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Valentino RR, Scotton WJ, Roemer SF, Lashley T, Heckman MG, Shoai M, Martinez-Carrasco A, Tamvaka N, Walton RL, Baker MC, Macpherson HL, Real R, Soto-Beasley AI, Mok K, Revesz T, Christopher EA, DeTure M, Seeley WW, Lee EB, Frosch MP, Molina-Porcel L, Gefen T, Redding-Ochoa J, Ghetti B, Robinson AC, Kobylecki C, Rowe JB, Beach TG, Teich AF, Keith JL, Bodi I, Halliday GM, Gearing M, Arzberger T, Morris CM, White CL, Mechawar N, Boluda S, MacKenzie IR, McLean C, Cykowski MD, Wang SHJ, Graff C, Nagra RM, Kovacs GG, Giaccone G, Neumann M, Ang LC, Carvalho A, Morris HR, Rademakers R, Hardy JA, Dickson DW, Rohrer JD, Ross OA. MAPT H2 haplotype and risk of Pick's disease in the Pick's disease International Consortium: a genetic association study. Lancet Neurol 2024; 23:487-499. [PMID: 38631765 DOI: 10.1016/s1474-4422(24)00083-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/04/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Pick's disease is a rare and predominantly sporadic form of frontotemporal dementia that is classified as a primary tauopathy. Pick's disease is pathologically defined by the presence in the frontal and temporal lobes of Pick bodies, composed of hyperphosphorylated, three-repeat tau protein, encoded by the MAPT gene. MAPT has two distinct haplotypes, H1 and H2; the MAPT H1 haplotype is the major genetic risk factor for four-repeat tauopathies (eg, progressive supranuclear palsy and corticobasal degeneration), and the MAPT H2 haplotype is protective for these disorders. The primary aim of this study was to evaluate the association of MAPT H2 with Pick's disease risk, age at onset, and disease duration. METHODS In this genetic association study, we used data from the Pick's disease International Consortium, which we established to enable collection of data from individuals with pathologically confirmed Pick's disease worldwide. For this analysis, we collected brain samples from individuals with pathologically confirmed Pick's disease from 35 sites (brainbanks and hospitals) in North America, Europe, and Australia between Jan 1, 2020, and Jan 31, 2023. Neurologically healthy controls were recruited from the Mayo Clinic (FL, USA, or MN, USA between March 1, 1998, and Sept 1, 2019). For the primary analysis, individuals were directly genotyped for the MAPT H1-H2 haplotype-defining variant rs8070723. In a secondary analysis, we genotyped and constructed the six-variant-defined (rs1467967-rs242557-rs3785883-rs2471738-rs8070723-rs7521) MAPT H1 subhaplotypes. Associations of MAPT variants and MAPT haplotypes with Pick's disease risk, age at onset, and disease duration were examined using logistic and linear regression models; odds ratios (ORs) and β coefficients were estimated and correspond to each additional minor allele or each additional copy of the given haplotype. FINDINGS We obtained brain samples from 338 people with pathologically confirmed Pick's disease (205 [61%] male and 133 [39%] female; 338 [100%] White) and 1312 neurologically healthy controls (611 [47%] male and 701 [53%] female; 1312 [100%] White). The MAPT H2 haplotype was associated with increased risk of Pick's disease compared with the H1 haplotype (OR 1·35 [95% CI 1·12 to 1·64], p=0·0021). MAPT H2 was not associated with age at onset (β -0·54 [95% CI -1·94 to 0·87], p=0·45) or disease duration (β 0·05 [-0·06 to 0·16], p=0·35). Although not significant after correcting for multiple testing, associations were observed at p less than 0·05: with risk of Pick's disease for the H1f subhaplotype (OR 0·11 [0·01 to 0·99], p=0·049); with age at onset for H1b (β 2·66 [0·63 to 4·70], p=0·011), H1i (β -3·66 [-6·83 to -0·48], p=0·025), and H1u (β -5·25 [-10·42 to -0·07], p=0·048); and with disease duration for H1x (β -0·57 [-1·07 to -0·07], p=0·026). INTERPRETATION The Pick's disease International Consortium provides an opportunity to do large studies to enhance our understanding of the pathobiology of Pick's disease. This study shows that, in contrast to the decreased risk of four-repeat tauopathies, the MAPT H2 haplotype is associated with an increased risk of Pick's disease in people of European ancestry. This finding could inform development of isoform-related therapeutics for tauopathies. FUNDING Wellcome Trust, Rotha Abraham Trust, Brain Research UK, the Dolby Fund, Dementia Research Institute (Medical Research Council), US National Institutes of Health, and the Mayo Clinic Foundation.
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Affiliation(s)
| | - William J Scotton
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK.
| | - Shanu F Roemer
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK; Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology London, UK
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Maryam Shoai
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology London, UK
| | - Alejandro Martinez-Carrasco
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology London, UK
| | - Nicole Tamvaka
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Hannah L Macpherson
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology London, UK
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology London, UK
| | | | - Kin Mok
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology London, UK; UK Dementia Research Institute at UCL, London, UK; Division of Life Science, State Key Laboratory of Molecular Neuroscience, Molecular Neuroscience Center, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China; Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Hong Kong, China
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK; Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology London, UK
| | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - William W Seeley
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew P Frosch
- Neuropathology Service, C S Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Molina-Porcel
- Neurological Tissue Bank, Biobanc-Hospital Clínic-Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Alzheimer's Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain; Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew C Robinson
- Division of Neuroscience, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Salford Royal Hospital, Salford, UK; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher Kobylecki
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Division of Neuroscience, School of Biological Sciences, University of Manchester, Manchester, UK
| | - James B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, UK; Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Thomas G Beach
- Civin Laboratory of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Andrew F Teich
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Julia L Keith
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Istvan Bodi
- Clinical Neuropathology Department, King's College Hospital NHS Foundation Trust, London, UK; London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Glenda M Halliday
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, Camperdown, NSW, Australia
| | - Marla Gearing
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Goizueta Alzheimer's Disease Center Brain Bank, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Arzberger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christopher M Morris
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Charles L White
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Naguib Mechawar
- Douglas Hospital Research Centre, McGill University, Montreal, QC, Canada
| | - Susana Boluda
- Laboratoire de Neuropathologie Escourolle, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Alzheimer Prion Team, L'Institut du Cerveau, Paris, France
| | - Ian R MacKenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catriona McLean
- Department of Anatomical Pathology Alfred Heath, Melbourne, VIC, Australia; Victorian Brain Bank, The Florey Institute of Neuroscience of Mental Health, Parkville, VIC, Australia
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Weill Cornell Medicine, Houston, TX, USA
| | - Shih-Hsiu J Wang
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Caroline Graff
- Division for Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Unit for Hereditary Dementias, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rashed M Nagra
- Human Brain and Spinal Fluid Resource Center, Brentwood Biomedical Research Institute, Los Angeles, CA, USA
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Giorgio Giaccone
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Carlo Besta, Milan, Italy
| | - Manuela Neumann
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, Tübingen, Germany; Department of Neuropathology, University Hospital of Tübingen, Tübingen, Germany
| | - Lee-Cyn Ang
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada; Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology London, UK
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Vlaams Instituut voor Biotechnologie-Universiteit Antwerpen, Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
| | - John A Hardy
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology London, UK; Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology London, UK; UK Dementia Research Institute at UCL, London, UK; Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong, China
| | | | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA.
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Lochner RH, Arumanayagam AS, Powell SZ, Masdeu JC, Pascual B, Cykowski MD. Anterior insula is more vulnerable than posterior insula to TDP-43 pathology in common dementias and ALS. J Neuropathol Exp Neurol 2024; 83:307-317. [PMID: 38591790 PMCID: PMC11029466 DOI: 10.1093/jnen/nlae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Based on the anatomic proximity, connectivity, and functional similarities between the anterior insula and amygdala, we tested the hypothesis that the anterior insula is an important focus in the progression of TDP-43 pathology in LATE-NC. Blinded to clinical and neuropathologic data, phospho-TDP (pTDP) inclusion pathology was assessed in paired anterior and posterior insula samples in 105 autopsied patients with Alzheimer disease, Lewy body disease, LATE-NC and hippocampal sclerosis (HS), amyotrophic lateral sclerosis (ALS), and other conditions. Insular pTDP pathology was present in 34.3% of the study cohort, most commonly as neuronal inclusions and/or short neurites in lamina II, and less commonly as subpial processes resembling those described in the amygdala region. Among positive samples, pTDP pathology was limited to the anterior insula (41.7%), or occurred in both anterior and posterior insula (58.3%); inclusion density was greater in anterior insula across all diseases (p < .001). pTDP pathology occurred in 46.7% of ALS samples, typically without a widespread TDP-43 proteinopathy. In LATE-NC, it was seen in 30.4% of samples (mostly LATE-NC stages 2 and 3), often co-occurring with basal forebrain pathology and comorbid HS, suggesting this is an important step in the evolution of this pathology beyond the medial temporal lobe.
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Affiliation(s)
- Riley H Lochner
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
- Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Joseph C Masdeu
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
- Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Belen Pascual
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
- Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
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Nelson PT, Fardo DW, Wu X, Aung KZ, Cykowski MD, Katsumata Y. Limbic-predominant age-related TDP-43 encephalopathy (LATE-NC): Co-pathologies and genetic risk factors provide clues about pathogenesis. J Neuropathol Exp Neurol 2024:nlae032. [PMID: 38613823 DOI: 10.1093/jnen/nlae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is detectable at autopsy in more than one-third of people beyond age 85 years and is robustly associated with dementia independent of other pathologies. Although LATE-NC has a large impact on public health, there remain uncertainties about the underlying biologic mechanisms. Here, we review the literature from human studies that may shed light on pathogenetic mechanisms. It is increasingly clear that certain combinations of pathologic changes tend to coexist in aging brains. Although "pure" LATE-NC is not rare, LATE-NC often coexists in the same brains with Alzheimer disease neuropathologic change, brain arteriolosclerosis, hippocampal sclerosis of aging, and/or age-related tau astrogliopathy (ARTAG). The patterns of pathologic comorbidities provide circumstantial evidence of mechanistic interactions ("synergies") between the pathologies, and also suggest common upstream influences. As to primary mediators of vulnerability to neuropathologic changes, genetics may play key roles. Genes associated with LATE-NC include TMEM106B, GRN, APOE, SORL1, ABCC9, and others. Although the anatomic distribution of TDP-43 pathology defines the condition, important cofactors for LATE-NC may include Tau pathology, endolysosomal pathways, and blood-brain barrier dysfunction. A review of the human phenomenology offers insights into disease-driving mechanisms, and may provide clues for diagnostic and therapeutic targets.
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Affiliation(s)
- Peter T Nelson
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - David W Fardo
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Xian Wu
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Khine Zin Aung
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Yuriko Katsumata
- Department of Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
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Stuebe CM, Jenson AV, Lines TW, Holloman AM, Cykowski MD, Fung SH, Fisher RE, McClain KL, Baskin DS. Letter to the Editor Response. J Neurosurg Case Lessons 2024; 7:CASE23667. [PMID: 38408349 PMCID: PMC10901124 DOI: 10.3171/case23667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 02/28/2024]
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Cykowski MD, Arumanayagam AS, Powell SZ, Appel SH. Primary visual cortex pathology in ALS patients with C9ORF72 expansion. Brain Pathol 2023:e13229. [PMID: 38009843 DOI: 10.1111/bpa.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
Poly-GA and poly-GP immunofluorescence studies show conspicuous dipeptide repeat pathology in layers IV and II of primary visual cortex in C9ALS patients.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Stanley H Appel
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
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Stuebe CM, Jenson AV, Lines TW, Holloman AM, Cykowski MD, Fung SH, Fisher RE, McClain KL, Baskin DS. Recurrent petit mal seizures in Erdheim-Chester disease mimicking an intra-axial brain tumor: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23248. [PMID: 37870750 PMCID: PMC10584085 DOI: 10.3171/case23248] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/19/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized histologically by foamy histiocytes and Touton giant cells in a background of fibrosis. Bone pain with long bone osteosclerosis is highly specific for ECD. Central nervous system involvement is rare, although dural, hypothalamic, cerebellar, brainstem, and sellar region involvement has been described. OBSERVATIONS A 59-year-old man with a history of ureteral obstruction, medically managed petit mal seizures, and a left temporal lesion followed with serial magnetic resonance imaging (MRI) presented with worsening seizure control. Repeat MRI identified bilateral amygdala region lesions. Gradual growth of the left temporal lesion over 1 year with increasing seizure frequency prompted resection. A non-Langerhans cell histiocytosis with a BRAF V600E mutation was identified on pathology. Imaging findings demonstrated retroperitoneal fibrosis and long bone osteosclerosis with increased fluorodeoxyglucose uptake that, together with the neuropathologic findings, were diagnostic of ECD. LESSONS This case of biopsy-proven ECD is unique in that the singular symptom was seizures well controlled with medical management in the presence of similarly located bilateral anterior mesial temporal lobe lesions. Although ECD is rare intracranially, its variable imaging presentation, including the potential to mimic seizure-associated medial temporal lobe tumors, emphasizes the need for a wide differential diagnosis.
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Affiliation(s)
| | | | | | - Ashley M Holloman
- 3Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Matthew D Cykowski
- 3Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | | | | | - Kenneth L McClain
- 4Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
| | - David S Baskin
- Departments of1Neurosurgery
- 5Department of Neurosurgery, Weill Cornell Medical College, New York, New York
- 6Department of Neurosurgery, Kenneth R. Peak Brain and Pituitary Tumor Treatment Center, Houston, Texas
- 7Department of Graduate Studies, Texas A&M School of Medicine, Bryan, Texas; and
- 8Department of Neurosciences Research, The Houston Methodist Research Institute, Houston, Texas
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Schrank BR, Manzar GS, Wu SY, Gunther JR, Fang P, Jabbour EJ, Lim TY, Daver NG, Cykowski MD, Fuller GN, Cachia D, Kamiya-Matsuoka C, Woodman KH, DiNardo CD, Jain N, Short NJ, Sasaki K, Dabaja B, Kantarjian HM, Pinnix CC. Dorsal Column Myelopathy Following Intrathecal Chemotherapy for Leukemia. Int J Radiat Oncol Biol Phys 2023; 117:e486-e487. [PMID: 37785537 DOI: 10.1016/j.ijrobp.2023.06.1715] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Intrathecal (IT) methotrexate (Mtx) and/or cytarabine (AraC) improve CNS disease control in patients (pts) with hematologic malignancies. There are increasing number of case reports of irreversible, primarily dorsal column myelopathy in pts treated with IT chemotherapy. By describing the largest case series of myelopathy following IT chemotherapy, we aim to raise awareness about this devastating albeit rare complication. MATERIALS/METHODS We retrospectively reviewed 25 pts with leukemia who developed paraplegia following IT chemotherapy between 2/2006 and 9/2021. Clinical/treatment characteristics, response, and toxicity were extracted from the medical records. RESULTS Seventeen pts (68%) were male, 16 had B-cell ALL (64%), 4 had AML (16%), 2 had CML (8%), 2 had T-ALL (8%), and 1 had BPDCN (4%). The median age at diagnosis was 38 years (IQR 30-59). All pts required systemic salvage treatment after induction chemotherapy with a median number of 3 regimens received (IQR 2-5.5). In total, the median number of IT treatments was 19 per pt (IQR 14-27). Most pts (84%, n = 21) received single agent IT Mtx alternating with single agent AraC. Fifteen pts (60%) received triple IT therapy with a median of 3 treatments (IQR 0-8). Prior to the onset of myelopathy, 10 pts (40%) received allogeneic SCT and 9 pts (36%) were treated with radiation therapy. Median follow-up from diagnosis was 1.9 yrs (IQR 1.3-4.1). Myelopathy was progressive and irreversible in all pts (n = 25); 84% (n = 21) experienced sensory loss, and all pts had extremity weakness. Symptoms were ascending in 11 pts (44%) and descending in 4 pts (16%). Irreversible bowel/bladder incontinence developed in 12 pts (48%). CSF analysis at the time of symptom onset was negative for leukemia cells in most pts (n = 21, 84%) and showed malignant cells in 4 pts (16%). CSF studies showed elevated protein in 21 pts (84%). Myelin basic protein was elevated in all 13 assessed pts. On T2 weighted spinal MRI, all pts had enhancement of the dorsal columns, including 80% of pts with this dorsal column abnormality reported at the time of the study and 20% of pts (n = 5) with the dorsal enhancement noted retrospectively. Due to concern for occult disease, 20 pts (80%) received additional CNS-directed therapy after symptom onset. Twenty-two pts (88%) died at last follow-up. The time between neurological symptom onset and death was a median 3.5 months (IQR 2.6 and 5). Three pts (12%) are alive with paraplegia at a median of 4.4 years from symptom onset. CONCLUSION Dorsal column myelopathy is a rare but devastating condition that can occur after IT chemotherapy in heavily pre-treated leukemia pts. T2 weighted spinal MRI can be helpful in the evaluation of pts that present with unexplained weakness and sensory changes. We recommend delaying additional CNS-directed therapy until work-up to rule out alternative etiologies is complete. Future strategies are desperately needed to address this irreversible treatment complication.
