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Domínguez D JF, Stewart A, Burmester A, Akhlaghi H, O'Brien K, Bollmann S, Caeyenberghs K. Improving quantitative susceptibility mapping for the identification of traumatic brain injury neurodegeneration at the individual level. Z Med Phys 2024:S0939-3889(24)00001-1. [PMID: 38336583 DOI: 10.1016/j.zemedi.2024.01.001] [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: 06/02/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Emerging evidence suggests that traumatic brain injury (TBI) is a major risk factor for developing neurodegenerative disease later in life. Quantitative susceptibility mapping (QSM) has been used by an increasing number of studies in investigations of pathophysiological changes in TBI. However, generating artefact-free quantitative susceptibility maps in brains with large focal lesions, as in the case of moderate-to-severe TBI (ms-TBI), is particularly challenging. To address this issue, we utilized a novel two-pass masking technique and reconstruction procedure (two-pass QSM) to generate quantitative susceptibility maps (QSMxT; Stewart et al., 2022, Magn Reson Med.) in combination with the recently developed virtual brain grafting (VBG) procedure for brain repair (Radwan et al., 2021, NeuroImage) to improve automated delineation of brain areas. We used QSMxT and VBG to generate personalised QSM profiles of individual patients with reference to a sample of healthy controls. METHODS Chronic ms-TBI patients (N = 8) and healthy controls (N = 12) underwent (multi-echo) GRE, and anatomical MRI (MPRAGE) on a 3T Siemens PRISMA scanner. We reconstructed the magnetic susceptibility maps using two-pass QSM from QSMxT. We then extracted values of magnetic susceptibility in grey matter (GM) regions (following brain repair via VBG) across the whole brain and determined if they deviate from a reference healthy control group [Z-score < -3.43 or > 3.43, relative to the control mean], with the aim of obtaining personalised QSM profiles. RESULTS Using two-pass QSM, we achieved susceptibility maps with a substantial increase in quality and reduction in artefacts irrespective of the presence of large focal lesions, compared to single-pass QSM. In addition, VBG minimised the loss of GM regions and exclusion of patients due to failures in the region delineation step. Our findings revealed deviations in magnetic susceptibility measures from the HC group that differed across individual TBI patients. These changes included both increases and decreases in magnetic susceptibility values in multiple GM regions across the brain. CONCLUSIONS We illustrate how to obtain magnetic susceptibility values at the individual level and to build personalised QSM profiles in ms-TBI patients. Our approach opens the door for QSM investigations in more severely injured patients. Such profiles are also critical to overcome the inherent heterogeneity of clinical populations, such as ms-TBI, and to characterize the underlying mechanisms of neurodegeneration at the individual level more precisely. Moreover, this new personalised QSM profiling could in the future assist clinicians in assessing recovery and formulating a neuroscience-guided integrative rehabilitation program tailored to individual TBI patients.
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Affiliation(s)
- Juan F Domínguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Ashley Stewart
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture, and Information Technology, The University of Queensland, Brisbane, Australia
| | - Alex Burmester
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Hamed Akhlaghi
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Department of Emergency Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Kieran O'Brien
- Siemens Healthcare Pty Ltd, Brisbane, Queensland, Australia
| | - Steffen Bollmann
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture, and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
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Burnham SC, Iaccarino L, Pontecorvo MJ, Fleisher AS, Lu M, Collins EC, Devous MD. A review of the flortaucipir literature for positron emission tomography imaging of tau neurofibrillary tangles. Brain Commun 2023; 6:fcad305. [PMID: 38187878 PMCID: PMC10768888 DOI: 10.1093/braincomms/fcad305] [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: 05/04/2023] [Revised: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Alzheimer's disease is defined by the presence of β-amyloid plaques and neurofibrillary tau tangles potentially preceding clinical symptoms by many years. Previously only detectable post-mortem, these pathological hallmarks are now identifiable using biomarkers, permitting an in vivo definitive diagnosis of Alzheimer's disease. 18F-flortaucipir (previously known as 18F-T807; 18F-AV-1451) was the first tau positron emission tomography tracer to be introduced and is the only Food and Drug Administration-approved tau positron emission tomography tracer (Tauvid™). It has been widely adopted and validated in a number of independent research and clinical settings. In this review, we present an overview of the published literature on flortaucipir for positron emission tomography imaging of neurofibrillary tau tangles. We considered all accessible peer-reviewed literature pertaining to flortaucipir through 30 April 2022. We found 474 relevant peer-reviewed publications, which were organized into the following categories based on their primary focus: typical Alzheimer's disease, mild cognitive impairment and pre-symptomatic populations; atypical Alzheimer's disease; non-Alzheimer's disease neurodegenerative conditions; head-to-head comparisons with other Tau positron emission tomography tracers; and technical considerations. The available flortaucipir literature provides substantial evidence for the use of this positron emission tomography tracer in assessing neurofibrillary tau tangles in Alzheimer's disease and limited support for its use in other neurodegenerative disorders. Visual interpretation and quantitation approaches, although heterogeneous, mostly converge and demonstrate the high diagnostic and prognostic value of flortaucipir in Alzheimer's disease.
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Affiliation(s)
| | | | | | | | - Ming Lu
- Avid, Eli Lilly and Company, Philadelphia, PA 19104, USA
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Stern RA, Trujillo-Rodriguez D, Tripodis Y, Pulukuri SV, Alosco ML, Adler CH, Balcer LJ, Bernick C, Baucom Z, Marek KL, McClean MD, Johnson KA, McKee AC, Stein TD, Mez J, Palmisano JN, Cummings JL, Shenton ME, Reiman EM. Amyloid PET across the cognitive spectrum in former professional and college American football players: findings from the DIAGNOSE CTE Research Project. Alzheimers Res Ther 2023; 15:166. [PMID: 37798671 PMCID: PMC10552261 DOI: 10.1186/s13195-023-01315-5] [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: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Exposure to repetitive head impacts (RHI) in American football players can lead to cognitive impairment and dementia due to neurodegenerative disease, particularly chronic traumatic encephalopathy (CTE). The pathognomonic lesion of CTE consists of perivascular aggregates of hyper-phosphorylated tau in neurons at the depths of cortical sulci. However, it is unclear whether exposure to RHI accelerates amyloid-β (Aβ) plaque formation and increases the risk for Alzheimer's disease (AD). Although the Aβ neuritic plaques characteristic of AD are observed in a minority of later-stage CTE cases, diffuse plaques are more common. This study examined whether former professional and college American football players, including those with cognitive impairment and dementia, have elevated neuritic Aβ plaque density, as measured by florbetapir PET. Regardless of cognitive and functional status, elevated levels of florbetapir uptake were not expected. METHODS We examined 237 men ages 45-74, including 119 former professional (PRO) and 60 former college (COL) football players, with and without cognitive impairment and dementia, and 58 same-age men without a history of contact sports or TBI (unexposed; UE) and who denied cognitive or behavioral symptoms at telephone screening. Former players were categorized into four diagnostic groups: normal cognition, subjective memory impairment, mild cognitive impairment, and dementia. Positive florbetapir PET was defined by cortical-cerebellar average SUVR of ≥ 1.10. Multivariable linear regression and analysis of covariance (ANCOVA) compared florbetapir average SUVR across diagnostic and exposure groups. Multivariable logistic regression compared florbetapir positivity. Race, education, age, and APOE4 were covariates. RESULTS There were no diagnostic group differences either in florbetapir average SUVR or the proportion of elevated florbetapir uptake. Average SUVR means also did not differ between exposure groups: PRO-COL (p = 0.94, 95% C.I. = [- 0.033, 0.025]), PRO-UE (p = 0.40, 95% C.I. = [- 0.010, 0.029]), COL-UE (p = 0.36, 95% CI = [0.0004, 0.039]). Florbetapir was not significantly associated with years of football exposure, cognition, or daily functioning. CONCLUSIONS Cognitive impairment in former American football players is not associated with PET imaging of neuritic Aβ plaque deposition. These findings are inconsistent with a neuropathological diagnosis of AD in individuals with substantial RHI exposure and have both clinical and medico-legal implications. TRIAL REGISTRATION NCT02798185.
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Affiliation(s)
- Robert A Stern
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA.
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Diana Trujillo-Rodriguez
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Graduate Program in Neuroscience, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Surya V Pulukuri
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
| | - Michael L Alosco
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Zachary Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Harvard Medical School, Gordon Center for Medical Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann C McKee
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Thor D Stein
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey L Cummings
- Department of Brain Health, School of Integrated Health Sciences, Chambers-Grundy Center for Transformative Neuroscience, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Harvard Medical School, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
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Mundada NS, Rojas JC, Vandevrede L, Thijssen EH, Iaccarino L, Okoye OC, Shankar R, Soleimani-Meigooni DN, Lago AL, Miller BL, Teunissen CE, Heuer H, Rosen HJ, Dage JL, Jagust WJ, Rabinovici GD, Boxer AL, La Joie R. Head-to-head comparison between plasma p-tau217 and flortaucipir-PET in amyloid-positive patients with cognitive impairment. Alzheimers Res Ther 2023; 15:157. [PMID: 37740209 PMCID: PMC10517500 DOI: 10.1186/s13195-023-01302-w] [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: 04/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Plasma phosphorylated tau (p-tau) has emerged as a promising biomarker for Alzheimer's disease (AD). Studies have reported strong associations between p-tau and tau-PET that are mainly driven by differences between amyloid-positive and amyloid-negative patients. However, the relationship between p-tau and tau-PET is less characterized within cognitively impaired patients with a biomarker-supported diagnosis of AD. We conducted a head-to-head comparison between plasma p-tau217 and tau-PET in patients at the clinical stage of AD and further assessed their relationships with demographic, clinical, and biomarker variables. METHODS We retrospectively included 87 amyloid-positive patients diagnosed with MCI or dementia due to AD who underwent structural MRI, amyloid-PET (11C-PIB), tau-PET (18F-flortaucipir, FTP), and blood draw assessments within 1 year (age = 66 ± 10, 48% female). Amyloid-PET was quantified in Centiloids (CL) while cortical tau-PET binding was measured using standardized uptake value ratios (SUVRs) referenced against inferior cerebellar cortex. Plasma p-tau217 concentrations were measured using an electrochemiluminescence-based assay on the Meso Scale Discovery platform. MRI-derived cortical volume was quantified with FreeSurfer. Mini-Mental State Examination (MMSE) scores were available at baseline (n = 85) and follow-up visits (n = 28; 1.5 ± 0.7 years). RESULTS Plasma p-tau217 and cortical FTP-SUVR were correlated (r = 0.61, p < .001), especially in temporo-parietal and dorsolateral frontal cortices. Both higher p-tau217 and FTP-SUVR values were associated with younger age, female sex, and lower cortical volume, but not with APOE-ε4 carriership. PIB-PET Centiloids were weakly correlated with FTP-SUVR (r = 0.26, p = 0.02), but not with p-tau217 (r = 0.10, p = 0.36). Regional PET-plasma associations varied with amyloid burden, with p-tau217 being more strongly associated with tau-PET in temporal cortex among patients with moderate amyloid-PET burden, and with tau-PET in primary cortices among patients with high amyloid-PET burden. Higher p-tau217 and FTP-SUVR values were independently associated with lower MMSE scores cross-sectionally, while only baseline FTP-SUVR predicted longitudinal MMSE decline when both biomarkers were included in the same model. CONCLUSION Plasma p-tau217 and tau-PET are strongly correlated in amyloid-PET-positive patients with MCI or dementia due to AD, and they exhibited comparable patterns of associations with demographic variables and with markers of downstream neurodegeneration.
