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Vieira TCRG, Barros CA, Domingues R, Outeiro TF. PrP meets alpha-synuclein: Molecular mechanisms and implications for disease. J Neurochem 2024; 168:1625-1639. [PMID: 37855859 DOI: 10.1111/jnc.15992] [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: 07/10/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
The discovery of prions has challenged dogmas and has revolutionized our understanding of protein-misfolding diseases. The concept of self-propagation via protein conformational changes, originally discovered for the prion protein (PrP), also applies to other proteins that exhibit similar behavior, such as alpha-synuclein (aSyn), a central player in Parkinson's disease and in other synucleinopathies. aSyn pathology appears to spread from one cell to another during disease progression, and involves the misfolding and aggregation of aSyn. How the transfer of aSyn between cells occurs is still being studied, but one important hypothesis involves receptor-mediated transport. Interestingly, recent studies indicate that the cellular prion protein (PrPC) may play a crucial role in this process. PrPC has been shown to act as a receptor/sensor for protein aggregates in different neurodegenerative disorders, including Alzheimer's disease and amyotrophic lateral sclerosis. Here, we provide a comprehensive overview of the current state of knowledge regarding the interaction between aSyn and PrPC and discuss its role in synucleinopathies. We examine the properties of PrP and aSyn, including their structure, function, and aggregation. Additionally, we discuss the current understanding of PrPC's role as a receptor/sensor for aSyn aggregates and identify remaining unanswered questions in this area of research. Ultimately, we posit that exploring the interaction between aSyn and PrPC may offer potential treatment options for synucleinopathies.
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Affiliation(s)
- Tuane C R G Vieira
- Institute of Medical Biochemistry Leopoldo de Meis and National Institute of Science and Technology for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroline A Barros
- Institute of Medical Biochemistry Leopoldo de Meis and National Institute of Science and Technology for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renato Domingues
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany
| | - Tiago Fleming Outeiro
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Scientific Employee with an Honorary Contract at Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Göttingen, Germany
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Ng D, Watson N, McDermott EA, Kurucu H, Summers D, Andrews M, Green A, Barria M, McKenzie J, Tam J, Smith C, Pal S. Characterisation of RT-QuIC negative cases from the UK National CJD Research and Surveillance programme. J Neurol 2024; 271:4216-4226. [PMID: 38597944 PMCID: PMC11233280 DOI: 10.1007/s00415-024-12345-w] [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: 02/05/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Incorporation of the real-time quaking-induced conversion (RT-QuIC) assays for diagnosis of sporadic Creutzfeldt-Jakob disease (CJD) has transformed diagnosis largely related to its extremely high specificity. However, the test has a c.10% false-negative result and we aim to characterize the clinical features, investigation profile, and molecular subtype in this cohort of patients. METHODS 250 individuals diagnosed with definite sporadic CJD were identified from the UK National CJD Research and Surveillance Unit from 2012 to 2023. We compared the clinical features and investigation profile in those with a negative CSF RT-QuIC to those with a positive RT-QuIC. RESULTS 27 individuals (10.8%) were CSF RT-QuIC negative. Median age of onset was younger (62 years vs 68 years, p = 0.002), median disease duration was longer (4.4 months vs 10.5 months, p < 0.001), and these individuals were less likely to present with gait difficulties (73% vs 93%, p = 0.003) or motor symptoms (62% vs 80%, p = 0.04). The sensitivity of electroencephalography and diffusion-weighted MRI were similar in both groups. In those who were RT-QuIC negative, there was an overrepresentation of the VV1 (32% vs 1%) and MM2 molecular subtypes (21% vs 3%). Co-occurring neurodegenerative disease was found in 33% (9/27) of those who were RT-QuIC negative. CONCLUSIONS Individuals with sporadic CJD and a negative CSF RT-QuIC present with younger age of onset, different clinical features and are over-represented with the VV1 and MM2 subtypes of sporadic CJD. Further work is required to better understand the biochemical properties contributing to RT-QuIC negative results in these cases.
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Affiliation(s)
- Dominic Ng
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Neil Watson
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Eugene Ace McDermott
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Hatice Kurucu
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Summers
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mary Andrews
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alison Green
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marcelo Barria
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Janet McKenzie
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Johnny Tam
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Colin Smith
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- UK National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Abdi G, Jain M, Patil N, Upadhyay B, Vyas N, Dwivedi M, Kaushal RS. 14-3-3 proteins-a moonlight protein complex with therapeutic potential in neurological disorder: in-depth review with Alzheimer's disease. Front Mol Biosci 2024; 11:1286536. [PMID: 38375509 PMCID: PMC10876095 DOI: 10.3389/fmolb.2024.1286536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024] Open
Abstract
Alzheimer's disease (AD) affects millions of people worldwide and is a gradually worsening neurodegenerative condition. The accumulation of abnormal proteins, such as tau and beta-amyloid, in the brain is a hallmark of AD pathology. 14-3-3 proteins have been implicated in AD pathology in several ways. One proposed mechanism is that 14-3-3 proteins interact with tau protein and modulate its phosphorylation, aggregation, and toxicity. Tau is a protein associated with microtubules, playing a role in maintaining the structural integrity of neuronal cytoskeleton. However, in the context of Alzheimer's disease (AD), an abnormal increase in its phosphorylation occurs. This leads to the aggregation of tau into neurofibrillary tangles, which is a distinctive feature of this condition. Studies have shown that 14-3-3 proteins can bind to phosphorylated tau and regulate its function and stability. In addition, 14-3-3 proteins have been shown to interact with beta-amyloid (Aβ), the primary component of amyloid plaques in AD. 14-3-3 proteins can regulate the clearance of Aβ through the lysosomal degradation pathway by interacting with the lysosomal membrane protein LAMP2A. Dysfunction of lysosomal degradation pathway is thought to contribute to the accumulation of Aβ in the brain and the progression of AD. Furthermore, 14-3-3 proteins have been found to be downregulated in the brains of AD patients, suggesting that their dysregulation may contribute to AD pathology. For example, decreased levels of 14-3-3 proteins in cerebrospinal fluid have been suggested as a biomarker for AD. Overall, these findings suggest that 14-3-3 proteins may play an important role in AD pathology and may represent a potential therapeutic target for the disease. However, further research is needed to fully understand the mechanisms underlying the involvement of 14-3-3 proteins in AD and to explore their potential as a therapeutic target.
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Affiliation(s)
- Gholamareza Abdi
- Department of Biotechnology, Persian Gulf Research Institute, Persian Gulf University, Bushehr, Iran
| | - Mukul Jain
- Cell and Developmental Biology Laboratory, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Nil Patil
- Cell and Developmental Biology Laboratory, Research and Development Cell, Parul University, Vadodara, Gujarat, India
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Bindiya Upadhyay
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
| | - Nigam Vyas
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
- Biophysics and Structural Biology Laboratory, Research and Development Cell, Parul University, Vadodara, Gujarat, India
| | - Manish Dwivedi
- Amity Institute of Biotechnology, Amity University, Lucknow, Uttar Pradesh, India
| | - Radhey Shyam Kaushal
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara, Gujarat, India
- Biophysics and Structural Biology Laboratory, Research and Development Cell, Parul University, Vadodara, Gujarat, India
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Bentivenga GM, Baiardi S, Mastrangelo A, Zenesini C, Mammana A, Polischi B, Capellari S, Parchi P. Diagnostic and prognostic value of cerebrospinal fluid SNAP-25 and neurogranin in Creutzfeldt-Jakob disease in a clinical setting cohort of rapidly progressive dementias. Alzheimers Res Ther 2023; 15:150. [PMID: 37684653 PMCID: PMC10485978 DOI: 10.1186/s13195-023-01300-y] [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: 03/10/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The levels of synaptic markers synaptosomal-associated protein 25 (SNAP-25) and neurogranin (Ng) have been shown to increase early in the cerebrospinal fluid (CSF) of patients with Creutzfeldt-Jakob disease (CJD) and to have prognostic potential. However, no validation studies assessed these biomarkers' diagnostic and prognostic value in a large clinical setting cohort of rapidly progressive dementia. METHODS In this retrospective study, using commercially available immunoassays, we measured the levels of SNAP-25, Ng, 14-3-3, total-tau (t-tau), neurofilament light chain (NfL), and phospho-tau181 (p-tau) in CSF samples from consecutive patients with CJD (n = 220) or non-prion rapidly progressive dementia (np-RPD) (n = 213). We evaluated and compared the diagnostic accuracy of each CSF biomarker and biomarker combination by receiver operating characteristics curve (ROC) analyses, studied SNAP-25 and Ng CSF concentrations distribution across CJD subtypes, and estimated their association with survival using multivariable Cox regression analyses. RESULTS CSF SNAP-25 and Ng levels were higher in CJD than in np-RPD (SNAP-25: 582, 95% CI 240-1250 vs. 115, 95% CI 78-157 pg/ml, p < 0.0001; Ng: 841, 95% CI 411-1473 vs. 390, 95% CI 260-766 pg/ml, p < 0.001). SNAP-25 diagnostic accuracy (AUC 0.902, 95% CI 0.873-0.931) exceeded that of 14-3-3 (AUC 0.853, 95% CI 0.816-0.889), t-tau (AUC 0.878, 95% CI 0.845-0.901), and the t-tau/p-tau ratio (AUC 0.884, 95% CI 0.851-0.916). In contrast, Ng performed worse (AUC 0.697, 95% CI 0.626-0.767) than all other surrogate biomarkers, except for NfL (AUC 0.649, 95% CI 0.593-0.705). SNAP-25 maintained a relatively high diagnostic value even for atypical CJD subtypes (AUC 0.792, 95% CI 0.729-0.854). In Cox regression analyses, SNAP-25 levels were significantly associated with survival in CJD (hazard ratio [HR] 1.71 95% CI 1.40-2.09). Conversely, Ng was associated with survival only in the most rapidly progressive CJD subtypes (sCJD MM(V)1 and gCJD M1) (HR 1.81 95% CI 1.21-2.93). CONCLUSIONS In the clinical setting, CSF SNAP-25 is a viable alternative to t-tau, 14-3-3, and the t-tau/p-tau ratio in discriminating the CJD subtypes from other RPDs. Additionally, SNAP-25 and, to a lesser extent, Ng predict survival in CJD, showing prognostic power in the range of CSF t-tau/14-3-3 and NfL, respectively.
