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Guillén-Yunta M, García-Aldea Á, Valcárcel-Hernández V, Sanz-Bógalo A, Muñoz-Moreno E, Matheus MG, Grijota-Martínez C, Montero-Pedrazuela A, Guadaño-Ferraz A, Bárez-López S. Defective thyroid hormone transport to the brain leads to astroglial alterations. Neurobiol Dis 2024; 200:106621. [PMID: 39097035 DOI: 10.1016/j.nbd.2024.106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/01/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024] Open
Abstract
Allan-Herndon-Dudley syndrome (AHDS) is a rare X-linked disorder that causes severe neurological damage, for which there is no effective treatment. AHDS is due to inactivating mutations in the thyroid hormone transporter MCT8 that impair the entry of thyroid hormones into the brain, resulting in cerebral hypothyroidism. However, the pathophysiology of AHDS is still not fully understood and this is essential to develop therapeutic strategies. Based on evidence suggesting that thyroid hormone deficit leads to alterations in astroglial cells, including gliosis, in this work, we have evaluated astroglial impairments in MCT8 deficiency by means of magnetic resonance imaging, histological, ultrastructural, and immunohistochemical techniques, and by mining available RNA sequencing outputs. Apparent diffusion coefficient (ADC) imaging values obtained from magnetic resonance imaging showed changes indicative of alterations in brain cytoarchitecture in MCT8-deficient patients (n = 11) compared to control subjects (n = 11). Astroglial alterations were confirmed by immunohistochemistry against astroglial markers in autopsy brain samples of an 11-year-old and a 30th gestational week MCT8-deficient subjects in comparison to brain samples from control subjects at similar ages. These findings were validated and further explored in a mouse model of AHDS. Our findings confirm changes in all the astroglial populations of the cerebral cortex in MCT8 deficiency that impact astrocytic metabolic and mitochondrial cellular respiration functions. These impairments arise early in brain development and persist at adult stages, revealing an abnormal distribution, density, morphology of cortical astrocytes, along with altered transcriptome, compatible with an astrogliosis-like phenotype at adult stages. We conclude that astrocytes are potential novel therapeutic targets in AHDS, and we propose ADC imaging as a tool to monitor the progression of neurological impairments and potential effects of treatments in MCT8 deficiency.
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Affiliation(s)
- Marina Guillén-Yunta
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ángel García-Aldea
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Víctor Valcárcel-Hernández
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ainara Sanz-Bógalo
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Emma Muñoz-Moreno
- Magnetic Imaging Resonance Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Gisele Matheus
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Carmen Grijota-Martínez
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain; Department of Cell Biology, Faculty of Biology, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Montero-Pedrazuela
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Ana Guadaño-Ferraz
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Soledad Bárez-López
- Department of Neurological Diseases and Aging, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
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Pierpont EI, Labounek R, Gupta A, Lund T, Orchard PJ, Dobyns WB, Bondy M, Paulson A, Metz A, Shanley R, Wozniak JR, Mueller BA, Loes D, Nascene D, Nestrasil I. Diffusion Tensor Imaging in Boys With Adrenoleukodystrophy: Identification of Cerebral Disease and Association With Neurocognitive Outcomes. Neurology 2024; 103:e209764. [PMID: 39151102 PMCID: PMC11329293 DOI: 10.1212/wnl.0000000000209764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Childhood cerebral adrenoleukodystrophy (C-ALD) is a severe inflammatory demyelinating disease that must be treated at an early stage to prevent permanent brain injury and neurocognitive decline. In standard clinical practice, C-ALD lesions are detected and characterized by a neuroradiologist reviewing anatomical MRI scans. We aimed to assess whether diffusion tensor imaging (DTI) is sensitive to the presence and severity of C-ALD lesions and to investigate associations with neurocognitive outcomes after hematopoietic cell therapy (HCT). METHODS In this retrospective cohort study, we analyzed high-resolution anatomical MRI, DTI, and neurocognitive assessments from boys with C-ALD undergoing HCT at the University of Minnesota between 2011 and 2021. Longitudinal DTI data were compared with an age-matched group of boys with ALD and no lesion (NL-ALD). DTI metrics were obtained for atlas-based regions of interest (ROIs) within 3 subdivisions of the corpus callosum (CC), corticospinal tract (CST), and total white matter (WM). Between-group baseline and slope differences in fractional anisotropy (FA) and axial (AD), radial (RD), and mean (MD) diffusivities were compared using analysis of covariance accounting for age, MRI severity (Loes score), and lesion location. RESULTS Among patients with NL-ALD (n = 14), stable or increasing FA, stable AD, and stable or decreasing RD and MD were generally observed during the 1-year study period across all ROIs. In comparison, patients with mild posterior lesions (Loes 1-2; n = 13) demonstrated lower baseline FA in the CC splenium (C-ALD 0.50 ± 0.08 vs NL-ALD 0.58 ± 0.04; pBH = 0.022 adjusted Benjamini-Hochberg p-value), lower baseline AD across ROIs (e.g., C-ALD 1.34 ± 0.03 ×10-9 m2/s in total WM vs NL-ALD 1.38 ± 0.04 ×10-9 m2/s; pBH = 0.005), lower baseline RD in CC body and CST, and lower baseline MD across ROIs except CC splenium. Longitudinal slopes in CC splenium showed high sensitivity and specificity in differentiating early C-ALD from NL-ALD. Among all patients with C-ALD (n = 38), baseline Loes scores and DTI metrics were associated with post-HCT neurocognitive functions, including processing speed (e.g., FA WM Spearman correlation coefficient R = 0.64) and visual-motor integration (e.g., FA WM R = 0.71). DISCUSSION DTI was sensitive to lesion presence and severity as well as clinical neurocognitive effects of C-ALD. DTI metrics quantify C-ALD even at an early stage.
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Affiliation(s)
- Elizabeth I Pierpont
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - René Labounek
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Ashish Gupta
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Troy Lund
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Paul J Orchard
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - William B Dobyns
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Monica Bondy
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Amy Paulson
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Andrew Metz
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Ryan Shanley
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Jeffrey R Wozniak
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Bryon A Mueller
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Daniel Loes
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - David Nascene
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
| | - Igor Nestrasil
- From the Departments of Pediatrics (E.I.P., R.L., A.G., T.L., P.J.O., W.B.D., M.B., A.P., I.N.), Neurology (A.M.), Psychiatry & Behavioral Sciences (J.R.W., B.A.M.), and Radiology (D.N.), University of Minnesota Medical School, Minneapolis; Biostatistical Design and Analysis Center (R.S.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis; and Independent Neuroradiologist-Consultant (D.L.), Minneapolis, MN
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Yska HAF, Engelen M, Bugiani M. The pathology of X-linked adrenoleukodystrophy: tissue specific changes as a clue to pathophysiology. Orphanet J Rare Dis 2024; 19:138. [PMID: 38549180 PMCID: PMC10976706 DOI: 10.1186/s13023-024-03105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/23/2024] [Indexed: 04/02/2024] Open
Abstract
Although the pathology of X-linked adrenoleukodystrophy (ALD) is well described, it represents the end-stage of neurodegeneration. It is still unclear what cell types are initially involved and what their role is in the disease process. Revisiting the seminal post-mortem studies from the 1970s can generate new hypotheses on pathophysiology. This review describes (histo)pathological changes of the brain and spinal cord in ALD. It aims at integrating older works with current insights and at providing an overarching theory on the pathophysiology of ALD. The data point to an important role for axons and glia in the pathology of both the myelopathy and leukodystrophy of ALD. In-depth pathological analyses with new techniques could help further unravel the sequence of events behind the pathology of ALD.
