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Butler ML, Pervaiz N, Ypsilantis P, Wang Y, Cammasola Breda J, Mazzilli S, Nicks R, Spurlock E, Hefti MM, Huber BR, Alvarez VE, Stein TD, Campbell JD, McKee AC, Cherry JD. Repetitive head impacts induce neuronal loss and neuroinflammation in young athletes. bioRxiv 2024:2024.03.26.586815. [PMID: 38585925 PMCID: PMC10996668 DOI: 10.1101/2024.03.26.586815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Repetitive head impacts (RHI) sustained from contact sports are the largest risk factor for chronic traumatic encephalopathy (CTE). Currently, CTE can only be diagnosed after death and the multicellular cascade of events that trigger initial hyperphosphorylated tau (p-tau) deposition remain unclear. Further, the symptoms endorsed by young individuals with early disease are not fully explained by the extent of p-tau deposition, severely hampering development of therapeutic interventions. Here, we show that RHI exposure associates with a multicellular response in young individuals (<51 years old) prior to the onset of CTE p-tau pathology that correlates with number of years of RHI exposure. Leveraging single nucleus RNA sequencing of tissue from 8 control, 9 RHI-exposed, and 11 low stage CTE individuals, we identify SPP1+ inflammatory microglia, angiogenic and inflamed endothelial cell profiles, reactive astrocytes, and altered synaptic gene expression in excitatory and inhibitory neurons in all individuals with exposure to RHI. Surprisingly, we also observe a significant loss of cortical sulcus layer 2/3 neurons in contact sport athletes compared to controls independent of p-tau pathology. These results provide robust evidence that multiple years of RHI exposure is sufficient to induce lasting cellular alterations that may underlie p-tau deposition and help explain the early clinical symptoms observed in young former contact sport athletes. Furthermore, these data identify specific cellular responses to repetitive head impacts that may direct future identification of diagnostic and therapeutic strategies for CTE.
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Affiliation(s)
- Morgane L.M.D. Butler
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Nida Pervaiz
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | | | - Yichen Wang
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Julia Cammasola Breda
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Sarah Mazzilli
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | | | | | - Marco M. Hefti
- Department of Pathology, University of Iowa Health Care, Iowa City IA, USA
| | - Bertrand R. Huber
- VA Boston Healthcare System, Jamaica Plain MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Victor E. Alvarez
- VA Boston Healthcare System, Jamaica Plain MA, USA
- VA Bedford Healthcare System, Bedford MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- VA Bedford Healthcare System, Bedford MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Joshua D. Campbell
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Jonathan D. Cherry
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
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2
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Alexander A, Alvarez VE, Huber BR, Alosco ML, Mez J, Tripodis Y, Nicks R, Katz DI, Dwyer B, Daneshvar DH, Martin B, Palmisano J, Goldstein LE, Crary JF, Nowinski C, Cantu RC, Kowall NW, Stern RA, Delalle I, McKee AC, Stein TD. Cortical-sparing chronic traumatic encephalopathy (CSCTE): a distinct subtype of CTE. Acta Neuropathol 2024; 147:45. [PMID: 38407651 DOI: 10.1007/s00401-024-02690-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repetitive head impacts (RHI) and pathologically defined as neuronal phosphorylated tau aggregates around small blood vessels and concentrated at sulcal depths. Cross-sectional studies suggest that tau inclusions follow a stereotyped pattern that begins in the neocortex in low stage disease, followed by involvement of the medial temporal lobe and subcortical regions with significant neocortical burden in high stage CTE. Here, we define a subset of brain donors with high stage CTE and with a low overall cortical burden of tau inclusions (mean semiquantitative value ≤1) and classify them as cortical-sparing CTE (CSCTE). Of 620 brain donors with pathologically diagnosed CTE, 66 (11%) met criteria for CSCTE. Compared to typical high stage CTE, those with CSCTE had a similar age at death and years of contact sports participation and were less likely to carry apolipoprotein ε4 (p < 0.05). CSCTE had less overall tau pathology severity, but a proportional increase of disease burden in medial temporal lobe and brainstem regions compared to the neocortex (p's < 0.001). CSCTE also had lower prevalence of comorbid neurodegenerative disease. Clinically, CSCTE participants were less likely to have dementia (p = 0.023) and had less severe cognitive difficulties (as reported by informants using the Functional Activities Questionnaire (FAQ); p < 0.001, meta-cognitional index T score; p = 0.002 and Cognitive Difficulties Scale (CDS); p < 0.001,) but had an earlier onset age of behavioral (p = 0.006) and Parkinsonian motor (p = 0.013) symptoms when compared to typical high stage CTE. Other comorbid tauopathies likely contributed in part to these differences: when cases with concurrent Alzheimer dementia or frontal temporal lobar degeneration with tau pathology were excluded, differences were largely retained, but only remained significant for FAQ (p = 0.042), meta-cognition index T score (p = 0.014) and age of Parkinsonian motor symptom onset (p = 0.046). Overall, CSCTE appears to be a distinct subtype of high stage CTE with relatively greater involvement of subcortical and brainstem regions and less severe cognitive symptoms.
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Affiliation(s)
- Abigail Alexander
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Douglas I Katz
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence and Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Nowinski
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Ivana Delalle
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA.
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- , 150 S. Huntington Avenue, Boston, MA, 02130, USA.
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3
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Baas PW, Sullivan KA, Terry AV, Case K, Yates PL, Sun X, Raghupathi R, Huber BR, Qiang L. Is Gulf War Illness a prolonged early phase tauopathy? Cytoskeleton (Hoboken) 2024; 81:41-46. [PMID: 37702426 PMCID: PMC10841075 DOI: 10.1002/cm.21786] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
The work of the Gulf War Illness (GWI) Consortium and that of basic and clinical researchers across the USA have resulted in a better understanding in recent years of the pathological basis of GWI, as well as of the mechanisms underlying the disorder. Among the most concerning symptoms suffered by veterans with GWI are cognitive decrements including those related to memory functioning. These decrements are not severe enough to meet dementia criteria, but there is significant concern that the mild cognitive impairment of these veterans will progress to dementia as they become older. Recent studies on GWI using human brain organoids as well as a rat model suggest that one potential cause of the cognitive problems may be elevated levels of tau in the brain, and this is supported by high levels of tau autoantibodies in the blood of veterans with GWI. There is urgency in finding treatments and preventive strategies for these veterans before they progress to dementia, with added value in doing so because their current status may represent an early phase of tauopathy common to many neurodegenerative diseases.
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Affiliation(s)
- Peter W. Baas
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Kimberly A. Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Alvin V. Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Kendra Case
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Philip L. Yates
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Xiaohuan Sun
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA; VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts, USA; Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
| | - Liang Qiang
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
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4
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Stewart W, Buckland ME, Abdolmohammadi B, Affleck AJ, Alvarez VE, Gilchrist S, Huber BR, Lee EB, Lyall DM, Nowinski CJ, Russell ER, Stein TD, Suter CM, McKee AC. Risk of chronic traumatic encephalopathy in rugby union is associated with length of playing career. Acta Neuropathol 2023; 146:829-832. [PMID: 37872234 PMCID: PMC10627955 DOI: 10.1007/s00401-023-02644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Affiliation(s)
- William Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK.
- Department of Neuropathology, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK.
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Bobak Abdolmohammadi
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Andrew J Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Victor E Alvarez
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Shannon Gilchrist
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Bertrand R Huber
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christopher J Nowinski
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
| | - Emma R Russell
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Thor D Stein
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Catherine M Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Ann C McKee
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
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5
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Chatzinakos C, Pernia CD, Morrison FG, Iatrou A, McCullough KM, Schuler H, Snijders C, Bajaj T, DiPietro CP, Soliva Estruch M, Gassen NC, Anastasopoulos C, Bharadwaj RA, Bowlby BC, Hartmann J, Maihofer AX, Nievergelt CM, Ressler NM, Wolf EJ, Carlezon WA, Krystal JH, Kleinman JE, Girgenti MJ, Huber BR, Kellis M, Logue MW, Miller MW, Ressler KJ, Daskalakis NP. Single-Nucleus Transcriptome Profiling of Dorsolateral Prefrontal Cortex: Mechanistic Roles for Neuronal Gene Expression, Including the 17q21.31 Locus, in PTSD Stress Response. Am J Psychiatry 2023; 180:739-754. [PMID: 37491937 DOI: 10.1176/appi.ajp.20220478] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Multidisciplinary studies of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) implicate the dorsolateral prefrontal cortex (DLPFC) in disease risk and pathophysiology. Postmortem brain studies have relied on bulk-tissue RNA sequencing (RNA-seq), but single-cell RNA-seq is needed to dissect cell-type-specific mechanisms. The authors conducted the first single-nucleus RNA-seq postmortem brain study in PTSD to elucidate disease transcriptomic pathology with cell-type-specific resolution. METHOD Profiling of 32 DLPFC samples from 11 individuals with PTSD, 10 with MDD, and 11 control subjects was conducted (∼415K nuclei; >13K cells per sample). A replication sample included 15 DLPFC samples (∼160K nuclei; >11K cells per sample). RESULTS Differential gene expression analyses identified significant single-nucleus RNA-seq differentially expressed genes (snDEGs) in excitatory (EX) and inhibitory (IN) neurons and astrocytes, but not in other cell types or bulk tissue. MDD samples had more false discovery rate-corrected significant snDEGs, and PTSD samples had a greater replication rate. In EX and IN neurons, biological pathways that were differentially enriched in PTSD compared with MDD included glucocorticoid signaling. Furthermore, glucocorticoid signaling in induced pluripotent stem cell (iPSC)-derived cortical neurons demonstrated greater relevance in PTSD and opposite direction of regulation compared with MDD, especially in EX neurons. Many snDEGs were from the 17q21.31 locus and are particularly interesting given causal roles in disease pathogenesis and DLPFC-based neuroimaging (PTSD: ARL17B, LINC02210-CRHR1, and LRRC37A2; MDD: LRRC37A and LRP4), while others were regulated by glucocorticoids in iPSC-derived neurons (PTSD: SLC16A6, TAF1C; MDD: CDH3). CONCLUSIONS The study findings point to cell-type-specific mechanisms of brain stress response in PTSD and MDD, highlighting the importance of examining cell-type-specific gene expression and indicating promising novel biomarkers and therapeutic targets.
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Affiliation(s)
- Chris Chatzinakos
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Cameron D Pernia
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Filomene G Morrison
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Artemis Iatrou
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Kenneth M McCullough
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Heike Schuler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Clara Snijders
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Thomas Bajaj
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Christopher P DiPietro
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Marina Soliva Estruch
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Nils C Gassen
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Constantin Anastasopoulos
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Rahul A Bharadwaj
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Benjamin C Bowlby
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Jakob Hartmann
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Adam X Maihofer
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Caroline M Nievergelt
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Nicholas M Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Erika J Wolf
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - William A Carlezon
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - John H Krystal
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Joel E Kleinman
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Matthew J Girgenti
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Bertrand R Huber
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Manolis Kellis
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Mark W Logue
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Mark W Miller
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
| | - Nikolaos P Daskalakis
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Chatzinakos, Pernia, Iatrou, McCullough, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Hartmann, N.M. Ressler, Carlezon, K.J. Ressler, Daskalakis); Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Mass. (Chatzinakos, Pernia, Iatrou, Schuler, Snijders, DiPietro, Soliva Estruch, Anastasopoulos, Bowlby, Daskalakis); National Center for PTSD, VA Boston Healthcare System, Boston (Morrison, Wolf, Logue, Miller); Department of Psychiatry (Morrison, Wolf, Logue, Miller), Department of Neurology (Huber), and Department of Biomedical Genetics (Logue), Boston University School of Medicine, Boston; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (Soliva Estruch, Snijders); RG Neurohomeostasis, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Bonn, Bonn, Germany (Bajaj, Gassen); Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (Anastasopoulos); Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore (Bharadwaj, Kleinman); Department of Psychiatry, University of California San Diego, La Jolla (Maihofer, Nievergelt); Center for Excellence in Stress and Mental Health (Maihofer, Nievergelt) and Research Service (Maihofer, Nievergelt), Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal, Girgenti); Psychiatry Service, VA Connecticut Healthcare System, West Haven (Krystal, Girgenti); National Center for PTSD, Clinical Neurosciences Division, U.S. Department of Veterans Affairs, West Haven, Conn. (Krystal, Girgenti); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (Kleinman); Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston (Huber); Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, and Broad Institute of MIT and Harvard, Cambridge, Mass. (Kellis); Department of Biostatistics, Boston University School of Public Health, Boston (Logue)
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6
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Rosen G, Kirsch D, Horowitz S, Cherry JD, Nicks R, Kelley H, Uretsky M, Dell'Aquila K, Mathias R, Cormier KA, Kubilus CA, Mez J, Tripodis Y, Stein TD, Alvarez VE, Alosco ML, McKee AC, Huber BR. Three dimensional evaluation of cerebrovascular density and branching in chronic traumatic encephalopathy. Acta Neuropathol Commun 2023; 11:123. [PMID: 37491342 PMCID: PMC10369801 DOI: 10.1186/s40478-023-01612-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI) and characterized by perivascular accumulations of hyperphosphorylated tau protein (p-tau) at the depths of the cortical sulci. Studies of living athletes exposed to RHI, including concussive and nonconcussive impacts, have shown increased blood-brain barrier permeability, reduced cerebral blood flow, and alterations in vasoreactivity. Blood-brain barrier abnormalities have also been reported in individuals neuropathologically diagnosed with CTE. To further investigate the three-dimensional microvascular changes in individuals diagnosed with CTE and controls, we used SHIELD tissue processing and passive delipidation to optically clear and label blocks of postmortem human dorsolateral frontal cortex. We used fluorescent confocal microscopy to quantitate vascular branch density and fraction volume. We compared the findings in 41 male brain donors, age at death 31-89 years, mean age 64 years, including 12 donors with low CTE (McKee stage I-II), 13 with high CTE (McKee stage III-IV) to 16 age- and sex-matched non-CTE controls (7 with RHI exposure and 9 with no RHI exposure). The density of vessel branches in the gray matter sulcus was significantly greater in CTE cases than in controls. The ratios of sulcus versus gyrus vessel branch density and fraction volume were also greater in CTE than in controls and significantly above one for the CTE group. Hyperphosphorylated tau pathology density correlated with gray matter sulcus fraction volume. These findings point towards increased vascular coverage and branching in the dorsolateral frontal cortex (DLF) sulci in CTE, that correlates with p-tau pathology.
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Affiliation(s)
- Grace Rosen
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA
| | - Daniel Kirsch
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Sarah Horowitz
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA
| | - Jonathan D Cherry
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Hunter Kelley
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Kevin Dell'Aquila
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Rebecca Mathias
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Kerry A Cormier
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Caroline A Kubilus
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Thor D Stein
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Victor E Alvarez
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Michael L Alosco
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Ann C McKee
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Bertrand R Huber
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA.
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA.
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7
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Daneshvar DH, Nair ES, Baucom ZH, Rasch A, Abdolmohammadi B, Uretsky M, Saltiel N, Shah A, Jarnagin J, Baugh CM, Martin BM, Palmisano JN, Cherry JD, Alvarez VE, Huber BR, Weuve J, Nowinski CJ, Cantu RC, Zafonte RD, Dwyer B, Crary JF, Goldstein LE, Kowall NW, Katz DI, Stern RA, Tripodis Y, Stein TD, McClean MD, Alosco ML, McKee AC, Mez J. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat Commun 2023; 14:3470. [PMID: 37340004 PMCID: PMC10281995 DOI: 10.1038/s41467-023-39183-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI), but the components of RHI exposure underlying this relationship are unclear. We create a position exposure matrix (PEM), composed of American football helmet sensor data, summarized from literature review by player position and level of play. Using this PEM, we estimate measures of lifetime RHI exposure for a separate cohort of 631 football playing brain donors. Separate models examine the relationship between CTE pathology and players' concussion count, athletic positions, years of football, and PEM-derived measures, including estimated cumulative head impacts, linear accelerations, and rotational accelerations. Only duration of play and PEM-derived measures are significantly associated with CTE pathology. Models incorporating cumulative linear or rotational acceleration have better model fit and are better predictors of CTE pathology than duration of play or cumulative head impacts alone. These findings implicate cumulative head impact intensity in CTE pathogenesis.
