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Cabreira V, Alty J, Antic S, Araújo R, Aybek S, Ball HA, Baslet G, Bhome R, Coebergh J, Dubois B, Edwards M, Filipović SR, Frederiksen KS, Harbo T, Hayhow B, Howard R, Huntley J, Isaacs J, LaFrance WC, Larner AJ, Di Lorenzo F, Main J, Mallam E, Marra C, Massano J, McGrath ER, McWhirter L, Moreira IP, Nobili F, Pennington C, Tábuas-Pereira M, Perez DL, Popkirov S, Rayment D, Rossor M, Russo M, Santana I, Schott J, Scott EP, Taipa R, Tinazzi M, Tomic S, Toniolo S, Tørring CW, Wilkinson T, Frostholm L, Stone J, Carson A. Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study. Eur J Neurol 2024:e16318. [PMID: 38700361 DOI: 10.1111/ene.16318] [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: 12/11/2023] [Revised: 03/18/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. METHODS International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken. RESULTS Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD. CONCLUSIONS Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Sonja Antic
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Selma Aybek
- Neurology, Faculty of Sciences and Medicine, Fribourg University, Fribourg, Switzerland
| | - Harriet A Ball
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rohan Bhome
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Jan Coebergh
- Department of Neurology, St George's University of London, London, UK
| | - Bruno Dubois
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), AP-HP, Brain Institute, Sorbonne University, Paris, France
| | - Mark Edwards
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry Psychology and Neurosciences, Kings College London, London, UK
| | - Saša R Filipović
- University of Belgrade Institute for Medical Research, Belgrade, Serbia
| | - Kristian Steen Frederiksen
- Clinical Trial Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bradleigh Hayhow
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Jeremy Isaacs
- Department of Neurology, St George's University of London, London, UK
| | - William Curt LaFrance
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Francesco Di Lorenzo
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - James Main
- Bristol Dementia Wellbeing Service, Devon Partnership NHS Trust, Bristol, UK
| | | | - Camillo Marra
- Department of Neuroscience, Catholic University of the Sacred Heart, Memory Clinic - Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - João Massano
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Emer R McGrath
- School of Medicine, University of Galway, Galway, Ireland
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Isabel Portela Moreira
- Neurology Department, Private Hospital of Gaia of the Trofa Saúde Group, Vila Nova de Gaia, Portugal
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Catherine Pennington
- Clinical Lecturer, University of Edinburgh, Edinburgh, UK
- Neurology Department, NHS Forth Valley, Larbert, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - David L Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Dane Rayment
- Rosa Burden Centre for Neuropsychiatry, Southmead Hospital, Bristol, UK
| | - Martin Rossor
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Emmi P Scott
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ricardo Taipa
- Neuropathology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Svetlana Tomic
- Department of Neurology, University Hospital Center Osijek, Medical School on University of Osijek, Osijek, Croatia
| | - Sofia Toniolo
- Cognitive Disorder Clinic, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Oliveira da Silva MI, Santejo M, Babcock IW, Magalhães A, Minamide LS, Won SJ, Castillo E, Gerhardt E, Fahlbusch C, Swanson RA, Outeiro TF, Taipa R, Ruff M, Bamburg JR, Liz MA. α-Synuclein triggers cofilin pathology and dendritic spine impairment via a PrP C-CCR5 dependent pathway. Cell Death Dis 2024; 15:264. [PMID: 38615035 PMCID: PMC11016063 DOI: 10.1038/s41419-024-06630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
Cognitive dysfunction and dementia are critical symptoms of Lewy Body dementias (LBD). Specifically, alpha-synuclein (αSyn) accumulation in the hippocampus leading to synaptic dysfunction is linked to cognitive deficits in LBD. Here, we investigated the pathological impact of αSyn on hippocampal neurons. We report that either αSyn overexpression or αSyn pre-formed fibrils (PFFs) treatment triggers the formation of cofilin-actin rods, synapse disruptors, in cultured hippocampal neurons and in the hippocampus of synucleinopathy mouse models and of LBD patients. In vivo, cofilin pathology is present concomitantly with synaptic impairment and cognitive dysfunction. Rods generation prompted by αSyn involves the co-action of the cellular prion protein (PrPC) and the chemokine receptor 5 (CCR5). Importantly, we show that CCR5 inhibition, with a clinically relevant peptide antagonist, reverts dendritic spine impairment promoted by αSyn. Collectively, we detail the cellular and molecular mechanism through which αSyn disrupts hippocampal synaptic structure and we identify CCR5 as a novel therapeutic target to prevent synaptic impairment and cognitive dysfunction in LBD.
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Grants
- R01 AG049668 NIA NIH HHS
- R01 NS105774 NINDS NIH HHS
- R43 AG071064 NIA NIH HHS
- S10 OD025127 NIH HHS
- Applicable Funding Source FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 – Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT - Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project POCI-01-0145-FEDER-028336 (PTDC/MED-NEU/28336/2017); National Funds through FCT – Fundação para a Ciência e a Tecnologia under the project IF/00902/2015; R&D@PhD from Luso-American Development Foundation (FLAD); FLAD Healthcare 2020; and Programme for Cooperation in Science between Portugal and Germany 2018/2019 (FCT/DAAD). Márcia A Liz is supported by CEECINST/00091/2018.
- FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 – Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT - Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project POCI-01-0145-FEDER-028336 (PTDC/MED-NEU/28336/2017); National Funds through FCT – Fundação para a Ciência e a Tecnologia under the project IF/00902/2015; R&D@PhD from Luso-American Development Foundation (FLAD); FLAD Healthcare 2020; and Programme for Cooperation in Science between Portugal and Germany 2018/2019 (FCT/DAAD).
- Generous gifts to the Colorado State University Development Fund (J.R.B) and by the National Institutes on Aging of the National Institutes of Health under award numbers R01AG049668, 1S10OD025127 (J.R.B), and R43AG071064 (J.R.B).
- National Institutes on Aging of the National Institutes of Health under award number RO1NS105774 (R.A.S).
- Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy - EXC 2067/1- 390729940) and SFB1286 (Project B8)
- Generous gifts to the Colorado State University Development Fund (J.R.B) and by the National Institutes on Aging of the National Institutes of Health under award numbers R01AG049668, 1S10OD025127 (J.R.B), R43AG071064 (J.R.B)
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Affiliation(s)
- Marina I Oliveira da Silva
- Neurodegeneration Team, Nerve Regeneration Group, IBMC -Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Porto, Portugal
| | - Miguel Santejo
- Neurodegeneration Team, Nerve Regeneration Group, IBMC -Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Porto, Portugal
| | - Isaac W Babcock
- Department of Biochemistry and Molecular Biology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Ana Magalhães
- Addiction Biology Group, IBMC -Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Porto, Portugal
| | - Laurie S Minamide
- Department of Biochemistry and Molecular Biology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Seok-Joon Won
- Department of Neurology, University of California, San Francisco, CA, 94158, USA
| | - Erika Castillo
- Department of Neurology, University of California, San Francisco, CA, 94158, USA
| | - Ellen Gerhardt
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, 37073, Göttingen, Germany
| | - Christiane Fahlbusch
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, 37073, Göttingen, Germany
| | - Raymond A Swanson
- Department of Neurology, University of California, San Francisco, CA, 94158, USA
| | - Tiago F Outeiro
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, 37073, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, 37077, Göttingen, Germany
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
- Scientific employee with an honorary contract at Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), 37075, Göttingen, Germany
| | - Ricardo Taipa
- Neuropathology Unit, Centro Hospitalar Universitário de Santo António, 4099-001, Porto, Portugal
- Autoimmune and Neuroscience Research Group, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, 4050-313, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, 4050-600, Porto, Portugal
| | - Michael Ruff
- Creative Bio-Peptides, Rockville, MD, 20854, USA
| | - James R Bamburg
- Department of Biochemistry and Molecular Biology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Márcia A Liz
- Neurodegeneration Team, Nerve Regeneration Group, IBMC -Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Porto, Portugal.
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Costa A, Silva C, Taipa R, Gabriel JP, Mendes M. Teaching NeuroImage: Perivascular Radial Enhancement in Neurosarcoidosis. Neurology 2023; 101:e1948-e1949. [PMID: 37643883 PMCID: PMC10663018 DOI: 10.1212/wnl.0000000000207830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- André Costa
- From the Neurology Department (A.C., C.S., J.P.G., M.M.), Trás-os-Montes and Alto Douro Hospital Center, Vila Real; and Santo António Hospital and University Center (R.T.), Porto, Portugal.
| | - Catarina Silva
- From the Neurology Department (A.C., C.S., J.P.G., M.M.), Trás-os-Montes and Alto Douro Hospital Center, Vila Real; and Santo António Hospital and University Center (R.T.), Porto, Portugal
| | - Ricardo Taipa
- From the Neurology Department (A.C., C.S., J.P.G., M.M.), Trás-os-Montes and Alto Douro Hospital Center, Vila Real; and Santo António Hospital and University Center (R.T.), Porto, Portugal
| | - João Paulo Gabriel
- From the Neurology Department (A.C., C.S., J.P.G., M.M.), Trás-os-Montes and Alto Douro Hospital Center, Vila Real; and Santo António Hospital and University Center (R.T.), Porto, Portugal
| | - Michel Mendes
- From the Neurology Department (A.C., C.S., J.P.G., M.M.), Trás-os-Montes and Alto Douro Hospital Center, Vila Real; and Santo António Hospital and University Center (R.T.), Porto, Portugal
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Malaquias MJ, Braz L, Santos Silva C, Damásio J, Jorge A, Lemos JM, Campos CF, Garcez D, Oliveira Santos M, Velon AG, Caetano A, Calejo M, Fernandes P, Rego Â, Castro S, Sousa AP, Cardoso MN, Fernandes M, Pinto MM, Taipa R, Lopes AM, Oliveira J, Magalhães M. Multisystemic RFC1-Related Disorder: Expanding the Phenotype Beyond Cerebellar Ataxia, Neuropathy, and Vestibular Areflexia Syndrome. Neurol Clin Pract 2023; 13:e200190. [PMID: 37674869 PMCID: PMC10479936 DOI: 10.1212/cpj.0000000000200190] [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] [Received: 01/05/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
Background and Objectives The RFC1 spectrum has become considerably expanded as multisystemic features beyond the triad of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) have started to be unveiled, although many still require clinical replication. Here, we aimed to clinically characterize a cohort of RFC1-positive patients by addressing both classic and multisystemic features. In a second part of this study, we prospectively assessed small nerve fibers (SNF) and autonomic function in a subset of these RFC1-related patients. Methods We retrospectively enrolled 67 RFC1-positive patients from multiple neurologic centers in Portugal. All patients underwent full neurologic and vestibular evaluation, as well as neuroimaging and neurophysiologic studies. For SNF and autonomic testing (n = 15), we performed skin biopsies, quantitative sensory testing, sudoscan, sympathetic skin response, heart rate deep breathing, and tilt test. Results Multisystemic features beyond CANVAS were present in 82% of the patients, mainly chronic cough (66%) and dysautonomia (43%). Other features included motor neuron (MN) affection and motor neuropathy (18%), hyperkinetic movement disorders (16%), sleep apnea (6%), REM and non-REM sleep disorders (5%), and cranial neuropathy (5%). Ten patients reported an inverse association between cough and ataxia severity. A very severe epidermal denervation was found in skin biopsies of all patients. Autonomic dysfunction comprised cardiovascular (67%), cardiovagal (54%), and/or sudomotor (50%) systems. Discussion The presence of MN involvement, motor neuropathy, small fiber neuropathy, or extrapyramidal signs should not preclude RFC1 testing in cases of sensory neuronopathy. Indeed, the RFC1 spectrum can overlap not only with multiple system atrophy but also with hereditary motor and sensory neuropathy, hereditary sensory and autonomic neuropathy, and feeding dystonia phenotypes. Some clinical-paraclinical dissociations can pose diagnostic challenges, namely large and small fiber neuropathy and sudomotor dysfunction which are usually subclinical.
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Affiliation(s)
- Maria João Malaquias
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Luis Braz
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Cláudia Santos Silva
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Joana Damásio
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - André Jorge
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - João M Lemos
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Catarina F Campos
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Daniela Garcez
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Miguel Oliveira Santos
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana G Velon
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - André Caetano
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Margarida Calejo
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Preza Fernandes
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ângela Rego
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Sandra Castro
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana P Sousa
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Marcio Neves Cardoso
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Marco Fernandes
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Miguel M Pinto
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ricardo Taipa
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana M Lopes
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Jorge Oliveira
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Marina Magalhães
- Department of Neurology (MJM, LB), Centro Hospitalar Universitário de São João, Porto; Department of Neurology (CSS, CFC, MOS), Centro Hospitalar Universitário Lisboa Norte; Centro de Estudos Egas Moniz (CSS), Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (JD, MCM), Centro Hospitalar Universitário do Porto; Department of Neurology (AJ, JML), Centro Hospitalar Universitário de Coimbra; Department of Neurology (DG), Instituto Português de Oncologia de Lisboa Francisco Gentil; Department of Neurology (AGV), Centro Hospitalar De Trás-Os-Montes e Alto Douro, Vila Real; Department of Neurology (AC, MF), Centro Hospitalar de Lisboa Ocidental; Department of Neurology (MC), Unidade Local de Saúde de Matosinhos, Porto; Department of Cardiology (PF), Centro Hospitalar Universitário Lisboa Central; Department of Otolaryngology, Head and Neck Surgery (ÂR, SC); Department of Neurophysiology (APS, MNC); Neuropathology Unit (MMP, RT), Centro Hospitalar Universitário do Porto; Center for Predictive and Preventive Genetics (CGPP) (AML, JO), Institute for Molecular and Cell Biology (IBMC), Instituto de Investigacão e Inovação em Saúde (i3S), Universidade do Porto; and Department of Neurology (MCM), Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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5
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Carvalho A, Costa C, Pinto M, Taipa R, Gonçalves A, Oliveira ME, Ferreira S, Ribeiro JA. X-Linked Myotubular Myopathy: A Novel Mutation Expanding the Genotypic Spectrum of a Phenotypically Heterogeneous Myopathy. J Pediatr Genet 2023; 12:258-262. [PMID: 37575650 PMCID: PMC10421687 DOI: 10.1055/s-0041-1728745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
X-linked myotubular myopathy (XLMTM), a centronuclear congenital myopathy secondary to pathogenic variants in the MTM1 gene encoding myotubularin, is typically recognized for its classic and severe phenotype which includes neonatal hypotonia, severe muscle weakness, long-term ventilator dependence, markedly delayed gross motor milestones with inability to independently ambulate, and a high neonatal and childhood mortality. However, milder congenital forms of the condition and other phenotypes are recognized. We describe a 6-year-old boy with a mild XLMTM phenotype with independent gait and no respiratory insufficiency even in the neonatal period. The child has a hemizygous novel splice site variant in the MTM1 gene (c.232-25A > T) whose pathogenicity was confirmed by cDNA studies (exon 5 skipping) and muscle biopsy findings. We also compared the phenotype of our patient with the few reported cases that presented a mild XLMTM phenotype and no respiratory distress at birth, and discussed the potential mechanisms underlying this phenotype such as the presence of residual expression of the normal myotubularin transcript.
