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Pollaci G, Potenza A, Gorla G, Carrozzini T, Marinoni G, De Toma C, Canavero I, Rifino N, Boncoraglio GB, Difrancesco JC, Damavandi PT, Stanziano M, Erbetta A, Caroppo P, Di Fede G, Catania M, Zulueta A, Parati EA, Bersano A, Gatti L, Storti B. CSF and Plasma Biomarkers in Patients With Iatrogenic Cerebral Amyloid Angiopathy. Neurology 2024; 103:e209828. [PMID: 39284112 PMCID: PMC11399065 DOI: 10.1212/wnl.0000000000209828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVES Recently, a subset of patients affected by cerebral amyloid angiopathy (CAA) distinguished by atypical juvenile onset and a hypothesized iatrogenic origin (iatrogenic CAA, iCAA) has emerged. β-Amyloid (Aβ) accumulation evidenced by amyloid PET positivity or CSF Aβ decrease was included in the iCAA diagnostic criteria. Conversely, diagnostic criteria for sporadic CAA (sCAA) do not involve biomarker analysis. The aim of this study was to assess CSF and plasma levels of Aβ and tau in iCAA and sCAA cohorts. METHODS Patients affected by probable or possible CAA according to established criteria (Boston 2.0) were prospectively recruited at Fondazione IRCCS Carlo Besta and San Gerardo dei Tintori from May 2021 to January 2024. Patients with probable and possible iCAA or sCAA with available plasma and/or CSF samples were included. Clinical and neurologic data were collected, and levels of Aβ40, Aβ42, total tau, and phospho-tau (p-tau) were assessed in CSF and plasma by SiMoA and Lumipulse. RESULTS 21 patients with iCAA (72% male, mean age at symptom onset 50 years [36-74]) and 32 patients with sCAA (44% male, mean age at symptom onset 68 years [52-80]) were identified. Cognitive impairment and cardiovascular risk factors in the sCAA cohort were more common compared with the iCAA cohort. Patients with sCAA and iCAA showed similar CSF levels for Aβ40 (p = 0.5 [sCAA, 95% CI 2,604-4,228; iCAA, 95% CI 1,958-3,736]), Aβ42 (p = 0.7 [sCAA, 95% CI 88-157; iCAA, 95% CI 83-155]), and total tau (p = 0.08 [sCAA, 95% CI 80-134; iCAA, 95% CI 37-99]). Plasma levels of Aβ40 (p = 0.08, 95% CI 181-222), Aβ42 (p = 0.3, 95% CI 6-8), and total tau (p = 0.4, 95% CI 3-6) were not statistically different in patients with sCAA compared with iCAA ones (Aβ40, 95% CI 153-193; Aβ42, 95% CI 6-7 and total tau, 95% CI 2-4). DISCUSSION Despite presenting with a younger age at onset, fewer cardiovascular risk factors, and lower cognitive impairment, patients with iCAA demonstrated Aβ and tau levels comparable with elderly patients with sCAA, supporting a common molecular paradigm between the 2 CAA forms.
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Affiliation(s)
- Giuliana Pollaci
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Antonella Potenza
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Gemma Gorla
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Tatiana Carrozzini
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Giulia Marinoni
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Carolina De Toma
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Isabella Canavero
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Nicola Rifino
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Giorgio B Boncoraglio
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Jacopo C Difrancesco
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Payam Tabaee Damavandi
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Mario Stanziano
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Alessandra Erbetta
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Paola Caroppo
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Giuseppe Di Fede
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Marcella Catania
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Aida Zulueta
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Eugenio Agostino Parati
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Anna Bersano
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Laura Gatti
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
| | - Benedetta Storti
- From the Cerebrovascular Unit (G.P., A.P., G.G., T.C., G.M., C.T., I.C., N.R., G.B.B., A.B., L.G., B.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; Department of Pharmacological and Biomolecular Sciences (G.P., A.P.), University of Milan; Department of Neurology (J.C.D., P.T.D.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Neuroradiology Unit (M.S., A.E.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; ALS Centre (M.S.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Neuropathology Unit (P.C., G.D.F., M.C.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan; and Istituti Clinici Scientifici Maugeri IRCCS (A.Z., E.A.P.), Neurorehabilitation Unit of Milan Institute, Italy
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Lombardo FL, Lorenzini P, Mayer F, Massari M, Piscopo P, Bacigalupo I, Ancidoni A, Sciancalepore F, Locuratolo N, Remoli G, Salemme S, Cappa S, Perani D, Spadin P, Tagliavini F, Redolfi A, Cotelli M, Marra C, Caraglia N, Vecchio F, Miraglia F, Rossini PM, Vanacore N. Development of a prediction model of conversion to Alzheimer's disease in people with mild cognitive impairment: the statistical analysis plan of the INTERCEPTOR project. Diagn Progn Res 2024; 8:11. [PMID: 39049042 PMCID: PMC11271065 DOI: 10.1186/s41512-024-00172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/13/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND In recent years, significant efforts have been directed towards the research and development of disease-modifying therapies for dementia. These drugs focus on prodromal (mild cognitive impairment, MCI) and/or early stages of Alzheimer's disease (AD). Literature evidence indicates that a considerable proportion of individuals with MCI do not progress to dementia. Identifying individuals at higher risk of developing dementia is essential for appropriate management, including the prescription of new disease-modifying therapies expected to become available in clinical practice in the near future. METHODS The ongoing INTERCEPTOR study is a multicenter, longitudinal, interventional, non-therapeutic cohort study designed to enroll 500 individuals with MCI aged 50-85 years. The primary aim is to identify a biomarker or a set of biomarkers able to accurately predict the conversion from MCI to AD dementia within 3 years of follow-up. The biomarkers investigated in this study are neuropsychological tests (mini-mental state examination (MMSE) and delayed free recall), brain glucose metabolism ([18F]FDG-PET), MRI volumetry of the hippocampus, EEG brain connectivity, cerebrospinal fluid (CSF) markers (p-tau, t-tau, Aβ1-42, Aβ1-42/1-40 ratio, Aβ1-42/p-Tau ratio) and APOE genotype. The baseline visit includes a full cognitive and neuropsychological evaluation, as well as the collection of clinical and socio-demographic information. Prognostic models will be developed using Cox regression, incorporating individual characteristics and biomarkers through stepwise selection. Model performance will be evaluated in terms of discrimination and calibration and subjected to internal validation using the bootstrapping procedure. The final model will be visually represented as a nomogram. DISCUSSION This paper contains a detailed description of the statistical analysis plan to ensure the reproducibility and transparency of the analysis. The prognostic model developed in this study aims to identify the population with MCI at higher risk of developing AD dementia, potentially eligible for drug prescriptions. The nomogram could provide a valuable tool for clinicians for risk stratification and early treatment decisions. TRIAL REGISTRATION ClinicalTrials.gov NCT03834402. Registered on February 8, 2019.