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Affiliation(s)
- Nidhi S Mundada
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lawren Vandevrede
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elisabeth H Thijssen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Ranjani Shankar
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - David N Soleimani-Meigooni
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Argentina L Lago
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hillary Heuer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Howie J Rosen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey L Dage
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- Global Brain Health Institute, San Francisco, CA, USA.
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Conway Kleven BD, Chien LC, Labus B, Cross CL, Ritter A, Randall R, Montes A, Bernick C. Longitudinal Changes in Regional Brain Volumes and Cognition of Professional Fighters With Traumatic Encephalopathy Syndrome. Neurology 2023; 101:e1118-e1126. [PMID: 37380429 PMCID: PMC10513890 DOI: 10.1212/wnl.0000000000207594] [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: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Due to current limitations in diagnosing chronic traumatic encephalopathy (CTE) clinically, traumatic encephalopathy syndrome (TES) has been proposed as the clinical presentation of suspected CTE. This study aimed to determine whether there was an association between a clinical diagnosis of TES and subsequent temporal decline in cognitive or MRI volumetric measures. METHODS This was a secondary analysis of the Professional Athletes Brain Health Study (PABHS), inclusive of active and retired professional fighters older than 34 years. All athletes were adjudicated as TES positive (TES+) or TES negative (TES-) based on the 2021 clinical criteria. General linear mixed models were used to compare MRI regional brain volumes and cognitive performance between groups. RESULTS A total of 130 fighters met inclusion criteria for consensus conference. Of them, 52 fighters (40%) were adjudicated as TES+. Athletes with a TES+ diagnosis were older and had significantly lower education. Statistically significant interactions and between-group total mean differences were found in all MRI volumetric measurements among the TES+ group compared with those among the TES- group. The rate of volumetric change indicated a significantly greater increase for lateral (estimate = 5,196.65; 95% CI = 2642.65, 7750.66) and inferior lateral ventricles (estimate = 354.28; 95% CI = 159.90, 548.66) and a decrease for the hippocampus (estimate = -385.04, 95% CI = -580.47, -189.62), subcortical gray matter (estimate = -4,641.08; 95% CI = -6783.98, -2498.18), total gray matter (estimate = -26492.00; 95% CI = -50402.00, -2582.32), and posterior corpus callosum (estimate = -147.98; 95% CI = -222.33, -73.62). Likewise, the rate of cognitive decline was significantly greater for reaction time (estimate = 56.31; 95% CI = 26.17, 86.45) and other standardized cognitive scores in the TES+ group. DISCUSSION The 2021 TES criteria clearly distinguishes group differences in the longitudinal presentation of volumetric loss in select brain regions and cognitive decline among professional fighters 35 years and older. This study suggests that a TES diagnosis may be useful in professional sports beyond football, such as boxing and mixed martial arts. These findings further suggest that the application of TES criteria may be valuable clinically in predicting cognitive decline.
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Affiliation(s)
- Brooke D Conway Kleven
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV.
| | - Lung-Chang Chien
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
| | - Brian Labus
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
| | - Chad L Cross
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
| | - Aaron Ritter
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
| | - Rebekah Randall
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
| | - Arturo Montes
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
| | - Charles Bernick
- From the School of Public Health (B.D.C.K., L.-C.C., B.L., C.L.C., A.M.), University of Nevada, Las Vegas; and Cleveland Clinic Lou Ruvo Center for Brain Health (A.R., R.R., A.M., C.B.), Las Vegas, NV
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Dhaynaut M, Grashow R, Normandin MD, Wu O, Marengi D, Terry DP, Sanchez JS, Weisskopf MG, Speizer FE, Taylor HA, Guehl NJ, Seshadri S, Beiser A, Daneshvar DH, Johnson K, Iverson GL, Zafonte R, El Fakhri G, Baggish AL. Tau Positron Emission Tomography and Neurocognitive Function Among Former Professional American-Style Football Players. J Neurotrauma 2023; 40:1614-1624. [PMID: 37282582 PMCID: PMC10458363 DOI: 10.1089/neu.2022.0454] [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: 06/08/2023] Open
Abstract
American-style football (ASF) players experience repetitive head impacts that may result in chronic traumatic encephalopathy neuropathological change (CTE-NC). At present, a definitive diagnosis of CTE-NC requires the identification of localized hyperphosphorylated Tau (p-Tau) after death via immunohistochemistry. Some studies suggest that positron emission tomography (PET) with the radiotracer [18F]-Flortaucipir (FTP) may be capable of detecting p-Tau and thus establishing a diagnosis of CTE-NC among living former ASF players. To assess associations between FTP, football exposure, and objective neuropsychological measures among former professional ASF players, we conducted a study that compared former professional ASF players with age-matched male control participants without repetitive head impact exposure. Former ASF players and male controls underwent structural magnetic resonance imaging and PET using FTP for p-Tau and [11C]-PiB for amyloid-β. Former players underwent neuropsychological testing. The ASF exposure was quantified as age at first exposure, professional career duration, concussion signs and symptoms burden, and total years of any football play. Neuropsychological testing included measures of memory, executive functioning, and depression symptom severity. P-Tau was quantified as FTP standardized uptake value ratios (SUVR) and [11C]-PiB by distribution volume ratios (DVR) using cerebellar grey matter as the reference region. There were no significant differences in [18F]-FTP uptake among former ASF players (n = 27, age = 50 ± 7 years) compared with control participants (n = 11, age = 55 ± 4 years), nor did any participant have significant amyloid-β burden. Among ASF participants, there were no associations between objective measures of neurocognitive functioning and [18F]-FTP uptake. There was a marginally significant difference, however, between [18F]-FTP uptake isolated to the entorhinal cortex among players in age-, position-, and race-adjusted models (p = 0.05) that may represent an area of future investigation. The absence of increased [18F]-FTP uptake in brain regions previously implicated in CTE among former professional ASF players compared with controls questions the utility of [18F]-FTP PET for clinical evaluation in this population.
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Affiliation(s)
- Maeva Dhaynaut
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc D. Normandin
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ona Wu
- Athinoula A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin S. Sanchez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E. Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachsetts, USA
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Nicolas J. Guehl
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sudha Seshadri
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UTHSA, San Antonio, Texas, USA
| | - Alexa Beiser
- NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics and Neurology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
| | - Keith Johnson
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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7
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Leiva-Salinas C, Singh A, Layfield E, Flors L, Patrie JT. Early Brain Amyloid Accumulation at PET in Military Instructors Exposed to Subconcussive Blast Injuries. Radiology 2023; 307:e221608. [PMID: 37158720 DOI: 10.1148/radiol.221608] [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: 05/10/2023]
Abstract
Background Traumatic brain injury (TBI) is the leading cause of disability in young adults. Recurrent TBI is associated with a range of neurologic sequelae, but the contributing factors behind the development of such chronic encephalopathy are poorly understood. Purpose To quantify early amyloid β deposition in the brain of otherwise healthy adult men exposed to repeated subconcussive blast injury using amyloid PET. Materials and Methods In this prospective study from January 2020 to December 2021, military instructors who were routinely exposed to repeated blast events were evaluated at two different points: baseline (before blast exposure from breacher or grenade) and approximately 5 months after baseline (after blast exposure). Age-matched healthy control participants not exposed to blasts and without a history of brain injury were evaluated at similar two points. Neurocognitive evaluation was performed with standard neuropsychologic testing in both groups. Analysis of PET data consisted of standardized uptake value measurements in six relevant brain regions and a whole-brain voxel-based statistical approach. Results Participants were men (nine control participants [median age, 33 years; IQR, 32-36 years] and nine blast-exposed participants [median age, 33 years; IQR, 30-34 years]; P = .82). In the blast-exposed participants, four brain regions showed significantly increased amyloid deposition after blast exposure: inferomedial frontal lobe (P = .004), precuneus (P = .02), anterior cingulum (P = .002), and superior parietal lobule (P = .003). No amyloid deposition was observed in the control participants. Discriminant analysis on the basis of regional changes of amyloid accumulation correctly classified the nine healthy control participants as healthy control participants (100%), and seven of the nine blast-exposed participants (78%) were correctly classified as blast exposed. Based on the voxel-based analysis, whole-brain parametric maps of early abnormal early amyloid uptake were obtained. Conclusion Early brain amyloid accumulation was identified and quantified at PET in otherwise healthy adult men exposed to repetitive subconcussive traumatic events. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Haller in this issue.
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Affiliation(s)
- Carlos Leiva-Salinas
- From the Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212 (C.L.S., A.S.); Department of Surgery, University of California-San Francisco, San Francisco, Calif (E.L.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.); and Department of Public Health Sciences, University of Virginia, Charlottesville, Va (J.T.P.)
| | - Amolak Singh
- From the Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212 (C.L.S., A.S.); Department of Surgery, University of California-San Francisco, San Francisco, Calif (E.L.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.); and Department of Public Health Sciences, University of Virginia, Charlottesville, Va (J.T.P.)
| | - Eleanor Layfield
- From the Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212 (C.L.S., A.S.); Department of Surgery, University of California-San Francisco, San Francisco, Calif (E.L.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.); and Department of Public Health Sciences, University of Virginia, Charlottesville, Va (J.T.P.)
| | - Lucia Flors
- From the Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212 (C.L.S., A.S.); Department of Surgery, University of California-San Francisco, San Francisco, Calif (E.L.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.); and Department of Public Health Sciences, University of Virginia, Charlottesville, Va (J.T.P.)
| | - James T Patrie
- From the Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212 (C.L.S., A.S.); Department of Surgery, University of California-San Francisco, San Francisco, Calif (E.L.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.); and Department of Public Health Sciences, University of Virginia, Charlottesville, Va (J.T.P.)
