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Martínez-Payá JJ, Ríos-Díaz J, Del Baño-Aledo ME, Hervás D, Tembl-Ferrairó JI, Sevilla-Mantecón T, Vázquez-Costa JF. The cross-sectional area of the median nerve: An independent prognostic biomarker in amyotrophic lateral sclerosis. Neurologia 2024; 39:564-572. [PMID: 39232594 DOI: 10.1016/j.nrleng.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/15/2022] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Ultrasound changes in the cross-sectional area of the median nerve (CSAmn) could be of interest as biomarkers in patients with amyotrophic lateral sclerosis (ALS). METHODS Eighty-four ALS patients (51 men [60.7%]; mean 62.0 [SD 11.46] years old) and forty-six controls (27 men [58.7%]; mean 59.9 [SD 8.08] years old) of two different cohorts were recruited between September 2013 and February 2018. The CSAmn was measured bilaterally in each cohort, by two different examiners with two different ultrasound machines (one in each cohort). Its association with clinical variables (disease duration, muscle strength, disability, progression rate and tracheostomy-free survival) was assessed. RESULTS The CSAmn was smaller in patients than in controls, and the study cohort did not influence its values. A mild correlation between the strength of the wrist flexor and the CSAmn was found. In the multivariable analysis, the probability of this association being true was 90%. In the cox regression, both a faster progression rate and a larger CSAmn independently predicted poor survival (HR=4.29, [Cr.I95%: 2.71-6.80], p<0.001; and HR=1.14, [Cr.I95%: 1.03-1.25], p=0.01), after adjusting by age, body mass index, bulbar onset, and diagnostic delay. CONCLUSIONS The CSAmn is an easy to assess biomarker that seems reliable and reproducible. Our data also suggest that it could act as a progression and prognostic biomarker in ALS patients. Longitudinal studies with repeated measures are warranted to confirm its usefulness in the clinical practice.
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Affiliation(s)
- J J Martínez-Payá
- Physiotherapy Department, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - J Ríos-Díaz
- Campus San Rafael, Escuela de Enfermería y Fisioterapia San Juan de Dios, Universidad Pontificia de Comillas, Madrid, Spain.
| | - M E Del Baño-Aledo
- Physiotherapy Department, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - D Hervás
- Department of Applied Statistics and Operations Research, and Quality, Universitat Politècnica de València, Valencia, Spain; Medicine Department, Facultad de Medicina, Universitat de València, Valencia, Spain
| | - J I Tembl-Ferrairó
- Neurosonology Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Sevilla-Mantecón
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Medicine Department, Facultad de Medicina, Universitat de València, Valencia, Spain
| | - J F Vázquez-Costa
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Medicine Department, Facultad de Medicina, Universitat de València, Valencia, Spain.
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Shin-Yi Lin C, Howells J, Rutkove S, Nandedkar S, Neuwirth C, Noto YI, Shahrizaila N, Whittaker RG, Bostock H, Burke D, Tankisi H. Neurophysiological and imaging biomarkers of lower motor neuron dysfunction in motor neuron diseases/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 162:91-120. [PMID: 38603949 DOI: 10.1016/j.clinph.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
This chapter discusses comprehensive neurophysiological biomarkers utilised in motor neuron disease (MND) and, in particular, its commonest form, amyotrophic lateral sclerosis (ALS). These encompass the conventional techniques including nerve conduction studies (NCS), needle and high-density surface electromyography (EMG) and H-reflex studies as well as novel techniques. In the last two decades, new methods of assessing the loss of motor units in a muscle have been developed, that are more convenient than earlier methods of motor unit number estimation (MUNE),and may use either electrical stimulation (e.g. MScanFit MUNE) or voluntary activation (MUNIX). Electrical impedance myography (EIM) is another novel approach for the evaluation that relies upon the application and measurement of high-frequency, low-intensity electrical current. Nerve excitability techniques (NET) also provide insights into the function of an axon and reflect the changes in resting membrane potential, ion channel dysfunction and the structural integrity of the axon and myelin sheath. Furthermore, imaging ultrasound techniques as well as magnetic resonance imaging are capable of detecting the constituents of morphological changes in the nerve and muscle. The chapter provides a critical description of the ability of each technique to provide neurophysiological insight into the complex pathophysiology of MND/ALS. However, it is important to recognise the strengths and limitations of each approach in order to clarify utility. These neurophysiological biomarkers have demonstrated reliability, specificity and provide additional information to validate and assess lower motor neuron dysfunction. Their use has expanded the knowledge about MND/ALS and enhanced our understanding of the relationship between motor units, axons, reflexes and other neural circuits in relation to clinical features of patients with MND/ALS at different stages of the disease. Taken together, the ultimate goal is to aid early diagnosis, distinguish potential disease mimics, monitor and stage disease progression, quantify response to treatment and develop potential therapeutic interventions.