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Affiliation(s)
- Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, MA, USA.
| | - Evan S Nair
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Zachary H Baucom
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Abigail Rasch
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nicole Saltiel
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Arsal Shah
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Johnny Jarnagin
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brett M Martin
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - John F Crary
- Neuropathology Brain Bank & Research Core, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Douglas I Katz
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael D McClean
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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8
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Nicks R, Clement NF, Alvarez VE, Tripodis Y, Baucom ZH, Huber BR, Mez J, Alosco ML, Aytan N, Cherry JD, Cormier KA, Kubilius C, Mathias R, Svirsky SE, Pothast MJ, Hildebrandt AM, Chung J, Han X, Crary JF, McKee AC, Frosch MP, Stein TD. Repetitive head impacts and chronic traumatic encephalopathy are associated with TDP-43 inclusions and hippocampal sclerosis. Acta Neuropathol 2023; 145:395-408. [PMID: 36681782 DOI: 10.1007/s00401-023-02539-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
Hippocampal sclerosis (HS) is associated with advanced age as well as transactive response DNA-binding protein with 43 kDa (TDP-43) deposits. Both hippocampal sclerosis and TDP-43 proteinopathy have also been described in chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to exposure to repetitive head impacts (RHI). However, the prevalence of HS in CTE, the pattern of TDP-43 pathology, and associations of HS and TDP-43 with RHI are unknown. A group of participants with a history of RHI and CTE at autopsy (n = 401) as well as a group with HS-aging without CTE (n = 33) was examined to determine the prevalence of HS and TDP-43 inclusions in CTE and to compare the clinical and pathological features of HS and TDP-43 inclusions in CTE to HS-aging. In CTE, HS was present in 23.4%, and TDP-43 inclusions were present in 43.3% of participants. HS in CTE occurred at a relatively young age (mean 77.0 years) and was associated with a greater number of years of RHI than CTE without HS adjusting for age (p = 0.029). In CTE, TDP-43 inclusions occurred frequently in the frontal cortex and occurred both with and without limbic TDP-43. Additionally, structural equation modeling demonstrated that RHI exposure years were associated with hippocampal TDP-43 inclusions (p < 0.001) through increased CTE stage (p < 0.001). Overall, RHI and the development of CTE pathology may contribute to TDP-43 deposition and hippocampal sclerosis.
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Affiliation(s)
- Raymond Nicks
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Nathan F Clement
- C.S. Kubik Laboratory for Neuropathology, Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pathology and Laboratory Services, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Zachery H Baucom
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Nurgul Aytan
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Kerry A Cormier
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Carol Kubilius
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Rebecca Mathias
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Sarah E Svirsky
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Morgan J Pothast
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | | | - Jaeyoon Chung
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Xudong Han
- Boston University Bioinformatics Graduate Program, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence and Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Matthew P Frosch
- C.S. Kubik Laboratory for Neuropathology, Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA.
- VA Boston Healthcare System, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA.
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9
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McKee AC, Stein TD, Huber BR, Crary JF, Bieniek K, Dickson D, Alvarez VE, Cherry JD, Farrell K, Butler M, Uretsky M, Abdolmohammadi B, Alosco ML, Tripodis Y, Mez J, Daneshvar DH. Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts. Acta Neuropathol 2023; 145:371-394. [PMID: 36759368 PMCID: PMC10020327 DOI: 10.1007/s00401-023-02540-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
Over the last 17 years, there has been a remarkable increase in scientific research concerning chronic traumatic encephalopathy (CTE). Since the publication of NINDS-NIBIB criteria for the neuropathological diagnosis of CTE in 2016, and diagnostic refinements in 2021, hundreds of contact sport athletes and others have been diagnosed at postmortem examination with CTE. CTE has been reported in amateur and professional athletes, including a bull rider, boxers, wrestlers, and American, Canadian, and Australian rules football, rugby union, rugby league, soccer, and ice hockey players. The pathology of CTE is unique, characterized by a pathognomonic lesion consisting of a perivascular accumulation of neuronal phosphorylated tau (p-tau) variably alongside astrocytic aggregates at the depths of the cortical sulci, and a distinctive molecular structural configuration of p-tau fibrils that is unlike the changes observed with aging, Alzheimer's disease, or any other tauopathy. Computational 3-D and finite element models predict the perivascular and sulcal location of p-tau pathology as these brain regions undergo the greatest mechanical deformation during head impact injury. Presently, CTE can be definitively diagnosed only by postmortem neuropathological examination; the corresponding clinical condition is known as traumatic encephalopathy syndrome (TES). Over 97% of CTE cases published have been reported in individuals with known exposure to repetitive head impacts (RHI), including concussions and nonconcussive impacts, most often experienced through participation in contact sports. While some suggest there is uncertainty whether a causal relationship exists between RHI and CTE, the preponderance of the evidence suggests a high likelihood of a causal relationship, a conclusion that is strengthened by the absence of any evidence for plausible alternative hypotheses. There is a robust dose-response relationship between CTE and years of American football play, a relationship that remains consistent even when rigorously accounting for selection bias. Furthermore, a recent study suggests that selection bias underestimates the observed risk. Here, we present the advances in the neuropathological diagnosis of CTE culminating with the development of the NINDS-NIBIB criteria, the multiple international studies that have used these criteria to report CTE in hundreds of contact sports players and others, and the evidence for a robust dose-response relationship between RHI and CTE.
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Affiliation(s)
- Ann C McKee
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA.
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA.
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
| | - Thor D Stein
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Bertrand R Huber
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - John F Crary
- Departments of Pathology, Neuroscience, and Artificial Intelligence and Human Health, Neuropathology Brain Bank and Research Core, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Bieniek
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dennis Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Victor E Alvarez
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Jonathan D Cherry
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kurt Farrell
- Departments of Pathology, Neuroscience, and Artificial Intelligence and Human Health, Neuropathology Brain Bank and Research Core, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgane Butler
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
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10
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Kirsch D, Shah A, Dixon E, Kelley H, Cherry JD, Xia W, Daley S, Aytan N, Cormier K, Kubilus C, Mathias R, Alvarez VE, Huber BR, McKee AC, Stein TD. Vascular injury is associated with repetitive head impacts and tau pathology in chronic traumatic encephalopathy. J Neuropathol Exp Neurol 2023; 82:127-139. [PMID: 36617181 PMCID: PMC9852946 DOI: 10.1093/jnen/nlac122] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repetitive head impacts (RHI) and characterized by perivascular hyperphosphorylated tau (p-tau) deposits. The role of vascular injury, blood-brain barrier leakage, and neuroinflammation in CTE pathogenesis is not well understood. We performed quantitative immunoassays for intercellular adhesion molecule 1 (ICAM1), vascular cellular adhesion molecule 1 (VCAM1), and C-reactive protein (CRP) within the postmortem dorsolateral frontal cortex of participants with and without a history of RHI and CTE (n = 156), and tested for associations with RHI, microgliosis, and tau pathology measures. Levels of vascular injury-associated markers ICAM1, VCAM1, and CRP were increased in CTE compared to RHI-exposed and -naïve controls. ICAM1 and CRP increased with RHI exposure duration (p < 0.01) and were associated with increased microglial density (p < 0.001) and tau pathology (AT8, p-tau396, p-tau202; p < 0.05). Histologically, there was significantly increased ICAM1 staining of the microvasculature, extracellular space, and astrocytes at the sulcal depths in high stage CTE compared to both low stage CTE and controls. Multifocal perivascular immunoreactivity for serum albumin was present in all RHI-exposed individuals. These findings demonstrate that vascular injury markers are associated with RHI exposure, duration, and microgliosis, are elevated in CTE, and increase with disease severity.
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Affiliation(s)
- Daniel Kirsch
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Erin Dixon
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Hunter Kelley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jonathan D Cherry
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Weiming Xia
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Sarah Daley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Nurgul Aytan
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kerry Cormier
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Carol Kubilus
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Rebecca Mathias
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Victor E Alvarez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bertrand R Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ann C McKee
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thor D Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
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11
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Rasch A, Tripodis Y, Martin BM, Palmisano J, Katz DI, Dwyer B, Daneshvar DH, Goldstein LE, Kowall NW, Stern RA, Huber BR, Stein TD, McKee AC, Mez JB, Alosco ML. Clinical and Neuropathological Correlates of Substance Use Disorders in Brain Donors Exposed to Repetitive Head Impacts. Alzheimers Dement 2022. [DOI: 10.1002/alz.067416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- Boston University School of Public Health Boston MA USA
- Boston University Boston MA USA
| | | | | | | | - Brigid Dwyer
- Boston University School of Medicine Boston MA USA
| | - Daniel H Daneshvar
- Boston University School of Medicine Boston MA USA
- Harvard University School of Medicine Cambridge MA USA
| | | | - Neil W Kowall
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- VA Boston Healthcare Boston MA USA
| | - Robert A Stern
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Bertrand R. Huber
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- VA Boston Healthcare Jamaica Plain MA USA
- Department of Neurology, Boston University School of Medicine Boston MA USA
| | - Thor D. Stein
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- VA Boston Healthcare System Jamaica Plain MA USA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- Department of Neurology, Boston University School of Medicine Boston MA USA
- VA Boston Healthcare System Jamaica Plain MA USA
| | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Michael L Alosco
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- Department of Neurology, Boston University School of Medicine Boston MA USA
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12
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Zhao X, Logue MW, Hawn SE, Neale ZE, Zhou Z, Huber BR, Miller MW, Wolf EJ. PTSD, major depression, and advanced transcriptomic age in brain tissue. Depress Anxiety 2022; 39:824-834. [PMID: 36281744 PMCID: PMC9729392 DOI: 10.1002/da.23289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Psychiatric disorders have been associated with advanced epigenetic age in DNA methylation, yet this relationship has not been studied in the brain transcriptome. We examined transcriptomic age using an RNA-based algorithm recently developed by Ren and Kuan ("RNAAgeCalc") and the associations between posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and alcohol use disorder with age-adjusted RNA age ("RNA age residuals") in three brain regions: dorsolateral prefrontal cortex, ventromedial prefrontal cortex (vmPFC), and motor cortex. METHODS RNA sequencing was used to measure gene expression in postmortem brain tissue from the VA National PTSD Brain Bank (n = 94; 59% male). RESULTS Linear models revealed that diagnoses of PTSD and/or MDD were positively associated with RNA age residuals in vmPFC only (p-adj = 0.012). Three genes in the RNAAgeCalc algorithm (KCNJ16, HYAL2, and CEBPB) were also differentially expressed in association with PTSD/MDD in vmPFC (p-adj = 6.45E-05 to 0.02). Enrichment analysis revealed that inflammatory and immune-related pathways were overrepresented (p-adj < 0.05) among the 43 genes in RNAAgeCalc that were also at least nominally associated with PTSD/MDD in vmPFC relative to the 448 RNAAgeCalc genes. Endothelial and mural cells were negatively associated with RNA age residuals in vmPFC (both p-adj = 0.028) and with PTSD/MDD (both p-adj = 0.017). CONCLUSIONS Results highlight the importance of inflammation and immune system dysregulation in the link between psychopathology and accelerated cellular aging and raise the possibility that blood-brain barrier degradation may play an important role in stress-related accelerated brain aging.
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Affiliation(s)
- Xiang Zhao
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Mark W. Logue
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Biomedical Genetics, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Sage E. Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Zoe E. Neale
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Zhenwei Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Bertrand R. Huber
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | | | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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13
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Nair ES, Daneshvar DH, Rasch A, Abdolmohammadi B, Saltiel N, Uretsky M, Shah A, Baucom ZH, Martin BM, Palmisano J, Cherry JD, Alvarez VE, Huber BR, Alosco ML, Tripodis Y, Crary JF, Stein TD, McKee AC, Mez JB. Leveraging American football helmet accelerometer data to estimate associations between cumulative repetitive head impact exposure and chronic traumatic encephalopathy. Alzheimers Dement 2022. [DOI: 10.1002/alz.067199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Evan S Nair
- Boston University School of Medicine Boston MA USA
| | | | | | | | - Nicole Saltiel
- Boston University School of Medicine Boston MA USA
- Department of Veterans Affairs Bedford MA USA
- VA Boston Healthcare System Boston MA USA
| | | | - Arsal Shah
- Boston University School of Medicine Boston MA USA
- Department of Veterans Affairs Bedford MA USA
- VA Boston Healthcare System Boston MA USA
| | | | | | | | - Jonathan D Cherry
- Boston University School of Medicine Boston MA USA
- Department of Veterans Affairs Bedford MA USA
- VA Boston Healthcare System Boston MA USA
| | - Victor E. Alvarez
- Boston University School of Medicine Boston MA USA
- Department of Veterans Affairs Bedford MA USA
- VA Boston Healthcare System Boston MA USA
| | - Bertrand R. Huber
- Boston University School of Medicine Boston MA USA
- Department of Veterans Affairs Bedford MA USA
- VA Boston Healthcare System Boston MA USA
| | - Michael L Alosco
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | - Thor D. Stein
- Boston University School of Medicine Boston MA USA
- VA Boston Healthcare System Boston MA USA
| | - Ann C. McKee
- Boston University School of Medicine Boston MA USA
- VA Boston Healthcare System Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
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14
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Yang J, Chang S, Chen IA, Kura S, Rosen GA, Saltiel NA, Huber BR, Varadarajan D, Balbastre Y, Magnain C, Chen SC, Fischl B, McKee AC, Boas DA, Wang H. Volumetric Characterization of Microvasculature in Ex Vivo Human Brain Samples By Serial Sectioning Optical Coherence Tomography. IEEE Trans Biomed Eng 2022; 69:3645-3656. [PMID: 35560084 PMCID: PMC9888394 DOI: 10.1109/tbme.2022.3175072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Serial sectioning optical coherence tomography (OCT) enables accurate volumetric reconstruction of several cubic centimeters of human brain samples. We aimed to identify anatomical features of the ex vivo human brain, such as intraparenchymal blood vessels and axonal fiber bundles, from the OCT data in 3D, using intrinsic optical contrast. METHODS We developed an automatic processing pipeline to enable characterization of the intraparenchymal microvascular network in human brain samples. RESULTS We demonstrated the automatic extraction of the vessels down to a 20 μm in diameter using a filtering strategy followed by a graphing representation and characterization of the geometrical properties of microvascular network in 3D. We also showed the ability to extend this processing strategy to extract axonal fiber bundles from the volumetric OCT image. CONCLUSION This method provides a viable tool for quantitative characterization of volumetric microvascular network as well as the axonal bundle properties in normal and pathological tissues of the ex vivo human brain.
