of China
| | - Ye Zhao
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Jilin Neuropsychiatric Hospital, Jilin, People's Republic of China
| | - Hong Ye
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Junjie Li
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Lin Wang
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
| | - Liyong Wu
- Department of Neurology, Xuanwu hospital,Capital Medical University, Beijing, People's Republic of China
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Phenotypic diversity of genetic Creutzfeldt-Jakob disease: a histo-molecular-based classification. Acta Neuropathol 2021; 142:707-728. [PMID: 34324063 PMCID: PMC8423680 DOI: 10.1007/s00401-021-02350-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/04/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023]
Abstract
The current classification of sporadic Creutzfeldt–Jakob disease (sCJD) includes six major clinicopathological subtypes defined by the physicochemical properties of the protease-resistant core of the pathologic prion protein (PrPSc), defining two major PrPSc types (i.e., 1 and 2), and the methionine (M)/valine (V) polymorphic codon 129 of the prion protein gene (PRNP). How these sCJD subtypes relate to the well-documented phenotypic heterogeneity of genetic CJD (gCJD) is not fully understood. We analyzed molecular and phenotypic features in 208 individuals affected by gCJD, carrying 17 different mutations, and compared them with those of a large series of sCJD cases. We identified six major groups of gCJD based on the combination PrPSc type and codon 129 genotype on PRNP mutated allele, each showing distinctive histopathological characteristics, irrespectively of the PRNP associated mutation. Five gCJD groups, named M1, M2C, M2T, V1, and V2, largely reproduced those previously described in sCJD subtypes. The sixth group shared phenotypic traits with the V2 group and was only detected in patients carrying the E200K-129M haplotype in association with a PrPSc type of intermediate size (“i”) between type 1 and type 2. Additional mutation-specific effects involved the pattern of PrP deposition (e.g., a “thickened” synaptic pattern in E200K carriers, cerebellar “stripe-like linear granular deposits” in those with insertion mutations, and intraneuronal globular dots in E200K-V2 or -M”i”). A few isolated cases linked to rare PRNP haplotypes (e.g., T183A-129M), showed atypical phenotypic features, which prevented their classification into the six major groups. The phenotypic variability of gCJD is mostly consistent with that previously found in sCJD. As in sCJD, the codon 129 genotype and physicochemical properties of PrPSc significantly correlated with the phenotypic variability of gCJD. The most common mutations linked to CJD appear to have a variable and overall less significant effect on the disease phenotype, but they significantly influence disease susceptibility often in a strain-specific manner. The criteria currently used for sCJD subtypes can be expanded and adapted to gCJD to provide an updated classification of the disease with a molecular basis.
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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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Takeuchi A, Mohri S, Kai H, Tamaoka A, Kobayashi A, Mizusawa H, Iwasaki Y, Yoshida M, Shimizu H, Murayama S, Kuroda S, Morita M, Parchi P, Kitamoto T. Two distinct prions in fatal familial insomnia and its sporadic form. Brain Commun 2019; 1:fcz045. [PMID: 32954274 PMCID: PMC7425372 DOI: 10.1093/braincomms/fcz045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 11/12/2022] Open
Abstract
Fatal familial insomnia is a genetic prion disease, which is associated with the aspartic acid to asparagine substitution at codon 178 of the prion protein gene. Although the hallmark pathological feature is thalamic and olivary degeneration, there is a patient with an atypical fatal familial insomnia without the hallmark feature. The cause of the pathological variability is unclear. We analysed a Japanese fatal familial insomnia kindred and compared one atypical clinicopathological fatal familial insomnia phenotype case and typical fatal familial insomnia phenotype cases with transmission studies using multiple lines of knock-in mice and with protein misfolding cyclic amplification. We also analysed the transmissibility and the amplification properties of sporadic fatal insomnia. Transmission studies revealed that the typical fatal familial insomnia with thalamic and olivary degeneration showed successful transmission only using knock-in mice expressing human-mouse chimeric prion protein gene. The atypical fatal familial insomnia with spongiform changes showed successful transmission only using knock-in mice expressing bank vole prion protein gene. Two sporadic fatal insomnia cases with thalamic and olivary degeneration showed the same transmissibility as the typical fatal familial insomnia phenotype. Interestingly, one sporadic fatal insomnia case with thalamic/olivary degeneration and spongiform changes showed transmissibility of both the typical and atypical fatal familial insomnia phenotypes. Protein misfolding cyclic amplification could amplify both typical fatal familial insomnia cases and sporadic fatal insomnia cases but not the atypical fatal familial insomnia phenotype or other sporadic Creutzfeldt-Jakob disease subtypes. In addition to clinical findings and neuropathological features, the transmission properties and the amplification properties were different between the typical and atypical fatal familial insomnia phenotypes. It is suggested that two distinct prions were associated with the diversity in the fatal familial insomnia phenotype, and these two prions could also be detected in sporadic fatal insomnia.
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Affiliation(s)
- Atsuko Takeuchi
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Shirou Mohri
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Hideaki Kai
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Akira Tamaoka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Atsushi Kobayashi
- Laboratory of Comparative Pathology, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
| | - Hidehiro Mizusawa
- The National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 102-0076, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Hiroshi Shimizu
- Department of Pathology, Brain Research Institute, University of Niigata, Niigata 951-8585, Japan
| | - Shigeo Murayama
- Department of Neurology and Neuropathology (The Brain Bank for Aging Research), Tokyo 173-0015, Japan
| | | | - Masanori Morita
- Research and Development Division, Japan Blood Products Organization, Kobe 650-0047, Japan
| | - Piero Parchi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna 40126, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna 40123, Italy
| | - Tetsuyuki Kitamoto
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
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Abstract
Throughout evolution the frontal lobes have progressively acquired a central role in most aspects of cognition and behavior. In humans, frontal lobe functions are conditional on the development of an intricate set of short- and long-range connections that guarantee direct access to sensory information and control over regions dedicated to planning and motor execution. Here the frontal cortical anatomy and the major connections that constitute the local and extended frontal connectivity are reviewed in the context of diffusion tractography studies, contemporary models of frontal lobe functions, and clinical syndromes. A particular focus of this chapter is the use of comparative anatomy and neurodevelopmental data to address the question of how frontal networks evolved and what this signified for unique human abilities.
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Affiliation(s)
- Marco Catani
- NatBrainLab, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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Abstract
AIMS To determine the association between the sleep duration and the risk of all-cause mortality in adults. METHODS A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. Cohort studies were included without language, time or setting restrictions. The risk of bias was evaluated with a modified Cochrane Collaboration's tool. An analysis of random effects was conducted. The primary outcome was all-cause mortality. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned comparisons were 7-9 h of sleep v. <7 h and the same reference v. >9 h. RESULTS Thirty-nine studies were included in our qualitative analysis, regarding the quantitative analysis, 19 studies were included in <7 v. 7-9 h analysis, and 18 studies in the >9 v. 7-9 h. A low risk of bias was shown for most of the study items. The overall RD for all-cause mortality was 0.09 (95% CI 0.07-0.11) favouring the >9 h group compared with our reference. In contrast, no differences were found between the <7 h and the reference sleep duration groups (RD 0.00, 95% CI 0.00-0.01). CONCLUSION We found a probable association of long sleep duration and higher mortality; however, it could reflect an underlying systemic or neurological disease that cause sleep fragmentation, deterioration in quality and micro-awakenings.
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He R, Hu Y, Yao L, Tian Y, Zhou Y, Yi F, Zhou L, Xu H, Sun Q. Clinical features and genetic characteristics of two Chinese pedigrees with fatal family insomnia. Prion 2019; 13:116-123. [PMID: 31122137 PMCID: PMC6629183 DOI: 10.1080/19336896.2019.1617027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Fatal familial insomnia (FFI) is a rare autosomal-dominant inherited prion disease characterized clinically by severe sleep disorder, motor signs, dysautonomia and abnormal behaviour. FFI is caused by a missense mutation at codon 178 of the prion protein gene (PRNP). Our study is aimed to explore typical clinical and genetic features of two Chinese pedigrees with FFI and review the related literatures. Methods: Two FFI cases with family histories were recruited in our study. The main clinical features, genetic features and possible pathophysiologic mechanisms of these two FFI cases were analysed. Results: The foremost symptoms seemed to be sleep disturbances and psychosis. Progressive sympathetic symptoms, movement disturbances and memory loss were frequently observed as well. Electroencephalography (EEG) showed a minor slowing without periodic triphasic waves. Polysomnography (PSG) showed reduction in total sleep time and disturbance of sleep-related respiratory. Brain magnetic resonance imaging (MRI) did not reveal obvious abnormality. Genetic analysis disclosed the prion protein gene mutation at codon 178 (D178N), with methionine (Met) homozygosity at the polymorphic position 129 (Met129Met). Conclusions: The major clinical features of Chinese FFI are sleep dysfunction, psychiatric symptoms and sympathetic symptoms. Our patients have similar clinical characteristics as that of the typical FFI cases.
