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Myskiw J, Lamoureux L, Peterson A, Knox D, Jansen GH, Coulthart MB, Booth SA. Development of an Automated Capillary Immunoassay to Detect Prion Glycotypes in Creutzfeldt-Jakob Disease. J Transl Med 2023; 103:100029. [PMID: 36925197 DOI: 10.1016/j.labinv.2022.100029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 01/11/2023] Open
Abstract
Creutzfeldt-Jakob disease (CJD) comprises a group of transmissible neurodegenerative diseases with vast phenotypic diversity. Sporadic CJD heterogeneity is predominantly influenced by the genotype at codon 129 of the prion-encoding gene and the molecular weight of PrPSc fragments after protease digestion, resulting in a classification of 6 subtypes of CJD (MM1, MM2, MV1, MV2, VV1, and VV2). The majority of cases with CJD can be distinguished using this classification system. However, a number of reported CJD cases are phenotypically unique from others within their same subtype, such as variably protease-sensitive prionopathies, or exist as a mixture of subtypes within the same patient. Western blotting of brain tissue, along with the genotyping of codon 129 of the prion-encoding gene, is considered the "gold standard" for the biochemical characterization of CJD. Western blotting requires a significant amount of prion protein for detection, is labor-intensive, and is also associated with high interassay variability. In addition to these limitations, a growing body of research suggests that unique subtypes of CJD are often undetected or misdiagnosed using standard diagnostic western blotting protocols. Consequently, we successfully optimized and developed a capillary-based western assay using the JESS Simple Western (ProteinSimple) to detect and characterize prion proteins from patients with CJD. We found that this novel assay consistently differentiated CJD type 1 and type 2 cases with a limit of detection 10 to 100× higher than traditional western blotting. Cases with CJD in which type 1 and type 2 coexist within the same brain region can be detected using type 1-specific and type 2-specific antibodies, and we found that there was remarkable specificity for the detection of cases with variably protease-sensitive prionopathy. The assay presented displays outstanding sensitivity, allowing for the preservation of valuable samples and enhancing current detection methods.
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Affiliation(s)
- Jennifer Myskiw
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada; Department of Medical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lise Lamoureux
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Anne Peterson
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - David Knox
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Stephanie A Booth
- One Health Division, Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada; Department of Medical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Puac-Polanco P, Zakhari N, Miller J, McComiskey D, Thornhill RE, Jansen GH, Nair VJ, Nguyen TB. Diagnostic Accuracy of Centrally Restricted Diffusion Sign in Cerebral Metastatic Disease: Differentiating Radiation Necrosis from Tumor Recurrence. Can Assoc Radiol J 2023; 74:100-109. [PMID: 35848632 DOI: 10.1177/08465371221115341] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: The centrally restricted diffusion sign of diffusion-weighted imaging (DWI) is associated with radiation necrosis (RN) in treated gliomas. Our goal was to evaluate its diagnostic accuracy to distinguish RN from tumor recurrence (TR) in treated brain metastases. Methods: Retrospective study of consecutive patients with brain metastases who developed a newly centrally necrotic lesion after radiotherapy (RT). One reader placed regions of interest (ROI) in the enhancing solid lesion and the non-enhancing central necrosis on the apparent diffusion coefficient (ADC) map. Two readers qualitatively assessed the presence of the centrally restricted diffusion sign. The final diagnosis was made by histopathology (n = 39) or imaging follow-up (n = 2). Differences between groups were assessed by Fisher's exact or Mann-Whitney U tests. Diagnostic accuracy and inter-reader agreement were evaluated using receiver operating characteristic (ROC) curve analysis and kappa scores. Results: Forty-one lesions (32 predominant RN; 9 predominant TR) were analyzed. An ADC value ≤ 1220 × 10-6 mm2/s (sensitivity 74%, specificity 89%, area under the curve [AUC] .85 [95% confidence interval {CI}, .70-.94] P < .0001) from the necrosis and an ADC necrosis/enhancement ratio ≤1.37 (sensitivity 74%, specificity 89%, AUC .82 [95% CI, .67-.93] P < .0001) provided the highest performance for RN diagnosis. The qualitative centrally restricted diffusion sign had a sensitivity of 69% (95% CI, .50-.83), specificity of 77% (95% CI, .40-.96), and a moderate (k = .49) inter-reader agreement for RN diagnosis. Conclusions: Radiation necrosis is associated with lower ADC values in the central necrosis than TR. A moderate interobserver agreement might limit the qualitative assessment of the centrally restricted diffusion sign.
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Affiliation(s)
- Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Nader Zakhari
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Jacob Miller
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada
| | - David McComiskey
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Rebecca E Thornhill
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, 6363University of Ottawa, Ottawa, ON, Canada
| | - Vimoj J Nair
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute (OHRI)
| | - Thanh Binh Nguyen
- Department of Radiology, Radiation Oncology and Medical Physics, 6363University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute (OHRI)
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Puac-Polanco P, Zakhari N, Jansen GH, Torres C. Case 309: Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy. Radiology 2023; 306:293-298. [PMID: 36534605 DOI: 10.1148/radiol.211954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
HISTORY A 64-year-old man presented with a 6-month history of lightheadedness and intermittent balance and coordination difficulties. Two months before admission, symptoms became more substantial and persistent, with a worsening sense of disequilibrium and unsteady gait. He reported difficulties pronouncing words and mild word-finding difficulties. His wife noted a change in his cognition and memory over the same time. His medical history included well-controlled chronic obstructive pulmonary disease (COPD) secondary to a long history of smoking with associated unintentional 30-lb (13.6-kg) weight loss over the previous 3 years, for which chest CT scanning was performed, revealing no abnormality. On clinical examination, the patient was alert and oriented but had slurred speech. A positive Romberg sign was noted, finger-to-nose and hand rapid alternating movement tests revealed impairment on the right side, and his gait was ataxic. The motor examination revealed normal muscle tone, bulk, and power in the upper and lower extremities. Sensory testing results were normal. Initial MRI of the brain at admission revealed abnormal findings in the left supratentorial brain. Of note, this patient's presentation predated the COVID-19 pandemic. Cerebrospinal fluid (CSF) analysis revealed predominant pleocytosis (23 × 106/L; normal range, [0-5] × 106/L) (78% lymphocytes, 22% monocytes), elevated protein level (1.23 g/L; normal range, 0.19-0.64 g/L), oligoclonal bands (faint one or two), and a high immunoglobulin G (IgG) index (0.130 g/L; normal reference, ≤0.059 g/L). Despite extensive initial work-up for inflammatory, infectious, autoimmune, or neoplastic causes, a definitive diagnosis was not reached. Thus, repeat MRI of the brain was performed 2 weeks after admission.
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Affiliation(s)
- Paulo Puac-Polanco
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
| | - Nader Zakhari
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
| | - Gerard H Jansen
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
| | - Carlos Torres
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
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Puac-Polanco P, Zakhari N, Jansen GH, Torres C. Case 309. Radiology 2022; 304:732-735. [PMID: 35994397 DOI: 10.1148/radiol.211953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HISTORY A 64-year-old man presented with a 6-month history of lightheadedness, intermittent balance, and coordination difficulties. Two months before admission, symptoms became more substantial and persistent, with a worsening sense of disequilibrium and unsteady gait. He reported difficulties pronouncing words and mild word-finding difficulties. His wife noted a change in his cognition and memory over the same time. His medical history included well-controlled chronic obstructive pulmonary disease (COPD) secondary to a long history of smoking with associated unintentional 30-lb (13.6-kg) weight loss over the previous 3 years, for which chest CT scanning was performed, revealing no abnormality. On clinical examination, the patient was alert and oriented but had slurred speech. A positive Romberg sign was noted, finger-to-nose and hand rapid alternating movement tests revealed impairment on the right side, and his gait was ataxic. The motor examination revealed normal muscle tone, bulk, and power in the upper and lower extremities. Sensory testing results were normal. Initial MRI of the brain at admission revealed abnormal findings in the left supratentorial brain (Figs 1-3). Of note, this patient's presentation predated the COVID-19 pandemic. Cerebrospinal fluid analysis revealed predominant pleocytosis (23 × 106/L; normal range, [0-5] × 106/L) (78% lymphocytes, 22% monocytes), elevated protein level (1.23 g/L; normal range, 0.19-0.64 g/L), oligoclonal bands (faint one or two), and a high immunoglobulin G index (0.130 g/L; normal reference, ≤0.059 g/L). Despite extensive initial work-up for inflammatory, infectious, autoimmune, or neoplastic causes, a definitive diagnosis was not reached. Thus, repeat MRI of the brain was performed 2 weeks after admission (Fig 4).
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Affiliation(s)
- Paulo Puac-Polanco
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
| | - Nader Zakhari
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
| | - Gerard H Jansen
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
| | - Carlos Torres
- From the Division of Neuroradiology, Department of Radiology, Radiation Oncology, and Medical Physics (P.P.P., N.Z., C.T.), and Department of Pathology and Laboratory Medicine (G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; and Neuroscience Program, The Ottawa Hospital Research Institute, Ottawa, Canada (C.T.)
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Horwitz J, Huang A, McAuley D, Jansen GH, Johnston D. Embryonal Tumor With Multilayered Rosettes of the Parietooccipital Region: A Case Report. J Pediatr Hematol Oncol 2022; 44:e255-e259. [PMID: 33448719 DOI: 10.1097/mph.0000000000002048] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Embryonal tumor with multilayered rosettes is a rare and highly malignant early childhood brain tumor. We report a case of embryonal tumor with multilayered rosettes in the parietooccipital region of a 2-year-old girl. Histopathology of the tumor demonstrated amplification of the 19q13.42 locus and strong positivity for LIN28A. Treatment was multimodal and included 3 surgical resections, adjuvant chemotherapy with autologous stem cell rescue, and focal radiotherapy. The use of the agents vorinostat and isotretinoin, and the addition of focal radiation have not been extensively described in this patient population, but may attribute to our patient's sustained remission at 2.5-years follow-up.
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Affiliation(s)
| | - Annie Huang
- Division of Pediatric Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | | | - Gerard H Jansen
- Divisin of Anatomical Pathology, Eastern Ontario Regional Laboratory Association, Ottawa, ON
| | - Donna Johnston
- Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario
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Luk CC, Mathiason CK, Orrù CD, Jansen GH, Thiele A, Caughey B, Sim VL. Creutzfeldt-Jakob disease in pregnancy: the use of modified RT-QuIC to determine infectivity in placental tissues. Prion 2021; 15:107-111. [PMID: 34132175 PMCID: PMC8210859 DOI: 10.1080/19336896.2021.1933872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 12/03/2022] Open
Abstract
Sporadic Creutzfeldt–Jakob Disease (sCJD) rarely affects women of childbearing age. There is currently no evidence of vertical transmission. Given the biosafety implications of performing Caesarean sections (C-section) in these patients, we used sensitive real-time quaking-induced conversion (RT-QuIC) assays to test for the infectious prion protein (PrPSc) in products of gestation. A 35-year-old woman with sCJD presented in her 10th gestational week with an eight month history of progressive cognitive impairment. During C-section, amniotic fluid, cord blood and placental tissue were collected and analysed using RT-QuIC protocols adapted for use with these tissues. The patient’s diagnosis of sCJD, MM2 subtype, was confirmed at autopsy. There were borderline positive results in one sampled area of the placenta, but otherwise the cord blood and amniotic fluid were negative on our RT-QuIC assays. A healthy baby was delivered via C-section at 36 weeks and 3 days gestational age, with no evidence of neurological disease to date. We conclude that precautions should be taken with products of gestation, but the level of PrPSc is extremely low.
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Affiliation(s)
- Collin C Luk
- Division of Neurology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Candace K Mathiason
- Department of Microbiology, Immunology, and Pathology, Prion Research Center, Colorado State University, Fort Collins, CO, USA
| | - Christina D Orrù
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, MT, USA
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Allison Thiele
- Department of Obstetrics and Gynaecology, Faculty of Medicine & Dentistry, Edmonton, Canada
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, MT, USA
| | - Valerie L Sim
- Division of Neurology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Centre for Prions & Protein Folding Diseases, University of Alberta, Edmonton, Canada
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Bakal JA, Charlton CL, Hlavay B, Jansen GH, Svenson LW, Power C. Progressive multifocal leukoencephalopathy and Creutzfeldt-Jakob disease: population-wide incidences, comorbidities, costs of care, and outcomes. J Neurovirol 2021; 27:476-481. [PMID: 33978904 DOI: 10.1007/s13365-021-00983-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Neurological disorders associated with chronic infections are often progressive as well as challenging to diagnose and manage. Among 4.4 million persons from 2004 to 2019 receiving universal health, progressive multifocal leukoencephalopathy (PML, n = 58) and Creutzfeldt-Jakob disease (CJD, n = 93) cases were identified, revealing stable yearly incidence rates with divergent comorbidities: HIV/AIDS affected 37.8% of PML cases while cerebrovascular disease affected 26.9% of CJD cases. Most CJD cases died within 1 year (73%) although PML cases lived beyond 5 years (34.1%) despite higher initial costs of care. PML and CJD represent important neurological disorders with evolving risk variables and impact on health care.