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Affiliation(s)
- Cindy Shin-Yi Lin
- Faculty of Medicine and Health, Central Clinical School, Brain and Mind Centre, University of Sydney, Sydney 2006, Australia.
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sanjeev Nandedkar
- Natus Medical Inc, Middleton, Wisconsin, USA and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Roger G Whittaker
- Newcastle University Translational and Clinical Research Institute (NUTCRI), Newcastle University., Newcastle Upon Tyne, United Kingdom
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - David Burke
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Darabi S, Ariaei A, Rustamzadeh A, Afshari D, Charkhat Gorgich EA, Darabi L. Cerebrospinal fluid and blood exosomes as biomarkers for amyotrophic lateral sclerosis; a systematic review. Diagn Pathol 2024; 19:47. [PMID: 38429818 PMCID: PMC10908104 DOI: 10.1186/s13000-024-01473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive and fatal motor neuron disease. Due to the limited knowledge about potential biomarkers that help in early diagnosis and monitoring disease progression, today's diagnoses are based on ruling out other diseases, neurography, and electromyography examination, which takes a time-consuming procedure. METHODS PubMed, ScienceDirect, and Web of Science were explored to extract articles published from January 2015 to June 2023. In the searching strategy following keywords were included; amyotrophic lateral sclerosis, biomarkers, cerebrospinal fluid, serum, and plama. RESULTS A total number of 6 studies describing fluid-based exosomal biomarkers were included in this study. Aggregated proteins including SOD1, TDP-43, pTDP-43, and FUS could be detected in the microvesicles (MVs). Moreover, TDP-43 and NFL extracted from plasma exosomes could be used as prognostic biomarkers. Also, downregulated miR-27a-3p detected through exoEasy Maxi and exoQuick Kit in the plasma could be measured as a diagnostic biomarker. Eventually, the upregulated level of CORO1A could be used to monitor disease progression. CONCLUSION Based on the results, each biomarker alone is insufficient to evaluate ALS. CNS-derived exosomes contain multiple ALS-related biomarkers (SOD1, TDP-43, pTDP-43, FUS, and miRNAs) that are detectable in cerebrospinal fluid and blood is a proper alternation. Exosome detecting kits listed as exoEasy, ExoQuick, Exo-spin, ME kit, ExoQuick Plus, and Exo-Flow, are helpful to reach this purpose.
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Affiliation(s)
- Shahram Darabi
- Cellular and Molecular Research Center, Research Institute for Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Armin Ariaei
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Auob Rustamzadeh
- Cellular and Molecular Research Center, Research Institute for Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
- Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, next to Milad Tower, Tehran, Iran.
| | - Dariush Afshari
- Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Leila Darabi
- Department of Neurology, Tehran Medical Science Branch, Amir Al Momenin Hospital, Islamic Azad University, Tehran, Iran
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Rogers ML, Schultz DW, Karnaros V, Shepheard SR. Urinary biomarkers for amyotrophic lateral sclerosis: candidates, opportunities and considerations. Brain Commun 2023; 5:fcad287. [PMID: 37946793 PMCID: PMC10631861 DOI: 10.1093/braincomms/fcad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/23/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
Amyotrophic lateral sclerosis is a relentless neurodegenerative disease that is mostly fatal within 3-5 years and is diagnosed on evidence of progressive upper and lower motor neuron degeneration. Around 15% of those with amyotrophic lateral sclerosis also have frontotemporal degeneration, and gene mutations account for ∼10%. Amyotrophic lateral sclerosis is a variable heterogeneous disease, and it is becoming increasingly clear that numerous different disease processes culminate in the final degeneration of motor neurons. There is a profound need to clearly articulate and measure pathological process that occurs. Such information is needed to tailor treatments to individuals with amyotrophic lateral sclerosis according to an individual's pathological fingerprint. For new candidate therapies, there is also a need for methods to select patients according to expected treatment outcomes and measure the success, or not, of treatments. Biomarkers are essential tools to fulfil these needs, and urine is a rich source for candidate biofluid biomarkers. This review will describe promising candidate urinary biomarkers of amyotrophic lateral sclerosis and other possible urinary candidates in future areas of investigation as well as the limitations of urinary biomarkers.