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Affiliation(s)
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Barbara Polischi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy.
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Jones SM, Lazar EB, Porter AL, Prusinski CC, Brier MR, Bucelli RC, Day GS. Real-time quaking-induced conversion assays for prions: Applying a sensitive but imperfect test in clinical practice. Eur J Neurol 2023; 30:1854-1860. [PMID: 36940265 PMCID: PMC10247483 DOI: 10.1111/ene.15795] [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: 02/23/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND AND PURPOSE Real-time quaking-induced conversion (RT-QuIC) assays offer a sensitive and specific means for detection of prions, although false negative results are recognized in clinical practice. We profile the clinical, laboratory, and pathologic features associated with false negative RT-QuIC assays and extend these to frame the diagnostic approach to patients with suspected prion disease. METHODS A total of 113 patients with probable or definite prion disease were assessed at Mayo Clinic (Rochester, MN; Jacksonville, FL; Scottsdale, AZ) or Washington University School of Medicine (Saint Louis, MO) from 2013 to 2021. RT-QuIC testing for prions was performed in cerebrospinal fluid (CSF) at the National Prion Disease Pathology Surveillance Center (Cleveland, OH). RESULTS Initial RT-QuIC testing was negative in 13 of 113 patients (sensitivity = 88.5%). RT-QuIC negative patients were younger (median = 52.0 years vs. 66.1 years, p < 0.001). Other demographic and presenting features, and CSF cell count, protein, and glucose levels were similar in RT-QuIC negative and positive patients. Frequency of 14-3-3 positivity (4/13 vs. 77/94, p < 0.001) and median CSF total tau levels were lower in RT-QuIC negative patients (2517 vs. 4001 pg/mL, p = 0.020), and time from symptom onset to first presentation (153 vs. 47 days, p = 0.001) and symptomatic duration (710 vs. 148 days, p = 0.001) were longer. CONCLUSIONS RT-QuIC is a sensitive yet imperfect measure necessitating incorporation of other test results when evaluating patients with suspected prion disease. Patients with negative RT-QuIC had lower markers of neuronal damage (CSF total tau and protein 14-3-3) and longer symptomatic duration of disease, suggesting that false negative RT-QuIC testing associates with a more indolent course.
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Affiliation(s)
- Samuel M Jones
- Mayo Clinic, Department of Neurology, Jacksonville, Florida, USA
| | - Evelyn B Lazar
- Mayo Clinic, Department of Neurology, Jacksonville, Florida, USA
- Hackensack Meridian JFK University Medical Center, Edison, New Jersey, USA
| | - Amanda L Porter
- Mayo Clinic, Department of Neurology, Jacksonville, Florida, USA
| | | | - Matthew R Brier
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Robert C Bucelli
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gregory S Day
- Mayo Clinic, Department of Neurology, Jacksonville, Florida, USA
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Kishida H, Ueda N, Tanaka F. The advances in the early and accurate diagnosis of Creutzfeldt-Jakob disease and other prion diseases: where are we today? Expert Rev Neurother 2023; 23:803-817. [PMID: 37581576 DOI: 10.1080/14737175.2023.2246653] [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: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Before the introduction of MRI diffusion-weighted images (DWI), the diagnosis of Creutzfeldt-Jakob disease (CJD) relied upon nonspecific findings including clinical symptoms, EEG abnormalities, and elevated levels of cerebrospinal fluid 14-3-3 protein. Subsequently, the use of DWI has improved diagnostic accuracy, but it sometimes remains difficult to differentiate CJD from encephalitis, epilepsy, and other dementing disorders. The revised diagnostic criteria include real-time quaking-induced conversion (RT-QuIC), detecting small amounts of CJD-specific prion protein, and clinically sensitive DWI. Combining these techniques has further improved diagnostic accuracy, enabling earlier diagnosis. AREAS COVERED Herein, the authors review the recent advances in diagnostic methods and revised diagnostic criteria for sporadic CJD. They also discuss other prion diseases, such as variant CJD and chronic wasting disease, where the emergence of new types is a concern. EXPERT OPINION Despite improvements in diagnostic methods and criteria, some subtypes of prion disease are still difficult to diagnose, and even the diagnosis using the most innovative RT-QuIC test remains a challenge in terms of accuracy and standardization. However, these revised criteria can be adapted to the emergence of new types of prion diseases. It is essential to continue careful surveillance and update information on the latest prion disease phenotypes.
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Affiliation(s)
- Hitaru Kishida
- Department of Neurology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Naohisa Ueda
- Department of Neurology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Herden JM, Hermann P, Schmidt I, Dittmar K, Canaslan S, Weglage L, Nuhn S, Volpers C, Schlung A, Goebel S, Kück F, Villar-Piqué A, Schmidt C, Wedekind D, Zerr I. Comparative evaluation of clinical and cerebrospinal fluid biomarker characteristics in rapidly and non-rapidly progressive Alzheimer's disease. Alzheimers Res Ther 2023; 15:106. [PMID: 37291640 DOI: 10.1186/s13195-023-01249-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Rapidly progressive forms of Alzheimer's disease (rpAD) are increasingly recognized and may have a prevalence of up to 30% of patients among all patients with Alzheimer's disease (AD). However, insights about risk factors, underlying pathophysiological processes, and clinical characteristics of rpAD remain controversial. This study aimed to gain a comprehensive picture of rpAD and new insights into the clinical manifestation to enable a better interpretation of disease courses in clinical practice as well as in future clinical studies. METHODS Patients (n = 228) from a prospective observational study on AD were selected and categorized into rpAD (n = 67) and non-rpAD (n = 161) disease groups. Patients were recruited through the German Creutzfeldt-Jakob disease surveillance center and the memory outpatient clinic of the Göttingen University Medical Center, representing diverse phenotypes of the AD population. Biomarkers and clinical presentation were assessed using standardized protocols. A drop of ≥ MMSE 6 points within 12 months defined rapid progressors. RESULTS Lower CSF Amyloid beta 1-42 concentrations (p = 0.048), lower Amyloid beta 42/40 ratio (p = 0.038), and higher Tau/Amyloid-beta 1-42 ratio, as well as pTau/Amyloid-beta 1-42 ratio (each p = 0.004) were associated with rpAD. Analyzes in a subset of the cohort (rpAD: n = 12; non-rpAD: n = 31) showed higher CSF NfL levels in rpAD (p = 0.024). Clinically, rpAD showed earlier impairment of functional abilities (p < 0.001) and higher scores on the Unified Parkinson's Disease Rating Scale III (p < 0.001), indicating pronounced extrapyramidal motor symptoms. Furthermore, cognitive profiles (adjusted for overall cognitive performance) indicated marked deficits in semantic (p = 0.008) and phonematic (0.023) verbal fluency tests as well as word list learning (p = 0.007) in rpAD compared to non-rpAD. The distribution of APOE genotypes did not differ significantly between groups. CONCLUSIONS Our results suggest that rpAD is associated with distinct cognitive profiles, earlier occurrence of non-cognitive symptoms, extrapyramidal motoric disturbance, and lower Amyloid-beta 1-42 concentrations in the CSF. The findings may help to characterize a distinct phenotype of rpAD and estimate prognosis based on clinical characteristics and biomarker results. However, an important future goal should be a unified definition for rpAD to enable targeted study designs and better comparability of the results.
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Affiliation(s)
- Janne Marieke Herden
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Peter Hermann
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany.
| | - Isabel Schmidt
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Kathrin Dittmar
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Sezgi Canaslan
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Luise Weglage
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Sabine Nuhn
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Corinna Volpers
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Astrid Schlung
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Stefan Goebel
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Fabian Kück
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, Göttingen, 37073, Germany
| | - Anna Villar-Piqué
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
| | - Christian Schmidt
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
- Neurologische Gemeinschaftspraxis Am Groner Tor, Göttingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University Medical Center, Von-Siebold-Straße 5, Göttingen, 37075, Germany
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Robert-Koch-Straße 40, Göttingen, 37075, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
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Santos F, Cabreira V, Rocha S, Massano J. Blood Biomarkers for the Diagnosis of Neurodegenerative Dementia: A Systematic Review. J Geriatr Psychiatry Neurol 2022:8919887221141651. [PMID: 36423207 DOI: 10.1177/08919887221141651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Accurately diagnosing neurodegenerative dementia is often challenging due to overlapping clinical features. Disease specific biomarkers could enhance diagnostic accuracy. However, CSF analysis procedures and advanced imaging modalities are either invasive or high-priced, and routinely unavailable. Easily accessible disease biomarkers would be of utmost value for accurate differential diagnosis of dementia subtypes. OBJECTIVE To assess the diagnostic accuracy of blood-based biomarkers for the differential diagnosis of AD from Frontotemporal Lobar Degeneration (FTLD), or AD from Dementia with Lewy Bodies (DLB). METHODS Systematic review. Three databases (PubMed, Scopus, and Web of Science) were searched. Studies assessing blood-based biomarkers levels in AD versus FTLD, or AD versus DLB, and its diagnostic accuracy, were selected. When the same biomarker was assessed in three or more studies, a meta-analysis was performed. QUADAS-2 criteria were used for quality assessment. RESULTS Twenty studies were included in this analysis. Collectively, 905 AD patients were compared to 1262 FTLD patients, and 209 AD patients were compared to 246 DLB patients. Regarding biomarkers for AD versus FTLD, excellent discriminative accuracy (AUC >0.9) was found for p-tau181, p-tau217, synaptophysin, synaptopodin, GAP43 and calmodulin. Other biomarkers also demonstrated good accuracy (AUC = 0.8-0.9). For AD versus DLB distinction, only miR-21-5p and miR-451a achieved excellent accuracy (AUC >0.9). CONCLUSION Encouraging results were found for several biomarkers, alone or in combination. Prospective longitudinal designs and consensual protocols, comprising larger cohorts and homogeneous testing modalities across centres, are essential to validate the clinical value of blood biomarkers for the precise etiological diagnosis of dementia.
