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Mikolajewicz N, Yee PP, Bhanja D, Trifoi M, Miller AM, Metellus P, Bagley SJ, Balaj L, de Macedo Filho LJM, Zacharia BE, Aregawi D, Glantz M, Weller M, Ahluwalia MS, Kislinger T, Mansouri A. Systematic Review of Cerebrospinal Fluid Biomarker Discovery in Neuro-Oncology: A Roadmap to Standardization and Clinical Application. J Clin Oncol 2024; 42:1961-1974. [PMID: 38608213 DOI: 10.1200/jco.23.01621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 04/14/2024] Open
Abstract
Effective diagnosis, prognostication, and management of CNS malignancies traditionally involves invasive brain biopsies that pose significant risk to the patient. Sampling and molecular profiling of cerebrospinal fluid (CSF) is a safer, rapid, and noninvasive alternative that offers a snapshot of the intracranial milieu while overcoming the challenge of sampling error that plagues conventional brain biopsy. Although numerous biomarkers have been identified, translational challenges remain, and standardization of protocols is necessary. Here, we systematically reviewed 141 studies (Medline, SCOPUS, and Biosis databases; between January 2000 and September 29, 2022) that molecularly profiled CSF from adults with brain malignancies including glioma, brain metastasis, and primary and secondary CNS lymphomas. We provide an overview of promising CSF biomarkers, propose CSF reporting guidelines, and discuss the various considerations that go into biomarker discovery, including the influence of blood-brain barrier disruption, cell of origin, and site of CSF acquisition (eg, lumbar and ventricular). We also performed a meta-analysis of proteomic data sets, identifying biomarkers in CNS malignancies and establishing a resource for the research community.
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Affiliation(s)
- Nicholas Mikolajewicz
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Patricia P Yee
- Medical Scientist Training Program, Penn State College of Medicine, Hershey, PA
| | - Debarati Bhanja
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Mara Trifoi
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Alexandra M Miller
- Departments of Neurology and Pediatrics, Memorial Sloan Kettering Cancer Center, Manhattan, NY
| | - Philippe Metellus
- Department of Neurosurgery, Ramsay Santé, Hôpital Privé Clairval, Marseille, France
| | - Stephen J Bagley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Leonora Balaj
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Brad E Zacharia
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Dawit Aregawi
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Michael Glantz
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Manmeet S Ahluwalia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Thomas Kislinger
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Lindhout JE, Richard E, Hafdi M, Perry M, Moll van Charante E, van Gool WA. The Association of Ancillary Diagnostic Tests With Outcome in Dementia. J Am Med Dir Assoc 2024:105040. [PMID: 38796169 DOI: 10.1016/j.jamda.2024.105040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES Dementia is a clinical diagnosis without curative treatment. It is uncertain whether ancillary testing is beneficial for patients. This study investigates the association between use of diagnostic tests and time to poor outcome and health care costs. DESIGN Nationwide register-based cohort study using health care reimbursement data in the Netherlands. SETTING AND PARTICIPANTS All Dutch hospitals, including 13,312 patients diagnosed with dementia in 2018. METHODS Diagnostic testing included computed tomography or magnetic resonance imaging (CT/MRI), neuropsychological examination (NPE), nuclear imaging (PET/SPECT), electroencephalography (EEG), and cerebrospinal fluid (CSF) testing. We compared time to poor outcome (institutionalization or death) and costs per month from 2018 to 2021 between those who underwent a specific diagnostic test in previous years to controls, propensity score matched for age, sex, type of hospital, and comorbidity. RESULTS Time to poor outcome in those who underwent CT/MRI, EEG, or CSF testing was similar to those who did not, but was longer for those who underwent NPE. Time to poor outcome was shorter in patients who underwent PET/SPECT. Patients who underwent CSF testing or PET/SPECT had higher mean total health care costs as compared to controls (CSF €248, 95% CI 64-433; PET/SPECT: €315, 95% CI 179-451). NPE during the diagnostic trajectory was associated with lower total health care cost (-€127, 95% CI -62, -193). CONCLUSION AND IMPLICATIONS NPE was associated with longer time to poor outcome and lower health care costs, potentially due to confounding by indication. Patients who underwent neuroimaging (CT, MRI, SPECT/PET), CSF testing, or EEG for dementia diagnostics did not experience a longer time to poor outcome or lower health care costs. This emphasizes the importance of clinical examination as anchor for the diagnosis of dementia.
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Affiliation(s)
- Josephine E Lindhout
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Melanie Hafdi
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Primary and Community Care, Donders Institute for Brain, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Moll van Charante
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Lopez E, Etxebarria-Elezgarai J, García-Sebastián M, Altuna M, Ecay-Torres M, Estanga A, Tainta M, López C, Martínez-Lage P, Amigo JM, Seifert A. Unlocking Preclinical Alzheimer's: A Multi-Year Label-Free In Vitro Raman Spectroscopy Study Empowered by Chemometrics. Int J Mol Sci 2024; 25:4737. [PMID: 38731955 PMCID: PMC11084676 DOI: 10.3390/ijms25094737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Alzheimer's disease is a progressive neurodegenerative disorder, the early detection of which is crucial for timely intervention and enrollment in clinical trials. However, the preclinical diagnosis of Alzheimer's encounters difficulties with gold-standard methods. The current definitive diagnosis of Alzheimer's still relies on expensive instrumentation and post-mortem histological examinations. Here, we explore label-free Raman spectroscopy with machine learning as an alternative to preclinical Alzheimer's diagnosis. A special feature of this study is the inclusion of patient samples from different cohorts, sampled and measured in different years. To develop reliable classification models, partial least squares discriminant analysis in combination with variable selection methods identified discriminative molecules, including nucleic acids, amino acids, proteins, and carbohydrates such as taurine/hypotaurine and guanine, when applied to Raman spectra taken from dried samples of cerebrospinal fluid. The robustness of the model is remarkable, as the discriminative molecules could be identified in different cohorts and years. A unified model notably classifies preclinical Alzheimer's, which is particularly surprising because of Raman spectroscopy's high sensitivity regarding different measurement conditions. The presented results demonstrate the capability of Raman spectroscopy to detect preclinical Alzheimer's disease for the first time and offer invaluable opportunities for future clinical applications and diagnostic methods.
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Affiliation(s)
- Eneko Lopez
- CIC nanoGUNE BRTA, 20018 San Sebasián, Spain; (E.L.); (J.E.-E.)
- Department of Physics, University of the Basque Country (UPV/EHU), 20018 San Sebastián, Spain
| | | | - Maite García-Sebastián
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Miren Altuna
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Mirian Ecay-Torres
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Ainara Estanga
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Mikel Tainta
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Carolina López
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Pablo Martínez-Lage
- Center for Research and Advanced Therapies, CITA-Alzhéimer Foundation, 20009 San Sebastián, Spain; (M.G.-S.); (M.A.); (M.E.-T.); (A.E.); (M.T.); (C.L.); (P.M.-L.)
| | - Jose Manuel Amigo
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Analytical Chemistry, University of the Basque Country, 48940 Leioa, Spain
| | - Andreas Seifert
- CIC nanoGUNE BRTA, 20018 San Sebasián, Spain; (E.L.); (J.E.-E.)
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
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Seo J, Saurkar S, Fernandez GS, Das A, Goutman SA, Heidenreich S. Preferences of Patients with Amyotrophic Lateral Sclerosis for Intrathecal Drug Delivery: Choosing between an Implanted Drug-Delivery Device and Therapeutic Lumbar Puncture. THE PATIENT 2024; 17:161-177. [PMID: 38097873 DOI: 10.1007/s40271-023-00665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Novel intrathecal treatments for amyotrophic lateral sclerosis (ALS) may require delivery using lumbar puncture (LP). Implanted drug-delivery devices (IDDDs) could be an alternative but little is known about patients' preferences for intrathecal drug-delivery methods. OBJECTIVE We aimed to elicit preferences of patients with ALS for routine LP and IDDD use. METHODS A discrete choice experiment (DCE) and a threshold technique (TT) exercise were conducted online among patients with ALS in the US and Europe. In the DCE, patients made trade-offs between administration attributes. Attributes were identified from qualitative interviews. The TT elicited maximum acceptable risks (MARs) of complications from device implantation surgery. DCE data were analyzed using mixed logit to quantify relative attribute importance (RAI) as the maximum contribution of each attribute to a preference, and to estimate MARs of device failure. TT data were analyzed using interval regression. Four scenarios of LP and IDDD were compared. RESULTS Participants (N = 295) had a mean age of 57.7 years; most (74.2%) were diagnosed < 3 years ago. Preferences were affected by device failure risk (RAI 28.6%), administration frequency (26.4%), administration risk (19.7%), overall duration (17.8%), and appointment location (7.5%). Patients accepted a 5.6% device failure risk to reduce overall duration from 2 h to 30 min and a 3.6% risk for administration in a local clinic instead of a hospital. The average MAR of complications from implantation surgery was 29%. Patients preferred IDDD over LP in three of four scenarios. CONCLUSION Patients considered an IDDD as a valuable alternative to LP in multiple clinical settings.
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Affiliation(s)
- Jaein Seo
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | | | - Anup Das
- Patient-Centered Research, Evidera Ltd, 201 Talgarth Rd Hammersmith, London, W6 8BJ, UK
| | | | - Sebastian Heidenreich
- Patient-Centered Research, Evidera Ltd, 201 Talgarth Rd Hammersmith, London, W6 8BJ, UK.
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5
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Kaya Tutar N, Kale N. The Relationship between Lumbar Puncture Opening Pressure and Retinal Nerve Fiber Layer Thickness in the Diagnosis of Idiopathic Intracranial Hypertension: Is a Lumbar Puncture Always Necessary? Neurologist 2024; 29:91-95. [PMID: 37839079 DOI: 10.1097/nrl.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Idiopathic intracranial hypertension (IIH), is characterized by elevated intracranial pressure (ICP) without an identified cause. Today, lumbar puncture (LP) is the most common method used for diagnosis by measuring cerebrospinal fluid (CSF) pressure to reflect intracranial pressure. This invasive examination has significant disadvantages, such as complications and negative experiences for patients. Therefore, noninvasive methods for ICP measurement are desired. Optical coherence tomography (OCT) is widely used for the diagnosis and follow-up of IIH patients as it reflects papilledema. The aim of this study is to investigate the relationship between CSF pressure and OCT parameters and the ability of OCT in the diagnostic approach. METHODS In our study, patients who were followed up with a diagnosis of IIH with complete neuro-ophthalmological examinations, including visual acuity (VA), visual field, and OCT imaging within 24 hours before lumbar puncture, were retrospectively evaluated. CSF pressure, visual acuity LogMAR, mean deviation of visual fields, retinal nerve fiber layer (RNFL) thickness measured by OCT, and treatment protocols were obtained from our hospital data system. RESULTS A total of 42 eyes of 21 patients were enrolled in the study. A statistically significant positive and moderate correlation was found between CSF pressure values and average RNFL thickness ( r =0.507; P =0.001). The same relationship was demonstrated in all 4 quadrants: inferior, superior, nasal, and temporal. CONCLUSIONS Increased peripapillary RNFL thickness in optic nerve head OCT may be correlated with increased ICP in IIH patients. A larger number of patients are needed to better understand the correlation between OCT parameters and CSF pressure in patients with IIH.
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Affiliation(s)
- Nurhan Kaya Tutar
- Department of Neurology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Zhuang YD, Xie HS, Chen J, Wu GH, Wu JF, Chen CM. Computer-modified paramedian approach technique reduces failures and alleviates pain in lumbar puncture: a prospective comparative study. Front Med (Lausanne) 2024; 10:1293689. [PMID: 38317755 PMCID: PMC10838980 DOI: 10.3389/fmed.2023.1293689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/31/2023] [Indexed: 02/07/2024] Open
Abstract
Background The conventional midline approach for lumbar puncture (MAT-LP) has a relatively low success rate of 70%. The paramedian approach can increase the effective puncture area and success rate but lacks standardized guidelines. This study evaluated a computer-modified paramedian approach technique (CMPAT) to optimize lumbar puncture using computational techniques. Methods In this prospective study, 120 patients underwent CMPAT-LP (n = 60) or MAT-LP (n = 60). Puncture failure was defined after 6 attempts. Failure rate, number of attempts, pain score, and complications were compared. Subgroup analysis was conducted for age (≥ 50 years). Results No significant demographic differences existed between groups. Failure rates were 3.3% for CMPAT vs. 13.3% for MAT. Puncture attempts averaged 2.0 vs. 3.5 and pain scores were 2.7 vs. 4.1 for CMPAT and MAT, respectively. All outcomes were significantly improved with CMPAT, especially in elderly patients. No significant difference in complications was observed. Conclusion Compared to MAT, CMPAT-LP demonstrated lower failure rates, fewer puncture attempts, and less pain, without compromising safety. CMPAT may be superior and should be more widely implemented in clinical practice.