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Affiliation(s)
- J A Bakal
- Provincial Research Data Services-Alberta Health Services, Edmonton, AB, Canada
| | - C L Charlton
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Li Ki Sheng Institute of Virology, Edmonton, AB, Canada
| | - B Hlavay
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada
| | - G H Jansen
- Division of Anatomical Pathology, University of Ottawa, Ottawa, ON, Canada
| | - L W Svenson
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada
- Analytics & Performance Reporting Branch, Alberta Health, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - C Power
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada.
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8
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Jones E, Hummerich H, Viré E, Uphill J, Dimitriadis A, Speedy H, Campbell T, Norsworthy P, Quinn L, Whitfield J, Linehan J, Jaunmuktane Z, Brandner S, Jat P, Nihat A, How Mok T, Ahmed P, Collins S, Stehmann C, Sarros S, Kovacs GG, Geschwind MD, Golubjatnikov A, Frontzek K, Budka H, Aguzzi A, Karamujić-Čomić H, van der Lee SJ, Ibrahim-Verbaas CA, van Duijn CM, Sikorska B, Golanska E, Liberski PP, Calero M, Calero O, Sanchez-Juan P, Salas A, Martinón-Torres F, Bouaziz-Amar E, Haïk S, Laplanche JL, Brandel JP, Amouyel P, Lambert JC, Parchi P, Bartoletti-Stella A, Capellari S, Poleggi A, Ladogana A, Pocchiari M, Aneli S, Matullo G, Knight R, Zafar S, Zerr I, Booth S, Coulthart MB, Jansen GH, Glisic K, Blevins J, Gambetti P, Safar J, Appleby B, Collinge J, Mead S. Identification of novel risk loci and causal insights for sporadic Creutzfeldt-Jakob disease: a genome-wide association study. Lancet Neurol 2020; 19:840-848. [PMID: 32949544 PMCID: PMC8220892 DOI: 10.1016/s1474-4422(20)30273-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Received: 04/13/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Human prion diseases are rare and usually rapidly fatal neurodegenerative disorders, the most common being sporadic Creutzfeldt-Jakob disease (sCJD). Variants in the PRNP gene that encodes prion protein are strong risk factors for sCJD but, although the condition has similar heritability to other neurodegenerative disorders, no other genetic risk loci have been confirmed. We aimed to discover new genetic risk factors for sCJD, and their causal mechanisms. METHODS We did a genome-wide association study of sCJD in European ancestry populations (patients diagnosed with probable or definite sCJD identified at national CJD referral centres) with a two-stage study design using genotyping arrays and exome sequencing. Conditional, transcriptional, and histological analyses of implicated genes and proteins in brain tissues, and tests of the effects of risk variants on clinical phenotypes, were done using deep longitudinal clinical cohort data. Control data from healthy individuals were obtained from publicly available datasets matched for country. FINDINGS Samples from 5208 cases were obtained between 1990 and 2014. We found 41 genome-wide significant single nucleotide polymorphisms (SNPs) and independently replicated findings at three loci associated with sCJD risk; within PRNP (rs1799990; additive model odds ratio [OR] 1·23 [95% CI 1·17-1·30], p=2·68 × 10-15; heterozygous model p=1·01 × 10-135), STX6 (rs3747957; OR 1·16 [1·10-1·22], p=9·74 × 10-9), and GAL3ST1 (rs2267161; OR 1·18 [1·12-1·25], p=8·60 × 10-10). Follow-up analyses showed that associations at PRNP and GAL3ST1 are likely to be caused by common variants that alter the protein sequence, whereas risk variants in STX6 are associated with increased expression of the major transcripts in disease-relevant brain regions. INTERPRETATION We present, to our knowledge, the first evidence of statistically robust genetic associations in sporadic human prion disease that implicate intracellular trafficking and sphingolipid metabolism as molecular causal mechanisms. Risk SNPs in STX6 are shared with progressive supranuclear palsy, a neurodegenerative disease associated with misfolding of protein tau, indicating that sCJD might share the same causal mechanisms as prion-like disorders. FUNDING Medical Research Council and the UK National Institute of Health Research in part through the Biomedical Research Centre at University College London Hospitals National Health Service Foundation Trust.
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Affiliation(s)
- Emma Jones
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Holger Hummerich
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Emmanuelle Viré
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - James Uphill
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Athanasios Dimitriadis
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Helen Speedy
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Tracy Campbell
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Penny Norsworthy
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Liam Quinn
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Jerome Whitfield
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Jacqueline Linehan
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Zane Jaunmuktane
- Division of Neuropathology, University College London Hospitals National Health Service Foundation Trust, London, UK; Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, University College London Queen Square Institute of Neurology, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, University College London Hospitals National Health Service Foundation Trust, London, UK; Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK
| | - Parmjit Jat
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Akin Nihat
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK; National Prion Clinic, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Tze How Mok
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK; National Prion Clinic, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Parvin Ahmed
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK
| | - Steven Collins
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christiane Stehmann
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shannon Sarros
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Michael D Geschwind
- University of California San Francisco Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Aili Golubjatnikov
- University of California San Francisco Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Karl Frontzek
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Herbert Budka
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland; Medical University Vienna, Vienna, Austria
| | - Adriano Aguzzi
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | | | - Sven J van der Lee
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Ewa Golanska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Pawel P Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Miguel Calero
- Chronic Disease Programme (UFIEC-CROSADIS) and Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), and Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - Olga Calero
- Chronic Disease Programme (UFIEC-CROSADIS) and Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), and Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - Pascual Sanchez-Juan
- Neurology Service, University Hospital Marqués de Valdecilla, University of Cantabria, CIBERNED and IDIVAL, Santander, Spain
| | - Antonio Salas
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain
| | - Elodie Bouaziz-Amar
- Department of Biochemistry and Molecular Biology, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Stéphane Haïk
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Cellule nationale de référence des maladies de Creutzfeldt-Jakob, AP-HP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Laplanche
- Department of Biochemistry and Molecular Biology, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Jean-Phillipe Brandel
- Sorbonne Université, INSERM U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Cellule nationale de référence des maladies de Creutzfeldt-Jakob, AP-HP, University Hospital Pitié-Salpêtrière, Paris, France
| | - Phillipe Amouyel
- INSERM, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Labex DISTALZ, University of Lille, Lille, France
| | - Jean-Charles Lambert
- INSERM, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE, Labex DISTALZ, University of Lille, Lille, France
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Sabina Capellari
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Poleggi
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | | | - Serena Aneli
- Department of Medical Sciences, Università degli studi di Torino, Torino, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, Università degli studi di Torino, Torino, Italy
| | - Richard Knight
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, Edinburgh, UK
| | - Saima Zafar
- Department of Neurology, Clinical Dementia Centre and National Reference Centre for Creutzfeldt-Jakob Disease Surveillance, University Medical School, Göttingen, Germany; German Centre for Neurodegenerative Diseases (DZNE), Göttingen, Germany; Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Centre and National Reference Centre for Creutzfeldt-Jakob Disease Surveillance, University Medical School, Göttingen, Germany; German Centre for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Stephanie Booth
- Prion Disease Program, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katie Glisic
- Departments of Pathology and Neurology, Case Western Reserve University, Cleveland, OH, USA; National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA
| | - Janis Blevins
- Departments of Pathology and Neurology, Case Western Reserve University, Cleveland, OH, USA; National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA
| | - Pierluigi Gambetti
- Departments of Pathology and Neurology, Case Western Reserve University, Cleveland, OH, USA; National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jiri Safar
- Departments of Pathology and Neurology, Case Western Reserve University, Cleveland, OH, USA; National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA
| | - Brian Appleby
- Departments of Pathology and Neurology, Case Western Reserve University, Cleveland, OH, USA; National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA
| | - John Collinge
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK; National Prion Clinic, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Simon Mead
- Medical Research Council Prion Unit, University College London Institute of Prion Diseases, London, UK; National Prion Clinic, University College London Hospitals National Health Service Foundation Trust, London, UK.
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D’Arcy CE, Bitnun A, Coulthart MB, D’Amour R, Friedman J, Knox JD, Rapoport A, Carter S, Widjaja E, Hazrati LN, Jansen GH. Sporadic Creutzfeldt-Jakob Disease in a Young Girl With Unusually Long Survival. J Neuropathol Exp Neurol 2019; 78:373-378. [DOI: 10.1093/jnen/nlz013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Colleen E D’Arcy
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, Ottawa, Canada
| | - Rolande D’Amour
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, Ottawa, Canada
| | - Jeremy Friedman
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - J David Knox
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Adam Rapoport
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Snead Carter
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lili-Naz Hazrati
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
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10
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Zakhari N, Taccone MS, Torres CH, Chakraborty S, Sinclair J, Woulfe J, Jansen GH, Cron GO, Thornhill RE, McInnes MDF, Nguyen TB. Prospective comparative diagnostic accuracy evaluation of dynamic contrast-enhanced (DCE) vs. dynamic susceptibility contrast (DSC) MR perfusion in differentiating tumor recurrence from radiation necrosis in treated high-grade gliomas. J Magn Reson Imaging 2019; 50:573-582. [PMID: 30614146 DOI: 10.1002/jmri.26621] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 09/12/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The appearance of a new enhancing lesion after surgery and chemoradiation for high-grade glioma (HGG) presents a common diagnostic dilemma. Histopathological analysis remains the reference standard in this situation. PURPOSE To prospectively compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) vs. dynamic susceptibility contrast (DSC) in differentiating tumor recurrence (TR) from radiation necrosis (RN). STUDY TYPE Prospective diagnostic accuracy study. POPULATION In all, 98 consecutive treated HGG patients with new enhancing lesion. We excluded 32 patients due to inadequate follow-up or technical limitation. FIELD STRENGTH/SEQUENCE 3 T DCE and DSC MR. ASSESSMENT Histogram and hot-spot analysis of cerebral blood volume (CBV), corrected CBV, Ktrans , area under the curve (AUC), and plasma volume (Vp). The reference standard of TR and/or RN was determined by histopathology in 43 surgically resected lesions or by clinical/imaging follow-up in the rest. STATISTICAL TESTS Mann-Whitney U-tests, receiver operating characteristic (ROC) curve, and logistic regression analysis. RESULTS A total of 68 lesions were included. There were 37 TR, 28 RN, and three lesions with equal proportions of TR and RN. TR had significantly higher CBV, corrected CBV, CBV ratio, corrected CBV ratio, AUC ratio, and Vp ratio (P < 0.05) than RN on hot-spot analysis. CBV had the highest diagnostic accuracy (AUROC 0.71). On histogram analysis, TR had higher CBV and corrected CBV maximal value compared with RN (P = 0.006, AUROC = 0.70). Only CBV on hot-spot analysis remained significant after correction for multiple comparison, with no significant improvement in diagnostic accuracy when using a combination of parameters (AUROC 0.71 vs. 0.76, P = 0.24). DATA CONCLUSION DSC-derived CBV is the most accurate perfusion parameter in differentiating TR and RN. DSC and DCE-derived parameters reflecting the blood volume in an enhancing lesion are more accurate than the DCE-derived parameter Ktrans . Clinical practice may be best guided by blood volume measurements, rather than permeability assessment for differentiation of TR from RN. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2019;50:573-582.