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Affiliation(s)
- B R Schrank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G S Manzar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Y Wu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - P Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Y Lim
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N G Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist, Houston, TX
| | - G N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Cachia
- Department of Neurology, UMass Memorial Health, Worcester, MA
| | - C Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K H Woodman
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - H M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Valentino RR, Scotton WJ, Roemer SF, Lashley T, Heckman MG, Shoai M, Martinez-Carrasco A, Tamvaka N, Walton RL, Baker MC, Macpherson HL, Real R, Soto-Beasley AI, Mok K, Revesz T, Warner TT, Jaunmuktane Z, Boeve BF, Christopher EA, DeTure M, Duara R, Graff-Radford NR, Josephs KA, Knopman DS, Koga S, Murray ME, Lyons KE, Pahwa R, Parisi JE, Petersen RC, Whitwell J, Grinberg LT, Miller B, Schlereth A, Seeley WW, Spina S, Grossman M, Irwin DJ, Lee EB, Suh E, Trojanowski JQ, Van Deerlin VM, Wolk DA, Connors TR, Dooley PM, Frosch MP, Oakley DH, Aldecoa I, Balasa M, Gelpi E, Borrego-Écija S, de Eugenio Huélamo RM, Gascon-Bayarri J, Sánchez-Valle R, Sanz-Cartagena P, Piñol-Ripoll G, Molina-Porcel L, Bigio EH, Flanagan ME, Gefen T, Rogalski EJ, Weintraub S, Redding-Ochoa J, Chang K, Troncoso JC, Prokop S, Newell KL, Ghetti B, Jones M, Richardson A, Robinson AC, Roncaroli F, Snowden J, Allinson K, Green O, Rowe JB, Singh P, Beach TG, Serrano GE, Flowers XE, Goldman JE, Heaps AC, Leskinen SP, Teich AF, Black SE, Keith JL, Masellis M, Bodi I, King A, Sarraj SA, Troakes C, Halliday GM, Hodges JR, Kril JJ, Kwok JB, Piguet O, Gearing M, Arzberger T, Roeber S, Attems J, Morris CM, Thomas AJ, Evers BM, White CL, Mechawar N, Sieben AA, Cras PP, De Vil BB, De Deyn PPP, Duyckaerts C, Le Ber I, Seihean D, Turbant-Leclere S, MacKenzie IR, McLean C, Cykowski MD, Ervin JF, Wang SHJ, Graff C, Nennesmo I, Nagra RM, Riehl J, Kovacs GG, Giaccone G, Nacmias B, Neumann M, Ang LC, Finger EC, Blauwendraat C, Nalls MA, Singleton AB, Vitale D, Cunha C, Carvalho A, Wszolek ZK, Morris HR, Rademakers R, Hardy JA, Dickson DW, Rohrer JD, Ross OA. Creating the Pick's disease International Consortium: Association study of MAPT H2 haplotype with risk of Pick's disease. medRxiv 2023:2023.04.17.23288471. [PMID: 37163045 PMCID: PMC10168402 DOI: 10.1101/2023.04.17.23288471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Pick's disease (PiD) is a rare and predominantly sporadic form of frontotemporal dementia that is classified as a primary tauopathy. PiD is pathologically defined by argyrophilic inclusion Pick bodies and ballooned neurons in the frontal and temporal brain lobes. PiD is characterised by the presence of Pick bodies which are formed from aggregated, hyperphosphorylated, 3-repeat tau proteins, encoded by the MAPT gene. The MAPT H2 haplotype has consistently been associated with a decreased disease risk of the 4-repeat tauopathies of progressive supranuclear palsy and corticobasal degeneration, however its role in susceptibility to PiD is unclear. The primary aim of this study was to evaluate the association between MAPT H2 and risk of PiD. Methods We established the Pick's disease International Consortium (PIC) and collected 338 (60.7% male) pathologically confirmed PiD brains from 39 sites worldwide. 1,312 neurologically healthy clinical controls were recruited from Mayo Clinic Jacksonville, FL (N=881) or Rochester, MN (N=431). For the primary analysis, subjects were directly genotyped for MAPT H1-H2 haplotype-defining variant rs8070723. In secondary analysis, we genotyped and constructed the six-variant MAPT H1 subhaplotypes (rs1467967, rs242557, rs3785883, rs2471738, rs8070723, and rs7521). Findings Our primary analysis found that the MAPT H2 haplotype was associated with increased risk of PiD (OR: 1.35, 95% CI: 1.12-1.64 P=0.002). In secondary analysis involving H1 subhaplotypes, a protective association with PiD was observed for the H1f haplotype (0.0% vs. 1.2%, P=0.049), with a similar trend noted for H1b (OR: 0.76, 95% CI: 0.58-1.00, P=0.051). The 4-repeat tauopathy risk haplotype MAPT H1c was not associated with PiD susceptibility (OR: 0.93, 95% CI: 0.70-1.25, P=0.65). Interpretation The PIC represents the first opportunity to perform relatively large-scale studies to enhance our understanding of the pathobiology of PiD. This study demonstrates that in contrast to its protective role in 4R tauopathies, the MAPT H2 haplotype is associated with an increased risk of PiD. This finding is critical in directing isoform-related therapeutics for tauopathies.
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Affiliation(s)
| | - William J Scotton
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Shanu F Roemer
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Maryam Shoai
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Alejandro Martinez-Carrasco
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Nicole Tamvaka
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Hannah L Macpherson
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | | | - Kin Mok
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Division of Life Science, State Key Laboratory of Molecular Neuroscience, Molecular Neuroscience Center, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Hong Kong, China
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Michael DeTure
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center Miami Beach, FL
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Parkinson’s Disease & Movement Disorder Division, Kansas City, KS. 66160
| | - Rajesh Pahwa
- University of Kansas Medical Center, Parkinson’s Disease & Movement Disorder Division, Kansas City, KS. 66160
| | - Joseph E Parisi
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Lea T Grinberg
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Athena Schlereth
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - William W Seeley
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - EunRan Suh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theresa R Connors
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Patrick M Dooley
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Matthew P Frosch
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Derek H Oakley
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Iban Aldecoa
- Pathology, BDC, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Neurological Tissue Bank, Biobanc-Hospital Clínic-FRCB-IDIBAPS, Barcelona, Spain
| | - Mircea Balasa
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sergi Borrego-Écija
- University of Barcelona, Barcelona, Spain
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | | | - Jordi Gascon-Bayarri
- Servei de Neurologia, Hospital Universitari de Bellvitge. Institut d’Investigació Biomèdica de Bellvitge (Idibell). L’Hospitalet de Llobregat, Spain
| | - Raquel Sánchez-Valle
- University of Barcelona, Barcelona, Spain
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | | | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research, IRBLleida, Santa Maria University Hospital, Lleida, Spain
| | - Laura Molina-Porcel
- Neurological Tissue Bank, Biobanc-Hospital Clínic-FRCB-IDIBAPS, Barcelona, Spain
- Alzheimer’s Disease and other Cognitive Disorders Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
- Barcelona Clinical Research Foundation-August Pi i Sunyer Biomedical Research Institute (FRCB-IDIBAPS), Barcelona, Spain
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Margaret E Flanagan
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology & Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Koping Chang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Stefan Prokop
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kathy L Newell
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Matthew Jones
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK
- Division of Neuroscience, School of Biological Sciences, University of Manchester, UK
| | - Anna Richardson
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK
- Division of Neuroscience, School of Biological Sciences, University of Manchester, UK
| | - Andrew C Robinson
- Division of Neuroscience, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Federico Roncaroli
- Division of Neuroscience, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Julie Snowden
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK
- Division of Neuroscience, School of Biological Sciences, University of Manchester, UK
| | - Kieren Allinson
- Histopathology Box 235 Cambridge University Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ
| | - Oliver Green
- Histopathology Box 235 Cambridge University Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ
| | - James B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Poonam Singh
- Histopathology Box 235 Cambridge University Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ
| | - Thomas G Beach
- Civin Laboratory of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ 85351, USA
| | - Geidy E Serrano
- Civin Laboratory of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ 85351, USA
| | - Xena E Flowers
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - James E Goldman
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Allison C Heaps
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Sandra P Leskinen
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Andrew F Teich
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Sandra E Black
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre and University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute
| | - Julia L Keith
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Laboratory Medicine and Pathobiology, University of Toronto
| | - Mario Masellis
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre and University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute
| | - Istvan Bodi
- Clinical Neuropathology Department, King’s College Hospital NHS Foundation Trust, London, UK
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrew King
- Clinical Neuropathology Department, King’s College Hospital NHS Foundation Trust, London, UK
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Safa-Al Sarraj
- Clinical Neuropathology Department, King’s College Hospital NHS Foundation Trust, London, UK
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Glenda M Halliday
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences
| | - John R Hodges
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences
| | - Jillian J Kril
- University of Sydney Faculty of Medicine and Health School of Medical Sciences
| | - John B Kwok
- University of Sydney Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences
| | - Olivier Piguet
- University of Sydney Brain and Mind Centre and Faculty of Science School of Psychology
| | - Marla Gearing
- Dept. of Pathology and Laboratory Medicine, Dept. of Neurology, and Goizueta Alzheimer’s Disease Center Brain Bank; Emory University School of Medicine, Atlanta, GA USA
| | - Thomas Arzberger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Germany
| | - Johannes Attems
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Christopher M Morris
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Bret M. Evers
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Charles L White
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Anne A Sieben
- Laboratory of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- IBB-NeuroBiobank BB190113, Born Bunge Institute, Antwerp, Belgium
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
- Department of Neurology, Ghent University Hospital, Ghent University, Belgium
| | - Patrick P Cras
- Laboratory of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- IBB-NeuroBiobank BB190113, Born Bunge Institute, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital - UZA, Antwerp, Belgium
| | - Bart B De Vil
- Laboratory of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- IBB-NeuroBiobank BB190113, Born Bunge Institute, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital - UZA, Antwerp, Belgium
| | - Peter Paul P.P. De Deyn
- Laboratory of Neurochemistry and Behavior, Experimental Neurobiology Unit, University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - Charles Duyckaerts
- Laboratoire de Neuropathologie Escourolle, Hôpital de la Salpêtrière, AP-HP, & Alzheimer Prion Team, ICM, 47 Bd de l’Hôpital, 75651 CEDEX 13 Paris, France
| | - Isabelle Le Ber
- Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris Brain Institute (ICM), Hôpital Pitié-Salpêtrière, Paris, France
- Centre de référence des démences rares ou précoces, Hôpital Pitié-Salpêtrière, Paris, France
| | - Danielle Seihean
- Laboratoire de Neuropathologie Escourolle, Hôpital de la Salpêtrière, AP-HP, & ICM, 47 Bd de l’Hôpital, 75651 CEDEX 13 Paris, France
| | - Sabrina Turbant-Leclere
- Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris Brain Institute (ICM) Hôpital Pitié-Salpêtrière, Paris, France
| | - Ian R MacKenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC Canada V6T 2B5
| | - Catriona McLean
- Department of Anatomical Pathology Alfred Heath, Melbourne, Victoria, 3004, Australia
- Victorian Brain Bank, The Florey Institute of Neuroscience of Mental Health, Parkville, Victoria, 3052, Australia
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Weill Cornell Medicine, Houston, TX
| | - John F Ervin
- Department of Neurology, Duke University Medical Center, Durham, USA
| | - Shih-Hsiu J Wang
- Department of Neurology, Duke University Medical Center, Durham, USA
| | - Caroline Graff
- Division for Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Unit for Hereditary Dementias, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Inger Nennesmo
- Dept of laboratory Medicine Huddinge Karolinska Institutet, Stockholm Sweden
- Dept of Pathology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rashed M Nagra
- Human Brain and Spinal Fluid Resource Center, Brentwood Biomedical Research Institute, Los Angeles, CA, United States
| | | | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease (CRND) and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | | | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Manuela Neumann
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neuropathology, University Hospital of Tübingen, Tübingen, Germany
| | - Lee-Cyn Ang
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London. ON, Canada
| | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Dan Vitale
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- VIBUAntwerp Center for Molecular Neurology, University of Antwerp, Antwerp 2610, Belgium
| | - John A Hardy
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224, USA
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Nelson PT, Lee EB, Cykowski MD, Alafuzoff I, Arfanakis K, Attems J, Brayne C, Corrada MM, Dugger BN, Flanagan ME, Ghetti B, Grinberg LT, Grossman M, Grothe MJ, Halliday GM, Hasegawa M, Hokkanen SRK, Hunter S, Jellinger K, Kawas CH, Keene CD, Kouri N, Kovacs GG, Leverenz JB, Latimer CS, Mackenzie IR, Mao Q, McAleese KE, Merrick R, Montine TJ, Murray ME, Myllykangas L, Nag S, Neltner JH, Newell KL, Rissman RA, Saito Y, Sajjadi SA, Schwetye KE, Teich AF, Thal DR, Tomé SO, Troncoso JC, Wang SHJ, White CL, Wisniewski T, Yang HS, Schneider JA, Dickson DW, Neumann M. LATE-NC staging in routine neuropathologic diagnosis: an update. Acta Neuropathol 2023; 145:159-173. [PMID: 36512061 PMCID: PMC9849315 DOI: 10.1007/s00401-022-02524-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
An international consensus report in 2019 recommended a classification system for limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC). The suggested neuropathologic staging system and nomenclature have proven useful for autopsy practice and dementia research. However, some issues remain unresolved, such as cases with unusual features that do not fit with current diagnostic categories. The goal of this report is to update the neuropathologic criteria for the diagnosis and staging of LATE-NC, based primarily on published data. We provide practical suggestions about how to integrate available genetic information and comorbid pathologies [e.g., Alzheimer's disease neuropathologic changes (ADNC) and Lewy body disease]. We also describe recent research findings that have enabled more precise guidance on how to differentiate LATE-NC from other subtypes of TDP-43 pathology [e.g., frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS)], and how to render diagnoses in unusual situations in which TDP-43 pathology does not follow the staging scheme proposed in 2019. Specific recommendations are also made on when not to apply this diagnostic term based on current knowledge. Neuroanatomical regions of interest in LATE-NC are described in detail and the implications for TDP-43 immunohistochemical results are specified more precisely. We also highlight questions that remain unresolved and areas needing additional study. In summary, the current work lays out a number of recommendations to improve the precision of LATE-NC staging based on published reports and diagnostic experience.