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Affiliation(s)
- Yuan-Dong Zhuang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Hai-Shu Xie
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Jing Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Guo-Hua Wu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
| | - Jian-Feng Wu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
- Department of Neurosurgery, Pingtan Comprehensive Experimentation Area Hospital, Pingtan, Fujian, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China
- Department of Neurosurgery, Pingtan Comprehensive Experimentation Area Hospital, Pingtan, Fujian, China
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Dyer AH, Dolphin H, O'Connor A, Morrison L, Sedgwick G, McFeely A, Killeen E, Gallagher C, Davey N, Connolly E, Lyons S, Young C, Gaffney C, Ennis R, McHale C, Joseph J, Knight G, Kelly E, O'Farrelly C, Bourke NM, Fallon A, O'Dowd S, Kennelly SP. Protocol for the Tallaght University Hospital Institute for Memory and Cognition-Biobank for Research in Ageing and Neurodegeneration. BMJ Open 2023; 13:e077772. [PMID: 38070888 PMCID: PMC10729202 DOI: 10.1136/bmjopen-2023-077772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Alzheimer's disease and other dementias affect >50 million individuals globally and are characterised by broad clinical and biological heterogeneity. Cohort and biobank studies have played a critical role in advancing the understanding of disease pathophysiology and in identifying novel diagnostic and treatment approaches. However, further discovery and validation cohorts are required to clarify the real-world utility of new biomarkers, facilitate research into the development of novel therapies and advance our understanding of the clinical heterogeneity and pathobiology of neurodegenerative diseases. METHODS AND ANALYSIS The Tallaght University Hospital Institute for Memory and Cognition Biobank for Research in Ageing and Neurodegeneration (TIMC-BRAiN) will recruit 1000 individuals over 5 years. Participants, who are undergoing diagnostic workup in the TIMC Memory Assessment and Support Service (TIMC-MASS), will opt to donate clinical data and biological samples to a biobank. All participants will complete a detailed clinical, neuropsychological and dementia severity assessment (including Addenbrooke's Cognitive Assessment, Repeatable Battery for Assessment of Neuropsychological Status, Clinical Dementia Rating Scale). Participants undergoing venepuncture/lumbar puncture as part of the clinical workup will be offered the opportunity to donate additional blood (serum/plasma/whole blood) and cerebrospinal fluid samples for longitudinal storage in the TIMC-BRAiN biobank. Participants are followed at 18-month intervals for repeat clinical and cognitive assessments. Anonymised clinical data and biological samples will be stored securely in a central repository and used to facilitate future studies concerned with advancing the diagnosis and treatment of neurodegenerative diseases. ETHICS AND DISSEMINATION Ethical approval has been granted by the St. James's Hospital/Tallaght University Hospital Joint Research Ethics Committee (Project ID: 2159), which operates in compliance with the European Communities (Clinical Trials on Medicinal Products for Human Use) Regulations 2004 and ICH Good Clinical Practice Guidelines. Findings using TIMC-BRAiN will be published in a timely and open-access fashion.
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Affiliation(s)
- Adam H Dyer
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Helena Dolphin
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Laura Morrison
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Gavin Sedgwick
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Aoife McFeely
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emily Killeen
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Conal Gallagher
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Naomi Davey
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Eimear Connolly
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
| | - Conor Young
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Christine Gaffney
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
| | - Ruth Ennis
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Cathy McHale
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Jasmine Joseph
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Graham Knight
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Emmet Kelly
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | | | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aoife Fallon
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Hazan J, Liu KY, Fox NC, Howard R. Online clinical tools to support the use of new plasma biomarker diagnostic technology in the assessment of Alzheimer's disease: a narrative review. Brain Commun 2023; 5:fcad322. [PMID: 38090277 PMCID: PMC10715781 DOI: 10.1093/braincomms/fcad322] [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: 06/26/2023] [Revised: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 02/15/2024] Open
Abstract
Recent advances in new diagnostic technologies for Alzheimer's disease have improved the speed and precision of diagnosis. However, accessing the potential benefits of this technology poses challenges for clinicians, such as deciding whether it is clinically appropriate to order a diagnostic test, which specific test or tests to order and how to interpret test results and communicate these to the patient and their caregiver. Tools to support decision-making could provide additional structure and information to the clinical assessment process. These tools could be accessed online, and such 'e-tools' can provide an interactive interface to support patients and clinicians in the use of new diagnostic technologies for Alzheimer's disease. We performed a narrative review of the literature to synthesize information available on this research topic. Relevant studies that provide an understanding of how these online tools could be used to optimize the clinical utility of diagnostic technology were identified. Based on these, we discuss the ways in which e-tools have been used to assist in the diagnosis of Alzheimer's disease and propose recommendations for future research to aid further development.
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Affiliation(s)
- Jemma Hazan
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, W1T 7NF, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London W1T 7BN, UK
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Kreple CJ, Gajagowni S, Jockel-Balsaratti J, Bucelli RC, Miller TM. Lumbar punctures are safe in patients with ALS and have a risk profile similar to that in the non-ALS population. Muscle Nerve 2023; 68:771-775. [PMID: 37566385 DOI: 10.1002/mus.27956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION/AIMS Analysis of biofluids, especially cerebrospinal fluid (CSF), is critically important for amyotrophic lateral sclerosis (ALS) research. Collection of CSF is typically performed by lumbar puncture (LP). Previous studies have demonstrated the safety of LPs in patients with other neurodegenerative diseases, such as Alzheimer's disease, although there are no published studies of the safety of LPs in patients with ALS. We performed a retrospective analysis of complications resulting from LPs. METHODS This is a retrospective study of LPs performed between 2015 and 2021 on a total of 233 participants (healthy controls [n = 63], ALS [n = 154], and disease controls [n = 16]) as part of clinical research studies at the Washington University ALS Center. We used bivariate logistical analyses looking for associations between participant characteristics and adverse events (AEs), and likelihood ratio tests were used for significance testing. RESULTS We found an overall AE rate of 21.03%. AEs included headache, back pain, vasovagal syncope, and severe headache requiring epidural blood patch. Participants with ALS were not more likely to experience post-LP AEs compared to controls (odds ratio [OR] 0.61 [0.32-1.18]). Post-LP headaches were significantly less likely in participants with ALS (OR 0.36 [0.15-0.83]). DISCUSSION Our findings demonstrate that LP is a safe procedure for participants with ALS, with a similar or lower rate of AEs than in participants without ALS.
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Affiliation(s)
- Collin J Kreple
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Jennifer Jockel-Balsaratti
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
| | - Robert C Bucelli
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
| | - Timothy M Miller
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
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Hammers DB, Eloyan A, Taurone A, Thangarajah M, Beckett L, Gao S, Kirby K, Aisen P, Dage JL, Foroud T, Griffin P, Grinberg LT, Jack CR, Kramer J, Koeppe R, Kukull WA, Mundada NS, Joie RL, Soleimani-Meigooni DN, Iaccarino L, Murray ME, Nudelman K, Polsinelli AJ, Rumbaugh M, Toga A, Touroutoglou A, Vemuri P, Atri A, Day GS, Duara R, Graff-Radford NR, Honig LS, Jones DT, Masdeu J, Mendez MF, Womack K, Musiek E, Onyike CU, Riddle M, Rogalski E, Salloway S, Sha SJ, Turner RS, Wingo TS, Wolk DA, Carrillo MC, Dickerson BC, Rabinovici GD, Apostolova LG. Profiling baseline performance on the Longitudinal Early-Onset Alzheimer's Disease Study (LEADS) cohort near the midpoint of data collection. Alzheimers Dement 2023; 19 Suppl 9:S8-S18. [PMID: 37256497 PMCID: PMC10806768 DOI: 10.1002/alz.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The Longitudinal Early-Onset Alzheimer's Disease Study (LEADS) seeks to provide comprehensive understanding of early-onset Alzheimer's disease (EOAD; onset <65 years), with the current study profiling baseline clinical, cognitive, biomarker, and genetic characteristics of the cohort nearing the data-collection mid-point. METHODS Data from 371 LEADS participants were compared based on diagnostic group classification (cognitively normal [n = 89], amyloid-positive EOAD [n = 212], and amyloid-negative early-onset non-Alzheimer's disease [EOnonAD; n = 70]). RESULTS Cognitive performance was worse for EOAD than other groups, and EOAD participants were apolipoprotein E (APOE) ε4 homozygotes at higher rates. An amnestic presentation was common among impaired participants (81%), with several clinical phenotypes present. LEADS participants generally consented at high rates to optional trial procedures. CONCLUSIONS We present the most comprehensive baseline characterization of sporadic EOAD in the United States to date. EOAD presents with widespread cognitive impairment within and across clinical phenotypes, with differences in APOE ε4 allele carrier status appearing to be relevant. HIGHLIGHTS Findings represent the most comprehensive baseline characterization of sporadic early-onset Alzheimer's disease (EOAD) to date. Cognitive impairment was widespread for EOAD participants and more severe than other groups. EOAD participants were homozygous apolipoprotein E (APOE) ε4 carriers at higher rates than the EOnonAD group. Amnestic presentation predominated in EOAD and EOnonAD participants, but other clinical phenotypes were present.
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Affiliation(s)
- Dustin B. Hammers
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ani Eloyan
- Department of Biostatistics, Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Alexander Taurone
- Department of Biostatistics, Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Maryanne Thangarajah
- Department of Biostatistics, Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Laurel Beckett
- Department of Public Health Sciences, University of California – Davis, Davis, California, USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kala Kirby
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, California, USA
| | - Jeffrey L. Dage
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Percy Griffin
- Medical & Scientific Relations Division, Alzheimer’s Association, Chicago, Illinois, USA
| | - Lea T. Grinberg
- Department of Pathology, University of California – San Francisco, San Francisco, California, USA
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | | | - Joel Kramer
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Robert Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Walter A. Kukull
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nidhi S Mundada
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Renaud La Joie
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | | | - Leonardo Iaccarino
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | | | - Kelly Nudelman
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Angelina J. Polsinelli
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Malia Rumbaugh
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Arthur Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Alexandra Touroutoglou
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami, Florida, USA
| | | | - Lawrence S. Honig
- Taub Institute and Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - David T. Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Masdeu
- Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston, Texas, USA
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kyle Womack
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Erik Musiek
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Chiadi U. Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meghan Riddle
- Department of Neurology, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Emily Rogalski
- Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Steven Salloway
- Department of Neurology, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sharon J. Sha
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA
| | | | - Thomas S. Wingo
- Department of Neurology and Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A. Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria C. Carrillo
- Medical & Scientific Relations Division, Alzheimer’s Association, Chicago, Illinois, USA
| | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gil D. Rabinovici
- Department of Neurology, University of California – San Francisco, San Francisco, California, USA
| | - Liana G. Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine Indianapolis, Indianapolis, Indiana, USA
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11
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Mollan SP, Momin SNA, Khatkar PS, Grech O, Sinclair AJ, Tsermoulas G. A Neuro-Ophthalmologist's Guide to Advances in Intracranial Pressure Measurements. Eye Brain 2023; 15:113-124. [PMID: 37790122 PMCID: PMC10543929 DOI: 10.2147/eb.s404642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
Cerebrospinal fluid disorders have a wide-ranging impact on vision, headache, cognition and a person's quality of life. Due to advances in technology and accessibility, intracranial pressure measurement and monitoring, usually managed by neurosurgeons, are being employed more widely in clinical practice. These developments are of direct importance for Ophthalmologists and Neurologists because the ability to readily measure intracranial pressure can aide management decisions. The aim of this review is to present the emerging evidence for intracranial pressure measurement methods and interpretation that is relevant to Neuro-ophthalmologists.