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8
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Haller S. Amyloid PET: A Potential Biomarker for Individuals with Mild Traumatic Brain Injury. Radiology 2023; 307:e230671. [PMID: 37158716 DOI: 10.1148/radiol.230671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Sven Haller
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland
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9
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Shi Y, Ghetti B, Goedert M, Scheres SHW. Cryo-EM Structures of Chronic Traumatic Encephalopathy Tau Filaments with PET Ligand Flortaucipir. J Mol Biol 2023; 435:168025. [PMID: 37330290 PMCID: PMC7615338 DOI: 10.1016/j.jmb.2023.168025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 06/19/2023]
Abstract
Positron emission tomography (PET) imaging allows monitoring the progression of amyloid aggregation in the living brain. [18F]-Flortaucipir is the only approved PET tracer compound for the visualisation of tau aggregation. Here, we describe cryo-EM experiments on tau filaments in the presence and absence of flortaucipir. We used tau filaments isolated from the brain of an individual with Alzheimer's disease (AD), and from the brain of an individual with primary age-related tauopathy (PART) with a co-pathology of chronic traumatic encephalopathy (CTE). Unexpectedly, we were unable to visualise additional cryo-EM density for flortaucipir for AD paired helical or straight filaments (PHFs or SFs), but we did observe density for flortaucipir binding to CTE Type I filaments from the case with PART. In the latter, flortaucipir binds in a 1:1 molecular stoichiometry with tau, adjacent to lysine 353 and aspartate 358. By adopting a tilted geometry with respect to the helical axis, the 4.7 Å distance between neighbouring tau monomers is reconciled with the 3.5 Å distance consistent with π-π-stacking between neighbouring molecules of flortaucipir.
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Affiliation(s)
- Yang Shi
- Medical Research Council Laboratory of Molecular Biology, Cambridge, UK.
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. https://twitter.com/GhettiBernardi1
| | - Michel Goedert
- Medical Research Council Laboratory of Molecular Biology, Cambridge, UK.
| | - Sjors H W Scheres
- Medical Research Council Laboratory of Molecular Biology, Cambridge, UK.
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10
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Aranha MR, Coutinho AM, Carneiro CDG, Pastorello BF, Studart-Neto A, Guariglia CC, Tsunemi MH, Moreira ELS, Ianof JN, Anghinah R, Nitrini R, Cerri GG, Fortea J, Buchpiguel CA, Leite CC. Brain glucose metabolism and gray matter volume in retired professional soccer players: a cross-sectional [18F]FDG-PET/MRI study. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:433-443. [PMID: 37257463 DOI: 10.1055/s-0043-1768666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Professional soccer athletes are exposed to repetitive head impacts and are at risk of developing chronic traumatic encephalopathy. OBJECTIVE To evaluate regional brain glucose metabolism (rBGM) and gray matter (GM) volume in retired soccer players (RSPs). METHODS Male RSPs and age and sex-matched controls prospectively enrolled between 2017 and 2019 underwent neurological and neuropsychological evaluations, brain MRI and [18F]FDG-PET in a 3.0-Tesla PET/MRI scanner. Visual analysis was performed by a blinded neuroradiologist and a blinded nuclear physician. Regional brain glucose metabolism and GM volume were assessed using SPM8 software. Groups were compared using appropriate statistical tests available at SPM8 and R. RESULTS Nineteen RSPs (median [IQR]: 62 [50-64.5] years old) and 20 controls (60 [48-73] years old) were included. Retired soccer players performed worse on mini-mental state examination, digit span, clock drawing, phonemic and semantic verbal fluency tests, and had reduced rBGM in the left temporal pole (pFDR = 0.008) and the anterior left middle temporal gyrus (pFDR = 0.043). Semantic verbal fluency correlated with rBGM in the right hippocampus, left temporal pole, and posterior left middle temporal gyrus (p ≤ 0.042). Gray matter volume reduction was observed in similar anatomic regions but was less extensive and did not survive correction for multiple comparisons (pFDR ≥ 0.085). Individual [18F]FDG-PET visual analysis revealed seven RSPs with overt hypometabolism in the medial and lateral temporal lobes, frontal lobes, and temporoparietal regions. Retired soccer players had a higher prevalence of septum pellucidum abnormalities on MRI. CONCLUSION Retired soccer players had reduced rBGM and GM volume in the temporal lobes and septum pellucidum abnormalities, findings possibly related to repetitive head impacts.
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Affiliation(s)
- Mateus Rozalem Aranha
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Radiologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Centro de Medicina Nuclear, São Paulo SP, Brazil
- Universidad Autónoma de Barcelona, Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Facultad de Medicina, Barcelona, Spain
| | - Artur Martins Coutinho
- Universidade de São Paulo, Faculdade de Medicina, Centro de Medicina Nuclear, São Paulo SP, Brazil
| | - Camila de Godoi Carneiro
- Universidade de São Paulo, Faculdade de Medicina, Centro de Medicina Nuclear, São Paulo SP, Brazil
| | | | - Adalberto Studart-Neto
- Universidade de São Paulo, Departamento de Neurologia, Faculdade de Medicina, São Paulo SP, Brazil
| | - Carla Cristina Guariglia
- Universidade de São Paulo, Departamento de Neurologia, Faculdade de Medicina, São Paulo SP, Brazil
| | - Miriam Harumi Tsunemi
- Universidade Estadual Paulista, Departamento de Bioestatística, Instituto de Biociências, Botucatu SP, Brazil
| | | | - Jéssica Natuline Ianof
- Universidade de São Paulo, Departamento de Neurologia, Faculdade de Medicina, São Paulo SP, Brazil
| | - Renato Anghinah
- Universidade de São Paulo, Departamento de Neurologia, Faculdade de Medicina, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Departamento de Neurologia, Faculdade de Medicina, São Paulo SP, Brazil
| | - Giovanni Guido Cerri
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Radiologia, São Paulo SP, Brazil
| | - Juan Fortea
- Universidad Autónoma de Barcelona, Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Facultad de Medicina, Barcelona, Spain
- Fundación Catalana de Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, Spain
| | | | - Claudia Costa Leite
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Radiologia, São Paulo SP, Brazil
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11
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Varlow C, Vasdev N. Evaluation of Tau Radiotracers in Chronic Traumatic Encephalopathy. J Nucl Med 2023; 64:460-465. [PMID: 36109185 PMCID: PMC10071800 DOI: 10.2967/jnumed.122.264404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurologic disorder associated with head injuries, diagnosed by the perivascular accumulation of hyperphosphorylated tau protein (phospho-tau) identified at autopsy. Tau PET radiopharmaceuticals developed for imaging Alzheimer disease are under evaluation for brain injuries. The goal of this study was to conduct a head-to-head in vitro evaluation of 5 tau PET radiotracers in subjects pathologically diagnosed with CTE. Methods: Autoradiography was used to assess the specific binding and distribution of 3H-flortaucipir (also known as Tauvid, AV-1451, and T807), 3H-MK-6240 (also known as florquinitau), 3H-PI-2620, 3H-APN-1607 (also known as PM-PBB3 and florzolotau), and 3H-CBD-2115 (also known as 3H-OXD-2115) in fresh-frozen human postmortem CTE brain tissue (stages I-IV). Immunohistochemistry was performed for phospho-tau with AT8, 3R tau with RD3, 4R tau with RD4 and amyloid-β with 6F/3D antibodies. Tau target density (maximum specific binding) was quantified by saturation analysis with 3H-flortaucipir in tissue sections. Results: 3H-flortaucipir demonstrated a positive signal in all CTE cases examined, with varying degrees of specific binding (68.7% ± 10.5%; n = 12) defined by homologous blockade and to a lesser extent by heterologous blockade with MK-6240 (27.3% ± 13.6%; n = 12). The 3H-flortaucipir signal was also displaced by the monoamine oxidase (MAO)-A inhibitor clorgyline (43.9% ± 4.6%; n = 3), indicating off-target binding to MAO-A. 3H-APN-1607 was moderately displaced in homologous blocking studies and was not displaced by 3H-flortaucipir; however, substantial displacement was observed when blocking with the β-amyloid-targeting compound NAV-4694. 3H-MK-6240 and 3H-PI-2620 had negligible binding in all but 2 CTE IV cases, and binding may be attributed to pathology severity or mixed Alzheimer disease/CTE pathology. 3H-CBD-2115 showed moderate binding, displaced under homologous blockade, and aligned with 4R-tau immunostaining. Conclusion: In human CTE tissues, 3H-flortaucipir and 3H-APN-1607 revealed off-target binding to MAO-A and amyloid-β, respectively, and should be considered if these radiotracers are used in PET imaging studies of patients with brain injuries. 3H-MK-6240 and 3H-PI-2620 bind to CTE tau in severe- or mixed-pathology cases, and their respective 18F PET radiotracers warrant further evaluation in patients with severe suspected CTE.
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Affiliation(s)
- Cassis Varlow
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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12
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Liang B, Alosco ML, Armañanzas R, Martin BM, Tripodis Y, Stern RA, Prichep LS. Long-Term Changes in Brain Connectivity Reflected in Quantitative Electrophysiology of Symptomatic Former National Football League Players. J Neurotrauma 2023; 40:309-317. [PMID: 36324216 PMCID: PMC9902050 DOI: 10.1089/neu.2022.0029] [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: 11/06/2022] Open
Abstract
Exposure to repetitive head impacts (RHI) has been associated with long-term disturbances in cognition, mood, and neurobehavioral dysregulation, and reflected in neuroimaging. Distinct patterns of changes in quantitative features of the brain electrical activity (quantitative electroencephalogram [qEEG]) have been demonstrated to be sensitive to brain changes seen in neurodegenerative disorders and in traumatic brain injuries (TBI). While these qEEG biomarkers are highly sensitive at time of injury, the long-term effects of exposure to RHI on brain electrical activity are relatively unexplored. Ten minutes of eyes closed resting EEG data were collected from a frontal and frontotemporal electrode montage (BrainScope Food and Drug Administration-cleared EEG acquisition device), as well as assessments of neuropsychiatric function and age of first exposure (AFE) to American football. A machine learning methodology was used to derive a qEEG-based algorithm to discriminate former National Football League (NFL) players (n = 87, 55.40 ± 7.98 years old) from same-age men without history of RHI (n = 68, 54.94 ± 7.63 years old), and a second algorithm to discriminate former players with AFE <12 years (n = 33) from AFE ≥12 years (n = 54). The algorithm separating NFL retirees from controls had a specificity = 80%, a sensitivity = 60%, and an area under curve (AUC) = 0.75. Within the NFL population, the algorithm separating AFE <12 from AFE ≥12 resulted in a sensitivity = 76%, a specificity = 52%, and an AUC = 0.72. The presence of a profile of EEG abnormalities in the NFL retirees and in those with younger AFE includes features associated with neurodegeneration and the disruption of neuronal transmission between regions. These results support the long-term consequences of RHI and the potential of EEG as a biomarker of persistent changes in brain function.