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15
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Culhane JE, Abdolmohammadi B, Nair ES, Saltiel N, Tripodis Y, Martin BM, Palmisano J, Katz DI, Dwyer B, Daneshvar DH, Goldstein LE, Dams‐O'Connor K, Kowall NW, Stern RA, Huber BR, Stein TD, Mez JB, McKee AC, Alosco ML. Moderate‐Severe Traumatic Brain Injury History and Chronic Traumatic Encephalopathy Neuropathology in Brain Donors Exposed to Repetitive Head Impacts. Alzheimers Dement 2022. [DOI: 10.1002/alz.064579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Evan S Nair
- Boston University School of Medicine Boston MA USA
| | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | | | - Brigid Dwyer
- Boston University School of Medicine Boston MA USA
| | | | | | | | | | | | | | | | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
| | - Ann C. McKee
- Boston University School of Medicine Boston MA USA
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16
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Farrell K, Iida MA, Cherry JD, Casella A, Stein TD, Bieniek KF, Walker JM, Richardson TE, White CL, Alvarez VE, Huber BR, Dickson DW, Insausti R, Dams-O'Connor K, McKee AC, Crary JF. Differential Vulnerability of Hippocampal Subfields in Primary Age-Related Tauopathy and Chronic Traumatic Encephalopathy. J Neuropathol Exp Neurol 2022; 81:781-789. [PMID: 36004533 PMCID: PMC9487677 DOI: 10.1093/jnen/nlac066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a tauopathy associated with repetitive mild head impacts characterized by perivascular hyperphosphorylated tau (p-tau) in neurofibrillary tangles (NFTs) and neurites in the depths of the neocortical sulci. In moderate to advanced CTE, NFTs accumulate in the hippocampus, potentially overlapping neuroanatomically with primary age-related tauopathy (PART), an age-related tauopathy characterized by Alzheimer disease-like tau pathology in the hippocampus devoid of amyloid plaques. We measured p-tau burden using positive-pixel counts on immunohistochemically stained and neuroanatomically segmented hippocampal tissue. Subjects with CTE had a higher total p-tau burden than PART subjects in all sectors (p = 0.005). Within groups, PART had significantly higher total p-tau burden in CA1/subiculum compared to CA3 (p = 0.02) and CA4 (p = 0.01) and total p-tau burden in CA2 trended higher than CA4 (p = 0.06). In CTE, total p-tau burden in CA1/subiculum was significantly higher than in the dentate gyrus; and CA2 also trended higher than dentate gyrus (p = 0.01, p = 0.06). When controlling for p-tau burden across the entire hippocampus, CA3 and CA4 had significantly higher p-tau burden in CTE than PART (p < 0.0001). These data demonstrate differences in hippocampal p-tau burden and regional distribution in CTE compared to PART that might be helpful in differential diagnosis and reveal insights into disease pathogenesis.
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Affiliation(s)
- Kurt Farrell
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan A Iida
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan D Cherry
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alicia Casella
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thor D Stein
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kevin F Bieniek
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jamie M Walker
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Timothy E Richardson
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victor E Alvarez
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bertrand R Huber
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dennis W Dickson
- Departments of Pathology and Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Ricardo Insausti
- Human Neuroanatomy Laboratory, School of Medicine, University of Castilla-La Mancha, Albacete, Spain
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ann C McKee
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - John F Crary
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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17
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Stathas S, Alvarez VE, Xia W, Nicks R, Meng G, Daley S, Pothast M, Shah A, Kelley H, Esnault C, McCormack R, Dixon E, Fishbein L, Cherry JD, Huber BR, Tripodis Y, Alosco ML, Mez J, McKee AC, Stein TD. Tau phosphorylation sites serine202 and serine396 are differently altered in chronic traumatic encephalopathy and Alzheimer's disease. Alzheimers Dement 2022; 18:1511-1522. [PMID: 34854540 PMCID: PMC9160206 DOI: 10.1002/alz.12502] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/03/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI) typically sustained by contact sport athletes. Post-translation modifications to tau in CTE have not been well delineated or compared to Alzheimer's disease (AD). METHODS We measured phosphorylated tau epitopes within dorsolateral frontal cortex from post mortem brains with neither CTE nor AD (n = 108), CTE (n = 109), AD (n = 223), and both CTE and AD (n = 33). RESULTS Levels of hyperphosphorylated tau (p-tau)202 , p-tau231 , and p-tau396 were significantly increased in CTE. Total years of RHI exposure was significantly associated with increased p-tau202 levels (P = .001), but not p-tau396 . Instead, p-tau396 was most closely related to amyloid beta (Aβ)1-42 levels (P < .001). The p-tau202 :p-tau396 ratio was significantly increased in early and late CTE compared to AD. DISCUSSION In frontal cortex, p-tau202 is the most upregulated p-tau species in CTE, while p-tau396 is most increased in AD. p-tau202 and p-tau396 measurements may aid in developing biomarkers for disease.
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Affiliation(s)
- SpiroAnthony Stathas
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Victor E. Alvarez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Weiming Xia
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Raymond Nicks
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Gaoyuan Meng
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Sarah Daley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Morgan Pothast
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Hunter Kelley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Camille Esnault
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Robert McCormack
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Erin Dixon
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Lucas Fishbein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Jonathan D. Cherry
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 20118, USA
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 20118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, 72 E Concord Street, B7800, Boston, MA, 02118, USA
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18
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Colvin LE, Foster ZW, Stein TD, Thakore-James M, Salajegheh MK, Carr K, Spencer KR, Rauf NA, Adams L, Averill JG, Walker SE, Robey I, Alvarez VE, Huber BR, McKee AC, Kowall NW, Brady CB. Utility of the ALSFRS-R for predicting ALS and comorbid disease neuropathology: The Veterans Affairs Biorepository Brain Bank. Muscle Nerve 2022; 66:167-174. [PMID: 35585776 PMCID: PMC9308705 DOI: 10.1002/mus.27635] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION/AIMS The amyotrophic lateral sclerosis (ALS) functional rating scale-revised (ALSFRS-R) is commonly used to track ALS disease progression; however, there are gaps in the literature regarding the extent to which the ALSFRS-R relates to underlying central nervous system (CNS) pathology. The current study explored the association between ALSFRS-R (total and subdomain) scores and postmortem neuropathology (both ALS-specific and comorbid disease). METHODS Within our sample of 93 military veterans with autopsy-confirmed ALS, we utilized hierarchical cluster analysis (HCA) to identify discrete profiles of motor dysfunction based on ALSFRS-R subdomain scores. We examined whether emergent clusters were associated with neuropathology. Separate analyses of variance and covariance with post-hoc comparisons were performed to examine relevant cluster differences. RESULTS Analyses revealed significant correlations between ALSFRS-R total and subdomain scores with some, but not all, neuropathological variables. The HCA illustrated three groups: Cluster 1-predominantly diffuse functional impairment; Cluster 2-spared respiratory/bulbar and impaired motor function; and Cluster 3-spared bulbar and impaired respiratory, and fine and gross motor function. Individuals in Cluster 1 (and to a lesser degree, Cluster 3) exhibited greater accumulation of ALS-specific neuropathology and less comorbid neuropathology than those in Cluster 2. DISCUSSION These results suggest that discrete patterns of motor dysfunction based on ALSFRS-R subdomain scores are related to postmortem neuropathology. Findings support use of ALSFRS-R subdomain scores to capture the heterogeneity of clinical presentation and disease progression in ALS, and may assist researchers in identifying endophenotypes for separate assessment in clinical trials.
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Affiliation(s)
| | | | - Thor D. Stein
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Manisha Thakore-James
- VA Boston Healthcare System, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - M. Kian Salajegheh
- VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women’s Hospital
| | | | | | | | | | | | | | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, Arizona
| | - Victor E. Alvarez
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
| | - Bertrand R. Huber
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
| | - Ann C. McKee
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Neil W. Kowall
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
| | - Christopher B. Brady
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Harvard Medical School, Boston, MA
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19
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Atherton K, Han X, Chung J, Cherry JD, Baucom Z, Saltiel N, Nair E, Abdolmohammadi B, Uretsky M, Khan MM, Shea C, Durape S, Martin BM, Palmisano JN, Farrell K, Nowinski CJ, Alvarez VE, Dwyer B, Daneshvar DH, Katz DI, Goldstein LE, Cantu RC, Kowall NW, Alosco ML, Huber BR, Tripodis Y, Crary JF, Farrer L, Stern RA, Stein TD, McKee AC, Mez J. Association of APOE Genotypes and Chronic Traumatic Encephalopathy. JAMA Neurol 2022; 79:787-796. [PMID: 35759276 PMCID: PMC9237800 DOI: 10.1001/jamaneurol.2022.1634] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Repetitive head impact (RHI) exposure is the chief risk factor for chronic traumatic encephalopathy (CTE). However, the occurrence and severity of CTE varies widely among those with similar RHI exposure. Limited evidence suggests that the APOEε4 allele may confer risk for CTE, but previous studies were small with limited scope. Objective To test the association between APOE genotype and CTE neuropathology and related endophenotypes. Design, Setting, and Participants This cross-sectional genetic association study analyzed brain donors from February 2008 to August 2019 from the Veterans Affairs-Boston University-Concussion Legacy Foundation Brain Bank. All donors had exposure to RHI from contact sports or military service. All eligible donors were included. Analysis took place between June 2020 and April 2022. Exposures One or more APOEε4 or APOEε2 alleles. Main Outcomes and Measures CTE neuropathological status, CTE stage (0-IV), semiquantitative phosphorylated tau (p-tau) burden in 11 brain regions (0-3), quantitative p-tau burden in the dorsolateral frontal lobe (log-transformed AT8+ pixel count per mm2), and dementia. Results Of 364 consecutive brain donors (100% male; 53 [14.6%] self-identified as Black and 311 [85.4%] as White; median [IQR] age, 65 [47-77] years) 20 years or older, there were 294 individuals with CTE and 70 controls. Among donors older than 65 years, APOEε4 status was significantly associated with CTE stage (odds ratio [OR], 2.34 [95% CI, 1.30-4.20]; false discovery rate [FDR]-corrected P = .01) and quantitative p-tau burden in the dorsolateral frontal lobe (β, 1.39 [95% CI, 0.83-1.94]; FDR-corrected P = 2.37 × 10-5). There was a nonsignificant association between APOEε4 status and dementia (OR, 2.64 [95% CI, 1.06-6.61]; FDR-corrected P = .08). Across 11 brain regions, significant associations were observed for semiquantitative p-tau burden in the frontal and parietal cortices, amygdala, and entorhinal cortex (OR range, 2.45-3.26). Among football players, the APOEε4 association size for CTE stage was similar to playing more than 7 years of football. Associations were significantly larger in the older half of the sample. There was no significant association for CTE status. Association sizes were similar when donors with an Alzheimer disease neuropathological diagnosis were excluded and were reduced but remained significant after adjusting for neuritic and diffuse amyloid plaques. No associations were observed for APOEε2 status. Models were adjusted for age at death and race. Conclusions and Relevance APOEε4 may confer increased risk for CTE-related neuropathological and clinical outcomes among older individuals with RHI exposure. Further work is required to validate these findings in an independent sample.
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Affiliation(s)
- Kathryn Atherton
- Boston University Bioinformatics Graduate Program, Boston, Massachusetts
| | - Xudong Han
- Boston University Bioinformatics Graduate Program, Boston, Massachusetts.,Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts
| | - Jaeyoon Chung
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, Massachusetts
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Zachary Baucom
- Boston University Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Nicole Saltiel
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Evan Nair
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts
| | - Madeline Uretsky
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts
| | | | - Conor Shea
- Boston University Bioinformatics Graduate Program, Boston, Massachusetts
| | - Shruti Durape
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts
| | - Brett M Martin
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Kurt Farrell
- Department of Pathology, Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Concussion Legacy Foundation, Boston, Massachusetts
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Brigid Dwyer
- Braintree Rehabilitation Hospital, Braintree, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Rehabilitation Medicine, Harvard Medical School, Boston, Massachusetts
| | - Douglas I Katz
- Braintree Rehabilitation Hospital, Braintree, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Lee E Goldstein
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Boston University Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - John F Crary
- Department of Pathology, Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lindsay Farrer
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, Massachusetts.,Boston University Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D Stein
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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20
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Rosenbloom R, Gavrish I, Tseng AE, Seidel K, Yabaji SM, Gertje HP, Huber BR, Kramnik I, Crossland NA. Progression and Dissemination of Pulmonary Mycobacterium Avium Infection in a Susceptible Immunocompetent Mouse Model. Int J Mol Sci 2022; 23:ijms23115999. [PMID: 35682679 PMCID: PMC9181083 DOI: 10.3390/ijms23115999] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 01/11/2023] Open
Abstract
Pulmonary infections caused by the group of nontuberculosis mycobacteria (NTM), Mycobacterium avium complex (MAC), are a growing public health concern with incidence and mortality steadily increasing globally. Granulomatous inflammation is the hallmark of MAC lung infection, yet reliable correlates of disease progression, susceptibility, and resolution are poorly defined. Unlike widely used inbred mouse strains, mice that carry the mutant allele at the genetic locus sst1 develop human-like pulmonary tuberculosis featuring well-organized caseating granulomas. We characterized pulmonary temporospatial outcomes of intranasal and left intrabronchial M. avium spp. hominissuis (M.av) induced pneumonia in B6.Sst1S mice, which carries the sst1 mutant allele. We utilized traditional semi-quantitative histomorphological evaluation, in combination with fluorescent multiplex immunohistochemistry (fmIHC), whole slide imaging, and quantitative digital image analysis. Followingintrabronchiolar infection with the laboratory M.av strain 101, the B6.Sst1S pulmonary lesions progressed 12-16 weeks post infection (wpi), with plateauing and/or resolving disease by 21 wpi. Caseating granulomas were not observed during the study. Disease progression from 12-16 wpi was associated with increased acid-fast bacilli, area of secondary granulomatous pneumonia lesions, and Arg1+ and double positive iNOS+/Arg1+ macrophages. Compared to B6 WT, at 16 wpi, B6.Sst1S lungs exhibited an increased area of acid-fast bacilli, larger secondary lesions with greater Arg1+ and double positive iNOS+/Arg1+ macrophages, and reduced T cell density. This morphomolecular analysis of histologic correlates of disease progression in B6.Sst1S could serve as a platform for assessment of medical countermeasures against NTM infection.
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Affiliation(s)
- Raymond Rosenbloom
- Graduate Medical Sciences, Boston University School of Medicine, Boston, MA 02118, USA;
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
| | - Igor Gavrish
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
| | - Anna E. Tseng
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Kerstin Seidel
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
| | - Shivraj M. Yabaji
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
| | - Hans P. Gertje
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Igor Kramnik
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Correspondence: (I.K.); (N.A.C.); Tel.: +1-617-358-9285 (I.K. & N.A.C.)
| | - Nicholas A. Crossland
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA 02215, USA; (I.G.); (A.E.T.); (K.S.); (S.M.Y.); (H.P.G.)
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Correspondence: (I.K.); (N.A.C.); Tel.: +1-617-358-9285 (I.K. & N.A.C.)
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21
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Alvia M, Aytan N, Spencer KR, Foster ZW, Rauf NA, Guilderson L, Robey I, Averill JG, Walker SE, Alvarez VE, Huber BR, Mathais R, Cormier KA, Nicks R, Pothast M, Labadorf A, Agus F, Alosco ML, Mez J, Kowall NW, McKee AC, Brady CB, Stein TD. MicroRNA Alterations in Chronic Traumatic Encephalopathy and Amyotrophic Lateral Sclerosis. Front Neurosci 2022; 16:855096. [PMID: 35663558 PMCID: PMC9160996 DOI: 10.3389/fnins.2022.855096] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Repetitive head impacts (RHI) and traumatic brain injuries are risk factors for the neurodegenerative diseases chronic traumatic encephalopathy (CTE) and amyotrophic lateral sclerosis (ALS). ALS and CTE are distinct disorders, yet in some instances, share pathology, affect similar brain regions, and occur together. The pathways involved and biomarkers for diagnosis of both diseases are largely unknown. MicroRNAs (miRNAs) involved in gene regulation may be altered in neurodegeneration and be useful as stable biomarkers. Thus, we set out to determine associations between miRNA levels and disease state within the prefrontal cortex in a group of brain donors with CTE, ALS, CTE + ALS and controls. Of 47 miRNAs previously implicated in neurological disease and tested here, 28 (60%) were significantly different between pathology groups. Of these, 21 (75%) were upregulated in both ALS and CTE, including miRNAs involved in inflammatory, apoptotic, and cell growth/differentiation pathways. The most significant change occurred in miR-10b, which was significantly increased in ALS, but not CTE or CTE + ALS. Overall, we found patterns of miRNA expression that are common and unique to CTE and ALS and that suggest shared and distinct mechanisms of pathogenesis.