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Affiliation(s)
- Hemmo A F Yska
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Marc Engelen
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pediatrics/Child Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Pathology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Thakkar RN, Patel D, Kioutchoukova IP, Al-Bahou R, Reddy P, Foster DT, Lucke-Wold B. Leukodystrophy Imaging: Insights for Diagnostic Dilemmas. Med Sci (Basel) 2024; 12:7. [PMID: 38390857 PMCID: PMC10885080 DOI: 10.3390/medsci12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
Leukodystrophies, a group of rare demyelinating disorders, mainly affect the CNS. Clinical presentation of different types of leukodystrophies can be nonspecific, and thus, imaging techniques like MRI can be used for a more definitive diagnosis. These diseases are characterized as cerebral lesions with characteristic demyelinating patterns which can be used as differentiating tools. In this review, we talk about these MRI study findings for each leukodystrophy, associated genetics, blood work that can help in differentiation, emerging diagnostics, and a follow-up imaging strategy. The leukodystrophies discussed in this paper include X-linked adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe's disease, Pelizaeus-Merzbacher disease, Alexander's disease, Canavan disease, and Aicardi-Goutières Syndrome.
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Affiliation(s)
- Rajvi N. Thakkar
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Drashti Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Raja Al-Bahou
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Pranith Reddy
- College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Devon T. Foster
- College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32610, USA
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5
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Wolf NI, Engelen M, van der Knaap MS. MRI pattern recognition in white matter disease. HANDBOOK OF CLINICAL NEUROLOGY 2024; 204:37-50. [PMID: 39322391 DOI: 10.1016/b978-0-323-99209-1.00019-3] [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: 09/27/2024]
Abstract
Magnetic resonance imaging (MRI) pattern recognition is a powerful tool for quick diagnosis of genetic and acquired white matter disorders. In many cases, distribution and character of white matter abnormalities directly point to a specific diagnosis and guide confirmatory testing. Knowledge of normal brain development is essential to interpret white matter changes in young children. MRI is also used for disease staging and treatment decisions in leukodystrophies and acquired disorders as multiple sclerosis, and as a biomarker to follow treatment effects.
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Affiliation(s)
- Nicole I Wolf
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Marc Engelen
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjo S van der Knaap
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Center, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Vrije Universiteit, Amsterdam, The Netherlands
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Jiang W, Jin W, Zhao H, Huang D, Wu L. Initial frontal lobe involvement in adult cerebral X-linked adrenoleukodystrophy. Acta Neurol Belg 2023; 123:2259-2268. [PMID: 37247117 DOI: 10.1007/s13760-023-02295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Adult cerebral X-linked adrenoleukodystrophy (ACALD) with initial frontal lobe involvement is a rare genetic disease that is easily misdiagnosed and underdiagnosed. We sought to improve the early identification of such diseases. METHODS We present three cases of adult X-linked adrenoleukodystrophy (ALD) with initial frontal lobe involvement and identify an additional 13 cases from the database. The clinical and imaging characteristics of the overall sixteen cases were analyzed. RESULTS The average age of onset was 37 years, with 15 male and 1 female patient. A total of 12 patients (75%) developed a decline in cerebral executive and cognitive functions. Brain trauma is the possible trigger for the onset of ALD in five patients (31%). An elevated level of very-long-chain fatty acids (VLCFA) was observed in all 15 patients on whom a plasma VLCFA was performed.10 patients with gene tests showed different mutation sites in the ABCD1 gene. Brain MRI of six patients (46%) were characterized by frontal lobe "butterfly wings"-like lesions with peripheral rim enhancement. Four patients underwent brain biopsies (patients 1, 3, 15, and 13), and five patients (31%) were initially misdiagnosed (patients 1, 2, 3, 11, and 15). Nine of the patients with follow-up records experienced poor prognoses, and five of them, unfortunately, died (56%). CONCLUSION ACALD patients with anterior patterns tend to be misdiagnosed. The early clinical manifestation is a decline in cerebral executive and cognitive function. Brain trauma may be a trigger for this pattern. Brain MRI findings are characterized by frontal lobe "butterfly wing"-like lesions with peripheral rim enhancement. The determination of the VLCFA levels and the genetic detection of the causative mutations are required to confirm the diagnosis.
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Affiliation(s)
- Wei Jiang
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
- Department of Neurology, The First Hospital, Changsha, 410005, Hunan, China
| | - Wei Jin
- Department of Pathology, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
| | - Hulin Zhao
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
| | - Dehui Huang
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Lei Wu
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
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Villoria-González A, Zierfuss B, Parzer P, Heuböck E, Zujovic V, Waidhofer-Söllner P, Ponleitner M, Rommer P, Göpfert J, Forss-Petter S, Berger J, Weinhofer I. Efficacy of HDAC Inhibitors in Driving Peroxisomal β-Oxidation and Immune Responses in Human Macrophages: Implications for Neuroinflammatory Disorders. Biomolecules 2023; 13:1696. [PMID: 38136568 PMCID: PMC10741867 DOI: 10.3390/biom13121696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Elevated levels of saturated very long-chain fatty acids (VLCFAs) in cell membranes and secreted lipoparticles have been associated with neurotoxicity and, therefore, require tight regulation. Excessive VLCFAs are imported into peroxisomes for degradation by β-oxidation. Impaired VLCFA catabolism due to primary or secondary peroxisomal alterations is featured in neurodegenerative and neuroinflammatory disorders such as X-linked adrenoleukodystrophy and multiple sclerosis (MS). Here, we identified that healthy human macrophages upregulate the peroxisomal genes involved in β-oxidation during myelin phagocytosis and pro-inflammatory activation, and that this response is impaired in peripheral macrophages and phagocytes in brain white matter lesions in MS patients. The pharmacological targeting of VLCFA metabolism and peroxisomes in innate immune cells could be favorable in the context of neuroinflammation and neurodegeneration. We previously identified the epigenetic histone deacetylase (HDAC) inhibitors entinostat and vorinostat to enhance VLCFA degradation and pro-regenerative macrophage polarization. However, adverse side effects currently limit their use in chronic neuroinflammation. Here, we focused on tefinostat, a monocyte/macrophage-selective HDAC inhibitor that has shown reduced toxicity in clinical trials. By using a gene expression analysis, peroxisomal β-oxidation assay, and live imaging of primary human macrophages, we assessed the efficacy of tefinostat in modulating VLCFA metabolism, phagocytosis, chemotaxis, and immune function. Our results revealed the significant stimulation of VLCFA degradation with the upregulation of genes involved in peroxisomal β-oxidation and interference with immune cell recruitment; however, tefinostat was less potent than the class I HDAC-selective inhibitor entinostat in promoting a regenerative macrophage phenotype. Further research is needed to fully explore the potential of class I HDAC inhibition and downstream targets in the context of neuroinflammation.
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Affiliation(s)
- Andrea Villoria-González
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
| | - Bettina Zierfuss
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
- Department of Neuroscience, Centre de Recherche du CHUM, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Patricia Parzer
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
| | - Elisabeth Heuböck
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
| | - Violetta Zujovic
- Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, APHP, Hôpital Pitié Salpétrière—University Hospital, Sorbonne University, DMU Neuroscience 6, 75013 Paris, France
| | - Petra Waidhofer-Söllner
- Division of Immune Receptors and T Cell Activation, Institute of Immunology Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Ponleitner
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Jens Göpfert
- Department of Pharma and Biotech, NMI Natural and Medical Sciences Institute, University of Tübingen, 72770 Reutlingen, Germany
| | - Sonja Forss-Petter
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
| | - Johannes Berger
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
| | - Isabelle Weinhofer
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria; (A.V.-G.)