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Affiliation(s)
- Runcheng He
- a Department of Neurology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China
| | - Yacen Hu
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Lingyan Yao
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Yun Tian
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Yafang Zhou
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Fang Yi
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Lin Zhou
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Hongwei Xu
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
| | - Qiying Sun
- b National Clinical Research Center for Geriatric Disorders , Changsha , Hunan , China.,c Department of Geriatrics , Xiangya Hospital, Central South University , Changsha , China
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Baldelli L, Provini F. Fatal familial insomnia and Agrypnia Excitata: Autonomic dysfunctions and pathophysiological implications. Auton Neurosci 2019; 218:68-86. [PMID: 30890351 DOI: 10.1016/j.autneu.2019.02.007] [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] [Received: 01/16/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 01/26/2023]
Abstract
Fatal Familial Insomnia (FFI) is a hereditary prion disease caused by a mutation at codon 178 of the prion-protein gene leading to a D178N substitution in the protein determining severe and selective atrophy of mediodorsal and anteroventral thalamic nuclei. FFI is characterized by physiological sleep loss, which polygraphically appears to be a slow wave sleep loss, autonomic and motor hyperactivation with peculiar episodes of oneiric stupor. Alteration of autonomic functions is a great burden for FFI patients consisting in sympathetic overactivation, dysregulation of its physiological responses and disruption of circadian rhythms. The cardiovascular system is the most frequently and severely affected confirming the increased sympathetic drive with preserved parasympathetic responses. Sleep loss, autonomic and motor hyperactivation define Agrypnia Excitata (AE), which is not exclusive to FFI, but it has been canonically described also in Morvan Syndrome and Delirium Tremens. These three conditions present different pathophysiological mechanisms but share the same thalamo-limbic impairment of which AE is one of the possible clinical presentations. FFI, and consequently also AE, is a model for the investigation of the essential role of the thalamus in the organization of body homeostasis, integrating both sleep and autonomic function control.
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Affiliation(s)
- Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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Weininger J, Roman E, Tierney P, Barry D, Gallagher H, Murphy P, Levins KJ, O’Keane V, O’Hanlon E, Roddy DW. Papez's Forgotten Tract: 80 Years of Unreconciled Findings Concerning the Thalamocingulate Tract. Front Neuroanat 2019; 13:14. [PMID: 30833890 PMCID: PMC6388660 DOI: 10.3389/fnana.2019.00014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
The thalamocingulate tract is a key component of the Papez circuit that connects the anterior thalamic nucleus (ATN) to the cingulum bundle. While the other white matter connections, consisting of the fornix, cingulum bundle and mammillothalamic tract, were well defined in Papez's original 1937 paper, the anatomy of the thalamocingulate pathway was mentioned only in passing. Subsequent research has been unable to clarify the precise anatomical trajectory of this tract. In particular, the site of thalamocingulate tract interactions with the cingulum bundle have been inconsistently reported. This review aims to synthesize research on this least studied component of the Papez circuit. A systemic approach to reviewing historical anatomical dissection and neuronal tracing studies as well as contemporary diffusion magnetic resonance imaging studies of the thalamocingulate tract was undertaken across species. We found that although inconsistent, prior research broadly encompasses two differing descriptions of how the ATN interfaces with the cingulum after passing laterally through the anterior limb of the internal capsule. The first group of studies show that the pathway turns medially and rostrally and passes to the anterior cingulate region (Brodmann areas 24, 33, and 32) only. A second group suggests that the thalamocingulate tract interfaces with both the anterior and posterior cingulate (Brodmann areas 23 and 31) and retrosplenial region (Brodmann area 29). We discuss potential reasons for these discrepancies such as altering methodologies and species differences. We also discuss how these inconsistencies may be resolved in further research with refinements of terminology for the cingulate cortex and the thalamocingulate tract. Understanding the precise anatomical course of the last remaining unresolved final white matter tract in the Papez circuit may facilitate accurate investigation of the role of the complete Papez circuit in emotion and memory.
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Affiliation(s)
- Joshua Weininger
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Elena Roman
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Paul Tierney
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Denis Barry
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Hugh Gallagher
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin, Ireland
| | - Paul Murphy
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin, Ireland
| | - Kirk J. Levins
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin, Ireland
| | - Veronica O’Keane
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Erik O’Hanlon
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Darren W. Roddy
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- Department of Physiology, School of Medicine, University College Dublin, Dublin, Ireland
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12
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Forloni G, Chiesa R, Bugiani O, Salmona M, Tagliavini F. Review: PrP 106-126 - 25 years after. Neuropathol Appl Neurobiol 2019; 45:430-440. [PMID: 30635947 DOI: 10.1111/nan.12538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022]
Abstract
A quarter of a century ago, we proposed an innovative approach to study the pathogenesis of prion disease, one of the most intriguing biomedical problems that remains unresolved. The synthesis of a peptide homologous to residues 106-126 of the human prion protein (PrP106-126), a sequence present in the PrP amyloid protein of Gerstmann-Sträussler-Scheinker syndrome patients, provided a tractable tool for investigating the mechanisms of neurotoxicity. Together with several other discoveries at the beginning of the 1990s, PrP106-126 contributed to underpin the role of amyloid in the pathogenesis of protein-misfolding neurodegenerative disorders. Later, the role of oligomers on one hand and of prion-like spreading of pathology on the other further clarified mechanisms shared by different neurodegenerative conditions. Our original report on PrP106-126 neurotoxicity also highlighted a role for programmed cell death in CNS diseases. In this review, we analyse the prion research context in which PrP106-126 first appeared and the advances in our understanding of prion disease pathogenesis and therapeutic perspectives 25 years later.
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Affiliation(s)
- G Forloni
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - R Chiesa
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - O Bugiani
- Department of Biochemistry, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - M Salmona
- Department of Biochemistry, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - F Tagliavini
- Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milano, Italy
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13
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Wu LY, Zhan SQ, Huang ZY, Zhang B, Wang T, Liu CF, Lu H, Dong XP, Wu ZY, Zhang JW, Zhang JH, Zhao ZX, Han F, Huang Y, Lu J, Gauthier S, Jia JP, Wang YP. Expert Consensus on Clinical Diagnostic Criteria for Fatal Familial Insomnia. Chin Med J (Engl) 2018; 131:1613-1617. [PMID: 29941716 PMCID: PMC6032681 DOI: 10.4103/0366-6999.235115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Li-Yong Wu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Shu-Qin Zhan
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhao-Yang Huang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Chun-Feng Liu
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Hui Lu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiao-Ping Dong
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Jie-Wen Zhang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
| | - Ji-Hui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR 000000, China
| | - Zhong-Xin Zhao
- Department of Neurology, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun Lu
- Department of Neurology, Program in Neuroscience and Division of Sleep Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston 02215, MA, USA
| | - Serge Gauthier
- McGill Centre for Studies in Aging, Alzheimer's Disease Research Unit, Montreal H4H 1R3, Canada
| | - Jian-Ping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Yu-Ping Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
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14
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Abstract
Fatal familial insomnia (FFI) and sporadic fatal insomnia (sFI), or thalamic form of sporadic Creutzfeldt-Jakob disease MM2 (sCJDMM2T), are prion diseases originally named and characterized in 1992 and 1999, respectively. FFI is genetically determined and linked to a D178N mutation coupled with the M129 genotype in the prion protein gene (PRNP) at chromosome 20. sFI is a phenocopy of FFI and likely its sporadic form. Both diseases are primarily characterized by progressive sleep impairment, disturbances of autonomic nervous system, and motor signs associated with severe loss of nerve cells in medial thalamic nuclei. Both diseases harbor an abnormal disease-associated prion protein isoform, resistant to proteases with relative mass of 19 kDa identified as resPrPTSE type 2. To date at least 70 kindreds affected by FFI with 198 members and 18 unrelated carriers along with 25 typical cases of sFI have been published. The D178N-129M mutation is thought to cause FFI by destabilizing the mutated prion protein and facilitating its conversion to PrPTSE. The thalamus is the brain region first affected. A similar mechanism triggered spontaneously may underlie sFI.