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Affiliation(s)
- Andreia Carvalho
- Neurology Department, Centro Hospitalar de Vila Nova de Gaia–Espinho, Portugal
| | - Carmen Costa
- Pediatric Neurology Department, Centro de Desenvolvimento da Criança, Hospital Pediátrico de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Pinto
- Neuropathology Unit, Hospital de Santo António - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Hospital de Santo António - Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research In Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ana Gonçalves
- Unit for Multidisciplinary Research In Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Molecular Genetics Unit, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Márcia E. Oliveira
- Unit for Multidisciplinary Research In Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Molecular Genetics Unit, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sofia Ferreira
- Pulmonology Department, Hospital Pediátrico de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Afonso Ribeiro
- Pediatric Neurology Department, Centro de Desenvolvimento da Criança, Hospital Pediátrico de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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6
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Lopes J, Doria H, Taipa R, Samões RF. Hydrocephalus: a rare complication of primary central nervous system vasculitis. BMJ Case Rep 2023; 16:16/4/e253187. [PMID: 37116956 PMCID: PMC10151971 DOI: 10.1136/bcr-2022-253187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Hydrocephalus is a known complication of central nervous system (CNS) vasculitis secondary to infectious diseases. We present an unusual case of primary CNS vasculitis (PCNSV) complicated by communicating hydrocephalus. A patient in their 50s with a few months' history of headache, psychomotor slowing and frequent falls presented with an acute left temporo-parieto-occipital infarction. Angiography revealed multiple arterial irregularities in the anterior circulation bilaterally, CSF was inflammatory and the remaining study was negative, fulfilling criteria for possible PCNSV. One month after successful treatment with corticosteroid, there was worsening of gait, urinary incontinence and neuropsychiatric symptoms. The investigation was remarkable only for active hydrocephalus. An external ventricular shunt was placed, followed by a ventriculoperitoneal shunt, and cyclophosphamide was started with subsequent recovery. Our discussion is that communicating hydrocephalus in PCNSV, due to impaired CSF flow, should be considered on subacute/chronic worsening of patients with PCNSV.
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Affiliation(s)
- Joana Lopes
- Neurology, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Hugo Doria
- Neuroradiology, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
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7
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Moura J, Oliveira V, Sardoeira A, Pinto M, Gelpi E, Taipa R, Santos E. Rapidly Progressive Corticobasal Degeneration Mimicking Brainstem Encephalitis. Mov Disord Clin Pract 2023; 10:300-306. [PMID: 36825044 PMCID: PMC9941924 DOI: 10.1002/mdc3.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/15/2022] [Accepted: 10/29/2022] [Indexed: 12/07/2022] Open
Abstract
Background Corticobasal degeneration (CBD) may have a rapidly progressive (RP) clinical course, mimicking other neurological conditions. Objectives To describe a neuropathologically proven case of RP-CBD in a patient initially diagnosed with immune-mediated brainstem encephalitis. Methods Retrospective data collection from electronic records and authorized video material. Results A 51-year-old man presented with bilateral ptosis, diplopia, and dysphagia. The diagnostic workup was negative for myasthenic syndromes. He progressively developed cognitive dysfunction with frontal release signs and asymmetric parkinsonism. Cerebrospinal fluid evaluation revealed 4 leukocytes/uL, 0.32 g/L proteins, 0.85 g/L glucose, and absent oligoclonal bands. Weakly positive anti-PNMA2 (Ma2/Ta) antibodies were present, and magnetic resonance imaging showed a T2 hyperintensity involving the midbrain and pons. Based on these features, the diagnosis of immune-mediated brainstem encephalitis was considered. The patient did not improve after several cycles of methylprednisolone, intravenous immunoglobulin, and plasma exchange. At 1 year after onset, he developed horizontal and vertical gaze limitation and worsening of the parkinsonism and cognitive dysfunction. By age 53, he was severely disabled, requiring percutaneous gastrostomy for feeding. Anti-IgLON5 was negative. He fulfilled the clinical criteria for probable progressive supranuclear palsy. He died from pneumonia at age 54. The neuropathological examination revealed a 4-repeat tauopathy with features of CBD with extensive involvement of the brainstem. Conclusions RP-CBD may resemble brainstem encephalitis. The severity of brainstem and upper spinal cord pathology in the postmortem examination correlated with the clinical and imaging features.
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Affiliation(s)
- João Moura
- Department of NeurologyCentro Hospitalar Universitário do PortoPortoPortugal
| | - Vanessa Oliveira
- Department of NeurologyCentro Hospitalar Universitário do PortoPortoPortugal
| | - Ana Sardoeira
- Department of NeurologyCentro Hospitalar Universitário do PortoPortoPortugal
| | - Miguel Pinto
- Portuguese Brain Bank, Neuropathology Unit, Department of NeurosciencesCentro Hospitalar Universitário do PortoPortoPortugal
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of NeurologyMedical University of ViennaViennaAustria
| | - Ricardo Taipa
- Portuguese Brain Bank, Neuropathology Unit, Department of NeurosciencesCentro Hospitalar Universitário do PortoPortoPortugal
- UMIB–Unit for Multidisciplinary Research in Biomedicine, ICBAS–School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- ITR–Laboratory for Integrative and Translational Research in Population HealthPortoPortugal
| | - Ernestina Santos
- Department of NeurologyCentro Hospitalar Universitário do PortoPortoPortugal
- UMIB–Unit for Multidisciplinary Research in Biomedicine, ICBAS–School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- ITR–Laboratory for Integrative and Translational Research in Population HealthPortoPortugal
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Martins A, Nadais G, Pinto M, Taipa R, Costa L, Pimenta S. Progressive proximal muscle weakness with subacute onset in an elderly patient: a case report. Rev Neurol 2023; 76:31-34. [PMID: 36544374 PMCID: PMC10364021 DOI: 10.33588/rn.7601.2021276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Statins are some of the most widely prescribed medications. Although statins are generally well tolerated, they can lead to musculoskeletal side effects. Statin-induced necrotizing autoimmune myositis (SINAM) is a rare condition and the prevalence is only 1 per 100,000 people. This disorder is characterized by progressive and severe symmetric muscle weakness, marked elevation of creatine kinase and persistent symptoms despite statin discontinuation. Electromyography commonly shows a nonspecific irritable myopathy pattern indistinguishable from other inflammatory myopathies. Muscle biopsy shows the presence of necrotic fibers, regenerating fibers without significant inflammatory cells and diffuse or focal upregulation of major histocompatibility complex class I expression. The anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies represent a characteristic serological feature of SINAM. CASE REPORT We present a patient who developed progressive muscle weakness after taking simvastatin for the last seven years. At initial presentation, her creatine kinase level was 2,954 U/L and anti-HMGCR antibodies were positive. The biopsy showed a profound myopathic features with numerous necrotic fibers, some regenerating fibers and perimysial inflammatory cell infiltrate, combined with a diffuse overexpression of major histocompatibility complex class I products. She was diagnosed with SINAM, statin was suspended and a high dose of systemic corticosteroids, intravenous immunoglobulin therapy and methotrexate was started. At three-month follow-up, she had significant improvement in muscle strength and creatine kinase level returned to normal. CONCLUSION In this case, exclusion of inflammatory myopathies, metabolic muscle disorders and other neurological diseases is necessary for establishing a reliable diagnosis. In SINAM, simply discontinuing statin is often insufficient and aggressive immunosuppression or immunomodulation therapy is needed to achieve disease remission. This case aims to demonstrate that statins can induce serious muscular diseases that require aggressive immunosuppression.
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Affiliation(s)
- Ana Martins
- Department of RheumatologyDepartment of RheumatologyDepartment of RheumatologyPortoPortugal
- Faculty of Medicine. Universidade do Porto. Porto, PortugalFaculty of MedicineUniversidade do PortoPortoPortugal
| | - Goreti Nadais
- Department of Neurology. Centro Hospitalar Universitário de São JoãoDepartment of NeurologyCentro Hospitalar Universitário de São JoãoPortoPortugal
| | - Miguel Pinto
- Neuropathology Unit. Department of Neurosciences. Centro Hospitalar e Universitário do PortoNeuropathology Unit. Department of NeurosciencesCentro Hospitalar e Universitário do PortoPortoPortugal
| | - Ricardo Taipa
- Neuropathology Unit. Department of Neurosciences. Centro Hospitalar e Universitário do PortoNeuropathology Unit. Department of NeurosciencesCentro Hospitalar e Universitário do PortoPortoPortugal
| | - Lúcia Costa
- Department of RheumatologyDepartment of RheumatologyDepartment of RheumatologyPortoPortugal
| | - Sofia Pimenta
- Department of RheumatologyDepartment of RheumatologyDepartment of RheumatologyPortoPortugal
- Faculty of Medicine. Universidade do Porto. Porto, PortugalFaculty of MedicineUniversidade do PortoPortoPortugal
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Taipa R, Sousa L, Pinto M, Reis I, Rodrigues A, Oliveira P, Melo-Pires M, Coelho T. Neuropathology of central nervous system involvement in TTR amyloidosis. Acta Neuropathol 2023; 145:113-126. [PMID: 36198883 PMCID: PMC9807485 DOI: 10.1007/s00401-022-02501-9] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 01/25/2023]
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a systemic disease caused by the accumulation of misfolded transthyretin (TTR). It usually presents with an adult-onset progressive axonal peripheral neuropathy and cardiomyopathy. In the central nervous system (CNS), variant TTR is produced by the choroid plexus and accumulates in the leptomeninges. CNS symptoms have been increasingly recognized in this population, including transient focal neurological episodes and stroke, particularly in patients with the V30M mutation and longstanding disease. The prevalence, pathophysiology, and progression of CNS involvement remain to be clarified. The present work explores if there is a recognizable sequence of CNS TTR deposition in ATTRv. We studied the topographical and severity distribution of TTR deposition in 16 patients with ATTRv, aged 27-69 years and with a mean disease duration of 10.9 years (range: 3-29). Our results suggest that CNS pathological involvement in V30M ATTRv occurs early in the disease course, probably starting in pre-symptomatic phases, and follows a distinct sequence. Leptomeninges and subarachnoid meningeal vessels are affected earlier, then followed by perforating cortical vessels and subpial deposition, and finally by deposition in the subependymal and basal ganglia vessels near the ependymal lining. Brainstem and spinal cord show early and severe involvement, with amyloid subpial deposition already seen in initial stages. Despite massive superficial amyloid deposition, no parenchymal deposition outside subpial or subependymal regions was found. Additionally, vascular lesions or superficial cortical siderosis were not frequent. Future studies with more patients from different populations and TTR mutations will be important to confirm these findings. Defining stages of TTR pathology in the CNS may be useful to better understand pathogenic mechanisms leading to symptoms and to interpret neuroimaging biomarkers.