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Affiliation(s)
- Flavia L Lombardo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | - Patrizia Lorenzini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Flavia Mayer
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Marco Massari
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Paola Piscopo
- Department of Neuroscience, Italian National Institute of Health, Rome, Italy
| | - Ilaria Bacigalupo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Antonio Ancidoni
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Francesco Sciancalepore
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Nicoletta Locuratolo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Giulia Remoli
- Neurology Department and Brain Health Service, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Simone Salemme
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Cappa
- University Institute of Advanced Studies IUSS Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Spadin
- "Associazione Italiana Malattia di Alzheimer" - AIMA, Milan, Italy
| | | | - Alberto Redolfi
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Camillo Marra
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Memory Clinic, Foundation Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Naike Caraglia
- Memory Clinic, Foundation Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
- Department of Theoretical and Applied Sciences, eCampus University, Novedrate, Como, Italy
| | - Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
- Department of Theoretical and Applied Sciences, eCampus University, Novedrate, Como, Italy
| | - Paolo Maria Rossini
- Memory Clinic, Foundation Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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3
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Barba L, Bellomo G, Oeckl P, Chiasserini D, Gaetani L, Torrigiani EG, Paoletti FP, Steinacker P, Abu-Rumeileh S, Parnetti L, Otto M. CSF neurosecretory proteins VGF and neuroserpin in patients with Alzheimer's and Lewy body diseases. J Neurol Sci 2024; 462:123059. [PMID: 38850771 DOI: 10.1016/j.jns.2024.123059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND VGF and neuroserpin are neurosecretory proteins involved in the pathophysiology of neurodegenerative diseases. We aimed to evaluate their cerebrospinal fluid (CSF) concentrations in patients with Alzheimer's disease (AD) and Lewy body disease (LBD). METHODS We measured CSF VGF [AQEE] peptide and neuroserpin levels in 108 LBD patients, 76 AD patients and 37 controls, and tested their associations with clinical scores and CSF AD markers. RESULTS We found decreased CSF levels of VGF [AQEE] in patients with LBD and dementia compared to controls (p = 0.016) and patients with AD-dementia (p = 0.011), but with significant influence of age and sex distribution. Moreover, we observed, on the one hand, a significant associations between lower VGF [AQEE] and neuroserpin levels and poorer cognitive performance (i.e., lower Mini-Mental State Examination scores). On the other hand, higher levels of CSF tau proteins, especially pTau181, were significantly associated with higher concentrations of VGF [AQEE] and neuroserpin. Indeed, LBD patients with AD-like CSF profiles, especially T+ profiles, had higher levels of VGF [AQEE] and neuroserpin compared to controls and LBD/T- cases. DISCUSSION CSF VGF [AQEE] and neuroserpin may show a complex relationship with cognitive decline when the levels are reduced, and with AD pathology when levels are increased. They may represent novel markers of neurosecretory impairment in neurodegenerative disorders.
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Affiliation(s)
- Lorenzo Barba
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Giovanni Bellomo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Patrick Oeckl
- Department of Neurology, Ulm University, Helmholzstrasse 8/1, 89081 Ulm, Germany; German Center for Neurodegenerative Diseases (DZNE e.V.), Helmholzstrasse 8/1, 89081 Ulm, Germany
| | - Davide Chiasserini
- Section of Biochemistry, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Edoardo Guido Torrigiani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Federico Paolini Paoletti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Petra Steinacker
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06129 Perugia, Italy
| | - Markus Otto
- Department of Neurology, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany.
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Polykretis P, D’Andrea C, Banchelli M, Napolitano L, Cascella R, de Angelis M, Matteini P. Exploring the Aβ 1-42 fibrillogenesis timeline by atomic force microscopy and surface enhanced Raman spectroscopy. Front Mol Biosci 2024; 11:1376411. [PMID: 38948077 PMCID: PMC11211275 DOI: 10.3389/fmolb.2024.1376411] [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: 01/25/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction: Alzheimer's disease (AD) is a progressive debilitating neurological disorder representing the most common neurodegenerative disease worldwide. Although the exact pathogenic mechanisms of AD remain unresolved, the presence of extracellular amyloid-β peptide 1-42 (Aβ1-42) plaques in the parenchymal and cortical brain is considered one of the hallmarks of the disease. Methods: In this work, we investigated the Aβ1-42 fibrillogenesis timeline up to 48 h of incubation, providing morphological and chemo-structural characterization of the main assemblies formed during the aggregation process of Aβ1-42, by atomic force microscopy (AFM) and surface enhanced Raman spectroscopy (SERS), respectively. Results: AFM topography evidenced the presence of characteristic protofibrils at early-stages of aggregation, which form peculiar macromolecular networks over time. SERS allowed to track the progressive variation in the secondary structure of the aggregation species involved in the fibrillogenesis and to determine when the β-sheet starts to prevail over the random coil conformation in the aggregation process. Discussion: Our research highlights the significance of investigating the early phases of fibrillogenesis to better understand the molecular pathophysiology of AD and identify potential therapeutic targets that may prevent or slow down the aggregation process.
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Affiliation(s)
- Panagis Polykretis
- Institute of Applied Physics “Nello Carrara”, National Research Council, Sesto Fiorentino, Italy
| | - Cristiano D’Andrea
- Institute of Applied Physics “Nello Carrara”, National Research Council, Sesto Fiorentino, Italy
| | - Martina Banchelli
- Institute of Applied Physics “Nello Carrara”, National Research Council, Sesto Fiorentino, Italy
| | - Liliana Napolitano
- Department of Experimental and Clinical Biomedical Sciences, Section of Biochemistry, University of Florence, Florence, Italy
| | - Roberta Cascella
- Department of Experimental and Clinical Biomedical Sciences, Section of Biochemistry, University of Florence, Florence, Italy
| | - Marella de Angelis
- Institute of Applied Physics “Nello Carrara”, National Research Council, Sesto Fiorentino, Italy
| | - Paolo Matteini
- Institute of Applied Physics “Nello Carrara”, National Research Council, Sesto Fiorentino, Italy
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Salvadori N, Torrigiani EG, Paoletti FP, Chipi E, Montanucci C, Verderosa C, Siena E, Fruttini D, Parnetti L. Predictive value for cerebrospinal fluid Alzheimer's disease profile of different measures of verbal episodic memory in patients with MCI. Sci Rep 2024; 14:12235. [PMID: 38806521 PMCID: PMC11133313 DOI: 10.1038/s41598-024-62604-z] [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: 01/16/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
Neuropsychological evidence of memory impairment represents the main feature of the clinical onset of typical Alzheimer's disease (AD). Rey's Auditory Verbal Learning Test (RAVLT) and Logical Memory (LM) are two tests both assessing verbal episodic memory, widely used in clinical practice. Our aim was to investigate the added value of their combined use in predicting cerebrospinal fluid (CSF) AD biomarkers positivity in a retrospective consecutive series of patients with mild cognitive impairment (MCI). 169 MCI patients were included. For all of them neuropsychological assessment and CSF analysis were available. According to CSF A/T/(N) profile, 109 were defined as MCI due to AD (A+T+), and 60 were non-AD MCI (A-T-). Logistic regression model and receiver-operating characteristic (ROC) curves were analyzed to evaluate the discriminatory power of single and combined sub-measures between AD and non-AD patients. The combination of RAVLT-del with LM could acceptably discriminate the two groups (AUC: 0.69, CI 95% 0.617-0.761, sens: 0.75, spec. 0.58, p < 0.001), while the single tests did not show sufficient discriminative performance. Our study shows that the combination of RAVLT delayed recall with LM better predicts the biological AD diagnosis (A+T+), showing a good discriminative power between MCI-AD from non-AD MCI. Since RAVLT and LM assess different components of verbal episodic memory, they should be considered as complementary, rather than interchangeable, tests.