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Affiliation(s)
- Bo Liang
- BrainScope Company, Chevy Chase, Maryland, USA
| | - Michael L. Alosco
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
- Department of Neurology, Boston University, Boston, Massachusetts, USA
| | - Ruben Armañanzas
- BrainScope Company, Chevy Chase, Maryland, USA
- Institute for Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain
- Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Brett M. Martin
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University, Boston, Massachusetts, USA
| | - Robert A. Stern
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
- Department of Neurology, Boston University, Boston, Massachusetts, USA
- Departments of Neurosurgery and Anatomy & Neurobiology, Boston University, Boston, Massachusetts, USA
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13
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Kelly JP, Priemer DS, Perl DP, Filley CM. Sports Concussion and Chronic Traumatic Encephalopathy: Finding a Path Forward. Ann Neurol 2023; 93:222-225. [PMID: 36504163 PMCID: PMC10108279 DOI: 10.1002/ana.26566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
Sports concussion has recently assumed special importance because of the widely publicized entity of chronic traumatic encephalopathy (CTE). Identified primarily in former contact sports athletes with repeated mild traumatic brain injury (mTBI), CTE is a distinct tauopathy that can only be diagnosed postmortem and for which no specific treatment is available. Although the hazards of repeated mTBI are generally acknowledged, a spirited controversy has developed because a firm link between sports concussion and CTE has been questioned. We briefly review the history of CTE, discuss areas of uncertainty, and offer suggestions to assist neurologists confronting these issues and advance understanding of this vexing problem. ANN NEUROL 2023;93:222-225.
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Affiliation(s)
- James P Kelly
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Marcus Institute for Brain Health, Anschutz Medical Campus, Aurora, CO, USA
| | - David S Priemer
- Department of Defense/Uniformed Services University Brain Tissue Repository, Bethesda, MD, USA.,Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Daniel P Perl
- Department of Defense/Uniformed Services University Brain Tissue Repository, Bethesda, MD, USA.,Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Christopher M Filley
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Marcus Institute for Brain Health, Anschutz Medical Campus, Aurora, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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14
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Loftus JR, Puri S, Meyers SP. Multimodality imaging of neurodegenerative disorders with a focus on multiparametric magnetic resonance and molecular imaging. Insights Imaging 2023; 14:8. [PMID: 36645560 PMCID: PMC9842851 DOI: 10.1186/s13244-022-01358-6] [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: 08/17/2022] [Accepted: 12/13/2022] [Indexed: 01/17/2023] Open
Abstract
Neurodegenerative diseases afflict a large number of persons worldwide, with the prevalence and incidence of dementia rapidly increasing. Despite their prevalence, clinical diagnosis of dementia syndromes remains imperfect with limited specificity. Conventional structural-based imaging techniques also lack the accuracy necessary for confident diagnosis. Multiparametric magnetic resonance imaging and molecular imaging provide the promise of improving specificity and sensitivity in the diagnosis of neurodegenerative disease as well as therapeutic monitoring of monoclonal antibody therapy. This educational review will briefly focus on the epidemiology, clinical presentation, and pathologic findings of common and uncommon neurodegenerative diseases. Imaging features of each disease spanning from conventional magnetic resonance sequences to advanced multiparametric methods such as resting-state functional magnetic resonance imaging and arterial spin labeling imaging will be described in detail. Additionally, the review will explore the findings of each diagnosis on molecular imaging including single-photon emission computed tomography and positron emission tomography with a variety of clinically used and experimental radiotracers. The literature and clinical cases provided demonstrate the power of advanced magnetic resonance imaging and molecular techniques in the diagnosis of neurodegenerative diseases and areas of future and ongoing research. With the advent of combined positron emission tomography/magnetic resonance imaging scanners, hybrid protocols utilizing both techniques are an attractive option for improving the evaluation of neurodegenerative diseases.
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Affiliation(s)
- James Ryan Loftus
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| | - Savita Puri
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| | - Steven P. Meyers
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
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15
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Abstract
Imaging of mild traumatic brain injury (TBI) using conventional techniques such as CT or MRI often results in no specific imaging correlation that would explain cognitive and clinical symptoms. Molecular imaging of mild TBI suggests that secondary events after injury can be detected using PET. However, no single specific pattern emerges that can aid in diagnosing the injury or determining the prognosis of the long-term behavioral profiles, indicating the heterogeneous and diffuse nature of TBI. Chronic traumatic encephalopathy, a primary tauopathy, has been shown to be strongly associated with repetitive TBI. In vivo data on the available tau PET tracers, however, have produced mixed results and overall low retention profiles in athletes with a history of repetitive mild TBI. Here, we emphasize that the lack of a mechanistic understanding of chronic TBI has posed a challenge when interpreting the results of molecular imaging biomarkers. We advocate for better target identification, improved analysis techniques such as machine learning or artificial intelligence, and novel tracer development.
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Affiliation(s)
- Gérard N. Bischof
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany;,Institute for Neuroscience and Medicine II–Molecular Organization of the Brain, Research Center Juelich, Juelich, Germany; and
| | - Donna J. Cross
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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16
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Alosco ML, Su Y, Stein TD, Protas H, Cherry JD, Adler CH, Balcer LJ, Bernick C, Pulukuri SV, Abdolmohammadi B, Coleman MJ, Palmisano JN, Tripodis Y, Mez J, Rabinovici GD, Marek KL, Beach TG, Johnson KA, Huber BR, Koerte I, Lin AP, Bouix S, Cummings JL, Shenton ME, Reiman EM, McKee AC, Stern RA. Associations between near end-of-life flortaucipir PET and postmortem CTE-related tau neuropathology in six former American football players. Eur J Nucl Med Mol Imaging 2023; 50:435-452. [PMID: 36152064 PMCID: PMC9816291 DOI: 10.1007/s00259-022-05963-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Flourine-18-flortaucipir tau positron emission tomography (PET) was developed for the detection for Alzheimer's disease. Human imaging studies have begun to investigate its use in chronic traumatic encephalopathy (CTE). Flortaucipir-PET to autopsy correlation studies in CTE are needed for diagnostic validation. We examined the association between end-of-life flortaucipir PET and postmortem neuropathological measurements of CTE-related tau in six former American football players. METHODS Three former National Football League players and three former college football players who were part of the DIAGNOSE CTE Research Project died and agreed to have their brains donated. The six players had flortaucipir (tau) and florbetapir (amyloid) PET prior to death. All brains from the deceased participants were neuropathologically evaluated for the presence of CTE. On average, the participants were 59.0 (SD = 9.32) years of age at time of PET. PET scans were acquired 20.33 (SD = 13.08) months before their death. Using Spearman correlation analyses, we compared flortaucipir standard uptake value ratios (SUVRs) to digital slide-based AT8 phosphorylated tau (p-tau) density in a priori selected composite cortical, composite limbic, and thalamic regions-of-interest (ROIs). RESULTS Four brain donors had autopsy-confirmed CTE, all with high stage disease (n = 3 stage III, n = 1 stage IV). Three of these four met criteria for the clinical syndrome of CTE, known as traumatic encephalopathy syndrome (TES). Two did not have CTE at autopsy and one of these met criteria for TES. Concomitant pathology was only present in one of the non-CTE cases (Lewy body) and one of the CTE cases (motor neuron disease). There was a strong association between flortaucipir SUVRs and p-tau density in the composite cortical (ρ = 0.71) and limbic (ρ = 0.77) ROIs. Although there was a strong association in the thalamic ROI (ρ = 0.83), this is a region with known off-target binding. SUVRs were modest and CTE and non-CTE cases had overlapping SUVRs and discordant p-tau density for some regions. CONCLUSIONS Flortaucipir-PET could be useful for detecting high stage CTE neuropathology, but specificity to CTE p-tau is uncertain. Off-target flortaucipir binding in the hippocampus and thalamus complicates interpretation of these associations. In vivo biomarkers that can detect the specific p-tau of CTE across the disease continuum are needed.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yi Su
- Banner Alzheimer's Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Hillary Protas
- Banner Alzheimer's Institute, Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Surya Vamsi Pulukuri
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Departments of Neurology, Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
| | - Inga Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig Maximilians University, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilians University, Munich, Germany
- NICUM (NeuroImaging Core Unit Munich), Ludwig Maximilians University, Munich, Germany
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- VA Boston Healthcare System, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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17
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van Amerongen S, Caton DK, Ossenkoppele R, Barkhof F, Pouwels PJW, Teunissen CE, Rozemuller AJM, Hoozemans JJM, Pijnenburg YAL, Scheltens P, Vijverberg EGB. Rationale and design of the “NEurodegeneration: Traumatic brain injury as Origin of the Neuropathology (NEwTON)” study: a prospective cohort study of individuals at risk for chronic traumatic encephalopathy. Alzheimers Res Ther 2022; 14:119. [PMID: 36050790 PMCID: PMC9438060 DOI: 10.1186/s13195-022-01059-8] [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] [Received: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022]
Abstract
Background Repetitive head injury in contact sports is associated with cognitive, neurobehavioral, and motor impairments and linked to a unique neurodegenerative disorder: chronic traumatic encephalopathy (CTE). As the clinical presentation is variable, risk factors are heterogeneous, and diagnostic biomarkers are not yet established, the diagnostic process of CTE remains a challenge. The general objective of the NEwTON study is to establish a prospective cohort of individuals with high risk for CTE, to phenotype the study population, to identify potential fluid and neuroimaging biomarkers, and to measure clinical progression of the disease. The present paper explains the protocol and design of this case-finding study. Methods NEwTON is a prospective study that aims to recruit participants at risk for CTE, with features of the traumatic encephalopathy syndrome (exposed participants), and healthy unexposed control individuals. Subjects are invited to participate after diagnostic screening at our memory clinic or recruited by advertisement. Exposed participants receive a comprehensive baseline screening, including neurological examination, neuropsychological tests, questionnaires and brain MRI for anatomical imaging, diffusion tensor imaging (DTI), resting-state functional MRI (rsfMRI), and quantitative susceptibility mapping (QSM). Questionnaires include topics on life-time head injury, subjective cognitive change, and neuropsychiatric symptoms. Optionally, blood and cerebrospinal fluid are obtained for storage in the NEwTON biobank. Patients are informed about our brain donation program in collaboration with the Netherlands Brain Brank. Follow-up takes place annually and includes neuropsychological assessment, questionnaires, and optional blood draw. Testing of control subjects is limited to baseline neuropsychological tests, MRI scan, and also noncompulsory blood draw. Results To date, 27 exposed participants have finished their baseline assessments. First baseline results are expected in 2023. Conclusions The NEwTON study will assemble a unique cohort with prospective observational data of male and female individuals with high risk for CTE. This study is expected to be a primary explorative base and designed to share data with international CTE-related cohorts. Sub-studies may be added in the future with this cohort as backbone.