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Affiliation(s)
- Mary-Louise Rogers
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide 5042, South Australia, Australia
| | - David W Schultz
- Neurology Department and MND Clinic, Flinders Medical Centre, Adelaide 5042, South Australia, Australia
| | - Vassilios Karnaros
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide 5042, South Australia, Australia
| | - Stephanie R Shepheard
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide 5042, South Australia, Australia
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Höhn L, Hußler W, Richter A, Smalla KH, Birkl-Toeglhofer AM, Birkl C, Vielhaber S, Leber SL, Gundelfinger ED, Haybaeck J, Schreiber S, Seidenbecher CI. Extracellular Matrix Changes in Subcellular Brain Fractions and Cerebrospinal Fluid of Alzheimer’s Disease Patients. Int J Mol Sci 2023; 24:ijms24065532. [PMID: 36982604 PMCID: PMC10058969 DOI: 10.3390/ijms24065532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
The brain’s extracellular matrix (ECM) is assumed to undergo rearrangements in Alzheimer’s disease (AD). Here, we investigated changes of key components of the hyaluronan-based ECM in independent samples of post-mortem brains (N = 19), cerebrospinal fluids (CSF; N = 70), and RNAseq data (N = 107; from The Aging, Dementia and TBI Study) of AD patients and non-demented controls. Group comparisons and correlation analyses of major ECM components in soluble and synaptosomal fractions from frontal, temporal cortex, and hippocampus of control, low-grade, and high-grade AD brains revealed a reduction in brevican in temporal cortex soluble and frontal cortex synaptosomal fractions in AD. In contrast, neurocan, aggrecan and the link protein HAPLN1 were up-regulated in soluble cortical fractions. In comparison, RNAseq data showed no correlation between aggrecan and brevican expression levels and Braak or CERAD stages, but for hippocampal expression of HAPLN1, neurocan and the brevican-interaction partner tenascin-R negative correlations with Braak stages were detected. CSF levels of brevican and neurocan in patients positively correlated with age, total tau, p-Tau, neurofilament-L and Aβ1-40. Negative correlations were detected with the Aβ ratio and the IgG index. Altogether, our study reveals spatially segregated molecular rearrangements of the ECM in AD brains at RNA or protein levels, which may contribute to the pathogenic process.
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Affiliation(s)
- Lukas Höhn
- Leibniz Institute for Neurobiology (LIN), 39118 Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Wilhelm Hußler
- Leibniz Institute for Neurobiology (LIN), 39118 Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Anni Richter
- Leibniz Institute for Neurobiology (LIN), 39118 Magdeburg, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, 07743 Jena, Germany
| | - Karl-Heinz Smalla
- Leibniz Institute for Neurobiology (LIN), 39118 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39104 Magdeburg, Germany
- Institute for Pharmacology and Toxicology, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Anna-Maria Birkl-Toeglhofer
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Diagnostic and Research Center for Molecular Biomedicine, Institute of Pathology, Medical University of Graz, 8036 Graz, Austria
| | - Christoph Birkl
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39104 Magdeburg, Germany
| | - Stefan L. Leber
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, 8036 Graz, Austria
| | - Eckart D. Gundelfinger
- Leibniz Institute for Neurobiology (LIN), 39118 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39104 Magdeburg, Germany
- Institute for Pharmacology and Toxicology, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Johannes Haybaeck
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Diagnostic and Research Center for Molecular Biomedicine, Institute of Pathology, Medical University of Graz, 8036 Graz, Austria
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39104 Magdeburg, Germany
- German Center for Neurodegenerative Disorders (DZNE), 39120 Magdeburg, Germany
| | - Constanze I. Seidenbecher
- Leibniz Institute for Neurobiology (LIN), 39118 Magdeburg, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, 07743 Jena, Germany
- Center for Behavioral Brain Sciences (CBBS), 39104 Magdeburg, Germany
- Correspondence:
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Martínez-Payá J, Ríos-Díaz J, del Baño-Aledo M, Hervás D, Tembl-Ferrairó J, Sevilla-Mantecón T, Vázquez-Costa J. The cross-sectional area of the median nerve: An independent prognostic biomarker in amyotrophic lateral sclerosis. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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7