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Affiliation(s)
- Ricardo Taipa
- Portuguese Brain Bank, Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal. .,UMIB, Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal. .,Laboratory for Integrative and Translational Research in Population Health, ITR, Porto, Portugal.
| | - Luísa Sousa
- UMIB, Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health, ITR, Porto, Portugal.,Department of Neurology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.,Unidade Corino de Andrade, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Pinto
- Portuguese Brain Bank, Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Inês Reis
- Portuguese Brain Bank, Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Aurora Rodrigues
- Portuguese Brain Bank, Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Pedro Oliveira
- Laboratory for Integrative and Translational Research in Population Health, ITR, Porto, Portugal.,Epidemiological Research Unit (EPIUnit), ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Manuel Melo-Pires
- Portuguese Brain Bank, Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Porto, Portugal
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10
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Nelson A, Russell LL, Peakman G, Convery RS, Bouzigues A, Greaves CV, Bocchetta M, Cash DM, van Swieten JC, Jiskoot L, Moreno F, Sanchez-Valle R, Laforce R, Graff C, Masellis M, Tartaglia MC, Rowe JB, Borroni B, Finger E, Synofzik M, Galimberti D, Vandenberghe R, de Mendonça A, Butler CR, Gerhard A, Ducharme S, Le Ber I, Santana I, Pasquier F, Levin J, Otto M, Sorbi S, Rohrer JD, Almeida MR, Anderl‐Straub S, Andersson C, Antonell A, Archetti S, Arighi A, Balasa M, Barandiaran M, Bargalló N, Bartha R, Bender B, Benussi A, Bertoux M, Bertrand A, Bessi V, Black S, Bocchetta M, Borrego‐Ecija S, Bras J, Brice A, Bruffaerts R, Camuzat A, Cañada M, Cantoni V, Caroppo P, Cash D, Castelo‐Branco M, Colliot O, Cope T, Deramecourt V, Arriba M, Di Fede G, Díez A, Duro D, Fenoglio C, Ferrari C, Ferreira CB, Fox N, Freedman M, Fumagalli G, Funkiewiez A, Gabilondo A, Gasparotti R, Gauthier S, Gazzina S, Giaccone G, Gorostidi A, Greaves C, Guerreiro R, Heller C, Hoegen T, Indakoetxea B, Jelic V, Karnath H, Keren R, Kuchcinski G, Langheinrich T, Lebouvier T, Leitão MJ, Lladó A, Lombardi G, Loosli S, Maruta C, Mead S, Meeter L, Miltenberger G, Minkelen R, Mitchell S, Moore K, Nacmias B, Nelson A, Öijerstedt L, Olives J, Ourselin S, Padovani A, Panman J, Papma JM, Pijnenburg Y, Polito C, Premi E, Prioni S, Prix C, Rademakers R, Redaelli V, Rinaldi D, Rittman T, Rogaeva E, Rollin A, Rosa‐Neto P, Rossi G, Rossor M, Santiago B, Saracino D, Sayah S, Scarpini E, Schönecker S, Seelaar H, Semler E, Shafei R, Shoesmith C, Swift I, Tábuas‐Pereira M, Tainta M, Taipa R, Tang‐Wai D, Thomas DL, Thompson P, Thonberg H, Timberlake C, Tiraboschi P, Todd E, Van Damme P, Vandenbulcke M, Veldsman M, Verdelho A, Villanua J, Warren J, Wilke C, Wlasich E, Zetterberg H, Zulaica M. The CBI-R detects early behavioural impairment in genetic frontotemporal dementia. Ann Clin Transl Neurol 2022; 9:644-658. [PMID: 35950369 PMCID: PMC9082390 DOI: 10.1002/acn3.51544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Behavioural dysfunction is a key feature of genetic frontotemporal dementia (FTD) but validated clinical scales measuring behaviour are lacking at present. METHODS We assessed behaviour using the revised version of the Cambridge Behavioural Inventory (CBI-R) in 733 participants from the Genetic FTD Initiative study: 466 mutation carriers (195 C9orf72, 76 MAPT, 195 GRN) and 267 non-mutation carriers (controls). All mutation carriers were stratified according to their global CDR plus NACC FTLD score into three groups: asymptomatic (CDR = 0), prodromal (CDR = 0.5) and symptomatic (CDR = 1+). Mixed-effects models adjusted for age, education, sex and family clustering were used to compare between the groups. Neuroanatomical correlates of the individual domains were assessed within each genetic group. RESULTS CBI-R total scores were significantly higher in all CDR 1+ mutation carrier groups compared with controls [C9orf72 mean 70.5 (standard deviation 27.8), GRN 56.2 (33.5), MAPT 62.1 (36.9)] as well as their respective CDR 0.5 groups [C9orf72 13.5 (14.4), GRN 13.3 (13.5), MAPT 9.4 (10.4)] and CDR 0 groups [C9orf72 6.0 (7.9), GRN 3.6 (6.0), MAPT 8.5 (13.3)]. The C9orf72 and GRN 0.5 groups scored significantly higher than the controls. The greatest impairment was seen in the Motivation domain for the C9orf72 and GRN symptomatic groups, whilst in the symptomatic MAPTgroup, the highest-scoring domains were Stereotypic and Motor Behaviours and Memory and Orientation. Neural correlates of each CBI-R domain largely overlapped across the different mutation carrier groups. CONCLUSIONS The CBI-R detects early behavioural change in genetic FTD, suggesting that it could be a useful measure within future clinical trials.
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Affiliation(s)
- Annabel Nelson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Georgia Peakman
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Arabella Bouzigues
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Caroline V Greaves
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | | | - Lize Jiskoot
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia Universitary Hospital, San Sebastian, Spain.,Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Québec, Canada
| | - Caroline Graff
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Bioclinicum, Karolinska Institutet, Solna, Sweden.,Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE, Tübingen, Germany
| | - Daniela Galimberti
- Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy.,University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Neurology Service, University Hospitals Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK.,Department of Brain Sciences, Imperial College London, London, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, QC, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France.,Département de Neurologie, Centre de référence des démences rares ou précoces, IM2A, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France.,Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France.,Reference Network for Rare Neurological Diseases (ERN-RND), European Union
| | - Isabel Santana
- University Hospital of Coimbra (HUC), Neurology Service, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Florence Pasquier
- Univ Lille, Lille, France.,Inserm 1172, Lille, France.,CHU, CNR-MAJ, Labex Distalz, LiCEND Lille, Lille, France
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Sandro Sorbi
- Department of Neurofarba, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
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Corrà MF, Vila-Chã N, Sardoeira A, Hansen C, Sousa AP, Reis I, Sambayeta F, Damásio J, Calejo M, Schicketmueller A, Laranjinha I, Salgado P, Taipa R, Magalhães R, Correia M, Maetzler W, Maia LF. Peripheral neuropathy in Parkinson's disease: prevalence and functional impact on gait and balance. Brain 2022; 146:225-236. [PMID: 35088837 PMCID: PMC9825570 DOI: 10.1093/brain/awac026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 01/12/2023] Open
Abstract
Peripheral neuropathy is a common problem in patients with Parkinson's disease. Peripheral neuropathy's prevalence in Parkinson's disease varies between 4.8-55%, compared with 9% in the general population. It remains unclear whether peripheral neuropathy leads to decreased motor performance in Parkinson's disease, resulting in impaired mobility and increased balance deficits. We aimed to determine the prevalence and type of peripheral neuropathy in Parkinson's disease patients and evaluate its functional impact on gait and balance. A cohort of consecutive Parkinson's disease patients assessed by movement disorders specialists based on the UK Brain Bank criteria underwent clinical, neurophysiological (nerve conduction studies and quantitative sensory testing) and neuropathological (intraepidermal nerve fibre density in skin biopsy punches) evaluation to characterize the peripheral neuropathy type and aetiology using a cross-sectional design. Gait and balance were characterized using wearable health-technology in OFF and ON medication states, and the main parameters were extracted using validated algorithms. A total of 99 Parkinson's disease participants with a mean age of 67.2 (±10) years and mean disease duration of 6.5 (±5) years were assessed. Based on a comprehensive clinical, neurophysiological and neuropathological evaluation, we found that 40.4% of Parkinson's disease patients presented peripheral neuropathy, with a predominance of small fibre neuropathy (70% of the group). In the OFF state, the presence of peripheral neuropathy was significantly associated with shorter stride length (P = 0.029), slower gait speed (P = 0.005) and smaller toe-off angles (P = 0.002) during straight walking; significantly slower speed (P = 0.019) and smaller toe-off angles (P = 0.007) were also observed during circular walking. In the ON state, the above effects remained, albeit moderately reduced. With regard to balance, significant differences between Parkinson's disease patients with and without peripheral neuropathy were observed in the OFF medication state during stance with closed eyes on a foam surface. In the ON states, these differences were no longer observable. We showed that peripheral neuropathy is common in Parkinson's disease and influences gait and balance parameters, as measured with mobile health-technology. Our study supports that peripheral neuropathy recognition and directed treatment should be pursued in order to improve gait in Parkinson's disease patients and minimize balance-related disability, targeting individualized medical care.
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Affiliation(s)
- Marta Francisca Corrà
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal,Institute for Research and Innovation in Health (i3s), University of Porto, 4200-135 Porto, Portugal
| | - Nuno Vila-Chã
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Ana Sardoeira
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Clint Hansen
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Ana Paula Sousa
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Inês Reis
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Firmina Sambayeta
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Joana Damásio
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Margarida Calejo
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Andreas Schicketmueller
- Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany,HASOMED GmbH, 39114 Magdeburg, Germany
| | - Inês Laranjinha
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Paula Salgado
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Ricardo Taipa
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Manuel Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Luís F Maia
- Correspondence to: Luís F. Maia Department of Neurology Centro Hospitalar Universitario do Porto (CHUPorto) Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal E-mail:
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Moura J, Duarte S, Sardoeira A, Neves-Maia J, Damásio J, Taipa R, Carneiro P, Neves E, Campar A, Santos E. Anti-NMDAr Encephalitis and COVID-19 in a Patient With Systemic pANCA-Vasculitis and Recurrent Varicella Zoster Infection. Neurohospitalist 2022; 12:383-387. [PMID: 35401915 PMCID: PMC8977756 DOI: 10.1177/19418744211063709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction There is a complex interplay between systemic autoimmunity,
immunosuppression, and infections. Any or all of these can result in
neurologic manifestations, requiring diligence on the part of
neurologists. Case report We herein report a case of a patient on immunosuppressive treatment for a
vasculitis that resulted in zoster meningoencephalitis. This was further
complicated by the development of anti-NMDAr encephalitis, the etiology of
which is undetermined and further discussed in this paper. The patient
eventually developed COVID-19 during hospitalization, succumbing to the
respiratory infection. Conclusion This case emphasizes that post-infectious autoimmune disorders are becoming
increasingly recognized and that they should still be considered in patients
who are on immunosuppression. Practitioners should be aware of the complex
relationship between autoimmunity and immunosuppression and consider both
throughout the disease course.
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Affiliation(s)
- João Moura
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sara Duarte
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Sardoeira
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Neves-Maia
- Department of Internal Medicine, Centro Hospitalar Unniversitário do Porto, Porto, Portugal
| | - Joana Damásio
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
| | - Ricardo Taipa
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paula Carneiro
- Immunology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Esmeralda Neves
- Immunology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Campar
- Department of Internal Medicine, Centro Hospitalar Unniversitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ernestina Santos
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
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13
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Abstract
T2-FLAIR mismatch sign has been advocated to be 100% specific for IDH-mutant 1p/19q non-codeleted gliomas (diffuse astrocytomas). However, false positives have been reported in recent works. Loose application of the criteria may lead to erroneous classification, especially by non-trained neuroradiologists. In this pictorial essay, we aim to bring attention to the need for strict criteria for the application of T2-FLAIR mismatch sign and to discuss the potential pitfalls in the application of these criteria. For that, a series of adult brain tumour cases are presented to demonstrate how to apply this radiological sign in the clinical practice.
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Affiliation(s)
- Catarina Pinto
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carolina Noronha
- Neurosurgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cristina Ramos
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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14
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Martins EP, Gonçalves CS, Pojo M, Carvalho R, Ribeiro AS, Miranda‐Gonçalves V, Taipa R, Pardal F, Pinto AA, Custódia C, Faria CC, Baltazar F, Sousa N, Paredes J, Costa BM. Cadherin‐3
is a novel oncogenic biomarker with prognostic value in glioblastoma. Mol Oncol 2021; 16:2611-2631. [PMID: 34919784 PMCID: PMC9297769 DOI: 10.1002/1878-0261.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022] Open
Abstract
Glioblastoma (GBM) is the most common and malignant primary brain tumor in adults. The prognosis of patients is very poor, with a median overall survival of ~ 15 months after diagnosis. Cadherin‐3 (also known as P‐cadherin), a cell–cell adhesion molecule encoded by the CDH3 gene, is deregulated in several cancer types, but its relevance in GBM is unknown. In this study, we investigated the functional roles, the associated molecular signatures, and the prognostic value of CDH3/P‐cadherin in this highly malignant brain tumor. CDH3/P‐cadherin mRNA and protein levels were evaluated in human glioma samples. Knockdown and overexpression models of P‐cadherin in GBM were used to evaluate its functional role in vitro and in vivo. CDH3‐associated gene signatures were identified by enrichment analyses and correlations. The impact of CDH3 in the survival of GBM patients was assessed in independent cohorts using both univariable and multivariable models. We found that P‐cadherin protein is expressed in a subset of gliomas, with an increased percentage of positive samples in grade IV tumors. Concordantly, CDH3 mRNA levels in glioma samples from The Cancer Genome Atlas (TCGA) database are increased in high‐grade gliomas. P‐cadherin displays oncogenic functions in multiple knockdown and overexpression GBM cell models by affecting cell viability, cell cycle, cell invasion, migration, and neurosphere formation capacity. Genes that were positively correlated with CDH3 are enriched for oncogenic pathways commonly activated in GBM. In vivo, GBM cells expressing high levels of P‐cadherin generate larger subcutaneous tumors and cause shorter survival of mice in an orthotopic intracranial model. Concomitantly, high CDH3 expression is predictive of shorter overall survival of GBM patients in independent cohorts. Together, our results show that CDH3/P‐cadherin expression is associated with aggressiveness features of GBM and poor patient prognosis, suggesting that it may be a novel therapeutic target for this deadly brain tumor.