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Affiliation(s)
- Filipa Santos
- Department of Clinical Neurosciences and Mental Health, 26705Faculty of Medicine University of Porto, Porto, Portugal
| | - Verónica Cabreira
- Department of Clinical Neurosciences and Mental Health, 26705Faculty of Medicine University of Porto, Porto, Portugal.,Department of Neurology, 285211Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Rocha
- iLoF - Intelligent Lab on Fiber, Oxford, UK.,Department of Biochemistry, 26705Faculty of Medicine University of Porto, Porto, Portugal
| | - João Massano
- Department of Clinical Neurosciences and Mental Health, 26705Faculty of Medicine University of Porto, Porto, Portugal.,Department of Neurology, 285211Centro Hospitalar Universitário de São João, Porto, Portugal
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Mesa-Herrera F, Marín R, Torrealba E, Santos G, Díaz M. Neuronal ER-Signalosome Proteins as Early Biomarkers in Prodromal Alzheimer's Disease Independent of Amyloid-β Production and Tau Phosphorylation. Front Mol Neurosci 2022; 15:879146. [PMID: 35600079 PMCID: PMC9119323 DOI: 10.3389/fnmol.2022.879146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 01/18/2023] Open
Abstract
There exists considerable interest to unveil preclinical period and prodromal stages of Alzheimer's disease (AD). The mild cognitive impairment (MCI) is characterized by significant memory and/or other cognitive domains impairments, and is often considered the prodromal phase of AD. The cerebrospinal fluid (CSF) levels of β-amyloid (βA), total tau (t-tau), and phosphorylated tau (p-tau) have been used as biomarkers of AD albeit their significance as indicators during early stages of AD remains far from accurate. The new biomarkers are being intensively sought as to allow identification of pathological processes underlying early stages of AD. Fifty-three participants (75.4 ± 8.3 years) were classified in three groups as cognitively normal healthy controls (HC), MCI, and subjective memory complaints (SMC). The subjects were subjected to a battery of neurocognitive tests and underwent lumbar puncture for CSF extraction. The CSF levels of estrogen-receptor (ER)-signalosome proteins, βA, t-tau and p-tau, were submitted to univariate, bivariate, and multivariate statistical analyses. We have found that the components of the ER-signalosome, namely, caveolin-1, flotilin-1, and estrogen receptor alpha (ERα), insulin growth factor-1 receptor β (IGF1Rβ), prion protein (PrP), and plasmalemmal voltage dependent anion channel 1 (VDAC) could be detected in the CSF from all subjects of the HC, MCI, and SMC groups. The six proteins appeared elevated in MCI and slightly increased in SMC subjects compared to HC, suggesting that signalosome proteins undergo very early modifications in nerve cells. Using a multivariate approach, we have found that the combination of ERα, IGF-1Rβ, and VDAC are the main determinants of group segregation with resolution enough to predict the MCI stage. The analyses of bivariate relationships indicated that collinearity of ER-signalosome proteins vary depending on the stage, with some pairs displaying opposed relationships between HC and MCI groups, and the SMC stage showing either no relationships or behaviors similar to either HC or MCI stages. The multinomial logistic regression models of changes in ER-signalosome proteins provide reliable predictive criteria, particularly for the MCI. Notably, most of the statistical analyses revealed no significant relationships or interactions with classical AD biomarkers at either disease stage. Finally, the multivariate functions were highly correlated with outcomes from neurocognitive tests for episodic memory. These results demonstrate that alterations in ER-signalosome might provide useful diagnostic information on preclinical stages of AD, independently from classical biomarkers.
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Affiliation(s)
- Fátima Mesa-Herrera
- Laboratory of Membrane Physiology and Biophysics, Department of Animal Biology, Edaphology and Geology, Biology Section, Science School, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Raquel Marín
- Laboratory of Cellular Neurobiology, Department of Basic Medical Sciences, Medicine Section, Health Sciences School, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Associate Research Unit ULL-CSIC “Membrane Physiology and Biophysics in Neurodegenerative and Cancer Diseases”, University of La Laguna, San Cristóbal de La Laguna, Spain
- Instituto Universitario de Neurociencias (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Eduardo Torrealba
- Department of Neurology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Guido Santos
- Systems Biology and Mathematical Modelling Group, Department of Department of Biochemistry, Microbiology, Cell Biology and Genetics Biology Section, Science School, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Mario Díaz
- Instituto Universitario de Neurociencias (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Department of Physics, Faculty of Sciences, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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10
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Mortberg MA, Zhao HT, Reidenbach AG, Gentile JE, Kuhn E, O'Moore J, Dooley PM, Connors TR, Mazur C, Allen SW, Trombetta BA, McManus AJ, Moore MR, Liu J, Cabin DE, Kordasiewicz HB, Mathews J, Arnold SE, Vallabh SM, Minikel EV. PrP concentration in the central nervous system: regional variability, genotypic effects, and pharmacodynamic impact. JCI Insight 2022; 7:156532. [PMID: 35133987 PMCID: PMC8986079 DOI: 10.1172/jci.insight.156532] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Prion protein (PrP) concentration controls the kinetics of prion replication and is a genetically and pharmacologically validated therapeutic target for prion disease. In order to evaluate PrP concentration as a pharmacodynamic biomarker and assess its contribution to known prion disease risk factors, we developed and validated a plate-based immunoassay reactive for PrP across six species of interest and applicable to brain and cerebrospinal fluid (CSF). PrP concentration varies dramatically between different brain regions in mice, cynomolgus macaques, and humans. PrP expression does not appear to contribute to the known risk factors of age, sex, or common PRNP genetic variants. CSF PrP is lowered in the presence of rare pathogenic PRNP variants, with heterozygous carriers of P102L displaying 55% and of D178N just 31% the CSF PrP concentration of mutation-negative controls. In rodents, pharmacologic reduction of brain Prnp RNA is reflected in brain parenchyma PrP, and in turn in CSF PrP, validating CSF as a sampling compartment for the effect of PrP-lowering therapy. Our findings support the use of CSF PrP as a pharmacodynamic biomarker for PrP-lowering drugs, and suggest that relative reduction from individual baseline CSF PrP concentration may be an appropriate marker for target engagement.