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Hußler W, Höhn L, Stolz C, Vielhaber S, Garz C, Schmitt FC, Gundelfinger ED, Schreiber S, Seidenbecher CI. Brevican and Neurocan Cleavage Products in the Cerebrospinal Fluid - Differential Occurrence in ALS, Epilepsy and Small Vessel Disease. Front Cell Neurosci 2022; 16:838432. [PMID: 35480959 PMCID: PMC9036369 DOI: 10.3389/fncel.2022.838432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
The neural extracellular matrix (ECM) composition shapes the neuronal microenvironment and undergoes substantial changes upon development and aging, but also due to cerebral pathologies. In search for potential biomarkers, cerebrospinal fluid (CSF) and serum concentrations of brain ECM molecules have been determined recently to assess ECM changes during neurological conditions including Alzheimer’s disease or vascular dementia. Here, we measured the levels of two signature proteoglycans of brain ECM, neurocan and brevican, in the CSF and serum of 96 neurological patients currently understudied regarding ECM alterations: 16 cases with amyotrophic lateral sclerosis (ALS), 26 epilepsy cases, 23 cerebral small vessel disease (CSVD) patients and 31 controls. Analysis of total brevican and neurocan was performed via sandwich Enzyme-linked immunosorbent assays (ELISAs). Major brevican and neurocan cleavage products were measured in the CSF using semiquantitative immunoblotting. Total brevican and neurocan concentrations in serum and CSF did not differ between groups. The 60 kDa brevican fragment resulting from cleavage by the protease ADAMTS-4 was also found unchanged among groups. The presumably intracellularly generated 150 kDa C-terminal neurocan fragment, however, was significantly increased in ALS as compared to all other groups. This group also shows the highest correlation between cleaved and total neurocan in the CSF. Brevican and neurocan levels strongly correlated with each other across all groups, arguing for a joint but yet unknown transport mechanism from the brain parenchyma into CSF. Conclusively our findings suggest an ALS-specific pattern of brain ECM remodeling and may thus contribute to new diagnostic approaches for this disorder.
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Affiliation(s)
- Wilhelm Hußler
- Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lukas Höhn
- Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | | | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Cornelia Garz
- Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Friedhelm C. Schmitt
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Eckart D. Gundelfinger
- Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Institute for Pharmacology and Toxicology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Constanze I. Seidenbecher
- Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- *Correspondence: Constanze I. Seidenbecher,
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Obrador E, Salvador-Palmer R, López-Blanch R, Jihad-Jebbar A, Vallés SL, Estrela JM. The Link between Oxidative Stress, Redox Status, Bioenergetics and Mitochondria in the Pathophysiology of ALS. Int J Mol Sci 2021; 22:ijms22126352. [PMID: 34198557 PMCID: PMC8231819 DOI: 10.3390/ijms22126352] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common neurodegenerative disease of the motor system. It is characterized by the degeneration of both upper and lower motor neurons, which leads to muscle weakness and paralysis. ALS is incurable and has a bleak prognosis, with median survival of 3-5 years after the initial symptomatology. In ALS, motor neurons gradually degenerate and die. Many features of mitochondrial dysfunction are manifested in neurodegenerative diseases, including ALS. Mitochondria have shown to be an early target in ALS pathophysiology and contribute to disease progression. Disruption of their axonal transport, excessive generation of reactive oxygen species, disruption of the mitochondrial structure, dynamics, mitophagy, energy production, calcium buffering and apoptotic triggering have all been directly involved in disease pathogenesis and extensively reported in ALS patients and animal model systems. Alterations in energy production by motor neurons, which severely limit their survival capacity, are tightly linked to the redox status and mitochondria. The present review focuses on this link. Placing oxidative stress as a main pathophysiological mechanism, the molecular interactions and metabolic flows involved are analyzed. This leads to discussing potential therapeutic approaches targeting mitochondrial biology to slow disease progression.