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Affiliation(s)
- Nicola Salvadori
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Edoardo Guido Torrigiani
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Federico Paolini Paoletti
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Montanucci
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Claudio Verderosa
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisa Siena
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniela Fruttini
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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Reichmann R, Schulze MB, Pischon T, Weikert C, Aleksandrova K. Biomarker signatures associated with ageing free of major chronic diseases: results from a population-based sample of the EPIC-Potsdam cohort. Age Ageing 2024; 53:ii60-ii69. [PMID: 38745490 DOI: 10.1093/ageing/afae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A number of biomarkers denoting various pathophysiological pathways have been implicated in the aetiology and risk of age-related diseases. Hence, the combined impact of multiple biomarkers in relation to ageing free of major chronic diseases, such as cancer, cardiovascular disease and type 2 diabetes, has not been sufficiently explored. METHODS We measured concentrations of 13 biomarkers in a random subcohort of 2,500 participants in the European Prospective Investigation into Cancer and Nutrition Potsdam study. Chronic disease-free ageing was defined as reaching the age of 70 years within study follow-up without major chronic diseases, including cardiovascular disease, type 2 diabetes or cancer. Using a novel machine-learning technique, we aimed to identify biomarker clusters and explore their association with chronic disease-free ageing in multivariable-adjusted logistic regression analysis taking socio-demographic, lifestyle and anthropometric factors into account. RESULTS Of the participants who reached the age of 70 years, 321 met our criteria for chronic-disease free ageing. Machine learning analysis identified three distinct biomarker clusters, among which a signature characterised by high concentrations of high-density lipoprotein cholesterol, adiponectin and insulin-like growth factor-binding protein 2 and low concentrations of triglycerides was associated with highest odds for ageing free of major chronic diseases. After multivariable adjustment, the association was attenuated by socio-demographic, lifestyle and adiposity indicators, pointing to the relative importance of these factors as determinants of healthy ageing. CONCLUSION These data underline the importance of exploring combinations of biomarkers rather than single molecules in understanding complex biological pathways underpinning healthy ageing.
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Affiliation(s)
- Robin Reichmann
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cornelia Weikert
- Department of Food Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Krasimira Aleksandrova
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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7
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Bellomo G, Toja A, Paolini Paoletti F, Ma Y, Farris CM, Gaetani L, Salvadori N, Chiasserini D, Wojdaƚa AL, Concha‐Marambio L, Parnetti L. Investigating alpha-synuclein co-pathology in Alzheimer's disease by means of cerebrospinal fluid alpha-synuclein seed amplification assay. Alzheimers Dement 2024; 20:2444-2452. [PMID: 38323747 PMCID: PMC11032521 DOI: 10.1002/alz.13658] [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: 10/10/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Lewy body disease, a frequently observed co-pathology in Alzheimer's disease (AD), can be identified antemortem in cerebrospinal fluid (CSF) by α-synuclein seed amplification assay (αS-SAA). The prevalence and clinical impact of CSF αS-SAA positivity in AD are still unknown. METHODS αS-SAA was performed on CSF samples from 240 AD patients (preclinical, prodromal, and dementia stages), 85 controls, 84 patients with Parkinson's disease (PD), and 21 patients with PD with dementia or dementia with Lewy bodies. In AD patients, associations between αS-SAA positivity and cognitive changes were also evaluated. RESULTS In agreement with available neuropathological studies, αS-SAA positivity was observed in 30% of AD patients (vs 9% in controls), and was associated with cognitive decline, visuospatial impairment, and behavioral disturbances. DISCUSSION αS-SAA positivity in AD patients reflects the prevalence observed in neuropathological series and is associated with a worse clinical outcome. These data confirm the validity of CSF αS-SAA positivity as biomarker of synucleinopathy.
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Affiliation(s)
- Giovanni Bellomo
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Andrea Toja
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Federico Paolini Paoletti
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Yihua Ma
- R&D Unit, Amprion IncSan DiegoCaliforniaUSA
| | | | - Lorenzo Gaetani
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Nicola Salvadori
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Davide Chiasserini
- Section of Physiology and BiochemistryDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Anna Lidia Wojdaƚa
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | | | - Lucilla Parnetti
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
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8
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Bellomo G, Bayoumy S, Megaro A, Toja A, Nardi G, Gaetani L, Blujdea ER, Paolini Paoletti F, Wojdaƚa AL, Chiasserini D, van der Flier WM, Verberk IMW, Teunissen C, Parnetti L. Fully automated measurement of plasma Aβ42/40 and p-tau181: Analytical robustness and concordance with cerebrospinal fluid profile along the Alzheimer's disease continuum in two independent cohorts. Alzheimers Dement 2024; 20:2453-2468. [PMID: 38323780 PMCID: PMC11032583 DOI: 10.1002/alz.13687] [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: 10/02/2023] [Revised: 11/30/2023] [Accepted: 12/16/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION For routine clinical implementation of Alzheimer's disease (AD) plasma biomarkers, fully automated random-access platforms are crucial to ensure reproducible measurements. We aimed to perform an analytical validation and to establish cutoffs for AD plasma biomarkers measured with Lumipulse. METHODS Two cohorts were included. UNIPG: n = 450 paired cerebrospinal fluid (CSF)/plasma samples from subjects along the AD-continuum, subjects affected by other neurodegenerative diseases, and controls with known CSF profile; AMS: n = 40 plasma samples from AD and n = 40 controls. Plasma amyloid β (Aβ)42, Aβ40, and p-tau181 were measured with Lumipulse. We evaluated analytical and diagnostic performance. RESULTS Lumipulse assays showed high analytical performance. Plasma p-tau181 levels accurately reflected CSF A+/T+ profile in AD-dementia and mild cognitive impairment (MCI)-AD, but not in asymptomatic-AD. Plasma and CSF Aβ42/40 values were concordant across clinical AD stages. Cutoffs and probability-based models performed satisfactorily in both cohorts. DISCUSSION The identified cutoffs and probability-based models represent a significant step toward plasma AD molecular diagnosis.