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Hashemi E, Narain Srivastava I, Aguirre A, Tilahan Yoseph E, Kaushal E, Awani A, Kyu. Ryu J, Akassoglou K, Talebian S, Chu P, Pisani L, Musolino P, Steinman L, Doyle K, Robinson WH, Sharpe O, Cayrol R, Orchard P, Lund T, Vogel H, Lenail M, Han MH, Bonkowsky JL, Van Haren KP. A novel mouse model of cerebral adrenoleukodystrophy highlights NLRP3 activity in lesion pathogenesis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.07.564025. [PMID: 37986739 PMCID: PMC10659266 DOI: 10.1101/2023.11.07.564025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Objective We sought to create and characterize a mouse model of the inflammatory, cerebral demyelinating phenotype of X-linked adrenoleukodystrophy (ALD) that would facilitate the study of disease pathogenesis and therapy development. We also sought to cross-validate potential therapeutic targets such as fibrin, oxidative stress, and the NLRP3 inflammasome, in post-mortem human and murine brain tissues. Background ALD is caused by mutations in the gene ABCD1 encoding a peroxisomal transporter. More than half of males with an ABCD1 mutation develop the cerebral phenotype (cALD). Incomplete penetrance and absence of a genotype-phenotype correlation imply a role for environmental triggers. Mechanistic studies have been limited by the absence of a cALD phenotype in the Abcd1-null mouse. Methods We generated a cALD phenotype in 8-week-old, male Abcd1-null mice by deploying a two-hit method that combines cuprizone (CPZ) and experimental autoimmune encephalomyelitis (EAE) models. We employed in vivo MRI and post-mortem immunohistochemistry to evaluate myelin loss, astrogliosis, blood-brain barrier (BBB) disruption, immune cell infiltration, fibrin deposition, oxidative stress, and Nlrp3 inflammasome activation in mice. We used bead-based immunoassay and immunohistochemistry to evaluate IL-18 in CSF and post-mortem human cALD brain tissue. Results MRI studies revealed T2 hyperintensities and post-gadolinium enhancement in the medial corpus callosum of cALD mice, similar to human cALD lesions. Both human and mouse cALD lesions shared common histologic features of myelin phagocytosis, myelin loss, abundant microglial activation, T and B-cell infiltration, and astrogliosis. Compared to wild-type controls, Abcd1-null mice had more severe cerebral inflammation, demyelination, fibrin deposition, oxidative stress, and IL-18 activation. IL-18 immunoreactivity co-localized with macrophages/microglia in the perivascular region of both human and mouse brain tissue. Interpretation This novel mouse model of cALD suggests loss of Abcd1 function predisposes to more severe cerebral inflammation, oxidative stress, fibrin deposition, and Nlrp3 pathway activation, which parallels the findings seen in humans with cALD. We expect this model to enable long-sought investigations into cALD mechanisms and accelerate development of candidate therapies for lesion prevention, cessation, and remyelination.
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Affiliation(s)
- Ezzat Hashemi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Isha Narain Srivastava
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Alejandro Aguirre
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ezra Tilahan Yoseph
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Esha Kaushal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Avni Awani
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jae Kyu. Ryu
- Gladstone Institute for Neurological Disease; San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF; San Francisco, CA USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; San Francisco, CA, USA
| | - Katerina Akassoglou
- Gladstone Institute for Neurological Disease; San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF; San Francisco, CA USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; San Francisco, CA, USA
| | - Shahrzad Talebian
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Pauline Chu
- Stanford Human Research Histology Core, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura Pisani
- Department of Radiology, Stanford University School of Medicine Stanford, CA, USA
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lawrence Steinman
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristian Doyle
- Department of Immunobiology, University of Arizona, Tucson, AZ, USA
| | - William H Robinson
- Department of Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Orr Sharpe
- Department of Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Romain Cayrol
- Department of Pathology, Clinical Department of Laboratory Medicine, University of Montreal, Quebec, Canada
| | - Paul Orchard
- Division of Pediatric Blood & Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Troy Lund
- Division of Pediatric Blood & Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Hannes Vogel
- Departments of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Lenail
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - May Htwe Han
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua Leith Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
- Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, Utah
- Primary Children’s Center for Personalized Medicine, Salt Lake City, Utah
| | - Keith P. Van Haren
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Stellingwerff MD, Pouwels PJW, Roosendaal SD, Barkhof F, van der Knaap MS. Quantitative MRI in leukodystrophies. Neuroimage Clin 2023; 38:103427. [PMID: 37150021 PMCID: PMC10193020 DOI: 10.1016/j.nicl.2023.103427] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
Leukodystrophies constitute a large and heterogeneous group of genetic diseases primarily affecting the white matter of the central nervous system. Different disorders target different white matter structural components. Leukodystrophies are most often progressive and fatal. In recent years, novel therapies are emerging and for an increasing number of leukodystrophies trials are being developed. Objective and quantitative metrics are needed to serve as outcome measures in trials. Quantitative MRI yields information on microstructural properties, such as myelin or axonal content and condition, and on the chemical composition of white matter, in a noninvasive fashion. By providing information on white matter microstructural involvement, quantitative MRI may contribute to the evaluation and monitoring of leukodystrophies. Many distinct MR techniques are available at different stages of development. While some are already clinically applicable, others are less far developed and have only or mainly been applied in healthy subjects. In this review, we explore the background, current status, potential and challenges of available quantitative MR techniques in the context of leukodystrophies.
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Affiliation(s)
- Menno D Stellingwerff
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Child Neurology, Emma Children's Hospital, and Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Petra J W Pouwels
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, and Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Stefan D Roosendaal
- Amsterdam UMC Location University of Amsterdam, Department of Radiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, and Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands; University College London, Institutes of Neurology and Healthcare Engineering, London, UK
| | - Marjo S van der Knaap
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Child Neurology, Emma Children's Hospital, and Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, De Boelelaan 1105, Amsterdam, the Netherlands.
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He R, Zhang J, Huang T, Cai G, Zou Z, Ye Q. Novel mutations in the ABCD1 gene caused adrenomyeloneuropathy in the Chinese population. Front Neurol 2023; 14:1126729. [PMID: 36925939 PMCID: PMC10011709 DOI: 10.3389/fneur.2023.1126729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Abstract
Background As a rare genetic disease, adrenomyeloneuropathy (AMN) is the most common adult phenotype of X-linked adrenoleukodystrophy (X-ALD). Mutations in the ABCD1 gene have been identified to cause AMN. Methods We applied clinical evaluation, laboratory tests, and neuroimaging on three patients with progressive spastic paraparesis. In genetic analysis, we investigated ABCD1 gene mutations by whole-exome sequencing and Sanger sequencing. Bioinformatics tools were used to predict the effects of identified ABCD1 mutations on the protein. Results All three patients were men with adult-onset disease, mainly characterized by progressive spastic paraparesis. Among them, two patients had peripheral neuropathy and one patient had signs of adrenal insufficiency. All three patients showed cerebral involvement on brain MRI, while two patients were found with diffuse cord atrophy on spinal MRI. High-VLCFA levels in plasma, as well as C24:0/C22:0 and C26:0/C22:0 ratios, were found in all three patients. In addition, three different ABCD1 mutations were identified in three unrelated Chinese families, including one known mutation (c.1415_1416delAG) and two novel mutations (c.217C>T and c.160_170delACGCAGGAGGC). Based on the clinical assessment, radiographic, biochemical, and genetic testing, the final diagnosis was AMN in these patients with spastic paraparesis. Conclusion This study reported three patients with AMN and identified two novel mutations in the ABCD1 in the Chinese population. Our finding emphasized that X-ALD is an important cause of adult-onset spastic paraplegia. Thus, neuroimaging, VLCFA testing, and especially the detection of the ABCD1 gene have important implications for the etiological diagnosis of adult patients with spastic paraplegia.
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Affiliation(s)
- Raoli He
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Jian Zhang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Tianwen Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhangyu Zou
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Key Laboratory of Molecular Neurology and Institute of Neuroscience, Fujian Medical University, Fuzhou, Fujian, China
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11
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van de Stadt SIW, Huffnagel IC, Turk BR, van der Knaap MS, Engelen M. Imaging in X-Linked Adrenoleukodystrophy. Neuropediatrics 2021; 52:252-260. [PMID: 34192790 DOI: 10.1055/s-0041-1730937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance imaging (MRI) is the gold standard for the detection of cerebral lesions in X-linked adrenoleukodystrophy (ALD). ALD is one of the most common peroxisomal disorders and is characterized by a defect in degradation of very long chain fatty acids (VLCFA), resulting in accumulation of VLCFA in plasma and tissues. The clinical spectrum of ALD is wide and includes adrenocortical insufficiency, a slowly progressive myelopathy in adulthood, and cerebral demyelination in a subset of male patients. Cerebral demyelination (cerebral ALD) can be treated with hematopoietic cell transplantation (HCT) but only in an early (pre- or early symptomatic) stage and therefore active MRI surveillance is recommended for male patients, both pediatric and adult. Although structural MRI of the brain can detect the presence and extent of cerebral lesions, it does not predict if and when cerebral demyelination will occur. There is a great need for imaging techniques that predict onset of cerebral ALD before lesions appear. Also, imaging markers for severity of myelopathy as surrogate outcome measure in clinical trials would facilitate drug development. New quantitative MRI techniques are promising in that respect. This review focuses on structural and quantitative imaging techniques-including magnetic resonance spectroscopy, diffusion tensor imaging, MR perfusion imaging, magnetization transfer (MT) imaging, neurite orientation dispersion and density imaging (NODDI), and myelin water fraction imaging-used in ALD and their role in clinical practice and research opportunities for the future.