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Affiliation(s)
- Elena Obrador
- Correspondence: (E.O.); (J.M.E.); Tel.: +34-963864646 (J.M.E.)
| | | | | | | | | | - José M. Estrela
- Correspondence: (E.O.); (J.M.E.); Tel.: +34-963864646 (J.M.E.)
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Loewenbrück KF, Werner R, Günther R, Dittrich M, Klingenberger R, Reichmann H, Storch A, Hermann A. One nerve suffices: A clinically guided nerve ultrasound protocol for the differentiation of multifocal motor neuropathy (MMN) and amyotrophic lateral sclerosis (ALS). J Neurol 2021; 268:1495-1507. [PMID: 33355881 PMCID: PMC7990818 DOI: 10.1007/s00415-020-10323-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate diagnostic accuracy of a nerve ultrasound (US) protocol that is individualized to a patient's clinical deficits for the differentiation of amyotrophic lateral sclerosis with predominant lower motoneuron disease (ALS/LMND) and multifocal motor neuropathy (MMN). METHODS Single-center, prospective, examiner-blinded, diagnostic study in two cohorts. Cohort I (model development): Convenience sample of subjects with ALS/LMND or MMN according to revised El-Escorial or EFNS guidelines. Cohort II (model validation): Consecutively recruited treatment-naïve subjects with suspected diagnosis of ALS/LMND or MMN. Cutoffs for 28 different US values were determined by Receiver Operating Curve (ROC) in cohort I. Area Under The Curve (AUC) of US was compared to nerve conduction studies (NCS). Diagnostic accuracy of US protocols, individualized according to clinical deficits, was compared to former rigid non-individualized protocols and to random examination site selection in cohort II. RESULTS 48 patients were recruited. In cohort I (28 patients), US had higher ROC AUCs than NCS, US 0.82 (0.12) (mean (standard deviation)), NCS (compound muscle action potential (CMAP) 0.60 (0.09), p < .001; two-sided t-test). US models based on the nerve innervating the clinically most affected muscles had higher correct classification rates (CCRs, 93%) in cohort II than former rigid protocols (85% and 80%), or models with random measurement site selection (66% and 80%). CONCLUSIONS Clinically guided US protocols for differentiation of ALS/LMND from MMN increase diagnostic accuracy when compared to clinically unguided protocols. They also require less measurements sites to achieve this accuracy.
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Affiliation(s)
- Kai F Loewenbrück
- Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases (DZNE), 01307, Dresden, Germany.
| | - Robin Werner
- Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), 01307, Dresden, Germany
| | - Markus Dittrich
- Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
- Department of Neurology, Elblandkliniken, 01662, Meissen, Germany
| | - Robert Klingenberger
- Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, 18147, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, 18147, Rostock, Germany
| | - Andreas Hermann
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, 18147, Rostock, Germany
- Department of Neurology, Translational Neurodegeneration Section "Albrecht Kossel", University of Rostock, 18147, Rostock, Germany
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10
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Schreiber F, Garz C, Heinze HJ, Petri S, Vielhaber S, Schreiber S. Textural markers of ultrasonographic nerve alterations in amyotrophic lateral sclerosis. Muscle Nerve 2020; 62:601-610. [PMID: 32779757 DOI: 10.1002/mus.27043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
Ultrasound has revealed cross-sectional nerve area (CSA) reduction in amyotrophic lateral sclerosis (ALS), but little is known about the sonographic nerve texture beyond CSA alterations. In a large cohort of 177 ALS patients and 57 control subjects, we investigated the covariance and disease-specific signature of several sonographic texture features of the median and ulnar nerves and their relationship to the patients' clinical characteristics. ALS patients showed atrophic nerves, a loss of the intranerve structures' echoic contrast, elevated coarseness, and a trend toward lower cluster shading compared with controls. A reduction in intranerve echoic contrast was related to longer disease duration and poorer functional status in ALS. Sonographic texture markers point toward a significant reorganization of the deep nerve microstructure in ALS. Future studies will be needed to further substantiate the markers' potential to assess peripheral nerve alterations in ALS.