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Affiliation(s)
- Peter T Nelson
- University of Kentucky, Rm 575 Todd Building, Lexington, KY, USA.
| | - Edward B Lee
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Konstantinos Arfanakis
- Rush University Medical Center, Chicago, IL, USA
- Illinois Institute of Technology, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Masato Hasegawa
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | | | | | | | | | | | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Canada
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Qinwen Mao
- University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | - Liisa Myllykangas
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sukriti Nag
- Rush University Medical Center, Chicago, IL, USA
| | - Janna H Neltner
- University of Kentucky, Rm 575 Todd Building, Lexington, KY, USA
| | | | | | - Yuko Saito
- Tokyo Metropolitan Geriatric Hospital & Institute of Gerontology, Tokyo, Japan
| | | | | | | | - Dietmar R Thal
- Laboratory for Neuropathology, Department of Imaging and Pathoogy, and Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Sandra O Tomé
- Laboratory for Neuropathology, Department of Imaging and Pathoogy, and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | | | - Charles L White
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Hyun-Sik Yang
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, BostonBoston, MAMA, USA
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10
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Di J, Nelson RS, Jicha GA, Moga DC, Barber JM, Cykowski MD, Fardo DW, Abner EL, Nelson PT. Urinary Incontinence in a Community-Based Autopsy Cohort Is Associated with Limbic Predominant Age-Related TDP-43 Encephalopathy Neuropathologic Changes. J Alzheimers Dis 2023; 94:333-346. [PMID: 37248909 PMCID: PMC10618953 DOI: 10.3233/jad-230425] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Dementia and urinary incontinence (UI) are etiologically complex clinical syndromes. Dementia and UI often occur in the same individuals, but underlying factors connecting them are incompletely understood. OBJECTIVE Query data from a community-based autopsy series to assess pathologies that underlie UI. METHODS Included research subjects came to autopsy from the University of Kentucky Alzheimer's Disease Research Center longitudinal cohort. A total of 368 research volunteers met inclusion criteria for this cross-sectional study. The average age at death was 85.3 years and the average number of annual clinic visits was 5.2 visits. Statistical models were run to evaluate which pathologies were associated with UI. Data included pathologies scored according to conventional stage-based systems, and these studies were complemented by quantitative digital neuropathology. RESULTS Dementia was diagnosed at the final clinical visit in 208 (56.7% of the sample) and UI was documented in 156 (42.7%). UI was associated with depression and dementia (both p < 0.001). More women than men had a history of UI (p < 0.04), and women with UI had had more biological children than those without UI (p < 0.005). Participants with limbic predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC) were more likely to have UI than those without LATE-NC (p < 0.001). The presence of LATE-NC (Stage > 1) was associated with UI with or without severe Alzheimer's disease neuropathologic changes and/or Lewy body pathology. CONCLUSION In this community-based autopsy cohort, multiple factors were associated with UI, but the neuropathologic change most robustly associated with UI was LATE-NC.
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Affiliation(s)
- Jing Di
- University of Kentucky Department of Pathology and Laboratory Medicine, Lexington, KY
| | | | - Gregory A. Jicha
- Sanders-Brown Center on Aging Lexington, KY
- Department of Neurology, Lexington, KY
| | - Daniela C. Moga
- Sanders-Brown Center on Aging Lexington, KY
- Department of Pharmacology, Lexington, KY
| | | | | | - David W. Fardo
- Sanders-Brown Center on Aging Lexington, KY
- Department of Biostatistics, Lexington, KY
| | - Erin L. Abner
- Sanders-Brown Center on Aging Lexington, KY
- College of Public Health, Lexington, KY
| | - Peter T. Nelson
- University of Kentucky Department of Pathology and Laboratory Medicine, Lexington, KY
- Sanders-Brown Center on Aging Lexington, KY
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11
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Lu L, Marisetty A, Liu B, Kamal MM, Gumin J, Veo B, Cai Y, Kassem DH, Weng C, Maynard ME, Hood KN, Fuller GN, Pan ZZ, Cykowski MD, Dash PK, Majumder S. Author Correction: REST overexpression in mice causes deficits in spontaneous locomotion. Sci Rep 2022; 12:21759. [PMID: 36526687 PMCID: PMC9758167 DOI: 10.1038/s41598-022-25607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Li Lu
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.39382.330000 0001 2160 926XPresent Address: Baylor College of Medicine, Houston, TX 77030 USA
| | - Anantha Marisetty
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.240145.60000 0001 2291 4776Present Address: Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Bin Liu
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.240145.60000 0001 2291 4776Present Address: Department of Epigenetics and Molecular Carcinogenesis, MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Mohamed Mostafa Kamal
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.7269.a0000 0004 0621 1570Present Address: Department of Biochemistry, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Joy Gumin
- grid.240145.60000 0001 2291 4776Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Bethany Veo
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.430503.10000 0001 0703 675XPresent Address: Department of Pediatrics/Hematology and Oncology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045 USA
| | - YouQing Cai
- grid.240145.60000 0001 2291 4776Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Dina Hamada Kassem
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.7269.a0000 0004 0621 1570Present Address: Department of Biochemistry, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Connie Weng
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Mark E. Maynard
- grid.267308.80000 0000 9206 2401Department of Neurobiology and Anatomy, The University of Texas McGovern Medical School, Houston, TX 77030 USA
| | - Kimberly N. Hood
- grid.267308.80000 0000 9206 2401Department of Neurobiology and Anatomy, The University of Texas McGovern Medical School, Houston, TX 77030 USA
| | - Gregory N. Fuller
- grid.240145.60000 0001 2291 4776Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Zhizhong Z. Pan
- grid.240145.60000 0001 2291 4776Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Matthew D. Cykowski
- grid.63368.380000 0004 0445 0041Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030 USA
| | - Pramod K. Dash
- grid.267308.80000 0000 9206 2401Department of Neurobiology and Anatomy, The University of Texas McGovern Medical School, Houston, TX 77030 USA
| | - Sadhan Majumder
- grid.240145.60000 0001 2291 4776Departments of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA ,grid.240145.60000 0001 2291 4776Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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12
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Nelson PT, Brayne C, Flanagan ME, Abner EL, Agrawal S, Attems J, Castellani RJ, Corrada MM, Cykowski MD, Di J, Dickson DW, Dugger BN, Ervin JF, Fleming J, Graff-Radford J, Grinberg LT, Hokkanen SRK, Hunter S, Kapasi A, Kawas CH, Keage HAD, Keene CD, Kero M, Knopman DS, Kouri N, Kovacs GG, Labuzan SA, Larson EB, Latimer CS, Leite REP, Matchett BJ, Matthews FE, Merrick R, Montine TJ, Murray ME, Myllykangas L, Nag S, Nelson RS, Neltner JH, Nguyen AT, Petersen RC, Polvikoski T, Reichard RR, Rodriguez RD, Suemoto CK, Wang SHJ, Wharton SB, White L, Schneider JA. Frequency of LATE neuropathologic change across the spectrum of Alzheimer's disease neuropathology: combined data from 13 community-based or population-based autopsy cohorts. Acta Neuropathol 2022; 144:27-44. [PMID: 35697880 PMCID: PMC9552938 DOI: 10.1007/s00401-022-02444-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [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: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) and Alzheimer's disease neuropathologic change (ADNC) are each associated with substantial cognitive impairment in aging populations. However, the prevalence of LATE-NC across the full range of ADNC remains uncertain. To address this knowledge gap, neuropathologic, genetic, and clinical data were compiled from 13 high-quality community- and population-based longitudinal studies. Participants were recruited from United States (8 cohorts, including one focusing on Japanese-American men), United Kingdom (2 cohorts), Brazil, Austria, and Finland. The total number of participants included was 6196, and the average age of death was 88.1 years. Not all data were available on each individual and there were differences between the cohorts in study designs and the amount of missing data. Among those with known cognitive status before death (n = 5665), 43.0% were cognitively normal, 14.9% had MCI, and 42.4% had dementia-broadly consistent with epidemiologic data in this age group. Approximately 99% of participants (n = 6125) had available CERAD neuritic amyloid plaque score data. In this subsample, 39.4% had autopsy-confirmed LATE-NC of any stage. Among brains with "frequent" neuritic amyloid plaques, 54.9% had comorbid LATE-NC, whereas in brains with no detected neuritic amyloid plaques, 27.0% had LATE-NC. Data on LATE-NC stages were available for 3803 participants, of which 25% had LATE-NC stage > 1 (associated with cognitive impairment). In the subset of individuals with Thal Aβ phase = 0 (lacking detectable Aβ plaques), the brains with LATE-NC had relatively more severe primary age-related tauopathy (PART). A total of 3267 participants had available clinical data relevant to frontotemporal dementia (FTD), and none were given the clinical diagnosis of definite FTD nor the pathological diagnosis of frontotemporal lobar degeneration with TDP-43 inclusions (FTLD-TDP). In the 10 cohorts with detailed neurocognitive assessments proximal to death, cognition tended to be worse with LATE-NC across the full spectrum of ADNC severity. This study provided a credible estimate of the current prevalence of LATE-NC in advanced age. LATE-NC was seen in almost 40% of participants and often, but not always, coexisted with Alzheimer's disease neuropathology.
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Affiliation(s)
- Peter T Nelson
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA.
| | | | | | - Erin L Abner
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | | | | | | | | | - Jing Di
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | | | | | | | | | - Lea T Grinberg
- University of California, San Francisco, CA, USA
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | | | - Mia Kero
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Liisa Myllykangas
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sukriti Nag
- Rush University Medical Center, Chicago, IL, USA
| | | | - Janna H Neltner
- University of Kentucky, Rm 311 Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | | | | | | | | | | | | | - Stephen B Wharton
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Lon White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
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13
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Cykowski MD, Arumanayagam AS, Powell SZ, Rivera AL, Abner EL, Roman GC, Masdeu JC, Nelson PT. Patterns of amygdala region pathology in LATE-NC: subtypes that differ with regard to TDP-43 histopathology, genetic risk factors, and comorbid pathologies. Acta Neuropathol 2022; 143:531-545. [PMID: 35366087 PMCID: PMC9038848 DOI: 10.1007/s00401-022-02416-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022]
Abstract
Transactive response (TAR) DNA-binding protein 43 kDa (TDP-43) pathology is a hallmark of limbic-predominant age-related TDP-43 encephalopathy (LATE). The amygdala is affected early in the evolution of LATE neuropathologic change (LATE-NC), and heterogeneity of LATE-NC in amygdala has previously been observed. However, much remains to be learned about how LATE-NC originates and progresses in the brain. To address this, we assessed TDP-43 and other pathologies in the amygdala region of 184 autopsied subjects (median age = 85 years), blinded to clinical diagnoses, other neuropathologic diagnoses, and risk genotype information. As previously described, LATE-NC was associated with older age at death, cognitive impairment, and the TMEM106B risk allele. Pathologically, LATE-NC was associated with comorbid hippocampal sclerosis (HS), myelin loss, and vascular disease in white matter (WM). Unbiased hierarchical clustering of TDP-43 inclusion morphologies revealed discernable subtypes of LATE-NC with distinct clinical, genetic, and pathologic associations. The most common patterns were: Pattern 1, with lamina II TDP-43 + processes and preinclusion pathology in cortices of the amygdala region, and frequent LATE-NC Stage 3 with HS; Pattern 2, previously described as type-β, with neurofibrillary tangle-like TDP-43 neuronal cytoplasmic inclusions (NCIs), high Alzheimer's disease neuropathologic change (ADNC), frequent APOE ε4, and usually LATE-NC Stage 2; Pattern 3, with round NCIs and thick neurites in amygdala, younger age at death, and often comorbid Lewy body disease; and Pattern 4 (the most common pattern), with tortuous TDP-43 processes in subpial and WM regions, low ADNC, rare HS, and lower dementia probability. TDP-43 pathology with features of patterns 1 and 2 were often comorbid in the same brains. Early and mild TDP-43 pathology was often best described to be localized in the "amygdala region" rather than the amygdala proper. There were also important shared attributes across patterns. For example, all four patterns were associated with the TMEM106B risk allele. Each pattern also demonstrated the potential to progress to higher LATE-NC stages with confluent anatomical and pathological patterns, and to contribute to dementia. Although LATE-NC showed distinct patterns of initiation in amygdala region, there was also apparent shared genetic risk and convergent pathways of clinico-pathological evolution.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA.
- Methodist Neurological Institute Department of Neurology, Houston Methodist Hospital, Weil Cornell Medicine, Houston, TX, 77030, USA.
| | | | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Erin L Abner
- Sanders-Brown Center On Aging, University of Kentucky, University of Kentucky, Lexington, KY, 40536, USA
- Department of Epidemiology, University of Kentucky, Lexington, KY, 40536, USA
| | - Gustavo C Roman
- Methodist Neurological Institute Department of Neurology, Houston Methodist Hospital, Weil Cornell Medicine, Houston, TX, 77030, USA
- Nantz National Alzheimer Center, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Joseph C Masdeu
- Methodist Neurological Institute Department of Neurology, Houston Methodist Hospital, Weil Cornell Medicine, Houston, TX, 77030, USA
- Nantz National Alzheimer Center, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Peter T Nelson
- Sanders-Brown Center On Aging, University of Kentucky, University of Kentucky, Lexington, KY, 40536, USA
- Department of Pathology, University of Kentucky, Lexington, KY, 40536, USA
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14
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Gauthreaux KM, Teylan MA, Katsumata Y, Mock C, Culhane JE, Chen YC, Chan KCG, Fardo DW, Dugan AJ, Cykowski MD, Jicha GA, Kukull WA, Nelson PT. Limbic-Predominant Age-Related TDP-43 Encephalopathy: Medical and Pathologic Factors Associated With Comorbid Hippocampal Sclerosis. Neurology 2022; 98:e1422-e1433. [PMID: 35121671 PMCID: PMC8992604 DOI: 10.1212/wnl.0000000000200001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/03/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Limbic-predominant age-related Tar DNA binding protein 43 (TDP-43) encephalopathy neuropathologic change (LATE-NC) is present in ≈25% of older persons' brains and is strongly associated with cognitive impairment. Hippocampal sclerosis (HS) pathology is often comorbid with LATE-NC, but the clinical and pathologic correlates of HS in LATE-NC are not well understood. METHODS This retrospective autopsy cohort study used data derived from the National Alzheimer's Coordinating Center Neuropathology Data Set, which included neurologic status, medical histories, and neuropathologic results. All autopsies were performed in 2014 or later. Among participants with LATE-NC, those who also had HS pathology were compared with those without HS with regard to candidate risk factors or common underlying diseases. Statistical significance was set at nominal p < 0.05 in this exploratory study. RESULTS A total of 408 participants were included (n = 221 were LATE-NC+/HS-, n = 145 were LATE-NC+/HS+, and n = 42 were LATE-NC-/HS+). Most of the included LATE-NC+ participants were severely impaired cognitively (83.3% with dementia). Compared to HS- participants, LATE-NC+ participants with HS trended toward having worse cognitive status and scored lower on the Personal Care and Orientation domains (both p = 0.03). Among LATE-NC+ participants with Braak neurofibrillary tangle (NFT) stages 0 to IV (n = 88), HS+ participants were more impaired in the Memory and Orientation domains (both p = 0.02). There were no differences (HS+ compared with HS-) in the proportion with clinical histories of seizures, stroke, cardiac bypass procedures, diabetes, or hypertension. The HS+ group lacking TDP-43 proteinopathy (n = 42) was relatively likely to have had strokes (p = 0.03). When LATE-NC+ participants with or without HS were compared, there were no differences in Alzheimer disease neuropathologies (Thal β-amyloid phases or Braak NFT stages) or Lewy body pathologies. However, the HS+ group was less likely to have amygdala-restricted TDP-43 proteinopathy (LATE-NC stage 1) and more likely to have neocortical TDP-43 proteinopathy (LATE-NC stage 3) (p < 0.001). LATE-NC+ brains with HS also tended to have more severe circle of Willis atherosclerosis and arteriolosclerosis pathologies. DISCUSSION In this cohort skewed toward participants with severe dementia, LATE-NC+ HS pathology was not associated with seizures or with Alzheimer-type pathologies. Rather, the presence of comorbid HS pathology was associated with more widespread TDP-43 proteinopathy and with more severe non-β-amyloid vessel wall pathologies.