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Affiliation(s)
- Nader Zakhari
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael S Taccone
- University of Ottawa, Ottawa, Ontario, Canada.,Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Carlos H Torres
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - Santanu Chakraborty
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Sinclair
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Woulfe
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gerard H Jansen
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
| | - Greg O Cron
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Matthew D F McInnes
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Thanh B Nguyen
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital, Ottawa, Ontario, Canada
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11
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Coakeley S, Ang LC, Jansen GH, Cho SS, Lang AE, Houle S, Kalia LV, Strafella AP. [ 18 F]AV-1451 binding and postmortem pathology of CBD. Mov Disord 2018; 33:1360-1361. [PMID: 30136331 DOI: 10.1002/mds.27356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sarah Coakeley
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Ontario, Canada
| | - Lee Cyn Ang
- Pathology and Laboratory Medicine, London Health Sciences Centre, St. Joseph's Health Care London, London, Ontario, Canada
| | - Gerard H Jansen
- Neuropathology Laboratory Services, Canadian Creutzfeld-Jakob Disease Neuropathology Laboratory, University of Ottawa, Ontario, Canada
| | - Sang Soo Cho
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Ontario, Canada
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorder Unit & Edmond J. Safra Program in Parkinson Disease, Division of Neurology, Dept. of Medicine, Toronto Western Hospital, UHN, University of Toronto, Ontario, Canada
| | - Sylvain Houle
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Lorraine V Kalia
- Morton and Gloria Shulman Movement Disorder Unit & Edmond J. Safra Program in Parkinson Disease, Division of Neurology, Dept. of Medicine, Toronto Western Hospital, UHN, University of Toronto, Ontario, Canada.,Division of Genetics & Development, Krembil Research Institute, UHN, University of Toronto, Ontario, Canada
| | - Antonio P Strafella
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorder Unit & Edmond J. Safra Program in Parkinson Disease, Division of Neurology, Dept. of Medicine, Toronto Western Hospital, UHN, University of Toronto, Ontario, Canada
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12
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Mercer RCC, Daude N, Dorosh L, Fu ZL, Mays CE, Gapeshina H, Wohlgemuth SL, Acevedo-Morantes CY, Yang J, Cashman NR, Coulthart MB, Pearson DM, Joseph JT, Wille H, Safar JG, Jansen GH, Stepanova M, Sykes BD, Westaway D. A novel Gerstmann-Sträussler-Scheinker disease mutation defines a precursor for amyloidogenic 8 kDa PrP fragments and reveals N-terminal structural changes shared by other GSS alleles. PLoS Pathog 2018; 14:e1006826. [PMID: 29338055 PMCID: PMC5786331 DOI: 10.1371/journal.ppat.1006826] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/06/2017] [Revised: 01/26/2018] [Accepted: 12/18/2017] [Indexed: 11/29/2022] Open
Abstract
To explore pathogenesis in a young Gerstmann-Sträussler-Scheinker Disease (GSS) patient, the corresponding mutation, an eight-residue duplication in the hydrophobic region (HR), was inserted into the wild type mouse PrP gene. Transgenic (Tg) mouse lines expressing this mutation (Tg.HRdup) developed spontaneous neurologic syndromes and brain extracts hastened disease in low-expressor Tg.HRdup mice, suggesting de novo formation of prions. While Tg.HRdup mice exhibited spongiform change, PrP aggregates and the anticipated GSS hallmark of a proteinase K (PK)-resistant 8 kDa fragment deriving from the center of PrP, the LGGLGGYV insertion also imparted alterations in PrP's unstructured N-terminus, resulting in a 16 kDa species following thermolysin exposure. This species comprises a plausible precursor to the 8 kDa PK-resistant fragment and its detection in adolescent Tg.HRdup mice suggests that an early start to accumulation could account for early disease of the index case. A 16 kDa thermolysin-resistant signature was also found in GSS patients with P102L, A117V, H187R and F198S alleles and has coordinates similar to GSS stop codon mutations. Our data suggest a novel shared pathway of GSS pathogenesis that is fundamentally distinct from that producing structural alterations in the C-terminus of PrP, as observed in other prion diseases such as Creutzfeldt-Jakob Disease and scrapie. Prion diseases can be sporadic, infectious or genetic. The central event of all prion diseases is the structural conversion of the cellular prion protein (PrPC) to its disease associated conformer, PrPSc. Gerstmann-Sträussler-Scheinker Disease (GSS) is a genetic prion disease presenting as a multi-systemic neurological syndrome. A novel mutation, an eight amino acid insertion, was discovered in a young GSS patient. We created transgenic mice expressing this mutation and found that they recapitulate key features of the disease; namely PrP deposition in the brain and a low molecular weight proteinase K (PK) resistant internal PrP fragment. While structural investigations did not reveal a gross alteration in the conformation of this mutant PrP, the insertion lying at the boundary of the globular domain causes alterations in the unstructured amino terminal portion of the protein such that it becomes resistant to digestion by the enzyme thermolysin. We demonstrate by kinetic analysis and sequential digestion that this novel thermolysin resistant species is a precursor to the pathognomonic PK resistant fragment. Analysis of samples from other GSS patients revealed this same signature, suggesting a common molecular pathway.
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Affiliation(s)
- Robert C. C. Mercer
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Nathalie Daude
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Lyudmyla Dorosh
- National Research Council of Canada, Edmonton, Alberta, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Ze-Lin Fu
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
- Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Charles E. Mays
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Hristina Gapeshina
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Serene L. Wohlgemuth
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jing Yang
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Neil R. Cashman
- Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael B. Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Dawn M. Pearson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey T. Joseph
- Hotchkiss Brain Institute and Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada
| | - Holger Wille
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
- Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jiri G. Safar
- Departments of Pathology and Neurology, School of Medicine Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Gerard H. Jansen
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
- Division of Anatomical Pathology, University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Stepanova
- National Research Council of Canada, Edmonton, Alberta, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Brian D. Sykes
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
- Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - David Westaway
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
- Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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13
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Zakhari N, Taccone MS, Torres C, Chakraborty S, Sinclair J, Woulfe J, Jansen GH, Nguyen TB. Diagnostic Accuracy of Centrally Restricted Diffusion in the Differentiation of Treatment-Related Necrosis from Tumor Recurrence in High-Grade Gliomas. AJNR Am J Neuroradiol 2017; 39:260-264. [PMID: 29217742 DOI: 10.3174/ajnr.a5485] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/17/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Centrally restricted diffusion has been demonstrated in recurrent high-grade gliomas treated with bevacizumab. Our purpose was to assess the accuracy of centrally restricted diffusion in the diagnosis of radiation necrosis in high-grade gliomas not treated with bevacizumab. MATERIALS AND METHODS In this prospective study, we enrolled patients with high-grade gliomas who developed a new ring-enhancing necrotic lesion and who underwent re-resection. The presence of a centrally restricted diffusion within the ring-enhancing lesion was assessed visually on diffusion trace images and by ADC measurements on 3T preoperative diffusion tensor examination. The percentage of tumor recurrence and radiation necrosis in each surgical specimen was defined histopathologically. The association between centrally restricted diffusion and radiation necrosis was assessed using the Fisher exact test. Differences in ADC and the ADC ratio between the groups were assessed via the Mann-Whitney U test, and receiver operating characteristic curve analysis was performed. RESULTS Seventeen patients had re-resected ring-enhancing lesions: 8 cases of radiation necrosis and 9 cases of tumor recurrence. There was significant association between centrally restricted diffusion by visual assessment and radiation necrosis (P = .015) with a sensitivity of 75% and a specificity of 88.9%, a positive predictive value 85.7%, and a negative predictive value of 80% for the diagnosis of radiation necrosis. There was a statistically significant difference in the ADC and ADC ratio between radiation necrosis and tumor recurrence (P = .027). CONCLUSIONS The presence of centrally restricted diffusion in a new ring-enhancing lesion might indicate radiation necrosis rather than tumor recurrence in high-grade gliomas previously treated with standard chemoradiation without bevacizumab.
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Affiliation(s)
- N Zakhari
- From the Department of Radiology (N.Z., C.T., S.C., T.B.N.), Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, Ottawa, Ontario, Canada
| | | | - C Torres
- From the Department of Radiology (N.Z., C.T., S.C., T.B.N.), Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, Ottawa, Ontario, Canada
| | - S Chakraborty
- From the Department of Radiology (N.Z., C.T., S.C., T.B.N.), Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, Ottawa, Ontario, Canada
| | | | - J Woulfe
- Department of Pathology and Laboratory Medicine (J.W., G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada
| | - G H Jansen
- Department of Pathology and Laboratory Medicine (J.W., G.H.J.), University of Ottawa, The Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada
| | - T B Nguyen
- From the Department of Radiology (N.Z., C.T., S.C., T.B.N.), Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, Ottawa, Ontario, Canada
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14
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McMillan HJ, Jansen GH, Koujok K, Milman N, Duffy CM, Watanabe Duffy K. Mononeuritis multiplex associated with minocycline in an adolescent. Muscle Nerve 2017; 56:E33-E35. [PMID: 28561927 DOI: 10.1002/mus.25718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Gerard H Jansen
- The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Khaldoun Koujok
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Nataliya Milman
- The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
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15
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Coulthart MB, Geschwind MD, Qureshi S, Phielipp N, Demarsh A, Abrams JY, Belay E, Gambetti P, Jansen GH, Lang AE, Schonberger LB. A case cluster of variant Creutzfeldt-Jakob disease linked to the Kingdom of Saudi Arabia. Brain 2016; 139:2609-2616. [PMID: 27671029 PMCID: PMC5082737 DOI: 10.1093/brain/aww206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/21/2016] [Revised: 06/15/2016] [Accepted: 06/23/2016] [Indexed: 11/12/2022] Open
Abstract
As of mid-2016, 231 cases of variant Creutzfeldt-Jakob disease-the human form of a prion disease of cattle, bovine spongiform encephalopathy-have been reported from 12 countries. With few exceptions, the affected individuals had histories of extended residence in the UK or other Western European countries during the period (1980-96) of maximum global risk for human exposure to bovine spongiform encephalopathy. However, the possibility remains that other geographic foci of human infection exist, identification of which may help to foreshadow the future of the epidemic. We report results of a quantitative analysis of country-specific relative risks of infection for three individuals diagnosed with variant Creutzfeldt-Jakob disease in the USA and Canada. All were born and raised in Saudi Arabia, but had histories of residence and travel in other countries. To calculate country-specific relative probabilities of infection, we aligned each patient's life history with published estimates of probability distributions of incubation period and age at infection parameters from a UK cohort of 171 variant Creutzfeldt-Jakob disease cases. The distributions were then partitioned into probability density fractions according to time intervals of the patient's residence and travel history, and the density fractions were combined by country. This calculation was performed for incubation period alone, age at infection alone, and jointly for incubation and age at infection. Country-specific fractions were normalized either to the total density between the individual's dates of birth and symptom onset ('lifetime'), or to that between 1980 and 1996, for a total of six combinations of parameter and interval. The country-specific relative probability of infection for Saudi Arabia clearly ranked highest under each of the six combinations of parameter × interval for Patients 1 and 2, with values ranging from 0.572 to 0.998, respectively, for Patient 2 (age at infection × lifetime) and Patient 1 (joint incubation and age at infection × 1980-96). For Patient 3, relative probabilities for Saudi Arabia were not as distinct from those for other countries using the lifetime interval: 0.394, 0.360 and 0.378, respectively, for incubation period, age at infection and jointly for incubation and age at infection. However, for this patient Saudi Arabia clearly ranked highest within the 1980-96 period: 0.859, 0.871 and 0.865, respectively, for incubation period, age at infection and jointly for incubation and age at infection. These findings support the hypothesis that human infection with bovine spongiform encephalopathy occurred in Saudi Arabia.