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Affiliation(s)
- Marcela Alvia
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
| | - Nurgul Aytan
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | | | | | | | | | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, AZ, United States
| | - James G. Averill
- Southern Arizona VA Healthcare System, Tucson, AZ, United States
| | - Sean E. Walker
- Southern Arizona VA Healthcare System, Tucson, AZ, United States
| | - Victor E. Alvarez
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
- Department of Veterans Affairs Medical Center, Bedford, MA, United States
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
| | - Rebecca Mathais
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
| | - Kerry A. Cormier
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
- Department of Veterans Affairs Medical Center, Bedford, MA, United States
| | - Raymond Nicks
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
| | - Morgan Pothast
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
| | - Adam Labadorf
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
| | - Filisia Agus
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Neil W. Kowall
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
- Department of Veterans Affairs Medical Center, Bedford, MA, United States
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Christopher B. Brady
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
- Department of Veterans Affairs Medical Center, Bedford, MA, United States
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA, United States
- VA Boston Healthcare System, Boston, MA, United States
- Department of Veterans Affairs Medical Center, Bedford, MA, United States
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
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22
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Kenney DJ, O’Connell AK, Turcinovic J, Montanaro P, Hekman RM, Tamura T, Berneshawi AR, Cafiero TR, Al Abdullatif S, Blum B, Goldstein SI, Heller BL, Gertje HP, Bullitt E, Trachtenberg AJ, Chavez E, Nono ET, Morrison C, Tseng AE, Sheikh A, Kurnick S, Grosz K, Bosmann M, Ericsson M, Huber BR, Saeed M, Balazs AB, Francis KP, Klose A, Paragas N, Campbell JD, Connor JH, Emili A, Crossland NA, Ploss A, Douam F. Humanized mice reveal a macrophage-enriched gene signature defining human lung tissue protection during SARS-CoV-2 infection. Cell Rep 2022; 39:110714. [PMID: 35421379 PMCID: PMC8977517 DOI: 10.1016/j.celrep.2022.110714] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/17/2022] [Accepted: 03/29/2022] [Indexed: 01/11/2023] Open
Abstract
The human immunological mechanisms defining the clinical outcome of SARS-CoV-2 infection remain elusive. This knowledge gap is mostly driven by the lack of appropriate experimental platforms recapitulating human immune responses in a controlled human lung environment. Here, we report a mouse model (i.e., HNFL mice) co-engrafted with human fetal lung xenografts (fLX) and a myeloid-enhanced human immune system to identify cellular and molecular correlates of lung protection during SARS-CoV-2 infection. Unlike mice solely engrafted with human fLX, HNFL mice are protected against infection, severe inflammation, and histopathological phenotypes. Lung tissue protection from infection and severe histopathology associates with macrophage infiltration and differentiation and the upregulation of a macrophage-enriched signature composed of 11 specific genes mainly associated with the type I interferon signaling pathway. Our work highlights the HNFL model as a transformative platform to investigate, in controlled experimental settings, human myeloid immune mechanisms governing lung tissue protection during SARS-CoV-2 infection.
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Affiliation(s)
- Devin J. Kenney
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Aoife K. O’Connell
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Jacquelyn Turcinovic
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Bioinformatics Program, Boston University, Boston, MA, USA
| | - Paige Montanaro
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ryan M. Hekman
- Center for Network Systems Biology, Boston University, Boston, MA, USA,Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - Tomokazu Tamura
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | | | - Thomas R. Cafiero
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Salam Al Abdullatif
- Single Cell RNA Sequencing Core, Boston University, Boston, MA, USA,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Benjamin Blum
- Center for Network Systems Biology, Boston University, Boston, MA, USA,Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - Stanley I. Goldstein
- Center for Network Systems Biology, Boston University, Boston, MA, USA,Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - Brigitte L. Heller
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Hans P. Gertje
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Esther Bullitt
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA, USA
| | - Alexander J. Trachtenberg
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Elizabeth Chavez
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Evans Tuekam Nono
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Catherine Morrison
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Anna E. Tseng
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Amira Sheikh
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Susanna Kurnick
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Animal Science Center, Boston University, Boston, MA, USA
| | - Kyle Grosz
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Animal Science Center, Boston University, Boston, MA, USA
| | - Markus Bosmann
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany
| | - Maria Ericsson
- Electron Microscopy Core Facility, Harvard Medical School, Boston, MA, USA
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Mohsan Saeed
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Neal Paragas
- In Vivo Analytics, Inc., New York, NY, USA,Department of Radiology Imaging Research Lab, University of Washington, Seattle, WA, USA
| | - Joshua D. Campbell
- Single Cell RNA Sequencing Core, Boston University, Boston, MA, USA,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - John H. Connor
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Andrew Emili
- Center for Network Systems Biology, Boston University, Boston, MA, USA,Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA,Department of Biology, Boston University School of Medicine, Boston, MA, USA
| | - Nicholas A. Crossland
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA,Corresponding author
| | - Alexander Ploss
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA,Corresponding author
| | - Florian Douam
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA,National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA,Corresponding author
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23
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Babcock KJ, Abdolmohammadi B, Kiernan PT, Mahar I, Cherry JD, Alvarez VE, Goldstein LE, Stein TD, McKee AC, Huber BR. Interface astrogliosis in contact sport head impacts and military blast exposure. Acta Neuropathol Commun 2022; 10:52. [PMID: 35418116 PMCID: PMC9009003 DOI: 10.1186/s40478-022-01358-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 12/11/2022] Open
Abstract
Exposure to military blast and repetitive head impacts (RHI) in contact sports is associated with increased risk of long-term neurobehavioral sequelae and cognitive deficits, and the neurodegenerative disease chronic traumatic encephalopathy (CTE). At present, the exact pathogenic mechanisms of RHI and CTE are unknown, and no targeted therapies are available. Astrocytes have recently emerged as key mediators of the multicellular response to head trauma. Here, we investigated interface astrogliosis in blast and impact neurotrauma, specifically in the context of RHI and early stage CTE. We compared postmortem brain tissue from former military veterans with a history of blast exposure with and without a neuropathological diagnosis of CTE, former American football players with a history of RHI with and without a neuropathological diagnosis of CTE, and control donors without a history of blast, RHI exposure or CTE diagnosis. Using quantitative immunofluorescence, we found that astrogliosis was higher at the grey-white matter interface in the dorsolateral frontal cortex, with mixed effects at the subpial surface and underlying cortex, in both blast and RHI donors with and without CTE, compared to controls. These results indicate that certain astrocytic alterations are associated with both impact and blast neurotrauma, and that different astroglial responses take place in distinct brain regions.
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24
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Carossino M, Kenney D, O’Connell AK, Montanaro P, Tseng AE, Gertje HP, Grosz KA, Ericsson M, Huber BR, Kurnick SA, Subramaniam S, Kirkland TA, Walker JR, Francis KP, Klose AD, Paragas N, Bosmann M, Saeed M, Balasuriya UBR, Douam F, Crossland NA. Fatal Neurodissemination and SARS-CoV-2 Tropism in K18-hACE2 Mice Is Only Partially Dependent on hACE2 Expression. Viruses 2022; 14:v14030535. [PMID: 35336942 PMCID: PMC8955233 DOI: 10.3390/v14030535] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 02/06/2023] Open
Abstract
Animal models recapitulating COVID-19 are critical to enhance our understanding of SARS-CoV-2 pathogenesis. Intranasally inoculated transgenic mice expressing human angiotensin-converting enzyme 2 under the cytokeratin 18 promoter (K18-hACE2) represent a lethal model of SARS-CoV-2 infection. We evaluated the clinical and virological dynamics of SARS-CoV-2 using two intranasal doses (104 and 106 PFUs), with a detailed spatiotemporal pathologic analysis of the 106 dose cohort. Despite generally mild-to-moderate pneumonia, clinical decline resulting in euthanasia or death was commonly associated with hypothermia and viral neurodissemination independent of inoculation dose. Neuroinvasion was first observed at 4 days post-infection, initially restricted to the olfactory bulb suggesting axonal transport via the olfactory neuroepithelium as the earliest portal of entry. Absence of viremia suggests neuroinvasion occurs independently of transport across the blood-brain barrier. SARS-CoV-2 tropism was neither restricted to ACE2-expressing cells (e.g., AT1 pneumocytes), nor inclusive of some ACE2-positive cell lineages (e.g., bronchiolar epithelium and brain vasculature). Absence of detectable ACE2 protein expression in neurons but overexpression in neuroepithelium suggest this as the most likely portal of neuroinvasion, with subsequent ACE2 independent lethal neurodissemination. A paucity of epidemiological data and contradicting evidence for neuroinvasion and neurodissemination in humans call into question the translational relevance of this model.
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Affiliation(s)
- Mariano Carossino
- Louisiana Animal Disease Diagnostic Laboratory (LADDL), Louisiana State University, Baton Rouge, LA 61329, USA; (M.C.); (U.B.R.B.)
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 61329, USA
| | - Devin Kenney
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Microbiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Aoife K. O’Connell
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
| | - Paige Montanaro
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Anna E. Tseng
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Hans P. Gertje
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
| | - Kyle A. Grosz
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
| | - Maria Ericsson
- Electron Microscopy Core Facility, Harvard Medical School, Boston, MA 02115, USA;
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Susanna A. Kurnick
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
| | - Saravanan Subramaniam
- Department of Medicine, Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Thomas A. Kirkland
- Promega Biosciences, LLC, San Luis Obispo, CA 93401, USA; (T.A.K.); (J.R.W.)
| | - Joel R. Walker
- Promega Biosciences, LLC, San Luis Obispo, CA 93401, USA; (T.A.K.); (J.R.W.)
| | | | | | - Neal Paragas
- InVivo Analytics Inc., New York, NY 10023, USA; (A.D.K.); (N.P.)
- Department of Radiology Imaging Research Lab, University of Washington, Seattle, WA 98133, USA
| | - Markus Bosmann
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Medicine, Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA;
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Mohsan Saeed
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Biochemistry, Boston University, Boston, MA 02118, USA
| | - Udeni B. R. Balasuriya
- Louisiana Animal Disease Diagnostic Laboratory (LADDL), Louisiana State University, Baton Rouge, LA 61329, USA; (M.C.); (U.B.R.B.)
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 61329, USA
| | - Florian Douam
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Microbiology, Boston University School of Medicine, Boston, MA 02118, USA
- Correspondence: (F.D.); (N.A.C.); Tel.: +1-(617)-358-9174 (F.D.); +1-(617)-358-9285 (N.A.C.)
| | - Nicholas A. Crossland
- National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, Boston, MA 02118, USA; (D.K.); (A.K.O.); (P.M.); (A.E.T.); (H.P.G.); (K.A.G.); (S.A.K.); (M.B.); (M.S.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Correspondence: (F.D.); (N.A.C.); Tel.: +1-(617)-358-9174 (F.D.); +1-(617)-358-9285 (N.A.C.)
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25
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Turk KW, Geada A, Alvarez VE, Xia W, Cherry JD, Nicks R, Meng G, Daley S, Tripodis Y, Huber BR, Budson AE, Dwyer B, Kowall NW, Cantu RC, Goldstein LE, Katz DI, Stern RA, Alosco ML, Mez J, McKee AC, Stein TD. A comparison between tau and amyloid-β cerebrospinal fluid biomarkers in chronic traumatic encephalopathy and Alzheimer disease. Alzheimers Res Ther 2022; 14:28. [PMID: 35139894 PMCID: PMC8830027 DOI: 10.1186/s13195-022-00976-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) tau and beta-amyloid levels in chronic traumatic encephalopathy (CTE), a disease which can be clinically indistinguishable from Alzheimer's disease (AD), are largely unknown. We examined postmortem CSF analytes among participants with autopsy confirmed CTE and AD. METHODS In this cross-sectional study 192 participants from the Boston University AD Research Center, VA-BU-CLF Center, and Framingham Heart Study (FHS) had post-mortem CSF collected at autopsy. Participants were divided into pathological groups based on AD and CTE criteria, with 61 CTE participants (18 low, 43 high stage), 79 AD participants (23 low, 56 intermediate to high), 11 participants with CTE combined with AD, and 41 participants lacking both CTE and AD neuropathology. The Meso Scale Discovery immunoassay system was utilized to measure amyloid-beta (Aβ1-40, Aβ1-42), total tau (t-tau), and phosphorylated tau (p-tau181 and p-tau231). CSF analytes were then compared across the pathological groups: no CTE/no AD (control), Low CTE, Low AD, High CTE, Intermediate/High AD, and AD+CTE. RESULTS Among the Low disease state groups, the Low CTE group had significantly higher levels of p-tau231 versus the control group and compared to the Low AD group. The Low CTE group was also found to have significantly lower levels of Aβ1-42 compared to the control group. The high CTE group had higher levels of p-tau231 and lower levels of Aβ1-42 compared to Intermediate/High AD group. CONCLUSIONS Importantly, p-tau231 and Aβ1-42 were predictors of diagnosis of CTE vs. control and CTE vs. AD. Increased CSF p-tau231 is a promising potentially sensitive biomarker of CTE, and CSF Aβ1-42 needs further investigation in CTE.
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Affiliation(s)
- Katherine W Turk
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Alexandra Geada
- Boston University School of Medicine, Boston, MA, 02118, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Weiming Xia
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Gaoyuan Meng
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Sarah Daley
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 20118, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Andrew E Budson
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, 02118, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 20119, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, 01742, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- Departments of Psychiatry, Ophthalmology, Boston University School of Medicine, Boston, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, 02118, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 20119, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- VA Bedford Healthcare System, Bedford, MA, 01730, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research and CTE Center, Boston University School of Medicine, Boston, MA, 02118, USA.
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA.
- VA Bedford Healthcare System, Bedford, MA, 01730, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.
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26
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Long KLP, Chao LL, Kazama Y, An A, Hu KY, Peretz L, Muller DCY, Roan VD, Misra R, Toth CE, Breton JM, Casazza W, Mostafavi S, Huber BR, Woodward SH, Neylan TC, Kaufer D. Regional gray matter oligodendrocyte- and myelin-related measures are associated with differential susceptibility to stress-induced behavior in rats and humans. Transl Psychiatry 2021; 11:631. [PMID: 34903726 PMCID: PMC8668977 DOI: 10.1038/s41398-021-01745-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/30/2021] [Accepted: 11/23/2021] [Indexed: 12/23/2022] Open
Abstract
Individual reactions to traumatic stress vary dramatically, yet the biological basis of this variation remains poorly understood. Recent studies demonstrate the surprising plasticity of oligodendrocytes and myelin with stress and experience, providing a potential mechanism by which trauma induces aberrant structural and functional changes in the adult brain. In this study, we utilized a translational approach to test the hypothesis that gray matter oligodendrocytes contribute to traumatic-stress-induced behavioral variation in both rats and humans. We exposed adult, male rats to a single, severe stressor and used a multimodal approach to characterize avoidance, startle, and fear-learning behavior, as well as oligodendrocyte and myelin basic protein (MBP) content in multiple brain areas. We found that oligodendrocyte cell density and MBP were correlated with behavioral outcomes in a region-specific manner. Specifically, stress-induced avoidance positively correlated with hippocampal dentate gyrus oligodendrocytes and MBP. Viral overexpression of the oligodendrogenic factor Olig1 in the dentate gyrus was sufficient to induce an anxiety-like behavioral phenotype. In contrast, contextual fear learning positively correlated with MBP in the amygdala and spatial-processing regions of the hippocampus. In a group of trauma-exposed US veterans, T1-/T2-weighted magnetic resonance imaging estimates of hippocampal and amygdala myelin associated with symptom profiles in a region-specific manner that mirrored the findings in rats. These results demonstrate a species-independent relationship between region-specific, gray matter oligodendrocytes and differential behavioral phenotypes following traumatic stress exposure. This study suggests a novel mechanism for brain plasticity that underlies individual variance in sensitivity to traumatic stress.