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18
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Asken BM, Tanner JA, VandeVrede L, Casaletto KB, Staffaroni AM, Mundada N, Fonseca C, Iaccarino L, La Joie R, Tsuei T, Mladinov M, Grant H, Shankar R, Wang KKW, Xu H, Cobigo Y, Rosen H, Gardner RC, Perry DC, Miller BL, Spina S, Seeley WW, Kramer JH, Grinberg LT, Rabinovici GD. Multi-Modal Biomarkers of Repetitive Head Impacts and Traumatic Encephalopathy Syndrome: A Clinicopathological Case Series. J Neurotrauma 2022; 39:1195-1213. [PMID: 35481808 PMCID: PMC9422800 DOI: 10.1089/neu.2022.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Traumatic encephalopathy syndrome (TES) criteria were developed to aid diagnosis of chronic traumatic encephalopathy (CTE) pathology during life. Interpreting clinical and biomarker findings in patients with TES during life necessitates autopsy-based determination of the neuropathological profile. We report a clinicopathological series of nine patients with previous repetitive head impacts (RHI) classified retrospectively using the recent TES research framework (100% male and white/Caucasian, age at death 49-84) who completed antemortem neuropsychological evaluations, T1-weighted magnetic resonance imaging, diffusion tensor imaging (n = 6), (18)F-fluorodeoxyglucose-positron emission tomography (n = 5), and plasma measurement of neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and total tau (n = 8). Autopsies were performed on all patients. Cognitively, low test scores and longitudinal decline were relatively consistent for memory and executive function. Medial temporal lobe atrophy was observed in all nine patients. Poor white matter integrity was consistently found in the fornix. Glucose hypometabolism was most common in the medial temporal lobe and thalamus. Most patients had elevated plasma GFAP, NfL, and total tau at their initial visit and a subset showed longitudinally increasing concentrations. Neuropathologically, five of the nine patients had CTE pathology (n = 4 "High CTE"/McKee Stage III-IV, n = 1 "Low CTE"/McKee Stage I). Primary neuropathological diagnoses (i.e., the disease considered most responsible for observed symptoms) were frontotemporal lobar degeneration (n = 2 FTLD-TDP, n = 1 FTLD-tau), Alzheimer disease (n = 3), CTE (n = 2), and primary age-related tauopathy (n = 1). In addition, hippocampal sclerosis was a common neuropathological comorbidity (n = 5) and associated with limbic-predominant TDP-43 proteinopathy (n = 4) or FTLD-TDP (n = 1). Memory and executive function decline, limbic system brain changes (atrophy, decreased white matter integrity, hypometabolism), and plasma biomarker alterations are common in RHI and TES but may reflect multiple neuropathologies. In particular, the neuropathological differential for patients with RHI or TES presenting with medial temporal atrophy and memory loss should include limbic TDP-43. Researchers and clinicians should be cautious in attributing cognitive, neuroimaging, or other biomarker changes solely to CTE tau pathology based on previous RHI or a TES diagnosis alone.
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Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy A. Tanner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Lawren VandeVrede
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Nidhi Mundada
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Corrina Fonseca
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Torie Tsuei
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Miho Mladinov
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Harli Grant
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Ranjani Shankar
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kevin K. W. Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, Neuroscience, Psychiatry and Chemistry, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Haiyan Xu
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, Neuroscience, Psychiatry and Chemistry, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Raquel C. Gardner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - David C. Perry
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Lea T. Grinberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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19
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Frontzkowski L, Ewers M, Brendel M, Biel D, Ossenkoppele R, Hager P, Steward A, Dewenter A, Römer S, Rubinski A, Buerger K, Janowitz D, Binette AP, Smith R, Strandberg O, Carlgren NM, Dichgans M, Hansson O, Franzmeier N. Earlier Alzheimer’s disease onset is associated with tau pathology in brain hub regions and facilitated tau spreading. Nat Commun 2022; 13:4899. [PMID: 35987901 PMCID: PMC9392750 DOI: 10.1038/s41467-022-32592-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/08/2022] [Indexed: 12/20/2022] Open
Abstract
AbstractIn Alzheimer’s disease (AD), younger symptom onset is associated with accelerated disease progression and tau spreading, yet the mechanisms underlying faster disease manifestation are unknown. To address this, we combined resting-state fMRI and longitudinal tau-PET in two independent samples of controls and biomarker-confirmed AD patients (ADNI/BioFINDER, n = 240/57). Consistent across both samples, we found that younger symptomatic AD patients showed stronger tau-PET in globally connected fronto-parietal hubs, i.e., regions that are critical for maintaining cognition in AD. Stronger tau-PET in hubs predicted faster subsequent tau accumulation, suggesting that tau in globally connected regions facilitates connectivity-mediated tau spreading. Further, stronger tau-PET in hubs mediated the association between younger age and faster tau accumulation in symptomatic AD patients, which predicted faster cognitive decline. These independently validated findings suggest that younger AD symptom onset is associated with stronger tau pathology in brain hubs, and accelerated tau spreading throughout connected brain regions and cognitive decline.
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20
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Asken BM, Tanner JA, VandeVrede L, Mantyh WG, Casaletto KB, Staffaroni AM, La Joie R, Iaccarino L, Soleimani-Meigooni D, Rojas JC, Gardner RC, Miller BL, Grinberg LT, Boxer AL, Kramer JH, Rabinovici GD. Plasma P-tau181 and P-tau217 in Patients With Traumatic Encephalopathy Syndrome With and Without Evidence of Alzheimer Disease Pathology. Neurology 2022; 99:e594-e604. [PMID: 35577574 PMCID: PMC9442622 DOI: 10.1212/wnl.0000000000200678] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/18/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic encephalopathy syndrome (TES) has overlapping clinical symptoms with Alzheimer disease (AD). AD pathology commonly co-occurs with chronic traumatic encephalopathy (CTE) pathology. There are currently no validated CTE biomarkers. AD-specific biomarkers such as plasma P-tau181 and P-tau217 may help to identify patients with TES who have AD pathology. METHODS We measured plasma P-tau181 and P-tau217 (Meso Scale Discovery electrochemiluminescence) in patients with TES, mild cognitive impairment/dementia with biomarker-confirmed AD ("AD"), and healthy controls ("HC"). Patients underwent amyloid-beta (Aβ)-PET and a subset underwent tau-PET using [18F]Flortaucipir. We compared plasma P-tau levels controlling for age and sex and also performed AUC analyses to evaluate the accuracy of group differentiation. In patients with TES, we evaluated associations between plasma P-tau, years of repetitive head impact exposure, and tau-PET. Four TES patients with autopsy-confirmed CTE were described qualitatively. RESULTS The sample included 131 participants (TES, N = 18; AD, N = 65; HC, N = 48). Aβ(+) patients with TES (N = 10), but not Aβ(-) TES, had significantly higher plasma P-tau levels than HC (P-tau181: p < 0.001, d = 1.34; P-tau217: p < 0.001, d = 1.59). There was a trend for Aβ(+) TES having higher plasma P-tau than Aβ(-) TES (P-tau181: p = 0.06, d = 1.06; P-tau217: p = 0.09, d = 0.93). AUC analyses showed good classification of Aβ(+) TES from HC for P-tau181 (AUC = 0.87 [0.71-1.00]) and P-tau217 (AUC = 0.93 [0.86-1.00]). Plasma P-tau217 showed fair differentiation of Aβ(+) TES from Aβ(-) TES (AUC = 0.79 [0.54-1.00], p = 0.04), whereas classification accuracy of P-tau181 was slightly lower and not statistically significant (AUC = 0.71 [0.46-0.96], p = 0.13). Patients with AD had higher tau-PET tracer uptake than Aβ(+) TES and were well differentiated using P-tau181 (AUC = 0.81 [0.68-0.94]) and P-tau217 (AUC = 0.86 [0.73-0.98]). Plasma P-tau correlated with the tau-PET signal in Aβ(+) TES but not in Aβ(-) TES, and there was no association between plasma P-tau and years of repetitive head impact exposure. TES patients with severe CTE and no AD at autopsy had low P-tau181 and P-tau217 levels. DISCUSSION Measuring P-tau181 and P-tau217 in plasma may be a feasible and scalable fluid biomarker for identifying AD pathology in TES. Low plasma P-tau levels may be used to increase clinical suspicion of CTE over AD as a primary pathology in TES. Currently, there is no support for P-tau181 or P-tau217 as in vivo biomarkers of CTE tau. Larger studies of patients with pathologically confirmed CTE are needed. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that (1) among patients with TES and abnormal Aβ-PET scans, elevated plasma P-tau can differentiate between affected individuals and HCs; (2) low plasma P-tau may help identify patients with TES who do not have Alzheimer; and (3) plasma P-tau181 and P-tau217 are not useful biomarkers of patients with TES who do not have AD.
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Affiliation(s)
- Breton M Asken
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco.
| | - Jeremy A Tanner
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Lawren VandeVrede
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - William G Mantyh
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Kaitlin B Casaletto
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Adam M Staffaroni
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Renaud La Joie
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Leonardo Iaccarino
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - David Soleimani-Meigooni
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Julio C Rojas
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Raquel C Gardner
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Bruce L Miller
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Lea T Grinberg
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Adam L Boxer
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Joel H Kramer
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Gil D Rabinovici
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
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21
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Pavel DG, Henderson TA, DeBruin S, Cohen PF. The Legacy of the TTASAAN Report - Premature Conclusions and Forgotten Promises About SPECT Neuroimaging: A Review of Policy and Practice Part II. Front Neurol 2022; 13:851609. [PMID: 35655621 PMCID: PMC9152128 DOI: 10.3389/fneur.2022.851609] [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: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970s. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was not stabilized until 1993 and most early SPECT scans were performed on single-head gamma cameras. These early scans were of inferior quality. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. This two-part series explores the policies and procedures related to perfusion SPECT functional neuroimaging. In Part I, the comparison between the quality of the SPECT scans and the depth of the data for key neurological and psychiatric indications at the time of the TTASAAN report vs. the intervening 25 years were presented. In Part II, the technical aspects of perfusion SPECT neuroimaging and image processing will be explored. The role of color scales will be reviewed and the process of interpreting a SPECT scan will be presented. Interpretation of a functional brain scans requires not only anatomical knowledge, but also technical understanding on correctly performing a scan, regardless of the scanning modality. Awareness of technical limitations allows the clinician to properly interpret a functional brain scan. With this foundation, four scenarios in which perfusion SPECT neuroimaging, together with other imaging modalities and testing, lead to a narrowing of the differential diagnoses and better treatment. Lastly, recommendations for the revision of current policies and practices are made.
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Affiliation(s)
- Dan G Pavel
- PathFinder Brain SPECT, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,Neuro-Laser Foundation, Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Baltimore, MD, United States
| | - Philip F Cohen
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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22
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Abstract
PURPOSE OF REVIEW This article reviews tau PET imaging with an emphasis on first-generation and second-generation tau radiotracers and their application in neurodegenerative disorders, including Alzheimer's disease and non-Alzheimer's disease tauopathies. RECENT FINDINGS Tau is a critical protein, abundant in neurons within the central nervous system, which plays an important role in maintaining microtubules by binding to tubulin in axons. In its abnormal hyperphosphorylated form, accumulation of tau has been linked to a variety of neurodegenerative disorders, collectively referred to as tauopathies, which include Alzheimer's disease and non-Alzheimer's disease tauopathies [e.g., corticobasal degeneration (CBD), argyrophilic grain disease, progressive supranuclear palsy (PSP), and Pick's disease]. A number of first-generation and second-generation tau PET radiotracers have been developed, including the first FDA-approved agent [18F]-flortaucipir, which allow for in-vivo molecular imaging of underlying histopathology antemortem, ultimately guiding disease staging and development of disease-modifying therapeutics. SUMMARY Tau PET is an emerging imaging modality in the diagnosis and staging of tauopathies.