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Affiliation(s)
- Eduarda P. Martins
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Céline S. Gonçalves
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Marta Pojo
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Rita Carvalho
- i3S – Instituto de Investigação e Inovação em Saúde Universidade do Porto Rua Alfredo Allen 208, 4200‐135 Porto Portugal
| | - Ana S. Ribeiro
- i3S – Instituto de Investigação e Inovação em Saúde Universidade do Porto Rua Alfredo Allen 208, 4200‐135 Porto Portugal
| | - Vera Miranda‐Gonçalves
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Ricardo Taipa
- Neuropathology Unit Department of Neurosciences Centro Hospitalar do Porto Porto Portugal
| | - Fernando Pardal
- Department of Pathology, Hospital de Braga 4710‐243 Braga Portugal
| | - Afonso A. Pinto
- Department of Neurosurgery, Hospital de Braga 4710‐243 Braga Portugal
| | - Carlos Custódia
- Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
| | - Cláudia C. Faria
- Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
- Neurosurgery Department Hospital de Santa Maria Centro Hospitalar Lisboa Norte (CHLN) Lisbon Portugal
| | - Fátima Baltazar
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Joana Paredes
- i3S – Instituto de Investigação e Inovação em Saúde Universidade do Porto Rua Alfredo Allen 208, 4200‐135 Porto Portugal
- Faculty of Medicine University of Porto Portugal
| | - Bruno M. Costa
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Campus Gualtar 4710‐057 Braga Portugal
- ICVS/3B’s ‐ PT Government Associate Laboratory Braga/Guimarães Portugal
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15
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Rodrigues P, Soares AR, Taipa R, Ferreira S, Reis H. Left Ventricular Hypertrophy: One Phenotype, Two Hypotheses, Three Lessons. Arq Bras Cardiol 2021; 117:1056-1059. [PMID: 34817018 PMCID: PMC8682104 DOI: 10.36660/abc.20210103] [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: 02/09/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Ana Rita Soares
- Centro Hospitalar Universitário do Porto EPE, Porto - Portugal
| | - Ricardo Taipa
- Centro Hospitalar Universitário do Porto EPE, Porto - Portugal
| | - Sofia Ferreira
- Centro Hospitalar Universitário do Porto EPE, Porto - Portugal
| | - Hipólito Reis
- Centro Hospitalar Universitário do Porto EPE, Porto - Portugal
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16
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Sousa L, Coelho T, Taipa R. CNS Involvement in Hereditary Transthyretin Amyloidosis. Neurology 2021; 97:1111-1119. [PMID: 34663645 DOI: 10.1212/wnl.0000000000012965] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv amyloidosis) is predominantly a disease of the peripheral nerves, heart, kidney and eye. CNS involvement has been a marginal issue in research and the clinical setting, until recently. Growing evidence shows that leptomeningeal amyloid accumulation is frequent and present from early stages of ATTRv amyloidosis. Several recent studies show CNS symptoms arise as a common late complication in patients with the V30M mutation, after at least 14 years of symptomatic peripheral nerve disease. Conversely, in non-V30M patients, there are several descriptions, mostly case reports, of patients presenting with severe phenotypes of ocular and CNS dysfunction (oculoleptomeningeal amyloidosis), with little systemic involvement. This phenotype is found in rare families worldwide, associated with at least 14 mutations.In both patients with late and early onset CNS dysfunction, symptoms include transient focal neurological episodes, haemorrhagic and ischemic stroke, cognitive decline and cranial nerve dysfunction. Pathologically, there is severe amyloid deposition in the leptomeninges and cerebral amyloid angiopathy of leptomeningeal and penetrating vessels. These amyloid aggregates are formed mostly by CSF produced TTR and seem resistant to the available ATTRv therapies that increase the stability or reduce the production of plasma TTR. This indicates that CNS involvement will become a meaningful issue in patient management in upcoming years.
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Affiliation(s)
- Luísa Sousa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto .,Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira
| | - Teresa Coelho
- Unidade Corino de Andrade, Centro Hospitalar Universitário do Porto, Porto
| | - Ricardo Taipa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto.,Portuguese Brain Bank, Neuropathology Unit, Centro Hospitalar Universitário do Porto, Porto
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17
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Noronha C, Ribeiro AS, Taipa R, Castro DS, Reis J, Faria C, Paredes J. Cadherin Expression and EMT: A Focus on Gliomas. Biomedicines 2021; 9:biomedicines9101328. [PMID: 34680444 PMCID: PMC8533397 DOI: 10.3390/biomedicines9101328] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 12/13/2022] Open
Abstract
Cadherins are calcium-binding proteins with a pivotal role in cell adhesion and tissue homeostasis. The cadherin-dependent mechanisms of cell adhesion and migration are exploited by cancer cells, contributing to tumor invasiveness and dissemination. In particular, cadherin switch is a hallmark of epithelial to mesenchymal transition, a complex development process vastly described in the progression of most epithelial cancers. This is characterized by drastic changes in cell polarity, adhesion, and motility, which lead from an E-cadherin positive differentiated epithelial state into a dedifferentiated mesenchymal-like state, prone to metastization and defined by N-cadherin expression. Although vastly explored in epithelial cancers, how these mechanisms contribute to the pathogenesis of other non-epithelial tumor types is poorly understood. Herein, the current knowledge on cadherin expression in normal development in parallel to tumor pathogenesis is reviewed, focusing on epithelial to mesenchymal transition. Emphasis is taken in the unascertained cadherin expression in CNS tumors, particularly in gliomas, where the potential contribution of an epithelial-to-mesenchymal-like process to glioma genesis and how this may be associated with changes in cadherin expression is discussed.
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Affiliation(s)
- Carolina Noronha
- Neurosurgery Department, Hospital de Santo António, Centro Hospitalar Universitario do Porto, 4099-001 Porto, Portugal; (C.N.); (J.R.)
- Cancer Metastasis Group, i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal;
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ana Sofia Ribeiro
- Cancer Metastasis Group, i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal;
| | - Ricardo Taipa
- Neuropathology Unit, Hospital de Santo António, Centro Hospitalar Universitario do Porto, 4099-001 Porto, Portugal;
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Diogo S. Castro
- Stem Cells & Neurogenesis Group, i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal;
| | - Joaquim Reis
- Neurosurgery Department, Hospital de Santo António, Centro Hospitalar Universitario do Porto, 4099-001 Porto, Portugal; (C.N.); (J.R.)
- Anatomy Department, Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Cláudia Faria
- Neurosurgery Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, 1649-028 Lisboa, Portugal;
- IMM—Instituto de Medicina Molecular Joao Lobo Antunes, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Joana Paredes
- Cancer Metastasis Group, i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal;
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence:
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18
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das Neves SP, Taipa R, Marques F, Soares Costa P, Monárrez-Espino J, Palha JA, Kivipelto M. Association Between Iron-Related Protein Lipocalin 2 and Cognitive Impairment in Cerebrospinal Fluid and Serum. Front Aging Neurosci 2021; 13:663837. [PMID: 34248600 PMCID: PMC8267056 DOI: 10.3389/fnagi.2021.663837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
A worldwide increase in longevity is bringing novel challenges to public health and health care professionals. Cognitive impairment in the elderly may compromise living conditions and precede Alzheimer’s disease (AD), the most prevalent form of dementia. Therefore, finding molecular markers associated with cognitive impairment is of crucial importance. Lipocalin 2 (LCN2), an iron-related protein, has been suggested as a potential marker for mild cognitive impairment (MCI) and AD. This study aimed at investigating the association between LCN2 measured in serum and cerebrospinal fluid (CSF) with cognitive impairment. A cross-sectional design based on two aging cohorts was used: individuals diagnosed with subjective cognitive complaints (SCC), MCI, and AD from a Swedish memory clinic-based cohort, and individuals diagnosed with SCC and AD from a Portuguese cohort. Binary logistic [for the outcome cognitive impairment (MCI + AD) in the Swedish cohort and AD in the Portuguese cohort] and multinomial logistic (for the outcomes MCI and AD) regression analyses were used. No associations were found in both cohorts when controlling for sex, education, and age. This explanatory study suggests that the association between serum and CSF LCN2 concentrations with cognitive impairment reported in the literature must be further analyzed for confounders.
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Affiliation(s)
- Sofia Pereira das Neves
- 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
| | - Ricardo Taipa
- 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.,Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Fernanda Marques
- 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
| | - Patrício Soares Costa
- 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
| | - Joel Monárrez-Espino
- Department of Health Research, Christus Muguerza Hospital-University of Monterrey, Chihuahua, Mexico
| | - Joana A Palha
- 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
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
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19
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Corrà MF, Sousa M, Reis I, Tanganelli F, Vila-Chã N, Sousa AP, Magalhães R, Sampaio P, Taipa R, Maia L. Advantages of an Automated Method Compared With Manual Methods for the Quantification of Intraepidermal Nerve Fiber in Skin Biopsy. J Neuropathol Exp Neurol 2021; 80:685-694. [PMID: 34041546 PMCID: PMC8357338 DOI: 10.1093/jnen/nlab045] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intraepidermal nerve fiber density (IENFD) measurements in skin biopsy are performed manually by 1–3 operators. To improve diagnostic accuracy and applicability in clinical practice, we developed an automated method for fast IENFD determination with low operator-dependency. Sixty skin biopsy specimens were stained with the axonal marker PGP9.5 and imaged using a widefield fluorescence microscope. IENFD was first determined manually by 3 independent observers. Subsequently, images were processed in their Z-max projection and the intradermal line was delineated automatically. IENFD was calculated automatically (fluorescent images automated counting [FIAC]) and compared with manual counting on the same fluorescence images (fluorescent images manual counting [FIMC]), and with classical manual counting (CMC) data. A FIMC showed lower variability among observers compared with CMC (interclass correlation [ICC] = 0.996 vs 0.950). FIMC and FIAC showed high reliability (ICC = 0.999). A moderate-to-high (ICC = 0.705) was observed between CMC and FIAC counting. The algorithm process took on average 15 seconds to perform FIAC counting, compared with 10 minutes for FIMC counting. This automated method rapidly and reliably detects small nerve fibers in skin biopsies with clear advantages over the classical manual technique.
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Affiliation(s)
- Marta Francisca Corrà
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Mafalda Sousa
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Inês Reis
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Fabiana Tanganelli
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Nuno Vila-Chã
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Ana Paula Sousa
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Rui Magalhães
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Paula Sampaio
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Ricardo Taipa
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
| | - Luís Maia
- From the Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (MFC, RM, RT, LM); Department of Neurology, Centro Hospitalar Universitário do Porto (CHUP) (MFC, IR, NV-C, APS, RM, RT, LM); Instituto de investigação e inovação em Saúde da Universidade do Porto (i3S) (MS, PS, LM), Porto, Portugal; Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany (FT)
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20
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Videira G, Damásio J, Pinto C, Melo-Pires M, Taipa R. Letter to the Editor on "Copathology in Progressive Supranuclear Palsy: Does It Matter?". Mov Disord 2021; 35:2124-2126. [PMID: 33463761 DOI: 10.1002/mds.28308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gonçalo Videira
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Damásio
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,CGPP and UnIGENE, Instituto de Biologia Molecular e Celular, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Catarina Pinto
- Department of Neurorradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Melo-Pires
- Portuguese Brain Bank, Neuropathology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Taipa
- Portuguese Brain Bank, Neuropathology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
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21
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Carvalho A, Nunes J, Taipa R, Melo Pires M, Pinto Basto J, Barros P. Adult polyglucosan body disease-an atypical compound heterozygous with a novel GBE1 mutation. Neurol Sci 2021; 42:2955-2959. [PMID: 33517539 DOI: 10.1007/s10072-021-05096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adult polyglucosan body disease (APBD) is an autosomal recessive leukodystrophy characterized by neurogenic bladder starting after 40 years old, spastic paraparesis and peripheral neuropathy. It is mainly resultant from the GBE1 homozygous p.Tyr329Ser (c.986A>C) mutation, especially in Ashkenazi-Jewish patients, although some cases of compound heterozygous have been reported. A genotype-phenotype correlation is not established, but atypical phenotypes have been described mainly in non-p.Tyr329Ser pathogenic variants. CASE REPORT We describe an atypical case in a 62-year-old Portuguese woman, presenting the typical clinical triad of APBD plus prominent autonomic dysfunction, suggested by orthostatic hypotension and thermoregulatory dysfunction; she has compound heterozygous GBE1 mutations, namely, p.Asn541Asp (c.1621A>G) and p.Arg515Gly (c.1543C>G), the last one not yet reported in literature and whose pathogenicity was suggested by bioinformatics analysis and confirmed by sural nerve biopsy that showed intra-axonal polyglucosan bodies. DISCUSSION Besides the report of a novel GBE1 mutation, this case also expands the phenotypic spectrum of this disorder, reinforcing autonomic dysfunction as a possible and prominent manifestation of APBD, mimicking autosomal dominant leukodystrophy with autonomic disease in some way. Therefore, we questioned a possible relationship between this genotype and the phenotype marked by dysautonomia. Additionally, we review previously reported cases of APBD in non-homozygous p.Tyr329Ser patients with atypical phenotypes.
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Affiliation(s)
- Andreia Carvalho
- Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Joana Nunes
- Neuroradiology Unit, Imagiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Hospital de Santo António - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Melo Pires
- Neuropathology Unit, Hospital de Santo António - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Pedro Barros
- Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Monteiro A, Velon AG, Rodrigues AM, Oliveira A, Valadas A, Nóbrega C, Cruto C, Neutel D, Simões do Couto F, Morgado J, Cerejeira J, Ruano L, Gago M, Grunho M, Tábuas-Pereira M, Taipa R, Moiron Simões R, Araújo R, Barreto R, Rocha S, Massano J. [Portuguese Consensus on the Diagnosis and Management of Lewy Body Dementia (PORTUCALE)]. ACTA MEDICA PORT 2020; 33:844-854. [PMID: 33496254 DOI: 10.20344/amp.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/07/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022]
Abstract
Lewy body dementia is a common cause of dementia leading to the progressive deterioration of cognitive function and motor skills, behavioral changes, and loss of autonomy, impairing the quality of life of patients and their families. Even though it is the second leading cause of neurodegenerative dementia, diagnosis is still challenging, due to its heterogenous clinical presentation, especially in the early stages of the disease. Accordingly, Lewy body dementia is often misdiagnosed and clinically mismanaged. The lack of diagnostic accuracy has important implications for patients, given their increased susceptibility to the adverse effects of certain drugs, such as antipsychotics, which may worsen some symptoms associated with Lewy body dementia. Therefore, a specialist consensus based on the analysis of the most updated and relevant literature, and on clinical experience, is useful to all professionals involved in the care of these patients. This work aims to inform and provide recommendations about the best diagnostic and therapeutic approaches in Lewy body dementia in Portugal. Moreover, we suggest some strategies in order to raise the awareness of physicians, policy makers, and the society at large regarding this disease.