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Affiliation(s)
- Giovanni Bellomo
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Sherif Bayoumy
- Neurochemistry LaboratoryDepartment of Laboratory MedicineAmsterdam Neuroscience, Amsterdam UMCAmsterdamThe Netherlands
| | - Alfredo Megaro
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Andrea Toja
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Giovanna Nardi
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Lorenzo Gaetani
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Elena R. Blujdea
- Neurochemistry LaboratoryDepartment of Laboratory MedicineAmsterdam Neuroscience, Amsterdam UMCAmsterdamThe Netherlands
| | - Federico Paolini Paoletti
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Anna Lidia Wojdaƚa
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Davide Chiasserini
- Section of BiochemistryDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Wiesje M. van der Flier
- Alzheimer CenterDepartment of NeurologyVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and Data ScienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Inge M. W. Verberk
- Neurochemistry LaboratoryDepartment of Laboratory MedicineAmsterdam Neuroscience, Amsterdam UMCAmsterdamThe Netherlands
| | - Charlotte Teunissen
- Neurochemistry LaboratoryDepartment of Laboratory MedicineAmsterdam Neuroscience, Amsterdam UMCAmsterdamThe Netherlands
| | - Lucilla Parnetti
- Center for Memory DisturbancesLab of Clinical NeurochemistrySection of NeurologyDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
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Hernández‐Lorenzo L, Gil‐Moreno MJ, Ortega‐Madueño I, Cárdenas MC, Diez‐Cirarda M, Delgado‐Álvarez A, Palacios‐Sarmiento M, Matias‐Guiu J, Corrochano S, Ayala JL, Matias‐Guiu JA. A data-driven approach to complement the A/T/(N) classification system using CSF biomarkers. CNS Neurosci Ther 2024; 30:e14382. [PMID: 37501389 PMCID: PMC10848077 DOI: 10.1111/cns.14382] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS The AT(N) classification system not only improved the biological characterization of Alzheimer's disease (AD) but also raised challenges for its clinical application. Unbiased, data-driven techniques such as clustering may help optimize it, rendering informative categories on biomarkers' values. METHODS We compared the diagnostic and prognostic abilities of CSF biomarkers clustering results against their AT(N) classification. We studied clinical (patients from our center) and research (Alzheimer's Disease Neuroimaging Initiative) cohorts. The studied CSF biomarkers included Aβ(1-42), Aβ(1-42)/Aβ(1-40) ratio, tTau, and pTau. RESULTS The optimal solution yielded three clusters in both cohorts, significantly different in diagnosis, AT(N) classification, values distribution, and survival. We defined these three CSF groups as (i) non-defined or unrelated to AD, (ii) early stages and/or more delayed risk of conversion to dementia, and (iii) more severe cognitive impairment subjects with faster progression to dementia. CONCLUSION We propose this data-driven three-group classification as a meaningful and straightforward approach to evaluating the risk of conversion to dementia, complementary to the AT(N) system classification.
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Affiliation(s)
- Laura Hernández‐Lorenzo
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
- Department of Computer Architecture and Automation, Computer Science FacultyComplutense University of MadridMadridSpain
| | - Maria José Gil‐Moreno
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Isabel Ortega‐Madueño
- Department of Clinical Analysis, Institute of Laboratory MedicineIdSSC, Hospital Clínico San CarlosMadridSpain
| | - Maria Cruz Cárdenas
- Department of Clinical Analysis, Institute of Laboratory MedicineIdSSC, Hospital Clínico San CarlosMadridSpain
| | - Maria Diez‐Cirarda
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Alfonso Delgado‐Álvarez
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Marta Palacios‐Sarmiento
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Jorge Matias‐Guiu
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Silvia Corrochano
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - José L. Ayala
- Department of Computer Architecture and Automation, Computer Science FacultyComplutense University of MadridMadridSpain
| | - Jordi A. Matias‐Guiu
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
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10
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Wojdała AL, Bellomo G, Toja A, Gaetani L, Parnetti L, Chiasserini D. CSF and plasma Aβ42/40 across Alzheimer's disease continuum: comparison of two ultrasensitive Simoa ® assays targeting distinct amyloid regions. Clin Chem Lab Med 2024; 62:332-340. [PMID: 37656487 DOI: 10.1515/cclm-2023-0659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Decreased cerebrospinal fluid (CSF) amyloid beta 42/40 ratio (Aβ42/40) is one of the core Alzheimer's disease (AD) biomarkers. Measurement of Aβ42/40 in plasma has also been proposed as a surrogate marker for amyloidosis, however the validity and the diagnostic performance of this biomarker is still uncertain. Here we evaluated two immunoassays targeting distinct regions of the amyloid peptides by (a) performing a method comparison in both CSF and plasma, and (b) assessing the diagnostic performance across the AD continuum. METHODS We used N4PE and N3PA Simoa® assays to measure Aβ42/40 in CSF and plasma of 134 patients: preclinical AD (pre-AD, n=19), mild cognitive impairment due to AD (MCI-AD, n=41), AD at the dementia stage (AD-dem, n=35), and a control group (CTRL, n=39). The N4PE includes a detector antibody targeting the amyloid N-terminus, while the N3PA uses a detector targeting amyloid mid-region. RESULTS Method comparison of N4PE and N3PA assays revealed discrepancies in assessment of plasma Aβ42/Aβ40. While the diagnostic performance of the two assays did not significantly differ in CSF, in plasma, N4PE assay provided better accuracy for AD discrimination than N3PA assay (AUC AD-dem vs. CTRL 0.77 N4PE, 0.68 N3PA). CONCLUSIONS While both Aβ42/40 assays allowed for an effective discrimination between CTRL and different AD stages, the assay targeting amyloid N-terminal region provided the best diagnostic performance in plasma. Differences observed in technical and diagnostic performance of the two assays may depend on matrix-specific amyloid processing, suggesting that further studies should be carried to standardize amyloid ratio measurement in plasma.