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Affiliation(s)
| | - Michelle Roytman
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical College, New York
| | - Gloria C. Chiang
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical College, New York
| | - Yi Li
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical College, New York
| | - Marc L. Gordon
- Departments of Neurology and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Litwin-Zucker Research Center, Feinstein Institutes for Medical Research, Manhasset
| | - Ana M. Franceschi
- Neuroradiology Division, Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, USA
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23
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Mavroudis I, Kazis D, Chowdhury R, Petridis F, Costa V, Balmus IM, Ciobica A, Luca AC, Radu I, Dobrin RP, Baloyannis S. Post-Concussion Syndrome and Chronic Traumatic Encephalopathy: Narrative Review on the Neuropathology, Neuroimaging and Fluid Biomarkers. Diagnostics (Basel) 2022; 12:diagnostics12030740. [PMID: 35328293 PMCID: PMC8947595 DOI: 10.3390/diagnostics12030740] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury is a significant public health issue and represents the main contributor to death and disability globally among all trauma-related injuries. Martial arts practitioners, military veterans, athletes, victims of physical abuse, and epileptic patients could be affected by the consequences of repetitive mild head injuries (RMHI) that do not resume only to short-termed traumatic brain injuries (TBI) effects but also to more complex and time-extended outcomes, such as post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). These effects in later life are not yet well understood; however, recent studies suggested that even mild head injuries can lead to an elevated risk of later-life cognitive impairment and neurodegenerative disease. While most of the PCS hallmarks consist in immediate consequences and only in some conditions in long-termed processes undergoing neurodegeneration and impaired brain functions, the neuropathological hallmark of CTE is the deposition of p-tau immunoreactive pre-tangles and thread-like neurites at the depths of cerebral sulci and neurofibrillary tangles in the superficial layers I and II which are also one of the main hallmarks of neurodegeneration. Despite different CTE diagnostic criteria in clinical and research approaches, their specificity and sensitivity remain unclear and CTE could only be diagnosed post-mortem. In CTE, case risk factors include RMHI exposure due to profession (athletes, military personnel), history of trauma (abuse), or pathologies (epilepsy). Numerous studies aimed to identify imaging and fluid biomarkers that could assist diagnosis and probably lead to early intervention, despite their heterogeneous outcomes. Still, the true challenge remains the prediction of neurodegeneration risk following TBI, thus in PCS and CTE. Further studies in high-risk populations are required to establish specific, preferably non-invasive diagnostic biomarkers for CTE, considering the aim of preventive medicine.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK; (I.M.); (R.C.)
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
- Research Institute for Alzheimer’s Disease and Neurodegenerative Diseases, Heraklion Langada, 57200 Thessaloniki, Greece
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (D.K.); (F.P.)
| | - Rumana Chowdhury
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK; (I.M.); (R.C.)
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (D.K.); (F.P.)
| | - Vasiliki Costa
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, “Alexandru Ioan Cuza” University of Iași, 700057 Iași, Romania;
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700506 Iași, Romania
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Alina-Costina Luca
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Iulian Radu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Romeo Petru Dobrin
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Stavros Baloyannis
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
- Research Institute for Alzheimer’s Disease and Neurodegenerative Diseases, Heraklion Langada, 57200 Thessaloniki, Greece
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24
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Stormezand GN, Doorduin J, Rakers SE, Spikman JM, van der Naalt J, García DV, van der Hoorn A, van der Weijden CWJ, Kremer BPH, Renken RJ, Dierckx RAJO. Imaging of neuroinflammation due to repetitive head injury in currently active kickboxers. Eur J Nucl Med Mol Imaging 2022; 49:3162-3172. [PMID: 35165788 PMCID: PMC9250484 DOI: 10.1007/s00259-022-05715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022]
Abstract
Purpose Chronic traumatic encephalopathy refers to a neurodegenerative disease resulting from repetitive head injury of participants in contact sports. Similar to other neurodegenerative diseases, neuroinflammation is thought to play a role in the onset and progression of the disease. Limited knowledge is available regarding the neuroinflammatory consequences of repetitive head injury in currently active contact sports athletes. PET imaging of the 18-kDa translocator protein (TSPO) allows quantification of microglial activation in vivo, a marker of neuroinflammation. Methods Eleven rank A kickboxers and 11 age-matched controls underwent TSPO PET using [11C]-PK11195, anatomical MRI, diffusion tensor imaging, and neuropsychological testing. Relevant imaging parameters were derived and correlated with the outcomes of the neuropsychological testing. Results On a group level, no statistically significant differences were detected in non-displaceable binding potential (BPND) using PET. Individually, 3 kickboxers showed increased BPNDs in widespread regions of the brain without a correlation with other modalities. Increased FA was observed in the superior corona radiata bilaterally. DTI parameters in other regions did not differ between groups. Conclusion Despite negative results on a group level, individual results suggest that neuroinflammation may be present as a consequence of repetitive head injury in active kickboxers. Future studies using a longitudinal design may determine whether the observed TSPO upregulation is related to the future development of neuropsychiatric symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05715-x.
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Affiliation(s)
- Gilles N Stormezand
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Sandra E Rakers
- Department of Clinical Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Clinical Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chris W J van der Weijden
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Berry P H Kremer
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remco J Renken
- Cognitive Neuroscience Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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25
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Filippi L, Schillaci O, Palumbo B. Neuroimaging with PET/CT in chronic traumatic encephalopathy: what nuclear medicine can do to move the field forward. Expert Rev Mol Diagn 2022; 22:149-156. [PMID: 35086415 DOI: 10.1080/14737159.2022.2035723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome, caused by single or repeated traumatic brain injuries. Since a few years ago, post mortem examination represented the only effective method to diagnose CTE through the detection of its peculiar neuropathological features (i.e. tau protein aggregates) at a macroscopic and microscopic level. Several efforts have been made to develop radiopharmaceuticals characterized by high affinity for tau aggregates, suitable for imaging through Positron Emission Computed Tomography (Tau-PET). AREAS COVERED : The various radiopharmaceuticals utilized for the molecular imaging of CTE through Tau-PET are covered, with specific reference to their applications in clinical practice. Furthermore, PET probes binding to the translocator protein (TSPO), a marker of brain injury and repair, are reviewed as potential tools for the imaging of neuroinflammatory cascade associated with CTE. EXPERT OPINION molecular neuroimaging of CTE with Tau-PET is an intriguing, although still not completely explored, tool for the in vivo detection and monitoring of neuropathological hallmarks associated with CTE. Furthermore, some novel tracers, such as TSPO-ligands, hold the promise to get an insight into the complex physiopathological mechanisms leading from brain injury to symptomatic CTE.
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Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Via Canova 3, 04100 Latina, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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26
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Huang CX, Li YH, Lu W, Huang SH, Li MJ, Xiao LZ, Liu J. Positron emission tomography imaging for the assessment of mild traumatic brain injury and chronic traumatic encephalopathy: recent advances in radiotracers. Neural Regen Res 2022; 17:74-81. [PMID: 34100430 PMCID: PMC8451552 DOI: 10.4103/1673-5374.314285] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A chronic phase following repetitive mild traumatic brain injury can present as chronic traumatic encephalopathy in some cases, which requires a neuropathological examination to make a definitive diagnosis. Positron emission tomography (PET) is a molecular imaging modality that has high sensitivity for detecting even very small molecular changes, and can be used to quantitatively measure a range of molecular biological processes in the brain using different radioactive tracers. Functional changes have also been reported in patients with different forms of traumatic brain injury, especially mild traumatic brain injury and subsequent chronic traumatic encephalopathy. Thus, PET provides a novel approach for the further evaluation of mild traumatic brain injury at molecular levels. In this review, we discuss the recent advances in PET imaging with different radiotracers, including radioligands for PET imaging of glucose metabolism, tau, amyloid-beta, γ-aminobutyric acid type A receptors, and neuroinflammation, in the identification of altered neurological function. These novel radiolabeled ligands are likely to have widespread clinical application, and may be helpful for the treatment of mild traumatic brain injury. Moreover, PET functional imaging with different ligands can be used in the future to perform large-scale and sequential studies exploring the time-dependent changes that occur in mild traumatic brain injury.
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Affiliation(s)
- Chu-Xin Huang
- Department of Radiology; Department of Neurology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yan-Hui Li
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wei Lu
- Department of Neurology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Si-Hong Huang
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Meng-Jun Li
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Li-Zhi Xiao
- PET-CT Center, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jun Liu
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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27
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Alosco ML, Mian AZ, Buch K, Farris CW, Uretsky M, Tripodis Y, Baucom Z, Martin B, Palmisano J, Puzo C, Ang TFA, Joshi P, Goldstein LE, Au R, Katz DI, Dwyer B, Daneshvar DH, Nowinski C, Cantu RC, Kowall NW, Huber BR, Alvarez VE, Stern RA, Stein TD, Killiany RJ, McKee AC, Mez J. Structural MRI profiles and tau correlates of atrophy in autopsy-confirmed CTE. Alzheimers Res Ther 2021; 13:193. [PMID: 34876229 PMCID: PMC8653514 DOI: 10.1186/s13195-021-00928-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE), a neurodegenerative tauopathy, cannot currently be diagnosed during life. Atrophy patterns on magnetic resonance imaging could be an effective in vivo biomarker of CTE, but have not been characterized. Mechanisms of neurodegeneration in CTE are unknown. Here, we characterized macrostructural magnetic resonance imaging features of brain donors with autopsy-confirmed CTE. The association between hyperphosphorylated tau (p-tau) and atrophy on magnetic resonance imaging was examined. METHODS Magnetic resonance imaging scans were obtained by medical record requests for 55 deceased symptomatic men with autopsy-confirmed CTE and 31 men (n = 11 deceased) with normal cognition at the time of the scan, all >60 years Three neuroradiologists visually rated regional atrophy and microvascular disease (0 [none]-4 [severe]), microbleeds, and cavum septum pellucidum presence. Neuropathologists rated tau severity and atrophy at autopsy using semi-quantitative scales. RESULTS Compared to unimpaired males, donors with CTE (45/55=stage III/IV) had greater atrophy of the orbital-frontal (mean diff.=1.29), dorsolateral frontal (mean diff.=1.31), superior frontal (mean diff.=1.05), anterior temporal (mean diff.=1.57), and medial temporal lobes (mean diff.=1.60), and larger lateral (mean diff.=1.72) and third (mean diff.=0.80) ventricles, controlling for age at scan (ps<0.05). There were no effects for posterior atrophy or microvascular disease. Donors with CTE had increased odds of a cavum septum pellucidum (OR = 6.7, p < 0.05). Among donors with CTE, greater tau severity across 14 regions corresponded to greater atrophy on magnetic resonance imaging (beta = 0.68, p < 0.01). CONCLUSIONS These findings support frontal-temporal atrophy as a magnetic resonance imaging finding of CTE and show p-tau accumulation is associated with atrophy in CTE.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, Boston, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Chad W Farris
- Department of Radiology, Boston University School of Medicine, Boston, USA
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Zachary Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Christian Puzo
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Prajakta Joshi
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Radiology, Boston University School of Medicine, Boston, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Douglas I Katz
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | | | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, USA
- Department of Neurosurgery, Emerson Hospital, Concord, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- National Center for PTSD, VA Boston Healthcare, Boston, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Ronald J Killiany
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA
- Center for Biomedical Imaging, Boston University School of Medicine, Boston, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA.