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Affiliation(s)
- Ana Monteiro
- Serviço de Neurologia. Hospital Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos; Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Ana Graça Velon
- Serviço de Neurologia. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real. Portugal
| | | | - Ana Oliveira
- Serviço de Medicina Nuclear. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Anabela Valadas
- Serviço de Neurologia. Departamento Neurociências. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Camila Nóbrega
- Unidade de Diagnóstico e Intervenção. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Cognition, Dementia and Memory Clinic. Campus Neurológico Sénior. Torres Vedras. Portugal
| | - Catarina Cruto
- Serviço de Neurologia. Hospital Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Dulce Neutel
- Unidade de Medicina de Sono. Hospital Cuf Descobertas. Lisboa. Portugal
| | - Frederico Simões do Couto
- Instituto de Farmacologia e Neurociências. Faculdade de Medicina, Universidade de Lisboa. Lisboa. Portugal
| | - Joana Morgado
- Cognition, Dementia and Memory Clinic. Campus Neurológico Sénior. Torres Vedras. Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal
| | | | - Luís Ruano
- Serviço de Neurologia. Centro Hospitalar de Entre Douro e Vouga. Santa Maria da Feira. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica. Faculdade de Medicina. Universidade do Porto. Porto. Unidade de Investigação em Epidemiologia (EPIUnit). Instituto de Saúde Pública. Universidade do Porto. Porto. Portugal
| | - Miguel Gago
- Serviço de Neurologia. Hospital da Senhora da Oliveira. Guimarães. Portugal
| | - Miguel Grunho
- Serviço de Neurologia. Hospital Garcia de Orta. Almada. Centro de Investigação Interdisciplinar Egas Moniz. Monte da Caparica. Portugal
| | - Miguel Tábuas-Pereira
- Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Ricardo Taipa
- Unidade de Neuropatologia, Departamento de Neurociências. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Rita Moiron Simões
- Cognition, Dementia and Memory Clinic. Campus Neurológico Sénior. Torres Vedras. Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal
| | - Rui Araújo
- Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Rui Barreto
- Serviço de Neurologia. Departamento Neurociências. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Sofia Rocha
- Serviço de Neurologia. Hospital de Braga. Braga. Portugal
| | - João Massano
- Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Portugal
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Rodrigues R, Branco M, Silva R, Ruano L, Fontão L, Lopes M, Scigliano H, Taipa R, Pires MM, Santos C. Peripheral neuropathy in systemic vasculitis and other autoimmune diseases - a report of five cases emphasizing the importance of etiologic characterization. eNeurologicalSci 2020; 21:100272. [PMID: 32995578 PMCID: PMC7502409 DOI: 10.1016/j.ensci.2020.100272] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 10/24/2022] Open
Abstract
Introduction Peripheral neuropathies may present in the context of systemic vasculitis and other autoimmune diseases. The etiologic characterization is crucial to define the treatment and prognosis in secondary vasculitis. The purpose of this study is to describe the pathway of etiologic investigation including the role of nerve biopsy. Methods Retrospective analysis of patients seen in the neuromuscular outpatient clinic during the last four years with peripheral neuropathy in the context of systemic vasculitis or other autoimmune diseases. Results We present five patients with stepwise progressive sensorimotor deficits of upper and lower limbs. All patients presented with systemic features and one of them had an established diagnosis of systemic vasculitis. They underwent an extended blood panel, including autoimmune and serologic tests. Electromyography and nerve conduction studies revealed asymmetric axonal sensorimotor polyneuropathies in four patients, and an axonal sensorimotor multiple mononeuropathy in one. Four patients underwent nerve biopsy and the other performed a skin biopsy, with findings suggestive of possible vasculitic processes. The etiologies identified included microscopic polyangiitis, HBV-related polyarteritis nodosa and two eosinophilic granulomatosis with polyangiitis. In the last patient a specific etiology could not be established. Conclusion This series reveals the etiologic and phenotypic diversity of peripheral neuropathies related with systemic vasculitis. The therapeutic approach and prognosis were distinct in each patient, emphasizing the importance of a prompt diagnosis and appropriate treatment.
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Affiliation(s)
- Rita Rodrigues
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mariana Branco
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Renata Silva
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Luís Ruano
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.,Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine of Porto University, Porto, Portugal
| | - Luís Fontão
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marta Lopes
- Neurology Department, Hospital Privado de Braga Sul, Trofa Saúde Hospitais, Braga, Portugal
| | | | - Ricardo Taipa
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Melo Pires
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Santos
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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Meireles E, Malheiro J, Taipa R, Alves M. Immune-mediated necrotizing myopathy associated with antibodies to the signal recognition particle: A rare cause of hyperCKaemia. Eur J Rheumatol 2020; 7:143-144. [DOI: 10.5152/eurjrheum.2019.19162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022] Open
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Videira G, Malaquias MJ, Laranjinha I, Martins R, Taipa R, Magalhães M. Diagnosis of Aicardi-Goutières Syndrome in Adults: A Case Series. Mov Disord Clin Pract 2020; 7:303-307. [PMID: 32258229 DOI: 10.1002/mdc3.12903] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 01/11/2020] [Accepted: 01/19/2020] [Indexed: 02/02/2023] Open
Abstract
Introduction Aicardi-Goutières syndrome (AGS) is a genetic disease presenting with early-onset encephalopathy, generalized dystonia, spasticity, and cognitive disability. Diagnosis may be difficult in adults, as the clinical course seems static from infancy. Methods AGS patients from an adult movement disorders outpatient clinic were retrospectively analyzed. Results A total of 5 patients and 1 asymptomatic carrier from 3 different families were identified. All had a homozygous c.529G>A,p.A177T mutation in exon 7 of the RNASEH2B gene. Two patients had neonatal-onset AGS, 2 had later onset forms, and 1 was slightly symptomatic. All were diagnosed in adulthood after chilblains, and basal ganglia calcifications were identified on computed tomography scans. Discussion AGS patients have marked phenotypic variability regarding psychomotor development and morbidity. The present series included 1 asymptomatic carrier and 1 slightly symptomatic patient, both with homozygous RNASEH2B mutations. Chilblains and basal ganglia calcifications identified on computed tomography scan (but not on magnetic resonance imaging) are important clues for late diagnosis.
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Affiliation(s)
- Gonçalo Videira
- Neurology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | | | - Inês Laranjinha
- Neurology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - Ricardo Martins
- Neuroradiology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - Ricardo Taipa
- Neuropathology Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - Marina Magalhães
- Neurology Department Centro Hospitalar Universitário do Porto Porto Portugal
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van der Ende EL, Meeter LH, Poos JM, Panman JL, Jiskoot LC, Dopper EGP, Papma JM, de Jong FJ, Verberk IMW, Teunissen C, Rizopoulos D, Heller C, Convery RS, Moore KM, Bocchetta M, Neason M, Cash DM, Borroni B, Galimberti D, Sanchez-Valle R, Laforce R, Moreno F, Synofzik M, Graff C, Masellis M, Carmela Tartaglia M, Rowe JB, Vandenberghe R, Finger E, Tagliavini F, de Mendonça A, Santana I, Butler C, Ducharme S, Gerhard A, Danek A, Levin J, Otto M, Frisoni GB, Cappa S, Pijnenburg YAL, Rohrer JD, van Swieten JC, Warren JD, Fox NC, Woollacott IO, Shafei R, Greaves C, Guerreiro R, Bras J, Thomas DL, Nicholas J, Mead S, van Minkelen R, Barandiaran M, Indakoetxea B, Gabilondo A, Tainta M, de Arriba M, Gorostidi A, Zulaica M, Villanua J, Diaz Z, Borrego-Ecija S, Olives J, Lladó A, Balasa M, Antonell A, Bargallo N, Premi E, Cosseddu M, Gazzina S, Padovani A, Gasparotti R, Archetti S, Black S, Mitchell S, Rogaeva E, Freedman M, Keren R, Tang-Wai D, Öijerstedt L, Andersson C, Jelic V, Thonberg H, Arighi A, Fenoglio C, Scarpini E, Fumagalli G, Cope T, Timberlake C, Rittman T, Shoesmith C, Bartha R, Rademakers R, Wilke C, Karnath HO, Bender B, Bruffaerts R, Vandamme P, Vandenbulcke M, Ferreira CB, Miltenberger G, Maruta C, Verdelho A, Afonso S, Taipa R, Caroppo P, Di Fede G, Giaccone G, Prioni S, Redaelli V, Rossi G, Tiraboschi P, Duro D, Rosario Almeida M, Castelo-Branco M, João Leitão M, Tabuas-Pereira M, Santiago B, Gauthier S, Schonecker S, Semler E, Anderl-Straub S, Benussi L, Binetti G, Ghidoni R, Pievani M, Lombardi G, Nacmias B, Ferrari C, Bessi V. Serum neurofilament light chain in genetic frontotemporal dementia: a longitudinal, multicentre cohort study. Lancet Neurol 2019; 18:1103-1111. [PMID: 31701893 DOI: 10.1016/s1474-4422(19)30354-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/26/2019] [Accepted: 08/13/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neurofilament light chain (NfL) is a promising blood biomarker in genetic frontotemporal dementia, with elevated concentrations in symptomatic carriers of mutations in GRN, C9orf72, and MAPT. A better understanding of NfL dynamics is essential for upcoming therapeutic trials. We aimed to study longitudinal NfL trajectories in people with presymptomatic and symptomatic genetic frontotemporal dementia. METHODS We recruited participants from 14 centres collaborating in the Genetic Frontotemporal Dementia Initiative (GENFI), which is a multicentre cohort study of families with genetic frontotemporal dementia done across Europe and Canada. Eligible participants (aged ≥18 years) either had frontotemporal dementia due to a pathogenic mutation in GRN, C9orf72, or MAPT (symptomatic mutation carriers) or were healthy at-risk first-degree relatives (either presymptomatic mutation carriers or non-carriers), and had at least two serum samples with a time interval of 6 months or more. Participants were excluded if they had neurological comorbidities that were likely to affect NfL, including cerebrovascular events. We measured NfL longitudinally in serum samples collected between June 8, 2012, and Dec 8, 2017, through follow-up visits annually or every 2 years, which also included MRI and neuropsychological assessments. Using mixed-effects models, we analysed NfL changes over time and correlated them with longitudinal imaging and clinical parameters, controlling for age, sex, and study site. The primary outcome was the course of NfL over time in the various stages of genetic frontotemporal dementia. FINDINGS We included 59 symptomatic carriers and 149 presymptomatic carriers of a mutation in GRN, C9orf72, or MAPT, and 127 non-carriers. Nine presymptomatic carriers became symptomatic during follow-up (so-called converters). Baseline NfL was elevated in symptomatic carriers (median 52 pg/mL [IQR 24-69]) compared with presymptomatic carriers (9 pg/mL [6-13]; p<0·0001) and non-carriers (8 pg/mL [6-11]; p<0·0001), and was higher in converters than in non-converting carriers (19 pg/mL [17-28] vs 8 pg/mL [6-11]; p=0·0007; adjusted for age). During follow-up, NfL increased in converters (b=0·097 [SE 0·018]; p<0·0001). In symptomatic mutation carriers overall, NfL did not change during follow-up (b=0·017 [SE 0·010]; p=0·101) and remained elevated. Rates of NfL change over time were associated with rate of decline in Mini Mental State Examination (b=-94·7 [SE 33·9]; p=0·003) and atrophy rate in several grey matter regions, but not with change in Frontotemporal Lobar Degeneration-Clinical Dementia Rating scale score (b=-3·46 [SE 46·3]; p=0·941). INTERPRETATION Our findings show the value of blood NfL as a disease progression biomarker in genetic frontotemporal dementia and suggest that longitudinal NfL measurements could identify mutation carriers approaching symptom onset and capture rates of brain atrophy. The characterisation of NfL over the course of disease provides valuable information for its use as a treatment effect marker. FUNDING ZonMw and the Bluefield project.
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Affiliation(s)
- Emma L van der Ende
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lieke H Meeter
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jackie M Poos
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jessica L Panman
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lize C Jiskoot
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Elise G P Dopper
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Inge M W Verberk
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Carolin Heller
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian S Convery
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Katrina M Moore
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Bocchetta
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Mollie Neason
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David M Cash
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurodegenerative Diseases Unit, Milan, Italy; University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Raquel Sanchez-Valle
- Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Fermin Moreno
- Department of Neurology, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - Matthis Synofzik
- Hertie-Institute for Clinical Brain Research Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE) Tübingen, Tübingen, Germany
| | - Caroline Graff
- Karolinska Institutet, Dept NVS, Division of Neurogeriatrics, Stockholm, Sweden; Unit of Hereditary Dementia, Theme Aging, Karolinska University Hospital-Solna, Stockholm, Sweden
| | | | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | | | | | - Isabel Santana
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Chris Butler
- Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Simon Ducharme
- Montreal Neurological Institute and McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Alex Gerhard
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Markus Otto
- Department of Neurology, Universität Ulm, Ulm, Germany
| | - Giovanni B Frisoni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Stefano Cappa
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam and Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, Netherlands
| | - Jonathan D Rohrer
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - John C van Swieten
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
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Fernandes A, Coelho T, Rodrigues A, Felgueiras H, Oliveira P, Guimarães A, Melo-Pires M, Taipa R. Clinicopathological correlations of sural nerve biopsies in TTR Val30Met familial amyloid polyneuropathy. Brain Commun 2019; 1:fcz032. [PMID: 32954271 PMCID: PMC7425381 DOI: 10.1093/braincomms/fcz032] [Citation(s) in RCA: 10] [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] [Received: 06/21/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 01/02/2023] Open
Abstract
Familial amyloid polyneuropathy with the substitution of methionine for valine at position 30 in the TTR gene is the most common type of hereditary transthyretin amyloidosis. Although several authors have previously reported a size-dependent fibre loss, predominantly involving unmyelinated and small-diameter myelinated fibres, the mechanisms of nerve fibre loss have not been fully understood. In this study, we establish the morphometric pattern of peripheral neuropathy in patients with familial amyloid polyneuropathy and asymptomatic mutation carriers in the biopsies from our archive and correlated the pathological findings with clinical features. A total of 98 patients with familial amyloid polyneuropathy and 37 asymptomatic mutation carriers (TTR Val30Met mutation), aged between 17 and 84 years, who underwent sural nerve biopsy between 1981 and 2017 at Centro Hospitalar Universitário do Porto were studied. Thirty-one controls were included for comparison. The median age at nerve biopsy was 26.0 [interquartile range = 23.5–39.5] years for asymptomatic mutation carriers, 45.0 [35.0–60.0] years for patients with familial amyloid polyneuropathy and 44.0 [30.0–63.0] years for controls. The median duration between nerve biopsy and symptoms’ onset was 7.0 [3.3–11.8] years (range: 1–27 years) in the asymptomatic carriers. Most patients were in an earlier disease stage (93% with a polyneuropathy disability scale ≤2). Patients had loss of small and myelinated fibres compared with both asymptomatic carriers and controls (P < 0.001), whereas asymptomatic carriers showed loss of small myelinated fibres when compared with controls (P < 0.05). The loss of myelinated fibres increased with disease progression (P < 0.001), and patients in more advanced clinical stage showed more frequent amyloid deposition in the nerve (P = 0.001). There was a positive correlation between large myelinated fibre density and time to symptoms’ onset in the asymptomatic carriers that developed early-onset form of the disease (r = 0.52, P < 0.01). In addition, asymptomatic carriers with amyloid deposition already present in sural nerve biopsies developed symptoms earlier than those with no amyloid (P < 0.01). In conclusion, this study confirms that the loss of small fibre size is an initial event in familial amyloid polyneuropathy, already present in asymptomatic gene carriers, starting several years before the onset of symptoms. We show for the first time that large myelinated fibres’ loss and amyloid deposition are pathological features that correlate independently with short period to the onset of symptoms for asymptomatic carriers that developed early-onset form of the disease. These findings are therapeutically relevant, as it would allow for a better interpretation of the role of disease-modifying agents in transthyretin familial amyloid polyneuropathy.
