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Clemmensen FK, Areskeviciute A, Lund EL, Roos P. Variably protease-sensitive prionopathy with methionine homozygosity at codon 129 in the prion protein gene. BMJ Case Rep 2024; 17:e258199. [PMID: 38388201 PMCID: PMC10884235 DOI: 10.1136/bcr-2023-258199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Variably protease-sensitive prionopathy (VPSPr) is a recently characterised rare subtype of sporadic prion disease, mainly affecting individuals with valine homozygosity at codon 129 in the prion protein gene, with only seven methionine homozygote cases reported to date. This case presents clinical, neuropathological and biochemical features of the eighth VPSPr case worldwide with methionine homozygosity at codon 129 and compares the features with the formerly presented cases.The patient, a woman in her 70s, presented with cognitive decline, impaired balance and frequent falls. Medical history and clinical presentation were suggestive of a rapidly progressive dementia disorder. MRI showed bilateral thalamic hyperintensity. Cerebrospinal fluid real-time quaking-induced conversion was negative, and the electroencephalogram was unremarkable. The diagnosis was established through post-mortem pathological examinations. VPSPr should be suspected in rapidly progressive dementia lacking typical features or paraclinical results of protein misfolding diseases.
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Affiliation(s)
- Frederikke Kragh Clemmensen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ausrine Areskeviciute
- Danish Reference Centre for Prion Disease, Department of Pathology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Eva Løbner Lund
- Danish Reference Centre for Prion Disease, Department of Pathology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Roos
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Maier AD, Meddis A, Haslund-Vinding J, Mirian C, Areskeviciute A, Nguyen P, Westergaard C, Melchior LC, Munch TN, Skjøth-Rasmussen J, Poulsgaard L, Ziebell M, Bartek Jr J, Broholm H, Poulsen FR, Gerds TA, Scheie D, Mathiesen T. P04.05 Targeted Gene-Expression analysis during malignant transformation in primary and secondary malignant meningioma. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Malignant meningiomas comprise 2–5% of all meningiomas. The process of malignant transformation when benign meningiomas (WHO grade I-II) become malignant (WHO grade III) has not previously been investigated in sequential tumour surgeries. Upregulation of FOXM1 expression and DREAM-complex repression have shown phenotypical subgroups correlating with WHO grade and aggressiveness. We investigated the RNA expression of 30 genes central to meningioma biology and 770 genes involved in neuroinflammatory pathways in primary and secondary malignant meningioma patients who underwent one to several operations.
MATERIALS AND METHODS
We identified a cohort of consecutive malignant meningioma patients treated at Rigshospitalet, Copenhagen from 2000–2020 (n=51) and gathered their malignant tumours and previous WHO grade I/II tumours. The malignant cohort (MC) was counter matched with a benign cohort (BC) where patients had no recurrences during follow-up. RNA expression signatures from 140 samples from the MC and 51 samples from the BC were analysed with the Nanostring Neuroinflammation panel customized with 30 genes known to be relevant in meningioma phenotypes.
RESULTS
49% of MC patients had a previous grade I/II meningioma making them secondary malignant meningioma patients. Progression-free survival calculated from first malignant surgery to first recurrence or death showed no significant difference in the primary vs. secondary patients. Preliminary results of single-gene analysis of MC tumours showed FOXM1, MYBL2, TOP2A, BIRC5 expression was higher in WHO grade III samples. Gene-expression signatures in the individual patients and gene ontology enrichment analyses are in process.
CONCLUSIONS
FOXM1, MYBL2, TOP2A, BIRC5 RNA expression levels seem to rise during malignant progression across patients. Gene-expression analysis using the Nanostring technology is feasible and a potentially powerful tool to distinguish meningiomas prone to malignant transformation from truly benign meningiomas.