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15
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Llorens F, Zarranz JJ, Fischer A, Zerr I, Ferrer I. Fatal Familial Insomnia: Clinical Aspects and Molecular Alterations. Curr Neurol Neurosci Rep 2017; 17:30. [PMID: 28324299 DOI: 10.1007/s11910-017-0743-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
PURPOSE OF REVIEW Fatal familiar insomnia (FFI) is an autosomal dominant inherited prion disease caused by D178N mutation in the prion protein gene (PRNP D178N) accompanied by the presence of a methionine at the codon 129 polymorphic site on the mutated allele. FFI is characterized by severe sleep disorder, dysautonomia, motor signs and abnormal behaviour together with primary atrophy of selected thalamic nuclei and inferior olives, and expansion to other brain regions with disease progression. This article reviews recent research on the clinical and molecular aspects of the disease. RECENT FINDINGS New clinical and biomarker tools have been implemented in order to assist in the diagnosis of the disease. In addition, the generation of mouse models, the availability of 'omics' data in brain tissue and the use of new seeding techniques shed light on the molecular events in FFI pathogenesis. Biochemical studies in human samples also reveal that neuropathological alterations in vulnerable brain regions underlie severe impairment in key cellular processes such as mitochondrial and protein synthesis machinery. Although the development of a therapy is still a major challenge, recent findings represent a step toward understanding of the clinical and molecular aspects of FFI.
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Affiliation(s)
- Franc Llorens
- Department of Neurology, Clinical Dementia Center, University Medical Center, Georg-August University, Robert Koch Strasse 40, Göttingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen, Germany.
| | - Juan-José Zarranz
- Neurology Department, University Hospital Cruces, University of the Basque Country, Bilbao, Bizkaia, Spain
| | - Andre Fischer
- German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center, University Medical Center, Georg-August University, Robert Koch Strasse 40, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen, Germany
| | - Isidro Ferrer
- Institute of Neuropathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/Feixa Llarga sn, 08907, Barcelona, Spain. .,University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. .,CIBERNED (Network Centre for Biomedical Research of Neurodegenerative Diseases), Institute Carlos III, Ministry of Health, Madrid, Spain.
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16
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Eberhardt O, Topka H. Myoclonic Disorders. Brain Sci 2017; 7:E103. [PMID: 28805718 PMCID: PMC5575623 DOI: 10.3390/brainsci7080103] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/06/2017] [Accepted: 08/08/2017] [Indexed: 01/17/2023] Open
Abstract
Few movement disorders seem to make a straightforward approach to diagnosis and treatment more difficult and frustrating than myoclonus, due to its plethora of causes and its variable classifications. Nevertheless, in recent years, exciting advances have been made in the elucidation of the pathophysiology and genetic basis of many disorders presenting with myoclonus. Here, we provide a review of all of the important types of myoclonus encountered in pediatric and adult neurology, with an emphasis on the recent developments that have led to a deeper understanding of this intriguing phenomenon. An up-to-date list of the genetic basis of all major myoclonic disorders is presented. Randomized studies are scarce in myoclonus therapy, but helpful pragmatic approaches at diagnosis as well as treatment have been recently suggested.
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Affiliation(s)
- Olaf Eberhardt
- Klinik für Neurologie, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Englschalkinger Str. 77, 81925 München, Germany.
| | - Helge Topka
- Klinik für Neurologie, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Englschalkinger Str. 77, 81925 München, Germany.
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17
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Clinical Features and Sleep Analysis of Chinese Patients with Fatal Familial Insomnia. Sci Rep 2017; 7:3625. [PMID: 28620158 PMCID: PMC5472586 DOI: 10.1038/s41598-017-03817-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/05/2017] [Indexed: 11/08/2022] Open
Abstract
This study aimed to examine clinical features, sleep, abnormal sleep-wake transition and non-sleep disturbances as well as lab tests in Chinese fatal familial insomnia (FFI) subjects. Patients with confirmed clinical and laboratory diagnosis of FFI have been retrospectively reviewed. The clinical features and the results of the complementary tests, including polysomnography (PSG), brain imaging and genetic analysis, were used. Two male and three female patients were recruited in this study. Three of the five patients had more comprehensive family medical records. The most typical clinical manifestations in all 5 patients were sleep disturbances, including insomnia, laryngeal stridor, sleep breath disturbance, and sleep-related involuntary movements. PSG of all these five cases showed reduction in total sleep time, sleep fragmentation, abnormal short non-rapid eye movement - rapid eye movement (REM) cycling, REM sleep reduction or loss, and REM sleep instruction in wakefulness. Patient 2's emission tomography scan demonstrated a reduction in glucose uptake in the left thalamus and bilateral inferior parietal lobe. In summary, Chinese FFI patients are typically characterized by organic sleep related symptoms, rapidly progressive dementia and sympathetic symptoms. We propose that structural damages in the thalamus and cortex are mostly responsible for clinical manifestations of FFI.
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18
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Frau-Méndez MA, Fernández-Vega I, Ansoleaga B, Blanco Tech R, Carmona Tech M, Antonio Del Rio J, Zerr I, Llorens F, José Zarranz J, Ferrer I. Fatal familial insomnia: mitochondrial and protein synthesis machinery decline in the mediodorsal thalamus. Brain Pathol 2016; 27:95-106. [PMID: 27338255 DOI: 10.1111/bpa.12408] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022] Open
Abstract
The expression of subunits of mitochondrial respiratory complexes and components of the protein synthesis machinery from the nucleolus to the ribosome was analyzed in the mediodorsal thalamus in seven cases of fatal familial insomnia (FFI) compared with age-matched controls. NDUFB8 (complex I subunit), SDHB (complex II subunit), UQCRC2 (complex III subunit), COX2 (complex IV subunit), and ATP50 (complex V subunit) expression levels, as revealed by western blotting, were reduced in FFI. Voltage-dependent anion channel (VDAC) and ATP5H were also reduced due to the marked depopulation of neurons. In contrast, a marked increase in superoxide dismutase 2 (SOD2) was found in reactive astrocytes thus suggesting that astrocytes are key factors in oxidative stress responses. The histone-binding chaperones nucleolin and nucleoplasmin 3, and histone H3 di-methylated K9 were markedly reduced together with a decrease in the expression of protein transcription elongation factor eEF1A. These findings show severe impairment in the expression of crucial components of mitochondrial function and protein synthesis in parallel with neuron loss in mediodorsal thalamus at terminal stages of FFI. Therapeutic measures must be taken long before the appearance of clinical symptoms to prevent the devastating effects of FFI.