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Affiliation(s)
- Armindo Fernandes
- Institute of Biomedical Sciences Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Department of Neurosciences, Centro Hospitalar do Porto, 4099-001 Porto, Portugalu
| | - Aurora Rodrigues
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Helena Felgueiras
- Department of Neurology, Centro Hospitalar Vila Nova de Gaia-Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Pedro Oliveira
- Institute of Biomedical Sciences Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal.,Epidemiological Research Unit (EPIUnit), Institute of Public Health, Universidade do Porto, 4050-091 Porto, Portugal
| | - António Guimarães
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Manuel Melo-Pires
- Institute of Biomedical Sciences Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal.,Unidade Corino de Andrade, Department of Neurosciences, Centro Hospitalar do Porto, 4099-001 Porto, Portugalu.,Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Ricardo Taipa
- Institute of Biomedical Sciences Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal.,Unidade Corino de Andrade, Department of Neurosciences, Centro Hospitalar do Porto, 4099-001 Porto, Portugalu.,Neuropathology Unit, Department of Neurosciences, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
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Garrido C, Sousa A, Cardoso M, Taipa R, Vieira E, Gonçalves A, Melo Pires M, Santos R, Coelho T, Santos M. P.169Sarcoglycanopathies: experience of a tertiary centre. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Noronha C, Figueiredo G, Pinheiro C, Carvalho E, Calheiros A, Pires MM, Taipa R. Brain biopsy in suspected non-neoplastic neurological disease. Acta Neurochir (Wien) 2019; 161:1139-1147. [PMID: 31016453 DOI: 10.1007/s00701-019-03910-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/17/2019] [Accepted: 04/10/2019] [Indexed: 12/18/2022]
Abstract
Brain biopsy has a well-established role in the diagnosis of CNS neoplasia. Nevertheless, despite being essential for the diagnosis of some benign neurological diseases, little consensus exists regarding its indications for disease diagnosis and patient orientation. Our aim was to assess brain biopsy diagnostic yield in patients with neurological deterioration of unknown etiology, to identify the clinical characteristics associated with an increased likelihood of achieving a diagnostic biopsy as well as the characteristics linked to a particular diagnosis. METHODS A retrospective analysis of 62 consecutive brain biopsies performed at a single tertiary care center between January 2004 and December 2015 for suspected non-neoplastic neurological disease was performed. The clinical presentation, imaging, and laboratory results were collected and compared between diagnostic groups. RESULTS Sixty-eight percent of the biopsies led to a definitive diagnosis. The most common histological diagnosis was central nervous system lymphoma (eight cases), followed by astrocytoma, demyelinating disease, and progressive multifocal leukoencephalopathy (four cases each). No clinical characteristics were found to predict a diagnostic biopsy or to correlate with a specific diagnosis. Importantly, a distinct diagnosis from the initially suspected was achieved in 52% of cases and biopsy findings led to a change of therapeutic orientation in 78% of the cases. CONCLUSIONS Our results suggest that brain biopsies have a significant impact on patient management and should be considered early in selected cases in which less invasive testing was unable to reach a definitive diagnosis.
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Affiliation(s)
- Carolina Noronha
- Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal.
- i3s Institute for Research and Innovation in Health, Universidade do Porto, Porto, Portugal.
| | - Gonçalo Figueiredo
- Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal
| | - Célia Pinheiro
- Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal
| | - Ernesto Carvalho
- Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal
| | - Alfredo Calheiros
- Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal
| | - Manuel Melo Pires
- Neuropathology Unit, Hospital de Santo Antonio, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Hospital de Santo Antonio, Centro Hospitalar e Universitario do Porto, Porto, Portugal
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Taipa R, das Neves SP, Sousa AL, Fernandes J, Pinto C, Correia AP, Santos E, Pinto PS, Carneiro P, Costa P, Santos D, Alonso I, Palha J, Marques F, Cavaco S, Sousa N. Proinflammatory and anti-inflammatory cytokines in the CSF of patients with Alzheimer's disease and their correlation with cognitive decline. Neurobiol Aging 2019; 76:125-132. [PMID: 30711675 DOI: 10.1016/j.neurobiolaging.2018.12.019] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/28/2018] [Accepted: 12/30/2018] [Indexed: 12/27/2022]
Abstract
Cumulative data suggest that neuroinflammation plays a prominent role in Alzheimer's disease (AD) pathogenesis. The purpose of this work was to assess if patients with AD present a specific cerebrospinal fluid (CSF) cytokine profile and if it correlates to disease progression. We determined the levels of 27 cytokines in CSF of patients with AD and compared them with patients with frontotemporal dementia and nondemented controls. In addition, we correlated the cytokine levels with cognitive status and disease progression after 12 months. Patients with AD had higher levels of proinflammatory and anti-inflammatory cytokines (eotaxin, interleukin [IL]-1ra, IL-4, IL-7, IL-8, IL-9, IL-10, IL-15, granulocyte colony-stimulating factor, monocyte chemotactic protein 1, platelet-derived growth factor, tumor necrosis factor alfa) compared to nondemented controls. There was a negative correlation between the disease progression and the levels of several cytokines (IL-1β, IL-4, IL-6, IL-9, IL-17A, basic fibroblast growth factor, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interferon gamma, macrophage inflammatory proteins-1β). To the best of our knowledge, this is the first study reporting a "protective" role of the upregulation of specific intrathecal cytokine levels in AD. This finding supports that a fine "rebalancing" of the immune system represents a new target in AD therapeutic approach.
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Affiliation(s)
- Ricardo Taipa
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal.
| | - Sofia P das Neves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Ana L Sousa
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Joana Fernandes
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Claudia Pinto
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana P Correia
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Ernestina Santos
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Pedro S Pinto
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Paula Carneiro
- Immunology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Patricio Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Diana Santos
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; UnIGENe, Instituto de Biologia Molecular e Celular (IBMC), Porto, Portugal
| | - Isabel Alonso
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; UnIGENe, Instituto de Biologia Molecular e Celular (IBMC), Porto, Portugal
| | - Joana Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Fernanda Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Sara Cavaco
- Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal; Centro Clínico Académico (2CA), Braga, Portugal
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Cação G, Calejo M, Alves JE, Medeiros PB, Vila-Cha N, Mendonça T, Taipa R, Silva AM, Damásio J. Clinical features of hypertrophic pachymeningitis in a center survey. Neurol Sci 2018; 40:543-551. [PMID: 30588552 DOI: 10.1007/s10072-018-3689-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypertrophic pachymeningitis (HP) is characterized by cranial and/or spinal thickening of the dura mater with or without associated inflammation. Neuroimaging studies reveal dura mater thickening and focal or diffuse contrast enhancement. It is described in association with trauma, infections, tumors, autoimmune/inflammatory diseases, and cerebrospinal fluid hypotension syndrome, with some cases remaining idiopathic. METHODS A retrospective study was conducted with patients' identification through a key terms search within MRI reports in the period of July 2008 to September 2015. Clinical files, MRI, laboratory, and pathology data were reviewed. RESULTS Fifty-three patients were identified and 20 were excluded because they did not meet the inclusion criteria. Of the 33 included, 19 were female, with a mean age at symptoms onset of 51.2 ± 17.6 years. The most common presenting symptoms were headache and cranial nerves palsy, followed by seizures, delirium, lumbar pain, cognitive decline, motor deficit, and language impairment. In 17 patients, a neoplastic etiology was identified; in eight, inflammatory/autoimmune; in six, infectious; and two were classified as idiopathic. Of the eight patients with inflammatory/autoimmune etiology, four had possible IgG4-related disease (IgG4-RD) and the remaining had granulomatosis with polyangiitis, sarcoidosis, rheumatoid arthritis, and Tolosa-Hunt syndrome. Treatment was directed according to the underlying etiology. DISCUSSION In the described series, a female predominance was identified, with symptoms' onset in the 5th decade. Although headache was the most common symptom, clinical presentation was varied, emphasizing the role of MRI in HP diagnosis. The underlying etiologies were diverse, with only a few cases remaining idiopathic, also reflecting the contribution of the recently described IgG4-RD.
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Affiliation(s)
- Gonçalo Cação
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Margarida Calejo
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - José Eduardo Alves
- Neuroradiology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Nuno Vila-Cha
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Martins Silva
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Joana Damásio
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
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Calejo M, Vilarinho L, Neiva R, Botelho L, Ramalheira J, Taipa R, Melo‐Pires M, Lima AB, Damásio J. Late‐onset Levodopa Responsive Parkinsonism Due to Polymerase γ 1 Mutations. Mov Disord Clin Pract 2018; 5:645-648. [DOI: 10.1002/mdc3.12668] [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] [Received: 02/26/2018] [Revised: 06/25/2018] [Accepted: 07/23/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Margarida Calejo
- Neurology DepartmentHospital de Santo António, Centro Hospitalar do Porto Portugal
| | - Laura Vilarinho
- Newborn Screening, Metabolism and Genetics UnitHuman Genetics Department, Dr. Ricardo Jorge National Health Institute Porto Portugal
| | - Raquel Neiva
- Newborn Screening, Metabolism and Genetics UnitHuman Genetics Department, Dr. Ricardo Jorge National Health Institute Porto Portugal
| | - Luís Botelho
- Neuroradiology DepartmentHospital de Santo António, Centro Hospitalar do Porto Portugal
| | - João Ramalheira
- Neurophysiology DepartmentHospital de Santo António, Centro Hospitalar do Porto Portugal
| | - Ricardo Taipa
- Neuropathology UnitHospital de Santo António, Centro Hospitalar do Porto Portugal
| | - Manuel Melo‐Pires
- Neuropathology UnitHospital de Santo António, Centro Hospitalar do Porto Portugal
| | - António Bastos Lima
- Neurology DepartmentHospital de Santo António, Centro Hospitalar do Porto Portugal
| | - Joana Damásio
- Neurology DepartmentHospital de Santo António, Centro Hospitalar do Porto Portugal
- UnIGENe and CGPP, IBMC – Instituto de Biologia Molecular e Celular; i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do Porto Portugal
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Salgado P, Taipa R, Domingos J, Dias D, Pires MM, Magalhães M. Vascular Pathology Causing Late Onset Generalized Chorea: A Clinico-Pathological Case Report. Mov Disord Clin Pract 2018; 4:819-823. [PMID: 30363429 DOI: 10.1002/mdc3.12528] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/27/2017] [Accepted: 07/09/2017] [Indexed: 12/29/2022] Open
Abstract
Background Chorea may occur as a manifestation of an acute stroke. Patients with vascular-related chorea typically present with an acute or subacute onset of hemichorea, contralateral to the lesion. Methods and Findings In this clinico-pathological case, we report a 90-year-old female who presented, at age 81, with a transient episode of generalized chorea. Over the years, the patient continued to have intermittent episodes of generalized chorea or hemichorea, followed by a progressive dementia syndrome with gait and sphincter disturbance. There was no family history of chorea or dementia. Laboratory tests for paraneoplastic or autoimmune disorders and genetic testing for Huntington's disease were normal or negative. Magnetic resonance imaging showed subcortical and basal ganglia atrophy associated with ischemic leukoencephalopathy and lacunar infarcts. The post-mortem examination identified multiple lacunar infarcts (cortex, white matter, thalamus, basal ganglia) and minor Alzheimer's disease neuropathological changes. Conclusions Vascular disease, affecting the basal ganglia, is included in most lists of causes of generalized chorea. Proven cases are difficult to find. We present a rare case of vascular pathology causing late onset generalized and intermittent chorea. We highlight the intermittent nature of the chorea that could be explained by cumulative vascular lesions or functional disconnection in a previous deficient circuit.