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Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
- Translational Brain Science, Institute of Metabolism and Systems Research; Birmingham, University of Birmingham, Birmingham, UK
| | - Sehrish N A Momin
- Ophthalmology Department, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Olivia Grech
- Translational Brain Science, Institute of Metabolism and Systems Research; Birmingham, University of Birmingham, Birmingham, UK
| | - Alex J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research; Birmingham, University of Birmingham, Birmingham, UK
- Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Georgios Tsermoulas
- Translational Brain Science, Institute of Metabolism and Systems Research; Birmingham, University of Birmingham, Birmingham, UK
- Department of Neurosurgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
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12
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Fentem R, Nagendran A, Marioni-Henry K, Madden M, Phillipps S, Cooper C, Gonçalves R. Complications associated with cerebrospinal fluid collection in dogs. Vet Rec 2023; 193:e2787. [PMID: 36906911 DOI: 10.1002/vetr.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/27/2023] [Accepted: 02/17/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND This study aimed to identify complications associated with cerebrospinal fluid (CSF) collection in dogs. METHODS This was a prospective, observational multicentre study using data collected from 102 dogs undergoing CSF collection for the investigation of neurological disease. CSF was collected from the cerebellomedullary cistern (CMC), lumbar subarachnoid space (LSAS) or both sites. Pre-, intra- and postprocedural data were collected. Descriptive statistics were performed to outline complications associated with CSF collection. RESULTS CSF sampling was attempted on 108 occasions, and CSF was acquired on 100 occasions (92.6%). Collection from the CMC was more likely to be successful than that from the LSAS. No dogs exhibited neurologic deterioration following CSF collection. There was no significant difference between pre- and post-CSF collection short-form Glasgow composite measure pain scores in ambulatory dogs (p = 0.13). LIMITATIONS The scarcity of complications limited the ability to quantify the incidence of some potential complications reported elsewhere. CONCLUSIONS Our results may be used to inform clinicians and owners that CSF sampling is associated with a low frequency of complications when performed by trained personnel.
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Affiliation(s)
- Rory Fentem
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Neston, UK
| | - Aran Nagendran
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Neston, UK
| | | | - Megan Madden
- Hospital for Small Animals, Royal (Dick) School for Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Stephanie Phillipps
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Neston, UK
| | - Camilla Cooper
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Neston, UK
| | - Rita Gonçalves
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Neston, UK
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13
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Juganavar A, Joshi A, Shegekar T. Navigating Early Alzheimer's Diagnosis: A Comprehensive Review of Diagnostic Innovations. Cureus 2023; 15:e44937. [PMID: 37818489 PMCID: PMC10561010 DOI: 10.7759/cureus.44937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
The hunt for early Alzheimer's disease detection has created cutting-edge diagnostic instruments with enormous promise. This article examines the many facets of these developments, focusing on how they have revolutionised diagnosis and patient outcomes. These tools make it possible to detect tiny brain changes even before they give birth to clinical symptoms by combining cutting-edge biomarkers, neuroimaging methods, and machine-learning algorithms. A significant opportunity for therapies that can slow the course of the disease exists during this early detection stage. Additionally, these cutting-edge techniques improve diagnostic precision, objectivity, and accessibility. Liquid biopsies and blood-based biomarkers provide non-invasive alternatives, filling accessibility gaps in diagnosis. While issues with standardisation, ethics, and data integration continue, collaboration within research, clinical practice, and policy realms fuels positive developments. As technology advances, the way towards better Alzheimer's diagnosis becomes more evident, giving patients and families dealing with this difficult illness fresh hope. The synergy between scientific advancement and compassionate treatment is crucial for improving Alzheimer's disease diagnosis, as this paper emphasises.
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Affiliation(s)
- Anup Juganavar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhishek Joshi
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejas Shegekar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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14
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Waury K, de Wit R, Verberk IMW, Teunissen CE, Abeln S. Deciphering Protein Secretion from the Brain to Cerebrospinal Fluid for Biomarker Discovery. J Proteome Res 2023; 22:3068-3080. [PMID: 37606934 PMCID: PMC10476268 DOI: 10.1021/acs.jproteome.3c00366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 08/23/2023]
Abstract
Cerebrospinal fluid (CSF) is an essential matrix for the discovery of neurological disease biomarkers. However, the high dynamic range of protein concentrations in CSF hinders the detection of the least abundant protein biomarkers by untargeted mass spectrometry. It is thus beneficial to gain a deeper understanding of the secretion processes within the brain. Here, we aim to explore if and how the secretion of brain proteins to the CSF can be predicted. By combining a curated CSF proteome and the brain elevated proteome of the Human Protein Atlas, brain proteins were classified as CSF or non-CSF secreted. A machine learning model was trained on a range of sequence-based features to differentiate between CSF and non-CSF groups and effectively predict the brain origin of proteins. The classification model achieves an area under the curve of 0.89 if using high confidence CSF proteins. The most important prediction features include the subcellular localization, signal peptides, and transmembrane regions. The classifier generalized well to the larger brain detected proteome and is able to correctly predict novel CSF proteins identified by affinity proteomics. In addition to elucidating the underlying mechanisms of protein secretion, the trained classification model can support biomarker candidate selection.
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Affiliation(s)
- Katharina Waury
- Department
of Computer Science, Vrije Universiteit
Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Renske de Wit
- Department
of Computer Science, Vrije Universiteit
Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Inge M. W. Verberk
- Neurochemistry
Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry
Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Sanne Abeln
- Department
of Computer Science, Vrije Universiteit
Amsterdam, 1081 HV Amsterdam, The Netherlands
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15
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Hu WT, Nayyar A, Kaluzova M. Charting the Next Road Map for CSF Biomarkers in Alzheimer's Disease and Related Dementias. Neurotherapeutics 2023; 20:955-974. [PMID: 37378862 PMCID: PMC10457281 DOI: 10.1007/s13311-023-01370-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/29/2023] Open
Abstract
Clinical prediction of underlying pathologic substrates in people with Alzheimer's disease (AD) dementia or related dementia syndromes (ADRD) has limited accuracy. Etiologic biomarkers - including cerebrospinal fluid (CSF) levels of AD proteins and cerebral amyloid PET imaging - have greatly modernized disease-modifying clinical trials in AD, but their integration into medical practice has been slow. Beyond core CSF AD biomarkers (including beta-amyloid 1-42, total tau, and tau phosphorylated at threonine 181), novel biomarkers have been interrogated in single- and multi-centered studies with uneven rigor. Here, we review early expectations for ideal AD/ADRD biomarkers, assess these goals' future applicability, and propose study designs and performance thresholds for meeting these ideals with a focus on CSF biomarkers. We further propose three new characteristics: equity (oversampling of diverse populations in the design and testing of biomarkers), access (reasonable availability to 80% of people at risk for disease, along with pre- and post-biomarker processes), and reliability (thorough evaluation of pre-analytical and analytical factors influencing measurements and performance). Finally, we urge biomarker scientists to balance the desire and evidence for a biomarker to reflect its namesake function, indulge data- as well as theory-driven associations, re-visit the subset of rigorously measured CSF biomarkers in large datasets (such as Alzheimer's disease neuroimaging initiative), and resist the temptation to favor ease over fail-safe in the development phase. This shift from discovery to application, and from suspended disbelief to cogent ingenuity, should allow the AD/ADRD biomarker field to live up to its billing during the next phase of neurodegenerative disease research.
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Affiliation(s)
- William T Hu
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA.
- Center for Innovation in Health and Aging Research, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.
| | - Ashima Nayyar
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
| | - Milota Kaluzova
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
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16
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Gaetani L, Chiasserini D, Paolini Paoletti F, Bellomo G, Parnetti L. Required improvements for cerebrospinal fluid-based biomarker tests of Alzheimer's disease. Expert Rev Mol Diagn 2023; 23:1195-1207. [PMID: 37902844 DOI: 10.1080/14737159.2023.2276918] [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: 04/26/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) biomarkers represent a well-established tool for diagnosing Alzheimer's disease (AD), independently from the clinical stage, by reflecting the presence of brain amyloidosis (A+) and tauopathy (T+). In front of this important achievement, so far, (i) CSF AD biomarkers have not yet been adopted for routine clinical use in all Centers dedicated to AD, mainly due to inter-lab variation and lack of internationally accepted cutoff values; (ii) we do need to add other biomarkers more suitable to correlate with the clinical stage and disease monitoring; (iii) we also need to detect the co-presence of other 'non-AD' pathologies. AREAS COVERED Efforts to establish standardized cutoff values based on large-scale multi-center studies are discussed. The influence of aging and comorbidities on CSF biomarker levels is also analyzed, and possible solutions are presented, i.e. complementing the A/T/(N) system with markers of axonal damage and synaptic derangement. EXPERT OPINION The first, mandatory need is to reach common cutoff values and defined (automated) methodologies for CSF AD biomarkers. To properly select subjects deserving CSF analysis, blood tests might represent the first-line approach. In those subjects undergoing CSF analysis, multiple biomarkers, able to give a comprehensive and personalized pathophysiological/prognostic information, should be included.
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Affiliation(s)
- Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Davide Chiasserini
- Section of Physiology and Biochemistry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Giovanni Bellomo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Aivar P, Bianchi C, Di Lauro C, Soria-Tobar L, Alvarez-Castelao B, Calero M, Medina M, Diaz-Hernandez M. TNAP and P2X7R: New Plasma Biomarkers for Alzheimer's Disease. Int J Mol Sci 2023; 24:10897. [PMID: 37446074 DOI: 10.3390/ijms241310897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Over the last few years, intense research efforts have been made to anticipate or improve the diagnosis of Alzheimer's disease by detecting blood biomarkers. However, the most promising blood biomarkers identified to date have some limitations, most of them related to the techniques required for their detection. Hence, new blood biomarkers should be identified to improve the diagnosis of AD, better discriminate between AD and mild cognitive impairment (MCI) and identify cognitively unimpaired (CU) older individuals at risk for progression to AD. Our previous studies demonstrated that both the purinergic receptor P2X7 and the tissue-nonspecific alkaline phosphatase ectoenzyme (TNAP) are upregulated in the brains of AD patients. Since both proteins are also present in plasma, we investigated whether plasma P2X7R and TNAP are altered in MCI and AD patients and, if so, their potential role as AD biomarkers. We found that AD but not MCI patients present increased plasma P2X7R levels. Nevertheless, TNAP plasma activity was increased in MCI patients and decreased in the AD group. ROC curve analysis indicated that measuring both parameters has a reasonable discriminating capability to diagnose MCI and AD conditions. In addition to confirming that individuals progressing to MCI have increased TNAP activity in plasma, longitudinal studies also revealed that CU individuals have lower plasma TNAP activity than stable controls. Thus, we propose that P2X7 and TNAP could serve as new plasma biomarkers for MCI and AD.
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Affiliation(s)
- Paloma Aivar
- Departamento de Bioquímica y Biología Molecular, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Departamento de Ciencias de la Salud, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Carolina Bianchi
- Departamento de Bioquímica y Biología Molecular, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Caterina Di Lauro
- Departamento de Bioquímica y Biología Molecular, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Lucia Soria-Tobar
- Departamento de Bioquímica y Biología Molecular, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Beatriz Alvarez-Castelao
- Departamento de Bioquímica y Biología Molecular, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
| | - Miguel Calero
- Centro de Investigación Biomédica En Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center, 28031 Madrid, Spain
| | - Miguel Medina
- Centro de Investigación Biomédica En Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center, 28031 Madrid, Spain
| | - Miguel Diaz-Hernandez
- Departamento de Bioquímica y Biología Molecular, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
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18
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Baldaranov D, Garcia V, Miller G, Donohue MC, Shaw LM, Weiner M, Petersen RC, Aisen P, Raman R, Rafii MS. Safety and tolerability of lumbar puncture for the evaluation of Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12431. [PMID: 37091309 PMCID: PMC10113881 DOI: 10.1002/dad2.12431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
Introduction Lumbar puncture (LP) to collect and examine cerebrospinal fluid (CSF) is an important option for the evaluation of Alzheimer's disease (AD) biomarkers but it is not routinely performed due to its invasiveness and link to adverse effects (AE). Methods We include all participants who received at least one LP in the Alzheimer's Disease Neuroimaging Initiative (ADNI) Study. For comparison between groups, two-sample t-tests for continuous, and Pearson's chi-square test for categorical variables were performed. Results Two hundred twenty-seven LP-related AEs were reported by 172 participants after 1702 LPs (13.3%). The mean age of participants who reported at least one AE was 69.79 (standard deviation (SD) 6.3) versus none 72.44 (7.17) years (p < 0.001) with female predominance (115/172 = 67.4% vs 435/913 = 48%), and had greater entorhinal cortical thickness and hippocampal volume (3.903 (0.782) vs 3.684 (0.775) mm, p = 0.002; 7.38 (1.06) vs 7.05 (1.15) mm3, p < 0.001), respectively. Discussion We found that younger age, female sex, and greater thickness of the entorhinal cortex were associated with a higher rate of LP-related AE reports.