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Affiliation(s)
- Meredith A Mortberg
- Stanley Center for Psychiatric Research, Broad Institute of Harvard & MIT, Cambridge, United States of America
| | - Hien T Zhao
- Neuroscience, Ionis Pharmaceuticals, Inc., Carlsbad, United States of America
| | - Andrew G Reidenbach
- Stanley Center for Psychiatric Research, Broad Institute of Harvard & MIT, Cambridge, United States of America
| | - Juliana E Gentile
- Stanley Center for Psychiatric Research, Broad Institute of Harvard & MIT, Cambridge, United States of America
| | - Eric Kuhn
- Proteomics Platform, Broad Institute of Harvard & MIT, Cambridge, United States of America
| | - Jill O'Moore
- Comparative Medicine, McLaughlin Research Institute, Great Falls, United States of America
| | - Patrick M Dooley
- Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, United States of America
| | - Theresa R Connors
- Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, United States of America
| | - Curt Mazur
- Neuroscience, Ionis Pharmaceuticals, Inc., Carlsbad, United States of America
| | - Shona W Allen
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, United States of America
| | - Bianca A Trombetta
- Department of Neurology, Massachusetts General Hospital, Boston, United States of America
| | - Alison J McManus
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, United States of America
| | | | - Jiewu Liu
- Bioagilytix, Bioagilytix, Boston, United States of America
| | - Deborah E Cabin
- Comparative Medicine, McLaughlin Research Institute, Great Falls, United States of America
| | | | - Joel Mathews
- Neuroscience, Ionis Pharmaceuticals, Inc., Carlsbad, United States of America
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Boston, United States of America
| | - Sonia M Vallabh
- Stanley Center for Psychiatric Research, Broad Institute of Harvard & MIT, Cambridge, United States of America
| | - Eric Vallabh Minikel
- Stanley Center for Psychiatric Research, Broad Institute of Harvard & MIT, Cambridge, United States of America
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11
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Hermann P, Haller P, Goebel S, Bunck T, Schmidt C, Wiltfang J, Zerr I. Total and Phosphorylated Cerebrospinal Fluid Tau in the Differential Diagnosis of Sporadic Creutzfeldt-Jakob Disease and Rapidly Progressive Alzheimer’s Disease. Viruses 2022; 14:v14020276. [PMID: 35215868 PMCID: PMC8874601 DOI: 10.3390/v14020276] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
Background: CSF total-tau (t-tau) became a standard cerebrospinal fluid biomarker in Alzheimer’s disease (AD). In parallel, extremely elevated levels were observed in Creutzfeldt-Jakob disease (CJD). Therefore, tau is also considered as an alternative CJD biomarker, potentially complicating the interpretation of results. We investigated CSF t-tau and the t-tau/phosphorylated tau181 ratio in the differential diagnosis of sCJD and rapidly-progressive AD (rpAD). In addition, high t-tau concentrations and associated tau-ratios were explored in an unselected laboratory cohort. Methods: Retrospective analyses included n = 310 patients with CJD (n = 205), non-rpAD (n = 65), and rpAD (n = 40). The diagnostic accuracies of biomarkers were calculated and compared. Differential diagnoses were evaluated in patients from a neurochemistry laboratory with CSF t-tau >1250 pg/mL (n = 199 out of 7036). Results: CSF t-tau showed an AUC of 0.942 in the discrimination of sCJD from AD and 0.918 in the discrimination from rpAD. The tau ratio showed significantly higher AUCs (p < 0.001) of 0.992 versus non-rpAD and 0.990 versus rpAD. In the neurochemistry cohort, prion diseases accounted for only 25% of very high CSF t-tau values. High tau-ratios were observed in CJD, but also in non-neurodegenerative diseases. Conclusions: CSF t-tau is a reliable biomarker for sCJD, but false positive results may occur, especially in rpAD and acute encephalopathies. The t-tau/p-tau ratio may improve the diagnostic accuracy in centers where specific biomarkers are not available.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
- Correspondence: ; Tel.: +49-551-39-8955
| | - Philip Haller
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Stefan Goebel
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Timothy Bunck
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Christian Schmidt
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
- Neurosciences and Signaling Group, Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Inga Zerr
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
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12
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Fayolle M, Lehmann S, Delaby C. Comparison of cerebrospinal fluid tau, ptau(181), synuclein, and 14-3-3 for the detection of Creutzfeldt-Jakob disease in clinical practice. J Neural Transm (Vienna) 2022; 129:133-139. [PMID: 35041062 DOI: 10.1007/s00702-021-02443-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) is the leading human prion disease and is a major public health concern, with the risk of secondary iatrogenic transmission. Screening for CJD is often based on the detection of 14-3-3 protein in cerebrospinal fluid (CSF) through western blot assay and, in a second step, on a more specific method such as RT-QuIC (Real-Time Quaking-Induced Conversion). Alternatives to the detection of 14-3-3 in CSF have recently been proposed, specifically CSF tau proteins, tau/p-tau(181) ratio, and alpha-synuclein. In the present work, we compare the diagnostic performance of these biomarkers with that of 14-3-3 protein in a cohort of suspected CJD patients. Our results indicate that tau detection is the most effective and suitable approach for routine disease detection in a clinical setting. Combination with other biomarkers does not improve overall performance, while the tau/p-tau(181) ratio remains useful for differentiating Alzheimer's from CJD. In the end, the performance of tau protein detection in CSF reached 78% sensitivity and 80% specificity for the detection of CJD. It is interesting to note that the use of an automated method with a high concentration range allows for rapid and accurate results, which is very useful in clinical practice and allows for confirmatory testing such as RT-QuIC without delay.
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Affiliation(s)
- Martin Fayolle
- Laboratoire de Biochimie Protéomique Clinique-PPC, Hôpital St Eloi, Univ Montpellier, CHU Montpellier, INM INSERM, IRMB 80 av A Fiche, 34295, Montpellier, France
| | - Sylvain Lehmann
- Laboratoire de Biochimie Protéomique Clinique-PPC, Hôpital St Eloi, Univ Montpellier, CHU Montpellier, INM INSERM, IRMB 80 av A Fiche, 34295, Montpellier, France.
| | - Constance Delaby
- Laboratoire de Biochimie Protéomique Clinique-PPC, Hôpital St Eloi, Univ Montpellier, CHU Montpellier, INM INSERM, IRMB 80 av A Fiche, 34295, Montpellier, France.,Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Höppner-Buchmann J, Seidel D, Block F, Briedigkeit L, Tietke M, Nürnberger J, Frank B. [Creutzfeldt-Jakob Disease Versus Anti-NMDA Receptor Encephalitis A Case Report]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:163-168. [PMID: 34986490 DOI: 10.1055/a-1682-7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinically differentiating between autoimmune and neurodegenerative disorders can often pose a diagnostic challenge. The differential diagnosis of rapidly progressing neurological and cognitive symptoms includes central nervous system tumours, cerebral vasculitis, and inflammatory, autoimmune, or paraneoplastic encephalopathies. Rarer neurodegenerative diseases such as Creutzfeldt-Jakob disease should also be considered. Detection of treatable causes, such as autoimmune disorders, remains important when potentially occurring in conjunction with Creutzfeldt-Jakob disease. The following report describes a rare case in which autoimmune encephalopathy and prion disease were considered as possible comorbidities.
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Affiliation(s)
| | - Desiree Seidel
- Klinik für Psychiatrie und Psychotherapie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Frank Block
- Klinik für Neurologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Lutz Briedigkeit
- Institut für Laboratoriums- und Transfusionsmedizin, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Marc Tietke
- Institut für Radiologie, Kinder- und Neuroradiologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Jens Nürnberger
- Klinik für Nephrologie und Dialyse, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Bernd Frank
- Akutklinik für Frührehabilitation und interdisziplinäres Rehabilitationszentrum, HELIOS Klinik Leezen GmbH, Leezen, Deutschland
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14
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Lourenço Rosa J, Dias SP, Dias M. Sporadic Creutzfeldt-Jakob disease as a mimic of progressive supranuclear palsy. Acta Neurol Belg 2021; 122:1661-1663. [PMID: 34689314 DOI: 10.1007/s13760-021-01832-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
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15
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Hermann P, Appleby B, Brandel JP, Caughey B, Collins S, Geschwind MD, Green A, Haïk S, Kovacs GG, Ladogana A, Llorens F, Mead S, Nishida N, Pal S, Parchi P, Pocchiari M, Satoh K, Zanusso G, Zerr I. Biomarkers and diagnostic guidelines for sporadic Creutzfeldt-Jakob disease. Lancet Neurol 2021; 20:235-246. [PMID: 33609480 DOI: 10.1016/s1474-4422(20)30477-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022]
Abstract
Sporadic Creutzfeldt-Jakob disease is a fatal neurodegenerative disease caused by misfolded prion proteins (PrPSc). Effective therapeutics are currently not available and accurate diagnosis can be challenging. Clinical diagnostic criteria use a combination of characteristic neuropsychiatric symptoms, CSF proteins 14-3-3, MRI, and EEG. Supportive biomarkers, such as high CSF total tau, could aid the diagnostic process. However, discordant studies have led to controversies about the clinical value of some established surrogate biomarkers. Development and clinical application of disease-specific protein aggregation and amplification assays, such as real-time quaking induced conversion (RT-QuIC), have constituted major breakthroughs for the confident pre-mortem diagnosis of sporadic Creutzfeldt-Jakob disease. Updated criteria for the diagnosis of sporadic Creutzfeldt-Jakob disease, including application of RT-QuIC, should improve early clinical confirmation, surveillance, assessment of PrPSc seeding activity in different tissues, and trial monitoring. Moreover, emerging blood-based, prognostic, and potentially pre-symptomatic biomarker candidates are under investigation.
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Affiliation(s)
- Peter Hermann
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Brian Appleby
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA; Departments of Neurology, Psychiatry, and Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jean-Philippe Brandel
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Steven Collins
- Australian National Creutzfeldt-Jakob disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | - Alison Green
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephane Haïk
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Franc Llorens
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Network Center For Biomedical Research Of Neurodegenerative Diseases, Institute Carlos III, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Simon Mead
- National Prion Clinic, University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Prion Unit at University College London, Institute of Prion Diseases, London, UK
| | - Noriyuki Nishida
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Suvankar Pal
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Piero Parchi
- Istituto di Ricovero e Cura e Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Katsuya Satoh
- Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Inga Zerr
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; German Center for Neurodegenerative Diseases, Göttingen, Germany
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16
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Shafiq M, Zafar S, Younas N, Noor A, Puig B, Altmeppen HC, Schmitz M, Matschke J, Ferrer I, Glatzel M, Zerr I. Prion protein oligomers cause neuronal cytoskeletal damage in rapidly progressive Alzheimer's disease. Mol Neurodegener 2021; 16:11. [PMID: 33618749 PMCID: PMC7898440 DOI: 10.1186/s13024-021-00422-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 01/02/2021] [Indexed: 12/27/2022] Open
Abstract
Background High-density oligomers of the prion protein (HDPs) have previously been identified in brain tissues of patients with rapidly progressive Alzheimer’s disease (rpAD). The current investigation aims at identifying interacting partners of HDPs in the rpAD brains to unravel the pathological involvement of HDPs in the rapid progression. Methods HDPs from the frontal cortex tissues of rpAD brains were isolated using sucrose density gradient centrifugation. Proteins interacting with HDPs were identified by co-immunoprecipitation coupled with mass spectrometry. Further verifications were carried out using proteomic tools, immunoblotting, and confocal laser scanning microscopy. Results We identified rpAD-specific HDP-interactors, including the growth arrest specific 2-like 2 protein (G2L2). Intriguingly, rpAD-specific disturbances were found in the localization of G2L2 and its associated proteins i.e., the end binding protein 1, α-tubulin, and β-actin. Discussion The results show the involvement of HDPs in the destabilization of the neuronal actin/tubulin infrastructure. We consider this disturbance to be a contributing factor for the rapid progression in rpAD. Supplementary Information The online version contains supplementary material available at 10.1186/s13024-021-00422-x.