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Affiliation(s)
- Paula Salgado
- Department of Neurology Centro Hospitalar do Porto Porto Portugal
| | - Ricardo Taipa
- Portuguese Brain Bank Neuropathology Unit Centro Hospitalar do Porto Porto Portugal
| | - Joana Domingos
- Department of Neurology Centro Hospitalar do Porto Porto Portugal.,UCL Great Ormond Street Institute of Child Health Dubowitz Neuromuscular Centre London UK
| | - Daniel Dias
- Department of Neurorradiology Centro Hospitalar do Porto Porto Portugal
| | - Manuel Melo Pires
- Portuguese Brain Bank Neuropathology Unit Centro Hospitalar do Porto Porto Portugal
| | - Marina Magalhães
- Department of Neurology Centro Hospitalar do Porto Porto Portugal
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Martins J, Oliveira J, Taipa R, Garrido C, Melo Pires M, Santos M. CONGENITAL MYOPATHIES: NEMALINE AND TITINOPATHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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35
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Espírito Santo VL, Jesus R, Mesquita B, Guerra M, Taipa R, Melo-Pires M, Cunha M, Guimarães P. P05.67 Primary Central Nervous System Lymphomas retrospective review of a single hospital center case series. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.393] [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: 11/14/2022] Open
Affiliation(s)
| | - R Jesus
- Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - B Mesquita
- Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - M Guerra
- Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Taipa
- Centro Hospitalar do Porto, Porto, Portugal
| | | | - M Cunha
- Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - P Guimarães
- Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
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36
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Gonçalves CS, de Castro JV, Pojo M, Martins EP, Queirós S, Chautard E, Taipa R, Pires MM, Pinto AA, Pardal F, Custódia C, Faria CC, Clara C, Reis RM, Sousa N, Costa BM. WNT6 is a novel oncogenic prognostic biomarker in human glioblastoma. Theranostics 2018; 8:4805-4823. [PMID: 30279739 PMCID: PMC6160775 DOI: 10.7150/thno.25025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/18/2018] [Accepted: 05/06/2018] [Indexed: 01/15/2023] Open
Abstract
Glioblastoma (GBM) is a universally fatal brain cancer, for which novel therapies targeting specific underlying oncogenic events are urgently needed. While the WNT pathway has been shown to be frequently activated in GBM, constituting a potential therapeutic target, the relevance of WNT6, an activator of this pathway, remains unknown. Methods: WNT6 protein and mRNA levels were evaluated in GBM. WNT6 levels were silenced or overexpressed in GBM cells to assess functional effects in vitro and in vivo. Phospho-kinase arrays and TCF/LEF reporter assays were used to identify WNT6-signaling pathways, and significant associations with stem cell features and cancer-related pathways were validated in patients. Survival analyses were performed with Cox regression and Log-rank tests. Meta-analyses were used to calculate the estimated pooled effect. Results: We show that WNT6 is significantly overexpressed in GBMs, as compared to lower-grade gliomas and normal brain, at mRNA and protein levels. Functionally, WNT6 increases typical oncogenic activities in GBM cells, including viability, proliferation, glioma stem cell capacity, invasion, migration, and resistance to temozolomide chemotherapy. Concordantly, in in vivo orthotopic GBM mice models, using both overexpressing and silencing models, WNT6 expression was associated with shorter overall survival, and increased features of tumor aggressiveness. Mechanistically, WNT6 contributes to activate typical oncogenic pathways, including Src and STAT, which intertwined with the WNT pathway may be critical effectors of WNT6-associated aggressiveness in GBM. Clinically, we establish WNT6 as an independent prognostic biomarker of shorter survival in GBM patients from several independent cohorts. Conclusion: Our findings establish WNT6 as a novel oncogene in GBM, opening opportunities to develop more rational therapies to treat this highly aggressive tumor.
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Oliveira J, Gruber A, Cardoso M, Taipa R, Fineza I, Gonçalves A, Laner A, Winder TL, Schroeder J, Rath J, Oliveira ME, Vieira E, Sousa AP, Vieira JP, Lourenço T, Almendra L, Negrão L, Santos M, Melo-Pires M, Coelho T, den Dunnen JT, Santos R, Sousa M. LAMA2 gene mutation update: Toward a more comprehensive picture of the laminin-α2 variome and its related phenotypes. Hum Mutat 2018; 39:1314-1337. [PMID: 30055037 DOI: 10.1002/humu.23599] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/05/2018] [Accepted: 07/25/2018] [Indexed: 12/15/2022]
Abstract
Congenital muscular dystrophy type 1A (MDC1A) is one of the main subtypes of early-onset muscle disease, caused by disease-associated variants in the laminin-α2 (LAMA2) gene. MDC1A usually presents as a severe neonatal hypotonia and failure to thrive. Muscle weakness compromises normal motor development, leading to the inability to sit unsupported or to walk independently. The phenotype associated with LAMA2 defects has been expanded to include milder and atypical cases, being now collectively known as LAMA2-related muscular dystrophies (LAMA2-MD). Through an international multicenter collaborative effort, 61 new LAMA2 disease-associated variants were identified in 86 patients, representing the largest number of patients and new disease-causing variants in a single report. The collaborative variant collection was supported by the LOVD-powered LAMA2 gene variant database (https://www.LOVD.nl/LAMA2), updated as part of this work. As of December 2017, the database contains 486 unique LAMA2 variants (309 disease-associated), obtained from direct submissions and literature reports. Database content was systematically reviewed and further insights concerning LAMA2-MD are presented. We focus on the impact of missense changes, especially the c.2461A > C (p.Thr821Pro) variant and its association with late-onset LAMA2-MD. Finally, we report diagnostically challenging cases, highlighting the relevance of modern genetic analysis in the characterization of clinically heterogeneous muscle diseases.
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Affiliation(s)
- Jorge Oliveira
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | | | - Márcio Cardoso
- Consulta de Doenças Neuromusculares e Serviço de Neurofisiologia, Departamento de Neurociências, Centro Hospitalar do Porto, Porto, Portugal
| | - Ricardo Taipa
- Unidade de Neuropatologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Isabel Fineza
- Unidade de Neuropediatria, Centro de Desenvolvimento da Criança Luís Borges, Hospital Pediátrico de Coimbra, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Ana Gonçalves
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | | | | | | | - Julie Rath
- PreventionGenetics, Marshfield, Wisconsin
| | - Márcia E Oliveira
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Emília Vieira
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ana Paula Sousa
- Consulta de Doenças Neuromusculares e Serviço de Neurofisiologia, Departamento de Neurociências, Centro Hospitalar do Porto, Porto, Portugal
| | - José Pedro Vieira
- Serviço de Neurologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Teresa Lourenço
- Serviço de Genética Médica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Luciano Almendra
- Consulta de Doenças Neuromusculares, Hospitais da Universidade de Coimbra, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Luís Negrão
- Consulta de Doenças Neuromusculares, Hospitais da Universidade de Coimbra, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Manuela Santos
- Consulta de Doenças Neuromusculares e Serviço de Neuropediatria, Centro Hospitalar do Porto, Porto, Portugal
| | - Manuel Melo-Pires
- Unidade de Neuropatologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Consulta de Doenças Neuromusculares e Serviço de Neurofisiologia, Departamento de Neurociências, Centro Hospitalar do Porto, Porto, Portugal
| | - Johan T den Dunnen
- Departments of Human Genetics and Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rosário Santos
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,UCIBIO/REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Mário Sousa
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Departamento de Microscopia, Laboratório de Biologia Celular, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Centro de Genética da Reprodução Prof. Alberto Barros, Porto, Portugal
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Gonçalves C, Vieira de Castro J, Pojo M, Martins E, Taipa R, Pinto A, Faria C, Reis R, Sousa N, Costa B. PO-473 WNT6 expression in glioblastoma: mechanistic, functional and clinical implications. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jaunmuktane Z, Quaegebeur A, Taipa R, Viana-Baptista M, Barbosa R, Koriath C, Sciot R, Mead S, Brandner S. Evidence of amyloid-β cerebral amyloid angiopathy transmission through neurosurgery. Acta Neuropathol 2018; 135:671-679. [PMID: 29450646 PMCID: PMC5904220 DOI: 10.1007/s00401-018-1822-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 01/14/2018] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/14/2022]
Abstract
Amyloid-β (Aβ) is a peptide deposited in the brain parenchyma in Alzheimer's disease and in cerebral blood vessels, causing cerebral amyloid angiopathy (CAA). Aβ pathology is transmissible experimentally in animals and through medical procedures in humans, such as contaminated growth hormone or dura mater transplantation in the context of iatrogenic prion disease. Here, we present four patients who underwent neurosurgical procedures during childhood or teenage years and presented with intracerebral haemorrhage approximately three decades later, caused by severe CAA. None of these patients carried pathogenic mutations associated with early Aβ pathology development. In addition, we identified in the literature four patients with a history of neurosurgical intervention and subsequent development of CAA. These findings raise the possibility that Aβ pathology may be transmissible, as prion disease is, through neurosurgical procedures.
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Affiliation(s)
- Zane Jaunmuktane
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Annelies Quaegebeur
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
| | - Ricardo Taipa
- Portuguese Brain Bank, Neuropathology Unit, Department of Neuroscience, Centro Hospitalar Universitario do Porto, 4099-001, Porto, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1449-005, Lisbon, Portugal
| | - Raquel Barbosa
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1449-005, Lisbon, Portugal
| | - Carolin Koriath
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Raf Sciot
- Department of Imaging and Pathology, University of Leuven, 3000, Louvain, Belgium
| | - Simon Mead
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Medical Research Council Prion Unit at UCL, UCL Institute of Prion Diseases, Queen Square, London, WC1N 3BG, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
| | - Sebastian Brandner
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Samões R, Oliveira J, Taipa R, Coelho T, Cardoso M, Gonçalves A, Santos R, Melo Pires M, Santos M. RYR1-Related Myopathies: Clinical, Histopathologic and Genetic Heterogeneity Among 17 Patients from a Portuguese Tertiary Centre. J Neuromuscul Dis 2018; 4:67-76. [PMID: 28269792 DOI: 10.3233/jnd-160199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pathogenic variants in ryanodine receptor type 1 (RYR1) gene are an important cause of congenital myopathy. The clinical, histopathologic and genetic spectrum is wide. OBJECTIVE Review a group of the patients diagnosed with ryanodinopathy in a tertiary centre from North Portugal, as an attempt to define some phenotypical patterns that may help guiding future diagnosis. METHODS Patients were identified from the database of the reference centre for Neuromuscular Disorders in North Portugal. Their data (clinical, histological and genetic) was retrospectively accessed. RESULTS Seventeen RYR1-related patients (including 4 familial cases) were identified. They were divided in groups according to three distinctive clinical characteristics: extraocular muscle (EOM) weakness (N = 6), disproportionate axial muscle weakness (N = 2) and joint laxity (N = 5). The fourth phenotype includes patients with mild tetraparesis and no distinctive clinical features (N = 4). Four different histopathological patterns were found: centronuclear (N = 5), central core (N = 4), type 1 fibres predominance (N = 4) and congenital fibre type disproportion (N = 1) myopathies. Each index case, except two patients, had a different RYR1 variant. Four new genetic variants were identified. All centronuclear myopathies were associated with autosomal recessive inheritance and EOM weakness. All central core myopathies were caused by pathogenic variants in hotspot 3 with autosomal dominant inheritance. Three genetic variants were reported to be associated to malignant hyperthermia susceptibility. CONCLUSIONS Distinctive clinical features were recognized as diagnostically relevant: extraocular muscle weakness (and centronuclear pattern on muscle biopsy), severe axial weakness disproportionate to the ambulatory state and mild tetraparesis associated with (proximal) joint laxity. There was a striking genetic heterogeneity, including four new RYR1 variants.
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Affiliation(s)
- Raquel Samões
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Oliveira
- Unidade de Genética Molecular, Centro de Genética Médica, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Department of Neurophysiology and Neuromuscular Disorders Outpatient Clinic, Centro Hospitalar do Porto, Porto, Portugal
| | - Márcio Cardoso
- Department of Neurophysiology and Neuromuscular Disorders Outpatient Clinic, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Gonçalves
- Unidade de Genética Molecular, Centro de Genética Médica, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Rosário Santos
- Unidade de Genética Molecular, Centro de Genética Médica, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,UCIBIO/REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | | | - Manuela Santos
- Neuromuscular Disorders Outpatient Clinic and Department of Neuropaediatrics, Centro Hospitalar do Porto, Porto, Portugal
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Taipa R, Sousa AL, Melo Pires M, Sousa N. Does the Interplay Between Aging and Neuroinflammation Modulate Alzheimer's Disease Clinical Phenotypes? A Clinico-Pathological Perspective. J Alzheimers Dis 2018; 53:403-17. [PMID: 27176075 DOI: 10.3233/jad-160121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alzheimer's disease (AD) is a chronic neurodegenerative disorder and is the most common cause of dementia worldwide. Cumulative data suggests that neuroinflammation plays a prominent and early role in AD, and there is compelling data from different research groups of age-associated dysregulation of the neuroimmune system. From the clinical point of view, despite clinical resemblance and neuropathological findings, there are important differences between the group of patients with sporadic early-onset (<65 years old) and late-onset AD (>65 years old). Thus, it seems important to understand the age-dependent relationship between neuroinflammation and the underlying biology of AD in order to identify potential explanations for clinical heterogeneity, interpret biomarkers, and promote the best treatment to different clinical AD phenotypes. The study of the delicate balance between pro-inflammatory or anti-inflammatory sides of immune players in the different ages of onset of AD would be important to understand treatment efficacy in clinical trials and eventually, not only direct treatment to early disease stages, but also the possibility of establishing different treatment approaches depending on the age of the patient. In this review, we would like to summarize what is currently known about the interplay between "normal" age associated inflammatory changes and AD pathological mechanisms, and also the potential differences between early-onset and late-onset AD taking into account the age-related neuroimmune background at disease onset.