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Affiliation(s)
- Dobri Baldaranov
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Victoria Garcia
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Garrett Miller
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Michael C. Donohue
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Leslie M. Shaw
- Department of Pathology and Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Mike Weiner
- Department of Veterans Affairs Medical CenterCenter for Imaging of Neurodegenerative DiseasesSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ronald C. Petersen
- Department of NeurologyMayo Clinic Alzheimer's Disease Research CenterMayo Clinic Study of AgingMayo Clinic Neurology and NeurosurgeryRochesterMinnesotaUSA
| | - Paul Aisen
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Rema Raman
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Michael S. Rafii
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
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Lilamand M, Vrillon A, Gonzales-Marabal L, Sindzingre L, Götze K, Boddaert J, Pautas E, François-Fasille V, Dumurgier J, Paquet C. Lumbar puncture training with healthcare simulation improves self-confidence and practical skills of French medical residents in geriatrics. Eur Geriatr Med 2023:10.1007/s41999-023-00769-y. [PMID: 36976436 DOI: 10.1007/s41999-023-00769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To assess the skill level and self-confidence of medical residents in geriatrics with regard to conducting the lumbar puncture (LP) procedure and to study the potential benefits of training with simulation and virtual reality. METHODS First, a questionnaire survey was conducted among all French residents in geriatrics in the Paris area to assess their knowledge and self-confidence regarding the practice of LP in older adults. Second, we set up a simulation LP training session combined with virtual reality (3D video) training for selected respondents of the first survey. Third, we performed post-simulation survey for the attendees of the simulation training. Finally, a follow-up survey was conducted to examine the change in self-confidence and the success rate in clinical practice. RESULTS Fifty-five residents responded to the survey (response rate = 36.4%). The importance of mastering LP was fully recognized by the residents in geriatrics (95.3%), so most of them (94.5%) advocated for the need for additional practical training. Fourteen residents took part in the training (average rating = 4.7 on a 5-point scale). Simulation was regarded by 83% of the respondents as the most useful tool for their practice. We observed a significant pre/post-training mean improvement in self-estimated success of 20.6% (Wilcoxon matched-pairs signed-rank W = - 36, p = 0.008). The post-training success rate of the residents in real-life clinical practice was good (85.8%). CONCLUSION Residents were aware of the importance of mastering LP and requested additional training. Simulation may represent a major driver to improve their self-confidence and practical skills.
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Affiliation(s)
- Matthieu Lilamand
- Department of Geriatrics Hôpital Lariboisière Fernand-Widal, AP-HP.Nord Université Paris Cité, Paris, France.
- AP-HP.Nord Université Paris Cité, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010, Paris, France.
- Université Paris Cité, INSERM, UMRS 1144, Paris, France.
| | - Agathe Vrillon
- AP-HP.Nord Université Paris Cité, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
- Université Paris Cité, INSERM, UMRS 1144, Paris, France
| | | | - Louise Sindzingre
- AP-HP.Nord Université Paris Cité, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Karl Götze
- Department of Geriatrics Hôpital Bretonneau, AP-HP.Nord Université Paris Cité, Paris, France
| | - Jacques Boddaert
- Department of Geriatrics Hôpital la Pitié Salpêtrière, AP-HP, Sorbonne Université, INSERM, UMR 1135, Paris, France
| | - Eric Pautas
- Department of Geriatrics Hôpital la Pitié Salpêtrière, AP-HP, Sorbonne Université, INSERM, UMR 1135, Paris, France
- Department of Geriatrics Hôpital Charles Foix, AP-HP, Sorbonne Université, Ivry-sur-Seine, France
| | - Véronique François-Fasille
- Department of Geriatrics Hôpital Lariboisière Fernand-Widal, AP-HP.Nord Université Paris Cité, Paris, France
| | - Julien Dumurgier
- AP-HP.Nord Université Paris Cité, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Claire Paquet
- AP-HP.Nord Université Paris Cité, Cognitive Neurology Center Hôpital Lariboisière-Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
- Université Paris Cité, INSERM, UMRS 1144, Paris, France
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20
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Hagen SM, Wibroe EA, Korsbæk JJ, Andersen MS, Nielsen AB, Nortvig MJ, Beier D, Poulsen FR, Jensen RH, Hamann S. Retinal vessel dynamics analysis as a surrogate marker for raised intracranial pressure in patients with suspected idiopathic intracranial hypertension. Cephalalgia 2023; 43:3331024221147494. [PMID: 36786365 DOI: 10.1177/03331024221147494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Retinal vessel dynamics analysis has proven to be a viable, non-invasive surrogate marker for increased intracranial pressure. We aimed to test this method in patients with suspected idiopathic intracranial hypertension. METHODS Patients with suspected idiopathic intracranial hypertension were prospectively enrolled for hand-held fundus-videography during diagnostic lumbar puncture. After extracting optic disc images, peripapillary arteriole-to-venule-ratios were measured using machine-learning algorithms with manual identification control. A general linear model was applied to arteriole-to-venule-ratios and corresponding lumbar opening pressures to estimate cerebrospinal fluid pressure. RESULTS Twenty-five patients were included with a significant difference in arteriole-to-venule-ratio between patients with (n = 17) and without (n = 8) idiopathic intracranial hypertension (0.78 ± 0.10 vs 0.90 ± 0.08, p = 0.006). Arteriole-to-venule-ratio correlated inversely with lumbar opening pressure (slope regression estimate -0.0043 (95% CI -0.0073 to -0.0023), p = 0.002) and the association was stronger when lumbar opening pressure exceeded 15 mm Hg (20 cm H2O) (slope regression estimate -0.0080 (95% CI -0.0123 to -0.0039), p < 0.001). Estimated cerebrospinal fluid pressure predicted increased lumbar opening pressure >20 mm Hg (27 cm H2O) with 78% sensitivity and 92% specificity (AUC 0.81, p = 0.02). A stand-alone arteriole-to-venule-ratio measurement predicting lumbar opening pressure >20 mm Hg (27 cm H2O) was inferior with a 48% sensitivity and 92% specificity (AUC 0.73, p = 0.002). CONCLUSION Retinal vessel dynamics analysis with the described model for estimating cerebrospinal fluid pressure is a promising non-invasive method with a high sensitivity and specificity for detecting elevated intracranial pressure at follow-up assessments of patients with confirmed idiopathic intracranial hypertension if initial lumbar opening pressure and arteriole-to-venule-ratio data are available.
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Affiliation(s)
- Snorre Malm Hagen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Johanne Juhl Korsbæk
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Denmark
| | - Mikkel Schou Andersen
- Department of Neurosurgery, Odense University Hospital, Denmark.,Department of Clinical Research and BRIDGE (Brain Research Interdisciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark
| | - Asger Bjørnær Nielsen
- Department of Neurosurgery, Odense University Hospital, Denmark.,Department of Clinical Research and BRIDGE (Brain Research Interdisciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark
| | - Mathias Just Nortvig
- Department of Neurosurgery, Odense University Hospital, Denmark.,Department of Clinical Research and BRIDGE (Brain Research Interdisciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark
| | - Dagmar Beier
- Department of Clinical Research and BRIDGE (Brain Research Interdisciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark.,Department of Neurology, Odense University Hospital, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Denmark.,Department of Clinical Research and BRIDGE (Brain Research Interdisciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
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21
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Hazan J, Hall S, Pemberton A, Sherriffs I, Joels S, Heslegrave A, Veleva E, Ghauri M, Laban R, Abel E, Zetterberg H, Fox NC, Howard R. Acceptability and feasibility of plasma phosphorylated-tau181 in two memory services. Int J Geriatr Psychiatry 2023; 38:e5897. [PMID: 36852663 DOI: 10.1002/gps.5897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Plasma phosphorylated-tau181 (p-tau181) represents a novel blood-based biomarker of Alzheimer's disease pathology. We explored clinicians' experience of the utility of plasma p-tau181 in Camden and Islington Memory Services. METHODS Patients were identified by their clinician as appropriate for p-tau181. Their p-tau181 result was plotted on a reference range graph provided to clinicians. This was discussed with the patient at diagnostic feedback appointment. RESULTS Twenty-nine participants' plasma p-tau181 samples were included (mean age 74 SD 8.5, 65% female). Nine clinicians participated in the study. Eighty-six percent of clinicians found the p-tau181 result to be helpful and in 93% of cases it was clearly understandable. The p-tau181 result was useful in making the diagnosis in 44% of cases. CONCLUSIONS Plasma p-tau181 is a feasible test for use in memory services and acceptable to clinicians. Clinician feedback on utility in dementia diagnoses was mixed. Further work is required to provide education and training in understanding and interpreting ambiguity in biomarker results.
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Affiliation(s)
- Jemma Hazan
- Division of Psychiatry, University College London, London, UK
| | - Simon Hall
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Ian Sherriffs
- Camden and Islington NHS Foundation Trust, London, UK
| | - Suzanne Joels
- Camden and Islington NHS Foundation Trust, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK
| | - Elena Veleva
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK
| | - Mamoona Ghauri
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK
| | - Rhiannon Laban
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK
| | - Emily Abel
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Nick C Fox
- Department of Neurodegenerative Disease, Institute of Neurology, London, UK.,Dementia Research Institute, UCL, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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22
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Chan L, Chung CC, Hsieh YC, Wu RM, Hong CT. Plasma extracellular vesicle tau, β-amyloid, and α-synuclein and the progression of Parkinson's disease: a follow-up study. Ther Adv Neurol Disord 2023; 16:17562864221150329. [PMID: 36741351 PMCID: PMC9896092 DOI: 10.1177/17562864221150329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background Plasma extracellular vesicle (EV) contents are promising biomarkers of Parkinson's disease (PD). The pathognomonic proteins of PD, including α-synuclein, tau, and β-amyloid, are altered in people with PD (PwP) and are associated with clinical presentation in previous cross-sectional studies. However, the dynamic changes in these plasma EV proteins in PwP and their correlation with clinical progression remain unclear. Objective We investigated the dynamic changes in plasma EV α-synuclein, tau, and β-amyloid and their correlation with/prediction of clinical progression in PwP. Design A cohort study. Methods In total, 103 PwP and 37 healthy controls (HCs) completed baseline assessment and 1-year follow-up. Clinical assessments included Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). Plasma EVs were isolated, and immunomagnetic reduction-based immunoassay was used to assess α-synuclein, tau, and β-amyloid 1-42 (Aβ1-42) levels within the EVs. Results Compared with HCs, significant differences were noted in the annual changes in all three EV pathognomonic proteins in PwP. Although the absolute changes in plasma EV pathognomonic proteins did not significantly correlate with clinical changes, PwP with elevated baseline plasma EV tau (upper-half) levels demonstrated significantly greater decline in motor and cognition, and increased plasma EV α-synuclein levels were associated with postural instability and the gait disturbance motor subtype. For PwP with elevated levels of all three biomarkers, clinical deterioration was significant, as indicated by UPDRS-II scores, postural instability and gait disturbance subscores of UPDRS-III, and MMSE score. Conclusion The combination of plasma EV α-synuclein, tau, and Aβ1-42 may identify PwP with a high risk of deterioration. Our findings can elucidate the interaction between these pathognomonic proteins, and they may serve as treatment response markers and can be applied in treatment approaches for disease modification.