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Affiliation(s)
- Mohsin Shafiq
- Department of Neurology, University Medicine Goettingen and German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
| | - Saima Zafar
- Department of Neurology, University Medicine Goettingen and German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany. .,Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Neelam Younas
- Department of Neurology, University Medicine Goettingen and German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany
| | - Aneeqa Noor
- Department of Neurology, University Medicine Goettingen and German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany
| | - Berta Puig
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany.,Department of Neurology, Experimental Research in Stroke and Inflammation (ERSI), University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Hermann Clemens Altmeppen
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
| | - Matthias Schmitz
- Department of Neurology, University Medicine Goettingen and German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
| | - Isidre Ferrer
- Institut de Neuropatologica, Servei Anatomia Patològica, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Carrer Feixa LLarga sn, 08907, Hospitalet de LLobregat, CIBERNED, Barcelona, Spain
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), 20246, Hamburg, Germany
| | - Inga Zerr
- Department of Neurology, University Medicine Goettingen and German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany
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17
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Abu-Rumeileh S, Giannini G, Polischi B, Albini-Riccioli L, Milletti D, Oppi F, Stanzani-Maserati M, Capellari S, Mantovani P, Palandri G, Cortelli P, Cevoli S, Parchi P. Revisiting the Cerebrospinal Fluid Biomarker Profile in Idiopathic Normal Pressure Hydrocephalus: The Bologna Pro-Hydro Study. J Alzheimers Dis 2020; 68:723-733. [PMID: 30883350 DOI: 10.3233/jad-181012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebrospinal fluid (CSF) biomarkers have been extensively investigated in idiopathic normal pressure hydrocephalus (iNPH) with the aim of a better differential diagnosis, but the pathophysiological mechanisms underlying CSF biomarker changes and the relationship between biomarker levels and clinical variables are still a matter of debate. We evaluated CSF amyloid-β (Aβ)42 and Aβ40, total (t)-tau, phosphorylated (p)-tau, total prion protein (t-PrP), and neurofilament light chain protein (NfL) in healthy controls (n = 50) and subjects with iNPH (n = 71), Alzheimer's disease (AD) (n = 60), and several other subtypes of dementia (n = 145). Patients with iNPH showed significantly lower levels of Aβ42, Aβ40, t-tau, and p-tau compared to controls. Similarly, t-PrP values showed a trend toward lower levels in iNPH patients than in controls. At variance, NfL levels were increased in iNPH as in all other neurodegenerative dementias, with no significant difference between "pure" iNPH cases and those with vascular or AD comorbidities. The Aβ42/Aβ40 ratio showed higher diagnostic value than Aβ42 alone in the differential diagnosis between iNPH and AD. There were no clinically relevant associations between neuroimaging markers, scores at clinical and cognitive scales/tests, or rates of response at tap test and CSF biomarker results. In summary, the CSF biomarker signature in patients with iNPH is mainly characterized by reduced CSF concentrations of Aβ- and tau-related proteins. The assessment of CSF neurodegenerative biomarker profile in iNPH, including the Aβ42/Aβ40 ratio, contributes to the differential diagnosis with AD and other dementias but shows poor associations with clinical variables.
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Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy
| | - Barbara Polischi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - David Milletti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Sabina Capellari
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Mantovani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy
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18
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Vallabh SM, Minikel EV, Williams VJ, Carlyle BC, McManus AJ, Wennick CD, Bolling A, Trombetta BA, Urick D, Nobuhara CK, Gerber J, Duddy H, Lachmann I, Stehmann C, Collins SJ, Blennow K, Zetterberg H, Arnold SE. Cerebrospinal fluid and plasma biomarkers in individuals at risk for genetic prion disease. BMC Med 2020; 18:140. [PMID: 32552681 PMCID: PMC7302371 DOI: 10.1186/s12916-020-01608-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prion disease is neurodegenerative disease that is typically fatal within months of first symptoms. Clinical trials in this rapidly declining symptomatic patient population have proven challenging. Individuals at high lifetime risk for genetic prion disease can be identified decades before symptom onset and provide an opportunity for early therapeutic intervention. However, randomizing pre-symptomatic carriers to a clinical endpoint is not numerically feasible. We therefore launched a cohort study in pre-symptomatic genetic prion disease mutation carriers and controls with the goal of evaluating biomarker endpoints that may enable informative trials in this population. METHODS We collected cerebrospinal fluid (CSF) and blood from pre-symptomatic individuals with prion protein gene (PRNP) mutations (N = 27) and matched controls (N = 16), in a cohort study at Massachusetts General Hospital. We quantified total prion protein (PrP) and real-time quaking-induced conversion (RT-QuIC) prion seeding activity in CSF and neuronal damage markers total tau (T-tau) and neurofilament light chain (NfL) in CSF and plasma. We compared these markers cross-sectionally, evaluated short-term test-retest reliability over 2-4 months, and conducted a pilot longitudinal study over 10-20 months. RESULTS CSF PrP levels were stable on test-retest with a mean coefficient of variation of 7% for both over 2-4 months in N = 29 participants and over 10-20 months in N = 10 participants. RT-QuIC was negative in 22/23 mutation carriers. The sole individual with positive RT-QuIC seeding activity at two study visits had steady CSF PrP levels and slightly increased tau and NfL concentrations compared with the others, though still within the normal range, and remained asymptomatic 1 year later. T-tau and NfL showed no significant differences between mutation carriers and controls in either CSF or plasma. CONCLUSIONS CSF PrP will be interpretable as a pharmacodynamic readout for PrP-lowering therapeutics in pre-symptomatic individuals and may serve as an informative surrogate biomarker in this population. In contrast, markers of prion seeding activity and neuronal damage do not reliably cross-sectionally distinguish mutation carriers from controls. Thus, as PrP-lowering therapeutics for prion disease advance, "secondary prevention" based on prodromal pathology may prove challenging; instead, "primary prevention" trials appear to offer a tractable paradigm for trials in pre-symptomatic individuals.
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Affiliation(s)
- Sonia M Vallabh
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA, 02142, USA.
- Prion Alliance, Cambridge, MA, 02139, USA.
| | - Eric Vallabh Minikel
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA, 02142, USA
- Prion Alliance, Cambridge, MA, 02139, USA
| | - Victoria J Williams
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Becky C Carlyle
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Alison J McManus
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Chase D Wennick
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Anna Bolling
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Bianca A Trombetta
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - David Urick
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Chloe K Nobuhara
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jessica Gerber
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Holly Duddy
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | | | - Christiane Stehmann
- Australian National CJD Registry, University of Melbourne, Parkville, 3010, Australia
| | - Steven J Collins
- Australian National CJD Registry, University of Melbourne, Parkville, 3010, Australia
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, S-431 80, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, S-431 80, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, S-431 80, Mölndal, Sweden
- UK Dementia Research Institute, University College London, London, WC1N 3BG, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Steven E Arnold
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA.
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19
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Detection of Pathognomonic Biomarker PrP Sc and the Contribution of Cell Free-Amplification Techniques to the Diagnosis of Prion Diseases. Biomolecules 2020; 10:biom10030469. [PMID: 32204429 PMCID: PMC7175149 DOI: 10.3390/biom10030469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
Transmissible spongiform encephalopathies or prion diseases are rapidly progressive neurodegenerative diseases, the clinical manifestation of which can resemble other promptly evolving neurological maladies. Therefore, the unequivocal ante-mortem diagnosis is highly challenging and was only possible by histopathological and immunohistochemical analysis of the brain at necropsy. Although surrogate biomarkers of neurological damage have become invaluable to complement clinical data and provide more accurate diagnostics at early stages, other neurodegenerative diseases show similar alterations hindering the differential diagnosis. To solve that, the detection of the pathognomonic biomarker of disease, PrPSc, the aberrantly folded isoform of the prion protein, could be used. However, the amounts in easily accessible tissues or body fluids at pre-clinical or early clinical stages are extremely low for the standard detection methods. The solution comes from the recent development of in vitro prion propagation techniques, such as Protein Misfolding Cyclic Amplification (PMCA) and Real Time-Quaking Induced Conversion (RT-QuIC), which have been already applied to detect minute amounts of PrPSc in different matrixes and make early diagnosis of prion diseases feasible in a near future. Herein, the most relevant tissues and body fluids in which PrPSc has been detected in animals and humans are being reviewed, especially those in which cell-free prion propagation systems have been used with diagnostic purposes.
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20
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Towards a treatment for genetic prion disease: trials and biomarkers. Lancet Neurol 2020; 19:361-368. [PMID: 32199098 DOI: 10.1016/s1474-4422(19)30403-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023]
Abstract
Prion disease is a rare, fatal, and exceptionally rapid neurodegenerative disease. Although incurable, prion disease follows a clear pathogenic mechanism, in which a single gene gives rise to a single prion protein (PrP) capable of converting into the sole causal disease agent, the misfolded prion. As efforts progress to leverage this mechanistic knowledge toward rational therapies, a principal challenge will be the design of clinical trials. Previous trials in prion disease have been done in symptomatic patients who are often profoundly debilitated at enrolment. About 15% of prion disease cases are genetic, creating an opportunity for early therapeutic intervention to delay or prevent disease. Highly variable age of onset and absence of established prodromal biomarkers might render infeasible existing models for testing drugs before disease onset. Advancement of near-term targeted therapeutics could crucially depend on thoughtful design of rigorous presymptomatic trials.