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Affiliation(s)
- Margalida A Frau-Méndez
- Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | - Iván Fernández-Vega
- Department of Neuropathology, Pathology Department, University Hospital Araba, Álava, Brain Bank Araba University Hospital, Basque Biobank for Research (O+eHun), Spain
| | - Belén Ansoleaga
- Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | - Rosa Blanco Tech
- Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.,Department of Neuropathology, Biomedical Research Center of Neurodegenerative Diseases (CIBERNED), Spain
| | - Margarita Carmona Tech
- Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.,Department of Neuropathology, Biomedical Research Center of Neurodegenerative Diseases (CIBERNED), Spain
| | - Jose Antonio Del Rio
- Department of Neuropathology, Biomedical Research Center of Neurodegenerative Diseases (CIBERNED), Spain.,Department of Cell Biology, Molecular and Cellular Neurobiotechnology, Institute of Bioengineering of Catalonia (IBEC), Parc Científic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center, University Medical School, Georg-August University and German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Franc Llorens
- Department of Neurology, Clinical Dementia Center, University Medical School, Georg-August University and German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Juan José Zarranz
- Neurology Department, University Hospital Cruces, University of the Basque Country, Bizkaia, Spain
| | - Isidro Ferrer
- Institute of Neuropathology, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.,Department of Neuropathology, Biomedical Research Center of Neurodegenerative Diseases (CIBERNED), Spain
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19
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Llorens F, Thüne K, Schmitz M, Ansoleaga B, Frau-Méndez MA, Cramm M, Tahir W, Gotzmann N, Berjaoui S, Carmona M, Silva CJ, Fernandez-Vega I, José Zarranz J, Zerr I, Ferrer I. Identification of new molecular alterations in fatal familial insomnia. Hum Mol Genet 2016; 25:2417-2436. [PMID: 27056979 DOI: 10.1093/hmg/ddw108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/12/2022] Open
Abstract
Fatal familial insomnia is a rare disease caused by a D178N mutation in combination with methionine (Met) at codon 129 in the mutated allele of PRNP (D178N-129M haplotype). FFI is manifested by sleep disturbances with insomnia, autonomic disorders and spontaneous and evoked myoclonus, among other symptoms. This study describes new neuropathological and biochemical observations in a series of eight patients with FFI. The mediodorsal and anterior nuclei of the thalamus have severe neuronal loss and marked astrocytic gliosis in every case, whereas the entorhinal cortex is variably affected. Spongiform degeneration only occurs in the entorhinal cortex. Synaptic and fine granular proteinase K digestion (PrPres) immunoreactivity is found in the entorhinal cortex but not in the thalamus. Interleukin 6, interleukin 10 receptor alpha subunit, colony stimulating factor 3 receptor and toll-like receptor 7 mRNA expression increases in the thalamus in FFI. PrPc levels are significantly decreased in the thalamus, entorhinal cortex and cerebellum in FFI. This is accompanied by a particular PrPc and PrPres band profile. Altered PrP solubility consistent with significantly reduced PrP levels in the cytoplasmic fraction and increased PrP levels in the insoluble fraction are identified in FFI cases. Amyloid-like deposits are only seen in the entorhinal cortex. The RT-QuIC assay reveals that all the FFI samples of the entorhinal cortex are positive, whereas the thalamus is positive only in three cases and the cerebellum in two cases. The present findings unveil particular neuropathological and neuroinflammatory profiles in FFI and novel characteristics of natural prion protein in FFI, altered PrPres and Scrapie PrP (abnormal and pathogenic PrP) patterns and region-dependent putative capacity of PrP seeding.
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Affiliation(s)
- Franc Llorens
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Katrin Thüne
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Matthias Schmitz
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Belén Ansoleaga
- Institute of Neuropathology, Service of Pathological Anatomy, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, and Biomedical Research Center of Neurodegenerative Diseases (CIBERNED) Hospitalet del Llobregat 08907, Spain
| | - Margalida A Frau-Méndez
- Institute of Neuropathology, Service of Pathological Anatomy, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, and Biomedical Research Center of Neurodegenerative Diseases (CIBERNED) Hospitalet del Llobregat 08907, Spain
| | - Maria Cramm
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Waqas Tahir
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Nadine Gotzmann
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Sara Berjaoui
- Institute of Neuropathology, Service of Pathological Anatomy, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, and Biomedical Research Center of Neurodegenerative Diseases (CIBERNED) Hospitalet del Llobregat 08907, Spain
| | - Margarita Carmona
- Institute of Neuropathology, Service of Pathological Anatomy, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, and Biomedical Research Center of Neurodegenerative Diseases (CIBERNED) Hospitalet del Llobregat 08907, Spain
| | - Christopher J Silva
- USDA, Produce Safety & Microbiology Research Unit, Western Regional Research Center, Albany, CA 94710, USA
| | - Ivan Fernandez-Vega
- Pathology Department University Hospital Araba, and Brain Bank Araba University Hospital, Basque Biobank for Research (O+eHun), Alava 01009, Spain
| | - Juan José Zarranz
- Neurology Department, University Hospital Cruces, University of the Basque Country, Bizkaia 48903, Spain
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen, and German Center for Neurodegenerative Diseases (DZNE)-site Göttingen, Göttingen 37075, Germany
| | - Isidro Ferrer
- Institute of Neuropathology, Service of Pathological Anatomy, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, and Biomedical Research Center of Neurodegenerative Diseases (CIBERNED) Hospitalet del Llobregat 08907, Spain
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20
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Rodriguez-Porcel F, Lowder L, Rademakers R, Ravenscroft T, Ghetti B, Hagen MC, Espay AJ. Fulminant corticobasal degeneration: Agrypnia excitata in corticobasal syndrome. Neurology 2016; 86:1164-6. [PMID: 26873956 DOI: 10.1212/wnl.0000000000002491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/12/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Federico Rodriguez-Porcel
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis
| | - Lindsey Lowder
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis
| | - Rosa Rademakers
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis
| | - Thomas Ravenscroft
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis
| | - Bernardino Ghetti
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis
| | - Mathew C Hagen
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis
| | - Alberto J Espay
- From the University of Cincinnati (F.R.-P., L.L., M.C.H., A.J.E.), OH; Mayo Clinic Jacksonville (R.R., T.R.), FL; and Indiana University School of Medicine (B.G.), Indianapolis.
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21
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Bouybayoune I, Mantovani S, Del Gallo F, Bertani I, Restelli E, Comerio L, Tapella L, Baracchi F, Fernández-Borges N, Mangieri M, Bisighini C, Beznoussenko GV, Paladini A, Balducci C, Micotti E, Forloni G, Castilla J, Fiordaliso F, Tagliavini F, Imeri L, Chiesa R. Transgenic fatal familial insomnia mice indicate prion infectivity-independent mechanisms of pathogenesis and phenotypic expression of disease. PLoS Pathog 2015; 11:e1004796. [PMID: 25880443 PMCID: PMC4400166 DOI: 10.1371/journal.ppat.1004796] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/09/2015] [Indexed: 11/18/2022] Open
Abstract
Fatal familial insomnia (FFI) and a genetic form of Creutzfeldt-Jakob disease (CJD178) are clinically different prion disorders linked to the D178N prion protein (PrP) mutation. The disease phenotype is determined by the 129 M/V polymorphism on the mutant allele, which is thought to influence D178N PrP misfolding, leading to the formation of distinctive prion strains with specific neurotoxic properties. However, the mechanism by which misfolded variants of mutant PrP cause different diseases is not known. We generated transgenic (Tg) mice expressing the mouse PrP homolog of the FFI mutation. These mice synthesize a misfolded form of mutant PrP in their brains and develop a neurological illness with severe sleep disruption, highly reminiscent of FFI and different from that of analogously generated Tg(CJD) mice modeling CJD178. No prion infectivity was detectable in Tg(FFI) and Tg(CJD) brains by bioassay or protein misfolding cyclic amplification, indicating that mutant PrP has disease-encoding properties that do not depend on its ability to propagate its misfolded conformation. Tg(FFI) and Tg(CJD) neurons have different patterns of intracellular PrP accumulation associated with distinct morphological abnormalities of the endoplasmic reticulum and Golgi, suggesting that mutation-specific alterations of secretory transport may contribute to the disease phenotype. Genetic prion diseases are degenerative brain disorders caused by mutations in the gene encoding the prion protein (PrP). Different PrP mutations cause different diseases, including Creutzfeldt-Jakob disease (CJD) and fatal familial insomnia (FFI). The reason for this variability is not known, but assembly of the mutant PrPs into distinct aggregates that spread in the brain by promoting PrP aggregation may contribute to the disease phenotype. We previously generated transgenic mice modeling genetic CJD, clinically identified by dementia and motor abnormalities. We have now generated transgenic mice carrying the PrP mutation associated with FFI, and found that they develop severe sleep abnormalities and other key features of the human disorder. Thus, transgenic mice recapitulate the phenotypic differences seen in humans. The mutant PrPs in FFI and CJD mice are aggregated but unable to promote PrP aggregation. They accumulate in different intracellular compartments and cause distinct morphological abnormalities of transport organelles. These results indicate that mutant PrP has disease-encoding properties that are independent of its ability to self-propagate, and suggest that the phenotypic heterogeneity may be due to different effects of aggregated PrP on intracellular transport. Our study provides new insights into the mechanisms of selective neuronal dysfunction due to protein aggregation.