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA.
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28
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Morgan R, Prosapio J, Kara S, Sonty S, Youssef P, Nedd K. Preliminary clinical diagnostic criteria for chronic traumatic encephalopathy: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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de Souza GS, Andrade MA, Borelli WV, Schilling LP, Matushita CS, Portuguez MW, da Costa JC, Marques da Silva AM. Amyloid-β PET Classification on Cognitive Aging Stages Using the Centiloid Scale. Mol Imaging Biol 2021; 24:394-403. [PMID: 34611766 DOI: 10.1007/s11307-021-01660-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
PROPOSE This study aims to explore the use of the Centiloid (CL) method in amyloid-β PET quantification to evaluate distinct cognitive aging stages, investigating subjects' mismatch classification using different cut-points for amyloid-β positivity. PROCEDURES The CL equation was applied in four groups of individuals: SuperAgers (SA), healthy age-matched controls (AC), healthy middle-aged controls (MC), and Alzheimer's disease (AD). The amyloid-β burden was calculated and compared between groups and quantitative variables. Three different cut-points (Jack CR, Wiste HJ, Weigand SD, et al., Alzheimer's Dement 13:205-216, 2017; Salvadó G, Molinuevo JL, Brugulat-Serrat A, et al., Alzheimer's Res Ther 11:27, 2019; and Amadoru S, Doré V, McLean CA, et al., Alzheimer's Res Ther 12:22, 2020) were applied in CL values to differentiate the earliest abnormal pathophysiological accumulation of Aβ and the established Aβ pathology. RESULTS The AD group exhibited a significantly increased Aβ burden compared to the MC, but not AC groups. Both healthy control (MC and AC) groups were not significantly different. Visually, the SA group showed a diverse distribution of CL values compared with MC; however, the difference was not significant. The CL values have a moderate and significant relationship between Aβ visual read, RAVLT DR and MMSE. Depending on the cut-point used, 10 CL, 19 CL, or 30 CL, 7.5% of our individuals had a different classification in the Aβ positivity. For the AC group, we obtained about 40 to 60% of the individuals classified as positive. CONCLUSION SuperAgers exhibited a similar Aβ load to AC and MC, differing in cognitive performance. Independently of cut-point used (10 CL, 19 CL, or 30 CL), three SA individuals were classified as Aβ positive, showing the duality between the individual's clinics and the biological definition of Alzheimer's. Different cut-points lead to Aβ positivity classification mismatch in individuals, and an extra care is needed for individuals who have a CL value between 10 and 30 CL.
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Affiliation(s)
- Giordana Salvi de Souza
- School of Medicine, PUCRS, Porto Alegre, Brazil.
- Medical Image Computing Laboratory, School of Technology, PUCRS, Porto Alegre, Brazil.
| | - Michele Alberton Andrade
- School of Medicine, PUCRS, Porto Alegre, Brazil
- Medical Image Computing Laboratory, School of Technology, PUCRS, Porto Alegre, Brazil
- Brain Institute of Rio Grande Do Sul (BraIns), PUCRS, Porto Alegre, Brazil
| | | | | | | | - Mirna Wetters Portuguez
- School of Medicine, PUCRS, Porto Alegre, Brazil
- Brain Institute of Rio Grande Do Sul (BraIns), PUCRS, Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- School of Medicine, PUCRS, Porto Alegre, Brazil
- Brain Institute of Rio Grande Do Sul (BraIns), PUCRS, Porto Alegre, Brazil
| | - Ana Maria Marques da Silva
- School of Medicine, PUCRS, Porto Alegre, Brazil
- Medical Image Computing Laboratory, School of Technology, PUCRS, Porto Alegre, Brazil
- Brain Institute of Rio Grande Do Sul (BraIns), PUCRS, Porto Alegre, Brazil
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Risacher SL, West JD, Deardorff R, Gao S, Farlow MR, Brosch JR, Apostolova LG, McAllister TW, Wu Y, Jagust WJ, Landau SM, Weiner MW, Saykin AJ. Head injury is associated with tau deposition on PET in MCI and AD patients. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12230. [PMID: 34466653 PMCID: PMC8383323 DOI: 10.1002/dad2.12230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Head injuries (HI) are a risk factor for dementia, but the underlying etiology is not fully known. Understanding whether tau might mediate this relationship is important. METHODS Cognition and tau deposition were compared between 752 individuals with (impaired, n = 302) or without cognitive impairment (CN, n = 450) with amyloid and [18F]flortaucipir positron emission tomography, HI history information, and cognitive testing from the Alzheimer's Disease Neuroimaging Initiative and the Indiana Memory and Aging Study. RESULTS Sixty-three (38 CN, 25 impaired) reported a history of HI. Higher neuropsychiatric scores and poorer memory were observed in those with a history of HI. Tau was higher in individuals with a history of HI, especially those who experienced a loss of consciousness (LOC). Results were driven by impaired individuals, especially amyloid beta-positive individuals with history of HI with LOC. DISCUSSION These findings suggest biological changes, such as greater tau, are associated with HI in individuals with cognitive impairment. Small effect sizes were observed; thus, further studies should replicate and extend these results.
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Affiliation(s)
- Shannon L. Risacher
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - John D. West
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - Rachael Deardorff
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sujuan Gao
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of BiostatisticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Martin R. Farlow
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jared R. Brosch
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Liana G. Apostolova
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Thomas W. McAllister
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Yu‐Chien Wu
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - William J. Jagust
- Helen Wills Neuroscience InstituteUniversity of California, BerkeleyBerkeleyCaliforniaUSA
- Lawrence Berkeley National LaboratoryBerkeleyCaliforniaUSA
| | - Susan M. Landau
- Helen Wills Neuroscience InstituteUniversity of California, BerkeleyBerkeleyCaliforniaUSA
- Lawrence Berkeley National LaboratoryBerkeleyCaliforniaUSA
| | - Michael W. Weiner
- Departments of RadiologyMedicine and PsychiatryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterSan FranciscoCaliforniaUSA
| | - Andrew J. Saykin
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
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Alosco ML, Mariani ML, Adler CH, Balcer LJ, Bernick C, Au R, Banks SJ, Barr WB, Bouix S, Cantu RC, Coleman MJ, Dodick DW, Farrer LA, Geda YE, Katz DI, Koerte IK, Kowall NW, Lin AP, Marcus DS, Marek KL, McClean MD, McKee AC, Mez J, Palmisano JN, Peskind ER, Tripodis Y, Turner RW, Wethe JV, Cummings JL, Reiman EM, Shenton ME, Stern RA. Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project. Alzheimers Res Ther 2021; 13:136. [PMID: 34384490 PMCID: PMC8357968 DOI: 10.1186/s13195-021-00872-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the "Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project." The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine and validate clinical research diagnostic criteria (i.e., traumatic encephalopathy syndrome [TES]); examine repetitive head impact exposure, genetic, and other risk factors; and provide shared resources of anonymized data and biological samples to the research community. In this paper, we provide a detailed overview of the rationale, design, and methods for the DIAGNOSE CTE Research Project. METHODS The targeted sample and sample size was 240 male participants, ages 45-74, including 120 former professional football players, 60 former collegiate football players, and 60 asymptomatic participants without a history of head trauma or participation in organized contact sports. Participants were evaluated at one of four U.S. sites and underwent the following baseline procedures: neurological and neuropsychological examinations; tau and amyloid positron emission tomography; magnetic resonance imaging and spectroscopy; lumbar puncture; blood and saliva collection; and standardized self-report measures of neuropsychiatric, cognitive, and daily functioning. Study partners completed similar informant-report measures. Follow-up evaluations were intended to be in-person and at 3 years post-baseline. Multidisciplinary diagnostic consensus conferences are held, and the reliability and validity of TES diagnostic criteria are examined. RESULTS Participant enrollment and all baseline evaluations were completed in February 2020. Three-year follow-up evaluations began in October 2019. However, in-person evaluation ceased with the COVID-19 pandemic, and resumed as remote, 4-year follow-up evaluations (including telephone-, online-, and videoconference-based cognitive, neuropsychiatric, and neurologic examinations, as well as in-home blood draw) in February 2021. CONCLUSIONS Findings from the DIAGNOSE CTE Research Project should facilitate detection and diagnosis of CTE during life, and thereby accelerate research on risk factors, mechanisms, epidemiology, treatment, and prevention of CTE. TRIAL REGISTRATION NCT02798185.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Megan L Mariani
- Boston University CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Framingham Heart Study, and Slone Epidemiology Center, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sarah J Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA, USA
| | - William B Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Lindsay A Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Epidemiology, and Biostatistics, BU Schools of Medicine and Public Health, Boston, MA, USA
| | - Yonas E Geda
- Alzheimer's Disease and Memory Disorders Program, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Framingham Heart Study, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elaine R Peskind
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Robert W Turner
- Department of Clinical Research & Leadership, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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Asken BM, Rabinovici GD. Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review. Acta Neuropathol Commun 2021; 9:96. [PMID: 34022959 PMCID: PMC8141132 DOI: 10.1186/s40478-021-01197-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND SCOPE OF REVIEW Varying severities and frequencies of head trauma may result in dynamic acute and chronic pathophysiologic responses in the brain. Heightened attention to long-term effects of head trauma, particularly repetitive head trauma, has sparked recent efforts to identify neuroimaging biomarkers of underlying disease processes. Imaging modalities like structural magnetic resonance imaging (MRI) and positron emission tomography (PET) are the most clinically applicable given their use in neurodegenerative disease diagnosis and differentiation. In recent years, researchers have targeted repetitive head trauma cohorts in hopes of identifying in vivo biomarkers for underlying biologic changes that might ultimately improve diagnosis of chronic traumatic encephalopathy (CTE) in living persons. These populations most often include collision sport athletes (e.g., American football, boxing) and military veterans with repetitive low-level blast exposure. We provide a clinically-oriented review of neuroimaging data from repetitive head trauma cohorts based on structural MRI, FDG-PET, Aβ-PET, and tau-PET. We supplement the review with two patient reports of neuropathology-confirmed, clinically impaired adults with prior repetitive head trauma who underwent structural MRI, FDG-PET, Aβ-PET, and tau-PET in addition to comprehensive clinical examinations before death. REVIEW CONCLUSIONS Group-level comparisons to controls without known head trauma have revealed inconsistent regional volume differences, with possible propensity for medial temporal, limbic, and subcortical (thalamus, corpus callosum) structures. Greater frequency and severity (i.e., length) of cavum septum pellucidum (CSP) is observed in repetitive head trauma cohorts compared to unexposed controls. It remains unclear whether CSP predicts a particular neurodegenerative process, but CSP presence should increase suspicion that clinical impairment is at least partly attributable to the individual's head trauma exposure (regardless of underlying disease). PET imaging similarly has not revealed a prototypical metabolic or molecular pattern associated with repetitive head trauma or predictive of CTE based on the most widely studied radiotracers. Given the range of clinical syndromes and neurodegenerative pathologies observed in a subset of adults with prior repetitive head trauma, structural MRI and PET imaging may still be useful for differential diagnosis (e.g., assessing suspected Alzheimer's disease).