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Affiliation(s)
- Michael B Coulthart
- 1 Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Michael D Geschwind
- 2 Memory and Aging Center, Box 1207, University of California, San Francisco (UCSF), San Francisco, CA 94143-1207, USA
| | - Shireen Qureshi
- 3 Consultant Neurologist, Dhahran Health Center, Dhahran, Saudi Arabia
| | - Nicolas Phielipp
- 4 Department of Neurology, Parkinson's and Movement Disorders Program, University of California Irvine, Irvine, CA 92697, USA
| | - Alex Demarsh
- 5 Zoonoses Division, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Joseph Y Abrams
- 6 Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ermias Belay
- 6 Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Pierluigi Gambetti
- 7 Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Gerard H Jansen
- 8 Eastern Ontario Regional Laboratory Association, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Anthony E Lang
- 7 Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Lawrence B Schonberger
- 6 Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Bourque PR, Shafi S, Jansen GH, McCurdy A, Warman Chardon J. Amyloid Neuropathy Following Domino Liver Transplantation: Response to Diflunisal. JAMA Neurol 2016; 73:477-8. [PMID: 26831189 DOI: 10.1001/jamaneurol.2015.4715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sharmi Shafi
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Arleigh McCurdy
- Department of Hematology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jodi Warman Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada4Ottawa Hospital Research Institute, Ottawa, Ontario, Canada5Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Nguyen TB, Cron GO, Bezzina K, Perdrizet K, Torres CH, Chakraborty S, Woulfe J, Jansen GH, Thornhill RE, Zanette B, Cameron IG. Correlation of Tumor Immunohistochemistry with Dynamic Contrast-Enhanced and DSC-MRI Parameters in Patients with Gliomas. AJNR Am J Neuroradiol 2016; 37:2217-2223. [PMID: 27585700 DOI: 10.3174/ajnr.a4908] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tumor CBV is a prognostic and predictive marker for patients with gliomas. Tumor CBV can be measured noninvasively with different MR imaging techniques; however, it is not clear which of these techniques most closely reflects histologically-measured tumor CBV. Our aim was to investigate the correlations between dynamic contrast-enhanced and DSC-MR imaging parameters and immunohistochemistry in patients with gliomas. MATERIALS AND METHODS Forty-three patients with a new diagnosis of glioma underwent a preoperative MR imaging examination with dynamic contrast-enhanced and DSC sequences. Unnormalized and normalized cerebral blood volume was obtained from DSC MR imaging. Two sets of plasma volume and volume transfer constant maps were obtained from dynamic contrast-enhanced MR imaging. Plasma volume obtained from the phase-derived vascular input function and bookend T1 mapping (Vp_Φ) and volume transfer constant obtained from phase-derived vascular input function and bookend T1 mapping (Ktrans_Φ) were determined. Plasma volume obtained from magnitude-derived vascular input function (Vp_SI) and volume transfer constant obtained from magnitude-derived vascular input function (Ktrans_SI) were acquired, without T1 mapping. Using CD34 staining, we measured microvessel density and microvessel area within 3 representative areas of the resected tumor specimen. The Mann-Whitney U test was used to test for differences according to grade and degree of enhancement. The Spearman correlation was performed to determine the relationship between dynamic contrast-enhanced and DSC parameters and histopathologic measurements. RESULTS Microvessel area, microvessel density, dynamic contrast-enhanced, and DSC-MR imaging parameters varied according to the grade and degree of enhancement (P < .05). A strong correlation was found between microvessel area and Vp_Φ and between microvessel area and unnormalized blood volume (rs ≥ 0.61). A moderate correlation was found between microvessel area and normalized blood volume, microvessel area and Vp_SI, microvessel area and Ktrans_Φ, microvessel area and Ktrans_SI, microvessel density and Vp_Φ, microvessel density and unnormalized blood volume, and microvessel density and normalized blood volume (0.44 ≤ rs ≤ 0.57). A weaker correlation was found between microvessel density and Ktrans_Φ and between microvessel density and Ktrans_SI (rs ≤ 0.41). CONCLUSIONS With dynamic contrast-enhanced MR imaging, use of a phase-derived vascular input function and bookend T1 mapping improves the correlation between immunohistochemistry and plasma volume, but not between immunohistochemistry and the volume transfer constant. With DSC-MR imaging, normalization of tumor CBV could decrease the correlation with microvessel area.
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Affiliation(s)
- T B Nguyen
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - G O Cron
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - K Bezzina
- Psychiatry (K.B.), The Ottawa Hospital, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - C H Torres
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - S Chakraborty
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | | | | | - R E Thornhill
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - B Zanette
- Department of Medical Biophysics (B.Z.), University of Toronto, Toronto, Ontario, Canada
| | - I G Cameron
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.).,Medical Physics (I.G.C.)
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18
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Rutgers DR, van der Grond J, Jansen GH, Somford DM, Mali WP. Radiologic-pathologic correlation of the hyperdense middle cerebral artery sign: A case report. Acta Radiol 2016; 42:467-9. [PMID: 11552883 DOI: 10.1080/028418501127347188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To provide a histopathologic substrate of the hyperdense middle cerebral artery (MCA) sign in a patient with MCA infarction. The sign was found to be correlated with accumulation of erythrocytes, fibrin and cellular debris.
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Affiliation(s)
- D R Rutgers
- Department of Radiology, University Medical Center Utrecht, The Netherlands
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Affiliation(s)
- Michael B Coulthart
- Canadian Creuztfeldt-Jakob Disease Surveillance System (Coulthart), Public Health Agency of Canada, Ottawa, Ont.; Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
| | - Gerard H Jansen
- Canadian Creuztfeldt-Jakob Disease Surveillance System (Coulthart), Public Health Agency of Canada, Ottawa, Ont.; Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
| | - Neil R Cashman
- Canadian Creuztfeldt-Jakob Disease Surveillance System (Coulthart), Public Health Agency of Canada, Ottawa, Ont.; Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
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20
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Nguyen TB, Cron GO, Perdrizet K, Bezzina K, Torres CH, Chakraborty S, Woulfe J, Jansen GH, Sinclair J, Thornhill RE, Foottit C, Zanette B, Cameron IG. Comparison of the Diagnostic Accuracy of DSC- and Dynamic Contrast-Enhanced MRI in the Preoperative Grading of Astrocytomas. AJNR Am J Neuroradiol 2015; 36:2017-22. [PMID: 26228886 DOI: 10.3174/ajnr.a4398] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/24/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dynamic contrast-enhanced MR imaging parameters can be biased by poor measurement of the vascular input function. We have compared the diagnostic accuracy of dynamic contrast-enhanced MR imaging by using a phase-derived vascular input function and "bookend" T1 measurements with DSC MR imaging for preoperative grading of astrocytomas. MATERIALS AND METHODS This prospective study included 48 patients with a new pathologic diagnosis of an astrocytoma. Preoperative MR imaging was performed at 3T, which included 2 injections of 5-mL gadobutrol for dynamic contrast-enhanced and DSC MR imaging. During dynamic contrast-enhanced MR imaging, both magnitude and phase images were acquired to estimate plasma volume obtained from phase-derived vascular input function (Vp_Φ) and volume transfer constant obtained from phase-derived vascular input function (K(trans)_Φ) as well as plasma volume obtained from magnitude-derived vascular input function (Vp_SI) and volume transfer constant obtained from magnitude-derived vascular input function (K(trans)_SI). From DSC MR imaging, corrected relative CBV was computed. Four ROIs were placed over the solid part of the tumor, and the highest value among the ROIs was recorded. A Mann-Whitney U test was used to test for difference between grades. Diagnostic accuracy was assessed by using receiver operating characteristic analysis. RESULTS Vp_ Φ and K(trans)_Φ values were lower for grade II compared with grade III astrocytomas (P < .05). Vp_SI and K(trans)_SI were not significantly different between grade II and grade III astrocytomas (P = .08-0.15). Relative CBV and dynamic contrast-enhanced MR imaging parameters except for K(trans)_SI were lower for grade III compared with grade IV (P ≤ .05). In differentiating low- and high-grade astrocytomas, we found no statistically significant difference in diagnostic accuracy between relative CBV and dynamic contrast-enhanced MR imaging parameters. CONCLUSIONS In the preoperative grading of astrocytomas, the diagnostic accuracy of dynamic contrast-enhanced MR imaging parameters is similar to that of relative CBV.
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Affiliation(s)
- T B Nguyen
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - G O Cron
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | | | - K Bezzina
- Faculty of Medicine (K.B.), Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - C H Torres
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - S Chakraborty
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | | | | | - J Sinclair
- Surgery, Division of Neurosurgery (J.S.)
| | - R E Thornhill
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | | | - B Zanette
- Department of Medical Biophysics (B.Z.), University of Toronto, Toronto, Ontario, Canada
| | - I G Cameron
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.) Medical Physics (C.F., I.G.C.)
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21
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Coulthart MB, Jansen GH, Connolly T, D’Amour R, Kruse J, Lynch J, Sabourin S, Wang Z, Giulivi A, Ricketts MN, Cashman NR. Creutzfeldt-Jakob disease mortality in Canada, 1998 to 2013. Can Commun Dis Rep 2015; 41:182-191. [PMID: 29769950 PMCID: PMC5864311 DOI: 10.14745/ccdr.v41i08a01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Human prion diseases, known collectively as Creutzfeldt-Jakob disease (CJD), are fatal, infectious neurodegenerative disorders that occur in all human populations. OBJECTIVE To summarize national surveillance data for CJD in Canada between January 1, 1998, and December 31, 2013. METHODS Detailed investigations were conducted of individual suspected CJD cases, with collaboration between Canadian health professionals and investigators affiliated with a central CJD surveillance registry operated by the Public Health Agency of Canada. Data were collected on the clinical profile, family history, and results of paraclinical and laboratory investigations, including post-mortem neuropathological examination. RESULTS A total of 662 deaths from definite and probable CJD were identified in Canadian residents during the study period, comprising 613 cases of sporadic CJD (92.6%), 43 cases of genetic prion disease (6.5%), 4 cases of iatrogenic CJD (0.6%), and 2 cases of variant CJD disease (0.3%). The overall crude mortality rate for sporadic CJD was 1.18 per million per year [95% confidence interval (CI): 1.08,1.27]. Age-specific rates ranged from 0.05 [95% CI: 0.03,0.08] in persons under 50 years of age to 7.11 [95% CI: 6.20,8.11] in those aged 70 to 79. A significant net upward trend in age-adjusted rates was observed over the study period. Standardized mortality ratios, calculated for 10 individual Canadian provinces with reference to national average mortality rates, did not differ significantly from 1.0. CONCLUSION Creutzfeldt-Jakob disease remains rare in Canada, although mortality rates vary by two orders of magnitude between older and younger age groups. The upward trend in age-standardized sporadic CJD mortality rate over the study period can be better accounted for by gradually improving case ascertainment than by a real increase in incidence.
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Affiliation(s)
- MB Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - GH Jansen
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
- The Ottawa Hospital, University of Ottawa and Eastern Ontario Regional Laboratory Association, Ottawa, ON
| | - T Connolly
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - R D’Amour
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - J Kruse
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - J Lynch
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - S Sabourin
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Z Wang
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
- Deceased November 2014
| | - A Giulivi
- The Ottawa Hospital, University of Ottawa and Eastern Ontario Regional Laboratory Association, Ottawa, ON
| | | | - NR Cashman
- Department of Medicine (Neurology), Brain Research Centre, University of British Columbia, Vancouver, BC
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Wasserman JK, Nicholas G, Yaworski R, Wasserman AM, Woulfe JM, Jansen GH, Chakraborty S, Nguyen TB. Radiological and pathological features associated with IDH1-R132H mutation status and early mortality in newly diagnosed anaplastic astrocytic tumours. PLoS One 2015; 10:e0123890. [PMID: 25849605 PMCID: PMC4388816 DOI: 10.1371/journal.pone.0123890] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/26/2015] [Indexed: 01/14/2023] Open
Abstract
Background Glioblastoma can occur either de novo or by the transformation of a low grade tumour; the majority of which harbor a mutation in isocitrate dehydrogenase (IDH1). Anaplastic tumours are high-grade gliomas that may represent the final step in the evolution of a secondary glioblastoma or the initial presentation of an early primary glioblastoma. We sought to determine whether pathological and/or radiological variables exist that can reliably distinguish IDH1-R132H-positive from IDH1-R132H-negative tumours and to identify variables associated with early mortality. Methods Patients diagnosed with anaplastic astrocytic tumours were included. Magnetic resonance imaging was performed and immunohistochemistry was used to identify tumours with the IDH1-R132H mutation. Survival was assessed 12 months after diagnosis. Variables associated with IDH1-R132H status were identified by univariate and ROC analysis. Results 37 gliomas were studied; 18 were positive for the IDH1-R132H mutation. No tumours demonstrated a combined loss of chromosomes 1p/19q. Patients with IDH1-R132H-positive tumours were less likely to die within 12 months of diagnosis (17% vs. 47%; p=0.046), more likely to have tumours located in the frontal lobe (55% vs. 16%; p=0.015), and have a higher minimum apparent diffusion coefficient (1.115 x 10-3 mm2/sec vs. 0.838 x 10-3 mm2/sec; p=0.016), however, these variables demonstrated only moderate strength for predicting the IDH1-R132H mutation status (AUC=0.735 and 0.711, respectively). The Ki-67 index was significantly lower in IDH1-R132H-positive tumours (0.13 vs. 0.21; p=0.034). An increased risk of death was associated with contrast-enhancement ≥ 5 cm3 in patients with IDH1-R132H-positive tumours while edema ≥ 1 cm beyond the tumour margin and < 5 mitoses/mm2 were associated with an increased risk of death in patients with IDH1-R132H-negative tumours. Conclusions IDH1-R132H-positive and -negative anaplastic tumours demonstrate unique features. Factors associated with early mortality are also dependent on IDH1-R132H status and can be used to identify patients at high risk for death.