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Affiliation(s)
| | | | - Yi-Chen Hsieh
- Ph.D. Program in Medical Neuroscience, College
of Medical Science and Technology, Taipei Medical University, Taipei
| | - Ruey-Meei Wu
- Department of Neurology, Centre of Parkinson
and Movement Disorders, National Taiwan University Hospital, College of
Medicine, National Taiwan University, Taipei, Taiwan
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23
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Hazan J, Wing M, Liu KY, Reeves S, Howard R. Clinical utility of cerebrospinal fluid biomarkers in the evaluation of cognitive impairment: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94:113-120. [PMID: 36096664 DOI: 10.1136/jnnp-2022-329530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The analytical and clinical validity of cerebrospinal (CSF) biomarkers has been extensively researched in dementia. Further work is needed to assess the ability of these biomarkers to improve diagnosis, management and health outcomes in the clinical setting OBJECTIVES: To assess the added value and clinical utility of CSF biomarkers in the diagnostic assessment of cognitively impaired patients under evaluation for Alzheimer's disease (AD). METHODS Systematic literature searches of Medline, EMBASE, PsycINFO and Web of Science research databases were conducted on 17 December 2022. Data from relevant studies were extracted and independently screened for quality using a tool for bias. Clinical utility was measured by clinicians' changes in diagnosis, diagnostic confidence and patient management (when available), after their examination of patients' CSF biomarkers. Cost-effectiveness was assessed by consideration of additional cost per patient and quality-adjusted life years. RESULTS Searches identified 17 studies comprising 2090 patient participants and 593 clinicians. The meta-analysis revealed that clinicians' use of CSF biomarkers resulted in a pooled percentage change in diagnosis of 25% (95% CI 14 to 37), an increase in diagnostic confidence of 14% (95% CI 9 to 18) and a pooled proportion of patients whose management changed of 31% (95% CI 12 to 50). CSF biomarkers were deemed cost-effective, particularly in memory services, where pre-test AD prevalence is higher compared with a primary care setting. CONCLUSIONS CSF biomarkers can be a helpful additional diagnostic tool for clinicians assessing patients with cognitive impairment. In particular, CSF biomarkers consistently improved clinicians' confidence in diagnosing AD and influenced on diagnostic change and patient management. Further research is needed to study the clinical utility of blood-based biomarkers in the clinical setting.
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Affiliation(s)
- Jemma Hazan
- Division of Psychiatry, University College London, London, UK
| | - Michelle Wing
- Division of Psychiatry, University College London, London, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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24
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Sievänen H, Kari J, Eskola V, Huurre A, Soukka H, Palmu S. Incidence of traumatic lumbar punctures in adults: the impact of a patient's first procedure. Clin Med (Lond) 2023; 23:31-37. [PMID: 36650062 PMCID: PMC11046507 DOI: 10.7861/clinmed.2022-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Lumbar puncture (LP) is a widely used diagnostic method in patients of all ages. Blood-contaminated cerebrospinal fluid samples are frequent and may compromise diagnostic accuracy. OBJECTIVES We determined age-specific incidences of traumatic LPs (TLPs) in adults and examined factors that accounted for the incidence of TLPs. METHODS Erythrocyte count data from 15,812 LP procedures (2,404 were performed twice) were collected from hospital records of patients aged from 18 to 104 years. The incidence of TLPs in a patient's second LP procedure was evaluated with logistic regression analysis using the first LP, the time between the procedures and age as predictors. RESULTS The incidence of TLP in the second procedure was at least double that in the first procedure. If the first procedure was traumatic, the odds ratio of a TLP in the second procedure was 7-40-fold. One day between the successive procedures was associated with an over 10-fold odds ratio increase of TLP, and a week was still 4-8-fold odds ratio increase. Age was also associated with the incidence of TLP. CONCLUSIONS Two factors (a week or less between a patient's two LP procedures or a traumatic first LP) multiply the odds of the second procedure being traumatic and contribute to whether a patient's following LP procedure is successful.
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Affiliation(s)
| | | | - Vesa Eskola
- Tampere University Hospital, Tampere, Finland and Tampere University, Tampere, Finland
| | - Anu Huurre
- Turku University Hospital, Turku, Finland and University of Turku, Turku, Finland
| | - Hanna Soukka
- Turku University Hospital, Turku, Finland and University of Turku, Turku, Finland
| | - Sauli Palmu
- Tampere University Hospital, Tampere, Finland and Tampere University, Tampere, Finland
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25
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Hazan J, Liu K, Fox N, Howard R. Advancing Diagnostic Certainty in Alzheimer's Disease: A Synthesis of the Diagnostic Process. J Alzheimers Dis 2023; 94:473-482. [PMID: 37248905 PMCID: PMC7614777 DOI: 10.3233/jad-230186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Changes in diagnostic certainty can be evaluated by assessing the impact of a diagnostic test in driving decision making. Diagnostic tests can be appraised using validated measures of accuracy, i.e., sensitivity, specificity, and positive or negative predictive values against a known reference standard. However, other less well formalized factors affect diagnostic certainty. These inputs are under-researched and more difficult to quantify. Clinicians assess the significance of available data in the context of their expertise, pre-diagnostic confidence, and background knowledge of populations and disease. Inherent qualities of the diagnostic test and an individual clinician's interpretation of the meaning of test results will also affect the subsequent level of diagnostic certainty. These factors are only infrequently considered alongside the diagnostic accuracy of a test. In this paper, we present a model of the different processes which can affect diagnostic certainty in Alzheimer's disease (AD). This model builds upon existing understanding and provides further insights into the complexity of diagnostic certainty in AD and how we might improve this.
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Affiliation(s)
- Jemma Hazan
- Division of Psychiatry, University College London, London
| | - Kathy Liu
- Division of Psychiatry, University College London, London
| | - Nick Fox
- Institute of Neurology, University College London, London, and Dementia Research Institute, UCL, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London
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26
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Padala SP, Newhouse PA. Blood-based biomarkers in Alzheimer's disease: a mini-review. Metab Brain Dis 2023; 38:185-193. [PMID: 36342582 PMCID: PMC10688968 DOI: 10.1007/s11011-022-01114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia and has far reaching consequences for patients and their caregivers. Early detection and treatment are key factors in limiting the impact of the disease. However, a definitive diagnosis of AD requires an examination of brain tissue during an autopsy. Although a plethora of biomarkers such as neuroimaging, electrophysiological, and cerebrospinal fluid (CSF) biomarkers are available, their utility is limited to research due to their poor reach and prohibitive cost. In order for biomarkers to be widely used, they need to be accessible, affordable, and conducive for the patient population or disease stage. Blood-based biomarkers may not only be less expensive and more accessible compared to neuroimaging or CSF tests, but they are also preferred by patients with AD as they are much less invasive. In this mini-review article, we expand on the rationale for the use of blood-based biomarkers, review currently available biomarkers and discuss the need for the standardization of these biomarkers. We contrast the blood-based biomarkers with other available biomarkers and discuss the advantages of using a panel of blood-based biomarkers to strengthen their accuracy.
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Affiliation(s)
- Sanjana P Padala
- Vanderbilt University , 2301 Vanderbilt Place, Nashville, TN, 37235, USA.
| | - Paul A Newhouse
- Vanderbilt University , 2301 Vanderbilt Place, Nashville, TN, 37235, USA
- Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
- VA-TVHS Geriatric Research Education and Clinical Center, Nashville, TN, USA
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27
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Nasreddine Z, Garibotto V, Kyaga S, Padovani A. The Early Diagnosis of Alzheimer's Disease: A Patient-Centred Conversation with the Care Team. Neurol Ther 2022; 12:11-23. [PMID: 36528836 PMCID: PMC9837364 DOI: 10.1007/s40120-022-00428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder which accounts for 60-80% of dementia cases, affecting approximately 10 million people in Europe. Neuroimaging techniques and cerebrospinal fluid biomarkers used in combination with cognitive assessment tools open the door to early diagnosis of AD. However, these tools present some challenges that need to be overcome, such as low sensitivity or specificity, high cost, limited availability or invasiveness. Thus, low-cost and non-invasive alternatives, such as plasma biomarkers, have the potential to drive changes in AD screening and diagnosis. In addition to the technical aspects, organisational challenges as well as ethical concerns need to be addressed. In many countries, there is an insufficient number of specialists to recognise, evaluate and diagnose dementia and the waiting times to see a specialist are long. Given that there is currently no cure for AD, it is important to consider the potential psychological impact of an early diagnosis. In addition, counselling before biomarker sampling and during diagnosis disclosure is vital to guarantee that the patients have all the information necessary and their queries are addressed in a sensitive manner. Here, we illustrate (using a clinical vignette) current challenges of diagnosis and discuss some of the benefits and challenges of early diagnosis in AD including the value of biomarkers in combination with clinical evaluation. Lastly, some guidelines for disclosing early diagnosis of AD are provided based on our experiences.
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Affiliation(s)
| | - Valentina Garibotto
- grid.150338.c0000 0001 0721 9812University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Simon Kyaga
- Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland.
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28
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Lyons HS, Ramalingam S, Mitchell JL, Yiangou A, Thaller M, Sinclair AJ, Mollan SP. Multiple lumbar punctures aiming to relieve headache results in iatrogenic spinal hematoma: a case report. J Med Case Rep 2022; 16:464. [PMID: 36514112 DOI: 10.1186/s13256-022-03687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Multiple lumbar punctures have historically been a strategy to relieve headaches associated with idiopathic intracranial hypertension despite limited clinical evidence of long-term efficacy. Lumbar puncture is typically a straightforward procedure with minimal complications reported, however, serious complications can occur. Lumbar-puncture-related spinal hematomas are rare but can lead to irreversible paralysis. CASE PRESENTATION We report a case of a 28-year-old Caucasian woman who was treated with multiple lumbar punctures to manage headache, thought to be attributed to idiopathic intracranial hypertension. The patient developed a lumbosacral epidural hematoma following a lumbar puncture, which led to incomplete cauda equina syndrome. Multiple lumbar punctures had been the long-term management for the patient's chronic headaches associated with her diagnosis of idiopathic intracranial hypertension. She had no risks of an underlying coagulopathy. Following a lumbar puncture, she re-presented with lower back pain and bilateral paresthesia. Over the subsequent 48 hours, this progressed to urinary incontinence and saddle paresthesia. Imaging revealed an epidural hematoma, which was conservatively managed. She continued to report saddle paresthesia and urinary incontinence 7 months following the lumbar puncture. Between 1974 to 2022, our literature search found 41 case reports detailing lumbar-puncture-related spinal hematomas. It is an established but rare complication of lumbar puncture and there are limited studies looking at the incidence of its occurrence. Whilst coagulopathy has been found to be a risk factor, it is unclear if the gauge of the needle is relevant. Case evidence suggests there may be no significant difference in outcomes between surgical and conservative management of spinal hematomas. This case highlights that lumbar punctures can be invasive, with potentially serious complications. A lumbar puncture should therefore only be performed when clinically justified. CONCLUSIONS This case highlights a rare complication of lumbar puncture and emphasizes the importance of a risk-benefit discussion for each procedure. Spinal hematoma following lumbar puncture is a rare complication but with potentially devastating consequences. Within the setting of idiopathic intracranial hypertension, the evidence base for the long-term benefit of headache relief by repeat lumbar puncture is low.
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Affiliation(s)
- Hannah S Lyons
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Satheesh Ramalingam
- Department of Interventional Radiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - James L Mitchell
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Andreas Yiangou
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Alexandra J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Susan P Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK. .,Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Lumbar puncture safety and tolerability in premanifest and manifest Huntington's disease: a multi-analysis cross-sectional study. Sci Rep 2022; 12:18377. [PMID: 36319718 PMCID: PMC9626630 DOI: 10.1038/s41598-022-21934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Lumbar puncture (LP) has become increasingly common for people with Huntington's disease (HD) both to administer intrathecal investigational medicinal products and to collect cerebrospinal fluid to develop biological markers to track disease stage and progression. We aimed to investigate the safety profile of LP in people with HD, building on a recently published work by increasing the sample size and more specifically, increasing the representation of the premanifest population and healthy controls. We conducted a multi-study cross-sectional analysis including eligible participants from the HDClarity (304 Huntington's disease gene expansion carriers and 91 controls) and HD-YAS studies (54 premanifest and 48 controls), enrolled between February 2016 and September 2019. We investigated the odds of any adverse events, headaches, and back pain independently. Intergroup comparisons and adjusted event odds were derived using hierarchical logistic regressions. A total of 669 LP procedures involving 497 participants were included in this analysis. There were 184 (27.5%) LP procedures associated with one or more adverse events. The two most common adverse events were: post LP headache and back pain. Younger age and female gender were found to be associated with a higher risk of developing adverse events. There was no difference in the rate of adverse events between the disease subgroups after adjusting for covariates such as age and gender. Our results suggest that the LP is safe and tolerable in premanifest and manifest HD subjects, providing useful reassurance about the procedure to the HD community.