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Affiliation(s)
- Anna Lidia Wojdała
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanni Bellomo
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea Toja
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenzo Gaetani
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Davide Chiasserini
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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11
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Ho M, Levy TJ, Koulas I, Founta K, Coppa K, Hirsch JS, Davidson KW, Spyropoulos AC, Zanos TP. Longitudinal dynamic clinical phenotypes of in-hospital COVID-19 patients across three dominant virus variants in New York. Int J Med Inform 2024; 181:105286. [PMID: 37956643 PMCID: PMC10843635 DOI: 10.1016/j.ijmedinf.2023.105286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND COVID-19 is a challenging disease to characterize given its wide-ranging heterogeneous symptomatology. Several studies have attempted to extract clinical phenotypes but often relied on data from small patient cohorts, usually limited to only one viral variant and utilizing a static snapshot of patient data. OBJECTIVE This study aimed to identify clinical phenotypes of hospitalized COVID-19 patients and investigate their longitudinal dynamics throughout the pandemic, with the goal to relate these phenotypes to clinical outcomes and treatment strategies. METHODS We utilized routinely collected demographic and clinical data throughout the hospitalization of 38,077 patients admitted between 3/2020 to 5/2022, in 12 New York hospitals. Uniform Manifold Approximation and Projection and agglomerative hierarchical clustering were used to derive the clusters, followed by exploratory data analysis to compare the prevalence of comorbidities and treatments per cluster. RESULTS 4 distinct clinical phenotypes remained robust in multi-site validation and were associated with different mortality rates. The temporal progression of these phenotypes throughout the COVID-19 pandemic demonstrated increased variability across the waves of the three dominant viral variants (alpha, delta, omicron). Longitudinal analysis evaluating changes in clinical phenotypes of each patient throughout the course of a 4-week hospital stay exemplified the dynamic nature of the disease progression. Factors such as sex, race/ethnicity and specific treatment modalities revealed significant and clinically relevant differences between the observed phenotypes. CONCLUSIONS Our proposed methodology has the potential of enabling clinicians and policy makers to draw evidence-based conclusions for guiding treatment modalities in a dynamic fashion.
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Affiliation(s)
- Matthew Ho
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549
| | - Todd J Levy
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030
| | - Ioannis Koulas
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030
| | - Kyriaki Founta
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549
| | - Kevin Coppa
- Department of Clinical Digital Solutions, Northwell Health, New Hyde Park, NY 11042
| | - Jamie S Hirsch
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549; Department of Clinical Digital Solutions, Northwell Health, New Hyde Park, NY 11042
| | - Karina W Davidson
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549
| | - Alex C Spyropoulos
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549
| | - Theodoros P Zanos
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549.
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12
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Paciotti S, Wojdała AL, Bellomo G, Toja A, Chipi E, Piersma SR, Pham TV, Gaetani L, Jimenez CR, Parnetti L, Chiasserini D. Potential diagnostic value of CSF metabolism-related proteins across the Alzheimer's disease continuum. Alzheimers Res Ther 2023; 15:124. [PMID: 37454217 DOI: 10.1186/s13195-023-01269-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) cerebrospinal fluid (CSF) core biomarkers (Aβ42/40 ratio, p-tau, and t-tau) provide high diagnostic accuracy, even at the earliest stage of disease. However, these markers do not fully reflect the complex AD pathophysiology. Recent large scale CSF proteomic studies revealed several new AD candidate biomarkers related to metabolic pathways. In this study we measured the CSF levels of four metabolism-related proteins not directly linked to amyloid- and tau-pathways (i.e., pyruvate kinase, PKM; aldolase, ALDO; ubiquitin C-terminal hydrolase L1, UCHL1, and fatty acid-binding protein 3, FABP3) across the AD continuum. We aimed at validating the potential value of these proteins as new CSF biomarkers for AD and their possible involvement in AD pathogenesis, with specific interest on the preclinical phase of the disease. METHODS CSF PKM and ALDO activities were measured with specific enzyme assays while UCHL1 and FABP3 levels were measured with immunoassays in a cohort of patients composed as follows: preclinical AD (pre-AD, n = 19, cognitively unimpaired), mild cognitive impairment due to AD (MCI-AD, n = 50), dementia due to AD (ADdem, n = 45), and patients with frontotemporal dementia (FTD, n = 37). Individuals with MCI not due to AD (MCI, n = 30) and subjective cognitive decline (SCD, n = 52) with negative CSF AD-profile, were enrolled as control groups. RESULTS CSF UCHL1 and FABP3 levels, and PKM activity were significantly increased in AD patients, already at the pre-clinical stage. CSF PKM activity was also increased in FTD patients compared with control groups, being similar between AD and FTD patients. No difference was found in ALDO activity among the groups. UCHL1 showed good performance in discriminating early AD patients (pre-AD and MCI-AD) from controls (AUC ~ 0.83), as assessed by ROC analysis. Similar results were obtained for FABP3. Conversely, PKM provided the best performance when comparing FTD vs. MCI (AUC = 0.80). Combination of PKM, FABP3, and UCHL1 improved the diagnostic accuracy for the detection of patients within the AD continuum when compared with single biomarkers. CONCLUSIONS Our study confirmed the potential role of UCHL1 and FABP3 as neurodegenerative biomarkers for AD. Furthermore, our results validated the increase of PKM activity in CSF of AD patients, already at the preclinical phase of the disease. Increased PKM activity was observed also in FTD patients, possibly underlining similar alterations in energy metabolism in AD and FTD.
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Affiliation(s)
- Silvia Paciotti
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Lidia Wojdała
- Laboratory of Clinical Neurochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanni Bellomo
- Laboratory of Clinical Neurochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea Toja
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Sander R Piersma
- OncoProteomics Laboratory, Laboratory Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Thang V Pham
- OncoProteomics Laboratory, Laboratory Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Connie R Jimenez
- OncoProteomics Laboratory, Laboratory Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Davide Chiasserini
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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13
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D'Andrea C, Cazzaniga FA, Bistaffa E, Barucci A, de Angelis M, Banchelli M, Farnesi E, Polykretis P, Marzi C, Indaco A, Tiraboschi P, Giaccone G, Matteini P, Moda F. Impact of seed amplification assay and surface-enhanced Raman spectroscopy combined approach on the clinical diagnosis of Alzheimer's disease. Transl Neurodegener 2023; 12:35. [PMID: 37438825 DOI: 10.1186/s40035-023-00367-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The current diagnosis of Alzheimer's disease (AD) is based on a series of analyses which involve clinical, instrumental and laboratory findings. However, signs, symptoms and biomarker alterations observed in AD might overlap with other dementias, resulting in misdiagnosis. METHODS Here we describe a new diagnostic approach for AD which takes advantage of the boosted sensitivity in biomolecular detection, as allowed by seed amplification assay (SAA), combined with the unique specificity in biomolecular recognition, as provided by surface-enhanced Raman spectroscopy (SERS). RESULTS The SAA-SERS approach supported by machine learning data analysis allowed efficient identification of pathological Aβ oligomers in the cerebrospinal fluid of patients with a clinical diagnosis of AD or mild cognitive impairment due to AD. CONCLUSIONS Such analytical approach can be used to recognize disease features, thus allowing early stratification and selection of patients, which is fundamental in clinical treatments and pharmacological trials.