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Affiliation(s)
- Frank Schreiber
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases within the Helmholtz Association, Magdeburg, Germany
| | - Cornelia Garz
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases within the Helmholtz Association, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases within the Helmholtz Association, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases within the Helmholtz Association, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases within the Helmholtz Association, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
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11
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Schreiber S, Vielhaber S, Schreiber F, Cartwright MS. Peripheral nerve imaging in amyotrophic lateral sclerosis. Clin Neurophysiol 2020; 131:2315-2326. [DOI: 10.1016/j.clinph.2020.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
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12
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de Leeuw C, Wijntjes J, Lassche S, van Alfen N. Nerve ultrasound for distinguishing inflammatory neuropathy from amyotrophic lateral sclerosis: Not black and white. Muscle Nerve 2020; 61:E33-E37. [PMID: 32129899 DOI: 10.1002/mus.26853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Carola de Leeuw
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Juerd Wijntjes
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia Lassche
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Barnes SL, Simon NG. Clinical and research applications of neuromuscular ultrasound in amyotrophic lateral sclerosis. Degener Neurol Neuromuscul Dis 2019; 9:89-102. [PMID: 31406480 PMCID: PMC6642653 DOI: 10.2147/dnnd.s215318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/14/2019] [Indexed: 12/20/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder characterized by dysfunction at multiple levels of the neuraxis. It remains a clinical diagnosis without a definitive diagnostic investigation. Electrodiagnostic testing provides supportive information and, along with imaging and biochemical markers, can help exclude mimicking conditions. Neuromuscular ultrasound has a valuable role in the diagnosis and monitoring of ALS and provides complementary information to clinical assessment and electrodiagnostic testing as well as insights into the underlying pathophysiology of this disease. This review highlights the evidence for ultrasound in the evaluation of bulbar, limb and respiratory musculature and peripheral nerves in ALS. Further research in this evolving area is required.
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Affiliation(s)
- Stephanie L Barnes
- Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
- St Vincent’s Clinical School, School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Neil G Simon
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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14
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Hobson-Webb LD, Simmons Z. ULTRASOUND IN THE DIAGNOSIS AND MONITORING OF AMYOTROPHIC LATERAL SCLEROSIS: A REVIEW. Muscle Nerve 2019; 60:114-123. [PMID: 30989697 DOI: 10.1002/mus.26487] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
Neuromuscular ultrasound is complementary to electrodiagnostic (EDx) testing and is useful in enhancing the diagnosis of mononeuropathies, peripheral nerve trauma, and demyelinating polyneuropathies. There is increasing interest in using ultrasound both to aid in the diagnosis of amyotrophic lateral sclerosis (ALS) and to monitor its progression. In this article we review the relevant literature on ultrasound in ALS. Ultrasound is more sensitive than EDx in identifying fasciculations in patients with ALS. It can detect decreased muscle thickness, increased muscle echointensity and echovariance, and reduced peripheral nerve size in these patients. Ultrasound is also a helpful tool in assessment of diaphragm function. Although additional studies are required to define the exact role of ultrasound in the evaluation and monitoring of ALS, it can improve the diagnostic yield in patients when ALS is suspected, but insufficiently supported, by clinical and EDx examinations. Muscle Nerve 60: 114-123, 2019.