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21
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Mok TH, Mead S. Preclinical biomarkers of prion infection and neurodegeneration. Curr Opin Neurobiol 2020; 61:82-88. [PMID: 32109717 DOI: 10.1016/j.conb.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
Abstract
Therapeutic strategies and study designs for neurodegenerative diseases have started to explore the potential of preventive treatment in healthy people, emphasising characterisation of biomarkers capable of indicating proximity to clinical onset. This need is even more pressing for individuals at risk of prion disease given its rarity which virtually precludes the probability of recruiting enough numbers for well powered preventive trials based on clinical endpoints. Experimental mouse inoculation studies have revealed a rapid exponential rise in infectious titres followed by a relative plateau of considerable duration before clinical onset. This clinically silent incubation period represents a potential window of opportunity for the adaptation of ultrasensitive prion seeding assays to define the onset of prion infection, and for neurodegenerative biomarker discovery through similarly sensitive digital immunoassay platforms.
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Affiliation(s)
- Tze How Mok
- National Prion Clinic, Box 98, National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom; MRC Prion Unit at UCL, Institute of Prion Diseases, Courtauld Building, 33 Cleveland Street, London W1W 7FF, United Kingdom
| | - Simon Mead
- National Prion Clinic, Box 98, National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom; MRC Prion Unit at UCL, Institute of Prion Diseases, Courtauld Building, 33 Cleveland Street, London W1W 7FF, United Kingdom.
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22
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Minikel EV, Kuhn E, Cocco AR, Vallabh SM, Hartigan CR, Reidenbach AG, Safar JG, Raymond GJ, McCarthy MD, O'Keefe R, Llorens F, Zerr I, Capellari S, Parchi P, Schreiber SL, Carr SA. Domain-specific Quantification of Prion Protein in Cerebrospinal Fluid by Targeted Mass Spectrometry. Mol Cell Proteomics 2019; 18:2388-2400. [PMID: 31558565 PMCID: PMC6885701 DOI: 10.1074/mcp.ra119.001702] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/16/2019] [Indexed: 01/11/2023] Open
Abstract
Therapies currently in preclinical development for prion disease seek to lower prion protein (PrP) expression in the brain. Trials of such therapies are likely to rely on quantification of PrP in cerebrospinal fluid (CSF) as a pharmacodynamic biomarker and possibly as a trial endpoint. Studies using PrP ELISA kits have shown that CSF PrP is lowered in the symptomatic phase of disease, a potential confounder for reading out the effect of PrP-lowering drugs in symptomatic patients. Because misfolding or proteolytic cleavage could potentially render PrP invisible to ELISA even if its concentration were constant or increasing in disease, we sought to establish an orthogonal method for CSF PrP quantification. We developed a multi-species targeted mass spectrometry method based on multiple reaction monitoring (MRM) of nine PrP tryptic peptides quantified relative to an isotopically labeled recombinant protein standard for human samples, or isotopically labeled synthetic peptides for nonhuman species. Analytical validation experiments showed process replicate coefficients of variation below 15%, good dilution linearity and recovery, and suitable performance for both CSF and brain homogenate and across humans as well as preclinical species of interest. In n = 55 CSF samples from individuals referred to prion surveillance centers with rapidly progressive dementia, all six human PrP peptides, spanning the N- and C-terminal domains of PrP, were uniformly reduced in prion disease cases compared with individuals with nonprion diagnoses. Thus, lowered CSF PrP concentration in prion disease is a genuine result of the disease process and not an artifact of ELISA-based measurement. As a result, dose-finding studies for PrP lowering drugs may need to be conducted in presymptomatic at-risk individuals rather than in symptomatic patients. We provide a targeted mass spectrometry-based method suitable for preclinical quantification of CSF PrP as a tool for drug development.
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Affiliation(s)
- Eric Vallabh Minikel
- Chemical Biology and Therapeutics Science Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142; Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115; Prion Alliance, Cambridge, MA 02139; Proteomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA 02142.
| | - Eric Kuhn
- Proteomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA 02142; Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115
| | - Alexandra R Cocco
- Proteomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA 02142
| | - Sonia M Vallabh
- Chemical Biology and Therapeutics Science Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142; Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115; Prion Alliance, Cambridge, MA 02139
| | | | - Andrew G Reidenbach
- Chemical Biology and Therapeutics Science Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142
| | - Jiri G Safar
- Departments of Pathology and Neurology Case Western Reserve University, Cleveland, OH 44106
| | - Gregory J Raymond
- Laboratory of Persistent Viral Diseases, NIAID Rocky Mountain Labs, Hamilton, MT 59840
| | - Michael D McCarthy
- Environmental Health and Safety, Broad Institute of MIT and Harvard, Cambridge, MA 02142
| | - Rhonda O'Keefe
- Environmental Health and Safety, Broad Institute of MIT and Harvard, Cambridge, MA 02142
| | - Franc Llorens
- National Reference Center for TSE, Georg-August University, Göttingen, 37073, Germany; Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Inga Zerr
- National Reference Center for TSE, Georg-August University, Göttingen, 37073, Germany
| | - Sabina Capellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, 40139, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, 40123, Italy
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, 40139, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, 40138, Italy
| | - Stuart L Schreiber
- Chemical Biology and Therapeutics Science Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142; Department of Chemistry & Chemical Biology, Harvard University, Cambridge, MA 02138
| | - Steven A Carr
- Proteomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA 02142.
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23
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Thüne K, Schmitz M, Villar-Piqué A, Altmeppen HC, Schlomm M, Zafar S, Glatzel M, Llorens F, Zerr I. The cellular prion protein and its derived fragments in human prion diseases and their role as potential biomarkers. Expert Rev Mol Diagn 2019; 19:1007-1018. [PMID: 31512940 DOI: 10.1080/14737159.2019.1667231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Human prion diseases are a heterogeneous group of incurable and debilitating conditions characterized by a progressive degeneration of the central nervous system. The conformational changes of the cellular prion protein and its formation into an abnormal isoform, spongiform degeneration, neuronal loss, and neuroinflammation are central to prion disease pathogenesis. It has been postulated that truncated variants of aggregation-prone proteins are implicated in neurodegenerative mechanisms. An increasing body of evidence indicates that proteolytic fragments and truncated variants of the prion protein are formed and accumulated in the brain of prion disease patients. These prion protein variants provide a high degree of relevance to disease pathology and diagnosis. Areas covered: In the present review, we summarize the current knowledge on the occurrence of truncated prion protein species and their potential roles in pathophysiological states during prion diseases progression. In addition, we discuss their usability as a diagnostic biomarker in prion diseases. Expert opinion: Either as a primary factor in the formation of prion diseases or as a consequence from neuropathological affection, abnormal prion protein variants and fragments may provide independent information about mechanisms of prion conversion, pathological states, or disease progression.
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Affiliation(s)
- Katrin Thüne
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany
| | - Matthias Schmitz
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany
| | - Anna Villar-Piqué
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany.,Network Center for Biomedical Research in Neurodegenerative Diseases, Institute Carlos III, Ministry of Health, CIBERNED, Hospitalet de Llobregat , Spain
| | | | - Markus Schlomm
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany
| | - Saima Zafar
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center HH-Eppendorf (UKE) , Hamburg , Germany
| | - Franc Llorens
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany.,Network Center for Biomedical Research in Neurodegenerative Diseases, Institute Carlos III, Ministry of Health, CIBERNED, Hospitalet de Llobregat , Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat , Barcelona , Spain
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases (DZNE) - site Göttingen , Göttingen , Germany
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24
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Zhang Y, Zhao Y, Zhang L, Yu W, Wang Y, Chang W. Cellular Prion Protein as a Receptor of Toxic Amyloid-β42 Oligomers Is Important for Alzheimer's Disease. Front Cell Neurosci 2019; 13:339. [PMID: 31417361 PMCID: PMC6682659 DOI: 10.3389/fncel.2019.00339] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022] Open
Abstract
The pathological features of Alzheimer's disease (AD) include senile plaques induced by amyloid-β (Aβ) protein deposits, neurofibrillary tangles formed by aggregates of hyperphosphorylated tau proteins and neuronal cell loss in specific position within the brain. Recent observations have suggested the possibility of an association between AD and cellular prion protein (PrP C ) levels. PrP C is a high affinity receptor for oligomeric Aβ and is important for Aβ-induced neurotoxicity and thus plays a critical role in AD pathogenesis. The determination of the relationship between PrP C and AD and the characterization of PrP C binding to Aβ will facilitate the development of novel therapies for AD.