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Affiliation(s)
- Cristiano D'Andrea
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Federico Angelo Cazzaniga
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Edoardo Bistaffa
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Andrea Barucci
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Marella de Angelis
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Martina Banchelli
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Edoardo Farnesi
- Institute of Physical Chemistry (IPC) and Abbe Center of Photonics (ACP), Friedrich Schiller University Jena, 07743, Jena, Germany
- Leibniz Institute of Photonic Technology, 07745, Jena, Germany
| | - Panagis Polykretis
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Antonio Indaco
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Pietro Tiraboschi
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Giorgio Giaccone
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Paolo Matteini
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy.
| | - Fabio Moda
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
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14
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Barba L, Abu-Rumeileh S, Halbgebauer S, Bellomo G, Paolini Paoletti F, Gaetani L, Oeckl P, Steinacker P, Massa F, Parnetti L, Otto M. CSF Synaptic Biomarkers in AT(N)-Based Subgroups of Lewy Body Disease. Neurology 2023; 101:e50-e62. [PMID: 37188538 PMCID: PMC10351307 DOI: 10.1212/wnl.0000000000207371] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with Lewy body disease (LBD) often show a co-occurring Alzheimer disease (AD) pathology. CSF biomarkers allow the detection in vivo of AD-related pathologic hallmarks included in the amyloid-tau-neurodegeneration (AT(N)) classification system. Here, we aimed to investigate whether CSF biomarkers of synaptic and neuroaxonal damage are correlated with the presence of AD copathology in LBD and can be useful to differentiate patients with LBD with different AT(N) profiles. METHODS We retrospectively measured CSF levels of AD core biomarkers (Aβ42/40 ratio, phosphorylated tau protein, and total tau protein) and of synaptic (β-synuclein, α-synuclein, synaptosomal-associated protein 25 [SNAP-25], and neurogranin) and neuroaxonal proteins (neurofilament light chain [NfL]) in 28 cognitively unimpaired participants with nondegenerative neurologic conditions and 161 participants with a diagnosis of either LBD or AD (at both mild cognitive impairment, AD-MCI, and dementia stages, AD-dem). We compared CSF biomarker levels in clinical and AT(N)-based subgroups. RESULTS CSF β-synuclein, α-synuclein, SNAP-25, neurogranin, and NfL levels did not differ between LBD (n = 101, age 67.2 ± 7.8 years, 27.7% females) and controls (age 64.8 ± 8.6 years, 39.3% females) and were increased in AD (AD-MCI: n = 30, AD-dem: n = 30, age 72.3 ± 6.0 years, 63.3% females) compared with both groups (p < 0.001 for all comparisons). In LBD, we found increased levels of synaptic and neuroaxonal degeneration biomarkers in patients with A+T+ (LBD/A+T+) than with A-T- profiles (LBD/A-T-) (p < 0.01 for all), and β-synuclein showed the highest discriminative accuracy between the 2 groups (area under the curve 0.938, 95% CI 0.884-0.991). CSF β-synuclein (p = 0.0021), α-synuclein (p = 0.0099), and SNAP-25 concentrations (p = 0.013) were also higher in LBD/A+T+ than in LBD/A+T- cases, which had synaptic biomarker levels within the normal range. CSF α-synuclein was significantly decreased only in patients with LBD with T- profiles compared with controls (p = 0.0448). Moreover, LBD/A+T+ and AD cases did not differ in any biomarker level. DISCUSSION LBD/A+T+ and AD cases showed significantly increased CSF levels of synaptic and neuroaxonal biomarkers compared with LBD/A-T- and control subjects. Patients with LBD and AT(N)-based AD copathology showed, thus, a distinct signature of synaptic dysfunction from other LBD cases. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that CSF levels of β-synuclein, α-synuclein, SNAP-25, neurogranin, and NfL are higher in patients with AD than in patients with LBD.
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Affiliation(s)
- Lorenzo Barba
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy.
| | - Samir Abu-Rumeileh
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Steffen Halbgebauer
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Giovanni Bellomo
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Federico Paolini Paoletti
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Lorenzo Gaetani
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Patrick Oeckl
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Petra Steinacker
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Federico Massa
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Lucilla Parnetti
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy
| | - Markus Otto
- From the Department of Neurology (L.B., S.A.-R., P.S., M.O.), Martin-Luther-University of Halle-Wittenberg, Germany; Section of Neurology (L.B., G.B., F.P.P., L.G., L.P.), Department of Medicine and Surgery, University of Perugia, Italy; Department of Neurology (S.H., P.O., M.O.), Ulm University, Germany; German Center for Neurodegenerative Disorders Ulm (DZNE e.V.) (P.O.); and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.M.), University of Genoa, Italy.
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15
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Gaetani L, Chiasserini D, Paolini Paoletti F, Bellomo G, Parnetti L. Required improvements for cerebrospinal fluid-based biomarker tests of Alzheimer's disease. Expert Rev Mol Diagn 2023; 23:1195-1207. [PMID: 37902844 DOI: 10.1080/14737159.2023.2276918] [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: 04/26/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) biomarkers represent a well-established tool for diagnosing Alzheimer's disease (AD), independently from the clinical stage, by reflecting the presence of brain amyloidosis (A+) and tauopathy (T+). In front of this important achievement, so far, (i) CSF AD biomarkers have not yet been adopted for routine clinical use in all Centers dedicated to AD, mainly due to inter-lab variation and lack of internationally accepted cutoff values; (ii) we do need to add other biomarkers more suitable to correlate with the clinical stage and disease monitoring; (iii) we also need to detect the co-presence of other 'non-AD' pathologies. AREAS COVERED Efforts to establish standardized cutoff values based on large-scale multi-center studies are discussed. The influence of aging and comorbidities on CSF biomarker levels is also analyzed, and possible solutions are presented, i.e. complementing the A/T/(N) system with markers of axonal damage and synaptic derangement. EXPERT OPINION The first, mandatory need is to reach common cutoff values and defined (automated) methodologies for CSF AD biomarkers. To properly select subjects deserving CSF analysis, blood tests might represent the first-line approach. In those subjects undergoing CSF analysis, multiple biomarkers, able to give a comprehensive and personalized pathophysiological/prognostic information, should be included.