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Affiliation(s)
- Jason K. Wasserman
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Garth Nicholas
- The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rebecca Yaworski
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | | | - John M. Woulfe
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gerard H. Jansen
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Santanu Chakraborty
- Division of Neuro-imaging, Department of Medical Imaging, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Thanh B. Nguyen
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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Wasserman JK, Tsai EC, Glikstein R, Mai KT, Jansen GH. Metastatic renal cell carcinoma mimicking a schwannoma in a dorsal root ganglion: case report. J Neurosurg Spine 2015; 22:314-7. [DOI: 10.3171/2014.9.spine131075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peripheral nerve tumors are soft-tissue tumors that can occur in any nerve throughout the body. The majority of peripheral nerve tumors arise from elements of the nerve sheath with the two most common being neurofibromas and schwannomas. More than 90% of all peripheral nerve tumors are benign. When there is peripheral nerve involvement in metastatic carcinoma, it is often via contiguous spread from the primary mass; hematogenous seeding to a peripheral nerve is seldom seen. In this report the authors describe the even rarer case of metastatic renal cell carcinoma mimicking a schwannoma in a dorsal root ganglion. Cases from the literature show the rarity of this finding and its late clinical appearance. Given that survival in patients with metastatic carcinoma continues to increase, dorsal root ganglion metastasis may become more common over time.
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Affiliation(s)
- Jason K. Wasserman
- 1Division of Anatomical Pathology, Pathology and Laboratory Medicine, University of Ottawa; and
| | | | - Rafael Glikstein
- 3Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kien T. Mai
- 1Division of Anatomical Pathology, Pathology and Laboratory Medicine, University of Ottawa; and
| | - Gerard H. Jansen
- 1Division of Anatomical Pathology, Pathology and Laboratory Medicine, University of Ottawa; and
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24
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Nguyen TB, Cron GO, Mercier JF, Foottit C, Torres CH, Chakraborty S, Woulfe J, Jansen GH, Caudrelier JM, Sinclair J, Hogan MJ, Thornhill RE, Cameron IG. Preoperative prognostic value of dynamic contrast-enhanced MRI-derived contrast transfer coefficient and plasma volume in patients with cerebral gliomas. AJNR Am J Neuroradiol 2015; 36:63-9. [PMID: 24948500 DOI: 10.3174/ajnr.a4006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of dynamic contrast-enhanced MR imaging-derived plasma volume obtained in tumor and the contrast transfer coefficient has not been well-established in patients with gliomas. We determined whether plasma volume and contrast transfer coefficient in tumor correlated with survival in patients with gliomas in addition to other factors such as age, type of surgery, preoperative Karnofsky score, contrast enhancement, and histopathologic grade. MATERIALS AND METHODS This prospective study included 46 patients with a new pathologically confirmed diagnosis of glioma. The contrast transfer coefficient and plasma volume obtained in tumor maps were calculated directly from the signal-intensity curve without T1 measurements, and values were obtained from multiple small ROIs placed within tumors. Survival curve analysis was performed by dichotomizing patients into groups of high and low contrast transfer coefficient and plasma volume. Univariate analysis was performed by using dynamic contrast-enhanced parameters and clinical factors. Factors that were significant on univariate analysis were entered into multivariate analysis. RESULTS For all patients with gliomas, survival was worse for groups of patients with high contrast transfer coefficient and plasma volume obtained in tumor (P < .05). In subgroups of high- and low-grade gliomas, survival was worse for groups of patients with high contrast transfer coefficient and plasma volume obtained in tumor (P < .05). Univariate analysis showed that factors associated with lower survival were age older than 50 years, low Karnofsky score, biopsy-only versus resection, marked contrast enhancement versus no/mild enhancement, high contrast transfer coefficient, and high plasma volume obtained in tumor (P < .05). In multivariate analysis, a low Karnofsky score, biopsy versus resection in combination with marked contrast enhancement, and a high contrast transfer coefficient were associated with lower survival rates (P < .05). CONCLUSIONS In patients with glioma, those with a high contrast transfer coefficient have lower survival than those with low parameters.
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Affiliation(s)
- T B Nguyen
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - G O Cron
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - J F Mercier
- Department of Radiology (J.F.M.), Hôpital de Hull, Gatineau, Québec, Canada
| | | | - C H Torres
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - S Chakraborty
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | | | | | - J M Caudrelier
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - J Sinclair
- Surgery, Division of Neurosurgery (J.S.)
| | - M J Hogan
- Medicine, Division of Neurology (M.J.H.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - R E Thornhill
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - I G Cameron
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.) Medical Physics (C.F., I.G.C.)
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25
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Bernard C, Chandrakanth SA, Cornell IS, Dalton J, Evans A, Garcia BM, Godin C, Godlewski M, Jansen GH, Kabani A, Louahlia S, Manning L, Maung R, Moore L, Philley J, Slatnik J, Srigley J, Thibault A, Picard DD, Cracower H, Tetu B. Guidelines from the Canadian Association of Pathologists for establishing a telepathology service for anatomic pathology using whole-slide imaging. J Pathol Inform 2014; 5:15. [PMID: 24843826 PMCID: PMC4023030 DOI: 10.4103/2153-3539.129455] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 11/29/2022] Open
Abstract
The use of telepathology for clinical applications in Canada has steadily become more attractive over the last 10 years, driven largely by its potential to provide rapid pathology consulting services throughout the country regardless of the location of a particular institution. Based on this trend, the president of the Canadian Association of Pathologists asked a working group consisting of pathologists, technologists, and healthcare administrators from across Canada to oversee the development of guidelines to provide Canadian pathologists with basic information on how to implement and use this technology. The guidelines were systematically developed, based on available medical literature and the clinical experience of early adopters of telepathology in Canada. While there are many different modalities and applications of telepathology, this document focuses specifically on whole-slide imaging as applied to intraoperative pathology consultation (frozen section), primary diagnosis, expert or second opinions and quality assurance activities. Applications such as hematopathology, microbiology, tumour boards, education, research and technical and/or standard-related issues are not covered.
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Affiliation(s)
| | | | | | | | - James Dalton
- Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Andrew Evans
- University Health Network, Toronto, Ontario, Canada
| | | | - Chris Godin
- Formerly with Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Marek Godlewski
- Dalhousie University, Saint John Regional Hospital, Horizon Health Network, New-Brunswick, Canada
| | | | - Amin Kabani
- Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lisa Manning
- Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lisa Moore
- Laboratory Informatics, Vancouver Island Health Authority, British Columbia, Canada
| | - Joanne Philley
- Laboratory Diagnostics and Blood Services Branch, Ministry of Health, British-Columbia, Canada
| | - Jack Slatnik
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - John Srigley
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Alain Thibault
- Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
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Coulthart MB, Jansen GH, Cashman NR. Interpretation of cerebrospinal fluid protein tests in the diagnosis of sporadic Creutzfeldt-Jakob disease: an evidence-based approach. CMAJ 2014; 186:E333-9. [PMID: 24446456 DOI: 10.1503/cmaj.130720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System (Coulthart, Jansen), Public Health Agency of Canada, Ottawa, Ont.; the Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
| | - Gerard H Jansen
- Canadian Creutzfeldt-Jakob Disease Surveillance System (Coulthart, Jansen), Public Health Agency of Canada, Ottawa, Ont.; the Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
| | - Neil R Cashman
- Canadian Creutzfeldt-Jakob Disease Surveillance System (Coulthart, Jansen), Public Health Agency of Canada, Ottawa, Ont.; the Department of Pathology and Laboratory Medicine (Jansen), The Ottawa Hospital - Civic Campus, Ottawa, Ont.; Brain Research Centre (Cashman), University of British Columbia, Vancouver, BC
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Klug GMJA, Wand H, Simpson M, Boyd A, Law M, Masters CL, Matěj R, Howley R, Farrell M, Breithaupt M, Zerr I, van Duijn C, Ibrahim-Verbaas C, Mackenzie J, Will RG, Brandel JP, Alperovitch A, Budka H, Kovacs GG, Jansen GH, Coulthard M, Collins SJ. Intensity of human prion disease surveillance predicts observed disease incidence. J Neurol Neurosurg Psychiatry 2013; 84:1372-7. [PMID: 23965290 DOI: 10.1136/jnnp-2012-304820] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prospective national screening and surveillance programmes serve a range of public health functions. Objectively determining their adequacy and impact on disease may be problematic for rare disorders. We undertook to assess whether objective measures of disease surveillance intensity could be developed for the rare disorder sporadic Creutzfeldt-Jakob disease (CJD) and whether such measures correlate with disease incidence. METHOD From 10 countries with national human prion disease surveillance centres, the annual number of suspected prion disease cases notified to each national unit (n=17,610), referrals for cerebrospinal fluid (CSF) 14-3-3 protein diagnostic testing (n=28,780) and the number of suspect cases undergoing diagnostic neuropathological examination (n=4885) from 1993 to 2006 were collected. Age and survey year adjusted incidence rate ratios with 95% CIs were estimated using Poisson regression models to assess risk factors for sporadic, non-sporadic and all prion disease cases. RESULTS Age and survey year adjusted analysis showed all three surveillance intensity measures (suspected human prion disease notifications, 14-3-3 protein diagnostic test referrals and neuropathological examinations of suspect cases) significantly predicted the incidence of sporadic CJD, non-sporadic CJD and all prion disease. CONCLUSIONS Routine national surveillance methods adjusted as population rates allow objective determination of surveillance intensity, which correlates positively with reported incidence for human prion disease, especially sporadic CJD, largely independent of national context. The predictive relationship between surveillance intensity and disease incidence should facilitate more rapid delineation of aberrations in disease occurrence and assessment of the adequacy of disease monitoring by national registries.
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Affiliation(s)
- Genevieve M J A Klug
- Australian National Creuztfeldt-Jakob Disease Registry, Department of Pathology, The University of Melbourne, , Parkville, Australia
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Nguyen TB, Cron GO, Mercier JF, Foottit C, Torres CH, Chakraborty S, Woulfe J, Jansen GH, Caudrelier JM, Sinclair J, Hogan MJ, Thornhill RE, Cameron IG. Diagnostic accuracy of dynamic contrast-enhanced MR imaging using a phase-derived vascular input function in the preoperative grading of gliomas. AJNR Am J Neuroradiol 2012; 33:1539-45. [PMID: 22442046 DOI: 10.3174/ajnr.a3012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The accuracy of tumor plasma volume and K(trans) estimates obtained with DCE MR imaging may have inaccuracies introduced by a poor estimation of the VIF. In this study, we evaluated the diagnostic accuracy of a novel technique by using a phase-derived VIF and "bookend" T1 measurements in the preoperative grading of patients with suspected gliomas. MATERIALS AND METHODS This prospective study included 46 patients with a new pathologically confirmed diagnosis of glioma. Both magnitude and phase images were acquired during DCE MR imaging for estimates of K(trans)_φ and V(p_)φ (calculated from a phase-derived VIF and bookend T1 measurements) as well as K(trans)_SI and V(p_)SI (calculated from a magnitude-derived VIF without T1 measurements). RESULTS Median K(trans)_φ values were 0.0041 minutes(-1) (95 CI, 0.00062-0.033), 0.031 minutes(-1) (0.011-0.150), and 0.088 minutes(-1) (0.069-0.110) for grade II, III, and IV gliomas, respectively (P ≤ .05 for each). Median V(p_)φ values were 0.64 mL/100 g (0.06-1.40), 0.98 mL/100 g (0.34-2.20), and 2.16 mL/100 g (1.8-3.1) with P = .15 between grade II and III gliomas and P = .015 between grade III and IV gliomas. In differentiating low-grade from high-grade gliomas, AUCs for K(trans)_φ, V(p_φ), K(trans)_SI, and V(p_)SI were 0.87 (0.73-1), 0.84 (0.69-0.98), 0.81 (0.59-1), and 0.84 (0.66-0.91). The differences between the AUCs were not statistically significant. CONCLUSIONS K(trans)_φ and V(p_)φ are parameters that can help in differentiating low-grade from high-grade gliomas.
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Affiliation(s)
- T B Nguyen
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
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Bratosiewicz-Wąsik J, Smoleń-Dzirba J, Rozemuller AJ, Jansen C, Spliet W, Jansen GH, Wąsik TJ, Liberski PP. Association between the PRNP 1368 polymorphism and the occurrence of sporadic Creutzfeldt-Jakob disease. Prion 2012; 6:413-6. [PMID: 22895088 DOI: 10.4161/pri.21773] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare transmissible neurodegenerative disorder. The etiology of sporadic form of CJD remains unsolved. In addition to the codon 129 polymorphism, polymorphisms in the non-coding region of PRNP are considered as important factors in sCJD development. To assess a possible association between PRNP 1368 SNP and sCJD, we compared the genotype, allele and haplotype frequencies of the 1368 SNP among 46 sCJD patients of Dutch origin with the respective frequencies in healthy controls. We detected a significant association between sCJD and 1368T/T genotype. A significant difference was also observed in 1368 alleles' distribution. In the haplotype analysis, haplotype 1368C-129G was associated with decreased risk of sCJD in Dutch population. Our findings support the hypothesis that genetic variations in the regulatory region of the PRNP gene may influence the pathogenesis of sCJD.