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Affiliation(s)
- Ihssane Bouybayoune
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Susanna Mantovani
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Federico Del Gallo
- Department of Health Sciences, University of Milan Medical School, Milan, Italy
| | - Ilaria Bertani
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Elena Restelli
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Liliana Comerio
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Laura Tapella
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Francesca Baracchi
- Department of Health Sciences, University of Milan Medical School, Milan, Italy
| | | | - Michela Mangieri
- Division of Neuropathology and Neurology, IRCCS Foundation “Carlo Besta” National Neurological Institute, Milan, Italy
| | - Cinzia Bisighini
- Bio-Imaging Unit, Department of Cardiovascular Research, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | | | - Alessandra Paladini
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Claudia Balducci
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Edoardo Micotti
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Gianluigi Forloni
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Joaquín Castilla
- CIC bioGUNE, Parque Tecnológico de Bizkaia, Derio, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Fabio Fiordaliso
- Bio-Imaging Unit, Department of Cardiovascular Research, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
| | - Fabrizio Tagliavini
- Division of Neuropathology and Neurology, IRCCS Foundation “Carlo Besta” National Neurological Institute, Milan, Italy
| | - Luca Imeri
- Department of Health Sciences, University of Milan Medical School, Milan, Italy
| | - Roberto Chiesa
- Department of Neuroscience, IRCCS—“Mario Negri” Institute for Pharmacological Research, Milan, Italy
- * E-mail:
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Noble GP, Walsh DJ, Miller MB, Jackson WS, Supattapone S. Requirements for mutant and wild-type prion protein misfolding in vitro. Biochemistry 2015; 54:1180-7. [PMID: 25584902 DOI: 10.1021/bi501495j] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Misfolding of the prion protein (PrP) plays a central role in the pathogenesis of infectious, sporadic, and inherited prion diseases. Here we use a chemically defined prion propagation system to study misfolding of the pathogenic PrP mutant D177N in vitro. This mutation causes PrP to misfold spontaneously in the absence of cofactor molecules in a process dependent on time, temperature, pH, and intermittent sonication. Spontaneously misfolded mutant PrP is able to template its unique conformation onto wild-type PrP substrate in a process that requires a phospholipid activity distinct from that required for the propagation of infectious prions. Similar results were obtained with a second pathogenic PrP mutant, E199K, but not with the polymorphic substitution M128V. Moreover, wild-type PrP inhibits mutant PrP misfolding in a dose-dependent manner, and cofactor molecules can antagonize this effect. These studies suggest that interactions between mutant PrP, wild-type PrP, and other cellular factors may control the rate of PrP misfolding in inherited prion diseases.
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Affiliation(s)
- Geoffrey P Noble
- Department of Biochemistry, The Geisel School of Medicine at Dartmouth , Vail Building Room 311, Hanover, New Hampshire 03755, United States
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Tian C, Liu D, Xiang W, Kretzschmar HA, Sun QL, Gao C, Xu Y, Wang H, Fan XY, Meng G, Li W, Dong XP. Analyses of the similarity and difference of global gene expression profiles in cortex regions of three neurodegenerative diseases: sporadic Creutzfeldt-Jakob disease (sCJD), fatal familial insomnia (FFI), and Alzheimer's disease (AD). Mol Neurobiol 2014; 50:473-81. [PMID: 24902808 DOI: 10.1007/s12035-014-8758-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
Neurodegenerative disease is a general designation for the disorders that are progressive loss of structure or function and final death of neurons, including Alzheimer's, Parkinson's, Huntington's, prion diseases, etc. In this study, we comparatively analyzed 21 individual microarray data sets of the cortex tissues from 11 sporadic Creutzfeldt-Jakob disease (sCJD), 3 fatal familial insomnia (FFI), 3 Alzheimer's disease (AD), and 4 normal controls. After normalization, a collection of 730 differently expressed sets (DESets) were obtained by comparison of the data of three diseases with their original controls. Principal component analysis (PCA) showed a background-related distribution within the groups of FFI, AD, and normal control, but two apparently different subgroups within the group of sCJD were observed. Review of the clinical materials of 11 sCJD patients identified the difference in brain PrP(Sc) deposits between two subgroups. Hierarchical cluster analysis illustrated the relatively independent clusters of normal controls, FFIs, six sCJD cases (subgroup 1) with more PrP(Sc) deposits, respectively, while an overlapped cluster of five cases of sCJD2 (subgroup 2) with less PrP(Sc) deposits and AD patients. Despite of the presence of special gene expressions, many common features were found among those neurodegenerative diseases. The most commonly changed biological processes (BPs) were signal transduction, synaptic transmission, and neuropeptide signaling pathway. The most commonly changed pathways were MAPK signaling pathway, Parkinson's disease, and oxidative phosphorylation. Our data here provide the similarity and difference in global gene expressions among the patients with sCJD, FFI, and AD, which may help to understand the common mechanism of neurodegenerative diseases.
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Affiliation(s)
- Chan Tian
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changbai Rd 155, Beijing, 102206, People's Republic of China
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Krasnianski A, Sanchez Juan P, Ponto C, Bartl M, Heinemann U, Varges D, Schulz-Schaeffer WJ, Kretzschmar HA, Zerr I. A proposal of new diagnostic pathway for fatal familial insomnia. J Neurol Neurosurg Psychiatry 2014; 85:654-9. [PMID: 24249784 PMCID: PMC4033028 DOI: 10.1136/jnnp-2013-305978] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/08/2013] [Accepted: 10/18/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND In absence of a positive family history, the diagnosis of fatal familial insomnia (FFI) might be difficult because of atypical clinical features and low sensitivity of diagnostic tests. FFI patients usually do not fulfil the established classification criteria for Creutzfeldt-Jakob disease (CJD); therefore, a prion disease is not always suspected. OBJECTIVE To propose an update of diagnostic pathway for the identification of patients for the analysis of D178-M129 mutation. DESIGN AND METHODS Data on 41 German FFI patients were analysed. Clinical symptoms and signs, MRI, PET, SPECT, polysomnography, EEG and cerebrospinal fluid biomarkers were studied. RESULTS An algorithm was developed which correctly identified at least 81% of patients with the FFI diagnosis during early disease stages. It is based on the detection of organic sleep disturbances, either verified clinically or by a polysomnography, and a combination of vegetative and focal neurological signs and symptoms. Specificity of the approach was tested on three cohorts of patients (MM1 sporadic CJD patients, non-selected sporadic CJD and other neurodegenerative diseases). CONCLUSIONS The proposed scheme may help to improve the clinical diagnosis of FFI. As the sensitivity of all diagnostic tests investigated but polysomnography is low in FFI, detailed clinical investigation is of special importance.
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Affiliation(s)
- A Krasnianski
- Clinical Dementia Center and National Reference Center for TSE at Department of Neurology Georg-August University, , Göttingen, Germany
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Kim B, Hwang E, Kim Y, Choi JH. Prolonged Sleep-Onset Latency during Chronic Sleep Restriction in Mice. SLEEP MEDICINE RESEARCH 2013. [DOI: 10.17241/smr.2013.4.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Comparative analysis of gene expression profiles between cortex and thalamus in Chinese fatal familial insomnia patients. Mol Neurobiol 2013; 48:36-48. [PMID: 23430483 DOI: 10.1007/s12035-013-8426-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022]
Abstract
Fatal familial insomnia (FFI) is a special subtype of genetic human prion diseases that is caused by the D178N mutation of the prion protein gene (PRNP). According to the surveillance data from 2006, FFI accounts for about half of all genetic prion disease cases in China. In this study, global expression patterns of the thalamus and parietal cortex from three patients with FFI were analyzed by Affymetrix Human Genome U133+ 2.0 chip. A total of 1,314 genes in the thalamus and 332 ones in the parietal lobe were determined to be differentially expressed genes (DEGs). The percentage of upregulated DEGs is much less in the thalamus (19.3 %) than that in the parietal lobe (42.8 %). Moreover, 255 of those DEGs showed the same altering tendencies in both tested regions, including 99 upregulated and 156 downregulated ones. The reliability of the results was confirmed by the real-time RT-PCR assays. There were 1,152 and 531 biological processes affected in the thalamus and the parietal lobe, respectively, as well as 391 overlapping ones in both regions. The most significantly changed molecular functions included transcription and DNA-dependent regulation of transcription, RNA splicing, mitochondrial electron transport, etc. The changed functions in the thalamus contained more numbers of DEGs than parietal lobe. According to KEGG classification, there were 167 and 115 different pathways changed in the thalamus and the parietal lobe, respectively, while 102 were changed in both. Interestingly, the top three changed pathways in the three groups mentioned above were Parkinson's disease, Alzheimer's disease, and oxidative phosphorylation. These results demonstrate the greater damage in the thalamus than in the parietal lobe during FFI pathogenesis, which is consistent with previous pathological observations. This study aims to describe the global expression profiles in various brain regions of FFI while proposing useful clues for understanding the pathogenesis of FFI and selecting potential biomarkers for diagnostic and therapeutic tools.