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Affiliation(s)
- Kathryn M Gauthreaux
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Merilee A Teylan
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Yuriko Katsumata
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Charles Mock
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Jessica E Culhane
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Yen-Chi Chen
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Kwun C G Chan
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - David W Fardo
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Adam J Dugan
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Matthew D Cykowski
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Gregory A Jicha
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Walter A Kukull
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington
| | - Peter T Nelson
- From the National Alzheimer's Coordinating Center (K.M.G., M.A.T., C.M., J.E.C., K.C.G.C., W.A.K.), Department of Epidemiology, and Department of Statistics (Y.-C.C.) University of Washington, Seattle; Houston Methodist Hospital (M.D.C.), TX; and Sanders-Brown Center on Aging (Y.K., D.W.F., G.A.J., P.T.N.), Department of Biostatistics (Y.K., D.W.F., A.J.D.), Department of Neurology (G.A.J.), and Department of Pathology (P.T.N.), Division of Neuropathology, University of Kentucky, Lexington.
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15
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Gal J, Katsumata Y, Zhu H, Srinivasan S, Chen J, Johnson LA, Wang WX, Golden LR, Wilcock DM, Jicha GA, Cykowski MD, Nelson PT. Apolipoprotein E Proteinopathy Is a Major Dementia-Associated Pathologic Biomarker in Individuals with or without the APOE Epsilon 4 Allele. Am J Pathol 2022; 192:564-578. [PMID: 34954207 PMCID: PMC8895423 DOI: 10.1016/j.ajpath.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/27/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022]
Abstract
The amygdala is vulnerable to multiple or "mixed" mis-aggregated proteins associated with neurodegenerative conditions that can manifest clinically with amnestic dementia; the amygdala region is often affected even at earliest disease stages. With the original intent of identifying novel dementia-associated proteins, the detergent-insoluble proteome was characterized from the amygdalae of 40 participants from the University of Kentucky Alzheimer's Disease Center autopsy cohort. These individuals encompassed a spectrum of clinical conditions (cognitively normal to severe amnestic dementia). Polypeptides from the detergent-insoluble fraction were interrogated using liquid chromatography-electrospray ionization-tandem mass spectrometry. As anticipated, portions of peptides previously associated with neurologic diseases were enriched from subjects with dementia. Among all detected peptides, Apolipoprotein E (ApoE) stood out: even more than the expected Tau, APP/Aβ, and α-Synuclein peptides, ApoE peptides were strongly enriched in dementia cases, including from individuals lacking the APOE ε4 genotype. The amount of ApoE protein detected in detergent-insoluble fractions was robustly associated with levels of complement proteins C3 and C4. Immunohistochemical staining of APOE ε3/ε3 subjects' amygdalae confirmed ApoE co-localization with C4 in amyloid plaques. Thus, analyses of human amygdala proteomics indicate that rather than being only an "upstream" genetic risk factor, ApoE is an aberrantly aggregated protein in its own right, and show that the ApoE protein may play active disease-driving mechanistic roles in persons lacking the APOE ε4 allele.
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Affiliation(s)
- Jozsef Gal
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky, Lexington, Kentucky,Department of Neuroscience, University of Kentucky, Lexington, Kentucky
| | - Yuriko Katsumata
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky,Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
| | - Haining Zhu
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky,Research & Development, Lexington VA Medical Center, Lexington, Kentucky
| | - Sukanya Srinivasan
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
| | - Jing Chen
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky
| | - Lance Allen Johnson
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky,Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
| | - Wang-Xia Wang
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky,Department of Pathology, University of Kentucky, Lexington, Kentucky
| | | | - Donna M. Wilcock
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky,Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky,Department of Physiology, University of Kentucky, Lexington, Kentucky
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky,Department of Neurology, University of Kentucky, Lexington, Kentucky
| | | | - Peter Tobias Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky; Department of Pathology, University of Kentucky, Lexington, Kentucky.
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16
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Pascual B, Hodics T, Funk Q, Cykowski MD, Nakawah MO, Masdeu JC. Translocator Protein 18 kDa PET Imaging Highlights Asymptomatic Isolated Cerebellar Dysplasia. Neurology 2022; 98:538-539. [PMID: 35131911 PMCID: PMC8967423 DOI: 10.1212/wnl.0000000000200221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Belen Pascual
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX
| | - Timea Hodics
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX
| | - Quentin Funk
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX
| | - Matthew D Cykowski
- Department ofPathology and Genomic Medicine, Houston Methodist Research Institute and Weill Cornell Medicine, Houston, TX
| | - Mohammad O Nakawah
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX
| | - Joseph C Masdeu
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX
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17
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Dugan AJ, Nelson PT, Katsumata Y, Shade LMP, Boehme KL, Teylan MA, Cykowski MD, Mukherjee S, Kauwe JSK, Hohman TJ, Schneider JA, Fardo DW. Analysis of genes (TMEM106B, GRN, ABCC9, KCNMB2, and APOE) implicated in risk for LATE-NC and hippocampal sclerosis provides pathogenetic insights: a retrospective genetic association study. Acta Neuropathol Commun 2021; 9:152. [PMID: 34526147 PMCID: PMC8442328 DOI: 10.1186/s40478-021-01250-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is the most prevalent subtype of TDP-43 proteinopathy, affecting up to 1/3rd of aged persons. LATE-NC often co-occurs with hippocampal sclerosis (HS) pathology. It is currently unknown why some individuals with LATE-NC develop HS while others do not, but genetics may play a role. Previous studies found associations between LATE-NC phenotypes and specific genes: TMEM106B, GRN, ABCC9, KCNMB2, and APOE. Data from research participants with genomic and autopsy measures from the National Alzheimer’s Coordinating Center (NACC; n = 631 subjects included) and the Religious Orders Study and Memory and the Rush Aging Project (ROSMAP; n = 780 included) were analyzed in the current study. Our goals were to reevaluate disease-associated genetic variants using newly collected data and to query whether the specific genotype/phenotype associations could provide new insights into disease-driving pathways. Research subjects included in prior LATE/HS genome-wide association studies (GWAS) were excluded. Single nucleotide variants (SNVs) within 10 kb of TMEM106B, GRN, ABCC9, KCNMB2, and APOE were tested for association with HS and LATE-NC, and separately for Alzheimer’s pathologies, i.e. amyloid plaques and neurofibrillary tangles. Significantly associated SNVs were identified. When results were meta-analyzed, TMEM106B, GRN, and APOE had significant gene-based associations with both LATE and HS, whereas ABCC9 had significant associations with HS only. In a sensitivity analysis limited to LATE-NC + cases, ABCC9 variants were again associated with HS. By contrast, the associations of TMEM106B, GRN, and APOE with HS were attenuated when adjusting for TDP-43 proteinopathy, indicating that these genes may be associated primarily with TDP-43 proteinopathy. None of these genes except APOE appeared to be associated with Alzheimer’s-type pathology. In summary, using data not included in prior studies of LATE or HS genomics, we replicated several previously reported gene-based associations and found novel evidence that specific risk alleles can differentially affect LATE-NC and HS.
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18
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Affiliation(s)
- Bette K Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew D Cykowski
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA.,Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
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19
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Cathcart SJ, Appel SH, Peterson LE, Greene EP, Powell SZ, Arumanayagam AS, Rivera AL, Cykowski MD. Fast Progression in Amyotrophic Lateral Sclerosis Is Associated With Greater TDP-43 Burden in Spinal Cord. J Neuropathol Exp Neurol 2021; 80:754-763. [PMID: 34383907 PMCID: PMC8433592 DOI: 10.1093/jnen/nlab061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Upper and lower motor neuron pathologies are critical to the autopsy diagnosis of amyotrophic lateral sclerosis (ALS). Further investigation is needed to determine how the relative burden of these pathologies affects the disease course. We performed a blinded, retrospective study of 38 ALS patients, examining the association between pathologic measures in motor cortex, hypoglossal nucleus, and lumbar cord with clinical data, including progression rate and disease duration, site of symptom onset, and upper and lower motor neuron signs. The most critical finding in our study was that TAR DNA-binding protein 43 kDa (TDP-43) pathologic burden in lumbar cord and hypoglossal nucleus was significantly associated with a faster progression rate with reduced survival (p < 0.02). There was no correlation between TDP-43 burden and the severity of cell loss, and no significant clinical associations were identified for motor cortex TDP-43 burden or severity of cell loss in motor cortex. C9orf72 expansion was associated with shorter disease duration (p < 0.001) but was not significantly associated with pathologic measures in these regions. The association between lower motor neuron TDP-43 burden and fast progression with reduced survival in ALS provides further support for the study of TDP-43 as a disease biomarker.
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Affiliation(s)
- Sahara J Cathcart
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Stanley H Appel
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Leif E Peterson
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Ericka P Greene
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Suzanne Z Powell
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Anithachristy S Arumanayagam
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Andreana L Rivera
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
| | - Matthew D Cykowski
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA (SJC, SZP, ASA, ALR, MDC); University of Nebraska Medical Center, Omaha, Nebraska, USA (SJC); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, MDC); Institute of Academic Medicine at the Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR, MDC); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA (SHA, EPG, SZP, ALR); NXG Logic, LLC, Houston, Texas, USA (LEP)
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20
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Stevens SR, Longley CM, Ogawa Y, Teliska LH, Arumanayagam AS, Nair S, Oses-Prieto JA, Burlingame AL, Cykowski MD, Xue M, Rasband MN. Ankyrin-R regulates fast-spiking interneuron excitability through perineuronal nets and Kv3.1b K + channels. eLife 2021; 10:66491. [PMID: 34180393 PMCID: PMC8257253 DOI: 10.7554/elife.66491] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Received: 01/13/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022] Open
Abstract
Neuronal ankyrins cluster and link membrane proteins to the actin and spectrin-based cytoskeleton. Among the three vertebrate ankyrins, little is known about neuronal Ankyrin-R (AnkR). We report AnkR is highly enriched in Pv+ fast-spiking interneurons in mouse and human. We identify AnkR-associated protein complexes including cytoskeletal proteins, cell adhesion molecules (CAMs), and perineuronal nets (PNNs). We show that loss of AnkR from forebrain interneurons reduces and disrupts PNNs, decreases anxiety-like behaviors, and changes the intrinsic excitability and firing properties of Pv+ fast-spiking interneurons. These changes are accompanied by a dramatic reduction in Kv3.1b K+ channels. We identify a novel AnkR-binding motif in Kv3.1b, and show that AnkR is both necessary and sufficient for Kv3.1b membrane localization in interneurons and at nodes of Ranvier. Thus, AnkR regulates Pv+ fast-spiking interneuron function by organizing ion channels, CAMs, and PNNs, and linking these to the underlying β1 spectrin-based cytoskeleton.
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Affiliation(s)
- Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Colleen M Longley
- Program in Developmental Biology, Baylor College of Medicine, Houston, United States.,The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Yuki Ogawa
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Lindsay H Teliska
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | | | - Supna Nair
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, United States
| | - Juan A Oses-Prieto
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, United States
| | - Alma L Burlingame
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, United States
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, United States
| | - Mingshan Xue
- Department of Neuroscience, Baylor College of Medicine, Houston, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, United States.,The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, United States
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, United States
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21
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Karanth S, Nelson PT, Katsumata Y, Kryscio RJ, Schmitt FA, Fardo DW, Cykowski MD, Jicha GA, Van Eldik LJ, Abner EL. Prevalence and Clinical Phenotype of Quadruple Misfolded Proteins in Older Adults. JAMA Neurol 2021; 77:1299-1307. [PMID: 32568358 DOI: 10.1001/jamaneurol.2020.1741] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Quadruple misfolded proteins (tau neurofibrillary tangles, amyloid-β [Aβ], α-synuclein, and transactive response DNA-binding protein 43 [TDP-43]) in the same brain are relatively common in aging. However, the clinical presentation, associated factors, frequency in community-based cohorts, genetic characteristics, and cognitive trajectories associated with the quadruple misfolded proteins phenotype are not well understood. Objective To describe the quadruple misfolded proteins phenotype, including the trajectories of global cognition, in an autopsy cohort. Design, Setting, and Participants This retrospective cohort study used brain autopsy data from the University of Kentucky Alzheimer Disease Center (UK-ADC) Brain Bank. Participants were deceased individuals who were enrolled in a longitudinal community-based cohort study of aging and dementia in central Kentucky conducted by the UK-ADC. Included participants were enrolled in the UK-ADC cohort between January 1, 1989, and December 31, 2017; aged 55 years or older at baseline; and followed up for a mean duration of 10.4 years. The participants had Alzheimer disease pathology (tau and Aβ), α-synuclein, and TDP-43 data, along with Braak neurofibrillary tangle stage I to VI. Data analysis was conducted between February 1, 2019, and September 30, 2019. Main Outcomes and Measures Frequency of quadruple misfolded proteins was estimated, and proteinopathy group characteristics and associations with global cognition were evaluated. Multinomial logistic regression was used to estimate the association of proteinopathy group with participant characteristics, including age at death, sex, and apolipoprotein ε4 (APOE ε4) allele. Generalized estimating equations were used to estimate the probability of obtaining Mini-Mental State Examination (MMSE) scores within the normal cognition (27-30 points) and severe impairment (≤13 points) ranges during the 12 years before death. Results The final sample included 375 individuals (mean [SD] age at death, 86.9 [8.0] years); 232 women [61.9%]). Quadruple misfolded proteins were detected in 41 of 214 individuals with dementia (19.2%). Overall, 46 individuals (12.3%) had quadruple misfolded proteins, whereas 143 individuals (38.1%) had 3 proteinopathies. Dementia frequency was highest among those with quadruple misfolded proteins (41 [89.1%]), and participants with quadruple misfolded proteins had the lowest final mean (SD) MMSE scores of 13.4 (9.8) points. Adjusting for age at death and sex, the APOE ε4 allele was associated with higher odds of quadruple misfolded proteins (adjusted odds ratio, 2.55; 95% CI, 1.16- 5.62; P = .02). The quadruple misfolded proteins group had both the lowest probability of obtaining MMSE scores in the normal cognition range, even 12 years before death, and the highest probability of having MMSE scores in the severe impairment range. Conclusions and Relevance Quadruple misfolded proteins appear to be a common substrate for cognitive impairment and to be associated with an aggressive course of disease that typically ends with severe dementia. The prevalence of comorbid α-synuclein and TDP-43 with Alzheimer disease pathology (tau and Aβ) may complicate efforts to identify therapies to treat and prevent Alzheimer disease.