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Affiliation(s)
- Kimberly L P Long
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
- Department of Psychiatry and Behavioral Sciences, University of California, SanFrancisco, San Francisco, CA, 94143, USA
| | - Linda L Chao
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Yurika Kazama
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Anjile An
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Kelsey Y Hu
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Lior Peretz
- Department of Molecular, Cellular, and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Dyana C Y Muller
- Department of Computer Science, University of Arizona, Tucson, AZ, 85721, USA
| | - Vivian D Roan
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Rhea Misra
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Claire E Toth
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Jocelyn M Breton
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA
- Department of Psychiatry, Columbia University, New York, NY, 10027, USA
| | - William Casazza
- Department of Statistics and Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Sara Mostafavi
- Department of Statistics and Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Canadian Institute for Advanced Research, Toronto, ON, M5G 1M1, Canada
| | - Bertrand R Huber
- Department of Neurology, Boston University, Boston, MA, 02215, USA
- National Center for PTSD, VA New England Health Care System, Boston, MA, 02130, USA
| | - Steven H Woodward
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Thomas C Neylan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- San Francisco VA Health Care System, San Francisco, CA, 94121, USA
| | - Daniela Kaufer
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA.
- Canadian Institute for Advanced Research, Toronto, ON, M5G 1M1, Canada.
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, 94720, USA.
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27
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Turk KW, Geada AW, Alvarez VE, Xia W, Cherry JD, Huber BR, Mez J, Alosco ML, Meng G, Nicks RW, Tripodis Y, Budson A, Dwyer B, Kowall NW, Cantu R, Goldstein LE, Katz DI, Stern RA, McKee AC, Stein TD. A comparison between tau and amyloid‐b cerebrospinal fluid biomarkers in chronic traumatic encephalopathy and Alzheimer disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.051392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine W. Turk
- VA Boston Healthcare System Jamaica Plain MA USA
- Boston University School of Medicine Boston MA USA
| | | | - Victor E. Alvarez
- Boston University School of Medicine Boston MA USA
- Department of Veterans Affairs Bedford MA USA
| | | | | | | | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | - Gaoyuan Meng
- VA Boston Healthcare System Jamaica Plain MA USA
| | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Andrew Budson
- VA Boston Healthcare System Jamaica Plain MA USA
- Boston University School of Medicine Boston MA USA
| | - Brigid Dwyer
- Boston University School of Medicine Boston MA USA
| | - Neil W. Kowall
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- Boston VA Medical Center Boston MA USA
| | - Robert Cantu
- Boston University School of Medicine Boston MA USA
| | | | | | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Ann C. McKee
- Boston University School of Medicine Boston MA USA
- VA Boston Healthcare System Boston MA USA
| | - Thor D. Stein
- VA Boston Healthcare System Jamaica Plain MA USA
- Boston University School of Medicine Boston MA USA
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28
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Brady CB, Robey I, Stein TD, Huber BR, Riley J, Abdul Rauf N, Spencer KR, Walt G, Adams L, Averill JG, Walker S, McKee AC, Thomson SP, Kowall NW. The Department of Veterans Affairs Gulf War Veterans' Illnesses Biorepository: Supporting Research on Gulf War Veterans' Illnesses. Brain Sci 2021; 11:1349. [PMID: 34679413 PMCID: PMC8533803 DOI: 10.3390/brainsci11101349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS To introduce a resource supporting research on Gulf War illness (GWI) and related disorders, the Gulf War Veterans' Illnesses Biorepository (GWVIB). METHODS Gulf War era veterans (GWVs) are recruited nationally and enrolled via telephone and email/postal mail. Enrolled veterans receive annual telephone and mail follow-up to collect health data until their passing. A postmortem neuropathological examination is performed, and fixed and frozen brain and spinal cord samples are banked to support research. Investigators studying GWI and related disorders may request tissue and data from the GWVIB. RESULTS As of September 2021, 127 GWVs from 39 states were enrolled; 60 met the criteria for GWI, and 14 met the criteria for chronic multisymptom illness (CMI). Enrollees have been followed up to six years. Postmortem tissue recoveries were performed on 14 GWVs. The most commonly found neuropathologies included amyotrophic lateral sclerosis, chronic traumatic encephalopathy, and Lewy body disease. Tissue was of good quality with an average RNA integrity number of 5.8 (SD = 1.0) and ≥4.8 in all of the cases. DISCUSSION The availability of health data and high-quality CNS tissue from this well-characterized GWV cohort will support research on GWI and related disorders affecting GWVs. Enrollment is ongoing.
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Affiliation(s)
- Christopher B. Brady
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Thor D. Stein
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Veterans Affairs Medical Center, Bedford, MA 01730, USA
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Jessica Riley
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Nazifa Abdul Rauf
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Keith R. Spencer
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Gabriel Walt
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Latease Adams
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - James G. Averill
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Sean Walker
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Ann C. McKee
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stephen P. Thomson
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Neil W. Kowall
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Neurology Service, VA Boston Healthcare System, Boston, MA 02130, USA
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29
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Cross DJ, Huber BR, Silverman MA, Cline MM, Gill TB, Cross CG, Cook DG, Minoshima S. Intranasal Paclitaxel Alters Alzheimer's Disease Phenotypic Features in 3xTg-AD Mice. J Alzheimers Dis 2021; 83:379-394. [PMID: 34308901 DOI: 10.3233/jad-210109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Microtubule stabilizing drugs, commonly used as anti-cancer therapeutics, have been proposed for treatment of Alzheimer's disease (AD); however, many do not cross the blood-brain barrier. OBJECTIVE This research investigated if paclitaxel (PTX) delivered via the intranasal (IN) route could alter the phenotypic progression of AD in 3xTg-AD mice. METHODS We administered intranasal PTX in 3XTg-AD mice (3xTg-AD n = 15, 10 weeks and n = 10, 44 weeks, PTX: 0.6 mg/kg or 0.9%saline (SAL)) at 2-week intervals. After treatment, 3XTg-AD mice underwent manganese-enhanced magnetic resonance imaging to measure in vivo axonal transport. In a separate 3XTg-AD cohort, PTX-treated mice were tested in a radial water tread maze at 52 weeks of age after four treatments, and at 72 weeks of age, anxiety was assessed by an elevated-plus maze after 14 total treatments. RESULTS PTX increased axonal transport rates in treated 3XTg-AD compared to controls (p≤0.003). Further investigation using an in vitro neuron model of Aβ-induced axonal transport disruption confirmed PTX prevented axonal transport deficits. Confocal microscopy after treatment found fewer phospho-tau containing neurons (5.25±3.8 versus 8.33±2.5, p < 0.04) in the CA1, altered microglia, and reduced reactive astrocytes. PTX improved performance of 3xTg-AD on the water tread maze compared to controls and not significantly different from WT (Day 5, 143.8±43 versus 91.5±77s and Day 12, 138.3±52 versus 107.7±75s for SAL versus PTX). Elevated plus maze revealed that PTX-treated 3xTg-AD mice spent more time exploring open arms (Open arm 129.1±80 versus 20.9±31s for PTX versus SAL, p≤0.05). CONCLUSION Taken collectively, these findings indicate that intranasal-administered microtubule-stabilizing drugs may offer a potential therapeutic option for treating AD.
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Affiliation(s)
- Donna J Cross
- Department of Radiology and Imaging Sciences>, University of Utah, Salt Lake City, UT, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael A Silverman
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada.,Centre for Cell Biology, Development, and Disease, Simon Fraser University, Burnaby, BC, Canada
| | - Marcella M Cline
- The Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Departments of Medicine, Pharmacology, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Trevor B Gill
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Chloe G Cross
- Department of Radiology and Imaging Sciences>, University of Utah, Salt Lake City, UT, USA
| | - David G Cook
- The Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Departments of Medicine, Pharmacology, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences>, University of Utah, Salt Lake City, UT, USA
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30
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Cherry JD, Esnault CD, Baucom ZH, Tripodis Y, Huber BR, Alvarez VE, Stein TD, Dickson DW, McKee AC. Tau isoforms are differentially expressed across the hippocampus in chronic traumatic encephalopathy and Alzheimer's disease. Acta Neuropathol Commun 2021; 9:86. [PMID: 33980303 PMCID: PMC8114683 DOI: 10.1186/s40478-021-01189-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 01/14/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease, characterized by hyperphosphorylated tau, found in individuals with a history of exposure to repetitive head impacts. While the neuropathologic hallmark of CTE is found in the cortex, hippocampal tau has proven to be an important neuropathologic feature to examine the extent of disease severity. However, the hippocampus is also heavily affected in many other tauopathies, such as Alzheimer's disease (AD). How CTE and AD differentially affect the hippocampus is unclear. Using immunofluorescent analysis, a detailed histologic characterization of 3R and 4R tau isoforms and their differential accumulation in the temporal cortex in CTE and AD was performed. CTE and AD were both observed to contain mixed 3R and 4R tau isoforms, with 4R predominating in mild disease and 3R increasing proportionally as pathological severity increased. CTE demonstrated high levels of tau in hippocampal subfields CA2 and CA3 compared to CA1. There were also low levels of tau in the subiculum compared to CA1 in CTE. In contrast, AD had higher levels of tau in CA1 and subiculum compared to CA2/3. Direct comparison of the tau burden between AD and CTE demonstrated that CTE had higher tau densities in CA4 and CA2/3, while AD had elevated tau in the subiculum. Amyloid beta pathology did not contribute to tau isoform levels. Finally, it was demonstrated that higher levels of 3R tau correlated to more severe extracellular tau (ghost tangles) pathology. These findings suggest that mixed 3R/4R tauopathies begin as 4R predominant then transition to 3R predominant as pathological severity increases and ghost tangles develop. Overall, this work demonstrates that the relative deposition of tau isoforms among hippocampal subfields can aid in differential diagnosis of AD and CTE, and might help improve specificity of biomarkers for in vivo diagnosis.
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Affiliation(s)
- Jonathan D. Cherry
- grid.410370.10000 0004 4657 1992VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA ,grid.189504.10000 0004 1936 7558Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Department of Neurology, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Boston University Alzheimer’s Disease Research and CTE Center, Boston University School of Medicine, Boston, MA 20118 USA
| | - Camille D. Esnault
- grid.410370.10000 0004 4657 1992VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA ,grid.189504.10000 0004 1936 7558Boston University Alzheimer’s Disease Research and CTE Center, Boston University School of Medicine, Boston, MA 20118 USA
| | - Zachary H. Baucom
- grid.189504.10000 0004 1936 7558Department of Biostatistics, Boston University School of Public Health, Boston, MA 20118 USA
| | - Yorghos Tripodis
- grid.189504.10000 0004 1936 7558Department of Biostatistics, Boston University School of Public Health, Boston, MA 20118 USA
| | - Bertrand R. Huber
- grid.410370.10000 0004 4657 1992VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA ,grid.189504.10000 0004 1936 7558Department of Neurology, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Boston University Alzheimer’s Disease Research and CTE Center, Boston University School of Medicine, Boston, MA 20118 USA ,grid.410370.10000 0004 4657 1992National Center for PTSD, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA
| | - Victor E. Alvarez
- grid.410370.10000 0004 4657 1992VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA ,grid.189504.10000 0004 1936 7558Department of Neurology, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Boston University Alzheimer’s Disease Research and CTE Center, Boston University School of Medicine, Boston, MA 20118 USA ,VA Bedford Healthcare System, Bedford, MA 01730 USA
| | - Thor D. Stein
- grid.410370.10000 0004 4657 1992VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA ,grid.189504.10000 0004 1936 7558Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Boston University Alzheimer’s Disease Research and CTE Center, Boston University School of Medicine, Boston, MA 20118 USA ,VA Bedford Healthcare System, Bedford, MA 01730 USA
| | - Dennis W. Dickson
- grid.417467.70000 0004 0443 9942Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Ann C. McKee
- grid.410370.10000 0004 4657 1992VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA ,grid.189504.10000 0004 1936 7558Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Department of Neurology, Boston University School of Medicine, Boston, MA 20118 USA ,grid.189504.10000 0004 1936 7558Boston University Alzheimer’s Disease Research and CTE Center, Boston University School of Medicine, Boston, MA 20118 USA ,VA Bedford Healthcare System, Bedford, MA 01730 USA
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31
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Mez J, Alosco ML, Daneshvar DH, Saltiel N, Baucom Z, Abdolmohammadi B, Uretsky M, Nicks R, Martin BM, Palmisano JN, Nowinski CJ, Montenigro P, Solomon TM, Mahar I, Cherry JD, Alvarez VE, Dwyer B, Goldstein LE, Katz DI, Cantu RC, Kowall NW, Tripodis Y, Huber BR, Stein TD, Stern RA, McKee AC. Validity of the 2014 traumatic encephalopathy syndrome criteria for CTE pathology. Alzheimers Dement 2021; 17:1709-1724. [PMID: 33826224 PMCID: PMC8596795 DOI: 10.1002/alz.12338] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022]
Abstract
Introduction Validity of the 2014 traumatic encephalopathy syndrome (TES) criteria, proposed to diagnose chronic traumatic encephalopathy (CTE) in life, has not been assessed. Methods A total of 336 consecutive brain donors exposed to repetitive head impacts from contact sports, military service, and/or physical violence were included. Blinded to clinical information, neuropathologists applied National Institute on Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering CTE criteria. Blinded to neuropathological information, clinicians interviewed informants and reviewed medical records. An expert panel adjudicated TES diagnoses. Results A total of 309 donors were diagnosed with TES; 244 donors had CTE pathology. TES criteria demonstrated sensitivity and specificity of 0.97 and 0.21, respectively. Cognitive (odds ratio [OR] = 3.6; 95% confidence interval [CI]: 1.2–5.1), but not mood/behavior or motor symptoms, were significantly associated with CTE pathology. Having Alzheimer's disease (AD) pathology was significantly associated with reduced TES accuracy (OR = 0.27; 95% CI: 0.12–0.59). Discussion TES criteria provided good evidence to rule out, but limited evidence to rule in, CTE pathology. Requiring cognitive symptoms in revised criteria and using AD biomarkers may improve CTE pathology prediction.