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Jansen C, Parchi P, Capellari S, Ibrahim-Verbaas CA, Schuur M, Strammiello R, Corrado P, Bishop MT, van Gool WA, Verbeek MM, Baas F, van Saane W, Spliet WGM, Jansen GH, van Duijn CM, Rozemuller AJM. Human prion diseases in the Netherlands (1998-2009): clinical, genetic and molecular aspects. PLoS One 2012; 7:e36333. [PMID: 22558438 PMCID: PMC3340342 DOI: 10.1371/journal.pone.0036333] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 04/01/2012] [Indexed: 12/30/2022] Open
Abstract
Prion diseases are rare and fatal neurodegenerative disorders that can be sporadic, inherited or acquired by infection. Based on a national surveillance program in the Netherlands we describe here the clinical, neuropathological, genetic and molecular characteristics of 162 patients with neuropathologically confirmed prion disease over a 12-year period (1998–2009). Since 1998, there has been a relatively stable mortality of Creutzfeldt-Jakob disease (CJD) in the Netherlands, ranging from 0.63 to 1.53 per million inhabitants per annum. Genetic analysis of the codon 129 methionine/valine (M/V) polymorphism in all patients with sporadic CJD (sCJD) showed a trend for under-representation of VV cases (7.0%), compared with sCJD cohorts in other Western countries, whereas the MV genotype was relatively over-represented (22,4%). Combined PrPSc and histopathological typing identified all sCJD subtypes known to date, except for the VV1 subtype. In particular, a “pure" phenotype was demonstrated in 60.1% of patients, whereas a mixed phenotype was detected in 39.9% of all sCJD cases. The relative excess of MV cases was largely accounted for by a relatively high incidence of the MV 2K subtype. Genetic analysis of the prion protein gene (PRNP) was performed in 161 patients and showed a mutation in 9 of them (5.6%), including one FFI and four GSS cases. Iatrogenic CJD was a rare phenomenon (3.1%), mainly associated with dura mater grafts. Three patients were diagnosed with new variant CJD (1.9%) and one with variably protease-sensitive prionopathy (VPSPr). Post-mortem examination revealed an alternative diagnosis in 156 patients, most commonly Alzheimer's disease (21.2%) or vascular causes of dementia (19.9%). The mortality rates of sCJD in the Netherlands are similar to those in other European countries, whereas iatrogenic and genetic cases are relatively rare. The unusual incidence of the VV2 sCJD subtype compared to that reported to date in other Western countries deserves further investigation.
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Affiliation(s)
- Casper Jansen
- Dutch Surveillance Centre for Prion Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Bratosiewicz-Wąsik J, Smoleń-Dzirba J, Watała C, Rozemuller AJ, Jansen C, Spliet W, Jansen GH, Wąsik TJ, Liberski PP. Association of the PRNP regulatory region polymorphisms with the occurrence of sporadic Creutzfeldt-Jakob disease. Folia Neuropathol 2012; 50:68-73. [PMID: 22505365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The prion protein (PrP) plays a central role in the pathogenesis of Creutzfeldt-Jakob disease and other transmissible spongiform encephalopathies (TSEs). Mutations in the coding region of the prion protein (PRNP) gene are linked to inherited forms of TSEs whereas aetiology of sporadic CJD (sCJD) remains obscure. It remains unclear whether the primary DNA sequence at non-coding region of PRNP gene influences development of the sCJD. Several recent reports showed non-coding region polymorphisms associated with sCJD but other could not support those findings. To test the hypothesis that there is a relationship between SNPs polymorphisms of PRNP non-coding regions and susceptibility to sCJD, we compared the primary structure of the regulatory region of the PRNP in 45 Dutch sCJD patients and in 135 healthy controls. We found a significant linkage of +310 C allele (OR 0.27, 95% CI 0.09-0.77; P = 0.009) and +310G/C genotype (OR 0.33, 95% CI 0.11-0.98; P = 0.048) with sCJD. No differences in frequencies of genotypes and allele of -101C/G and +258 G/A polymorphisms were found between sCJD patients and controls. We found two haplotypes protecting from sCJD (C-V in block 1 and G-C in block 2) and one susceptible haplotype for sCJD (G-G in block 2). Our findings support the hypothesis that polymorphism in the regulatory region of the PRNP gene may play an important role in the pathogenesis of sCJD.
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Coulthart MB, Jansen GH, Olsen E, Godal DL, Connolly T, Choi BCK, Wang Z, Cashman NR. Diagnostic accuracy of cerebrospinal fluid protein markers for sporadic Creutzfeldt-Jakob disease in Canada: a 6-year prospective study. BMC Neurol 2011; 11:133. [PMID: 22032272 PMCID: PMC3216246 DOI: 10.1186/1471-2377-11-133] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 10/27/2011] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To better characterize the value of cerebrospinal fluid (CSF) proteins as diagnostic markers in a clinical population of subacute encephalopathy patients with relatively low prevalence of sporadic Creutzfeldt-Jakob disease (sCJD), we studied the diagnostic accuracies of several such markers (14-3-3, tau and S100B) in 1000 prospectively and sequentially recruited Canadian patients with clinically suspected sCJD. METHODS The study included 127 patients with autopsy-confirmed sCJD (prevalence = 12.7%) and 873 with probable non-CJD diagnoses. Standard statistical measures of diagnostic accuracy were employed, including sensitivity (Se), specificity (Sp), predictive values (PVs), likelihood ratios (LRs), and Receiver Operating Characteristic (ROC) analysis. RESULTS At optimal cutoff thresholds (empirically selected for 14-3-3, assayed by immunoblot; 976 pg/mL for tau and 2.5 ng/mL for S100B, both assayed by ELISA), Se and Sp respectively were 0.88 (95% CI, 0.81-0.93) and 0.72 (0.69-0.75) for 14-3-3; 0.91 (0.84-0.95) and 0.88 (0.85-0.90) for tau; and 0.87 (0.80-0.92) and 0.87 (0.84-0.89) for S100B. The observed differences in Sp between 14-3-3 and either of the other 2 markers were statistically significant. Positive LRs were 3.1 (2.8-3.6) for 14-3-3; 7.4 (6.9-7.8) for tau; and 6.6 (6.1-7.1) for S100B. Negative LRs were 0.16 (0.10-0.26) for 14-3-3; 0.10 (0.06-0.20) for tau; and 0.15 (0.09-0.20) for S100B. Estimates of areas under ROC curves were 0.947 (0.931-0.961) for tau and 0.908 (0.888-0.926) for S100B. Use of interval LRs (iLRs) significantly enhanced accuracy for patient subsets [e.g., 41/120 (34.2%) of tested sCJD patients displayed tau levels > 10,000 pg/mL, with an iLR of 56.4 (22.8-140.0)], as did combining tau and S100B [e.g., for tau > 976 pg/mL and S100B > 2.5 ng/mL, positive LR = 18.0 (12.9-25.0) and negative LR = 0.02 (0.01-0.09)]. CONCLUSIONS CSF 14-3-3, tau and S100B proteins are useful diagnostic markers of sCJD even in a low-prevalence clinical population. CSF tau showed better overall diagnostic accuracy than 14-3-3 or S100B. Reporting of quantitative assay results and combining tau with S100B could enhance case definitions used in diagnosis and surveillance of sCJD.
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Affiliation(s)
- Michael B Coulthart
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg MB R3E 3R2, Canada
| | - Gerard H Jansen
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
- Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory, CCW 4240B, The Ottawa Hospital - General Campus, 501 Smyth Rd, Ottawa ON K1H 8L6, Canada
| | - Elina Olsen
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
| | - Deborah L Godal
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg MB R3E 3R2, Canada
| | - Tim Connolly
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
| | - Bernard CK Choi
- Chronic Disease Surveillance and Monitoring Division, CCDPC, HPCDPB, Public Health Agency of Canada, Room 622A3, 785 Carling Avenue, PL# 6806A, Ottawa ON K1A 0K9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, ON, Canada
- Shantou University Medical College, Shantou, China
| | - Zheng Wang
- Canadian Creutzfeldt-Jakob Disease Surveillance System, Public Health Agency of Canada, 200 Églantine Driveway AL 1910B, Ottawa ON K1A 0K9, Canada
| | - Neil R Cashman
- Brain Research Centre and PrioNet Canada, University of British Columbia, 2011 Wesbrook Mall, Vancouver BC V6T 2B5, Canada
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Deng HX, Chen W, Hong ST, Boycott KM, Gorrie GH, Siddique N, Yang Y, Fecto F, Shi Y, Zhai H, Jiang H, Hirano M, Rampersaud E, Jansen GH, Donkervoort S, Bigio EH, Brooks BR, Ajroud K, Sufit RL, Haines JL, Mugnaini E, Pericak-Vance MA, Siddique T. Mutations in UBQLN2 cause dominant X-linked juvenile and adult-onset ALS and ALS/dementia. Nature 2011; 477:211-5. [PMID: 21857683 PMCID: PMC3169705 DOI: 10.1038/nature10353] [Citation(s) in RCA: 869] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 07/05/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Han-Xiang Deng
- Division of Neuromuscular Medicine, Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Hinnell C, Coulthart MB, Jansen GH, Cashman NR, Lauzon J, Clark A, Costello F, White C, Midha R, Wiebe S, Furtado S. Gerstmann-Straussler-Scheinker disease due to a novel prion protein gene mutation. Neurology 2011; 76:485-7. [PMID: 21282596 DOI: 10.1212/wnl.0b013e31820a0ab2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Hinnell
- Area 3, University of Calgary Medical Centre, 3350 Hospital Dr., NW, Calgary, AB, T2N 4N1
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Wijnberg ID, Franssen H, Jansen GH, van den Ingh TSGAM, van der Harst MR, van der Kolk JH. The role of quantitative electromyography (EMG) in horses suspected of acute and chronic grass sickness. Equine Vet J 2010; 38:230-7. [PMID: 16706277 DOI: 10.2746/042516406776866309] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING THE STUDY Clinical evidence of motor neuron involvement in equine grass sickness (EGS) has not been reported. HYPOTHESIS Quantitative electromyography (EMG) analysis can elucidate subtle changes of the lower motor neuron system present in horses with EGS, performed ante mortem. METHODS Fourteen horses diagnosed clinically with acute, subacute or chronic EGS were examined and quantitative EMG performed. Previously published data on healthy horses and horses with proven lower motor neuron disease (LMND) were used as controls. In 8 horses post mortem examination was performed, and in 7 muscle biopsies of the lateral vastus muscle underwent histopathology and morphometry. RESULTS Clinical electrophysiological evidence of neuropathy was present in 12 horses. Analysis of data from the first 4 horses resulted in 95% confidence intervals (CI) of nontransformed data for motor unit action potential (MUP) duration in subclavian, triceps and lateral vastus muscle of 11.0-13.7, 14.8-20.3 and 12.2-17.2 msecs, respectively, and for MUP amplitude 291-453, 1026-1892 and 957-1736 microV, respectively. For number of phases the 95% CI was 3.6-4.4, 2.9-3.6 and 2.9-3.4, respectively, and for number of turns 5.0-6.5, 4.3-5.3 and 3.7-4.6, respectively. No changes in duration of insertional activity were measured. Pathological spontaneous activity was observed in all horses. EGS as evidenced by degenerative changes in the autonomic ganglia in combination with minor degenerative changes of the spinal lower motor neurons was observed on post mortem examination in all 8 available autopsies. In muscle biopsies of 4 out of 7 horses changes consistent with slight neurogenic atrophy were found. CONCLUSIONS AND POTENTIAL RELEVANCE EMG results demonstrated the presence of a neuropathy of skeletal muscles in all horses suspected to have EGS. The combination of clinical and electrophysiological evidence may aid differential diagnosis of neurogenic disease in cases of weight loss and colic.