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Affiliation(s)
- Shama Karanth
- Department of Epidemiology, University of Kentucky, Lexington.,Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Pathology, University of Kentucky, Lexington
| | - Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Biostatistics, University of Kentucky, Lexington
| | - Richard J Kryscio
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Biostatistics, University of Kentucky, Lexington.,Department of Statistics, University of Kentucky, Lexington
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Neurology, University of Kentucky, Lexington
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Biostatistics, University of Kentucky, Lexington
| | | | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Neurology, University of Kentucky, Lexington
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Neuroscience, University of Kentucky, Lexington
| | - Erin L Abner
- Department of Epidemiology, University of Kentucky, Lexington.,Sanders-Brown Center on Aging, University of Kentucky, Lexington.,Department of Biostatistics, University of Kentucky, Lexington
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22
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Pascual B, Funk Q, Zanotti-Fregonara P, Cykowski MD, Veronese M, Rockers E, Bradbury K, Yu M, Nakawah MO, Román GC, Schulz PE, Arumanayagam AS, Beers D, Faridar A, Fujita M, Appel SH, Masdeu JC. Neuroinflammation is highest in areas of disease progression in semantic dementia. Brain 2021; 144:1565-1575. [PMID: 33824991 DOI: 10.1093/brain/awab057] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/19/2020] [Revised: 11/25/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
Despite epidemiological and genetic data linking semantic dementia to inflammation, the topography of neuroinflammation in semantic dementia, also known as the semantic variant of primary progressive aphasia, remains unclear. The pathology starts at the tip of the left temporal lobe where, in addition to cortical atrophy, a strong signal appears with the tau PET tracer 18F-flortaucipir, even though the disease is not typically associated with tau but with TDP-43 protein aggregates. Here, we characterized the topography of inflammation in semantic variant primary progressive aphasia using high-resolution PET and the tracer 11C-PBR28 as a marker of microglial activation. We also tested the hypothesis that inflammation, by providing non-specific binding targets, could explain the 18F-flortaucipir signal in semantic variant primary progressive aphasia. Eight amyloid-PET-negative patients with semantic variant primary progressive aphasia underwent 11C-PBR28 and 18F-flortaucipir PET. Healthy controls underwent 11C-PBR28 PET (n = 12) or 18F-flortaucipir PET (n = 12). Inflammation in PET with 11C-PBR28 was analysed using Logan graphical analysis with a metabolite-corrected arterial input function. 18F-flortaucipir standardized uptake value ratios were calculated using the cerebellum as the reference region. Since monoamine oxidase B receptors are expressed by astrocytes in affected tissue, selegiline was administered to one patient with semantic variant primary progressive aphasia before repeating 18F-flortaucipir scanning to test whether monoamine oxidase B inhibition blocked flortaucipir binding, which it did not. While 11C-PBR28 uptake was mostly cortical, 18F-flortaucipir uptake was greatest in the white matter. The uptake of both tracers was increased in the left temporal lobe and in the right temporal pole, as well as in regions adjoining the left temporal pole such as insula and orbitofrontal cortex. However, peak uptake of 18F-flortaucipir localized to the left temporal pole, the epicentre of pathology, while the peak of inflammation 11C-PBR28 uptake localized to a more posterior, mid-temporal region and left insula and orbitofrontal cortex, in the periphery of the damage core. Neuroinflammation, greatest in the areas of progression of the pathological process in semantic variant primary progressive aphasia, should be further studied as a possible therapeutic target to slow disease progression.
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Affiliation(s)
- Belen Pascual
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Quentin Funk
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Paolo Zanotti-Fregonara
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA.,Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Mattia Veronese
- Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Elijah Rockers
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Kathleen Bradbury
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Meixiang Yu
- Cyclotron and Radiopharmaceutical Core, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Mohammad O Nakawah
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Gustavo C Román
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School of UT Health, Houston, TX, USA
| | - Anithachristy S Arumanayagam
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - David Beers
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Alireza Faridar
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Masahiro Fujita
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Stanley H Appel
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
| | - Joseph C Masdeu
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, USA
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Cathcart SJ, Greene EP, Powell SZ, Arumanayagam AS, Rivera AL, Tawil R, Appel SH, Cykowski MD. Spinal Cord and Motor Neuron TDP-43 Pathology in a Sporadic Inclusion Body Myositis Patient. J Neuropathol Exp Neurol 2021; 79:1130-1133. [PMID: 32954435 PMCID: PMC7559233 DOI: 10.1093/jnen/nlaa066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Ericka P Greene
- Stanley H. Appel Department of Neurology.,Institute of Academic Medicine at the Houston Methodist Research Institute.,Houston Methodist Neurological Institute, Houston, Texas
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine.,Houston Methodist Neurological Institute, Houston, Texas
| | | | - Andreana L Rivera
- Department of Pathology and Genomic Medicine.,Houston Methodist Neurological Institute, Houston, Texas
| | - Rabi Tawil
- Neuromuscular Disease Unit, Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Stanley H Appel
- Stanley H. Appel Department of Neurology.,Institute of Academic Medicine at the Houston Methodist Research Institute.,Houston Methodist Neurological Institute, Houston, Texas
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine.,Stanley H. Appel Department of Neurology.,Institute of Academic Medicine at the Houston Methodist Research Institute
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24
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Perez A, Roman GC, Powell SZ, Fisher R, Rivera AL, Masdeu JC, Cykowski MD. A 70-Year Old Man with Dystonic and Choreiform Movements. Brain Pathol 2021; 30:415-416. [PMID: 32100432 DOI: 10.1111/bpa.12819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Alejandro Perez
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Gustavo C Roman
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Ron Fisher
- Department of Radiology, Houston Methodist Hospital, Houston, TX
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Joseph C Masdeu
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
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25
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Blevins BL, Vinters HV, Love S, Wilcock DM, Grinberg LT, Schneider JA, Kalaria RN, Katsumata Y, Gold BT, Wang DJJ, Ma SJ, Shade LMP, Fardo DW, Hartz AMS, Jicha GA, Nelson KB, Magaki SD, Schmitt FA, Teylan MA, Ighodaro ET, Phe P, Abner EL, Cykowski MD, Van Eldik LJ, Nelson PT. Brain arteriolosclerosis. Acta Neuropathol 2021; 141:1-24. [PMID: 33098484 PMCID: PMC8503820 DOI: 10.1007/s00401-020-02235-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Brain arteriolosclerosis (B-ASC), characterized by pathologic arteriolar wall thickening, is a common finding at autopsy in aged persons and is associated with cognitive impairment. Hypertension and diabetes are widely recognized as risk factors for B-ASC. Recent research indicates other and more complex risk factors and pathogenetic mechanisms. Here, we describe aspects of the unique architecture of brain arterioles, histomorphologic features of B-ASC, relevant neuroimaging findings, epidemiology and association with aging, established genetic risk factors, and the co-occurrence of B-ASC with other neuropathologic conditions such as Alzheimer's disease and limbic-predominant age-related TDP-43 encephalopathy (LATE). There may also be complex physiologic interactions between metabolic syndrome (e.g., hypertension and inflammation) and brain arteriolar pathology. Although there is no universally applied diagnostic methodology, several classification schemes and neuroimaging techniques are used to diagnose and categorize cerebral small vessel disease pathologies that include B-ASC, microinfarcts, microbleeds, lacunar infarcts, and cerebral amyloid angiopathy (CAA). In clinical-pathologic studies that factored in comorbid diseases, B-ASC was independently associated with impairments of global cognition, episodic memory, working memory, and perceptual speed, and has been linked to autonomic dysfunction and motor symptoms including parkinsonism. We conclude by discussing critical knowledge gaps related to B-ASC and suggest that there are probably subcategories of B-ASC that differ in pathogenesis. Observed in over 80% of autopsied individuals beyond 80 years of age, B-ASC is a complex and under-studied contributor to neurologic disability.
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Affiliation(s)
- Brittney L Blevins
- Department of Neuroscience, University Kentucky, Lexington, KY, 40536, USA
| | - Harry V Vinters
- Department of Pathology and Laboratory Medicine, David Geffen SOM at UCLA and Ronald Reagan UCLA Medical Center, Los Angeles, CA, 90095-1732, USA
| | - Seth Love
- University of Bristol and Southmead Hospital, Bristol, BS10 5NB, UK
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, Department of Neuroscience, University Kentucky, Lexington, KY, 40536, USA
| | - Lea T Grinberg
- Department of Neurology and Pathology, UCSF, San Francisco, CA, USA
- Global Brain Health Institute, UCSF, San Francisco, CA, USA
- LIM-22, Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Julie A Schneider
- Departments of Neurology and Pathology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Yuriko Katsumata
- Sanders-Brown Center on Aging, Department of Biostatistics, University Kentucky, Lexington, KY, 40536, USA
| | - Brian T Gold
- Sanders-Brown Center on Aging, Department of Neuroscience, University Kentucky, Lexington, KY, 40536, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Samantha J Ma
- Laboratory of FMRI Technology (LOFT), USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Lincoln M P Shade
- Sanders-Brown Center on Aging, Department of Biostatistics, University Kentucky, Lexington, KY, 40536, USA
| | - David W Fardo
- Sanders-Brown Center on Aging, Department of Biostatistics, University Kentucky, Lexington, KY, 40536, USA
| | - Anika M S Hartz
- Sanders-Brown Center on Aging, Department of Pharmacology and Nutritional Sciences, University Kentucky, Lexington, KY, 40536, USA
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, Department of Neurology, University Kentucky, Lexington, KY, 40536, USA
| | | | - Shino D Magaki
- Department of Pathology and Laboratory Medicine, David Geffen SOM at UCLA and Ronald Reagan UCLA Medical Center, Los Angeles, CA, 90095-1732, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, Department of Neurology, University Kentucky, Lexington, KY, 40536, USA
| | - Merilee A Teylan
- Department of Epidemiology, University Washington, Seattle, WA, 98105, USA
| | | | - Panhavuth Phe
- Sanders-Brown Center on Aging, University Kentucky, Lexington, KY, 40536, USA
| | - Erin L Abner
- Sanders-Brown Center on Aging, Department of Epidemiology, University Kentucky, Lexington, KY, 40536, USA
| | - Matthew D Cykowski
- Departments of Pathology and Genomic Medicine and Neurology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, Department of Neuroscience, University Kentucky, Lexington, KY, 40536, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, Department of Pathology, University of Kentucky, Lexington, KY, 40536, USA.
- Rm 311 Sanders-Brown Center on Aging, University of Kentucky, 800 S. Limestone Avenue, Lexington, KY, 40536, USA.
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26
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Katsumata Y, Abner EL, Karanth S, Teylan MA, Mock CN, Cykowski MD, Lee EB, Boehme KL, Mukherjee S, Kauwe JSK, Kryscio RJ, Schmitt FA, Fardo DW, Nelson PT. Distinct clinicopathologic clusters of persons with TDP-43 proteinopathy. Acta Neuropathol 2020; 140:659-674. [PMID: 32797255 PMCID: PMC7572241 DOI: 10.1007/s00401-020-02211-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022]
Abstract
To better understand clinical and neuropathological features of TDP-43 proteinopathies, data were analyzed from autopsied research volunteers who were followed in the National Alzheimer's Coordinating Center (NACC) data set. All subjects (n = 495) had autopsy-proven TDP-43 proteinopathy as an inclusion criterion. Subjects underwent comprehensive longitudinal clinical evaluations yearly for 6.9 years before death on average. We tested whether an unsupervised clustering algorithm could detect coherent groups of TDP-43 immunopositive cases based on age at death and extensive neuropathologic data. Although many of the brains had mixed pathologies, four discernible clusters were identified. Key differentiating features were age at death and the severity of comorbid Alzheimer's disease neuropathologic changes (ADNC), particularly neuritic amyloid plaque densities. Cluster 1 contained mostly cases with a pathologic diagnosis of frontotemporal lobar degeneration (FTLD-TDP), consistent with enrichment of frontotemporal dementia clinical phenotypes including appetite/eating problems, disinhibition and primary progressive aphasia (PPA). Cluster 2 consisted of elderly limbic-predominant age-related TDP-43 encephalopathy (LATE-NC) subjects without severe neuritic amyloid plaques. Subjects in Cluster 2 had a relatively slow cognitive decline. Subjects in both Clusters 3 and 4 had severe ADNC + LATE-NC; however, Cluster 4 was distinguished by earlier disease onset, swifter disease course, more Lewy body pathology, less neocortical TDP-43 proteinopathy, and a suggestive trend in a subgroup analysis (n = 114) for increased C9orf72 risk SNP rs3849942 T allele (Fisher's exact test p value = 0.095). Overall, clusters enriched with neocortical TDP-43 proteinopathy (Clusters 1 and 2) tended to have lower levels of neuritic amyloid plaques, and those dying older (Clusters 2 and 3) had far less PPA or disinhibition, but more apathy. Indeed, 98% of subjects dying past age 85 years lacked clinical features of the frontotemporal dementia syndrome. Our study revealed discernible subtypes of LATE-NC and underscored the importance of age of death for differentiating FTLD-TDP and LATE-NC.
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Affiliation(s)
- Yuriko Katsumata
- Department of Biostatistics, University of Kentucky, Lexington, KY, 40536, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA
- Department of Epidemiology, University of Kentucky, Lexington, KY, 40536, USA
| | - Shama Karanth
- Department of Epidemiology, University of Kentucky, Lexington, KY, 40536, USA
| | - Merilee A Teylan
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, 98105, USA
| | - Charles N Mock
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, 98105, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98105, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Edward B Lee
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kevin L Boehme
- Department of Biology, Brigham Young University, Provo, UT, 84602, USA
| | | | - John S K Kauwe
- Brigham Young University-Hawaii, Laie, HI, 96762, USA
- Biology Department, Brigham Young University, Provo, UT, 84602, USA
| | - Richard J Kryscio
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA
- Department of Statistics, University of Kentucky, Lexington, KY, 40536, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA
- Department of Neurology, University of Kentucky, Lexington, KY, 40536, USA
| | - David W Fardo
- Department of Biostatistics, University of Kentucky, Lexington, KY, 40536, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA.
- Department of Pathology, University of Kentucky, Rm 311 Sanders-Brown Center on Aging, 800 S. Limestone Avenue, Lexington, KY, 40536, USA.
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27
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Monroig-Bosque PDC, Hsu JW, Lin MS, Shehabeldin AN, Rogers JT, Kim CF, Kalsekar AG, Jin Z, Cara LR, Barbieri AN, El-Zaatari Z, Eskandari G, Sheu TG, Tomsula JA, Long SW, Zieske AW, Leveque CM, Salazar E, Mody DR, Schwartz MR, Cykowski MD, Yi X, Powell SZ, Thomas JS. Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience. Acad Pathol 2020; 7:2374289520953548. [PMID: 32995494 PMCID: PMC7503005 DOI: 10.1177/2374289520953548] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
Pathology training programs throughout the United States have endured unprecedented challenges dealing with the ongoing coronavirus disease 2019 pandemic. At Houston Methodist Hospital, the Department of Pathology and Genomic Medicine planned and executed a trainee-oriented, stepwise emergency response. The focus was on optimizing workflows among areas of both clinical and anatomic pathology, maintaining an excellent educational experience, and minimizing trainee exposure to coronavirus disease 2019. During the first phase of the response, trainees were divided into 2 groups: one working on-site and the other working remotely. With the progression of the pandemic, all trainees were called back on-site and further redeployed within our department to meet the significantly increased workload demands of our clinical laboratory services. Adjustments to trainee educational activities included, among others, the organization of a daily coronavirus disease 2019 virtual seminar series. This series served to facilitate communication between faculty, laboratory managers, and trainees. Moreover, it became a forum for trainees to provide updates on individual service workflows and volumes, ongoing projects and research, as well as literature reviews on coronavirus disease 2019–related topics. From our program’s experience, redeploying pathology trainees within our department during the coronavirus disease 2019 pandemic resulted in optimization of patient care while ensuring trainee safety, and importantly, helped to maintain continuous high-quality education through active involvement in unique learning opportunities.