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Affiliation(s)
- Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Rehabilitation Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Saltiel
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
| | - Zachary Baucom
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston University Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
| | - Brett M Martin
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Concussion Legacy Foundation, Boston, Massachusetts, USA
| | - Philip Montenigro
- Department of Neuropsychology, University of New Hampshire, Durham, New Hampshire, USA
| | - Todd M Solomon
- Avanir Pharmaceuticals Inc, Aliso Viejo, California, USA
| | - Ian Mahar
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,Braintree Rehabilitation Hospital, Braintree, Massachusetts, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, Massachusetts, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,Braintree Rehabilitation Hospital, Braintree, Massachusetts, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Concussion Legacy Foundation, Boston, Massachusetts, USA.,Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston University Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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32
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Wolf EJ, Chen CD, Zhao X, Zhou Z, Morrison FG, Daskalakis NP, Stone A, Schichman S, Grenier JG, Fein-Schaffer D, Huber BR, Abraham CR, Miller MW, Logue MW. Klotho, PTSD, and advanced epigenetic age in cortical tissue. Neuropsychopharmacology 2021; 46:721-730. [PMID: 33096543 PMCID: PMC8027437 DOI: 10.1038/s41386-020-00884-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/12/2020] [Accepted: 09/29/2020] [Indexed: 01/04/2023]
Abstract
This study examined the klotho (KL) longevity gene polymorphism rs9315202 and psychopathology, including posttraumatic stress disorder (PTSD), depression, and alcohol-use disorders, in association with advanced epigenetic age in three postmortem cortical tissue regions: dorsolateral and ventromedial prefrontal cortices and motor cortex. Using data from the VA National PTSD Brain Bank (n = 117), we found that rs9315202 interacted with PTSD to predict advanced epigenetic age in motor cortex among the subset of relatively older (>=45 years), white non-Hispanic decedents (corrected p = 0.014, n = 42). An evaluation of 211 additional common KL variants revealed that only variants in linkage disequilibrium with rs9315202 showed similarly high levels of significance. Alcohol abuse was nominally associated with advanced epigenetic age in motor cortex (p = 0.039, n = 114). The rs9315202 SNP interacted with PTSD to predict decreased KL expression via DNAm age residuals in motor cortex among older white non-Hispanics decedents (indirect β = -0.198, p = 0.027). Finally, in dual-luciferase enhancer reporter system experiments, we found that inserting the minor allele of rs9315202 in a human kidney cell line HK-2 genomic DNA resulted in a change in KL transcriptional activities, likely operating via long noncoding RNA in this region. This was the first study to examine multiple forms of psychopathology in association with advanced DNA methylation age across several brain regions, to extend work concerning the association between rs9315202 and advanced epigenetic to brain tissue, and to identify the effects of rs9315202 on KL gene expression. KL augmentation holds promise as a therapeutic intervention to slow the pace of cellular aging, disease onset, and neuropathology, particularly in older, stressed populations.
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Affiliation(s)
- Erika J Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Ci-Di Chen
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - Xiang Zhao
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Zhenwei Zhou
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Filomene G Morrison
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | | | - Annjanette Stone
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Steven Schichman
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Jaclyn Garza Grenier
- Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA
| | - Dana Fein-Schaffer
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | - Bertrand R Huber
- Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Carmela R Abraham
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Mark W Logue
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Biomedical Genetics, Boston University School of Medicine, Boston, MA, USA
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33
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Girgenti MJ, Wang J, Ji D, Cruz DA, Stein MB, Gelernter J, Young KA, Huber BR, Williamson DE, Friedman MJ, Krystal JH, Zhao H, Duman RS. Transcriptomic organization of the human brain in post-traumatic stress disorder. Nat Neurosci 2021; 24:24-33. [PMID: 33349712 DOI: 10.1038/s41593-020-00748-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
Despite extensive study of the neurobiological correlates of post-traumatic stress disorder (PTSD), little is known about its molecular determinants. Here, differential gene expression and network analyses of four prefrontal cortex subregions from postmortem tissue of people with PTSD demonstrate extensive remodeling of the transcriptomic landscape. A highly connected downregulated set of interneuron transcripts is present in the most significant gene network associated with PTSD. Integration of this dataset with genotype data from the largest PTSD genome-wide association study identified the interneuron synaptic gene ELFN1 as conferring significant genetic liability for PTSD. We also identified marked transcriptomic sexual dimorphism that could contribute to higher rates of PTSD in women. Comparison with a matched major depressive disorder cohort revealed significant divergence between the molecular profiles of individuals with PTSD and major depressive disorder despite their high comorbidity. Our analysis provides convergent systems-level evidence of genomic networks within the prefrontal cortex that contribute to the pathophysiology of PTSD in humans.
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Affiliation(s)
- Matthew J Girgenti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Psychiatry Service, VA Connecticut Health Care System, West Haven, CT, USA.
- National Center for PTSD, US Department of Veterans Affairs, White River Junction, VT, USA.
| | - Jiawei Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Dingjue Ji
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Dianne A Cruz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Murray B Stein
- VA San Diego Healthcare System, San Diego, CA, USA
- Departments of Psychiatry and of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Psychiatry Service, VA Connecticut Health Care System, West Haven, CT, USA
- National Center for PTSD, US Department of Veterans Affairs, White River Junction, VT, USA
| | - Keith A Young
- Baylor Scott and White Psychiatry, Temple, TX, USA
- Department of Psychiatry, Texas A&M College of Medicine, Bryan, Texas, USA
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
- Central Texas Veterans Health Care System, Temple, TX, USA
| | - Bertrand R Huber
- National Center for PTSD, US Department of Veterans Affairs, White River Junction, VT, USA
- VA Boston Healthcare System, Boston, MA, USA
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Douglas E Williamson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Durham VA Healthcare System, Durham, NC, USA
| | - Matthew J Friedman
- National Center for PTSD, US Department of Veterans Affairs, White River Junction, VT, USA.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Psychiatry Service, VA Connecticut Health Care System, West Haven, CT, USA.
- National Center for PTSD, US Department of Veterans Affairs, White River Junction, VT, USA.
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.
| | - Ronald S Duman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, US Department of Veterans Affairs, White River Junction, VT, USA
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34
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Atherton K, Khan MM, Shea C, Chung J, Nair E, Baucom ZH, Abdolmohammadi B, Uretsky M, Martin BM, Palmisano J, Farrell KW, Cherry JD, Alvarez VE, Huber BR, Alosco ML, Lunetta KL, Tripodis Y, Stein TD, Farrer LA, Crary JF, McKee AC, Mez J. Genome wide association study of chronic traumatic encephalopathy. Alzheimers Dement 2020. [DOI: 10.1002/alz.046505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Evan Nair
- Boston University School of Medicine Boston MA USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - John F. Crary
- Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ann C. McKee
- Boston University School of Medicine Boston MA USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Center Boston MA USA
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35
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Yang K, Stein TD, Huber BR, Sartor EA, Rachlin JR, Mahalingam M. Glioblastoma and malignant melanoma: Serendipitous or anticipated association? Neuropathology 2020; 41:65-71. [PMID: 33103282 DOI: 10.1111/neup.12702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/18/2022]
Abstract
We describe a patient who had primary glioblastoma (GB) and malignant melanoma (MM). A 78-year-old man presented with several weeks to months of history of gait disturbance, confusion, memory disturbance, and worsening speech. Imaging studies performed on admission revealed a large frontotemporal lobe mass associated with the surrounding zone of vasogenic edema. Given the patient's medical history of incomplete biopsy of a midback tumor performed three weeks before, the presumptive clinical diagnosis was metastatic MM. Pathological examination of frozen sections of fragmented specimens obtained at stereotactic biopsy performed on admission revealed a high-grade malignant neoplasm characterized by discohesive cells in a blue myxoid background and abundant foci of tumor necrosis. Given these features, in conjunction with the abovementioned pathological report, the frozen section diagnosis by the neuropathologist was "neoplasm identified, favor melanoma." Due to the paucity of lesional tissue, a limited immunohistochemistry performed on the permanent sections revealed positive staining of lesional cells for Sox10 alone using a multiplex MART1/Sox10 immunostain and S-100 protein, an immunohistochemical profile supporting the presumptive frozen section diagnosis. A tumor debulk procedure, performed two weeks later, revealed histopathologic features most compatible with GB, IDH wild-type. Thus, additional immunohistochemistry on the permanent sections revealed positive staining of glial fibrillary acidic protein (GFAP), Sox10, and S-100 protein as well as negative staining of gp100, a complex carbohydrate matrix protein in embryonic melanosomes, using a specific antibody HMB45. The concomitant occurrence of MM and GB in our patient underscores the association between these two entities. Our literature review suggests that the sporadic co-occurrence of these two conditions is likely not serendipitous.
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Affiliation(s)
- Kevin Yang
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Thor D Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
| | - Bertrand R Huber
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
| | - Emmett A Sartor
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
| | - Jacob R Rachlin
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
| | - Meera Mahalingam
- Tufts University School of Medicine, Boston, Massachusetts, USA.,Dermatopathology Section, Department of Pathology and Laboratory Medicine, VA Consolidated Laboratories, West Roxbury, Massachusetts, USA
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36
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Mez J, Daneshvar DH, Alosco ML, Alvarez VE, Huber BR, Stein TD, McKee AC. Reply to "Chronic Traumatic Encephalopathy and Primary Age-Related Tauopathy". Ann Neurol 2020; 88:1052-1053. [PMID: 32754941 DOI: 10.1002/ana.25858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA.,Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA.,Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA.,US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA.,Department of Veterans Affairs Medical Center, Bedford, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA.,US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA.,Department of Veterans Affairs Medical Center, Bedford, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
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37
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Spencer KR, Foster ZW, Rauf NA, Guilderson L, Collins D, Averill JG, Walker SE, Robey I, Cherry JD, Alvarez VE, Huber BR, McKee AC, Kowall NW, Brady CB, Stein TD. Neuropathological profile of long-duration amyotrophic lateral sclerosis in military Veterans. Brain Pathol 2020; 30:1028-1040. [PMID: 32633852 PMCID: PMC8018169 DOI: 10.1111/bpa.12876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting both the upper and lower motor neurons. Although ALS typically leads to death within 3 to 5 years after initial symptom onset, approximately 10% of patients with ALS live more than 10 years after symptom onset. We set out to determine similarities and differences in clinical presentation and neuropathology in persons with ALS with long vs. those with standard duration. Participants were United States military Veterans with a pathologically confirmed diagnosis of ALS (n = 179), dichotomized into standard duration (<10 years) and long-duration (≥10 years). The ALS Functional Rating Scale-Revised (ALSFRS-R) was administered at study entry and semi-annually thereafter until death. Microglial density was determined in a subset of participants. long-duration ALS occurred in 76 participants (42%) with a mean disease duration of 16.3 years (min/max = 10.1/42.2). Participants with long-duration ALS were younger at disease onset (P = 0.002), had a slower initial ALS symptom progression on the ALSFRS-R (P < 0.001) and took longer to diagnose (P < 0.002) than standard duration ALS. Pathologically, long-duration ALS was associated with less frequent TDP-43 pathology (P < 0.001). Upper motor neuron degeneration was similar; however, long-duration ALS participants had less severe lower motor neuron degeneration at death (P < 0.001). In addition, the density of microglia was decreased in the corticospinal tract (P = 0.017) and spinal cord anterior horn (P = 0.009) in long-duration ALS. Notably, many neuropathological markers of ALS were similar between the standard and long-duration groups and there was no difference in the frequency of known ALS genetic mutations. These findings suggest that the lower motor neuron system is relatively spared in long-duration ALS and that pathological progression is likely slowed by as yet unknown genetic and environmental modifiers.
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Affiliation(s)
| | | | | | | | | | | | | | - Ian Robey
- Southern Arizona VA Healthcare SystemTucsonAZ
| | - Jonathan D. Cherry
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMA
| | - Victor E. Alvarez
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Bertrand R. Huber
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Ann C. McKee
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Neil W. Kowall
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA
| | - Christopher B. Brady
- VA Boston Healthcare SystemBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Division of AgingBrigham and Women's Hospital, Harvard Medical SchoolBostonMA
| | - Thor D. Stein
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
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38
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Cherry JD, Kim SH, Stein TD, Pothast MJ, Nicks R, Meng G, Huber BR, Mez J, Alosco ML, Tripodis Y, Farrell K, Alvarez VE, McKee AC, Crary JF. Evolution of neuronal and glial tau isoforms in chronic traumatic encephalopathy. Brain Pathol 2020; 30:913-925. [PMID: 32500646 DOI: 10.1111/bpa.12867] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy characterized by accumulation of hyperphosphorylated tau (p-tau) in perivascular aggregates in neurons and glia at the depths of neocortical sulci and progresses to diffuse neocortical, allocortical and brainstem structures. The strongest risk factor is exposure to repetitive head impacts acquired most commonly through contact sports and military service. Given that CTE can only be definitively diagnosed after death, a better understanding of the cellular and molecular changes in CTE brains may lead to identification of mechanisms that could be used for novel biomarkers, monitoring progression or therapeutic development. Disruption of alternative pre-mRNA splicing of tau mRNA plays a pathogenic role in tauopathy, with multiple characteristic patterns of isoform accumulation varying among tauopathies. Limited data are available on CTE, particularly at early stages. Using biochemical and histological approaches, we performed a detailed characterization of tau isoform signatures in post-mortem human brain tissue from individuals with a range of CTE stages (n = 99). In immunoblot analyses, severity was associated with decreased total monomeric tau and increased total oligomeric tau. Immunoblot with isoform-specific antisera revealed that oligomeric tau with three and four microtubule binding domain repeats (3R and 4R) also increased with CTE severity. Similarly, immunohistochemical studies revealed p-tau accumulation consisting of both 3R and 4R in perivascular lesions. When the ratio of 4R:3R was analyzed, there was mixed expression throughout CTE stages, although 4R predominated in early CTE stages (I-II), a 3R shift was observed in later stages (III-IV). While neurons were found to contain both 3R and 4R, astrocytes only contained 4R. These 4R-positive cells were exclusively neuronal at early stages. Overall, these findings demonstrate that CTE is a mixed 4R/3R tauopathy. Furthermore, histologic analysis reveals a progressive shift in tau isoforms that correlates with CTE stage and extent of neuronal pathology.
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Affiliation(s)
- Jonathan D Cherry
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA.,Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA
| | - Soong Ho Kim
- Neuropathology Brain Bank & Research CoRE, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thor D Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
| | - Morgan J Pothast
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA
| | - Raymond Nicks
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
| | - Gaoyuan Meng
- Department of Veterans Affairs Medical Center, Bedford, MA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA.,Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | - Michael L Alosco
- Department of Neurology, Boston University School of Medicine, Boston, MA.,Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA
| | - Kurt Farrell
- Neuropathology Brain Bank & Research CoRE, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
| | - Ann C McKee
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA.,Boston University Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA.,Department of Veterans Affairs Medical Center, Bedford, MA
| | - John F Crary
- Neuropathology Brain Bank & Research CoRE, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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39
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Greenberg A, Huber BR, Liu DX, Logue JP, Hischak AMW, Hart RJ, Abbott M, Isic N, Hisada YM, Mackman N, Bennett RS, Hensley LE, Connor JH, Crossland NA. Quantification of Viral and Host Biomarkers in the Liver of Rhesus Macaques: A Longitudinal Study of Zaire Ebolavirus Strain Kikwit (EBOV/Kik). Am J Pathol 2020; 190:1449-1460. [PMID: 32275904 PMCID: PMC7322367 DOI: 10.1016/j.ajpath.2020.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 12/21/2022]
Abstract
Zaire ebolavirus (EBOV) causes Ebola virus disease (EVD), which carries a fatality rate between 25% and 90% in humans. Liver pathology is a hallmark of terminal EVD; however, little is known about temporal disease progression. We used multiplexed fluorescent immunohistochemistry and in situ hybridization in combination with whole slide imaging and image analysis (IA) to quantitatively characterize temporospatial signatures of viral and host factors as related to EBOV pathogenesis. Eighteen rhesus monkeys euthanized between 3 and 8 days post-infection, and 3 uninfected controls were enrolled in this study. Compared with semiquantitative histomorphologic ordinal scoring, quantitative IA detected subtle and progressive features of early and terminal EVD that was not feasible with routine approaches. Sinusoidal macrophages were the earliest cells to respond to infection, expressing proinflammatory cytokine interleukin 6 (IL6) mRNA, which was subsequently also observed in fibrovascular compartments. The mRNA of interferon-stimulated gene-15 (ISG-15), also known as ISG15 ubiquitin like modifier (ISG15), was observed early, with a progressive and ubiquitous hybridization signature involving mesenchymal and epithelial compartments. ISG-15 mRNA was prominent near infected cells, but not in infected cells, supporting the hypothesis that bystander cells produce a robust interferon gene response. This study contributes to our current understanding of early EVD progression and illustrates the value that digital pathology and quantitative IA serve in infectious disease research.