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Sturmey E, Malaspina A. Blood biomarkers in ALS: challenges, applications and novel frontiers. Acta Neurol Scand 2022; 146:375-388. [PMID: 36156207 PMCID: PMC9828487 DOI: 10.1111/ane.13698] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease among adults. With diagnosis reached relatively late into the disease process, extensive motor cell loss narrows the window for therapeutic opportunities. Clinical heterogeneity in ALS and the lack of disease-specific biomarkers have so far led to large-sized clinical trials with long follow-up needed to define clinical outcomes. In advanced ALS patients, there is presently limited scope to use imaging or invasive cerebrospinal fluid (CSF) collection as a source of disease biomarkers. The development of more patient-friendly and accessible blood biomarker assays is hampered by analytical hurdles like the matrix effect of blood components. However, blood also provides the opportunity to identify disease-specific adaptive changes of the stoichiometry and conformation of target proteins and the endogenous immunological response to low-abundance brain peptides, such as neurofilaments (Nf). Among those biomarkers under investigation in ALS, the change in concentration before or after diagnosis of Nf has been shown to aid prognostication and to allow the a priori stratification of ALS patients into smaller sized and clinically more homogeneous cohorts, supporting more affordable clinical trials. Here, we discuss the technical hurdles affecting reproducible and sensitive biomarker measurement in blood. We also summarize the state of the art of non-CSF biomarkers in the study of prognosis, disease progression, and treatment response. We will then address the potential as disease-specific biomarkers of the newly discovered cryptic peptides which are formed down-stream of TDP-43 loss of function, the hallmark of ALS pathobiology.
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Affiliation(s)
- Ellie Sturmey
- Centre of Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
| | - Andrea Malaspina
- Centre of Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK.,Queen Square Institute of Neurology, University College London, London, UK
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Kim KT. Lumbar puncture: considerations, procedure, and complications. ENCEPHALITIS 2022; 2:93-97. [PMID: 37469996 PMCID: PMC10295920 DOI: 10.47936/encephalitis.2022.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 07/21/2023] Open
Abstract
Lumbar puncture is an important technique used to obtain cerebrospinal fluid, administer medications, and monitor intracerebral pressure. As essential invasive approach to diagnosing and treating central nervous system disorders, clinicians should be familiar with lumbar puncture. This review includes the considerations, contraindications, procedures, and complications of lumbar puncture.
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Affiliation(s)
- Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
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Giagkou N, Spanou I, Mitsikostas DD. Current perspectives on the recognition and diagnosis of low CSF pressure headache syndromes. Expert Rev Neurother 2022; 22:815-827. [PMID: 36453212 DOI: 10.1080/14737175.2022.2152674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Headaches occur when cerebrospinal fluid (CSF) pressure drops following dural puncture or trauma or spontaneously. As the features of these headaches and their accompanying symptoms might not be typical, low CSF pressure headache syndromes, and spontaneous intracranial hypotension in particular, are often misdiagnosed and underdiagnosed. AREAS COVERED The aim of this narrative review is to summarize the most recent evidence regarding the clinical presentation and the diagnosis of low CSF pressure headache syndromes. EXPERT OPINION The clinical spectrum low CSF pressure headache syndromes varies significantly and key signs might be missing. Low CSF pressure headache syndromes should be included in the differential diagnosis of any case of refractory headache, even when the headache is not orthostatic, or there are normal neuroimaging findings, and/or lumbar puncture opening pressure is within normal limits. Future research should focus on controlled interventional studies on the treatment of low CSF pressure headache syndromes, which are currently lacking.
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Affiliation(s)
- Nikolaos Giagkou
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Spanou
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos D Mitsikostas
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Umemura Y, Khan B, Weill BJ, Buthorn JJ, Skakodub A, Ridder AJ, Nevel KS, Sun Y, Boire A. Discordance Between Perceptions and Experience of Lumbar Puncture: A Prospective Study. Neurol Clin Pract 2022; 12:344-351. [PMID: 36380890 PMCID: PMC9647808 DOI: 10.1212/cpj.0000000000200061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/26/2022] [Indexed: 01/13/2023]
Abstract
Background and Objectives Novel diagnostic techniques and neurologic biomarkers have greatly expanded clinical indications for CSF studies. CSF is most commonly obtained via lumbar puncture (LP). Although it is generally believed that LPs are well tolerated, there is a lack of supportive data for this claim, and patients anticipate LP to be painful. The objective of this study was to prospectively investigate discordance between patient perception and tolerability of LP. Methods Adult patients were surveyed before and after LP regarding their perceptions and experience of LP. Physician perceptions were gathered through a web-based survey. Relative risk and Spearman correlation were used to assess the relationship between responses. Paired binomial and paired ordinal responses were compared by McNemar and paired Wilcoxon rank-sum tests. Results A total of 178 patients completed the surveys. About half of the patients (58%) reported anxiety pre-LP, at median 3.0 of 10. Physicians overpredicted patients' pre-LP anxiety (median score 5.0, p < 0.001). Experienced pain was significantly less than predicted pain (median scores 0 and 3.0, respectively, p < 0.001). Patients who predicted pain were more likely to report pain from LP (relative risk [RR] 1.3). Predicting pain was also correlated with anxiety before LP (p < 0.001). Discussion LP was generally well tolerated. The majority of patients experienced minimal pain. Anticipation of pain was correlated with both feeling anxious and experiencing pain. The results of this study can be used to reassure patients and providers that LP is indeed not as painful as imagined, which may both reduce pre-LP anxiety and improve LP tolerability.
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Affiliation(s)
- Yoshie Umemura
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Baber Khan
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Benjamin J Weill
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Justin J Buthorn
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Anna Skakodub
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Andrew J Ridder
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Kathryn S Nevel
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Yilun Sun
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Adrienne Boire
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
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Abdul-Rahman A, Morgan W, Yu DY. A machine learning approach in the non-invasive prediction of intracranial pressure using Modified Photoplethysmography. PLoS One 2022; 17:e0275417. [PMID: 36174066 PMCID: PMC9521929 DOI: 10.1371/journal.pone.0275417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
The ideal Intracranial pressure (ICP) estimation method should be accurate, reliable, cost-effective, compact, and associated with minimal morbidity/mortality. To this end several described non-invasive methods in ICP estimation have yielded promising results, however the reliability of these techniques have yet to supersede invasive methods of ICP measurement. Over several publications, we described a novel imaging method of Modified Photoplethysmography in the evaluation of the retinal vascular pulse parameters decomposed in the Fourier domain, which enables computationally efficient information filtering of the retinal vascular pulse wave. We applied this method in a population of 21 subjects undergoing lumbar puncture manometry. A regression model was derived by applying an Extreme Gradient Boost (XGB) machine learning algorithm using retinal vascular pulse harmonic regression waveform amplitude (HRWa), first and second harmonic cosine and sine coefficients (an1,2, bn1,2) among other features. Gain and SHapley Additive exPlanation (SHAP) values ranked feature importance in the model. Agreement between the predicted ICP mean, median and peak density with measured ICP was assessed using Bland-Altman bias±standard error. Feature gain of intraocular pressure (IOPi) (arterial = 0.6092, venous = 0.5476), and of the Fourier coefficients, an1 (arterial = 0.1000, venous = 0.1024) ranked highest in the XGB model for both vascular systems. The arterial model SHAP values demonstrated the importance of the laterality of the tested eye (1.2477), which was less prominent in the venous model (0.8710). External validation was achieved using seven hold-out test cases, where the median venous predicted ICP showed better agreement with measured ICP. Although the Bland-Altman bias from the venous model (0.034±1.8013 cm water (p<0.99)) was lower compared to that of the arterial model (0.139±1.6545 cm water (p<0.94)), the arterial model provided a potential avenue for internal validation of the prediction. This approach can potentially be integrated into a neurological clinical decision algorithm to evaluate the indication for lumbar puncture.
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Affiliation(s)
- Anmar Abdul-Rahman
- Department of Ophthalmology, Counties Manukau District Health Board, Auckland, New Zealand
- * E-mail:
| | - William Morgan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, University of Western Australia, Perth, Australia
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Caprioglio C, Garibotto V, Jessen F, Frölich L, Allali G, Assal F, Frisoni GB, Altomare D. The Clinical Use of Alzheimer's Disease Biomarkers in Patients with Mild Cognitive Impairment: A European Alzheimer's Disease Consortium Survey. J Alzheimers Dis 2022; 89:535-551. [PMID: 35912743 PMCID: PMC9535580 DOI: 10.3233/jad-220333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recent advances occurred in the field of Alzheimer's disease (AD) biomarkers and the introduction of a research framework grounded on a biomarker-based definition of AD might have fostered an increased clinical use of AD biomarkers. For this reason, an up-to-date depiction of the clinical use of AD biomarkers is needed. OBJECTIVE To investigate the clinical use of the main AD biomarkers in patients with mild cognitive impairment (MCI) by examining the beliefs and preferences of professionals (clinicians and biomarker experts) of the European Alzheimer's Disease Consortium (EADC). METHODS 150 professionals filled in an online survey from May to September 2020. The investigated biomarkers were medial temporal lobe atrophy score (MTA) on structural MRI, typical AD (i.e., temporoparietal and posterior cingulate) hypometabolism on FDG-PET, CSF (Aβ42, p-tau, t-tau), amyloid-PET and tau-PET. RESULTS The frequency of responders reporting a frequent-to-constant use of MTA (77%) is higher than that of those reporting a frequent-to-constant use of the other AD biomarkers (i.e. , CSF 45%, p = 0.014; FDG-PET: 32%, p < 0.001; amyloid-PET: 8%, p < 0.001; and tau-PET: 2%, p < 0.001). CSF is considered the most valuable biomarker in terms of additional diagnostic value, followed by amyloid-PET, tau-PET, and typical AD hypometabolism on FDG-PET. CONCLUSION AD biomarkers are widely used across European memory clinics with a clinical research background for the diagnosis of MCI. Overall, we observed that CSF is currently considered as the most useful biomarker, followed by amyloid-PET.
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Affiliation(s)
- Camilla Caprioglio
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland,Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland,Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
| | - Frank Jessen
- Department of Psychiatry, University Hospital and Medical Faculty, University of Cologne, Cologne, Germany,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute for Mental Health, University of Heidelberg, Mannheim, Germany
| | - Gilles Allali
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland,Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Frédéric Assal
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland,Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland,Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland,Correspondence to: Daniele Altomare, PhD, Memory Clinic, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland. Tel.: +41 22 372 58 00; E-mail:
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Atkins KJ, Evered L, Scott DA, Fowler C, Masters CL, Silbert B. Cerebrospinal fluid sampling for research of Alzheimer’s disease and other neurodegenerative diseases when lumbar punctures are performed by anaesthetists. BMJ Neurol Open 2022; 4:e000335. [PMID: 36110925 PMCID: PMC9445826 DOI: 10.1136/bmjno-2022-000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectivesAn increasing number of people are undergoing lumbar puncture (LP) for the purposes of research. Performing LP for research purposes introduces considerations that differ from LP performed for clinical, diagnostic or therapeutic reasons. The demand for research LP will greatly increase as biomarkers are used to both diagnose and monitor disease progression in clinical trials. Minimising adverse events is paramount because research participants receive no clinical benefit and often need repeat procedures. We describe the experience of performing LP for research by anaesthetists.MethodsWe reviewed the clinical protocol and incidence of adverse events in 326 research LP in an anaesthesia department.ResultsThere was a lower incidence of adverse events compared with previous reports when LP was undertaken for clinical reasons. The incidence of severe post-LP headache was 1.3% when an atraumatic spinal needle with a 27 gauge tip and a 22 gauge shaft was used.ConclusionsWe describe the practice to sample cerebrospinal fluid (CSF) by LP for research purposes. Specific practices include the sitting position of the participant, aspiration rather than passive CSF withdrawal, attention to the sterility of the procedure, monitoring of vital signs and importantly the use of 22/27 gauge microtip spinal needle.Trial registration numbersACTRN12612000493842, NCT04623242.