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Affiliation(s)
- Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Davide Chiasserini
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Giovanni Bellomo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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16
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Bellomo G, Paciotti S, Concha-Marambio L, Rizzo D, Wojdaƚa AL, Chiasserini D, Gatticchi L, Cerofolini L, Giuntini S, De Luca CMG, Ma Y, Farris CM, Pieraccini G, Bologna S, Filidei M, Ravera E, Lelli M, Moda F, Fragai M, Parnetti L, Luchinat C. Cerebrospinal fluid lipoproteins inhibit α-synuclein aggregation by interacting with oligomeric species in seed amplification assays. Mol Neurodegener 2023; 18:20. [PMID: 37005644 PMCID: PMC10068178 DOI: 10.1186/s13024-023-00613-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/12/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Aggregation of α-synuclein (α-syn) is a prominent feature of Parkinson's disease (PD) and other synucleinopathies. Currently, α-syn seed amplification assays (SAAs) using cerebrospinal fluid (CSF) represent the most promising diagnostic tools for synucleinopathies. However, CSF itself contains several compounds that can modulate the aggregation of α-syn in a patient-dependent manner, potentially undermining unoptimized α-syn SAAs and preventing seed quantification. METHODS In this study, we characterized the inhibitory effect of CSF milieu on detection of α-syn aggregates by means of CSF fractionation, mass spectrometry, immunoassays, transmission electron microscopy, solution nuclear magnetic resonance spectroscopy, a highly accurate and standardized diagnostic SAA, and different in vitro aggregation conditions to evaluate spontaneous aggregation of α-syn. RESULTS We found the high-molecular weight fraction of CSF (> 100,000 Da) to be highly inhibitory on α-syn aggregation and identified lipoproteins to be the main drivers of this effect. Direct interaction between lipoproteins and monomeric α-syn was not detected by solution nuclear magnetic resonance spectroscopy, on the other hand we observed lipoprotein-α-syn complexes by transmission electron microscopy. These observations are compatible with hypothesizing an interaction between lipoproteins and oligomeric/proto-fibrillary α-syn intermediates. We observed significantly slower amplification of α-syn seeds in PD CSF when lipoproteins were added to the reaction mix of diagnostic SAA. Additionally, we observed a decreased inhibition capacity of CSF on α-syn aggregation after immunodepleting ApoA1 and ApoE. Finally, we observed that CSF ApoA1 and ApoE levels significantly correlated with SAA kinetic parameters in n = 31 SAA-negative control CSF samples spiked with preformed α-syn aggregates. CONCLUSIONS Our results describe a novel interaction between lipoproteins and α-syn aggregates that inhibits the formation of α-syn fibrils and could have relevant implications. Indeed, the donor-specific inhibition of CSF on α-syn aggregation explains the lack of quantitative results from analysis of SAA-derived kinetic parameters to date. Furthermore, our data show that lipoproteins are the main inhibitory components of CSF, suggesting that lipoprotein concentration measurements could be incorporated into data analysis models to eliminate the confounding effects of CSF milieu on α-syn quantification efforts.
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Affiliation(s)
- Giovanni Bellomo
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, Italy.
| | - Silvia Paciotti
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, Italy
| | - Luis Concha-Marambio
- R&D Unit, Amprion Inc, 11095 Flintkote Av., San Diego, San Diego, CA, 92121, USA
| | - Domenico Rizzo
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
- Department of Chemistry "Ugo Schiff", University of Florence, Via Della Lastruccia 3, 50019, Sesto Fiorentino, Italy
| | - Anna Lidia Wojdaƚa
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, Italy
| | - Davide Chiasserini
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, PerugiaPerugia, Italy
| | - Leonardo Gatticchi
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, PerugiaPerugia, Italy
| | - Linda Cerofolini
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP), Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
| | - Stefano Giuntini
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
| | - Chiara Maria Giulia De Luca
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Yihua Ma
- R&D Unit, Amprion Inc, 11095 Flintkote Av., San Diego, San Diego, CA, 92121, USA
| | - Carly M Farris
- R&D Unit, Amprion Inc, 11095 Flintkote Av., San Diego, San Diego, CA, 92121, USA
| | - Giuseppe Pieraccini
- Department of Health Sciences, CISM Mass Spectrometry Centre, University of Florence, Viale Gaetano Pieraccini 6, 50139, Florence, Italy
| | - Sara Bologna
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
| | - Marta Filidei
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, Italy
| | - Enrico Ravera
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
- Department of Chemistry "Ugo Schiff", University of Florence, Via Della Lastruccia 3, 50019, Sesto Fiorentino, Italy
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP), Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
| | - Moreno Lelli
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
- Department of Chemistry "Ugo Schiff", University of Florence, Via Della Lastruccia 3, 50019, Sesto Fiorentino, Italy
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP), Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
| | - Fabio Moda
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Marco Fragai
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
- Department of Chemistry "Ugo Schiff", University of Florence, Via Della Lastruccia 3, 50019, Sesto Fiorentino, Italy
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP), Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy
| | - Lucilla Parnetti
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Piazzale Lucio Severi 1/8, 06132, Perugia, Italy
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy.
- Department of Chemistry "Ugo Schiff", University of Florence, Via Della Lastruccia 3, 50019, Sesto Fiorentino, Italy.
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP), Via Luigi Sacconi 6, 50019, Sesto Fiorentino, Italy.
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17
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Peña-Bautista C, Álvarez-Sánchez L, Pascual R, Moreno MJ, Baquero M, Cháfer-Pericás C. Clinical usefulness of cerebrospinal fluid biomarkers in Alzheimer's disease. Eur J Clin Invest 2023; 53:e13910. [PMID: 36401799 DOI: 10.1111/eci.13910] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/05/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a complex disease that shares clinical features with other dementias. It is important to establish a specific and reliable diagnosis. Nowadays, AD diagnosis is based on cerebrospinal fluid (CSF) biomarkers. However, the corresponding cut-offs differ amongst studies. This study aims to evaluate the CSF biomarkers in the AD differential diagnosis. METHODS Clinical relevant biomarkers (amyloid β42 (Aβ42), t-Tau, p-Tau, amyloid β40 (Aβ40), neurofilament light chain (NfL)) were determined in CSF samples from participants classified as AD (n = 124) and non-AD (n = 148) patients from the Neurology Unit. They were included and evaluated consecutively (August 2018-October 2020). The clinical utility of these biomarkers was evaluated by AUC-ROC curves and the corresponding cut-off points were defined. RESULTS The results showed satisfactory accuracy (AUC-ROC 0.91 for Aβ42, 0.890 for t-Tau and 0.933 for p-Tau); whilst Aβ40 and NfL did not show good discriminatory capacity (AUC-ROC 0.557 and 0.738, respectively). The ratios Aβ42/Aβ40 and t-Tau/Aβ42 improved the diagnosis indices of each individual biomarker, with AUC-ROC of 0.980 and 0.971, respectively. Also, elevated levels of NfL were found in the frontotemporal dementia group compared with the other participant groups. CONCLUSIONS The ratio Aβ42/Aβ40 showed the highest discriminating capacity between AD and non-AD patients and might be useful in clinical practice. Regarding NfL, it is not a specific biomarker for AD; however, it might be helpful for the differential diagnosis of frontotemporal dementia. Nevertheless, further analysis in an external cohort is required in order to validate these results.