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Affiliation(s)
- Alexandra Greenberg
- Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts
| | - Bertrand R Huber
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - David X Liu
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - James P Logue
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Amanda M W Hischak
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Randy J Hart
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Maureen Abbott
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Nejra Isic
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Yohei M Hisada
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nigel Mackman
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard S Bennett
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Lisa E Hensley
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - John H Connor
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Nicholas A Crossland
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.
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Mez J, Daneshvar DH, Abdolmohammadi B, Chua AS, Alosco ML, Kiernan PT, Evers L, Marshall L, Martin BM, Palmisano JN, Nowinski CJ, Mahar I, Cherry JD, Alvarez VE, Dwyer B, Huber BR, Stein TD, Goldstein LE, Katz DI, Cantu RC, Au R, Kowall NW, Stern RA, McClean MD, Weuve J, Tripodis Y, McKee AC. Duration of American Football Play and Chronic Traumatic Encephalopathy. Ann Neurol 2020; 87:116-131. [PMID: 31589352 PMCID: PMC6973077 DOI: 10.1002/ana.25611] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/27/2019] [Accepted: 09/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to contact and collision sports, including American football. We hypothesized a dose-response relationship between duration of football played and CTE risk and severity. METHODS In a convenience sample of 266 deceased American football players from the Veterans Affairs-Boston University-Concussion Legacy Foundation and Framingham Heart Study Brain Banks, we estimated the association of years of football played with CTE pathological status and severity. We evaluated the ability of years played to classify CTE status using receiver operating characteristic curve analysis. Simulation analyses quantified conditions that might lead to selection bias. RESULTS In total, 223 of 266 participants met neuropathological diagnostic criteria for CTE. More years of football played were associated with having CTE (odds ratio [OR] = 1.30 per year played, 95% confidence interval [CI] = 1.19-1.41; p = 3.8 × 10-9 ) and with CTE severity (severe vs mild; OR = 1.14 per year played, 95% CI = 1.07-1.22; p = 3.1 × 10-4 ). Participants with CTE were 1/10th as likely to have played <4.5 years (negative likelihood ratio [LR] = 0.102, 95% CI = 0.100-0.105) and were 10 times as likely to have played >14.5 years (positive LR = 10.2, 95% CI = 9.8-10.7) compared with participants without CTE. Sensitivity and specificity were maximized at 11 years played. Simulation demonstrated that years played remained adversely associated with CTE status when years played and CTE status were both related to brain bank selection across widely ranging scenarios. INTERPRETATION The odds of CTE double every 2.6 years of football played. After accounting for brain bank selection, the magnitude of the relationship between years played and CTE status remained consistent. ANN NEUROL 2020;87:116-131.
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Minaeva O, Hua N, Franz ES, Lupoli N, Mian AZ, Farris CW, Hildebrandt AM, Kiernan PT, Evers LE, Griffin AD, Liu X, Chancellor SE, Babcock KJ, Moncaster JA, Jara H, Alvarez VE, Huber BR, Guermazi A, Latour LL, McKee AC, Soto JA, Anderson SW, Goldstein LE. Nonhomogeneous Gadolinium Retention in the Cerebral Cortex after Intravenous Administration of Gadolinium-based Contrast Agent in Rats and Humans. Radiology 2019; 294:377-385. [PMID: 31769744 DOI: 10.1148/radiol.2019190461] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Gadolinium retention after repeated gadolinium-based contrast agent (GBCA) exposure has been reported in subcortical gray matter. However, gadolinium retention in the cerebral cortex has not been systematically investigated. Purpose To determine whether and where gadolinium is retained in rat and human cerebral cortex. Materials and Methods The cerebral cortex in Sprague-Dawley rats treated with gadopentetate dimeglumine (three doses over 4 weeks; cumulative gadolinium dose, 7.2 mmol per kilogram of body weight; n = 6) or saline (n = 6) was examined with antemortem MRI. Two human donors with repeated GBCA exposure (three and 15 doses; 1 and 5 months after exposure), including gadopentetate dimeglumine, and two GBCA-naive donors were also evaluated. Elemental brain maps (gadolinium, phosphorus, zinc, copper, iron) for rat and human brains were constructed by using laser ablation inductively coupled plasma mass spectrometry. Results Gadopentetate dimeglumine-treated rats showed region-, subregion-, and layer-specific gadolinium retention in the neocortex (anterior cingulate cortex: mean gadolinium concentration, 0.28 µg ∙ g-1 ± 0.04 [standard error of the mean]) that was comparable (P > .05) to retention in the allocortex (mean gadolinium concentration, 0.33 µg ∙ g-1 ± 0.04 in piriform cortex, 0.24 µg ∙ g-1 ± 0.04 in dentate gyrus, 0.17 µg ∙ g-1 ± 0.04 in hippocampus) and subcortical structures (0.47 µg ∙ g-1 ± 0.10 in facial nucleus, 0.39 µg ∙ g-1 ± 0.10 in choroid plexus, 0.29 µg ∙ g-1 ± 0.05 in caudate-putamen, 0.26 µg ∙ g-1 ± 0.05 in reticular nucleus of the thalamus, 0.24 µg ∙ g-1 ± 0.04 in vestibular nucleus) and significantly greater than that in the cerebellum (0.17 µg ∙ g-1 ± 0.03, P = .01) and white matter tracts (anterior commissure: 0.05 µg ∙ g-1 ± 0.01, P = .002; corpus callosum: 0.05 µg ∙ g-1 ± 0.02, P = .001; cranial nerve: 0.02 µg ∙ g-1 ± 0.01, P = .004). Retained gadolinium colocalized with parenchymal iron. T1-weighted MRI signal intensification was not observed. Gadolinium retention was detected in the cerebral cortex, pia mater, and pia-ensheathed leptomeningeal vessels in two GBCA-exposed human brains but not in two GBCA-naive human brains. Conclusion Repeated gadopentetate dimeglumine exposure is associated with gadolinium retention in specific regions, subregions, and layers of cerebral cortex that are critical for higher cognition, affect, and behavior regulation, sensorimotor coordination, and executive function. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Kanal in this issue.
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Affiliation(s)
- Olga Minaeva
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Ning Hua
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Erich S Franz
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Nicola Lupoli
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Asim Z Mian
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Chad W Farris
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Audrey M Hildebrandt
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Patrick T Kiernan
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Laney E Evers
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Allison D Griffin
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Xiuping Liu
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Sarah E Chancellor
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Katharine J Babcock
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Juliet A Moncaster
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Hernan Jara
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Victor E Alvarez
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Bertrand R Huber
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Ali Guermazi
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Lawrence L Latour
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Ann C McKee
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Jorge A Soto
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Stephan W Anderson
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
| | - Lee E Goldstein
- From the Departments of Radiology (O.M., N.H., N.L., A.Z.M., C.W.F., X.L., J.A.M., H.J., A.G., J.A.S., S.W.A., L.E.G.), Neurology (A.C.M., L.E.G.), Pathology and Laboratory Medicine (V.E.A., B.R.H., A.C.M., L.E.G.), Behavioral Neuroscience (S.E.C.), and Anatomy and Neurobiology (K.J.B.), Boston University School of Medicine, 670 Albany St, Boston, MA 02118; Boston University Alzheimer's Disease Center, Boston, Mass (O.M., N.H., P.T.K., L.E.E., S.E.C., J.A.M., V.E.A., B.R.H., A.C.M., L.E.G.); VA Boston Healthcare System, Jamaica Plain, Mass (A.M.H., V.E.A., B.R.H., A.C.M.); Stroke Branch, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Md (A.D.G., L.L.L.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Md (A.D.G., L.L.L.); and Center for Biometals and Metallomics (O.M., N.L., J.A.M., L.E.G.), College of Engineering (E.S.F., A.C.M., S.W.A., L.E.G.), and Photonics Center (O.M., J.A.M., S.W.A., L.E.G.), Boston University, Boston, Mass
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Standring OJ, Friedberg J, Tripodis Y, Chua AS, Cherry JD, Alvarez VE, Huber BR, Xia W, Mez J, Alosco ML, Nicks R, Mahar I, Pothast MJ, Gardner HM, Meng G, Palmisano JN, Martin BM, Dwyer B, Kowall NW, Cantu RC, Goldstein LE, Katz DI, Stern RA, McKee AC, Stein TD. Contact sport participation and chronic traumatic encephalopathy are associated with altered severity and distribution of cerebral amyloid angiopathy. Acta Neuropathol 2019; 138:401-413. [PMID: 31183671 DOI: 10.1007/s00401-019-02031-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022]
Abstract
Cerebral amyloid angiopathy (CAA) consists of beta-amyloid deposition in the walls of the cerebrovasculature and is commonly associated with Alzheimer's disease (AD). However, the association of CAA with repetitive head impacts (RHI) and with chronic traumatic encephalopathy (CTE) is unknown. We evaluated the relationship between RHI from contact sport participation, CTE, and CAA within a group of deceased contact sport athletes (n = 357), a community-based cohort (n = 209), and an AD cohort from Boston University AD Center (n = 241). Unsupervised hierarchal cluster analysis demonstrated a unique cluster (n = 11) with increased CAA in the leptomeningeal vessels compared to the intracortical vessels (p < 0.001) comprised of participants with significantly greater frequencies of CTE (7/11) and history of RHI. Overall, participants with CTE (n = 251) had more prevalent (p < 0.001) and severe (p = 0.010) CAA within the frontal leptomeningeal vessels compared to intracortical vessels. Compared to those with AD, participants with CTE had more severe CAA in frontal than parietal lobes (p < 0.001) and more severe CAA in leptomeningeal than intracortical vessels (p = 0.002). The overall frequency of CAA in participants with CTE was low, and there was no significant association between contact sport participation and the presence of CAA. However, in those with CAA, a history of contact sports was associated with increased CAA severity in the frontal leptomeningeal vessels (OR = 4.01, 95% CI 2.52-6.38, p < 0.001) adjusting for AD, APOE ε4 status, and age. Participants with CAA had increased levels of sulcal tau pathology and decreased levels of the synaptic marker PSD-95 (p's < 0.05), and CAA was a predictor of dementia (OR = 1.75, 95% CI 1.02-2.99, p = 0.043) adjusting for age, sex, and comorbid pathology. Overall, contact sport participation and CTE were associated with more severe frontal and leptomeningeal CAA, and CAA was independently associated with worse pathological and clinical outcomes.
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Affiliation(s)
- Oliver J Standring
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Jacob Friedberg
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Yorghos Tripodis
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 20118, USA
| | - Alicia S Chua
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 20118, USA
| | - Jonathan D Cherry
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Victor E Alvarez
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Bertrand R Huber
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Weiming Xia
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Jesse Mez
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Michael L Alosco
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Raymond Nicks
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Ian Mahar
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Morgan J Pothast
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Hannah M Gardner
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Gaoyuan Meng
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Joseph N Palmisano
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Brett M Martin
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, 02118, USA
| | - Neil W Kowall
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Robert C Cantu
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 20119, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, 01742, USA
| | - Lee E Goldstein
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Departments of Psychiatry, Ophthalmology, Boston University School of Medicine, Boston, USA
- Departments of Biomedical, Electrical and Computer Engineering, Boston University College of Engineering, Boston, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, 02118, USA
| | - Robert A Stern
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 20119, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Ann C McKee
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Thor D Stein
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA.
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA.
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.
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Alosco ML, Mian A, Buch K, Farris C, Tripodis Y, Evers L, Uretsky M, Martin BM, Palmisano J, Puzo C, Goldstein L, Katz DI, Dwyer B, Kowall NW, Huber BR, Stein TD, Killiany R, Stern RA, McKee AC, Mez J. O1‐04‐03: VISUALLY‐RATED STRUCTURAL MRI PROFILES IN NEUROPATHOLOGICALLY‐CONFIRMED CHRONIC TRAUMATIC ENCEPHALOPATHY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Karen Buch
- Massachusetts General Hospital Boston MA USA
| | | | - Yorghos Tripodis
- Boston University School of Medicine Boston MA USA
- Boston University School of Public Health Boston MA USA
| | - Laney Evers
- Boston University School of Medicine Boston MA USA
| | | | | | | | | | | | | | - Brigid Dwyer
- Boston University School of Medicine Boston MA USA
| | - Neil W. Kowall
- Boston University School of Medicine Boston MA USA
- VA Boston Healthcare Boston MA USA
| | | | - Thor D. Stein
- Boston University School of Medicine Boston MA USA
- VA Boston Healthcare System Boston MA USA
| | | | | | - Ann C. McKee
- Boston University School of Medicine Boston MA USA
- VA Boston Healthcare System Boston MA USA
| | - Jesse Mez
- Boston University School of Medicine Boston MA USA
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Goldstein L, Minaeva O, Fisher AM, Tagge CA, Moncaster JA, Gaudreau-Balderrama A, Zhang XL, Wojnarowicz MW, Babcock KJ, Franz ES, Chancellor SE, Pietro JH, O'Brien JW, Liu X, Casey NF, Lupoli N, Lu H, Kokiko-Cochran O, Saman S, Kondo A, Zhou X, Miry O, Vose LR, Ericsson M, Onos K, Veksler R, Senatorov V, Gopaul K, Upreti C, Nowinski C, Cantu R, Alvarez VE, Hua N, Tripodis Y, Anderson A, Howell G, Kaufer D, Hall GF, Lu KP, Ransohoff R, Cleveland RO, Kowall NW, Huber BR, Stein TD, Lamb BT, Moss WC, Friedman A, Stanton PK, McKee AC. P2-206: CONTRIBUTION OF FOCAL MICROVASCULAR DISRUPTION TO NEUROINFLAMMATION AND TAU PATHOLOGY IN A MOUSE MODEL OF IMPACT CONCUSSION AND CHRONIC TRAUMATIC ENCEPHALOPATHY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lee Goldstein
- Boston University; School of Medicine; Boston MA USA
| | - Olga Minaeva
- Boston University; School of Medicine; Boston MA USA
| | | | | | | | | | | | | | | | | | | | | | | | - Xiuping Liu
- Boston University; School of Medicine; Boston MA USA
| | - Noel F. Casey
- Boston University; School of Medicine; Boston MA USA
| | - Nicola Lupoli
- Boston University; School of Medicine; Boston MA USA
| | | | | | - Sudad Saman
- University of Massachusetts Lowell; Lowell MA USA
| | | | | | - Omid Miry
- New York Medical College; Valhalla NY USA
| | | | | | | | | | | | | | | | | | - Robert Cantu
- Boston University; School of Medicine; Boston MA USA
| | | | - Ning Hua
- Boston University; School of Medicine; Boston MA USA
| | | | | | | | | | | | | | | | | | - Neil W. Kowall
- Boston University; Alzheimer's Disease Center; Boston MA USA
| | | | | | - Bruce T. Lamb
- Indiana University; Stark Neurosciences Research Institute; Indianapolis IN USA
| | | | | | | | - Ann C. McKee
- Boston University; School of Medicine; Boston MA USA
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Walt GS, Burris HM, Brady CB, Spencer KR, Alvarez VE, Huber BR, Guilderson L, Abdul Rauf N, Collins D, Singh T, Mathias R, Averill JG, Walker SE, Robey I, McKee AC, Kowall NW, Stein TD. Chronic Traumatic Encephalopathy Within an Amyotrophic Lateral Sclerosis Brain Bank Cohort. J Neuropathol Exp Neurol 2018; 77:1091-1100. [PMID: 30299493 PMCID: PMC6927868 DOI: 10.1093/jnen/nly092] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/06/2018] [Indexed: 01/05/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive head impacts and has been associated with amyotrophic lateral sclerosis (ALS), a fatal, degenerative neuromuscular disorder. The Department of Veterans Affairs Biorepository Brain Bank (VABBB) is a tissue repository that collects antemortem disease progression data and postmortem central nervous system tissue from veterans with ALS. We set out to determine the frequency of co-morbid ALS and CTE in the VABBB cohort and to characterize the clinical, genetic, and pathological distinctions between participants with ALS only and those with both ALS and CTE (ALS+CTE). Of 155 participants, 9 (5.8%) had neuropathologically confirmed ALS+CTE. Participants with ALS+CTE were more likely to have a history of traumatic brain injury (p < 0.001), served during the first Persian Gulf War (p < 0.05), and to have more severe tau pathology within the frontal cortex and spinal cord (p < 0.05). The most common exposures to head impacts included contact sports (n = 5) and military service (n = 2). Clinically, participants with ALS+CTE were more likely to have bulbar onset ALS (p = 0.006), behavioral changes (p = 0.002), and/or mood changes (p < 0.001). Overall, compared with ALS in isolation, comorbid ALS+CTE is associated with a history of TBI and has a distinct clinical and pathological presentation.