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Affiliation(s)
- Stephanie I W van de Stadt
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Irene C Huffnagel
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bela R Turk
- Departments of Neurology and Pediatrics, Moser Center for Leukodystrophies, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | - Marjo S van der Knaap
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Zarekiani P, Breur M, Wolf NI, de Vries HE, van der Knaap MS, Bugiani M. Pathology of the neurovascular unit in leukodystrophies. Acta Neuropathol Commun 2021; 9:103. [PMID: 34082828 PMCID: PMC8173888 DOI: 10.1186/s40478-021-01206-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/24/2021] [Indexed: 01/20/2023] Open
Abstract
The blood-brain barrier is a dynamic endothelial cell barrier in the brain microvasculature that separates the blood from the brain parenchyma. Specialized brain endothelial cells, astrocytes, neurons, microglia and pericytes together compose the neurovascular unit and interact to maintain blood-brain barrier function. A disturbed brain barrier function is reported in most common neurological disorders and may play a role in disease pathogenesis. However, a comprehensive overview of how the neurovascular unit is affected in a wide range of rare disorders is lacking. Our aim was to provide further insights into the neuropathology of the neurovascular unit in leukodystrophies to unravel its potential pathogenic role in these diseases. Leukodystrophies are monogenic disorders of the white matter due to defects in any of its structural components. Single leukodystrophies are exceedingly rare, and availability of human tissue is unique. Expression of selective neurovascular unit markers such as claudin-5, zona occludens 1, laminin, PDGFRβ, aquaporin-4 and α-dystroglycan was investigated in eight different leukodystrophies using immunohistochemistry. We observed tight junction rearrangements, indicative of endothelial dysfunction, in five out of eight assessed leukodystrophies of different origin and an altered aquaporin-4 distribution in all. Aquaporin-4 redistribution indicates a general astrocytic dysfunction in leukodystrophies, even in those not directly related to astrocytic pathology or without prominent reactive astrogliosis. These findings provide further evidence for dysfunction in the orchestration of the neurovascular unit in leukodystrophies and contribute to a better understanding of the underlying disease mechanism.
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Affiliation(s)
- Parand Zarekiani
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, de Boelelaan 1117, 1081HV Amsterdam, The Netherlands
- Amsterdam Leukodystrophy Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marjolein Breur
- Amsterdam Leukodystrophy Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Child Neurology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Nicole I. Wolf
- Amsterdam Leukodystrophy Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Child Neurology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Helga E. de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marjo S. van der Knaap
- Amsterdam Leukodystrophy Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Child Neurology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Neuroscience, de Boelelaan 1117, 1081HV Amsterdam, The Netherlands
- Amsterdam Leukodystrophy Center, Amsterdam UMC, Amsterdam, The Netherlands
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Lazari A, Lipp I. Can MRI measure myelin? Systematic review, qualitative assessment, and meta-analysis of studies validating microstructural imaging with myelin histology. Neuroimage 2021; 230:117744. [PMID: 33524576 PMCID: PMC8063174 DOI: 10.1016/j.neuroimage.2021.117744] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 12/16/2022] Open
Abstract
Recent years have seen an increased understanding of the importance of myelination in healthy brain function and neuropsychiatric diseases. Non-invasive microstructural magnetic resonance imaging (MRI) holds the potential to expand and translate these insights to basic and clinical human research, but the sensitivity and specificity of different MR markers to myelination is a subject of debate. To consolidate current knowledge on the topic, we perform a systematic review and meta-analysis of studies that validate microstructural imaging by combining it with myelin histology. We find meta-analytic evidence for correlations between various myelin histology metrics and markers from different MRI modalities, including fractional anisotropy, radial diffusivity, macromolecular pool, magnetization transfer ratio, susceptibility and longitudinal relaxation rate, but not mean diffusivity. Meta-analytic correlation effect sizes range widely, between R2 = 0.26 and R2 = 0.82. However, formal comparisons between MRI-based myelin markers are limited by methodological variability, inconsistent reporting and potential for publication bias, thus preventing the establishment of a single most sensitive strategy to measure myelin with MRI. To facilitate further progress, we provide a detailed characterisation of the evaluated studies as an online resource. We also share a set of 12 recommendations for future studies validating putative MR-based myelin markers and deploying them in vivo in humans.
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Affiliation(s)
- Alberto Lazari
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Ilona Lipp
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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Ozturk K, Nascene D. Dentate Nucleus Signal Intensity Changes in Children with Adrenoleukodystrophy in Comparison to Primary Brain Tumor with and without Radiotherapy after Gadobutrol Administration. J Neuroimaging 2021; 31:602-608. [PMID: 33783925 DOI: 10.1111/jon.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE To determine whether cerebral adrenoleukodystrophy (cALD) or brain irradiation in patients with primary brain tumor affects T1-weighted imaging (T1WI) signal intensity (SI) of the dentate nucleus (DN) in a pediatric cohort who had received consecutive macrocyclic gadolinium-based contrast agent (mcGBCA) gadobutrol. METHODS This study included 97 pediatric patients who underwent mcGBCA-enhanced MRI from 2010 to 2020 (29 children with primary brain tumors without brain radiation therapy [mcGBCA group-1], 33 children with primary brain tumors and radiation treatment [mcGBCA group-2], 35 children with cALD [mcGBCA group-3], and 97 sex-/age-matched control subjects [subgroups matched to each of the three subject groups] without GBCA administration). The DN-to-middle cerebellar peduncle (MCP) SI ratios on T1WI were then determined. A paired t-test was performed to compare SI ratios between children exposed to mcGBCA in each group and control subjects. The relationships between SI ratios and confounding variables were analyzed utilizing the Pearson correlation analysis. RESULTS The DN-to-MCP SI ratio was significantly higher of mcGBCA group-2 (1.046±.071) or mcGBCA group-3 (.972±.038) than in the control group-2 (.983±.041, P<.001) and control group-3 (.937±.051, P = .002), respectively, but no significant difference of the SI ratio was noted between mcGBCA group-1 (.984±.032) and control-group-1 (.982±.035, P = .860). No significant correlation was noted between SI ratio values and the cumulative dose or number of mcGBCA administrations, age, or the elapsed time between the MRI examinations (all P>.05). CONCLUSIONS Hyperintense T1WI signal in the DN may be seen in children with brain tumors undergoing brain irradiation, as well as in children with cALD.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Health, Minneapolis, MN
| | - David Nascene
- Department of Radiology, University of Minnesota Health, Minneapolis, MN
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Abstract
X-linked adrenoleukodystrophy (ALD) is a peroxisomal disorder caused by mutations in the ABCD1 gene and characterized by impaired very long-chain fatty acid beta-oxidation. Clinically, male patients develop adrenal failure and a progressive myelopathy in adulthood, although age of onset and rate of progression are highly variable. Additionally, 40% of male patients develop a leukodystrophy (cerebral ALD) before the age of 18 years. Women with ALD also develop a myelopathy but generally at a later age than men and with slower progression. Adrenal failure and leukodystrophy are exceedingly rare in women. Allogeneic hematopoietic cell transplantation (HCT), or more recently autologous HCT with ex vivo lentivirally transfected bone marrow, halts the leukodystrophy. Unfortunately, there is no curative treatment for the myelopathy. In the following chapter, the biochemistry, pathology, and clinical spectrum of ALD are discussed in detail.