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Affiliation(s)
- Ricardo Taipa
- Neuropathology Unit, Department of Neuroscience, Hospital Santo António - Centro Hospitalar do Porto, Porto, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - Ana Luísa Sousa
- Department of Neurology, Hospital Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Manuel Melo Pires
- Neuropathology Unit, Department of Neuroscience, Hospital Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
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42
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Taipa R, Ferreira V, Brochado P, Robinson A, Reis I, Marques F, Mann DM, Melo-Pires M, Sousa N. Inflammatory pathology markers (activated microglia and reactive astrocytes) in early and late onset Alzheimer disease: a post mortem study. Neuropathol Appl Neurobiol 2017; 44:298-313. [PMID: 29044639 DOI: 10.1111/nan.12445] [Citation(s) in RCA: 47] [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: 03/14/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023]
Abstract
AIMS The association between the pathological features of AD and dementia is stronger in younger old persons than in older old persons suggesting that additional factors are involved in the clinical expression of dementia in the oldest old. Cumulative data suggests that neuroinflammation plays a prominent role in Alzheimer's disease (AD) and different studies reported an age-associated dysregulation of the neuroimmune system. Consequently, we sought to characterize the pattern of microglial cell activation and astrogliosis in brain post mortem tissue of pathologically confirmed cases of early and late onset AD (EOAD and LOAD) and determine their relation to age. METHODS Immunohistochemistry (CD68 and glial fibrillary acidic protein) with morphometric analysis of astroglial profiles in 36 cases of AD and 28 similarly aged controls. RESULTS Both EOAD and LOAD groups had higher microglial scores in CA1, entorhinal and temporal cortices, and higher astroglial response in CA1, dentate gyrus, entorhinal and temporal cortices, compared to aged matched controls. Additionally, EOAD had higher microglial scores in subiculum, entorhinal and temporal subcortical white matter, and LOAD higher astrogliosis in CA2 region. CONCLUSIONS Overall, we found that the neuroinflammatory pathological markers in late stage AD human tissue to have a similar pattern in both EOAD and LOAD, though the severity of the pathological markers in the younger group was higher. Understanding the age effect in AD will be important when testing modifying agents that act on the neuroinflammation.
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Affiliation(s)
- R Taipa
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal.,Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - V Ferreira
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - P Brochado
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - A Robinson
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, Salford Royal Hospital Foundation NHS Trust, University of Manchester, Salford, UK
| | - I Reis
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - F Marques
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - D M Mann
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, Salford Royal Hospital Foundation NHS Trust, University of Manchester, Salford, UK
| | - M Melo-Pires
- Neuropathology Unit, Department of Neurosciences, Centro Hospitalar do Porto, Porto, Portugal
| | - N Sousa
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
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Cruz S, Taipa R, Nogueira C, Melo‐Pires M, Vilarinho L. Reply. Muscle Nerve 2017; 56:E49. [DOI: 10.1002/mus.25650] [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] [Received: 03/07/2017] [Revised: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Simão Cruz
- Neurology DepartmentHospital Prof. Doutor Fernando FonsecaAmadora Portugal
| | - Ricardo Taipa
- Neuropathology UnitHospital Santo António/Centro Hospitalar do PortoPorto Portugal
| | - Célia Nogueira
- Newborn Screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr Ricardo Jorge National Health InstitutePorto Portugal
| | - Manuel Melo‐Pires
- Neuropathology UnitHospital Santo António/Centro Hospitalar do PortoPorto Portugal
| | - Laura Vilarinho
- Newborn Screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr Ricardo Jorge National Health InstitutePorto Portugal
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44
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Rocha L, Noronha C, Taipa R, Reis J, Gomes M, Carvalho E. Supratentorial hemangioblastomas in von Hippel–Lindau wild-type patients – case series and literature review. Int J Neurosci 2017; 128:295-303. [DOI: 10.1080/00207454.2017.1385613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Luís Rocha
- Serviço de Neurocirurgia, Centro Hospitalar do Porto, Porto, Portugal
| | - Carolina Noronha
- Serviço de Neurocirurgia, Centro Hospitalar do Porto, Porto, Portugal
| | - Ricardo Taipa
- Serviço de Neurocirurgia, Centro Hospitalar do Porto, Porto, Portugal
| | - Joaquim Reis
- Serviço de Neurocirurgia, Centro Hospitalar do Porto, Porto, Portugal
| | - Mário Gomes
- Serviço de Neurocirurgia, Centro Hospitalar do Porto, Porto, Portugal
| | - Ernesto Carvalho
- Serviço de Neurocirurgia, Centro Hospitalar do Porto, Porto, Portugal
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45
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Gonçalves A, Oliveira J, Coelho T, Taipa R, Melo-Pires M, Sousa M, Santos R. Exonization of an Intronic LINE-1 Element Causing Becker Muscular Dystrophy as a Novel Mutational Mechanism in Dystrophin Gene. Genes (Basel) 2017; 8:genes8100253. [PMID: 28972564 PMCID: PMC5664103 DOI: 10.3390/genes8100253] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 12/25/2022] Open
Abstract
A broad mutational spectrum in the dystrophin (DMD) gene, from large deletions/duplications to point mutations, causes Duchenne/Becker muscular dystrophy (D/BMD). Comprehensive genotyping is particularly relevant considering the mutation-centered therapies for dystrophinopathies. We report the genetic characterization of a patient with disease onset at age 13 years, elevated creatine kinase levels and reduced dystrophin labeling, where multiplex-ligation probe amplification (MLPA) and genomic sequencing failed to detect pathogenic variants. Bioinformatic, transcriptomic (real time PCR, RT-PCR), and genomic approaches (Southern blot, long-range PCR, and single molecule real-time sequencing) were used to characterize the mutation. An aberrant transcript was identified, containing a 103-nucleotide insertion between exons 51 and 52, with no similarity with the DMD gene. This corresponded to the partial exonization of a long interspersed nuclear element (LINE-1), disrupting the open reading frame. Further characterization identified a complete LINE-1 (~6 kb with typical hallmarks) deeply inserted in intron 51. Haplotyping and segregation analysis demonstrated that the mutation had a de novo origin. Besides underscoring the importance of mRNA studies in genetically unsolved cases, this is the first report of a disease-causing fully intronic LINE-1 element in DMD, adding to the diversity of mutational events that give rise to D/BMD.
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Affiliation(s)
- Ana Gonçalves
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, 4050-106 Porto, Portugal.
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313 Porto, Portugal.
| | - Jorge Oliveira
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, 4050-106 Porto, Portugal.
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313 Porto, Portugal.
| | - Teresa Coelho
- Serviço de Neurofisiologia, Departamento de Neurociências, Centro Hospitalar do Porto, 4099-001 Porto, Portugal.
| | - Ricardo Taipa
- Unidade de Neuropatologia, Centro Hospitalar do Porto, 4099-001 Porto, Portugal.
| | - Manuel Melo-Pires
- Unidade de Neuropatologia, Centro Hospitalar do Porto, 4099-001 Porto, Portugal.
| | - Mário Sousa
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313 Porto, Portugal.
- Departamento de Microscopia, Laboratório de Biologia Celular, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313 Porto, Portugal.
- Centro de Genética da Reprodução Prof. Alberto Barros, 4050-313 Porto, Portugal.
| | - Rosário Santos
- Unidade de Genética Molecular, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, 4050-106 Porto, Portugal.
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313 Porto, Portugal.
- UCIBIO/REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal.
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Sousa AL, Taipa R, Quinn N, Revesz T, Pires MM, Magalhães M. Frontotemporal lobar degeneration-TDP with ‘multiple system atrophy phenocopy syndrome’. Neuropathol Appl Neurobiol 2017; 43:533-536. [DOI: 10.1111/nan.12391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 12/13/2022]
Affiliation(s)
- A. L. Sousa
- Department of Neurology; Department of Neuroscience; Centro Hospitalar Universitário do Porto; Porto Portugal
| | - R. Taipa
- Portuguese Brain Bank; Neuropathology Unit; Department of Neuroscience; Centro Hospitalar Universitário do Porto; Porto Portugal
| | - N. Quinn
- UCL Institute of Neurology; London UK
| | - T. Revesz
- Queen Square Brain Bank for Neurological Disorders; Department of Molecular Neuroscience; UCL Institute of Neurology; University College London; London UK
| | - M. M. Pires
- Portuguese Brain Bank; Neuropathology Unit; Department of Neuroscience; Centro Hospitalar Universitário do Porto; Porto Portugal
| | - M. Magalhães
- Department of Neurology; Department of Neuroscience; Centro Hospitalar Universitário do Porto; Porto Portugal
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Samões R, Taipa R, Valdrez K, Gonçalves I, Melo Pires M, Martins da Silva A, Coelho T. Amyloid detection in the transverse carpal ligament of patients with hereditary ATTR V30M amyloidosis and carpal tunnel syndrome. Amyloid 2017; 24:73-77. [PMID: 28413892 DOI: 10.1080/13506129.2017.1313222] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is a nonspecific manifestation of hereditary ATTR amyloidosis (ATTRm). Amyloid deposition of wild-type TTR (WT-ATTR) has been found in transverse carpal ligament (TCL) in idiopathic CTS. We retrospectively studied a group of patients with ATTRm and CTS submitted to carpal tunnel release surgery (CTRS). METHODS From the nerve conduction studies performed in our Clinical Unit dedicated to hereditary amyloidosis between July 2009 and October 2013, we selected patients who fulfilled neurophysiological criteria for CTS, had been submitted to CTRS and whose TCL was available for pathology. Clinical registries were reviewed and amyloid detection in the ligaments was performed using Congo-red staining. RESULTS We included 16 patients: three males (18.8%), mean age = 46.1 years old, all with V30M mutation. At the time of surgery, four patients were considered asymptomatic and 12 symptomatic carriers, five of them late-onset ATTRm (onset age >50 years old). In all but one patient, the CTS preceded the polyneuropathy. Amyloid detection in the TCL was positive in 14 patients (87.5%). DISCUSSION/CONCLUSIONS In most patients, CTS preceded or was contemporary to the polyneuropathy and amyloid detection in TCL was positive. The detection of amyloid in TCL may add specificity to CTS as an early manifestation of the disease but more studies are needed.
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Affiliation(s)
- Raquel Samões
- a Neurology Department , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
| | - Ricardo Taipa
- a Neurology Department , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal.,b Neuropathology Unit , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
| | - Kátia Valdrez
- c Neurophysiology Department , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
| | - Isabel Gonçalves
- d Orthopedics Department , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
| | - Manuel Melo Pires
- b Neuropathology Unit , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
| | - Ana Martins da Silva
- a Neurology Department , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal.,e Corino de Andrade Unit , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
| | - Teresa Coelho
- c Neurophysiology Department , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal.,e Corino de Andrade Unit , Centro Hospitalar do Porto - Hospital de Santo António , Porto , Portugal
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48
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Santos E, Coutinho E, Martins da Silva A, Marinho A, Vasconcelos C, Taipa R, Pires MM, Gonçalves G, Lopes C, Leite MI. Inflammatory myopathy associated with myasthenia gravis with and without thymic pathology: Report of four cases and literature review. Autoimmun Rev 2017; 16:644-649. [DOI: 10.1016/j.autrev.2017.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 12/31/2022]
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49
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Taipa R, Brochado P, Robinson A, Reis I, Costa P, Mann DM, Melo Pires M, Sousa N. Patterns of Microglial Cell Activation in Alzheimer Disease and Frontotemporal Lobar Degeneration. NEURODEGENER DIS 2017; 17:145-154. [PMID: 28445885 DOI: 10.1159/000457127] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 09/23/2016] [Accepted: 01/20/2017] [Indexed: 12/12/2022] Open
Abstract
AIMS Microglia-driven neuroinflammation can play an important role in the pathophysiology of neurodegenerative disorders. In this study, we sought to characterize the distribution of microglial cell activation in 2 neurodegenerative dementias with distinct protein signatures, Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD) of the TDP subtype, and to determine if there was an anatomical correlation with the phenotypes most commonly associated with these conditions. METHODS The distribution and extent of microglial cell activation was assessed semiquantitatively in the hippocampal formation, cortical gray matter, and subcortical white matter of CD68-immunostained sections of the frontal, temporal, parietal, and occipital cortices from 15 pathologically confirmed cases of AD, 13 cases of FTLD, and 18 controls. RESULTS Significantly higher levels of microglial cell activation occurred in the subiculum in AD and FTLD than in controls. Additionally, AD had higher microglial activation in the CA1 and FTLD in the hippocampal white matter than the controls. Microglial activation was greater in the dentate gyrus molecular layer in AD than in FTLD. In the cortical regions, the 2 pathological groups differed only in frontal white matter, with the FTLD group showing higher microglial scores. FTLD showed higher microglial activation in the white matter compared to the respective gray matter in the entorhinal, temporal, and frontal regions. CONCLUSIONS Our work expands the knowledge of the distribution and magnitude of microglial activation in these disorders. Additionally, we found some microglial circuit-specific patterns that could help to explain some of the clinical overlap between AD and FTLD-TDP, namely in memory deficits.
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Affiliation(s)
- Ricardo Taipa
- Neuropathology Unit, Neurosciences Department, Centro Hospitalar do Porto, Porto, Portugal
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Cruz S, Taipa R, Nogueira C, Pereira C, Almeida LS, Neiva R, Geraldes T, Guimarães A, Melo‐Pires M, Vilarinho L. Clinical, biochemical, molecular, and histological features of 65 Portuguese patients with mitochondrial disorders. Muscle Nerve 2017; 56:868-872. [DOI: 10.1002/mus.25593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Simão Cruz
- Neurology DepartmentHospital Prof. Doutor Fernando FonsecaIC 19, 2720‐276, Amadora Portugal
| | - Ricardo Taipa
- Neuropathology UnitHospital Santo António / Centro Hospitalar do PortoPorto Portugal
| | - Célia Nogueira
- Newborn screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr. Ricardo Jorge National Health InstitutePorto Portugal
| | - Cristina Pereira
- Newborn screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr. Ricardo Jorge National Health InstitutePorto Portugal
| | - Lígia S. Almeida
- Newborn screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr. Ricardo Jorge National Health InstitutePorto Portugal
| | - Raquel Neiva
- Newborn screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr. Ricardo Jorge National Health InstitutePorto Portugal
| | - Tiago Geraldes
- Neurology DepartmentHospital Garcia de OrtaAlmada Portugal
| | - António Guimarães
- Neuropathology UnitHospital Santo António / Centro Hospitalar do PortoPorto Portugal
| | - Manuel Melo‐Pires
- Neuropathology UnitHospital Santo António / Centro Hospitalar do PortoPorto Portugal
| | - Laura Vilarinho
- Newborn screening, Metabolism and Genetics Unit, Human Genetics DepartmentDr. Ricardo Jorge National Health InstitutePorto Portugal
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