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Xie WL, Shi Q, Xia SL, Zhang BY, Gong HS, Wang SB, Xu Y, Guo Y, Tian C, Zhang J, Xu BL, Liu Y, Dong XP. Comparison of the pathologic and pathogenic features in six different regions of postmortem brains of three patients with fatal familial insomnia. Int J Mol Med 2012; 31:81-90. [PMID: 23175354 DOI: 10.3892/ijmm.2012.1194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/05/2012] [Indexed: 11/05/2022] Open
Abstract
Fatal familial insomnia (FFI) is an autosomal dominant prion disease clinically characterized by rapidly progressive insomnia, prominent autonomic alterations and behavioral disturbance. The D178N mutation of the prion protein gene (PRNP) on chromosome 20 in conjunction with methionine at codon 129 is a molecular feature. Although the neuropathological characteristics of FFI are well documented, the neuropathologic and pathogenic features of FFI patients remain poorly understood. Six brain regions of postmortem brains from 3 FFI patients were examined using immunohistochemistry, western blot analyses and quantitative real-time PCR. In all 3 brain specimens, reactive astrogliosis was found to be more severe in the thalamus than in the cortex regions. Western blot analyses showed that all three brains expressed PrP, but only 2 were associated with significantly weak proteinase K (PK) resistance. However, the conformational stabilities of PrPSc in the 3 FFI brains were significantly weaker than those presented in a G114V genetic Creutzfeldt-Jakob disease (gCJD) case. Immunohistochemistry and western blot analyses showed comparable amounts of neuron-specific enolase (NSE)-positive stained cells and NSE protein among the different regions in the three brains. In addition, the transcriptional levels of glial fibrillary acidic protein (GFAP) and NSE-specific mRNAs were coincident with the expression of these proteins. In conclusion, in the present study, we described the detailed regional neuropathology of FFI cases.
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Affiliation(s)
- Wu-Ling Xie
- School of Medicine, Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, PR China
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28
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Filali H, Martin-Burriel I, Harders F, Varona L, Serrano C, Acín C, Badiola JJ, Bossers A, Bolea R. Medulla oblongata transcriptome changes during presymptomatic natural scrapie and their association with prion-related lesions. BMC Genomics 2012; 13:399. [PMID: 22897917 PMCID: PMC3495657 DOI: 10.1186/1471-2164-13-399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathogenesis of natural scrapie and other prion diseases is still poorly understood. Determining the variations in the transcriptome in the early phases of the disease might clarify some of the molecular mechanisms of the prion-induced pathology and allow for the development of new biomarkers for diagnosis and therapy. This study is the first to focus on the identification of genes regulated during the preclinical phases of natural scrapie in the ovine medulla oblongata (MO) and the association of these genes with prion deposition, astrocytosis and spongiosis. RESULTS A custom microarray platform revealed that 86 significant probes had expression changes greater than 2-fold. From these probes, we identified 32 genes with known function; the highest number of regulated genes was included in the phosphoprotein-encoding group. Genes encoding extracellular marker proteins and those involved in the immune response and apoptosis were also differentially expressed. In addition, we investigated the relationship between the gene expression profiles and the appearance of the main scrapie-associated brain lesions. Quantitative Real-time PCR was used to validate the expression of some of the regulated genes, thus showing the reliability of the microarray hybridization technology. CONCLUSIONS Genes involved in protein and metal binding and oxidoreductase activity were associated with prion deposition. The expression of glial fibrillary acidic protein (GFAP) was associated with changes in the expression of genes encoding proteins with oxidoreductase and phosphatase activity, and the expression of spongiosis was related to genes encoding extracellular matrix components or transmembrane transporters. This is the first genome-wide expression study performed in naturally infected sheep with preclinical scrapie. As in previous studies, our findings confirm the close relationship between scrapie and other neurodegenerative diseases.
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Affiliation(s)
- Hicham Filali
- Centro de Investigación en Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, Universidad de Zaragoza, Zaragoza, Spain
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Portaluppi F, Tiseo R, Smolensky MH, Hermida RC, Ayala DE, Fabbian F. Circadian rhythms and cardiovascular health. Sleep Med Rev 2011; 16:151-66. [PMID: 21641838 DOI: 10.1016/j.smrv.2011.04.003] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/27/2011] [Indexed: 11/30/2022]
Abstract
The functional organization of the cardiovascular system shows clear circadian rhythmicity. These and other circadian rhythms at all levels of organization are orchestrated by a central biological clock, the suprachiasmatic nuclei of the hypothalamus. Preservation of the normal circadian time structure from the level of the cardiomyocyte to the organ system appears to be essential for cardiovascular health and cardiovascular disease prevention. Myocardial ischemia, acute myocardial infarct, and sudden cardiac death are much greater in incidence than expected in the morning. Moreover, supraventricular and ventricular cardiac arrhythmias of various types show specific day-night patterns, with atrial arrhythmias--premature beats, tachycardias, atrial fibrillation, and flutter - generally being of higher frequency during the day than night--and ventricular fibrillation and ventricular premature beats more common, respectively, in the morning and during the daytime activity than sleep span. Furthermore, different circadian patterns of blood pressure are found in arterial hypertension, in relation to different cardiovascular morbidity and mortality risk. Such temporal patterns result from circadian periodicity in pathophysiological mechanisms that give rise to predictable-in-time differences in susceptibility-resistance to cyclic environmental stressors that trigger these clinical events. Circadian rhythms also may affect the pharmacokinetics and pharmacodynamics of cardiovascular and other medications. Knowledge of 24-h patterns in the risk of cardiac arrhythmias and cardiovascular disease morbidity and mortality plus circadian rhythm-dependencies of underlying pathophysiologic mechanisms suggests the requirement for preventive and therapeutic interventions is not the same throughout the day and night, and should be tailored accordingly to improve outcomes.
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Abstract
The University of Geneva brain collection was founded at the beginning of the 20th century. Today, it consists of 10,154 formaldehyde- or buffered formaldehyde-fixed brains obtained from the autopsies of the Department of Psychiatry and, since 1971, from the Department of Geriatrics. More than 100,000 paraffin-embedded blocks and 200,000 histological slides have also been collected since 1901. From the time of its creation, this collection has served as an important resource for pathological studies and clinicopathological correlations, primarily in the field of dementing illnesses and brain aging research. These materials have permitted a number of original neuropathological observations, such as the classification of Pick's disease by Constantinidis, or the description of dyshoric angiopathy and laminar sclerosis by Morel. The large number of cases, including some very rare conditions, provides a unique resource and an opportunity for worldwide collaborations.
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Affiliation(s)
- Enikö Kövari
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
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Abstract
One of the major current challenges to both medicine and neuroscience is the treatment of neurodegenerative diseases, which pose an ever-increasing medical, social and economic burden in the developed world. These disorders, which include Alzheimer's, Huntington's and Parkinson's diseases, and the rarer prion diseases, are separate entities clinically but have common features, including aggregates of misfolded proteins and varying patterns of neurodegeneration. A key barrier to effective treatment is that patients present clinically with advanced, irreversible, neuronal loss. Critically, mechanisms of neurotoxicity are poorly understood. Prevention of neuronal loss, ideally by targeting underlying pathogenic mechanisms, must be the aim of therapy. The present review describes the rationale and experimental approaches that have allowed such prevention, rescuing neurons in mice with prion disease. This rescue cured animals of a rapidly fatal neurodegenerative condition, resulting in symptom-free survival for their natural lifespan. Early pathological changes were reversed; behavioural, cognitive and neurophysiological deficits were recovered; and there was no neuronal loss. This was achieved by targeting the central pathogenic process in prion disease rather than the presumed toxic species, first by proof-of-principle experiments in transgenic mice and then by treatment using RNA interference for gene knockdown. The results have been a new therapeutic target for prion disease, further insight into mechanisms of prion neurotoxicity and the discovery of a window of reversibility in neuronal damage. Furthermore, the work gives rise to new concepts for treatment strategies for other neurodegenerative disorders, and highlights the need for clinical detection of early neuronal dysfunction, so that similar early rescue can also be achieved for these disorders.