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Affiliation(s)
- Marc Engelen
- Department of Pediatric Neurology, Emma Children's Hospital, and Amsterdam Leukodystrophy Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - Stephan Kemp
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Florian Eichler
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
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van der Weijden CWJ, García DV, Borra RJH, Thurner P, Meilof JF, van Laar PJ, Dierckx RAJO, Gutmann IW, de Vries EFJ. Myelin quantification with MRI: A systematic review of accuracy and reproducibility. Neuroimage 2020; 226:117561. [PMID: 33189927 DOI: 10.1016/j.neuroimage.2020.117561] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Currently, multiple sclerosis is treated with anti-inflammatory therapies, but these treatments lack efficacy in progressive disease. New treatment strategies aim to repair myelin damage and efficacy evaluation of such new therapies would benefit from validated myelin imaging techniques. Several MRI methods for quantification of myelin density are available now. This systematic review aims to analyse the performance of these MRI methods. METHODS Studies comparing myelin quantification by MRI with histology, the current gold standard, or assessing reproducibility were retrieved from PubMed/MEDLINE and Embase (until December 2019). Included studies assessed both myelin histology and MRI quantitatively. Correlation or variance measurements were extracted from the studies. Non-parametric tests were used to analyse differences in study methodologies. RESULTS The search yielded 1348 unique articles. Twenty-two animal studies and 13 human studies correlated myelin MRI with histology. Eighteen clinical studies analysed the reproducibility. Overall bias risk was low or unclear. All MRI methods performed comparably, with a mean correlation between MRI and histology of R2=0.54 (SD=0.30) for animal studies, and R2=0.54 (SD=0.18) for human studies. Reproducibility for the MRI methods was good (ICC=0.75-0.93, R2=0.90-0.98, COV=1.3-27%), except for MTR (ICC=0.05-0.51). CONCLUSIONS Overall, MRI-based myelin imaging methods show a fairly good correlation with histology and a good reproducibility. However, the amount of validation data is too limited and the variability in performance between studies is too large to select the optimal MRI method for myelin quantification yet.
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Affiliation(s)
- Chris W J van der Weijden
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Ronald J H Borra
- Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Patrick Thurner
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Austria.
| | - Jan F Meilof
- Multiple Sclerosis Center Noord Nederland, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Peter-Jan van Laar
- Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Department of Radiology, Zorggroep Twente, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands.
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Ingomar W Gutmann
- Physics of Functional Material, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria.
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
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Richmond PA, van der Kloet F, Vaz FM, Lin D, Uzozie A, Graham E, Kobor M, Mostafavi S, Moerland PD, Lange PF, van Kampen AHC, Wasserman WW, Engelen M, Kemp S, van Karnebeek CDM. Multi-Omic Approach to Identify Phenotypic Modifiers Underlying Cerebral Demyelination in X-Linked Adrenoleukodystrophy. Front Cell Dev Biol 2020; 8:520. [PMID: 32671069 PMCID: PMC7330173 DOI: 10.3389/fcell.2020.00520] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
X-linked adrenoleukodystrophy (ALD) is a peroxisomal metabolic disorder with a highly complex clinical presentation. ALD is caused by mutations in the ABCD1 gene, and is characterized by the accumulation of very long-chain fatty acids in plasma and tissues. Disease-causing mutations are 'loss of function' mutations, with no prognostic value with respect to the clinical outcome of an individual. All male patients with ALD develop spinal cord disease and a peripheral neuropathy in adulthood, although age of onset is highly variable. However, the lifetime prevalence to develop progressive white matter lesions, termed cerebral ALD (CALD), is only about 60%. Early identification of transition to CALD is critical since it can be halted by allogeneic hematopoietic stem cell therapy only in an early stage. The primary goal of this study is to identify molecular markers which may be prognostic of cerebral demyelination from a simple blood sample, with the hope that blood-based assays can replace the current protocols for diagnosis. We collected six well-characterized brother pairs affected by ALD and discordant for the presence of CALD and performed multi-omic profiling of blood samples including genome, epigenome, transcriptome, metabolome/lipidome, and proteome profiling. In our analysis we identify discordant genomic alleles present across all families as well as differentially abundant molecular features across the omics technologies. The analysis was focused on univariate modeling to discriminate the two phenotypic groups, but was unable to identify statistically significant candidate molecular markers. Our study highlights the issues caused by a large amount of inter-individual variation, and supports the emerging hypothesis that cerebral demyelination is a complex mix of environmental factors and/or heterogeneous genomic alleles. We confirm previous observations about the role of immune response, specifically auto-immunity and the potential role of PFN1 protein overabundance in CALD in a subset of the families. We envision our methodology as well as dataset has utility to the field for reproducing previous or enabling future modifier investigations.
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Affiliation(s)
- Phillip A. Richmond
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Frans van der Kloet
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Frederic M. Vaz
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Chemistry, Amsterdam Gastroenterology & Metabolism, Amsterdam, Netherlands
| | - David Lin
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Anuli Uzozie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Michael Cuccione Childhood Cancer Research Program, BC Children’s Hospital, Vancouver, BC, Canada
| | - Emma Graham
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Michael Kobor
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Sara Mostafavi
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Perry D. Moerland
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Philipp F. Lange
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Michael Cuccione Childhood Cancer Research Program, BC Children’s Hospital, Vancouver, BC, Canada
| | - Antoine H. C. van Kampen
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Wyeth W. Wasserman
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Neuroscience, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Stephan Kemp
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Chemistry, Amsterdam Gastroenterology & Metabolism, Amsterdam, Netherlands
- Department of Pediatric Neurology, Amsterdam Neuroscience, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Clara D. M. van Karnebeek
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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18
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Zhang Y, Cui G, Wang Y, Gong Y, Wang Y. SIRT1 activation alleviates brain microvascular endothelial dysfunction in peroxisomal disorders. Int J Mol Med 2019; 44:995-1005. [PMID: 31257461 PMCID: PMC6657955 DOI: 10.3892/ijmm.2019.4250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/11/2019] [Indexed: 02/03/2023] Open
Abstract
Peroxisomal disorders are genetically heterogeneous metabolic disorders associated with a deficit of very long chain fatty acid β-oxidation that commonly manifest as early-onset neurodegeneration. Brain microvascular endothelial dysfunction with increased permeability to monocytes has been described in X-linked adrenoleukodystrophy, one of the most common peroxisomal disorders caused by mutations of the ATP binding cassette subfamily D member 1 (ABCD1) gene. The present study demonstrated that dysregulation of sirtuin 1 (SIRT1) in human brain microvascular endothelial cells (HBMECs) mediates changes in adhesion molecules and tight-junction protein expression, as well as increased adhesion to monocytes associated with peroxisomal dysfunction due to ABCD1 or hydroxysteroid 17-β dehydrogenase 4 silencing. Furthermore, enhancement of the function of SIRT1 by resve-ratrol attenuated this molecular and functional dysregulation of HBMECs via modulation of the nuclear factor-κB and Krüppel-like factor 4 signaling pathways.