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Affiliation(s)
- A D Maier
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - A Meddis
- University of Copenhagen, Section of Biostatistics, Copenhagen, Denmark
| | | | - C Mirian
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
| | - A Areskeviciute
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - P Nguyen
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - C Westergaard
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - L C Melchior
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - T N Munch
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
- Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark
| | | | - L Poulsgaard
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
| | - M Ziebell
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
| | - J Bartek Jr
- Karolinska University Hospital, Department of Neurosurgery, Stockholm, Sweden
| | - H Broholm
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - F R Poulsen
- Odense University Hospital, Department of Neurosurgery, Odense, Denmark
- University of Southern Denmark and BRIDGE, Clinical Institute, Odense, Denmark
| | - T A Gerds
- University of Copenhagen, Section of Biostatistics, Copenhagen, Denmark
| | - D Scheie
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - T Mathiesen
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
- University of Copenhagen, Institute of Clinical Medicine, Copenhagen, Denmark
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Maier AD, Meddis A, Haslund-Vinding J, Mirian C, Areskeviciute A, Nguyen P, Westergaard C, Melchior LC, Munch TN, Skjøth-Rasmussen J, Poulsgaard L, Ziebell M, Bartek J, Broholm H, Poulsen FR, Gerds TA, Scheie D, Mathiesen TI. OTEH-3. Targeted Gene-Expression analysis during malignant transformation in primary and secondary malignant meningioma. Neurooncol Adv 2021. [PMCID: PMC8255439 DOI: 10.1093/noajnl/vdab070.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Malignant meningiomas comprise 2–5% of all meningiomas. The process of malignant transformation when benign meningiomas (WHO grade I-II) become malignant (WHO grade III) has not previously been investigated in sequential tumour surgeries. Upregulation of FOXM1 expression and DREAM-complex repression have shown phenotypical subgroups correlating with WHO grade and aggressiveness. We investigated the RNA expression of 30 genes central to meningioma biology and 770 genes involved in neuroinflammatory pathways in primary and secondary malignant meningioma patients who underwent one to several operations. Methods We identified a cohort of consecutive malignant meningioma patients treated at Rigshospitalet, Copenhagen from 2000–2020 (n=51) and gathered their malignant tumours and previous WHO grade I/II tumours. The malignant cohort (MC) was counter matched with a benign cohort (BC) where patients had no recurrences during follow-up. RNA expression signatures from 140 samples from the MC and 51 samples from the BC were analysed with the Nanostring Neuroinflammation panel customized with 30 genes known to be relevant in meningioma phenotypes. Results 49% of MC patients had a previous grade I/II meningioma making them secondary malignant meningioma patients. Progression-free survival calculated from first malignant surgery to first recurrence or death showed no significant difference in the primary vs. secondary patients. Preliminary results of single-gene analysis of MC tumours showed FOXM1, MYBL2, TOP2A, BIRC5 expression was higher in WHO grade III samples. Gene-expression signatures in the individual patients and gene ontology enrichment analyses are in process. Conclusions FOXM1, MYBL2, TOP2A, BIRC5 RNA expression levels seem to rise during malignant progression across patients. Gene-expression analysis using the Nanostring technology is feasible and a potentially powerful tool to distinguish meningiomas prone to malignant transformation from truly benign meningiomas.
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Affiliation(s)
- Andrea Daniela Maier
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - Alessandra Meddis
- University of Copenhagen, Section of Biostatistics, Copenhagen, Denmark
| | | | | | | | - Phuong Nguyen
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | | | | | - Tina Nørgaard Munch
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
- Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark
| | | | - Lars Poulsgaard
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
| | - Morten Ziebell
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
| | - Jiri Bartek
- Karolinska University Hospital, Department of Neurosurgery, Stockholm, Sweden
| | - Helle Broholm
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - Frantz Rom Poulsen
- Odense University Hospital, Department of Neurosurgery, Odense, Denmark
- University of Southern Denmark and BRIDGE, Clinical Institute, Odense, Denmark
| | | | - David Scheie
- Rigshospitalet, Department of Pathology, Copenhagen, Denmark
| | - Tiit Illimar Mathiesen
- Rigshospitalet, Department of Neurosurgery, Copenhagen, Denmark
- University of Copenhagen, Institute of Clinical Medicine, Copenhagen, Denmark
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