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Affiliation(s)
- Paloma Del C Monroig-Bosque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Jim W Hsu
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Michelle S Lin
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Ahmed N Shehabeldin
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - John T Rogers
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Charlotte F Kim
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Ayaz G Kalsekar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Zhicheng Jin
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Lukas R Cara
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Andreia N Barbieri
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Ziad El-Zaatari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Ghazaleh Eskandari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Tiffany G Sheu
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Jessica A Tomsula
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Scott W Long
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Arthur W Zieske
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Christopher M Leveque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Eric Salazar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Dina R Mody
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Mary R Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Xin Yi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Jessica S Thomas
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
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28
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Cykowski MD, Dickson DW, Powell SZ, Arumanayagam AS, Rivera AL, Appel SH. Dipeptide repeat (DPR) pathology in the skeletal muscle of ALS patients with C9ORF72 repeat expansion. Acta Neuropathol 2019; 138:667-670. [PMID: 31375896 PMCID: PMC6778061 DOI: 10.1007/s00401-019-02050-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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29
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Vakil H, Tran L, Lewis GD, Cykowski MD, Butler EB, Teh BS. Biopsy proven metastatic meningioma: A case report and review of the literature. Rep Pract Oncol Radiother 2019; 24:528-532. [PMID: 31516399 DOI: 10.1016/j.rpor.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/21/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022] Open
Abstract
Meningiomas are the most common type of benign tumor found in the brain and are typically benign, slow-growing lesions. The current standard of care consists of surgical resection and subsequent postoperative radiotherapy to prevent local recurrence. Because of their indolent nature, meningiomas are rarely found to spread extracranially and develop distant metastases. We present the clinical, imaging, and pathologic features of a patient who had meningioma with multiple local recurrences, who was incidentally found to have metastatic disease in the lungs. In addition, we discuss details of this case in the context of the previously reported literature.
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Affiliation(s)
- Haris Vakil
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Lena Tran
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Gary D Lewis
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Edward Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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30
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Ballester LY, Boghani Z, Baskin DS, Britz GW, Olsen R, Fuller GN, Powell SZ, Cykowski MD. Creutzfeldt astrocytes may be seen in IDH-wildtype glioblastoma and retain expression of DNA repair and chromatin binding proteins. Brain Pathol 2018; 28:1012-1019. [PMID: 29509313 PMCID: PMC8028565 DOI: 10.1111/bpa.12604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/02/2018] [Accepted: 03/02/2018] [Indexed: 01/22/2023] Open
Abstract
Astrocytes with multiple micronuclei ("Creutzfeldt cells") in a brain biopsy are classically associated with demyelinating disease. However, glioblastoma may also have prominent Creutzfeldt astrocytes, along with granular mitoses. Therefore, Creutzfeldt cells may raise the diagnostic dilemma of high-grade glioma vs tumefactive demyelination. While cases of glioblastoma (GBM) with Creutzfeldt astrocytes have been reported, their clinicopathologic spectrum and genetic features are not understood. Studies have proposed that micronuclei in Creutzfeldt cells are a consequence of DNA damage, or may be susceptible to DNA damage and chromothripsis, but their biology in the context of glioblastoma remains unclear. Based on a challenging index case of GBM with mild hypercellularity, Creutzfeldt astrocytes, and granular mitoses on biopsy, we searched our archives for additional cases with similar histopathologic features. We identified 13 cases, reviewed their clinico-radiologic and pathologic features, and examined them for recurrent genetic alterations via NGS (9 cases) and for evidence of DNA damage by immunohistochemistry for DNA repair and chromatin remodeling proteins. We found that Creutzfeldt cell-rich GBMs were IDH-wildtype with no recurring genetic alterations. To test our hypothesis that micronuclei demonstrate loss of DNA repair or chromatin remodeling proteins, we examined the expression of various proteins (MDM2, p53, MLH1, MSH2, PMS2, MSH6, ATRX, INI1, SATB2, Ki67, pHH3) in Creutzfeldt cell rich-GBM. There was intact expression of DNA repair and chromatin remodeling proteins, with accumulation of p53 and reduced MDM2 expression within micronuclei. In contrast, granular mitoses showed pHH3 expression, confirming these cells are undergoing mitotic division, with no accumulation of p53 and reduced expression of DNA repair proteins. Our results emphasize that Creutzfeldt cells are part of the morphologic spectrum of IDH-wildtype glioblastoma. We did not find a role for DNA damage in the generation of Creutzfeldt cells, as both DNA repair and chromatin remodeling protein expression was retained in these cells.
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Affiliation(s)
- Leomar Y. Ballester
- Department of Pathology and Genomic MedicineHouston Methodist HospitalHoustonTX
- Department of Pathology and Laboratory Medicine, Department of NeurosurgeryUniversity of Texas Health Science CenterHoustonTX
| | - Zain Boghani
- Department of NeurosurgeryHouston Methodist HospitalHoustonTX
| | - David S. Baskin
- Department of NeurosurgeryHouston Methodist HospitalHoustonTX
- Weill Cornel Medical CollegeNew YorkNY
- Houston Methodist Research Institute, Institute of Academic MedicineHoustonTX
| | - Gavin W. Britz
- Department of NeurosurgeryHouston Methodist HospitalHoustonTX
- Weill Cornel Medical CollegeNew YorkNY
- Houston Methodist Research Institute, Institute of Academic MedicineHoustonTX
| | - Randall Olsen
- Department of Pathology and Genomic MedicineHouston Methodist HospitalHoustonTX
- Weill Cornel Medical CollegeNew YorkNY
- Houston Methodist Research Institute, Institute of Academic MedicineHoustonTX
| | - Gregory N. Fuller
- Department of PathologyUniversity of Texas MD Anderson Cancer CenterHoustonTX
| | - Suzanne Z. Powell
- Department of Pathology and Genomic MedicineHouston Methodist HospitalHoustonTX
- Weill Cornel Medical CollegeNew YorkNY
- Houston Methodist Research Institute, Institute of Academic MedicineHoustonTX
| | - Matthew D. Cykowski
- Department of Pathology and Genomic MedicineHouston Methodist HospitalHoustonTX
- Weill Cornel Medical CollegeNew YorkNY
- Houston Methodist Research Institute, Institute of Academic MedicineHoustonTX
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31
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Gilbert AR, Chévez-Barrios P, Cykowski MD. Perineurial-like Cells and EMA Expression in the Suprachoroidal Region of the Human Eye. J Histochem Cytochem 2018; 66:367-375. [PMID: 29446690 PMCID: PMC5958356 DOI: 10.1369/0022155418756308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/02/2018] [Indexed: 11/22/2022] Open
Abstract
The suprachoroidal region of the eye comprises vascular channels, melanocytes, and thin fibroblasts with elongated cytoplasm that are positioned directly adjacent to the densely collagenous sclera. Morphological similarities between these suprachoroidal fibroblasts and arachnoid cells and perineurial cells have been recognized, but whether these fibroblasts have a perineurial cell-like immunophenotype is not known. To further examine the relationship of these three cell types, we investigated the comparative expression of epithelial membrane antigen (EMA), the tight junction protein claudin-1, glucose transporter-1 (Glut-1), and CD34 in suprachoroidal fibroblasts, arachnoid of the optic nerve sheath, and perineurium of ciliary nerves in eight human eye specimens. Granular, diffuse, and cytoplasmic EMA expression was seen in suprachoroidal fibroblasts, but this was not contiguous with the similar pattern of EMA expression in adjacent perineurium and arachnoid. CD34 expression in suprachoroidal fibroblasts was also seen, similar to arachnoid and perineurium. Claudin-1 and Glut-1 were not consistently expressed in suprachoroidal fibroblasts, distinguishing them from perineurial cells in particular and suggesting that these fibroblasts do not arise directly from adjacent arachnoid or perineurium. Nonetheless, the overlapping morphology and protein expression suggest phenotypic similarities in these cells that protect and support adjacent retina, optic nerve, and peripheral nerve.
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Affiliation(s)
- Andrea R. Gilbert
- Department of Pathology, UT Health San Antonio,
San Antonio, Texas
- Department of Pathology and Genomic Medicine,
Houston Methodist Hospital, Houston, Texas
| | - Patricia Chévez-Barrios
- Department of Pathology and Genomic Medicine,
Houston Methodist Hospital, Houston, Texas
- Department of Ophthalmology, Blanton Eye
Institute, Houston Methodist Hospital, Houston, Texas
- Departments of Pathology and Laboratory
Medicine, Weill Cornell Medicine, New York City, New York
- Ophthalmology, Weill Cornell Medicine, New York
City, New York
| | - Matthew D. Cykowski
- Department of Pathology and Genomic Medicine,
Houston Methodist Hospital, Houston, Texas
- Departments of Pathology and Laboratory
Medicine, Weill Cornell Medicine, New York City, New York
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Cykowski MD, Powell SZ, Appel JW, Arumanayagam AS, Rivera AL, Appel SH. Phosphorylated TDP-43 (pTDP-43) aggregates in the axial skeletal muscle of patients with sporadic and familial amyotrophic lateral sclerosis. Acta Neuropathol Commun 2018; 6:28. [PMID: 29653597 PMCID: PMC5899326 DOI: 10.1186/s40478-018-0528-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023] Open
Abstract
Muscle atrophy with weakness is a core feature of amyotrophic lateral sclerosis (ALS) that has long been attributed to motor neuron loss alone. However, several studies in ALS patients, and more so in animal models, have challenged this assumption with the latter providing direct evidence that muscle can play an active role in the disease. Here, we examined the possible role of cell autonomous pathology in 148 skeletal muscle samples from 57 ALS patients, identifying phosphorylated TAR DNA-binding protein (pTDP-43) inclusions in the muscle fibers of 19 patients (33.3%) and 24 tissue samples (16.2% of specimens). A muscle group-specific difference was identified with pTDP-43 pathology being significantly more common in axial (paraspinous, diaphragm) than appendicular muscles (P = 0.0087). This pathology was not significantly associated with pertinent clinical, genetic (c9ALS) or nervous system pathologic data, suggesting it is not limited to any particular subgroup of ALS patients. Among 25 non-ALS muscle samples, pTDP-43 inclusions were seen only in the autophagy-related disorder inclusion body myositis (IBM) (n = 4), where they were more diffuse than in positive ALS samples (P = 0.007). As in IBM samples, pTDP-43 aggregates in ALS were p62/ sequestosome-1-positive, potentially indicating induction of autophagy. Phospho-TDP-43-positive ALS and IBM samples also showed significant up-regulation of TARDBP and SQSTM1 expression. These findings implicate axial skeletal muscle as an additional site of pTDP-43 pathology in some ALS patients, including sporadic and familial cases, which is deserving of further investigation.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA.
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA.
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Joan W Appel
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Anithachristy S Arumanayagam
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Stanley H Appel
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
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Nelson PT, Abner EL, Patel E, Anderson S, Wilcock DM, Kryscio RJ, Van Eldik LJ, Jicha GA, Gal Z, Nelson RS, Nelson BG, Gal J, Azam MT, Fardo DW, Cykowski MD. The Amygdala as a Locus of Pathologic Misfolding in Neurodegenerative Diseases. J Neuropathol Exp Neurol 2018; 77:2-20. [PMID: 29186501 DOI: 10.1093/jnen/nlx099] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
Over the course of most common neurodegenerative diseases the amygdala accumulates pathologically misfolded proteins. Misfolding of 1 protein in aged brains often is accompanied by the misfolding of other proteins, suggesting synergistic mechanisms. The multiplicity of pathogenic processes in human amygdalae has potentially important implications for the pathogenesis of Alzheimer disease, Lewy body diseases, chronic traumatic encephalopathy, primary age-related tauopathy, and hippocampal sclerosis, and for the biomarkers used to diagnose those diseases. Converging data indicate that the amygdala may represent a preferential locus for a pivotal transition from a relatively benign clinical condition to a more aggressive disease wherein multiple protein species are misfolded. Thus, understanding of amygdalar pathobiology may yield insights relevant to diagnoses and therapies; it is, however, a complex and imperfectly defined brain region. Here, we review aspects of amygdalar anatomy, connectivity, vasculature, and pathologic involvement in neurodegenerative diseases with supporting data from the University of Kentucky Alzheimer's Disease Center autopsy cohort. Immunohistochemical staining of amygdalae for Aβ, Tau, α-synuclein, and TDP-43 highlight the often-coexisting pathologies. We suggest that the amygdala may represent an "incubator" for misfolded proteins and that it is possible that misfolded amygdalar protein species are yet to be discovered.
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Affiliation(s)
- Peter T Nelson
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Erin L Abner
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Ela Patel
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Sonya Anderson
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Donna M Wilcock
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Richard J Kryscio
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Linda J Van Eldik
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Gregory A Jicha
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Zsombor Gal
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Ruth S Nelson
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Bela G Nelson
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Jozsef Gal
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Md Tofial Azam
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - David W Fardo
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Matthew D Cykowski
- Division of Neuropathology; Sanders-Brown Center on Aging; Department of Pathology; Department of Epidemiology; Department of Physiology; Department of Statistics; Department of Neurology; Department of Neuroscience; Department of Molecular and Cellular Biochemistry; Department of Biostatistics, University of Kentucky, Lexington, Kentucky; and Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
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Abstract
Differentiating demyelinating conditions from neoplastic conditions can pose a significant challenge. There are a number of reports in the literature of large ring-enhancing, space-occupying lesions that were initially considered neoplastic or infectious but, on further review, were deemed demyelinating. Creutzfeldt-Peters cells (CPC) are reactive astrocytes with fragmented nuclear inclusions that are routinely seen in multiple sclerosis (MS) and generally exclude the diagnosis of glioblastoma (GB). The patient is a 78-year-old man with a history of prostate cancer, which was treated with radiation therapy, who presented with altered mental status. A magnetic resonance imaging (MRI) scan of the brain revealed a 4.6 x 3.1 cm mass lesion in the right posterior temporal lobe with minimal mass effect and heterogeneous contrast enhancement. The patient underwent an open biopsy of the mass, which on histology was rich with Creutzfeldt-Peters cells. Frozen histology was unclear and full resection of the mass was delayed. A molecular and immunohistochemical analysis confirmed glioblastoma. The patient returned four weeks later for a subtotal resection of the tumor. The case presented demonstrates an example of a challenging diagnosis. Differentiating between demyelinating and neoplastic conditions is critical since the management and prognosis differ greatly. More importantly, we present a case of glioblastoma rich with Creutzfeldt-Peters cells, which has previously not been reported in the literature.
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Affiliation(s)
- Zain Boghani
- Department of Neurological Surgery, Houston Methodist Hospital
| | | | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital
| | - Leomar Y Ballester
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital
| | - Gavin Britz
- Department of Neurological Surgery, Houston Methodist Hospital
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35
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Cykowski MD, Powell SZ, Peterson LE, Appel JW, Rivera AL, Takei H, Chang E, Appel SH. Clinical Significance of TDP-43 Neuropathology in Amyotrophic Lateral Sclerosis. J Neuropathol Exp Neurol 2017; 76:402-413. [PMID: 28521037 PMCID: PMC5901081 DOI: 10.1093/jnen/nlx025] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 01/06/2023] Open
Abstract
To determine the significance of TAR DNA binding protein 43 kDa (TDP-43) pathology in amyotrophic lateral sclerosis (ALS), we examined the whole brains and spinal cords of 57 patients (35 men; 22 women; mean age 63.3 years; 15 patients with c9orf72-associated ALS [c9ALS]). TDP-43 pathologic burden was determined relative to symptom onset site, disease duration, progression rate, cognitive status, and c9ALS status. There was a trend for greater TDP-43 pathologic burden in cognitively impaired patients (p = 0.07), though no association with disease duration or progression rate was seen. Shorter disease duration (p = 0.0016), more severe striatal pathology (p = 0.0029), and a trend toward greater whole brain TDP-43 pathology (p = 0.059) were found in c9ALS. Cluster analysis identified “TDP43-limited,” “TDP43-moderate,” and “TDP43-severe” subgroups. The TDP43-limited group contained more cognitively intact (p = 0.005) and lower extremity onset site (p = 0.019) patients, while other subgroups contained more cognitively impaired patients. We conclude that TDP-43 pathologic burden in ALS is associated with cognitive impairment and c9ALS, but not duration of disease or rate of progression. Further, we demonstrate a subgroup of patients with low TDP-43 burden, lower extremity onset, and intact cognition, which requires further investigation.