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Affiliation(s)
- I D Wijnberg
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 12, 3584 CM, The Netherlands
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Zerr I, Kallenberg K, Summers DM, Romero C, Taratuto A, Heinemann U, Breithaupt M, Varges D, Meissner B, Ladogana A, Schuur M, Haik S, Collins SJ, Jansen GH, Stokin GB, Pimentel J, Hewer E, Collie D, Smith P, Roberts H, Brandel JP, van Duijn C, Pocchiari M, Begue C, Cras P, Will RG, Sanchez-Juan P. Updated clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease. Brain 2009; 132:2659-68. [PMID: 19773352 PMCID: PMC2759336 DOI: 10.1093/brain/awp191] [Citation(s) in RCA: 553] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Several molecular subtypes of sporadic Creutzfeldt–Jakob disease have been identified and electroencephalogram and cerebrospinal fluid biomarkers have been reported to support clinical diagnosis but with variable utility according to subtype. In recent years, a series of publications have demonstrated a potentially important role for magnetic resonance imaging in the pre-mortem diagnosis of sporadic Creutzfeldt–Jakob disease. Magnetic resonance imaging signal alterations correlate with distinct sporadic Creutzfeldt–Jakob disease molecular subtypes and thus might contribute to the earlier identification of the whole spectrum of sporadic Creutzfeldt–Jakob disease cases. This multi-centre international study aimed to provide a rationale for the amendment of the clinical diagnostic criteria for sporadic Creutzfeldt–Jakob disease. Patients with sporadic Creutzfeldt–Jakob disease and fluid attenuated inversion recovery or diffusion-weight imaging were recruited from 12 countries. Patients referred as ‘suspected sporadic Creutzfeldt–Jakob disease’ but with an alternative diagnosis after thorough follow up, were analysed as controls. All magnetic resonance imaging scans were assessed for signal changes according to a standard protocol encompassing seven cortical regions, basal ganglia, thalamus and cerebellum. Magnetic resonance imaging scans were evaluated in 436 sporadic Creutzfeldt–Jakob disease patients and 141 controls. The pattern of high signal intensity with the best sensitivity and specificity in the differential diagnosis of sporadic Creutzfeldt–Jakob disease was identified. The optimum diagnostic accuracy in the differential diagnosis of rapid progressive dementia was obtained when either at least two cortical regions (temporal, parietal or occipital) or both caudate nucleus and putamen displayed a high signal in fluid attenuated inversion recovery or diffusion-weight imaging magnetic resonance imaging. Based on our analyses, magnetic resonance imaging was positive in 83% of cases. In all definite cases, the amended criteria would cover the vast majority of suspected cases, being positive in 98%. Cerebral cortical signal increase and high signal in caudate nucleus and putamen on fluid attenuated inversion recovery or diffusion-weight imaging magnetic resonance imaging are useful in the diagnosis of sporadic Creutzfeldt–Jakob disease. We propose an amendment to the clinical diagnostic criteria for sporadic Creutzfeldt–Jakob disease to include findings from magnetic resonance imaging scans.
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Affiliation(s)
- I Zerr
- National TSE Reference Center, Department of Neurology, Georg-August University Goettingen, Robert-Koch-Strasse 40, Goettingen, Germany
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Abstract
UNLABELLED INTRODUCTION AND IMPORTANCE: Spinal ependymomas are slow-growing lesions that comprise the majority of primary spinal cord neoplasms. When surgery is indicated, the extent of tumor removal is most prognostic for long-term survival. Unusual histological subtypes can make intraoperative diagnosis spurious, possibly altering the surgical approach from gross total resection for ependymomas to debulking for high-grade astrocytomas. CLINICAL PRESENTATION We describe a 67-year-old woman with a thoracic spine intramedullary giant cell ependymoma. She presented with decreased lower extremity sensation leading to unsteadiness and an eventual fall. A physical examination revealed lower extremity hyperreflexia and ankle clonus, but no clear sensory level. Magnetic resonance imaging demonstrated an intramedullary T1 and T2 hypointense, homogenously enhancing lesion at T8 with extensive cephalad and caudal edema. INTERVENTION AND TECHNIQUE A laminectomy at T8 to T9 afforded gross total resection of the lesion that had a clear cleavage plane with normal spinal cord. Intraoperative pathology suggested a high-grade glioblastoma, but final section showed sporadic giant cells with marked pleomorphism, uniform immunofluorescence staining with both glial fibrillary acidic protein and cluster of differentiation 99, and high MIB-1 index. Electron microscopy showed "zipper-like" junctions. There were no detected genomic abnormalities consistent with glioblastoma. CONCLUSION We present this first reported case of thoracic spine giant cell ependymoma alongside scant literature yielding 1 case in the cervical spine and 2 cases at the filum terminale. Those cases had benign courses, whereas ours demonstrates a high degree of proliferation, making the malignant potential difficult to assess.
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Kallenberg K, Meissner B, Sanchez-Juan P, Summers DM, Mellina V, Collins SJ, Cras P, Jansen GH, Brandel JP, Galanaud D, Will RG, Zerr I. Zerebrale MRT-Veränderungen molekularer Subtypen der sCJK: eine Multizenterstudie. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Almutairi BM, Nguyen TB, Jansen GH, Asseri AH. Invasive Aspergillosis of the Brain: Radiologic-Pathologic Correlation. Radiographics 2009; 29:375-9. [DOI: 10.1148/rg.292075143] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jansen GH, Franke HR, Wolbers F, Brinkhuis M, Vermes I. Effects of fulvestrant alone or combined with different steroids in human breast cancer cells in vitro. Climacteric 2008; 11:315-21. [PMID: 18645697 DOI: 10.1080/13697130802232500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Fulvestrant is an estrogen receptor (ER) antagonist that binds, blocks and degrades the estrogen receptor and is currently used in adjuvant treatment in postmenopausal women with ER-positive breast cancer as an alternative for tamoxifen. As an antagonist, it may induce or aggravate climacteric symptoms. In order to alleviate these symptoms, one could consider hormone therapy. The objective of this study was to analyze the effect of fulvestrant alone or in combination with different steroids in human breast cancer cells in vitro, and to demonstrate whether these steroids will compromise the efficacy of fulvestrant in ER-positive breast cancer cells. METHODS We performed experiments in vitro with various hormone therapy preparations (estradiol (E2), dihydrodydrogesterone (DHD) and tibolone) at a concentration of 10(-6) mol/l alone or combined with fulvestrant in different breast cancer cell lines, ER-positive and ER-negative. After an incubation of 144 h, proliferation and apoptosis were measured. The first was measured by quantification of the expression of cyclin D1 mRNA, the latter by the Nicoletti fragmentation assay. RESULTS This in vitro study revealed clear differences in results when various hormone therapy preparations, alone or combined with fulvestrant, are added to ER-positive and ER-negative breast cancer cell lines. CONCLUSIONS Our study demonstrated that fulvestrant, an ER antagonist used in the treatment of ER-positive breast cancer, combined with E2 and DHD or in combination with tibolone, is not compromised in its efficacy in inducing apoptosis in ER-positive breast cancer cell lines in vitro.
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Affiliation(s)
- G H Jansen
- Department of Obstetrics, Twente Hospital Group, Enschede, The Netherlands
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41
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Jansen GH, Oosterhuis GJE. [Diagnostic image (336). A woman with a calcified pelvic mass]. Ned Tijdschr Geneeskd 2007; 151:1788. [PMID: 17822251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In a 34-year-old woman with uterine fibroids, one of the fibroids was calcified and was therefore visible on a conventional radiograph.
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Affiliation(s)
- G H Jansen
- Medisch Spectrum Twente, afd. Obstetrie en Gynaecologie, Enschede.
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Chen JT, Kuhlmann T, Jansen GH, Collins DL, Atkins HL, Freedman MS, O'Connor PW, Arnold DL. Voxel-based analysis of the evolution of magnetization transfer ratio to quantify remyelination and demyelination with histopathological validation in a multiple sclerosis lesion. Neuroimage 2007; 36:1152-8. [PMID: 17543541 DOI: 10.1016/j.neuroimage.2007.03.073] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 03/14/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022] Open
Abstract
We present a new method for advanced image processing to separately quantify significant decreases and increases in the magnetization transfer ratio (MTR) of individual voxels of MS lesions as markers of demyelination and remyelination. We used this method to analyze the evolution of MTR in individual voxels of an acute, Gadolinium (Gd)-enhancing lesion that was available for pathology. Over 6.5 months following enhancement, MTR was low and stable in the lesion center (81% of the initially Gd-enhancing lesion volume (GdLV)) and MTR increased at the lesion border with normal-appearing white matter (14%GdLV). The estimated error of these measurements was less than 1.8%GdLV based on scan/rescan analysis. Histopathological analysis confirmed a demyelinated lesion centre with diffuse presence of macrophages/microglia and marked loss of oligodendrocytes and a partially remyelinated lesion border with diffuse presence of macrophages/microglia and relatively more oligodendrocytes compared to the lesion centre. The correlation of imaging and histopathological findings support the validity and sensitivity of our method of voxel-based MTR image processing for monitoring demyelination and remyelination in vivo.
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Affiliation(s)
- J T Chen
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Canada H3A 2B4
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43
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Gorgels TGMF, van der Pluijm I, Brandt RMC, Garinis GA, van Steeg H, van den Aardweg G, Jansen GH, Ruijter JM, Bergen AAB, van Norren D, Hoeijmakers JHJ, van der Horst GTJ. Retinal degeneration and ionizing radiation hypersensitivity in a mouse model for Cockayne syndrome. Mol Cell Biol 2006; 27:1433-41. [PMID: 17145777 PMCID: PMC1800713 DOI: 10.1128/mcb.01037-06] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [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] [Indexed: 11/20/2022] Open
Abstract
Mutations in the CSB gene cause Cockayne syndrome (CS), a DNA repair disorder characterized by UV sensitivity and severe physical and neurological impairment. CSB functions in the transcription-coupled repair subpathway of nucleotide excision repair. This function may explain the UV sensitivity but hardly clarifies the other CS symptoms. Many of these, including retinopathy, are associated with premature aging. We studied eye pathology in a mouse model for CS. Csb(m/m) mice were hypersensitive to UV light and developed epithelial hyperplasia and squamous cell carcinomas in the cornea, which underscores the importance of transcription-coupled repair of photolesions in the mouse. In addition, we observed a spontaneous loss of retinal photoreceptor cells with age in the Csb(m/m) retina, resulting in a 60% decrease in the number of rods by the age of 18 months. Importantly, when Csb(m/m) mice (as well as Csa(-/-) mice) were exposed to 10 Gy of ionizing radiation, we noticed an increase in apoptotic photoreceptor cells, which was not observed in wild-type animals. This finding, together with our observation that the expression of established oxidative stress marker genes is upregulated in the Csb(m/m) retina, suggests that (endogenous) oxidative DNA lesions play a role in this CS-specific premature-aging feature and supports the oxidative DNA damage theory of aging.
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Affiliation(s)
- Theo G M F Gorgels
- Department of Genetics, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
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de Pedro-Cuesta J, Glatzel M, Almazán J, Stoeck K, Mellina V, Puopolo M, Pocchiari M, Zerr I, Kretszchmar HA, Brandel JP, Delasnerie-Lauprêtre N, Alpérovitch A, Van Duijn C, Sanchez-Juan P, Collins S, Lewis V, Jansen GH, Coulthart MB, Gelpi E, Budka H, Mitrova E. Human transmissible spongiform encephalopathies in eleven countries: diagnostic pattern across time, 1993-2002. BMC Public Health 2006; 6:278. [PMID: 17096829 PMCID: PMC1665456 DOI: 10.1186/1471-2458-6-278] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 11/10/2006] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The objective of this study was to describe the diagnostic panorama of human transmissible spongiform encephalopathies across 11 countries. METHODS From data collected for surveillance purposes, we describe annual proportions of deaths due to different human transmissible spongiform encephalopathies in eleven EUROCJD-consortium countries over the period 1993-2002, as well as variations in the use of diagnostic tests. Using logistic models we quantified international differences and changes across time. RESULTS In general, pre-mortem use of diagnostic investigations increased with time. International differences in pathological confirmation of sporadic Creutzfeldt-Jakob disease, stable over time, were evident. Compared to their counterparts, some countries displayed remarkable patterns, such as: 1) the high proportion, increasing with time, of variant Creutzfeldt-Jakob disease in the United Kingdom, (OR 607.99 95% CI 84.72-4363.40), and France (OR 18.35, 95% CI 2.20-152.83); 2) high, decreasing proportions of iatrogenic Creutzfeldt-Jakob disease in France, (OR 5.81 95% CI 4.09-8.24), and the United Kingdom, (OR 1.54 95% CI 1.03-2.30); and, 3) high and stable ratios of genetic forms in Slovakia (OR 21.82 95% CI 12.42-38.33) and Italy (OR 2.12 95% CI 1.69-2.68). CONCLUSION Considerable international variation in aetiological subtypes of human transmissible spongiform encephalopathies was evident over the observation period. With the exception of variant Creutzfeldt-Jakob disease and iatrogenic Creutzfeldt-Jakob disease in France and the United Kingdom, these differences persisted across time.