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Hauw JJ, Sazdovitch V, Seilhean D, Camilleri S, Lazarini F, Delasnerie-Lauprétre N, Duyckaerts C. The nosology and neuropathology of human conditions related to unconventional infectious agents or prions. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00263.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Montagna P. Fatal familial insomnia and the role of the thalamus in sleep regulation. HANDBOOK OF CLINICAL NEUROLOGY 2011; 99:981-996. [PMID: 21056239 DOI: 10.1016/b978-0-444-52007-4.00018-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Pasquale Montagna
- Department of Neurological Sciences, University of Bologna Medical School, Bologna, Italy.
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Auger RR, Boeve BF. Sleep disorders in neurodegenerative diseases other than Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2011; 99:1011-1050. [PMID: 21056241 DOI: 10.1016/b978-0-444-52007-4.00020-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- R Robert Auger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Capellari S, Strammiello R, Saverioni D, Kretzschmar H, Parchi P. Genetic Creutzfeldt-Jakob disease and fatal familial insomnia: insights into phenotypic variability and disease pathogenesis. Acta Neuropathol 2011; 121:21-37. [PMID: 20978903 DOI: 10.1007/s00401-010-0760-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/17/2010] [Accepted: 10/11/2010] [Indexed: 01/18/2023]
Abstract
Human prion diseases are a group of rare neurodegenerative disorders characterized by the conversion of the constitutively expressed prion protein, PrP(C), into an abnormally aggregated isoform, called PrP(Sc). While most people who develop a prion disease have no identifiable cause and a few acquire the disease through an identified source of infection, about 10-15% of patients are affected by a genetic form and carry either a point mutation or an insertion of octapeptide repeats in the prion protein gene. Prion diseases show the highest extent of phenotypic heterogeneity among neurodegenerative disorders and comprise three major disease entities with variable though overlapping phenotypic features: Creutzfeldt-Jakob disease (CJD), fatal insomnia and the Gerstmann-Sträussler-Scheinker syndrome. Both CJD and fatal insomnia are fully transmissible diseases, a feature that led to the isolation and characterization of different strains of the agent or prion showing distinctive clinical and neuropathological features after transmission to syngenic animals. Here, we review the current knowledge of the effects of the pathogenic mutations linked to genetic CJD and fatal familial insomnia on the prion protein metabolism and physicochemical properties, the disease phenotype and the strain characteristics. The data derived from studies in vitro and from those using cell and animal models are compared with those obtained from the analyses of the naturally occurring disease. The extent of phenotypic variation in genetic prion disease is analyzed in comparison to that of the sporadic disease, which has recently been the topic of a systematic and detailed characterization.
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Velayos J, Irujo A, Cuadrado-Tejedor M, Paternain B, Moleres F, Ferrer V. La proteína priónica celular en el sistema nervioso central de mamíferos. Correlatos anatomoclínicos. Neurologia 2010. [DOI: 10.1016/j.nrl.2009.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Clinical, histopathological and genetic studies in a family with fatal familial insomnia. INFECTION GENETICS AND EVOLUTION 2010; 10:292-7. [PMID: 20096809 DOI: 10.1016/j.meegid.2010.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 01/09/2010] [Accepted: 01/15/2010] [Indexed: 11/23/2022]
Abstract
We compared clinical data from two related Chinese patients with fatal familial insomnia (FFI) and collected information about their pedigree. The clinical features in the two cases were similar and included initial progressive insomnia and sympathetic activation, which persisted throughout the clinical course. A total of 135 members of this family, across seven generations, were retrospectively investigated. Eleven family members, including the two FFI cases, were found to have died with similar neurological problems. Analysis of PRNP in 32 family members revealed eleven carrying the D178N allele, including the two FFI patients. Spongiform degeneration in brains was not found, but gliosis was obvious in the thalamus of the two cases at postmortem. Proteinase K-resistant prion protein (PrP) was not found in proband's brain by immunohistochemistry, but observed in some areas of brain for both cases by PrP-specific Western blot. Investigation of the pedigree has led to the identification of an additional 9 family members who had similar clinical symptoms and 9 currently healthy individuals with the D178N mutation.
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Velayos J, Irujo A, Cuadrado-Tejedor M, Paternain B, Moleres F, Ferrer V. Cellular prion protein in the central nervous system of mammals. Anatomoclinical associations. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jackson WS, Borkowski AW, Faas H, Steele AD, King OD, Watson N, Jasanoff A, Lindquist S. Spontaneous generation of prion infectivity in fatal familial insomnia knockin mice. Neuron 2009; 63:438-50. [PMID: 19709627 PMCID: PMC2775465 DOI: 10.1016/j.neuron.2009.07.026] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 07/20/2009] [Accepted: 07/30/2009] [Indexed: 11/18/2022]
Abstract
A crucial tenet of the prion hypothesis is that misfolding of the prion protein (PrP) induced by mutations associated with familial prion disease is, in an otherwise normal mammalian brain, sufficient to generate the infectious agent. Yet this has never been demonstrated. We engineered knockin mice to express a PrP mutation associated with a distinct human prion disease, fatal familial insomnia (FFI). An additional substitution created a strong transmission barrier against pre-existing prions. The mice spontaneously developed a disease distinct from that of other mouse prion models and highly reminiscent of FFI. Unique pathology was transmitted from FFI mice to mice expressing wild-type PrP sharing the same transmission barrier. FFI mice were highly resistant to infection by pre-existing prions, confirming infectivity did not arise from contaminating agents. Thus, a single amino acid change in PrP is sufficient to induce a distinct neurodegenerative disease and the spontaneous generation of prion infectivity.
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Affiliation(s)
- Walker S Jackson
- Whitehead Institute for Biomedical Research, Nine Cambridge Center, Cambridge, MA 02142, USA
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Raggi A, Perani D, Giaccone G, Iannaccone S, Manconi M, Zucconi M, Garibotto V, Marcone A, Zamboni M, Limido L, Tagliavini F, Ferini-Strambi L, Cappa SF. The behavioural features of fatal familial insomnia: A new Italian case with pathological verification. Sleep Med 2009; 10:581-5. [DOI: 10.1016/j.sleep.2008.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 04/25/2008] [Accepted: 05/08/2008] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Sleep deprivation is a common problem in the intensive care unit. Animal models have demonstrated that sleep deprivation alone is associated with increased mortality. We have previously shown that septic insult with sleep deprivation results in increased mortality in a murine model. The aging process is known to reduce the restorative phases of sleep. The purpose of this study was to evaluate the effect of age on mortality with sleep deprivation during recovery from septic insult. METHODS C57BL/6J male mice aged 2 months (young) or 9 months (old) underwent cecal ligation and puncture (CLP). Animals were randomized to receive sleep interruption (SI) for 48 hours or standard recovery (no SI). Sham animals underwent laparotomy and cecal manipulation without puncture. SI was achieved by securing animal housing to an orbital shaker set to repeatedly cycle at 30 rpm over 120 seconds (30 seconds on/90 seconds off). The primary outcome was survival at 5 days post-CLP. Kaplan-Meier survival analysis with log-rank test was used to explore differences in mortality. RESULTS SI resulted in an increase in time awake for both light and dark cycles (p < 0.001). Mortality after CLP with SI (n = 30) was 57% and mortality after CLP without SI (controls; n = 33) was 24%. SI was associated with a greater than 3-fold increase in mortality after CLP (RR = 3.29; 95% CI, 1.42-7.63). Young mice (n = 28) had a mortality of 31% with CLP alone increasing to 67% with SI (p = 0.03). Old mice (n = 35) had a mortality of 18% with CLP alone increasing to 50% with SI (p = 0.05). There was no difference in survival between young and old mice undergoing SI (p = 0.49). CONCLUSIONS Sleep deprivation after septic insult increases mortality in both young and old mice. However, sleep deprivation after septic insult does not have a more profound effect on mortality in either age group. These findings suggest that sleep deprivation experienced in the intensive care unit setting during recovery from critical illness may increase mortality. This effect appears independent of increased age. Further studies evaluating extremes of age are warranted.
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Infectious Diseases of the Nervous System. ATLAS OF CLINICAL NEUROLOGY 2009. [PMCID: PMC7120376 DOI: 10.1007/978-1-57340-359-7_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In this chapter infectious diseases of the nervous system are discussed. These include bacterial, viral, fungal, spirochetal, and parasitic infections. Although the central nervous system (CNS) is protected from bacterial invasion by the intact blood-brain barrier, bacterial invasion is enhanced by the special surface properties of bacteria as well as host immune deficiencies. Similar to any type of infection of the nervous system, bacteria may involve any of the nervous system compartments: the epidural space (epidural abscess); the dura (pachymeningitis); the subdural space (subdural empyema); the leptomeninges and the subarachnoid space containing cerebrospinal fluid (meningitis or leptomeningitis); and the brain parenchyma (brain abscess). The clinical manifestations, pathogenesis, pathology, etiology, epidemiology, diagnosis, differential diagnosis, and treatment of these syndromes are presented.