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Affiliation(s)
- Yunshan Zhang
- Department of Anatomy and Embryology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yue Wang
- Department of Neurobiology and Anatomy, Xuzhou Key Laboratory of Neurobiology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yi Gong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yulan Wang
- Department of Anatomy and Embryology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
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19
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Liberato AP, Mallack EJ, Aziz-Bose R, Hayden D, Lauer A, Caruso PA, Musolino PL, Eichler FS. MRI brain lesions in asymptomatic boys with X-linked adrenoleukodystrophy. Neurology 2019; 92:e1698-e1708. [PMID: 30902905 PMCID: PMC6511088 DOI: 10.1212/wnl.0000000000007294] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/30/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the brain MRI findings in asymptomatic patients with childhood cerebral adrenoleukodystrophy (CCALD). METHODS We retrospectively reviewed a series of biochemically or genetically confirmed cases of adrenoleukodystrophy followed at our institution between 2001 and 2015. We identified and analyzed 219 brain MRIs from 47 asymptomatic boys (median age 6.0 years). Patient age, MRI scan, and brain lesion characteristics (e.g., contrast enhancement, volume, and Loes score) were recorded. The rate of lesion growth was estimated using a linear mixed effect model. RESULTS Sixty percent of patients (28/47) showed brain lesions (median Loes score of 3.0 points; range 0.5-11). Seventy-nine percent of patients with CCALD (22/28) had contrast enhancement on first lesional or subsequent MRI. Lesion progression (Loes increase of ≥0.5 point) was seen in 50% of patients (14/28). The rate of lesion growth (mL/mo) was faster in younger patients (r = -0.745; p < 0.0001). Older patients (median age 14.4 y/o) tended to undergo spontaneous arrest of disease. Early lesions grew 46× faster when still limited to the splenium, genu of the corpus callosum, or the brainstem (p = 0.001). CONCLUSION We provide a description of CCALD lesion development in a cohort of asymptomatic boys. Understanding the early stages of CCALD is crucial to optimize treatments for children diagnosed by newborn screening.
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Affiliation(s)
- Afonso P Liberato
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Eric J Mallack
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Razina Aziz-Bose
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Doug Hayden
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Arne Lauer
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Paul A Caruso
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Patricia L Musolino
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York
| | - Florian S Eichler
- From the Department of Radiology, Division of Neuroradiology (A.P.L., P.A.C.), Department of Neurology (E.J.M., R.A.-B., A.L., P.L.M., F.S.E.), and Department of Biostatistics (D.H.), Harvard Medical School, Massachusetts General Hospital, Boston; and Department of Pediatrics, Division of Child Neurology (E.J.M.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York.
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20
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Lauer A, Da X, Hansen MB, Boulouis G, Ou Y, Cai X, Liberato Celso Pedrotti A, Kalpathy-Cramer J, Caruso P, Hayden DL, Rost N, Mouridsen K, Eichler FS, Rosen B, Musolino PL. ABCD1 dysfunction alters white matter microvascular perfusion. Brain 2017; 140:3139-3152. [PMID: 29136088 PMCID: PMC5841142 DOI: 10.1093/brain/awx262] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/18/2017] [Indexed: 12/17/2022] Open
Abstract
Cerebral X-linked adrenoleukodystrophy is a devastating neurodegenerative disorder caused by mutations in the ABCD1 gene, which lead to a rapidly progressive cerebral inflammatory demyelination in up to 60% of affected males. Selective brain endothelial dysfunction and increased permeability of the blood–brain barrier suggest that white matter microvascular dysfunction contributes to the conversion to cerebral disease. Applying a vascular model to conventional dynamic susceptibility contrast magnetic resonance perfusion imaging, we demonstrate that lack of ABCD1 function causes increased capillary flow heterogeneity in asymptomatic hemizygotes predominantly in the white matter regions and developmental stages with the highest probability for conversion to cerebral disease. In subjects with ongoing inflammatory demyelination we observed a sequence of increased capillary flow heterogeneity followed by blood–brain barrier permeability changes in the perilesional white matter, which predicts lesion progression. These white matter microvascular alterations normalize within 1 year after treatment with haematopoietic stem cell transplantation. For the first time in vivo, our studies unveil a model to assess how ABCD1 alters white matter microvascular function and explores its potential as an earlier biomarker for monitoring disease progression and response to treatment.
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Affiliation(s)
- Arne Lauer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neuroradiology, Goethe University, Frankfurt a.M., Germany
| | - Xiao Da
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | | | - Gregoire Boulouis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, France
| | - Yangming Ou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Xuezhu Cai
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | | | | | - Paul Caruso
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas L Hayden
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kim Mouridsen
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Florian S Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia L Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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21
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Curiel J, Steinberg SJ, Bright S, Snowden A, Moser AB, Eichler F, Dubbs HA, Hacia JG, Ely JJ, Bezner J, Gean A, Vanderver A. X-linked adrenoleukodystrophy in a chimpanzee due to an ABCD1 mutation reported in multiple unrelated humans. Mol Genet Metab 2017; 122:130-133. [PMID: 28919002 DOI: 10.1016/j.ymgme.2017.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND X-linked adrenoleukodystrophy (X-ALD) is a genetic disorder leading to the accumulation of very long chain fatty acids (VLCFA) due to a mutation in the ABCD1 gene. ABCD1 mutations lead to a variety of phenotypes, including cerebral X-ALD and adrenomyeloneuropathy (AMN) in affected males and 80% of carrier females. There is no definite genotype-phenotype correlation with intrafamilial variability. Cerebral X-ALD typically presents in childhood, but can also present in juveniles and adults. The most affected tissues are the white matter of the brain and adrenal cortex. MRI demonstrates a characteristic imaging appearance in cerebral X-ALD that is used as a diagnostic tool. OBJECTIVES We aim to correlate a mutation in the ABCD1 gene in a chimpanzee to the human disease X-ALD based on MRI features, neurologic symptoms, and plasma levels of VLCFA. METHODS Diagnosis of X-ALD made using MRI, blood lipid profiling, and DNA sequencing. RESULTS An 11-year-old chimpanzee showed remarkably similar features to juvenile onset cerebral X-ALD in humans including demyelination of frontal lobes and corpus callosum on MRI, elevated plasma levels of C24:0 and C26:0, and identification of the c.1661G>A ABCD1 variant. CONCLUSIONS This case study presents the first reported case of a leukodystrophy in a great ape, and underscores the fidelity of MRI pattern recognition in this disorder across species.
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Affiliation(s)
- Julian Curiel
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Steven Jeffrey Steinberg
- DNA Diagnostic Laboratory, Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, United States.
| | - Sarah Bright
- DNA Diagnostic Laboratory, Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, United States.
| | - Ann Snowden
- The Hugo W. Moser Research Institute, Kennedy Krieger Institute Inc, Baltimore, MD, United States.
| | - Ann B Moser
- The Hugo W. Moser Research Institute, Kennedy Krieger Institute Inc, Baltimore, MD, United States.
| | - Florian Eichler
- Center for Rare Neurological Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Holly A Dubbs
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Joseph G Hacia
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, LA, California, United States.
| | | | | | - Alisa Gean
- Department of Neuroradiology, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States.
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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22
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Abstract
Neuroinflammation is an intrinsic component of the neurodegeneration of inborn errors of neurometabolic diseases. Diseases resulting in lysosomal, peroxisomal, and autophagocytic disruption lead to neuroinflammation by different mechanisms relating to accumulated substrates and/or downstream deficiencies that cause presymptomatic microglial activation, axonal instabilities and/or direct hyperactivation of intrinsic inflammatory mechanisms. Only in selected diseases is the blood-brain barrier (BBB) breached, thereby permitting peripheral adaptive immune mechanisms to amplify intrinsic immune reactions in the central nervous system. These result in evoking several different programmed cell death pathways, including apoptosis, necroptosis, and pyroptosis, with the subsequent neuronal death of specific types and in selected regions of the brain or spinal cord. In addition to correction of the primary genetic or metabolic defects, successful therapeutic interventions require greater molecular understanding of the specific neuroinflammatory components of neurometabolic diseases to permit identification of significant targets for intervention.
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Affiliation(s)
- Gregory A Grabowski
- The Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Kiniksa Pharmaceuticals Ltd., Wellesley, MA.