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Affiliation(s)
- Kelly J Atkins
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisbeth Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Fowler
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brendan Silbert
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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Exploring Early Physical Examination Diagnostic Biomarkers for Alzheimer’s Disease Based on Least Absolute Shrinkage and Selection Operator. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3039248. [PMID: 36035305 PMCID: PMC9410865 DOI: 10.1155/2022/3039248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022]
Abstract
Neurodegenerative diseases such as Alzheimer’s disease (AD) are an increasing public health challenge. There is an urgent need to shift the focus to accurate detection of clinical AD at the physical examination stage. The purpose of this study was to identify biomarkers for AD diagnosis. Differential expression analysis was performed on a dataset including prefrontal cortical samples and peripheral blood samples of AD to identify shared differentially expressed genes (DEGs) shared between the two datasets. In addition, a minimum absolute contraction and selection operator (LASSO) model based on shared-DEGs identified nine signature genes (MT1X, IGF1, DLEU7, TRIM36, PTPRC, WNK2, SPG20, C8orf59, and BRWD1) that accurately predict AD occurrence. Enrichment analysis showed that the signature gene was significantly associated with the AD-related p53 signaling pathway, T-cell receptor signaling pathway, HIF-1 signaling pathway, AMPK signaling pathway, and FoxO signaling pathway. Thus, our results identify not only biomarkers for diagnosing AD but also potentially specific pathways. The AD biomarkers proposed in this study could serve as indicators for prevention and diagnosis during physical examination.
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Keshavan A, O'Shea F, Chapman MD, Hart MS, Lunn MP, Paterson RW, Rohrer JD, Mummery CJ, Fox NC, Zetterberg H, Schott JM. CSF biomarkers for dementia. Pract Neurol 2022; 22:285-294. [PMID: 35301255 DOI: 10.1136/practneurol-2021-003310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
Abstract
Although cerebrospinal fluid (CSF) biomarker testing is incorporated into some current guidelines for the diagnosis of dementia (such as England's National Institute for Health and Care Excellence (NICE)), it is not widely accessible for most patients for whom biomarkers could potentially change management. Here we share our experience of running a clinical cognitive CSF service and discuss recent developments in laboratory testing including the use of the CSF amyloid-β 42/40 ratio and automated assay platforms. We highlight the importance of collaborative working between clinicians and laboratory staff, of preanalytical sample handling, and discuss the various factors influencing interpretation of the results in appropriate clinical contexts. We advocate for broadening access to CSF biomarkers by sharing clinical expertise, protocols and interpretation with colleagues working in psychiatry and elderly care, especially when access to CSF may be part of a pathway to disease-modifying treatments for Alzheimer's disease and other forms of dementia.
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Affiliation(s)
- Ashvini Keshavan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Frankie O'Shea
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Miles D Chapman
- Neuroimmunology and CSF Laboratory, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Melanie S Hart
- Neuroimmunology and CSF Laboratory, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Michael Pt Lunn
- Neuroimmunology and CSF Laboratory, National Hospital for Neurology and Neurosurgery, London, UK.,MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Ross W Paterson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Institute of Neurology, London, UK
| | - Catherine J Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Fluid Biomarkers Laboratory, UK DRI at University College London, UK Dementia Research Institute, London, UK.,Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
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Al-Hashel J, Rady A, Massoud F, Ismail II. Post-dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures. BMC Neurol 2022; 22:261. [PMID: 35836140 PMCID: PMC9281177 DOI: 10.1186/s12883-022-02785-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lumbar puncture (LP) is a common and relatively safe neurological procedure. It can be complicated by post-dural puncture headache (PDPH) after both diagnostic and therapeutic procedures. The aim of this study is to identify the incidence, risk factors and clinical characterization of PDPH in the inpatient setting of the main tertiary neurology hospital in Kuwait. Methods We conducted a prospective observational cohort study that included patients who were admitted to neurology department at Ibn Sina hospital, Kuwait, from January 1, 2019 to December 31, 2020, on whom, LP was performed for diagnostic and/or therapeutic reasons. Multivariate logistic regression analysis was performed to evaluate the association between PDPH and different clinical parameters. Results A total of 285 patients were included; 225 females (78.9%), mean age of 32.9 ± 11.7 years. PDPH was reported by 84 patients (29.5%), with mean headache onset of 1.7 ± 0.8 days, and mean duration of 2.4 ± 2.1 days. The commonest headache type was dull aching in 49 patients (58.3%). Headache severity was mild to moderate in 64 patients (76.2%), with mean NRS of 4.1 ± 0.9. Most PDPH (99.3%) resolved with conservative medical management, with only 2 patients (0.7%) requiring epidural blood patch. In multivariate logistic regression model, there was a statistically significant correlation between development of PDPH and young age (p = 0.001), female gender (p = 0 .001), low BMI (p < 0 .001), pre-LP headache (p = 0.001), history of previous PDPH (p = 0.001), and number of LP attempts (p < 0.001). PDPH was statistically significantly higher in patients with optic neuritis (p = 0.009), and cerebral venous thrombosis (p = 0.007), and lower in patients with peripheral neuropathy (p = 0.011) and spinal muscular atrophy (p = 0.042). Conclusions Findings from clinical practice in the main tertiary neurology hospital in Kuwait were in line with literature findings. Younger age, female gender, lower BMI, pre-procedural headache, previous history of PDPH, and number of LP attempts were found to be independent risk factors for developing PDPH. To our knowledge, this study represents the first comprehensive description of PDPH in a population from the Arabian Gulf Region.
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Affiliation(s)
- Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.,Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Azza Rady
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Fathi Massoud
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
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40
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Functional Imaging for Neurodegenerative Diseases. Presse Med 2022; 51:104121. [PMID: 35490910 DOI: 10.1016/j.lpm.2022.104121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/13/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022] Open
Abstract
Diagnosis and monitoring of neurodegenerative diseases has changed profoundly over the past twenty years. Biomarkers are now included in most diagnostic procedures as well as in clinical trials. Neuroimaging biomarkers provide access to brain structure and function over the course of neurodegenerative diseases. They have brought new insights into a wide range of neurodegenerative diseases and have made it possible to describe some of the imaging challenges in clinical populations. MRI mainly explores brain structure while molecular imaging, functional MRI and electro- and magnetoencephalography examine brain function. In this paper, we describe and analyse the current and potential contribution of MRI and molecular imaging in the field of neurodegenerative diseases.
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Schindler SE. Fluid Biomarkers in Dementia Diagnosis. Continuum (Minneap Minn) 2022; 28:822-833. [PMID: 35678404 DOI: 10.1212/con.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses how fluid biomarkers can augment the routine dementia evaluation and improve diagnostic accuracy. The tests that are currently available and the indications for their use are described. Further, tests that are under development and likely to be used in the future are identified. RECENT FINDINGS Technical improvements in assay sensitivity and precision have led to the rapid development of blood-based biomarkers for Alzheimer disease (AD) over the past several years. Studies have found that the ratio of amyloid-β (Aβ) peptides (Aβ42/Aβ40) and concentrations of phosphorylated tau isoforms in plasma can identify individuals with AD brain pathology. Blood-based tests may enable much broader use of AD biomarkers in the evaluation of patients with cognitive impairment. SUMMARY Even after a detailed history, examination, routine laboratory testing, and brain imaging, the cause of dementia sometimes remains unclear. CSF and blood-based biomarkers can evaluate for a range of neurologic disorders that are associated with dementia, including AD. Integrating data from fluid biomarker tests and the routine dementia evaluation may improve the accuracy of dementia diagnosis.
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Rodrigues FB, Owen G, Sathe S, Pak E, Kaur D, Ehrhardt AG, Lifer S, Townhill J, Schubert K, Leavitt BR, Guttman M, Bang J, Lewerenz J, Levey J, Sampaio C, Wild EJ. Safety and Feasibility of Research Lumbar Puncture in Huntington's Disease: The HDClarity Cohort and Bioresource. J Huntingtons Dis 2022; 11:59-69. [PMID: 35253773 DOI: 10.3233/jhd-210508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biomarkers are needed to monitor disease progression, target engagement and efficacy in Huntington's disease (HD). Cerebrospinal fluid (CSF) is an ideal medium to research such biomarkers due to its proximity to the brain. OBJECTIVE To investigate the safety and feasibility of research lumbar punctures (LP) in HD. METHODS HDClarity is an ongoing international biofluid collection initiative built on the Enroll-HD platform, where clinical assessments are recorded. It aims to recruit 1,200 participants. Biosamples are collected following an overnight fast: blood via venipuncture and CSF via LP. Participants are healthy controls and HD gene expansion carriers across the disease spectrum. We report on monitored data from February 2016 to September 2019. RESULTS Of 448 participants screened, 398 underwent at least 1 sampling visit, of which 98.24% were successful (i.e., CSF was collected), amounting to 10,610 mL of CSF and 8,200 mL of plasma. In the total 572 sampling visits, adverse events were reported in 24.13%, and headaches of any kind and post-LP headaches in 14.86% and 12.24%, respectively. Frequencies were less in manifest HD; gender, age, body mass index and disease burden score were not associated with the occurrence of the events in gene expansion carriers. Headaches and back pain were the most frequent adverse events. CONCLUSION HDClarity is the largest CSF collection initiative to support scientific research into HD and is now stablished as a leading resource for HD research. Our data confirm that research LP in HD are feasible and acceptable to the community, and have a manageable safety profile.
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Affiliation(s)
- Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Gail Owen
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Swati Sathe
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Elena Pak
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | | | | | - Sherry Lifer
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Jenny Townhill
- Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | - Katarzyna Schubert
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Mark Guttman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, USA.,Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | | | | | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
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Soo SA, Zailan FZ, Tan JY, Sandhu GK, Wong BYX, Wang BZ, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Safety and Usefulness of Lumbar Puncture for the Diagnosis and Management of Young-Onset Cognitive Disorders. J Alzheimers Dis 2022; 87:479-488. [PMID: 35275537 DOI: 10.3233/jad-215453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Young-onset cognitive disorders (YOCD) often manifests with complex and atypical presentations due to underlying heterogenous pathologies. Therefore, a biomarker-based evaluation will allow for timely diagnosis and definitive management. OBJECTIVE Here, we evaluated the safety and usefulness of cerebrospinal fluid (CSF) sampling through lumbar puncture (LP) in YOCD patients in a tertiary clinical setting. METHODS Patients with mild cognitive impairment (MCI) and mild dementia with age of onset between 45-64 years were evaluated. Patients underwent magnetic resonance imaging and their medial temporal lobe atrophy (MTA) was rated. LP side-effects and the impact of the CSF findings on diagnosis and management were analyzed. RESULTS 142 patients (53 (37.32%) MCI, 51 (35.92%) dementia of the Alzheimer's disease [DAT] type, and 38 (26.76%) non-AD type dementia) who underwent LP between 2015 to 2021 were analyzed. Using post-LP results and MTA ratings, 74 (52.11%) patients met the AT(N) criteria for AD. 56 (39.44%) patients (28 out of 53 (50.0%) MCI, 12 out of 51 (21.43%) DAT, and 16 out of 38 (28.57%) non-AD dementia) had a change in diagnosis following LP. 13 (9.15%) patients developed side-effects post-LP (11 (84.62%) patients had headache, 1 (7.69%) patient had backache, and 1 (7.69%) patient had headache and backache). 32 (22.54%) patients had a change in management post-LP, 24 (75.0%) had medication changes, 10 (31.30%) had referrals to other specialists, and 3 (9.40%) was referred for clinical trial with disease modifying interventions. CONCLUSION LP is well-tolerated in YOCD and can bring about relevant clinical decisions with regards to the diagnosis and management of this complex clinical condition.
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Affiliation(s)
- See Ann Soo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Jayne Yi Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
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44
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Tatò M, Perneczky R. [Diagnosing Alzheimer's dementia - a playground for academics or a sensible clinical measure?]. Dtsch Med Wochenschr 2022; 147:564-569. [PMID: 35468638 DOI: 10.1055/a-1769-1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The number of dementia cases continues to increase with Alzheimer's disease as the leading cause. The diagnostic workup of Alzheimer's dementia is complex, and its clinical relevance debatable considering the current lack of disease-modifying treatments. From this perspective, a stepwise diagnostic approach is recommended. Whenever Alzheimer's dementia is suspected, a patient' history a physical and psychiatric examination, neuropsychological tests, routine blood tests and standard cerebral imaging should be conducted. This allows in many cases a diagnosis to be given. In cases remaining unclear, modern biomarker tests are proving increasingly useful. Knowledge of the diagnosis is pivotal for the patients to assess the prognosis, to enable them to make plans for their future and to get access to available treatment. The approval of aducanumab in the USA and other promising monoclonal antibodies currently in phase 3-trials as well as the development of blood biomarkers give us hope for the future.