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Affiliation(s)
| | | | - Christopher B Brady
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Victor E Alvarez
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Bertrand R Huber
- VA Boston Healthcare System, Boston, Massachusetts
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | | | | | | | | | - Rebecca Mathias
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Sean E Walker
- Southern Arizona VA Healthcare System, Tucson, Arizona
| | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, Arizona
| | - Ann C McKee
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Neil W Kowall
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D Stein
- VA Boston Healthcare System, Boston, Massachusetts
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- Send correspondence to: Thor D. Stein, MD, PhD, Department of Pathology and Laboratory Medicine, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130; E-mail:
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Cherry JD, Mez J, Crary JF, Tripodis Y, Alvarez VE, Mahar I, Huber BR, Alosco ML, Nicks R, Abdolmohammadi B, Kiernan PT, Evers L, Svirsky S, Babcock K, Gardner HM, Meng G, Nowinski CJ, Martin BM, Dwyer B, Kowall NW, Cantu RC, Goldstein LE, Katz DI, Stern RA, Farrer LA, McKee AC, Stein TD. Variation in TMEM106B in chronic traumatic encephalopathy. Acta Neuropathol Commun 2018; 6:115. [PMID: 30390709 PMCID: PMC6215686 DOI: 10.1186/s40478-018-0619-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 12/14/2022] Open
Abstract
The genetic basis of chronic traumatic encephalopathy (CTE) is poorly understood. Variation in transmembrane protein 106B (TMEM106B) has been associated with enhanced neuroinflammation during aging and with TDP-43-related neurodegenerative disease, and rs3173615, a missense coding SNP in TMEM106B, has been implicated as a functional variant in these processes. Neuroinflammation and TDP-43 pathology are prominent features in CTE. The purpose of this study was to determine whether genetic variation in TMEM106B is associated with CTE risk, pathological features, and ante-mortem dementia. Eighty-six deceased male athletes with a history of participation in American football, informant-reported Caucasian, and a positive postmortem diagnosis of CTE without comorbid neurodegenerative disease were genotyped for rs3173615. The minor allele frequency (MAF = 0.42) in participants with CTE did not differ from previously reported neurologically normal controls (MAF = 0.43). However, in a case-only analysis among CTE cases, the minor allele was associated with reduced phosphorylated tau (ptau) pathology in the dorsolateral frontal cortex (DLFC) (AT8 density, odds ratio [OR] of increasing one quartile = 0.42, 95% confidence interval [CI] 0.22–0.79, p = 0.008), reduced neuroinflammation in the DLFC (CD68 density, OR of increasing one quartile = 0.53, 95% CI 0.29–0.98, p = 0.043), and increased synaptic protein density (β = 0.306, 95% CI 0.065–0.546, p = 0.014). Among CTE cases, TMEM106B minor allele was also associated with reduced ante-mortem dementia (OR = 0.40, 95% CI 0.16–0.99, p = 0.048), but was not associated with TDP-43 pathology. All case-only models were adjusted for age at death and duration of football play. Taken together, variation in TMEM106B may have a protective effect on CTE-related outcomes.
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Morrison FG, Miller MW, Wolf EJ, Logue MW, Maniates H, Kwasnik D, Cherry JD, Svirsky S, Restaino A, Hildebrandt A, Aytan N, Stein TD, Alvarez VE, McKee AC, Huber BR. Reduced interleukin 1A gene expression in the dorsolateral prefrontal cortex of individuals with PTSD and depression. Neurosci Lett 2018; 692:204-209. [PMID: 30366016 DOI: 10.1016/j.neulet.2018.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/13/2018] [Accepted: 10/13/2018] [Indexed: 12/13/2022]
Abstract
The inflammatory system has been implicated in the pathophysiology of a variety of psychiatric conditions. Individuals with PTSD, depression, and other fear- and anxiety-related disorders exhibit alterations in peripheral circulating inflammatory markers, suggesting dysregulation of the inflammatory system. The relationship between inflammation and PTSD has been investigated almost exclusively in the periphery, and has not been extensively explored in human postmortem brain tissue. Interleukins (ILs) represent a subtype of cytokines and are key signaling proteins in the immune and inflammatory systems. Based on prior research implicating IL signaling in PTSD and depression, we performed a preliminary investigation of IL gene expression in a region of the cortex involved in emotion regulation and PTSD, the dorsolateral prefrontal cortex (dlPFC), using tissue from the newly established VA National PTSD Brain Bank. Gene expression analyses were conducted on post-mortem tissue from the dlPFC from 50 donors: 13 controls, 12 PTSD cases, and 25 depressed cases. RNA was extracted from frozen dlPFC tissue, reverse transcribed to cDNA, and quantitative polymerase chain reaction (qPCR) was performed to assess gene expression of IL1A, IL1B, IL6, IL8, IL10, IL13, and IL15. We found a multiple-testing corrected significant decrease in IL1A expression in the dlPFC for PTSD and depression cases compared to controls (p < 0.005) with age at death, sex, race and RNA integrity number (RIN) included as covariates. To our knowledge this finding is the first demonstration of altered IL expression in brain tissue from deceased individuals with histories of PTSD and/or depression.
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Affiliation(s)
- Filomene G Morrison
- National Center for PTSD at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States
| | - Erika J Wolf
- National Center for PTSD at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States
| | - Mark W Logue
- National Center for PTSD at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States; Biomedical Genetics, Boston University School of Medicine, United States; Department of Biostatistics, Boston University School of Public Health, United States
| | - Hannah Maniates
- National Center for PTSD at VA Boston Healthcare System, United States
| | - David Kwasnik
- Department of Psychiatry, Boston University School of Medicine, United States
| | - Jonathan D Cherry
- Department of Neurology, Boston University School of Medicine, United States
| | - Sarah Svirsky
- Pathology and Laboratory Medicine, VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States
| | - Anthony Restaino
- Department of Neurology, Boston University School of Medicine, United States
| | - Audrey Hildebrandt
- National Center for PTSD at VA Boston Healthcare System, United States; Pathology and Laboratory Medicine, VA Boston Healthcare System, United States
| | - Nurgül Aytan
- Department of Neurology, Boston University School of Medicine, United States
| | - Thor D Stein
- Pathology and Laboratory Medicine, VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States; Department of Pathology, Boston University School of Medicine, United States
| | - Victor E Alvarez
- National Center for PTSD at VA Boston Healthcare System, United States; Pathology and Laboratory Medicine, VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States
| | - Ann C McKee
- Pathology and Laboratory Medicine, VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States; Department of Pathology, Boston University School of Medicine, United States
| | | | - Bertrand R Huber
- National Center for PTSD at VA Boston Healthcare System, United States; Pathology and Laboratory Medicine, VA Boston Healthcare System, United States; Department of Neurology, Boston University School of Medicine, United States.
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Adams JW, Alvarez VE, Mez J, Huber BR, Tripodis Y, Xia W, Meng G, Kubilus CA, Cormier K, Kiernan PT, Daneshvar DH, Chua AS, Svirsky S, Nicks R, Abdolmohammadi B, Evers L, Solomon TM, Cherry JD, Aytan N, Mahar I, Devine S, Auerbach S, Alosco ML, Nowinski CJ, Kowall NW, Goldstein LE, Dwyer B, Katz DI, Cantu RC, Stern RA, Au R, McKee AC, Stein TD. Lewy Body Pathology and Chronic Traumatic Encephalopathy Associated With Contact Sports. J Neuropathol Exp Neurol 2018; 77:757-768. [PMID: 30053297 PMCID: PMC6097837 DOI: 10.1093/jnen/nly065] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Traumatic brain injury has been associated with increased risk of Parkinson disease and parkinsonism, and parkinsonism and Lewy body disease (LBD) can occur with chronic traumatic encephalopathy (CTE). To test whether contact sports and CTE are associated with LBD, we compared deceased contact sports athletes (n = 269) to cohorts from the community (n = 164) and the Boston University Alzheimer disease (AD) Center (n = 261). Participants with CTE and LBD were more likely to have β-amyloid deposition, dementia, and parkinsonism than CTE alone (p < 0.05). Traditional and hierarchical clustering showed a similar pattern of LBD distribution in CTE compared to LBD alone that was most frequently neocortical, limbic, or brainstem. In the community-based cohort, years of contact sports play were associated with neocortical LBD (OR = 1.30 per year, p = 0.012), and in a pooled analysis a threshold of >8 years of play best predicted neocortical LBD (ROC analysis, OR = 6.24, 95% CI = 1.5-25, p = 0.011), adjusting for age, sex, and APOE ɛ4 allele status. Clinically, dementia was significantly associated with neocortical LBD, CTE stage, and AD; parkinsonism was associated with LBD pathology but not CTE stage. Contact sports participation may increase risk of developing neocortical LBD, and increased LBD frequency may partially explain extrapyramidal motor symptoms sometimes observed in CTE.
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Affiliation(s)
- Jason W Adams
- Boston University Alzheimer’s Disease and CTE Center
| | - Victor E Alvarez
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA,VA Boston Healthcare System, Boston, MA
| | - Jesse Mez
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease and CTE Center,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Weiming Xia
- Boston University Alzheimer’s Disease and CTE Center,Department of Veterans Affairs Medical Center, Bedford, MA
| | - Gaoyuan Meng
- Boston University Alzheimer’s Disease and CTE Center,VA Boston Healthcare System, Boston, MA,Department of Veterans Affairs Medical Center, Bedford, MA
| | | | - Kerry Cormier
- Boston University Alzheimer’s Disease and CTE Center
| | | | | | - Alicia S Chua
- Boston University Alzheimer’s Disease and CTE Center,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Sarah Svirsky
- Boston University Alzheimer’s Disease and CTE Center
| | - Raymond Nicks
- Boston University Alzheimer’s Disease and CTE Center
| | | | - Laney Evers
- Boston University Alzheimer’s Disease and CTE Center
| | | | | | | | | | - Sherral Devine
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | - Sanford Auerbach
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | - Michael L Alosco
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | | | - Neil W Kowall
- Department of Neurology,VA Boston Healthcare System, Boston, MA
| | - Lee E Goldstein
- Boston University Alzheimer’s Disease and CTE Center,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Brigid Dwyer
- Department of Neurology,Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA
| | - Douglas I Katz
- Department of Neurology,Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA
| | - Robert C Cantu
- Boston University Alzheimer’s Disease and CTE Center,Concussion Legacy Foundation,Department of Anatomy and Neurobiology,Department of Neurosurgery, Boston University School of Medicine, Boston, MA,Department of Neurosurgery, Emerson Hospital, Concord, MA
| | - Robert A Stern
- Department of Neurology,Department of Anatomy and Neurobiology,Department of Neurosurgery, Boston University School of Medicine, Boston, MA
| | - Rhoda Au
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA,Department of Biostatistics, Boston University School of Public Health, Boston, MA,Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Ann C McKee
- Department of Neurology,Framingham Heart Study, Boston University School of Medicine, Boston, MA,VA Boston Healthcare System, Boston, MA,Department of Veterans Affairs Medical Center, Bedford, MA,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Thor D Stein
- Boston University Alzheimer’s Disease and CTE Center,Framingham Heart Study, Boston University School of Medicine, Boston, MA,VA Boston Healthcare System, Boston, MA,Department of Veterans Affairs Medical Center, Bedford, MA,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA,Send correspondence to: Thor D. Stein, MD, PhD, Department of Pathology and Laboratory Medicine, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130; E-mail:
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49
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Cherry JD, Huber BR, Svirsky SE, Meng G, Au R, Tripodis Y, Mez J, Alosco ML, Alvarez VE, Stein TD, McKee AC. O1‐06‐01: INCREASED ACCUMULATION OF HYPERPHOSPHORYLATED TAU IS STRONGLY CORRELATED WITH CCL2 DURING ALZHEIMER'S DISEASE AND CHRONIC TRAUMATIC ENCEPHALOPATHY INDEPENDENTLY OF Aβ. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | | | - Rhoda Au
- Boston University Schools of Medicine & Public HealthBostonMAUSA
| | | | - Jesse Mez
- Boston University School of MedicineBostonMAUSA
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Mufson EJ, He B, Ginsberg SD, Carper BA, Bieler GS, Crawford F, Alvarez VE, Huber BR, Stein TD, McKee AC, Perez SE. Gene Profiling of Nucleus Basalis Tau Containing Neurons in Chronic Traumatic Encephalopathy: A Chronic Effects of Neurotrauma Consortium Study. J Neurotrauma 2018; 35:1260-1271. [PMID: 29338612 PMCID: PMC5962931 DOI: 10.1089/neu.2017.5368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Military personnel and athletes exposed to traumatic brain injury may develop chronic traumatic encephalopathy (CTE). Brain pathology in CTE includes intracellular accumulation of abnormally phosphorylated tau proteins (p-tau), the main constituent of neurofibrillary tangles (NFTs). Recently, we found that cholinergic basal forebrain (CBF) neurons within the nucleus basalis of Meynert (nbM), which provide the major cholinergic innervation to the cortex, display an increased number of NFTs across the pathological stages of CTE. However, molecular mechanisms underlying nbM neurodegeneration in the context of CTE pathology remain unknown. Here, we assessed the genetic signature of nbM neurons containing the p-tau pretangle maker pS422 from CTE subjects who came to autopsy and received a neuropathological CTE staging assessment (Stages II, III, and IV) using laser capture microdissection and custom-designed microarray analysis. Quantitative analysis revealed dysregulation of key genes in several gene ontology groups between CTE stages. Specifically, downregulation of the nicotinic cholinergic receptor subunit β-2 gene (CHRNB2), monoaminergic enzymes catechol-O-methyltransferase (COMT) and dopa decarboxylase (DDC), chloride channels CLCN4 and CLCN5, scaffolding protein caveolin 1 (CAV1), cortical development/cytoskeleton element lissencephaly 1 (LIS1), and intracellular signaling cascade member adenylate cyclase 3 (ADCY3) was observed in pS422-immunreactive nbM neurons in CTE patients. By contrast, upregulation of calpain 2 (CAPN2) and microtubule-associated protein 2 (MAP2) transcript levels was found in Stage IV CTE patients. These single-population data in vulnerable neurons indicate alterations in gene expression associated with neurotransmission, signal transduction, the cytoskeleton, cell survival/death signaling, and microtubule dynamics, suggesting novel molecular pathways to target for drug discovery in CTE.
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Affiliation(s)
- Elliott J. Mufson
- Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona
| | - Bin He
- Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona
| | - Stephen D. Ginsberg
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, New York and NYU Medical Center, New York, New York
| | | | | | | | - Victor E. Alvarez
- VA Boston HealthCare System, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer Disease Center and CTE Center Program, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Bertrand R. Huber
- VA Boston HealthCare System, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer Disease Center and CTE Center Program, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- VA Boston HealthCare System, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer Disease Center and CTE Center Program, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Ann C. McKee
- VA Boston HealthCare System, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer Disease Center and CTE Center Program, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Sylvia E. Perez
- Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona
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