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Affiliation(s)
- Yuan Zhang
- Institute for Translational Medicine, Qingdao University, Qingdao, China
| | - Yanfang Zhao
- School for Life Science, Institute of Biomedical Research, Shandong University of Technology, Zibo, China
| | - Lei Zhang
- Institute for Translational Medicine, Qingdao University, Qingdao, China
| | - Wanpeng Yu
- Institute for Translational Medicine, Qingdao University, Qingdao, China
| | - Yu Wang
- Institute for Translational Medicine, Qingdao University, Qingdao, China
| | - Wenguang Chang
- Institute for Translational Medicine, Qingdao University, Qingdao, China
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25
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Prion protein quantification in human cerebrospinal fluid as a tool for prion disease drug development. Proc Natl Acad Sci U S A 2019; 116:7793-7798. [PMID: 30936307 DOI: 10.1073/pnas.1901947116] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Reduction of native prion protein (PrP) levels in the brain is an attractive strategy for the treatment or prevention of human prion disease. Clinical development of any PrP-reducing therapeutic will require an appropriate pharmacodynamic biomarker: a practical and robust method for quantifying PrP, and reliably demonstrating its reduction in the central nervous system (CNS) of a living patient. Here we evaluate the potential of ELISA-based quantification of human PrP in human cerebrospinal fluid (CSF) to serve as a biomarker for PrP-reducing therapeutics. We show that CSF PrP is highly sensitive to plastic adsorption during handling and storage, but its loss can be minimized by the addition of detergent. We find that blood contamination does not affect CSF PrP levels, and that CSF PrP and hemoglobin are uncorrelated, together suggesting that CSF PrP is CNS derived, supporting its relevance for monitoring the tissue of interest and in keeping with high PrP abundance in brain relative to blood. In a cohort with controlled sample handling, CSF PrP exhibits good within-subject test-retest reliability (mean coefficient of variation, 13% in samples collected 8-11 wk apart), a sufficiently stable baseline to allow therapeutically meaningful reductions in brain PrP to be readily detected in CSF. Together, these findings supply a method for monitoring the effect of a PrP-reducing drug in the CNS, and will facilitate development of prion disease therapeutics with this mechanism of action.
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26
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Abstract
Neurodegenerative diseases represent a daunting challenge in clinical diagnosis and management. Biomarkers that might aid in the diagnosis of these devastating and globally important diseases are urgently sought and required. Here we describe the application and state of development of a range of cerebrospinal fluid biomarkers in common neurodegenerative disorders including Alzheimer's disease, frontotemporal dementia and prion diseases.
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Affiliation(s)
- Thalia T Robey
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, Western Australia 6005, Australia
| | - Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, Western Australia 6005, Australia
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27
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Cerebrospinal Fluid and Plasma Tau as a Biomarker for Brain Tauopathy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1184:393-405. [PMID: 32096052 DOI: 10.1007/978-981-32-9358-8_29] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cerebrospinal fluid (CSF) tau and phosphorylated tau (ptau) are definite biomarkers of Alzheimer's disease (AD). After discovery of presence and increased levels tau in CSF from AD patients using specific ELISA, numerous reports revealed that CSF levels of tau are increased in AD and brain injury, phosphorylated tau are specifically increased in AD. Many large cohort studies also confirmed that natural course of CSF tau and ptau levels initiated from cognitively unimpaired AD stage after longstanding progress of brain Aß amyloidosis. Close correlation with neuroimaging findings of Tau PET and with deterioration of cognitive function domains have been elucidated. CSF tau also increase in neurodegeneration and acute brain injury. Global standardization, assay technology inventions, and research of tau kinetics from brain synthesis and clearance into CSF are developing. Trace amount of plasma p-tau assay are also validated. Development of these studies provide that CSF tau is the biomarker of CNS neurodegeneration and CSF ptau is the specific biomarker of CNS tauopathy. Assays of CSF and plasma tau and ptau are essential tools not only for prediction and diagnosis of AD and but for newly developing disease modified therapies of AD.
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28
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Abstract
Sporadic Creutzfeldt-Jakob disease (CJD), the most common human prion disease, is generally regarded as a spontaneous neurodegenerative illness, arising either from a spontaneous PRNP somatic mutation or a stochastic PrP structural change. Alternatively, the possibility of an infection from animals or other source remains to be completely ruled out. Sporadic CJD is clinically characterized by rapidly progressive dementia with ataxia, myoclonus, or other neurologic signs and, neuropathologically, by the presence of aggregates of abnormal prion protein, spongiform change, neuronal loss, and gliosis. Despite these common features the disease shows a wide phenotypic variability which was recognized since its early descriptions. In the late 1990s the identification of key molecular determinants of phenotypic expression and the availability of a large series of neuropathologically verified cases led to the characterization of definite clinicopathologic and molecular disease subtypes and to an internationally recognized disease classification. By showing that these disease subtypes correspond to specific agent strain-host genotype combinations, recent transmission studies have confirmed the biologic basis of this classification. The introduction of brain magnetic resonance imaging techniques such as fluid-attenuated inversion recovery and diffusion-weighted imaging sequences and cerebrospinal fluid biomarker assays for the detection of brain-derived proteins as well as real-time quaking-induced conversion assay, allowing the specific detection of prions in accessible biologic fluids and tissues, has significantly contributed to the improved accuracy of the clinical diagnosis of sporadic CJD in recent years.
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Affiliation(s)
- Inga Zerr
- Department of Neurology, University Hospital, Georg-August-University, Goettingen, Germany.
| | - Piero Parchi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna and IRCCS Institute of Neurological Sciences, Bologna, Italy
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29
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Villar-Piqué A, Schmitz M, Lachmann I, Karch A, Calero O, Stehmann C, Sarros S, Ladogana A, Poleggi A, Santana I, Ferrer I, Mitrova E, Žáková D, Pocchiari M, Baldeiras I, Calero M, Collins SJ, Geschwind MD, Sánchez-Valle R, Zerr I, Llorens F. Cerebrospinal Fluid Total Prion Protein in the Spectrum of Prion Diseases. Mol Neurobiol 2018; 56:2811-2821. [PMID: 30062673 DOI: 10.1007/s12035-018-1251-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Cerebrospinal fluid (CSF) total prion protein (t-PrP) is decreased in sporadic Creutzfeldt-Jakob disease (sCJD). However, data on the comparative signatures of t-PrP across the spectrum of prion diseases, longitudinal changes during disease progression, and levels in pre-clinical cases are scarce. T-PrP was quantified in neurological diseases (ND, n = 147) and in prion diseases from different aetiologies including sporadic (sCJD, n = 193), iatrogenic (iCJD, n = 12) and genetic (n = 209) forms. T-PrP was also measured in serial lumbar punctures obtained from sCJD cases at different symptomatic disease stages, and in asymptomatic prion protein gene (PRNP) mutation carriers. Compared to ND, t-PrP concentrations were significantly decreased in sCJD, iCJD and in genetic prion diseases associated with the three most common mutations E200K, V210I (associated with genetic CJD) and D178N-129M (associated with fatal familial insomnia). In contrast, t-PrP concentrations in P102L mutants (associated with the Gerstmann-Sträussler-Scheinker syndrome) remained unaltered. In serial lumbar punctures obtained at different disease stages of sCJD patients, t-PrP concentrations inversely correlated with disease progression. Decreased mean t-PrP values were detected in asymptomatic D178-129M mutant carriers, but not in E200K and P102L carriers. The presence of low CSF t-PrP is common to all types of prion diseases regardless of their aetiology albeit with mutation-specific exceptions in a minority of genetic cases. In some genetic prion disease, decreased levels are already detected at pre-clinical stages and diminish in parallel with disease progression. Our data indicate that CSF t-PrP concentrations may have a role as a pre-clinical or early symptomatic diagnostic biomarker in prion diseases as well as in the evaluation of therapeutic interventions.
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Affiliation(s)
- Anna Villar-Piqué
- Department of Neurology, University Medical School, Göttingen, Germany.
| | - Matthias Schmitz
- Department of Neurology, University Medical School, Göttingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.
| | | | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Olga Calero
- Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center, Chronic Disease Programme Carlos III Institute of Health, Madrid, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Christiane Stehmann
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute, The University of Melbourne, Melbourne, Australia
| | - Shannon Sarros
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute, The University of Melbourne, Melbourne, Australia
| | - Anna Ladogana
- Department of Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Poleggi
- Department of Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Isabel Santana
- Neurology Department, CHUC - Centro Hospitalar e Universitário de Coimbra, CNC- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isidre Ferrer
- Bellvitge University Hospital-IDIBELL, Department of Pathology and Experimental Therapeutics, Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Eva Mitrova
- Department of Prion Diseases, Slovak Medical University, Bratislava, Slovakia
| | - Dana Žáková
- Department of Prion Diseases, Slovak Medical University, Bratislava, Slovakia
| | | | - Inês Baldeiras
- Neurology Department, CHUC - Centro Hospitalar e Universitário de Coimbra, CNC- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Calero
- Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center, Chronic Disease Programme Carlos III Institute of Health, Madrid, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Steven J Collins
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute, The University of Melbourne, Melbourne, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Australia
| | - Michael D Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Inga Zerr
- Department of Neurology, University Medical School, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Franc Llorens
- Department of Neurology, University Medical School, Göttingen, Germany. .,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
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Abu-Rumeileh S, Capellari S, Parchi P. Rapidly Progressive Alzheimer’s Disease: Contributions to Clinical-Pathological Definition and Diagnosis. J Alzheimers Dis 2018; 63:887-897. [DOI: 10.3233/jad-171181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Piero Parchi
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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Cerebrospinal Fluid Prion Disease Biomarkers in Pre-clinical and Clinical Naturally Occurring Scrapie. Mol Neurobiol 2018; 55:8586-8591. [PMID: 29572672 DOI: 10.1007/s12035-018-1014-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
The analysis of the cerebrospinal fluid (CSF) biomarkers in patients with suspected prion diseases became a useful tool in diagnostic routine. Prion diseases can only be identified at clinical stages when the disease already spread throughout the brain and massive neuronal damage occurs. Consequently, the accuracy of CSF tests detecting non-symptomatic patients is unknown. Here, we aimed to investigate the usefulness of CSF-based diagnostic tests in pre-clinical and clinical naturally occurring scrapie. While decreased total prion protein (PrP) levels and positive PrP seeding activity were already detectable at pre-symptomatic stages, the surrogate markers of neuronal damage total tau (tau) and 14-3-3 proteins were exclusively increased at clinical stages. The present findings confirm that alterations in PrP levels and conformation are primary events in the pathology of prion diseases preceding neuronal damage. Our work also supports the potential use of these tests in the screening of pre-symptomatic scrapie and human prion disease cases.