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Schneider K, Fangerau H, Michaelsen B, Raab WHM. The early history of the transmissible spongiform encephalopathies exemplified by scrapie. Brain Res Bull 2008; 77:343-55. [PMID: 18951958 DOI: 10.1016/j.brainresbull.2008.09.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 05/27/2008] [Accepted: 09/18/2008] [Indexed: 10/21/2022]
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Linden R, Martins VR, Prado MAM, Cammarota M, Izquierdo I, Brentani RR. Physiology of the prion protein. Physiol Rev 2008; 88:673-728. [PMID: 18391177 DOI: 10.1152/physrev.00007.2007] [Citation(s) in RCA: 435] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prion diseases are transmissible spongiform encephalopathies (TSEs), attributed to conformational conversion of the cellular prion protein (PrP(C)) into an abnormal conformer that accumulates in the brain. Understanding the pathogenesis of TSEs requires the identification of functional properties of PrP(C). Here we examine the physiological functions of PrP(C) at the systemic, cellular, and molecular level. Current data show that both the expression and the engagement of PrP(C) with a variety of ligands modulate the following: 1) functions of the nervous and immune systems, including memory and inflammatory reactions; 2) cell proliferation, differentiation, and sensitivity to programmed cell death both in the nervous and immune systems, as well as in various cell lines; 3) the activity of numerous signal transduction pathways, including cAMP/protein kinase A, mitogen-activated protein kinase, phosphatidylinositol 3-kinase/Akt pathways, as well as soluble non-receptor tyrosine kinases; and 4) trafficking of PrP(C) both laterally among distinct plasma membrane domains, and along endocytic pathways, on top of continuous, rapid recycling. A unified view of these functional properties indicates that the prion protein is a dynamic cell surface platform for the assembly of signaling modules, based on which selective interactions with many ligands and transmembrane signaling pathways translate into wide-range consequences upon both physiology and behavior.
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Affiliation(s)
- Rafael Linden
- Instituto de Biofísica da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Krasnianski A, Bartl M, Sanchez Juan PJ, Heinemann U, Meissner B, Varges D, Schulze-Sturm U, Kretzschmar HA, Schulz-Schaeffer WJ, Zerr I. Fatal familial insomnia: Clinical features and early identification. Ann Neurol 2008; 63:658-61. [PMID: 18360821 DOI: 10.1002/ana.21358] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Our aim was to develop a detailed clinical description of fatal familial insomnia in a large patient group with respect to the M129V genotype. Data on 41 German fatal familial insomnia patients were analyzed. Clinical features, 14-3-3 proteins in the cerebrospinal fluid, magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, polysomnography, and electroencephalography were studied. Age at disease onset, disease duration, and clinical syndrome varied depending on the codon 129 genotype. Because the sensitivity of the most diagnostic tests is low in fatal familial insomnia, detailed clinical investigation is extremely important. Polysomnography may help to support the diagnosis.
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Affiliation(s)
- Anna Krasnianski
- National TSE Surveillance Reference Center, Department of Neurology, Georg-August University, Göttingen, Germany
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Sleep and recovery from critical illness and injury: a review of theory, current practice, and future directions. Crit Care Med 2008; 36:697-705. [PMID: 18176314 DOI: 10.1097/ccm.0b013e3181643f29] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objectives of this article were to describe the deleterious effects of sleep deprivation, characterize sleep in patients cared for in an intensive care unit (ICU) environment, and propose an integrated strategy to improve sleep in critical care units. STUDY SELECTION Clinical trials and review articles assessing sleep deprivation, sleep in a critical care setting, and interventions to improve sleep in the critical care environment were identified through an in depth PubMed search. CONCLUSIONS Sleep deprivation and disruption are particularly prevalent in patients cared for in the critical care environment. Although numerous observational studies during the past several decades have demonstrated that sleep in patients cared for in ICUs is highly abnormal, little is known about the effects of poor sleep quality on outcomes from critical illness or injury. Reasons for sleep deprivation during recovery from illness and injury in the ICU are multifactorial. Major contributing factors in this patient population are type and severity of underlying illness, the pathophysiology of acute illness/injury, pain from surgical procedures, and perhaps most importantly, the ICU environment itself. Sleep in ICU patients is characterized by prolonged sleep latencies, sleep fragmentation, decreased sleep efficiency, frequent arousals, a predominance of stage 1 and 2 nonrapid eye movement sleep, decreased or absent stage 3 and 4 nonrapid eye movement sleep, and decreased or absent rapid eye movement sleep. Optimizing patient comfort and ensuring that patients achieve adequate restorative sleep while cared for in the ICU is an arduous task. However, environmental alterations in the ICU may reliably improve sleep quality and subsequently alter outcomes during recovery from critical illness and injury.
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Smolensky MH, Hermida RC, Castriotta RJ, Portaluppi F. Role of sleep-wake cycle on blood pressure circadian rhythms and hypertension. Sleep Med 2007; 8:668-80. [PMID: 17383936 DOI: 10.1016/j.sleep.2006.11.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 11/08/2006] [Accepted: 11/11/2006] [Indexed: 11/25/2022]
Abstract
Stages of different depth characterize the temporal organization of sleep. Each stage exerts an effect on blood pressure (BP) regulation and contributes to its 24-h variation. The main determinant of the circadian influences of sleep and wakefulness on BP is the daytime sympathetic and nighttime parasympathetic prevalence, but many other physiologic mechanisms known either to induce sleep or determine arousal may play an important role in the mediation of sleep influences on BP. Alteration of one or more of such mechanisms may be reflected in altered circadian BP rhythms. Sleep- and arousal-related mechanisms and phenomena that affect circadian BP rhythms include neurohumoral sleep factors (arginine vasopressin, vasoactive intestinal peptide, somatotropin, insulin, steroid hormones and metabolites, and serotonin among others) and waking factors (corticotropin-releasing factor, adrenocorticotropin, thyrotropin-releasing hormone, endogenous opioids, and prostaglandin (E(2))). Pathologic respiratory variations (sleep-disordered breathing) and insomnia are major causes of the sleep-related alteration of the circadian BP profile, including loss of the expected normal decline in BP by 10-20% from the daytime level. A great number of medical disorders can cause insomnia, but objective sleep studies have been performed only in a minority of them. Overall, the sleep-related pathophysiological mechanisms actually involved in causing altered circadian BP rhythms in different normotensive and hypertensive conditions are not completely understood. In any case, changes in the circadian BP rhythm are known to be strongly related to one's risk of cardiovascular morbidity and mortality, thus representing strong prognostic indicators worthy of further investigation.
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Affiliation(s)
- Michael H Smolensky
- School of Public Health, RAS-W606, The University of Texas-Houston Health Sciences Center, 1200 Herman Pressler, Houston, TX 77030, USA.
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Schneider K, Fangerau H, Raab WHM. [The early history of transmissible spongiform encephalopathies exemplified by scrapie]. DER NERVENARZT 2007; 78:156, 158-60, 162-5. [PMID: 17226012 DOI: 10.1007/s00115-006-2228-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transmissible spongiform encephalopathies (TSE) are unique diseases in that they are sporadic, hereditary, and infectious. The transmissible pathogen--the prion--stands out from all other pathogens in being devoid of nucleic acids. Instead its most important and possibly only constituent is a host-encoded protein, the prion protein (PrP), in an alternative conformation induced by post-translational modifications. Thus TSEs belong to and are so far the only transmissible member of the continuously growing group of disorders collectively referred to as protein conformational disorders. During elucidation of these disorders, many different--and contradictory--theories have been put forward. Early researchers, mostly driven by the economic effect of these diseases upon sheep farming, engaged in heavy disputes concerning the heredity vs infectivity of scrapie. After the experimental demonstration of scrapie's infectivity during the twentieth century, research focused on elucidating the nature of the transmissible agent. The current work comprehensively summarizes the early literature available on TSE research.
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Affiliation(s)
- K Schneider
- Abteilung für Operative und Präventive Zahnheilkunde, Heinrich-Heine-Universität / Westdeutsche Kieferklinik, Düsseldorf
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