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Affiliation(s)
- Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University Medical Center, DUMC 3403, Durham, North Carolina 27710, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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15
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Schreiber S, Schreiber F, Garz C, Debska‐Vielhaber G, Assmann A, Perosa V, Petri S, Dengler R, Nestor P, Vielhaber S. Toward
in vivo
determination of peripheral nervous system immune activity in amyotrophic lateral sclerosis. Muscle Nerve 2019; 59:567-576. [DOI: 10.1002/mus.26444] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Stefanie Schreiber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Frank Schreiber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Cornelia Garz
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Grazyna Debska‐Vielhaber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
| | - Anne Assmann
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Valentina Perosa
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Susanne Petri
- Department of NeurologyHannover Medical School Hannover Germany
| | | | - Peter Nestor
- Queensland Brain InstituteUniversity of Queensland Brisbane Queensland Australia
| | - Stefan Vielhaber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
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16
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Pawlitzki M, Schreiber S, Bittner D, Kreipe J, Leypoldt F, Rupprecht K, Carare RO, Meuth SG, Vielhaber S, Körtvélyessy P. CSF Neurofilament Light Chain Levels in Primary Progressive MS: Signs of Axonal Neurodegeneration. Front Neurol 2018; 9:1037. [PMID: 30631300 PMCID: PMC6315185 DOI: 10.3389/fneur.2018.01037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives: Elevated neurofilament light chain (NFL) levels within the cerebrospinal fluid (CSF) are a biomarker representing axonal neurodegeneration in rapid progressive neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS). It is unclear to what extent the levels of NFL increase in the CSF (CSF-NFL) in a chronic neuroinflammatory process with axonal neurodegeneration, as found in primary progressive multiple sclerosis (PPMS). Methods: We used a multicenter approach to statistically compare CSF-NFL levels between PPMS patients (n = 50), ALS patients (n = 50), and healthy controls (n = 50). Clinical findings, including disease duration, expanded disability status scale (EDSS), electrophysiological recordings such as visual evoked potentials or spinal and cerebral MRI, and previously administered treatment were selected as experimental parameters retrospectively. Results: Median [range] CSF-NFL concentrations in PPMS patients were significantly higher than in the controls [1724 (799–4275) pg/ml vs. 1202 (612–2934) pg/ml, p = 0.015], and significantly lower compared to ALS patients [1724 (799–4275) pg/ml vs. 10238 (2610–35138) pg/ml, p < 0.001]. There was no correlation between CSF-NFL and disease duration (p = 0.5), EDSS (p = 0.2) or treatment (p = 0.3). Conclusion: We conclude that CSF-NFL may mirror the proposed slow axonal degeneration in PPMS, but does not reflect the disease severity.
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Affiliation(s)
- Marc Pawlitzki
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Daniel Bittner
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Julia Kreipe
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Klemens Rupprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
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17
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Suárez-Calvet M, Capell A, Araque Caballero MÁ, Morenas-Rodríguez E, Fellerer K, Franzmeier N, Kleinberger G, Eren E, Deming Y, Piccio L, Karch CM, Cruchaga C, Paumier K, Bateman RJ, Fagan AM, Morris JC, Levin J, Danek A, Jucker M, Masters CL, Rossor MN, Ringman JM, Shaw LM, Trojanowski JQ, Weiner M, Ewers M, Haass C. CSF progranulin increases in the course of Alzheimer's disease and is associated with sTREM2, neurodegeneration and cognitive decline. EMBO Mol Med 2018; 10:e9712. [PMID: 30482868 PMCID: PMC6284390 DOI: 10.15252/emmm.201809712] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 12/12/2022] Open
Abstract
Progranulin (PGRN) is predominantly expressed by microglia in the brain, and genetic and experimental evidence suggests a critical role in Alzheimer's disease (AD). We asked whether PGRN expression is changed in a disease severity-specific manner in AD We measured PGRN in cerebrospinal fluid (CSF) in two of the best-characterized AD patient cohorts, namely the Dominant Inherited Alzheimer's Disease Network (DIAN) and the Alzheimer's Disease Neuroimaging Initiative (ADNI). In carriers of AD causing dominant mutations, cross-sectionally assessed CSF PGRN increased over the course of the disease and significantly differed from non-carriers 10 years before the expected symptom onset. In late-onset AD, higher CSF PGRN was associated with more advanced disease stages and cognitive impairment. Higher CSF PGRN was associated with higher CSF soluble TREM2 (triggering receptor expressed on myeloid cells 2) only when there was underlying pathology, but not in controls. In conclusion, we demonstrate that, although CSF PGRN is not a diagnostic biomarker for AD, it may together with sTREM2 reflect microglial activation during the disease.
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Affiliation(s)
- Marc Suárez-Calvet
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
| | - Anja Capell
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Miguel Ángel Araque Caballero
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Estrella Morenas-Rodríguez
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, Institut d'Investigacions Biomèdiques, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Katrin Fellerer
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gernot Kleinberger
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Erden Eren
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Izmir International Biomedicine and Genome Institute Dokuz, Eylul University, Izmir, Turkey
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Yuetiva Deming
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura Piccio
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Celeste M Karch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Katrina Paumier
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne M Fagan
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mathias Jucker
- German Center for Neurodegenerative Diseases (DZNE) Tübingen, Tübingen, Germany
- Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - John M Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Weiner
- University of California at San Francisco, San Francisco, CA, USA
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian Haass
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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