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Day GS, Gordon BA, Perrin RJ, Cairns NJ, Beaumont H, Schwetye K, Ferguson C, Sinha N, Bucelli R, Musiek ES, Ghoshal N, Ponisio MR, Vincent B, Mishra S, Jackson K, Morris JC, Benzinger TLS, Ances BM. In vivo [ 18F]-AV-1451 tau-PET imaging in sporadic Creutzfeldt-Jakob disease. Neurology 2018; 90:e896-e906. [PMID: 29438042 DOI: 10.1212/wnl.0000000000005064] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/05/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether specific patterns of [18F]-AV-1451 tau-PET retention are observed in patients with autopsy-proven sporadic Creutzfeldt-Jakob disease (CJD). METHODS In vivo [18F]-AV-1451 PET neuroimaging was performed in 5 patients with sporadic CJD (median age, 66 years [63-74]), and results were compared to cognitively normal (CN) persons (n = 44; median age, 68 years [63-74]) and to participants with very mild Alzheimer disease (AD) dementia (n = 8; median age, 77 years [63-90]). Autopsy was completed in all patients with CJD, confirming the clinical diagnosis and permitting characterization of AD neuropathologic change (ADNC). RESULTS All patients with CJD presented with rapidly progressive dementia, typical magnetic resonance brain imaging changes, and elevated CSF total tau (median = 6,519; range = 1,528-13,240 pg/mL). Death occurred within 9 months of symptom onset, with a median 1 month (0.2-3.3) interval from [18F]-AV-1451 PET to autopsy. No unique pattern of [18F]-AV-1451 retention was observed on visual inspection. Summary standardized uptake value ratios in patients with CJD (1.17, 1.08-1.36) were indistinguishable from CN persons (1.14, 0.84-1.54; p = 0.6), and well below those of participants with AD (2.23, 1.60-3.04; p ≤ 0.01). [18F]-AV-1451 retention in patients with CJD and CN persons was similar in brain areas frequently affected in AD and CJD. Neuropathologic analysis confirmed the clinical diagnosis in all patients with CJD. Four patients with CJD also had low-level ADNC (A1B1C0); one patient had intermediate-level ADNC (A2B2C1/2). CONCLUSION Increased [18F]-AV-1451 retention was not observed in patients with rapidly progressive dementia due to sporadic CJD. The [18F]-AV-1451 PET tracer maintains good specificity for paired helical tau filaments associated with AD dementia.
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Affiliation(s)
- Gregory S Day
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO.
| | - Brian A Gordon
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Richard J Perrin
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Nigel J Cairns
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Helen Beaumont
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Katherine Schwetye
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Cole Ferguson
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Namita Sinha
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Robert Bucelli
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Erik S Musiek
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Nupur Ghoshal
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Maria R Ponisio
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Benjamin Vincent
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Shruti Mishra
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Kelley Jackson
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - John C Morris
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Tammie L S Benzinger
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
| | - Beau M Ances
- From The Charles F. and Joanne Knight Alzheimer Disease Research Center (G.S.D., B.A.G., R.J.P., N.J.C., H.B., E.S.M., N.G., J.C.M., T.L.S.B., B.M.A.), Department of Neurology (G.S.D., R.B., E.S.M., N.G., J.C.M., B.M.A.), Mallinckrodt Institute of Radiology (B.A.G., H.B., M.R.P., B.V., S.M., K.J., T.L.S.B., B.M.A.), and Department of Pathology (R.J.P., N.J.C., K.S., C.F., N.S., J.C.M.), Washington University School of Medicine (G.S.D., B.A.G., R.J.P., N.J.C., H.B., K.S., C.F., N.S., R.B., E.S.M., N.G., M.R.P., B.V., S.M., K.J., J.C.M., T.L.S.B., B.M.A.), St. Louis, MO
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Abu-Rumeileh S, Capellari S, Stanzani-Maserati M, Polischi B, Martinelli P, Caroppo P, Ladogana A, Parchi P. The CSF neurofilament light signature in rapidly progressive neurodegenerative dementias. ALZHEIMERS RESEARCH & THERAPY 2018; 10:3. [PMID: 29368621 PMCID: PMC5784714 DOI: 10.1186/s13195-017-0331-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022]
Abstract
Background Neurofilament light chain protein (NfL) is a surrogate biomarker of neurodegeneration that has never been systematically tested, either alone or in combination with other biomarkers, in atypical/rapidly progressive neurodegenerative dementias (NDs). Methods Using validated, commercially available enzyme-linked immunosorbent assay kits, we measured cerebrospinal fluid (CSF) NfL, total tau (t-tau), phosphorylated tau, and β-amyloid 42 in subjects with a neuropathological or clinical diagnosis of prion disease (n = 141), Alzheimer’s disease (AD) (n = 73), dementia with Lewy bodies (DLB) (n = 35), or frontotemporal lobar degeneration (FTLD) (n = 44). Several cases with an atypical/rapidly progressive course were included in each group. We evaluated the diagnostic accuracy of every CSF biomarker and their combinations by ROC curve analyses. Results In each patient group CSF NfL showed higher levels than in control subjects, reaching the highest values in those with Creutzfeldt-Jakob disease (CJD). In the latter, NfL showed a divergent, subtype-specific correlation with t-tau, depending on the degree of subcortical involvement and disease duration. Most significantly, patients with classic sporadic CJD (sCJD) MM1 showed a significantly lower concentration of CSF NfL than those with sCJD MV2, despite the much higher t-tau levels and the more rapid clinical course. High NfL levels were also detected in most atypical CJD cases, showing a disease duration longer than 2 years and/or borderline/negative results in other CSF assays (e.g., 14-3-3, t-tau, and prion real-time quaking-induced conversion). Rapidly progressive/atypical cases showed higher NfL levels than typical patients in FTLD, but not in AD or DLB. NfL showed accuracy similar to that of t-tau in discriminating CJD from other NDs, but it had higher efficacy in differentiating atypical forms, especially in regard to Alzheimer’s disease. Conclusions The present data indicate that CSF NfL and t-tau levels reflect distinct pathophysiological mechanisms of neurodegeneration and support the clinical use of NfL as a fast screening biomarker for the differential diagnosis of atypical/rapidly progressive NDs. Electronic supplementary material The online version of this article (doi:10.1186/s13195-017-0331-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40123, Bologna, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Institute of Neurological Sciences of Bologna, Bellaria Hospital, 40139, Bologna, Italy
| | - Michelangelo Stanzani-Maserati
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Institute of Neurological Sciences of Bologna, Bellaria Hospital, 40139, Bologna, Italy
| | - Barbara Polischi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Institute of Neurological Sciences of Bologna, Bellaria Hospital, 40139, Bologna, Italy
| | - Paolo Martinelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - Paola Caroppo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation "Carlo Besta" Neurological Institute, 20133, Milan, Italy
| | - Anna Ladogana
- Department of Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Piero Parchi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Institute of Neurological Sciences of Bologna, Bellaria Hospital, 40139, Bologna, Italy. .,Department of Diagnostic Experimental and Specialty Medicine (DIMES), University of Bologna, 40138, Bologna, Italy.
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Prion-specific and surrogate CSF biomarkers in Creutzfeldt-Jakob disease: diagnostic accuracy in relation to molecular subtypes and analysis of neuropathological correlates of p-tau and Aβ42 levels. Acta Neuropathol 2017; 133:559-578. [PMID: 28205010 PMCID: PMC5348556 DOI: 10.1007/s00401-017-1683-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 01/28/2023]
Abstract
The differential diagnosis of Creutzfeldt-Jakob disease (CJD) from other, sometimes treatable, neurological disorders is challenging, owing to the wide phenotypic heterogeneity of the disease. Real-time quaking-induced prion conversion (RT-QuIC) is a novel ultrasensitive in vitro assay, which, at variance with surrogate neurodegenerative biomarker assays, specifically targets the pathological prion protein (PrPSc). In the studies conducted to date in CJD, cerebrospinal fluid (CSF) RT-QuIC showed good diagnostic sensitivity (82–96%) and virtually full specificity. In the present study, we investigated the diagnostic value of both prion RT-QuIC and surrogate protein markers in a large patient population with suspected CJD and then evaluated the influence on CSF findings of the CJD type, and the associated amyloid-β (Aβ) and tau neuropathology. RT-QuIC showed an overall diagnostic sensitivity of 82.1% and a specificity of 99.4%. However, sensitivity was lower in CJD types linked to abnormal prion protein (PrPSc) type 2 (VV2, MV2K and MM2C) than in typical CJD (MM1). Among surrogate proteins markers (14-3-3, total (t)-tau, and t-tau/phosphorylated (p)-tau ratio) t-tau performed best in terms of both specificity and sensitivity for all sCJD types. Sporadic CJD VV2 and MV2K types demonstrated higher CSF levels of p-tau when compared to other sCJD types and this positively correlated with the amount of tiny tau deposits in brain areas showing spongiform change. CJD patients showed moderately reduced median Aβ42 CSF levels, with 38% of cases having significantly decreased protein levels in the absence of Aβ brain deposits. Our results: (1) support the use of both RT-QuIC and t-tau assays as first line laboratory investigations for the clinical diagnosis of CJD; (2) demonstrate a secondary tauopathy in CJD subtypes VV2 and MV2K, correlating with increased p-tau levels in the CSF and (3) provide novel insight into the issue of the accuracy of CSF p-tau and Aβ42 as markers of brain tauopathy and β-amyloidosis.
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