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Affiliation(s)
- Carmen Peña-Bautista
- Alzheimer Disease Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Lourdes Álvarez-Sánchez
- Alzheimer Disease Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Rosa Pascual
- University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Miguel Baquero
- Alzheimer Disease Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Consuelo Cháfer-Pericás
- Alzheimer Disease Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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18
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A Novel Automated Chemiluminescence Method for Detecting Cerebrospinal Fluid Amyloid-Beta 1-42 and 1-40, Total Tau and Phosphorylated-Tau: Implications for Improving Diagnostic Performance in Alzheimer's Disease. Biomedicines 2022; 10:biomedicines10102667. [PMID: 36289929 PMCID: PMC9599653 DOI: 10.3390/biomedicines10102667] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Recently, a fully automated instrument for the detection of the Cerebrospinal Fluid (CSF) biomarker for Alzheimer’s disease (AD) (low concentration of Amyloid-beta 42 (Aβ42), high concentration of total tau (T-tau) and Phosphorylated-tau (P-tau181)), has been implemented, namely CLEIA. We conducted a comparative analysis between ELISA and CLEIA methods in order to evaluate the analytical precision and the diagnostic performance of the novel CLEIA system on 111 CSF samples. Results confirmed a robust correlation between ELISA and CLEIA methods, with an improvement of the accuracy with the new CLEIA methodology in the detection of the single biomarkers and in their ratio values. For Aβ42 regression analysis with Passing−Bablok showed a Pearson correlation coefficient r = 0.867 (0.8120; 0.907% 95% CI p < 0.0001), T-tau analysis: r = 0.968 (0.954; 0.978% 95% CI p < 0.0001) and P-tau181: r = 0.946 (0.922; 0.962 5% 95% CI p < 0.0001). The overall ROC AUC comparison between ROC in ELISA and ROC in CLEIA confirmed a more accurate ROC AUC with the new automatic method: T-tau AUC ELISA = 0.94 (95% CI 0.89; 0.99 p < 0.0001) vs. AUC CLEIA = 0.95 (95% CI 0.89; 1.00 p < 0.0001), and P-tau181 AUC ELISA = 0.91 (95% CI 0.85; 0.98 p < 0.0001) vs. AUC CLEIA = 0.98 (95% CI 0.95; 1.00 p < 0.0001). The performance of the new CLEIA method in automation is comparable and, for tau and P-tau181, even better, as compared with standard ELISA. Hopefully, in the future, automation could be useful in clinical diagnosis and also in the context of clinical studies.
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19
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Bonomo R, Elia AE, Cilia R, Romito LM, Golfrè Andreasi N, Devigili G, Bonvegna S, Straccia G, Garavaglia B, Panteghini C, Eleopra R. Cerebrospinal fluid neuropathological biomarkers in beta-propeller protein-associated neurodegeneration, with complicated parkinsonian phenotype. Parkinsonism Relat Disord 2022; 98:38-40. [PMID: 35462318 DOI: 10.1016/j.parkreldis.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Roberta Bonomo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy; Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Antonio E Elia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy.
| | - Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Luigi M Romito
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Nico Golfrè Andreasi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Grazia Devigili
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Salvatore Bonvegna
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Giulia Straccia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Barbara Garavaglia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Unit of Medical Genetics and Neurogenetics, Milan, Italy
| | - Celeste Panteghini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Unit of Medical Genetics and Neurogenetics, Milan, Italy
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
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20
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Pomilio AB, Vitale AA, Lazarowski AJ. Neuroproteomics Chip-Based Mass Spectrometry and Other Techniques for Alzheimer´S Disease Biomarkers – Update. Curr Pharm Des 2022; 28:1124-1151. [DOI: 10.2174/1381612828666220413094918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022]
Abstract
Background:
Alzheimer's disease (AD) is a progressive neurodegenerative disease of growing interest given that there is cognitive damage and symptom onset acceleration. Therefore, it is important to find AD biomarkers for early diagnosis, disease progression, and discrimination of AD and other diseases.
Objective:
To update the relevance of mass spectrometry for the identification of peptides and proteins involved in AD useful as discriminating biomarkers.
Methods:
Proteomics and peptidomics technologies that show the highest possible specificity and selectivity for AD biomarkers are analyzed, together with the biological fluids used. In addition to positron emission tomography and magnetic resonance imaging, MALDI-TOF mass spectrometry is widely used to identify proteins and peptides involved in AD. The use of protein chips in SELDI technology and electroblotting chips for peptides makes feasible small amounts (L) of samples for analysis.
Results:
Suitable biomarkers are related to AD pathology, such as intracellular neurofibrillary tangles; extraneuronal senile plaques; neuronal and axonal degeneration; inflammation and oxidative stress. Recently, peptides were added to the candidate list, which are not amyloid-b or tau fragments, but are related to coagulation, brain plasticity, and complement/neuroinflammation systems involving the neurovascular unit.
Conclusion:
The progress made in the application of mass spectrometry and recent chip techniques is promising for discriminating between AD, mild cognitive impairment, and matched healthy controls. The application of this technique to blood samples from patients with AD has shown to be less invasive and fast enough to determine the diagnosis, stage of the disease, prognosis, and follow-up of the therapeutic response.
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Affiliation(s)
- Alicia B. Pomilio
- Departamento de Bioquímica Clínica, Área Hematología, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Av. Córdoba 2351, C1120AAF Buenos Aires, Argentina
| | - Arturo A. Vitale
- Departamento de Bioquímica Clínica, Área Hematología, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Av. Córdoba 2351, C1120AAF Buenos Aires, Argentina
| | - Alberto J. Lazarowski
- Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Córdoba 2351, C1120AAF Buenos Aires, Argentina
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21
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Jo T, Nho K, Bice P, Saykin AJ. Deep learning-based identification of genetic variants: application to Alzheimer's disease classification. Brief Bioinform 2022; 23:bbac022. [PMID: 35183061 PMCID: PMC8921609 DOI: 10.1093/bib/bbac022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 01/29/2023] Open
Abstract
Deep learning is a promising tool that uses nonlinear transformations to extract features from high-dimensional data. Deep learning is challenging in genome-wide association studies (GWAS) with high-dimensional genomic data. Here we propose a novel three-step approach (SWAT-CNN) for identification of genetic variants using deep learning to identify phenotype-related single nucleotide polymorphisms (SNPs) that can be applied to develop accurate disease classification models. In the first step, we divided the whole genome into nonoverlapping fragments of an optimal size and then ran convolutional neural network (CNN) on each fragment to select phenotype-associated fragments. In the second step, using a Sliding Window Association Test (SWAT), we ran CNN on the selected fragments to calculate phenotype influence scores (PIS) and identify phenotype-associated SNPs based on PIS. In the third step, we ran CNN on all identified SNPs to develop a classification model. We tested our approach using GWAS data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) including (N = 981; cognitively normal older adults (CN) = 650 and AD = 331). Our approach identified the well-known APOE region as the most significant genetic locus for AD. Our classification model achieved an area under the curve (AUC) of 0.82, which was compatible with traditional machine learning approaches, random forest and XGBoost. SWAT-CNN, a novel deep learning-based genome-wide approach, identified AD-associated SNPs and a classification model for AD and may hold promise for a range of biomedical applications.
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Affiliation(s)
- Taeho Jo
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Network Science Institute, Bloomington, IN, USA
| | - Kwangsik Nho
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Network Science Institute, Bloomington, IN, USA
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paula Bice
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Network Science Institute, Bloomington, IN, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
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