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23
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정을식, 강훈철, 고아라. X-linked adrenoleukodystrophy; Recent Advances in Classification, Diagnosis and Management. ACTA ACUST UNITED AC 2016. [DOI: 10.26815/jkcns.2016.24.3.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Steenweg ME, Wolf NI, van Wieringen WN, Barkhof F, van der Knaap MS, Pouwels PJ. Quantitative MRI in hypomyelinating disorders. Neurology 2016; 87:752-8. [DOI: 10.1212/wnl.0000000000003000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/12/2016] [Indexed: 12/31/2022] Open
Abstract
Objective:To assess the correlation of tissue parameters estimated by quantitative magnetic resonance (MR) techniques and motor handicap in patients with hypomyelination.Methods:Twenty-eight patients with different causes of hypomyelination (12 males, 16 females; mean age 10 years) and 61 controls (33 males, 28 females; mean age 8 years) were prospectively investigated. We quantified T2 relaxation time, magnetization transfer ratio, fractional anisotropy, mean, axial, and radial diffusivities, and brain metabolites. We performed measurements in the splenium, parietal deep white matter, and corticospinal tracts in the centrum semiovale. We further analyzed diffusion measures using tract-based spatial statistics. We estimated severity of motor handicap by the gross motor function classification system. We evaluated correlation of handicap with MR measures by linear regression analyses.Results:Fractional anisotropy, magnetization transfer ratio, choline, and N-acetylaspartate/creatine ratio were lower and diffusivities, T2 values, and inositol were higher in patients than in controls. Tract-based spatial statistics showed that these changes were widespread for fractional anisotropy (96% of the white matter skeleton), radial (93%) and mean (84%) diffusivity, and less so for axial diffusivity (20%). Correlation with handicap yielded radial diffusivity and N-acetylaspartate/creatine ratio as strongest independent explanatory variables.Conclusions:Gross motor function classification system grades are in part explained by MR measures. They indicate that mainly lack of myelin and, to a lesser degree, loss of axonal integrity codetermine the degree of motor handicap in patients with hypomyelinating disorders. These MR measures can be used to evaluate strategies that are aimed at promotion of myelination.
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25
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Musolino PL, Gong Y, Snyder JMT, Jimenez S, Lok J, Lo EH, Moser AB, Grabowski EF, Frosch MP, Eichler FS. Brain endothelial dysfunction in cerebral adrenoleukodystrophy. Brain 2015; 138:3206-20. [PMID: 26377633 DOI: 10.1093/brain/awv250] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 07/03/2015] [Indexed: 01/31/2023] Open
Abstract
See Aubourg (doi:10.1093/awv271) for a scientific commentary on this article.X-linked adrenoleukodystrophy is caused by mutations in the ABCD1 gene leading to accumulation of very long chain fatty acids. Its most severe neurological manifestation is cerebral adrenoleukodystrophy. Here we demonstrate that progressive inflammatory demyelination in cerebral adrenoleukodystrophy coincides with blood-brain barrier dysfunction, increased MMP9 expression, and changes in endothelial tight junction proteins as well as adhesion molecules. ABCD1, but not its closest homologue ABCD2, is highly expressed in human brain microvascular endothelial cells, far exceeding its expression in the systemic vasculature. Silencing of ABCD1 in human brain microvascular endothelial cells causes accumulation of very long chain fatty acids, but much later than the immediate upregulation of adhesion molecules and decrease in tight junction proteins. This results in greater adhesion and transmigration of monocytes across the endothelium. PCR-array screening of human brain microvascular endothelial cells after ABCD1 silencing revealed downregulation of both mRNA and protein levels of the transcription factor c-MYC (encoded by MYC). Interestingly, MYC silencing mimicked the effects of ABCD1 silencing on CLDN5 and ICAM1 without decreasing the levels of ABCD1 protein itself. Together, these data demonstrate that ABCD1 deficiency induces significant alterations in brain endothelium via c-MYC and may thereby contribute to the increased trafficking of leucocytes across the blood-brain barrier as seen in cerebral adrenouleukodystrophy.
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Affiliation(s)
- Patricia L Musolino
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 2 Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Yi Gong
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 2 Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Juliet M T Snyder
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sandra Jimenez
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Josephine Lok
- 3 Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Eng H Lo
- 3 Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ann B Moser
- 4 Hugo W Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Eric F Grabowski
- 5 Department of Paediatric Haematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew P Frosch
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 6 C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
| | - Florian S Eichler
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 2 Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, MA, USA
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26
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Bladowska J, Kulej D, Biel A, Zimny A, Kałwak K, Owoc-Lempach J, Porwolik J, Stradomska TJ, Zaleska-Dorobisz U, Sąsiadek MJ. The Role of MR Imaging in the Assessment of Clinical Outcomes in Children with X-Linked Adrenoleukodystrophy after Allogeneic Haematopoietic Stem Cell Transplantation. Pol J Radiol 2015; 80:181-90. [PMID: 25908949 PMCID: PMC4396687 DOI: 10.12659/pjr.893285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/05/2015] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the study was to analyse MR images of the brain, including advanced MR techniques, such as single voxel spectroscopy (MRS) and diffusion tensor imaging (DTI), in children with X-linked adrenoleukodystrophy (X-ALD) before and after haematopoietic stem cell transplantation (HSCT) and to establish the imaging criteria which may be helpful in the assessment of disease staging, qualification to HSCT and follow-up. Material/Methods Seven boys, aged 5–10 years, (mean 8.14 years) with biochemically proved X-ALD, underwent plain MR imaging with a 1.5 T unit before and after HSCT. Structural images were analyzed using an MRI severity scale (Loes scale). In one patient the follow-up examinations included MRS with the assessment of metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr), as well as DTI with evaluation of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in several white matter tracts. Results Two boys had an MRI severity score before HSCT equal to <8 points, and after HSCT they showed no clinical or radiological progression. In 5 patients with a higher severity score (from 8 to 16 points, mean 10.9) before HSCT, clinical and radiological progression was observed (MRI severity score from 17 to 25 points, mean 20.9). Follow-up advanced MRI techniques in one boy showed metabolic alterations, as well as decreased FA and ADC values in all evaluated areas. Conclusions Children at an early stage of X-ALD (below 8 points in MRI severity scale) are more likely to benefit from HSCT. DTI and MRS seem to be more useful imaging methods to assess the progression of X-ALD.
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Affiliation(s)
- Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Dominika Kulej
- Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Wrocław Medical University, Wrocław, Poland
| | - Anna Biel
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Anna Zimny
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Wrocław Medical University, Wrocław, Poland
| | - Joanna Owoc-Lempach
- Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Wrocław Medical University, Wrocław, Poland
| | - Julita Porwolik
- Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Wrocław Medical University, Wrocław, Poland
| | - Teresa Joanna Stradomska
- Department of Biochemistry, Radioimmunology and Experimental Medicine, Children's Memorial Health Institute, Warsaw, Poland
| | | | - Marek J Sąsiadek
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University, Wrocław, Poland
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27
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Ono SE, de Carvalho Neto A, Gasparetto EL, Coelho LODM, Escuissato DL, Bonfim CMS, Ribeiro LL. X-linked adrenoleukodystrophy: correlation between Loes score and diffusion tensor imaging parameters. Radiol Bras 2015; 47:342-9. [PMID: 25741116 PMCID: PMC4341377 DOI: 10.1590/0100-3984.2013.1886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 04/29/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The present study was aimed at evaluating the correlation between diffusion tensor imaging parameters and Loes score as well as whether those parameters could indicate early structural alterations. MATERIALS AND METHODS Diffusion tensor imaging measurements were obtained in 30 studies of 14 patients with X-linked adrenoleukodystrophy and were correlated with Loes scores. A control group including 28 male patients was created to establish agematched diffusion tensor imaging measurements. Inter- and intraobserver statistical analyses were undertaken. RESULTS Diffusion tensor imaging measurements presented strong Pearson correlation coefficients (r) of -0.86, 0.89, 0.89 and 0.84 for fractional anisotropy and mean, radial and axial diffusivities (p < 0.01). Analysis of changes in diffusion tensor measurements at early stage of the disease indicates that mean and radial diffusivities might be useful to predict the disease progression. CONCLUSION Measurements of diffusion tensor parameters can be used as an adjunct to the Loes score, aiding in the monitoring of the disease and alerting for possible Loes score progression in the range of interest for therapeutic decisions.