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Affiliation(s)
- Jesús de Pedro-Cuesta
- Instituto de Salud Carlos III, Centro Nacional de Epidemiologia, Departamento de Epidemiologia Aplicada, Calle Sinesio Delgado 6, 28029, Madrid, Spain.
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Collins SJ, Sanchez-Juan P, Masters CL, Klug GM, van Duijn C, Poleggi A, Pocchiari M, Almonti S, Cuadrado-Corrales N, de Pedro-Cuesta J, Budka H, Gelpi E, Glatzel M, Tolnay M, Hewer E, Zerr I, Heinemann U, Kretszchmar HA, Jansen GH, Olsen E, Mitrova E, Alpérovitch A, Brandel JP, Mackenzie J, Murray K, Will RG. Determinants of diagnostic investigation sensitivities across the clinical spectrum of sporadic Creutzfeldt-Jakob disease. Brain 2006; 129:2278-87. [PMID: 16816392 DOI: 10.1093/brain/awl159] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To validate the provisional findings of a number of smaller studies and explore additional determinants of characteristic diagnostic investigation results across the entire clinical spectrum of sporadic Creutzfeldt-Jakob disease (CJD), an international collaborative study was undertaken comprising 2451 pathologically confirmed (definite) patients. We assessed the influence of age at disease onset, illness duration, prion protein gene (PRNP) codon 129 polymorphism (either methionine or valine) and molecular sub-type on the diagnostic sensitivity of EEG, cerebral MRI and the CSF 14-3-3 immunoassay. For EEG and CSF 14-3-3 protein detection, we also assessed the influence of the time point in a patient's illness at which the investigation was performed on the likelihood of a typical or positive result. Analysis included a large subset of patients (n = 743) in whom molecular sub-typing had been performed using a combination of the PRNP codon 129 polymorphism and the form of protease resistant prion protein [type 1 or 2 according to Parchi et al. (Parchi P, Giese A, Capellari S, Brown P, Schulz-Schaeffer W, Windl O, Zerr I, Budka H, Kopp N, Piccardo P, Poser S, Rojiani A, Streichemberger N, Julien J, Vital C, Ghetti B, Gambetti P, Kretzschmar H. Classification of sporadic Creutzfeldt-Jakob disease based on molecular and phenotypic analysis of 300 subjects. Ann Neurol 1999; 46: 224-233.)] present in the brain. Findings for the whole group paralleled the subset with molecular sub-typing data available, showing that age at disease onset and disease duration were independent determinants of typical changes on EEG, while illness duration significantly influenced positive CSF 14-3-3 protein detection; changes on brain MRI were not influenced by either of these clinical parameters, but overall, imaging data were less complete and consequently conclusions are more tentative. In addition to age at disease onset and illness duration, molecular sub-type was re-affirmed as an important independent determinant of investigation results. In multivariate analyses that included molecular sub-type, time point of the investigation during a patient's illness was found not to influence the occurrence of a typical or positive EEG or CSF 14-3-3 protein result. A typical EEG was most often seen in MM1 patients and was significantly less likely in the MV1, MV2 and VV2 sub-types, whereas VV2 patients had an increased likelihood of a typical brain MRI. Overall, the CSF 14-3-3 immunoassay was the most frequently positive investigation (88.1%) but performed significantly less well in the very uncommon MV2 and MM2 sub-types. Our findings confirm a number of determinants of principal investigation results in sporadic CJD and underscore the importance of recognizing these pre-test limitations before accepting the diagnosis excluded or confirmed. Combinations of investigations offer the best chance of detection, especially for the less common molecular sub-types such as MV2 and MM2.
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Affiliation(s)
- S J Collins
- Australian National Creutzfeldt-Jakob disease Registry, Department of Pathology, The University of Melbourne, Parkville, Vic., Australia.
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Notenboom RGE, Hampson DR, Jansen GH, van Rijen PC, van Veelen CWM, van Nieuwenhuizen O, de Graan PNE. Up-regulation of hippocampal metabotropic glutamate receptor 5 in temporal lobe epilepsy patients. ACTA ACUST UNITED AC 2005; 129:96-107. [PMID: 16311265 DOI: 10.1093/brain/awh673] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Metabotropic glutamate receptors (mGluRs) are G protein-coupled receptors involved in the regulation of glutamatergic transmission. Recent studies indicate that excitatory group I mGluRs (mGluR1 and mGluR5) contribute to neurotoxicity and hyperexcitability during epileptogenesis. In this study, we examined the distribution of mGluR1alpha and mGluR5 immunoreactivity (IR) in hippocampal resection tissue from pharmaco-resistant temporal lobe epilepsy (TLE) patients. IR was detected with panels of receptor subtype specific antisera in hippocampi from TLE patients without (non-HS group) and with hippocampal sclerosis (HS group) and was compared with that of non-epileptic autopsy controls (control group). By immunohistochemistry and immunoblot analysis, we found a marked increase of mGluR5 IR in hippocampi from the non-HS compared with the control group. High mGluR5 IR was most prominent in the cell bodies and apical dendrites of hippocampal principal neurons and in the dentate gyrus molecular layer. In the HS group, this increase in neuronal mGluR5 IR was even more pronounced, but owing to neuronal loss the number of mGluR5-immunoreactive neurons was reduced compared with the non-HS group. IR for mGluR1alpha was found in the cell bodies of principal neurons in all hippocampal subfields and in stratum oriens and hilar interneurons. No difference in mGluR1alpha IR was observed between neurons in both TLE groups and the control group. However, owing to neuronal loss, the number of mGluR1alpha-positive neurons was markedly reduced in the HS group. The up-regulation of mGluR5 in surviving neurons is probably a consequence rather than a cause of the epileptic seizures and may contribute to the hyperexcitability of the hippocampus in pharmaco-resistant TLE patients. Thus, our data point to a prominent role of mGluR5 in human TLE and indicate mGluR5 signalling as potential target for new anti-epileptic drugs.
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Affiliation(s)
- Robbert G E Notenboom
- Rudolf Magnus Institute of Neuroscience, Department of Pharmacology and Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.
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Hoogland G, van Oort RJ, Proper EA, Jansen GH, van Rijen PC, van Veelen CWM, van Nieuwenhuizen O, Troost D, de Graan PNE. Alternative splicing of glutamate transporter EAAT2 RNA in neocortex and hippocampus of temporal lobe epilepsy patients. Epilepsy Res 2004; 59:75-82. [PMID: 15246112 DOI: 10.1016/j.eplepsyres.2004.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Revised: 02/09/2004] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
RATIONALE Altered expression of glutamate transporter EAAT2 protein has been reported in the hippocampus of patients with temporal lobe epilepsy (TLE). Two alternative EAAT2 mRNA splice forms, one resulting from a partial retention of intron 7 (I7R), the other from a deletion of exon 9 (E9S), were previously implicated in the loss of EAAT2 protein in patients with amyotrophic lateral sclerosis. METHODS By RT-PCR we studied the occurrence of I7R and E9S in neocortical and hippocampal specimens from TLE patients and non-neurological controls. RESULTS Both splice forms were found in all neocortical specimens from TLE patients (100% I7R, 100% E9S). This was significantly more than in controls (67% I7R, 60% E9S; P < 0.05). We also detected I7R and E9S in all seven motor cortex post-mortem samples from patients with amyotrophic lateral sclerosis. Within the TLE patient group, both splice variants appeared significantly more in non-sclerotic (100%), than in sclerotic hippocampi (69%, P < 0.05). CONCLUSION These data indicate that the epileptic brain, especially that of TLE patients without hippocampal sclerosis, is highly prone to alternative EAAT2 mRNA splicing. Our data confirm that the presence of alternative EAAT2 splice forms is not disease specific.
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Affiliation(s)
- G Hoogland
- Rudolf Magnus Institute for Neurosciences, University Medical Center Utrecht, P.O. Box 85500, Utrecht AB 3508, The Netherlands
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Vrancken AFJE, Notermans NC, Jansen GH, Wokke JHJ, Said G. Progressive idiopathic axonal neuropathy. J Neurol 2004; 251:269-78. [PMID: 15015005 DOI: 10.1007/s00415-004-0275-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2003] [Revised: 09/04/2003] [Accepted: 09/16/2003] [Indexed: 10/26/2022]
Abstract
Patients with a progressive disabling idiopathic axonal neuropathy could have a potentially treatable immune mediated neuropathy. To evaluate whether progressive idiopathic axonal neuropathy could be a pathologically difficult to prove vasculitic neuropathy pathologically difficult to prove or if it could be a separate clinical entity (i. e. with the axon as the primary immunological target), we performed a comparative clinical and histopathological study in 10 patients with progressive idiopathic axonal neuropathy, 10 patients with vasculitic neuropathy, and 12 patients with chronic idiopathic axonal polyneuropathy (CIAP). The clinical features and disease course in patients with progressive idiopathic axonal neuropathy and patients with vasculitic neuropathy were similar. Six patients with progressive idiopathic axonal neuropathy had been treated with prednisone and/or intravenous immunoglobulin. Disability decreased in all these six patients, but also in two of the four non-treated patients. Upon reviewing the sural nerve biopsy specimens, vasculitis was found in one patient with progressive idiopathic axonal neuropathy. Vasculitis-associated signs of ischemic injury or inflammation (most notably: large variation in fascicular axonal degeneration, perivascular inflammation, inflammation of the blood vessel wall without lumen obstruction) were found in four patients with progressive idiopathic axonal neuropathy, in all patients with vasculitic neuropathy, but were absent in patients with CIAP. The findings show that there is a small chance of finding sural nerve vasculitis upon scrutinising biopsy examination in progressive idiopathic axonal neuropathy. The presence of vasculitis-associated signs in progressive idiopathic axonal neuropathy suggests that some of these patients could have vasculitic neuropathy, even if vasculitic lesions cannot be demonstrated. However, if inflammatory changes cannot be demonstrated this does not preclude an immune-mediated origin.
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Affiliation(s)
- Alexander F J E Vrancken
- Service de Neurologie et Laboratoire Louis Ranvier, Centre Hospitalier Universitaire de Bicêtre, Université Paris Sud XI, Le Kremlin-Bicêtre, France.
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Brandsma D, Jansen GH, Spliet W, Van Nielen K, Taphoorn MJB. The diagnostic difficulties of meningeal and intracerebral plasma cell granulomas?presentation of three cases. J Neurol 2003; 250:1302-6. [PMID: 14648145 DOI: 10.1007/s00415-003-0200-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Revised: 05/07/2003] [Accepted: 06/24/2003] [Indexed: 11/29/2022]
Abstract
Meningeal and intracerebral plasma cell granulomas are uncommon inflammatory lesions of unknown etiology. In this paper the diagnostic difficulties in two patients with meningeal plasma cell granuloma and one patient with intracerebral plasma cell granuloma are described. The first patient had an intracranial extra-axial lesion, which was first diagnosed as a meningioma. One and a half years later she underwent a second resection for recurrent tumor growth and the diagnosis of a meningeal plasma cell granuloma was made. The second patient was treated for a central nervous system B-cell lymphoma but proved to have an intracerebral plasma cell granuloma in retrospect 11 years later. In the third patient tuberculous meningitis was considered to be the most likely diagnosis because infratentorial contrast-enhanced thickened meninges (pachymeningitis) were found together with a high protein level in the cerebrospinal fluid and a positive Mantoux test. However, pathological examination of an extra-axial, cervical lesion that was operated upon revealed a meningeal plasma cell granuloma. These cases show the importance of diagnosing a meningeal or intracerebral plasma cell granuloma correctly, since it has both therapeutical and prognostic implications.
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Affiliation(s)
- Dieta Brandsma
- Dept. of Neurology, G03.228, University Medical Center Utrecht, 85500, 3584 CX, Utrecht, The Netherlands.
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Jansen GH, Voll CL, Robinson CA, Gervais R, Sutcliffe T, Bergeron C, Coulthart MB, Giulivi A. First case of variant Creutzfeldt-Jakob disease in Canada. Can Commun Dis Rep 2003; 29:117-20. [PMID: 12861661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- G H Jansen
- Department of Neurology, St. Paul's Hospital, Saskatoon, SK
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