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Cyr B, Curiel Cid R, Loewenstein D, Vontell RT, Dietrich WD, Keane RW, de Rivero Vaccari JP. The Inflammasome Adaptor Protein ASC in Plasma as a Biomarker of Early Cognitive Changes. Int J Mol Sci 2024; 25:7758. [PMID: 39063000 PMCID: PMC11276719 DOI: 10.3390/ijms25147758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a group of symptoms including memory loss, language difficulties, and other types of cognitive and functional impairments that affects 57 million people worldwide, with the incidence expected to double by 2040. Therefore, there is an unmet need to develop reliable biomarkers to diagnose early brain impairments so that emerging interventions can be applied before brain degeneration. Here, we performed biomarker analyses for apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and amyloid-β 42/40 (Aβ42/40) ratio in the plasma of older adults. Participants had blood drawn at baseline and underwent two annual clinical and cognitive evaluations. The groups tested either cognitively normal on both evaluations (NN), cognitively normal year 1 but cognitively impaired year 2 (NI), or cognitively impaired on both evaluations (II). ASC was elevated in the plasma of the NI group compared to the NN and II groups. Additionally, Aβ42 was increased in the plasma in the NI and II groups compared to the NN group. Importantly, the area under the curve (AUC) for ASC in participants older than 70 years old in NN vs. NI groups was 0.81, indicating that ASC is a promising plasma biomarker for early detection of cognitive decline.
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Affiliation(s)
- Brianna Cyr
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA; (B.C.); (W.D.D.); (R.W.K.)
| | - Rosie Curiel Cid
- Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL 33136, USA; (R.C.C.); (D.L.)
| | - David Loewenstein
- Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL 33136, USA; (R.C.C.); (D.L.)
| | | | - W. Dalton Dietrich
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA; (B.C.); (W.D.D.); (R.W.K.)
| | - Robert W. Keane
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA; (B.C.); (W.D.D.); (R.W.K.)
- Department of Physiology and Biophysics, University of Miami, Miami, FL 33136, USA
| | - Juan Pablo de Rivero Vaccari
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA; (B.C.); (W.D.D.); (R.W.K.)
- Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL 33136, USA; (R.C.C.); (D.L.)
- Department of Physiology and Biophysics, University of Miami, Miami, FL 33136, USA
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Howe MD, Britton KJ, Joyce HE, Menard W, Emrani S, Kunicki ZJ, Faust MA, Dawson BC, Riddle MC, Huey ED, Janelidze S, Hansson O, Salloway SP. Clinical application of plasma P-tau217 to assess eligibility for amyloid-lowering immunotherapy in memory clinic patients with early Alzheimer's disease. Alzheimers Res Ther 2024; 16:154. [PMID: 38971815 PMCID: PMC11227160 DOI: 10.1186/s13195-024-01521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND With the approval of disease-modifying treatments (DMTs) for early Alzheimer's disease (AD), there is an increased need for efficient and non-invasive detection methods for cerebral amyloid-β (Aβ) pathology. Current methods, including positron emission tomography (PET) and cerebrospinal fluid (CSF) analysis, are costly and invasive methods that may limit access to new treatments. Plasma tau phosphorylated at threonine-217 (P-tau217) presents a promising alternative, yet optimal cutoffs for treatment eligibility with DMTs like aducanumab require further investigation. This study evaluates the efficacy of one- and two-cutoff strategies for determining DMT eligibility at the Butler Hospital Memory & Aging Program (MAP). METHODS In this retrospective, cross-sectional diagnostic cohort study, we first developed P-tau217 cutoffs using site-specific and BioFINDER-2 training data, which were then tested in potential DMT candidates from Butler MAP (total n = 150). ROC analysis was used to calculate the area under the curve (AUC) and accuracy of P-tau217 interpretation strategies, using Aβ-PET/CSF testing as the standard of truth. RESULTS Potential DMT candidates at Butler MAP (n = 50), primarily diagnosed with mild cognitive impairment (n = 29 [58%]) or mild dementia (21 [42%]), were predominantly Aβ-positive (38 [76%]), and half (25 [50%]) were subsequently treated with aducanumab. Elevated P-tau217 predicted cerebral Aβ positivity in potential DMT candidates (AUC = 0.97 [0.92-1]), with diagnostic accuracy ranging from 0.88 (0.76-0.95, p = 0.028) to 0.96 (0.86-1, p < .001). When using site-specific cutoffs, a subset of DMT candidates (10%) exhibited borderline P-tau217 (between 0.273 and 0.399 pg/mL) that would have potentially required confirmatory testing. CONCLUSIONS This study, which included participants treated with aducanumab, confirms the utility of one- and two-cutoff strategies for interpreting plasma P-tau217 in assessing DMT eligibility. Using P-tau217 could potentially replace more invasive diagnostic methods, and all aducanumab-treated participants would have been deemed eligible based on P-tau217. However, false positives remain a concern, particularly when applying externally derived cutoffs that exhibited lower specificity which could have led to inappropriate treatment of Aβ-negative participants. Future research should focus on prospective validation of P-tau217 cutoffs to enhance their generalizability and inform standardized treatment decision-making across diverse populations.