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Affiliation(s)
- Sergio Eiji Ono
- Master, MD, Radiologist at Clínica DAPI - Diagnóstico Avançado por Imagem, Curitiba, PR, Brazil
| | - Arnolfo de Carvalho Neto
- PhDs, Associate Professors, Universidade Federal do Paraná (UFPR), Radiologists at Clínica DAPI - Diagnóstico Avançado por Imagem, Curitiba, PR, Brazil
| | - Emerson Leandro Gasparetto
- PhD, Research Productivity Scholar - Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Course of Post-graduation in Medicine (Radiology), Department of Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luiz Otávio de Mattos Coelho
- Titular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at Clínica DAPI - Diagnóstico Avançado por Imagem, Curitiba, PR, Brazil
| | - Dante Luiz Escuissato
- PhDs, Associate Professors, Universidade Federal do Paraná (UFPR), Radiologists at Clínica DAPI - Diagnóstico Avançado por Imagem, Curitiba, PR, Brazil
| | - Carmem Maria Sales Bonfim
- MD, Hematologist, Coordinator for the Pediatric Bone Marrow Transplant Program at Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | - Lisandro Lima Ribeiro
- MD, Hematologist, Fanconi Anemia Clinica at Service of Bone Marrow Transplant, Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
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28
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Chen X, Chen Z, Huang D, Liu X, Gui Q, Yu S. Adult cerebral adrenoleukodystrophy and Addison's disease in a female carrier. Gene 2014; 544:248-51. [PMID: 24768737 DOI: 10.1016/j.gene.2014.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/10/2014] [Accepted: 04/24/2014] [Indexed: 12/24/2022]
Abstract
We described a 38-year-old woman of rapidly progressive dementia with white matter encephalopathy and death. She had Addison's disease but the adrenal glands were hyperplastic. Brain magnetic resonance imaging revealed diffuse white matter lesion predominantly in the frontal lobe with band-like contrast enhancement. l-Methyl-11C-methionine positron emission tomography revealed accumulation of tracer in bilateral frontal lobes. Stereotactic biopsy demonstrated demyelination changes. A number of urinary organic acids were elevated. Adrenoleukodystrophy was diagnosed by elevated plasma very long chain fatty acid and ABCD1 gene mutation (C1544C/T). Adrenoleukodystrophy should be considered as a differential diagnosis in women with rapidly progressive white matter encephalopathy.
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Affiliation(s)
- Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dehui Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiaofeng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Qiuping Gui
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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29
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Pop M, Ghugre NR, Ramanan V, Morikawa L, Stanisz G, Dick AJ, Wright GA. Quantification of fibrosis in infarcted swine hearts byex vivolate gadolinium-enhancement and diffusion-weighted MRI methods. Phys Med Biol 2013; 58:5009-28. [DOI: 10.1088/0031-9155/58/15/5009] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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30
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McKinney AM, Nascene D, Miller WP, Eisengart J, Loes D, Benson M, Tolar J, Orchard PJ, Ziegler RS, Zhang L, Provenzale J. Childhood cerebral X-linked adrenoleukodystrophy: diffusion tensor imaging measurements for prediction of clinical outcome after hematopoietic stem cell transplantation. AJNR Am J Neuroradiol 2013; 34:641-9. [PMID: 22899791 DOI: 10.3174/ajnr.a3232] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI in cerebral X-linked adrenoleukodystrophy may demonstrate abnormalities in both affected and nonaffected WM; these values have not been studied serially after hematopoietic stem cell transplantation. The purpose of this study was to study pretransplant and posttransplant DTI parameters serially and ultimately to determine the ability of pretransplant DTI parameters to predict clinical outcome after HSCT in children with ALD. MATERIALS AND METHODS Eight patients with posterior-pattern cerebral ALD underwent DTI at 3T before HSCT (T0), at 30-60 days (T1), 90-120 days (T2), 180 days (T3), and 1 year (T4) after HSCT. FA and MD were serially measured in 19 regions, and these measurements were compared with those in control patients. MR imaging severity (Loes) scores were recorded. Correlations were performed between DTI parameters and Loes scores, neurologic function scores, and several neuropsychologic scores. RESULTS Both FA and MD in subjects differed significantly from that in controls at nearly every time point within cerebellar WM, callosal splenium, and parieto-occipital WM; FA alone was significantly different at each time point within the optic radiations, lateral geniculate, and the Meyer loop (P < .05). Loes scores at T0 correlated strongly with each clinical score at T4 (r = 0.771-0.986, P < .05). The only significant DTI correlation at T0 with a clinical score at T4 was callosal body FA with adaptive function (r = 0.976, P < .001). Correlating the change in DTI values with change in NFS (change between T0 and T4) showed that only ΔMD within the optic radiations correlated strongly with ΔNFS (r = 0.903, P < .05). CONCLUSIONS DTI values at T0 were generally poor predictors of outcome at 1 year, whereas Loes scores were generally good predictors. ΔMD within the optic radiations strongly correlates with ΔNFS over that year. In addition, certain normal-appearing regions, such as cerebellar WM, may have DTI abnormalities before HSCT that persist after HSCT.
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Affiliation(s)
- A M McKinney
- Department of Radiology, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota, USA.
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31
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Musolino PL, Rapalino O, Caruso P, Caviness VS, Eichler FS. Hypoperfusion predicts lesion progression in cerebral X-linked adrenoleukodystrophy. Brain 2012; 135:2676-83. [PMID: 22961546 DOI: 10.1093/brain/aws206] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance imaging sequences such as diffusion and spectroscopy have been well studied in X-linked adrenoleukodystrophy, but no data exist on magnetic resonance perfusion imaging. Since inflammation is known to modulate the microcirculation, we investigated the hypothesis that changes in the local perfusion might be one of the earliest signs of lesion development. Twenty patients with different phenotypes of adrenoleukodystrophy and seven age-matched controls were evaluated between 2006 and 2011. Fluid attenuated inversion recovery, post-contrast T(1)-weighted and normalized dynamic susceptibility contrast magnetic resonance perfusion cerebral blood volume maps were co-registered, segmented when cerebral lesion was present, and normalized cerebral blood volume values were analysed using a Food and Drug Association approved magnetic resonance perfusion software (NordicICE). Clinical and imaging data were reviewed to determine phenotype and status of progression. All eight patients with cerebral adrenoleukodystrophy had an average 80% decrease in normalized cerebral blood volume at the core of the lesion (P < 0.0001). Beyond the leading edge of contrast enhancement cerebral perfusion varied, patients with progressive lesions showed an average 60% decrease in normalized cerebral blood volume (adults P < 0.05; children P < 0.001), while one child with arrested progression normalized cerebral blood volume in this region. In six of seven patients with cerebral adrenoleukodystrophy lesions and follow-up imaging (2-24 month interval period), we found progression of contrast enhancement into the formerly hypoperfused perilesional zone. Asymptomatic, adrenomyeloneuropathy and female heterozygote patients had no significant changes in cerebral perfusion. Our data indicate that decreased brain magnetic resonance perfusion precedes leakage of the blood-brain barrier as demonstrated by contrast enhancement in cerebral adrenoleukodystrophy and is an early sign of lesion progression.
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32
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2012; 19:233-47. [PMID: 22531108 DOI: 10.1097/med.0b013e3283542fb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Due to nonspecific clinical presentation, diagnosis of metabolic disorders affecting the brain is very challenging for physicians. It is always the constellation of the clinical examination, biochemical assay and imaging that helps in reaching the diagnosis of metabolic disorders. Diagnosis of these disorders or even limiting the differential diagnosis on imaging may pose a formidable challenge to the radiologist. In these two articles (Metabolic Disorders of the Brain: Parts I and II) we have tried to highlight the important clinical and imaging pearls of the major and more commonly encountered metabolic disorders. In the first article we discuss metabolic disorders related to dysfunction of the cellular organelle namely lysosomal, peroxisomal, and mitochondrial. We have also discussed the relevant genetic abnormalities, biochemical findings and application of newer imaging techniques which may aid in diagnosis of these various disorders.
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Affiliation(s)
- Sangam Kanekar
- Department of Radiology, Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA 17033, USA.
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