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Affiliation(s)
- Maia Tatò
- Sektion für Psychische Gesundheit im Alter, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der LMU, München
| | - Robert Perneczky
- Sektion für Psychische Gesundheit im Alter, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der LMU, München.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), München.,Munich Cluster for Systems Neurology (SyNergy), München.,Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, Vereinigtes Königreich.,Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, Vereinigtes Königreich
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45
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Vrillon A, Gonzales-Marabal L, Ceccaldi PF, Plaisance P, Desrentes E, Paquet C, Dumurgier J. Using virtual reality in lumbar puncture training improves students learning experience. BMC MEDICAL EDUCATION 2022; 22:244. [PMID: 35379253 PMCID: PMC8981937 DOI: 10.1186/s12909-022-03317-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lumbar puncture (LP) is a commonly performed medical procedure in a wide range of indications. Virtual reality (VR) provides a stimulating, safe and efficient learning environment. We report the design and the evaluation of a three dimensions (3D) video for LP training. METHODS We recorded a stereoscopic 180-degrees 3D video from two LPs performed in clinical settings in Fernand Widal Lariboisière University Hospital, Paris, France. The video was administered to third-year medical students as well as to a residents and attendings group during LP simulation-based training sessions. RESULTS On 168 participants (108 novice third-year medical students, and 60 residents and attendings with prior LP experience), satisfaction after video exposure was high (rated 4.7 ± 0.6 on a 5-point scale). No significant discomfort was reported (comfort score graded 4.5 ± 0.8 on 5). LP-naive students displayed higher satisfaction and perceived benefit than users with prior LP experience (overall, P < 0.05). Trainees evaluated favorably the 3D feature and supported the development of similar tutorials for other medical procedures (respectively, 3.9 ± 1.1 and 4.4 ± 0.9 on 5). CONCLUSION We report our experience with a 3D video for LP training. VR support could increase knowledge retention and skill acquisition in association to LP simulation training.
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Affiliation(s)
- Agathe Vrillon
- Cognitive Neurology Centre, GHU APHP Nord University Hospital Lariboisière Fernand-Widal, Paris, France.
- Université de Paris, INSERM U1144, Therapeutic Optimization in Neuropsychopharmacology, Paris, France.
| | | | | | - Patrick Plaisance
- Université de Paris, Simulation department, iLumens Paris Nord, Medical School, Paris, France
| | - Eric Desrentes
- Université de Paris, Simulation department, iLumens Paris Nord, Medical School, Paris, France
| | - Claire Paquet
- Cognitive Neurology Centre, GHU APHP Nord University Hospital Lariboisière Fernand-Widal, Paris, France
- Université de Paris, INSERM U1144, Therapeutic Optimization in Neuropsychopharmacology, Paris, France
| | - Julien Dumurgier
- Cognitive Neurology Centre, GHU APHP Nord University Hospital Lariboisière Fernand-Widal, Paris, France
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
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Ren J, Pan C, Wang Y, Xue C, Lin H, Xu J, Wang H, Zhang W, Xu P, Chen Y, Liu W. Plasma α-synuclein and phosphorylated tau 181 as a diagnostic biomarker panel for de novo Parkinson's Disease. J Neurochem 2022; 161:506-515. [PMID: 35234288 PMCID: PMC9314946 DOI: 10.1111/jnc.15601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
The use of a diagnostic panel comprising multiple biomarkers has the potential to accurately diagnose Parkinson’s disease (PD). However, a panel consisting solely of plasma biomarkers to diagnose PD is not available. This study aimed to examine the diagnostic ability of plasma biomarker panels for de novo PD using novel digital ultrasensitive immunoassay technology. We recruited 45 patients with de novo PD and 20 healthy controls (HCs). The concentrations of plasma α‐synuclein (α‐syn), amyloid β‐42 (Aβ42), Aβ40, phosphorylated tau 181 (p‐tau181), neurofilament light (NFL), and glial fibrillary acidic protein (GFAP) were quantified using the ultrasensitive single molecule array (Simoa) platform. Patients with de novo PD had higher plasma levels of α‐syn and p‐tau181 than HCs, adjusting for age and sex. Plasma levels of α‐syn and p‐tau181 were positively correlated in de novo PD patients. Higher plasma α‐syn levels were significantly associated with worse Unified Parkinson’s Disease Rating Scale (UPDRS) Part III motor scores, modified Hoehn and Yahr (H‐Y) stages, and increased risk of PD with mild cognitive impairment (PD‐MCI). Higher plasma p‐tau181 concentrations were linked to worse H‐Y stages. The diagnostic panel using plasma α‐syn and p‐tau181, combined with age and sex, showed good performance in discriminating de novo PD patients from HCs (area under the curve = 0.806). These findings suggest that plasma α‐syn and p‐tau181 together may be a promising diagnostic biomarker panel for de novo PD patients.
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Affiliation(s)
- Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenxi Pan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yajie Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Xue
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Huixia Lin
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jianxia Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pingyi Xu
- Department of Neurology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yong Chen
- Department of Laboratory, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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47
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Picca A, Guerra F, Calvani R, Coelho-Junior HJ, Bucci C, Marzetti E. Circulating extracellular vesicles: friends and foes in neurodegeneration. Neural Regen Res 2022; 17:534-542. [PMID: 34380883 PMCID: PMC8504375 DOI: 10.4103/1673-5374.320972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/19/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022] Open
Abstract
Extracellular vesicles have been identified as pivotal mediators of intercellular communication with critical roles in physiological and pathological conditions. Via this route, several molecules (e.g., nucleic acids, proteins, metabolites) can be transferred to proximal and distant targets to convey specific information. Extracellular vesicle-associated cargo molecules have been proposed as markers of several disease conditions for their potential of tracking down the generating cell. Indeed, circulating extracellular vesicles may represent biomarkers of dysfunctional cellular quality control systems especially in conditions characterized by the accrual of intracellular misfolded proteins. Furthermore, the identification of extracellular vesicles as tools for the delivery of nucleic acids or other cargo molecules to diseased tissues makes these circulating shuttles possible targets for therapeutic development. The increasing interest in the study of extracellular vesicles as biomarkers resides mainly in the fact that the identification of peripheral levels of extracellular vesicle-associated proteins might reflect molecular events occurring in hardly accessible tissues, such as the brain, thereby serving as a "brain liquid biopsy". The exploitation of extracellular vesicles for diagnostic and therapeutic purposed might offer unprecedented opportunities to develop personalized approaches. Here, we discuss the bright and dark sides of extracellular vesicles in the setting of two main neurodegenerative diseases (i.e., Parkinson's and Alzheimer's diseases). A special focus will be placed on the possibility of using extracellular vesicles as biomarkers for the two conditions to enable disease tracking and treatment monitoring.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Flora Guerra
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, Lecce, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Hélio José Coelho-Junior
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
| | - Cecilia Bucci
- Department of Biological and Environmental Sciences and Technologies, Università del Salento, Lecce, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
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48
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Mehrani I, Sachdev PS. The role of Memory Clinics in the assessment and management of dementia, now and into the future. Curr Opin Psychiatry 2022; 35:118-122. [PMID: 35026801 DOI: 10.1097/yco.0000000000000777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of dementia is often delayed and many individuals with the disorder go undiagnosed or receive an inadequate assessment. Specialist Memory Clinics have long been at the centre of such assessments. Recent developments in biomarkers and disease-modifying treatments are likely increase the need for specialist assessments. It is therefore timely to review the role of Memory Clinics internationally. RECENT FINDINGS The timely diagnosis of dementia and cognitive decline is the main responsibility of Memory Clinics. These clinics can diagnose dementia up to 4 years earlier than primary care services, but their low numbers and capacity of leads to long waiting times and a focus on complex cases. Few clinics are resourced to offer specific postdiagnostic support services, and their roles in clinical trials and research have not been realised. They are often well integrated with primary care and aged care services. SUMMARY Memory Clinics play an important role in bridging the gap between research and clinical practice and providing high-quality assessment and care. Additional Memory Clinic services and greater harmonisation of their responsibilities and procedures are needed to exploit their full potential.
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Affiliation(s)
- Inga Mehrani
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, The University of New South Wales
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, The University of New South Wales
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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49
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Li Y, Schindler SE, Bollinger JG, Ovod V, Mawuenyega KG, Weiner MW, Shaw LM, Masters CL, Fowler CJ, Trojanowski JQ, Korecka M, Martins RN, Janelidze S, Hansson O, Bateman RJ. Validation of Plasma Amyloid-β 42/40 for Detecting Alzheimer Disease Amyloid Plaques. Neurology 2022; 98:e688-e699. [PMID: 34906975 PMCID: PMC8865895 DOI: 10.1212/wnl.0000000000013211] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the diagnostic accuracy of a plasma Aβ42/Aβ40 assay in classifying amyloid PET status across global research studies using samples collected by multiple centers that utilize different blood collection and processing protocols. METHODS Plasma samples (n = 465) were obtained from 3 large Alzheimer disease (AD) research cohorts in the United States (n = 182), Australia (n = 183), and Sweden (n = 100). Plasma Aβ42/Aβ40 was measured by a high precision immunoprecipitation mass spectrometry (IPMS) assay and compared to the reference standards of amyloid PET and CSF Aβ42/Aβ40. RESULTS In the combined cohort of 465 participants, plasma Aβ42/Aβ40 had good concordance with amyloid PET status (receiver operating characteristic area under the curve [AUC] 0.84, 95% confidence interval [CI] 0.80-0.87); concordance improved with the inclusion of APOE ε4 carrier status (AUC 0.88, 95% CI 0.85-0.91). The AUC of plasma Aβ42/Aβ40 with CSF amyloid status was 0.85 (95% CI 0.78-0.91) and improved to 0.93 (95% CI 0.89-0.97) with APOE ε4 status. These findings were consistent across the 3 cohorts, despite differences in protocols. The assay performed similarly in both cognitively unimpaired and impaired individuals. DISCUSSION Plasma Aβ42/Aβ40 is a robust measure for detecting amyloid plaques and can be utilized to aid in the diagnosis of AD, identify those at risk for future dementia due to AD, and improve the diversity of populations enrolled in AD research and clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that plasma Aβ42/Aβ40, as measured by a high precision IPMS assay, accurately diagnoses brain amyloidosis in both cognitively unimpaired and impaired research participants.
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Affiliation(s)
- Yan Li
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Suzanne E Schindler
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - James G Bollinger
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Vitaliy Ovod
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Kwasi G Mawuenyega
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Michael W Weiner
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Leslie M Shaw
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Colin L Masters
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Christopher J Fowler
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - John Q Trojanowski
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Magdalena Korecka
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Ralph N Martins
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Shorena Janelidze
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Oskar Hansson
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden
| | - Randall J Bateman
- From the Department of Neurology (Y.L., S.E.S., J.G.B., V.O., K.G.M., R.J.B.), Division of Biostatistics (Y.L.), Knight Alzheimer's Disease Research Center (S.E.S., R.J.B.), and Hope Center for Neurological Disorders (R.J.B.), Washington University School of Medicine, St. Louis, MO; Departments of Psychiatry, Radiology and Biomedical Imaging, Medicine, and Neurology (M.W.W.), Center for Imaging and Neurodegenerative Diseases, Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, University of California San Francisco; Department of Pathology and Laboratory Medicine (S.M.L., J.Q.T., M.K.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Florey Institute of Neuroscience and Mental Health (C.L.M., C.J.F.), University of Melbourne, Victoria; Edith Cowan University (R.N.M.), Joondalup, Australia; Department of Clinical Sciences, Clinical Memory Research Unit (S.J., O.H.), Lund University; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden.
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Pachner AR. The Neuroimmunology of Multiple Sclerosis: Fictions and Facts. Front Neurol 2022; 12:796378. [PMID: 35197914 PMCID: PMC8858985 DOI: 10.3389/fneur.2021.796378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
There have been tremendous advances in the neuroimmunology of multiple sclerosis over the past five decades, which have led to improved diagnosis and therapy in the clinic. However, further advances must take into account an understanding of some of the complex issues in the field, particularly an appreciation of “facts” and “fiction.” Not surprisingly given the incredible complexity of both the nervous and immune systems, our understanding of the basic biology of the disease is very incomplete. This lack of understanding has led to many controversies in the field. This review identifies some of these controversies and facts/fictions with relation to the basic neuroimmunology of the disease (cells and molecules), and important clinical issues. Fortunately, the field is in a healthy transition from excessive reliance on animal models to a broader understanding of the disease in humans, which will likely lead to many improved treatments especially of the neurodegeneration in multiple sclerosis (MS).
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Affiliation(s)
- Andrew R. Pachner
- Dartmouth–Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- *Correspondence: Andrew R. Pachner
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