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Affiliation(s)
- Matthew D Howe
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | | | - Hannah E Joyce
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - William Menard
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Sheina Emrani
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Melanie A Faust
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Brittany C Dawson
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Meghan C Riddle
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Edward D Huey
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Shorena Janelidze
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Stephen P Salloway
- Butler Hospital Memory & Aging Program, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Howe MD, Britton KJ, Joyce HE, Menard W, Emrani S, Kunicki ZJ, Faust MA, Dawson BC, Riddle MC, Huey ED, Janelidze S, Hansson O, Salloway SP. Clinical application of plasma P-tau217 to assess eligibility for amyloid-lowering immunotherapy in memory clinic patients with early Alzheimer's disease. RESEARCH SQUARE 2024:rs.3.rs-3755419. [PMID: 38853872 PMCID: PMC11160917 DOI: 10.21203/rs.3.rs-3755419/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background With the approval of disease-modifying treatments (DMTs) for early Alzheimer's disease (AD), there is an increased need for efficient and non-invasive detection methods for cerebral amyloid-β (Aβ) pathology. Current methods, including positron emission tomography (PET) and cerebrospinal fluid (CSF) analysis, are costly and invasive methods that may limit access to new treatments. Plasma tau phosphorylated at threonine-217 (P-tau217) presents a promising alternative, yet optimal cutoffs for treatment eligibility with DMTs like aducanumab require further investigation. This study evaluates the efficacy of one- and two-cutoff strategies for determining DMT eligibility at the Butler Hospital Memory & Aging Program (MAP). Methods In this retrospective, cross-sectional diagnostic cohort study, we first developed P-tau217 cutoffs using site-specific training data and BioFINDER-2, which were then tested in potential DMT candidates from Butler MAP (total n = 150). ROC analysis was used to calculate the area under the curve (AUC) and accuracy of P-tau217 interpretation strategies, using Aβ-PET/CSF testing as the standard of truth. Results Potential DMT candidates at Butler MAP (n = 50), primarily diagnosed with mild cognitive impairment (n = 29 [58%]) or mild dementia (21 [42%]), were predominantly Aβ-positive (38 [76%]), and half (25 [50%]) were subsequently treated with aducanumab. Elevated P-tau217 predicted cerebral Aβ positivity in potential DMT candidates (AUC = 0.97 [0.92-1]), with diagnostic accuracy ranging from 0.88 (0.76-0.95, p = 0.028) to 0.96 (0.86-1, p < .001). When using site-specific cutoffs, a subset of DMT candidates (10%) exhibited borderline P-tau217 (between 0.273 and 0.399 pg/mL) that would have potentially required from confirmatory testing. Conclusions This study, which included participants treated with aducanumab, confirms the utility of one- and two-cutoff strategies for interpreting plasma P-tau217 in assessing DMT eligibility. Using P-tau217 could potentially replace more invasive diagnostic methods, and all aducanumab-treated participants would have been deemed eligible based on P-tau217. However, false positives remain a concern, particularly when applying externally derived cutoffs that exhibited lower specificity which could have led to inappropriate treatment of Aβ-negative participants. Future research should focus on prospective validation of P-tau217 cutoffs to enhance their generalizability and inform standardized treatment decision-making across diverse populations.
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Suridjan I, van der Flier WM, Monsch AU, Burnie N, Baldor R, Sabbagh M, Vilaseca J, Cai D, Carboni M, Lah JJ. Blood-based biomarkers in Alzheimer's disease: Future directions for implementation. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12508. [PMID: 38058357 PMCID: PMC10696162 DOI: 10.1002/dad2.12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Disease-modifying therapies (DMTs) for Alzheimer's disease (AD) will increase diagnostic demand. A non-invasive blood-based biomarker (BBBM) test for detection of amyloid-β pathology may reduce diagnostic barriers and facilitate DMT initiation. OBJECTIVE To explore heterogeneity in AD care pathways and potential role of BBBM tests. METHODS Survey of 213 healthcare professionals/payers in US/China/UK/Germany/Spain/France and two advisory boards (US/Europe). RESULTS Current diagnostic pathways are heterogeneous, meaning many AD patients are missed while low-risk patients undergo unnecessary procedures. Confirmatory amyloid testing (cerebrospinal fluid biomarkers/positron emission tomography) is utilized in few patients, resulting in diagnostic/treatment delays. A high negative-predictive-value test could streamline the diagnostic pathway by reducing unnecessary procedures in low-risk patients; supporting confirmatory testing where needed. Imminent approval of DMTs will increase need for fast and reliable AD diagnostic tests. DISCUSSION An easy-to-use, accurate, non-invasive BBBM test for amyloid pathology could guide diagnostic procedures or referral, streamlining early diagnosis and DMT initiation. Highlights This study explored AD care pathways and how BBBM may meet diagnostic demandsCurrent diagnostic pathways are heterogeneous, with country and setting variationsMany AD patients are missed, while low-risk patients undergo unnecessary proceduresAn easy-to-use, accurate, non-invasive BBBM test for amyloid pathology is neededThis test could streamline early diagnosis of amyloid pathology and DMT initiation.
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Affiliation(s)
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamNeurology, Epidemiology and Data Science, Vrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Andreas U. Monsch
- Memory ClinicUniversity Department of Geriatric Medicine FELIX PLATTERBaselSwitzerland
| | | | - Robert Baldor
- Department of Family Medicine and Community HealthUMass Chan Medical School, North WorcesterMassachusettsUSA
| | - Marwan Sabbagh
- Barrow Neurological InstituteDignity Health/St Joseph's Hospital and Medical CenterPhoenixArizonaUSA
| | - Josep Vilaseca
- Department of MedicineUniversitat de Vic‐Central Catalonia UniversityVicSpain
- Primary Health Care ServiceAlthaia Foundation ‐ Clinical and University Network in Manresa, Dr. Joan SolerManresaSpain
| | - Dongming Cai
- Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- N. Bud Grossman Center for Memory Research and CareUniversity of MinnesotaMinneapolisMinnesotaUSA
- Geriatric ResearchEducation and Clinical Center (GRECC)Minneapolis VA Health Care System, One Veterans DrMinneapolisMinnesotaUSA
| | | | - James J. Lah
- Goizueta Alzheimer's Disease Research CenterEmory University School of MedicineAtlantaGeorgiaUSA
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