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Affiliation(s)
- Matthew D Cykowski
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Suzanne Z Powell
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Leif E Peterson
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Joan W Appel
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Andreana L Rivera
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Hidehiro Takei
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Ellen Chang
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
| | - Stanley H Appel
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX (MDC, SZP, ALR, HT); Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas (SZP, JWA, ALR, HT, SHA); Center for Biostatistics, Houston Methodist Research Institute, Houston, Texas (LP); Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas (JWA, SHA); and Residency Program in the Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California (EC)
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Cykowski MD, Powell SZ, Schulz PE, Takei H, Rivera AL, Jackson RE, Roman G, Jicha GA, Nelson PT. Hippocampal Sclerosis in Older Patients: Practical Examples and Guidance With a Focus on Cerebral Age-Related TDP-43 With Sclerosis. Arch Pathol Lab Med 2017; 141:1113-1126. [PMID: 28467211 DOI: 10.5858/arpa.2016-0469-sa] [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] [Indexed: 12/12/2022]
Abstract
CONTEXT - Autopsy studies of the older population (≥65 years of age), and particularly of the "oldest-old" (≥85 years of age), have identified a significant proportion (∼20%) of cognitively impaired patients in which hippocampal sclerosis is the major substrate of an amnestic syndrome. Hippocampal sclerosis may also be comorbid with frontotemporal lobar degeneration, Alzheimer disease, and Lewy body disease. Until recently, the terms hippocampal sclerosis of aging or hippocampal sclerosis dementia were applied in this context. Recent discoveries have prompted a conceptual expansion of hippocampal sclerosis of aging because (1) cellular inclusions of TAR DNA-binding protein 43 kDa (TDP-43) are frequent; (2) TDP-43 pathology may be found outside hippocampus; and (3) brain arteriolosclerosis is a common, possibly pathogenic, component. OBJECTIVE - To aid pathologists with recent recommendations for diagnoses of common neuropathologies in older persons, particularly hippocampal sclerosis, and highlight the recent shift in diagnostic terminology from HS-aging to cerebral age-related TDP-43 with sclerosis (CARTS). DATA SOURCES - Peer-reviewed literature and 5 autopsy examples that illustrate common age-related neuropathologies, including CARTS, and emphasize the importance of distinguishing CARTS from late-onset frontotemporal lobar degeneration with TDP-43 pathology and from advanced Alzheimer disease with TDP-43 pathology. CONCLUSIONS - In advanced old age, the substrates of cognitive impairment are often multifactorial. This article demonstrates common and frequently comorbid neuropathologic substrates of cognitive impairment in the older population, including CARTS, to aid those practicing in this area of pathology.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Peter T Nelson
- From the Departments of Pathology and Genomic Medicine (Drs Cykowski, Powell, Rivera, and Takei), Internal Medicine (Dr Jackson), and Neurology (Dr Roman), Houston Methodist Hospital, Houston, Texas; the Department of Neurology, University of Texas Health Science Center at Houston (Dr Schulz); the Department of Pathology, Division of Neuropathology (Dr Nelson) and Sanders-Brown Center on Aging (Drs Jicha and Nelson), University of Kentucky, Lexington
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37
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Pinnix CC, Chi L, Jabbour EJ, Milgrom SA, Smith GL, Daver N, Garg N, Cykowski MD, Fuller G, Cachia D, Kamiya-Matsuoka C, Woodman K, Dinardo C, Jain N, Kadia TM, Pemmaraju N, Ohanian M, Konopleva M, Kantarjian HM, Dabaja BS. Dorsal column myelopathy after intrathecal chemotherapy for leukemia. Am J Hematol 2017; 92:155-160. [PMID: 27874212 DOI: 10.1002/ajh.24611] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 01/09/2023]
Abstract
Intrathecal chemotherapy with methotrexate, a folate antagonist, is widely used to treat central nervous system malignancies. The mechanisms underlying methotrexate-induced neurotoxicity are unclear but may be related to increased homocysteine levels. Intrathecal methotrexate-induced myelopathy mimicking subacute combined degeneration, with normal B12 levels, has been documented. We examined treatment and magnetic resonance imaging (MRI) characteristics of 13 patients with leukemia who received intrathecal methotrexate and developed urinary and bowel incontinence, ascending motor weakness, and sensory loss with dorsal column hyperintensity on MRI between 2000 and 2016. Cerebrospinal fluid evaluation was negative for leukemia in all patients and positive for elevated protein in 12 patients. Seven of eight patients with available data had reduced serum folate, increased serum homocysteine, or both, implicating methotrexate as the cause of neurotoxicity. Autopsy of one patient revealed loss of myelinated axons in the posterior columns. These findings suggest that methotrexate neurotoxicity may be mediated by folate antagonism. Awareness and a high index of suspicion of these characteristic clinical and radiographic features in patients who develop myelopathy after intrathecal methotrexate may help to avoid additional neurotoxic therapy in such patients.
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Affiliation(s)
- Chelsea C. Pinnix
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Linda Chi
- Department of Diagnostic Radiology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Elias J. Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Sarah A. Milgrom
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Grace L. Smith
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Naval Daver
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Naveen Garg
- Department of Diagnostic Radiology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Matthew D. Cykowski
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Greg Fuller
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - David Cachia
- Department of Neuro-Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Karin Woodman
- Department of Neuro-Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Courtney Dinardo
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Nitin Jain
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Tapan M. Kadia
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Maro Ohanian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Bouthaina S. Dabaja
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas USA
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Strickland BA, Cachia D, Jalali A, Cykowski MD, Penas-Prado M, Langford LA, Li J, Shah K, Weinberg JS. Spinal Anaplastic Oligodendroglioma With Oligodendrogliomatosis: Molecular Markers and Management: Case Report. Neurosurgery 2016; 78:E466-73. [PMID: 26352098 DOI: 10.1227/neu.0000000000001019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
BACKGROUND AND IMPORTANCE Spinal cord oligodendrogliomas are rare tumors, with a reported incidence varying between 0.8% and 4.7% of all spinal cord tumors and just over 50 cases reported in the literature. Of these, only 9 cases are histologically defined as anaplastic oligodendrogliomas, with few having complete molecular characterization. The diffuse tumor spread that can occur along the subarachnoid space with secondary invasion of the leptomeninges is called oligodendrogliomatosis and is associated with poor outcome. CLINICAL PRESENTATION A 68-year-old man with a history of lumbar stenosis status after lumbar decompression presented with new-onset right lower-extremity weakness. Magnetic resonance imaging demonstrated an intramedullary lesion from T9 to T12. During an attempted diagnostic biopsy, numerous intradural intramedullary lesions not present on magnetic resonance imaging were observed. Tissue biopsy demonstrated a 1p/19q-codeleted anaplastic oligodendroglioma with diffuse oligodendrogliomatosis. Postoperative treatment included 39.2-Gy radiation over 22 fractions from T1 to the bottom of the thecal sac with a boost to the T9-T12 area, the primary site of disease, to a total dose of 43.2 Gy in 24 fractions, followed by adjuvant temozolomide at a dose of 200 mg/m on days 1 to 5 in a 28-day cycle. At the 1-year follow-up, the patient demonstrated moderate neurological improvement. CONCLUSION Management, prognosis, and use of molecular data in the decision-making algorithm for these patients are discussed, together with a review of all cases of primary intradural intramedullary spinal anaplastic oligodendrogliomas reported to date. Our study indicates that the combination of sequential treatment with radiation and temozolomide might provide a favorable outcome in the case of 1p/19q-codeleted spinal anaplastic oligodendrogliomas and that molecular analysis can be beneficial in guiding treatment strategies, although the impact of IDH mutations on these tumors is still unclear.
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Affiliation(s)
- Ben A Strickland
- *Departments of Neurosurgery, ¶Pathology, Section of Neuropathology, ‖Neuro-Oncology, #Radiation Oncology, and **Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas; ‡Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; §Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; ‡‡Current: Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California
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Coon EA, Schmeichel AM, Parisi JE, Cykowski MD, Low PA, Benarroch EE. Medullary neuronal loss is not associated with α-synuclein burden in multiple system atrophy. Mov Disord 2016; 31:1802-1809. [DOI: 10.1002/mds.26798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | - Joseph E. Parisi
- Department of Neurology; Mayo Clinic; Rochester Minnesota USA
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota USA
| | - Matthew D. Cykowski
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas USA
| | - Phillip A. Low
- Department of Neurology; Mayo Clinic; Rochester Minnesota USA
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40
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Nelson PT, Trojanowski JQ, Abner EL, Al-Janabi OM, Jicha GA, Schmitt FA, Smith CD, Fardo DW, Wang WX, Kryscio RJ, Neltner JH, Kukull WA, Cykowski MD, Van Eldik LJ, Ighodaro ET. "New Old Pathologies": AD, PART, and Cerebral Age-Related TDP-43 With Sclerosis (CARTS). J Neuropathol Exp Neurol 2016; 75:482-98. [PMID: 27209644 DOI: 10.1093/jnen/nlw033] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 12/12/2022] Open
Abstract
The pathology-based classification of Alzheimer's disease (AD) and other neurodegenerative diseases is a work in progress that is important for both clinicians and basic scientists. Analyses of large autopsy series, biomarker studies, and genomics analyses have provided important insights about AD and shed light on previously unrecognized conditions, enabling a deeper understanding of neurodegenerative diseases in general. After demonstrating the importance of correct disease classification for AD and primary age-related tauopathy, we emphasize the public health impact of an underappreciated AD "mimic," which has been termed "hippocampal sclerosis of aging" or "hippocampal sclerosis dementia." This pathology affects >20% of individuals older than 85 years and is strongly associated with cognitive impairment. In this review, we provide an overview of current hypotheses about how genetic risk factors (GRN, TMEM106B, ABCC9, and KCNMB2), and other pathogenetic influences contribute to TDP-43 pathology and hippocampal sclerosis. Because hippocampal sclerosis of aging affects the "oldest-old" with arteriolosclerosis and TDP-43 pathologies that extend well beyond the hippocampus, more appropriate terminology for this disease is required. We recommend "cerebral age-related TDP-43 and sclerosis" (CARTS). A detailed case report is presented, which includes neuroimaging and longitudinal neurocognitive data. Finally, we suggest a neuropathology-based diagnostic rubric for CARTS.
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Affiliation(s)
- Peter T Nelson
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC).
| | - John Q Trojanowski
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Erin L Abner
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Omar M Al-Janabi
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Gregory A Jicha
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Frederick A Schmitt
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Charles D Smith
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - David W Fardo
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Wang-Xia Wang
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Richard J Kryscio
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Janna H Neltner
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Walter A Kukull
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Matthew D Cykowski
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Linda J Van Eldik
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Eseosa T Ighodaro
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
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41
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Cykowski MD, Takei H, Baskin DS, Rivera AL, Powell SZ. Epithelial and organ-related marker expression in pituitary adenomas. Neuropathology 2016; 36:354-64. [PMID: 26991787 DOI: 10.1111/neup.12284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 01/04/2023]
Abstract
The histologic expression of epithelial and organ-related immunohistochemical markers in primary sellar region tumors has received little attention to date. This lack of empirical data may lead to mistaken assumptions in the evaluation of sellar region neoplasms. To address this issue, the frequency and specificity of epithelial (cytokeratin 7(CK7), CK20) and organ-related differentiation markers (gross cystic disease fluid protein-15 (GCDFP-15), thyroid transcription factor-1 (TTF-1), Napsin A, paired box 8 (PAX-8), hepatocyte paraffin 1 (HepPar1) and estrogen receptor (ER)) were studied in 40 patients with adenomas comprising five hormonal sub-types. Non-parametric statistical procedures were used to examine associations between marker expression and tumor sub-type. CK7 and CK20 immunoreactivity were seen in 48% and 8% of tumors, respectively, although never in a diffuse pattern. CK20 expression was nearly exclusive to corticotrophs, whereas CK7 frequently highlighted cells with dendritic-type morphology. The specificity of organ-related differentiation markers was 100% (monoclonal Napsin A, GCDFP-15 and TTF-1), 97% (HepPar1 and PAX-8), 90% (polyclonal Napsin A) and 72% (ER); no tumors demonstrated significant co-expression of these organ-related markers with either CK7 or CK20. The first major conclusion of this study is that CK7 staining in adenoma is more frequent than has been previously than has been previously described. CK7 immunoreactive cells often displayed a dendritic-type morphology, including within large macroadenomas, which raises the question as to whether these represent tumor cells with folliculo-stellate cell-type differentiation, as these also have dendritic cell-type morphology and express CK7 in non-neoplastic glands. The second major conclusion, which confirms earlier findings, is that CK20 staining is a very infrequent immunohistochemical finding in adenomas that is virtually limited to corticotrophs and thus is helpful in diagnostic confirmation of that sub-type. The final conclusion is in regard to those features that separate adenomas from sellar region metastases: adenomas do not demonstrate significant expression of TTF-1, monoclonal Napsin A, PAX-8, HepPar1 or GCDFP-15, nor do they exhibit diffuse expression of CK7 and CK20.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Hidehiro Takei
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA.,Houston Methodist Neurologic Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - David S Baskin
- Department of Neurosurgery and Kenneth R Peak Brain and Pituitary Tumor Center, Houston Methodist Hospital, Houston, Texas, USA.,Houston Methodist Neurologic Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA.,Houston Methodist Neurologic Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA.,Houston Methodist Neurologic Institute, Houston Methodist Hospital, Houston, Texas, USA
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42
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Cykowski MD, Takei H, Van Eldik LJ, Schmitt FA, Jicha GA, Powell SZ, Nelson PT. Hippocampal Sclerosis but Not Normal Aging or Alzheimer Disease Is Associated With TDP-43 Pathology in the Basal Forebrain of Aged Persons. J Neuropathol Exp Neurol 2016; 75:397-407. [PMID: 26971127 DOI: 10.1093/jnen/nlw014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Transactivating responsive sequence (TAR) DNA-binding protein 43-kDa (TDP-43) pathology has been described in various brain diseases, but the full anatomical distribution and clinical and biological implications of that pathology are incompletely characterized. Here, we describe TDP-43 neuropathology in the basal forebrain, hypothalamus, and adjacent nuclei in 98 individuals (mean age, 86 years; median final mini-mental state examination score, 27). On examination blinded to clinical and pathologic diagnoses, we identified TDP-43 pathology that most frequently involved the ventromedial basal forebrain in 19 individuals (19.4%). As expected, many of these brains had comorbid pathologies including those of Alzheimer disease (AD), Lewy body disease (LBD), and/or hippocampal sclerosis of aging (HS-Aging). The basal forebrain TDP-43 pathology was strongly associated with comorbid HS-Aging (odds ratio = 6.8, p = 0.001), whereas there was no significant association between basal forebrain TDP-43 pathology and either AD or LBD neuropathology. In this sample, there were some cases with apparent preclinical TDP-43 pathology in the basal forebrain that may indicate that this is an early affected area in HS-Aging. We conclude that TDP-43 pathology in the basal forebrain is strongly associated with HS-Aging. These results raise questions about a specific pathogenetic relationship between basal forebrain TDP-43 and non-HS-Aging comorbid diseases (AD and LBD).
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Affiliation(s)
- Matthew D Cykowski
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky.
| | - Hidehiro Takei
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky
| | - Linda J Van Eldik
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky
| | - Frederick A Schmitt
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky
| | - Gregory A Jicha
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky
| | - Suzanne Z Powell
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky
| | - Peter T Nelson
- From the Department of Pathology and Genomic Medicine (MDC, HT, SZP) and Houston Methodist Neurological Institute (HT, SZP), Houston Methodist Hospital, Houston, Texas; and Sanders-Brown Center on Aging (LJVE, FAS, GAJ, PTN), Department of Anatomy & Neurobiology(LJVE), Department of Neurology(FAS, GAJ), and Division of Neuropathology, Department of Pathology (PTN), University of Kentucky, Lexington, Kentucky
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Cachia D, Kamiya-Matsuoka C, Mandel JJ, Olar A, Cykowski MD, Armstrong TS, Fuller GN, Gilbert MR, De Groot JF. Primary and secondary gliosarcomas: clinical, molecular and survival characteristics. J Neurooncol 2015; 125:401-10. [PMID: 26354773 DOI: 10.1007/s11060-015-1930-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022]
Abstract
Gliosarcoma is classified by the World Health Organization as a variant of glioblastoma. These tumors exhibit biphasic histologic and immunophenotypic features, reflecting both glial and mesenchymal differentiation. Gliosarcomas can be further classified into primary (de novo) tumors, and secondary gliosarcomas, which are diagnosed at recurrence after a diagnosis of glioblastoma. Using a retrospective review, patients seen at MD Anderson Cancer Center between 2004 and 2014 with a pathology-confirmed diagnosis of gliosarcoma were identified. 34 patients with a diagnosis of gliosarcoma seen at the time of initial diagnosis or at recurrence were identified (24 primary gliosarcomas (PGS), 10 secondary gliosarcomas (SGS)). Molecular analysis performed on fourteen patients revealed a high incidence of TP53 mutations and, rarely, EGFR and IDH mutations. Median overall survival (OS) for all patients was 17.5 months from the diagnosis of gliosarcoma, with a progression free survival (PFS) of 6.4 months. Comparing PGS with SGS, the median OS was 24.7 and 8.95 months, respectively (from the time of sarcomatous transformation in the case of SGS). The median OS in SGS patients from the initial diagnosis of GB was 25 months, with a PFS of 10.7 months. Molecular analysis revealed a higher than expected rate of TP53 mutations in GS patients and, typical of primary glioblastoma, IDH mutations were uncommon. Though our data shows improved outcomes for both PGS and SGS when compared to the literature, this is most likely a reflection of selection bias of patients treated on clinical trials at a quaternary center.
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Affiliation(s)
- David Cachia
- Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA.
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jacob J Mandel
- Department of Neurology, Baylor College of Medicine, 6550 Fannin St, Houston, TX, 77030, USA
| | - Adriana Olar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Terri S Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Family Health, The University of Texas Health Science Center School of Nursing, 6901 Bertner Ave, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 82, Bethesda, MD, 20892, USA
| | - John F De Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Cykowski MD, Coon EA, Powell SZ, Jenkins SM, Benarroch EE, Low PA, Schmeichel AM, Parisi JE. Expanding the spectrum of neuronal pathology in multiple system atrophy. Brain 2015; 138:2293-309. [PMID: 25981961 DOI: 10.1093/brain/awv114] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022] Open
Abstract
Multiple system atrophy is a sporadic alpha-synucleinopathy that typically affects patients in their sixth decade of life and beyond. The defining clinical features of the disease include progressive autonomic failure, parkinsonism, and cerebellar ataxia leading to significant disability. Pathologically, multiple system atrophy is characterized by glial cytoplasmic inclusions containing filamentous alpha-synuclein. Neuronal inclusions also have been reported but remain less well defined. This study aimed to further define the spectrum of neuronal pathology in 35 patients with multiple system atrophy (20 male, 15 female; mean age at death 64.7 years; median disease duration 6.5 years, range 2.2 to 15.6 years). The morphologic type, topography, and frequencies of neuronal inclusions, including globular cytoplasmic (Lewy body-like) neuronal inclusions, were determined across a wide spectrum of brain regions. A correlation matrix of pathologic severity also was calculated between distinct anatomic regions of involvement (striatum, substantia nigra, olivary and pontine nuclei, hippocampus, forebrain and thalamus, anterior cingulate and neocortex, and white matter of cerebrum, cerebellum, and corpus callosum). The major finding was the identification of widespread neuronal inclusions in the majority of patients, not only in typical disease-associated regions (striatum, substantia nigra), but also within anterior cingulate cortex, amygdala, entorhinal cortex, basal forebrain and hypothalamus. Neuronal inclusion pathology appeared to follow a hierarchy of region-specific susceptibility, independent of the clinical phenotype, and the severity of pathology was duration-dependent. Neuronal inclusions also were identified in regions not previously implicated in the disease, such as within cerebellar roof nuclei. Lewy body-like inclusions in multiple system atrophy followed the stepwise anatomic progression of Lewy body-spectrum disease inclusion pathology in 25.7% of patients with multiple system atrophy, including a patient with visual hallucinations. Further, the presence of Lewy body-like inclusions in neocortex, but not hippocampal alpha-synuclein pathology, was associated with cognitive impairment (P = 0.002). However, several cases had the presence of isolated Lewy body-like inclusions at atypical sites (e.g. thalamus, deep cerebellar nuclei) that are not typical for Lewy body-spectrum disease. Finally, interregional correlations (rho ≥ 0.6) in pathologic glial and neuronal lesion burden suggest shared mechanisms of disease progression between both discrete anatomic regions (e.g. basal forebrain and hippocampus) and cell types (neuronal and glial inclusions in frontal cortex and white matter, respectively). These findings suggest that in addition to glial inclusions, neuronal pathology plays an important role in the developmental and progression of multiple system atrophy.
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Affiliation(s)
- Matthew D Cykowski
- 1 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin St Houston, Texas, 77030, USA
| | - Elizabeth A Coon
- 2 Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Suzanne Z Powell
- 1 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin St Houston, Texas, 77030, USA
| | - Sarah M Jenkins
- 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Eduardo E Benarroch
- 2 Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Phillip A Low
- 2 Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Ann M Schmeichel
- 2 Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Joseph E Parisi
- 2 Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA 4 Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, USA
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Abstract
OBJECTIVES To report a case of primary rhabdomyosarcoma (RMS) of the pineal gland in an adult, as well as review the literature on this rare entity. METHODS The case is compared with previous reports of similar entities, with emphasis on this patient's characteristics and clinical presentation, investigations, and management. RESULTS Diagnosis of primary RMS of the pineal gland was based on the presence of strap cells and multinucleated myotube-like structures, as well as tumor cell expression of skeletal muscle markers consistent with myogenic differentiation. Multimodality treatment was initiated based on pediatric protocols. Unfortunately, the disease progressed on treatment, and the patient survived only 5 months from diagnosis. CONCLUSIONS Pineal RMS is a rare disease with poor prognosis. Optimal management is unknown but likely to involve aggressive multimodality therapy.
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Affiliation(s)
| | - Matthew D. Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Shiv Desai
- Department of Surgery, Straub Clinic & Hospital, Honolulu, HI
| | - Ying Cao
- Department of Pathology, Straub Clinic & Hospital, Honolulu, HI
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Janet Bruner
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ian Okazaki
- Department of Hematology & Oncology, Straub Clinic & Hospital, Honolulu, HI
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Cykowski MD, Takei H, Schulz PE, Appel SH, Powell SZ. TDP-43 pathology in the basal forebrain and hypothalamus of patients with amyotrophic lateral sclerosis. Acta Neuropathol Commun 2014; 2:171. [PMID: 25539830 PMCID: PMC4297460 DOI: 10.1186/s40478-014-0171-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis is a neurodegenerative disease characterized clinically by motor symptoms including limb weakness, dysarthria, dysphagia, and respiratory compromise, and pathologically by inclusions of transactive response DNA-binding protein 43 kDa (TDP-43). Patients with amyotrophic lateral sclerosis also may demonstrate non-motor symptoms and signs of autonomic and energy dysfunction as hypermetabolism and weight loss that suggest the possibility of pathology in the forebrain, including hypothalamus. However, this region has received little investigation in amyotrophic lateral sclerosis. In this study, the frequency, topography, and clinical associations of TDP-43 inclusion pathology in the basal forebrain and hypothalamus were examined in 33 patients with amyotrophic lateral sclerosis: 25 men and 8 women; mean age at death of 62.7 years, median disease duration of 3.1 years (range of 1.3 to 9.8 years). Results TDP-43 pathology was present in 11 patients (33.3%), including components in both basal forebrain (n= 10) and hypothalamus (n= 7). This pathology was associated with non-motor system TDP-43 pathology (Χ2= 17.5, p= 0.00003) and bulbar symptoms at onset (Χ2= 4.04, p= 0.044), but not age or disease duration. Furthermore, TDP-43 pathology in the lateral hypothalamic area was associated with reduced body mass index (W= 11, p= 0.023). Conclusions This is the first systematic demonstration of pathologic involvement of the basal forebrain and hypothalamus in amyotrophic lateral sclerosis. Furthermore, the findings suggest that involvement of the basal forebrain and hypothalamus has significant phenotypic associations in amyotrophic lateral sclerosis, including site of symptom onset, as well as deficits in energy metabolism with loss of body mass index.
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Richardson TE, Lee NE, Cykowski MD, Chang SA, Powell SZ. Necrotizing fasciitis as the initial presentation of disseminated infection with fluconazole-resistant Cryptococcus neoformans. JMM Case Rep 2014; 1:e003608. [PMID: 28663814 PMCID: PMC5415936 DOI: 10.1099/jmmcr.0.003608-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/12/2014] [Indexed: 01/21/2023] Open
Abstract
Introduction: Cryptococcus neoformans is an encapsulated budding yeast that is a common cause of opportunistic infections, rarely giving rise to cellulitis, vasculitis or fasciitis. Necrotizing fasciitis caused by C. neoformans is a rare but serious problem in post-transplant immunosuppression. Case presentation: We report a case of cryptococcal necrotizing fasciitis in the left adductor longus of a patient on immunosuppressive therapy. The patient’s medical history was significant for orthotopic heart transplant secondary to cardiac and systemic amyloidosis (AL type) with subsequent cardiac biopsy demonstrating mild rejection (grade 1R). A thigh muscle biopsy demonstrated numerous encapsulated fungi in the fascia and no evidence of myositis. Cryptococcal antigen was subsequently identified in the patient’s serum and cerebrospinal fluid. The patient progressed to involvement of the central nervous system, left biceps femoris and skin of the left lower leg by fluconazole-resistant C. neoformans. Conclusion: This case illustrates a rare initial presentation of disseminated fluconazole-resistant C. neoformans as an isolated necrotizing fasciitis of the thigh. Necrotizing fungal fasciitis should be considered in immunosuppressed patients with clinical findings of either myositis or cellulitis of a lower extremity.
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Affiliation(s)
- Timothy E Richardson
- Texas College of Osteopathic Medicine and The Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Nathan E Lee
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
| | - Spencer A Chang
- Department of Radiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
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Cykowski MD, Hicks J, Sandberg DI, Olar A, Bridge JA, Greipp PT, Navarro P, Kolodziej S, Bhattacharjee MB. Brain metastasis of crystal-deficient, CD68-positive alveolar soft part sarcoma: ultrastructural features and differential diagnosis. Ultrastruct Pathol 2014; 39:69-77. [PMID: 25268941 DOI: 10.3109/01913123.2014.950778] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/13/2022]
Abstract
We report a case of alveolar soft part sarcoma (ASPS) presenting as an isolated frontal lobe metastasis. The tumor demonstrated little or no immunoreactivity for a broad panel of antibodies yet strong, diffuse immunoreactivity with CD68. On electron microscopy, the characteristic rectangular to rhomboid crystalline inclusions of ASPS were not present. Electron-dense granules resembling peroxisomes were present, sometimes in association with elongated granular structures having a periodic, lattice-like arrangement. Metastatic ASPS was confirmed by demonstration of an ASPSCR1-TFE3 fusion and imaging studies that excluded metastatic Xp11.2 translocation renal cell carcinoma. The primary site was subsequently identified in the lower extremity.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital , Houston, TX , USA
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Ritterhouse LL, Cykowski MD, Hassell LA, Slobodov G, Bane BL. Melanotic Xp11 translocation renal cancer: report of a case with a unique intratumoral sarcoid-like reaction. Diagn Pathol 2014; 9:81. [PMID: 24735727 PMCID: PMC4003493 DOI: 10.1186/1746-1596-9-81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/22/2014] [Indexed: 12/24/2022] Open
Abstract
Background Melanotic Xp11 translocation renal cancer is a rare tumor belonging to the family of microphthalmia-associated transcription factor (MiTF)/transcription factor E (TFE) neoplasms. This tumor family also includes alveolar soft part sarcoma, perivascular epithelioid cell neoplasms, Xp11 translocation renal cell carcinoma, and melanoma. To date, six confirmed melanotic Xp11 translocation cancers (five renal, one ovarian) have been reported in the literature. Case Report Here, we report the clinical, histologic, immunohistochemical, and molecular features of a unique melanotic Xp11 translocation renal cancer arising in a 34-year-old African-American female. Histologically, the tumor was composed of epithelioid tumor cells arranged in a nested pattern. The cells had clear to eosinophilic granular cytoplasm, vesicular nuclear chromatin, and prominent nucleoli. Multifocal intracytoplasmic deposits of granular brown melanin pigment were identified and confirmed by Fontana-Masson stain. An unusual histologic feature, not previously reported in melanotic Xp11 translocation renal cancer, was a sarcoid-like granulomatous reaction consisting of tight epithelioid granulomas with lymphocytic cuffing, numerous giant cells, and calcifications. Nuclear transcription factor E3 expression was identified by immunohistochemistry and TFE3 rearrangement was confirmed by fluorescence in situ hybridization. Additional immunohistochemical findings included immunoreactivity for HMB45, cathepsin K, and progesterone receptor; negative staining was seen with actin, desmin, cytokeratins, epithelial membrane antigen, CD10, vimentin, and PAX-8. The patient is currently free of disease, two years following initial clinicoradiologic presentation and twenty-two months following partial nephrectomy without additional therapy. Conclusion This report further expands the spectrum of morphologic and clinical findings previously described in melanotic Xp11 translocation renal cancer, a distinctive tumor showing overlapping features between Xp11 translocation renal cell carcinoma, melanoma, and perivascular epithelioid cell neoplasms. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7225796341180634
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Affiliation(s)
| | | | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, BMSB 451 940 SL Young Blvd,, Oklahoma City, OK 73104, USA.
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Cykowski MD, Allen RA, Fung KM, Harmon MA, Dunn ST. Pyrosequencing of IDH1 and IDH2 mutations in brain tumors and non-neoplastic conditions. ACTA ACUST UNITED AC 2013; 21:214-20. [PMID: 23111198 DOI: 10.1097/pdm.0b013e31825d802b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The molecular profiling of brain tumors, including testing for MGMT promoter methylation and chromosome 1p/19q deletion, can provide both diagnostic and prognostic information that may guide treatment. Isocitrate dehydrogenase (IDH) mutation testing is a recent addition to this armamentarium of molecular pathology tools that similarly provides both diagnostic (eg, glioma vs. gliosis) and prognostic information. Herein, we describe a pyrosequencing-based approach to IDH1 and IDH2 mutation testing and its application to 139 neoplastic and non-neoplastic central nervous system specimens. Several technical issues encountered in the development of the assay, particularly with regard to the optimization of the sequencing reaction, are described. Mutations in IDH1 codon 132 or IDH2 codon 172 were identified in 31.2% of all screened cases and 46.2% of screened World Health Organization grade I to IV gliomas (n=93), with mutations arising exclusively in grade II to IV oligodendroglial, astrocytic, or mixed oligoastrocytic neoplasms. Examination of the relationship between the mutation status and other pertinent variables demonstrated a significant male predominance among IDH1-mutated gliomas, most notably in grade III to IV astrocytic neoplasms. A significant association between IDH1/IDH2 mutation and 1p/19q deletion was also seen (Kendall τ coefficient=0.26, P=0.018), although several cases with 1p/19q deletion were IDH1/IDH2 wild type.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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