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Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
| | - Gil D. Rabinovici
- Departments of Neurology, Radiology & Biomedical Imaging, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
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Alosco ML, Culhane J, Mez J. Neuroimaging Biomarkers of Chronic Traumatic Encephalopathy: Targets for the Academic Memory Disorders Clinic. Neurotherapeutics 2021; 18:772-791. [PMID: 33847906 PMCID: PMC8423967 DOI: 10.1007/s13311-021-01028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts, such as those from contact sports. The pathognomonic lesion for CTE is the perivascular accumulation of hyper-phosphorylated tau in neurons and other cell process at the depths of sulci. CTE cannot be diagnosed during life at this time, limiting research on risk factors, mechanisms, epidemiology, and treatment. There is an urgent need for in vivo biomarkers that can accurately detect CTE and differentiate it from other neurological disorders. Neuroimaging is an integral component of the clinical evaluation of neurodegenerative diseases and will likely aid in diagnosing CTE during life. In this qualitative review, we present the current evidence on neuroimaging biomarkers for CTE with a focus on molecular, structural, and functional modalities routinely used as part of a dementia evaluation. Supporting imaging-pathological correlation studies are also presented. We targeted neuroimaging studies of living participants at high risk for CTE (e.g., aging former elite American football players, fighters). We conclude that an optimal tau PET radiotracer with high affinity for the 3R/4R neurofibrillary tangles in CTE has not yet been identified. Amyloid PET scans have tended to be negative. Converging structural and functional imaging evidence together with neuropathological evidence show frontotemporal and medial temporal lobe neurodegeneration, and increased likelihood for a cavum septum pellucidum. The literature offers promising neuroimaging biomarker targets of CTE, but it is limited by cross-sectional studies of small samples where the presence of underlying CTE is unknown. Imaging-pathological correlation studies will be important for the development and validation of neuroimaging biomarkers of CTE.
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Affiliation(s)
- Michael L Alosco
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA.
| | - Julia Culhane
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA
| | - Jesse Mez
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA
- Framingham Heart Study, Boston University School of Medicine, MA, Boston, USA
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Gaetz M. Understanding Post-Career adjustment in Ex-Professional Ice Hockey Enforcers: Concussion history and chronic pain. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1876321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Michael Gaetz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, Canada
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Jie CVML, Treyer V, Schibli R, Mu L. Tauvid™: The First FDA-Approved PET Tracer for Imaging Tau Pathology in Alzheimer's Disease. Pharmaceuticals (Basel) 2021; 14:ph14020110. [PMID: 33573211 PMCID: PMC7911942 DOI: 10.3390/ph14020110] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/03/2022] Open
Abstract
Tauvid has been approved by the U.S. Food and Drug Administration (FDA) in 2020 for positron emission tomography (PET) imaging of adult patients with cognitive impairments undergoing evaluation for Alzheimer’s disease (AD) based on tau pathology. Abnormal aggregation of tau proteins is one of the main pathologies present in AD and is receiving increasing attention as a diagnostic and therapeutic target. In this review, we summarised the production and quality control of Tauvid, its clinical application, pharmacology and pharmacokinetics, as well as its limitation due to off-target binding. Moreover, a brief overview on the second-generation of Tau PET tracers is provided. The approval of Tauvid marks a step forward in the field of AD research and opens up opportunities for second-generation tau tracers to advance tau PET imaging in the clinic.
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Affiliation(s)
- Caitlin V. M. L. Jie
- Center for Radiopharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zürich, 8093 Zurich, Switzerland; (C.V.M.L.J.); (R.S.)
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zürich, 8093 Zurich, Switzerland; (C.V.M.L.J.); (R.S.)
| | - Linjing Mu
- Center for Radiopharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zürich, 8093 Zurich, Switzerland; (C.V.M.L.J.); (R.S.)
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
- Correspondence:
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Krishnadas N, Doré V, Lamb F, Groot C, McCrory P, Guzman R, Mulligan R, Huang K, O'Donnell M, Ponsford J, Hopwood M, Villemagne VL, Rowe CC. Case Report: 18F-MK6240 Tau Positron Emission Tomography Pattern Resembling Chronic Traumatic Encephalopathy in a Retired Australian Rules Football Player. Front Neurol 2020; 11:598980. [PMID: 33414760 PMCID: PMC7783156 DOI: 10.3389/fneur.2020.598980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: It remains unclear if tau imaging may assist diagnosis of chronic traumatic encephalopathy (CTE). Flortaucipir PET has shown superior frontal with medial temporal tau binding consistent with the provisional neuropathological criteria for mid-stage CTE in group-level analyses of retired symptomatic NFL players and in one individual with pathologically confirmed CTE. 18F-MK6240 is a new PET ligand that has high affinity for tau. We present the case of a 63-year-old cognitively impaired, former Australian rules football player with distinct superior frontal and medial temporal 18F-MK6240 binding and show it to be significantly different to the pattern seen in prodromal Alzheimer's disease (AD). Findings: The participant was recruited for a study of amyloid-β and tau several decades after traumatic brain injury. He had multiple concussions during his football career but no cognitive complaints at retirement. A thalamic stroke in his mid 50s left stable mild cognitive deficits but family members reported further short-term memory, behavioral, and personality decline preceding the study. Imaging showed extensive small vessel disease on MRI, a moderate burden of amyloid-β plaques, and 18F-MK6240 binding in bilateral superior frontal and medial temporal cortices. Voxel-wise analysis demonstrated that the frontally predominant pattern of the participant was significantly different to the posterior temporo-parietal predominant pattern of prodromal AD. Conclusion: Although lacking neuropathological examination to distinguish CTE from a variant of AD, the clear demonstration of a CTE-like tau pattern in a single at-risk individual suggests further research on the potential of 18F-MK6240 PET for identifying CTE is warranted.
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Affiliation(s)
- Natasha Krishnadas
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Vincent Doré
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia.,The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Parkville, VIC, Australia
| | - Fiona Lamb
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Colin Groot
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Rodney Guzman
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Rachel Mulligan
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Kun Huang
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Meaghan O'Donnell
- Phoenix Australia, Parkville, VIC, Australia.,The Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Centre, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Malcolm Hopwood
- The Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Victor L Villemagne
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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Soleimani-Meigooni DN, Iaccarino L, La Joie R, Baker S, Bourakova V, Boxer AL, Edwards L, Eser R, Gorno-Tempini ML, Jagust WJ, Janabi M, Kramer JH, Lesman-Segev OH, Mellinger T, Miller BL, Pham J, Rosen HJ, Spina S, Seeley WW, Strom A, Grinberg LT, Rabinovici GD. 18F-flortaucipir PET to autopsy comparisons in Alzheimer's disease and other neurodegenerative diseases. Brain 2020; 143:3477-3494. [PMID: 33141172 PMCID: PMC7719031 DOI: 10.1093/brain/awaa276] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022] Open
Abstract
Few studies have evaluated the relationship between in vivo18F-flortaucipir PET and post-mortem pathology. We sought to compare antemortem 18F-flortaucipir PET to neuropathology in a consecutive series of patients with a broad spectrum of neurodegenerative conditions. Twenty patients were included [mean age at PET 61 years (range 34-76); eight female; median PET-to-autopsy interval of 30 months (range 4-59 months)]. Eight patients had primary Alzheimer's disease pathology, nine had non-Alzheimer tauopathies (progressive supranuclear palsy, corticobasal degeneration, argyrophilic grain disease, and frontotemporal lobar degeneration with MAPT mutations), and three had non-tau frontotemporal lobar degeneration. Using an inferior cerebellar grey matter reference, 80-100-min 18F-flortaucipir PET standardized uptake value ratio (SUVR) images were created. Mean SUVRs were calculated for progressive supranuclear palsy, corticobasal degeneration, and neurofibrillary tangle Braak stage regions of interest, and these values were compared to SUVRs derived from young, non-autopsy, cognitively normal controls used as a standard for tau negativity. W-score maps were generated to highlight areas of increased tracer retention compared to cognitively normal controls, adjusting for age as a covariate. Autopsies were performed blinded to PET results. There was excellent correspondence between areas of 18F-flortaucipir retention, on both SUVR images and W-score maps, and neurofibrillary tangle distribution in patients with primary Alzheimer's disease neuropathology. Patients with non-Alzheimer tauopathies and non-tau frontotemporal lobar degeneration showed a range of tracer retention that was less than Alzheimer's disease, though higher than age-matched, cognitively normal controls. Overall, binding across both tau-positive and tau-negative non-Alzheimer disorders did not reliably correspond with post-mortem tau pathology. 18F-flortaucipir SUVRs in subcortical regions were higher in autopsy-confirmed progressive supranuclear palsy and corticobasal degeneration than in controls, but were similar to values measured in Alzheimer's disease and tau-negative neurodegenerative pathologies. Quantification of 18F-flortaucipir SUVR images at Braak stage regions of interest reliably detected advanced Alzheimer's (Braak VI) pathology. However, patients with earlier Braak stages (Braak I-IV) did not show elevated tracer uptake in these regions compared to young, tau-negative controls. In summary, PET-to-autopsy comparisons confirm that 18F-flortaucipir PET is a reliable biomarker of advanced Braak tau pathology in Alzheimer's disease. The tracer cannot reliably differentiate non-Alzheimer tauopathies and may not detect early Braak stages of neurofibrillary tangle pathology.
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Affiliation(s)
- David N Soleimani-Meigooni
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Suzanne Baker
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Viktoriya Bourakova
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rana Eser
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - William J Jagust
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Mustafa Janabi
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Orit H Lesman-Segev
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Taylor Mellinger
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Julie Pham
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Amelia Strom
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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A critical review of radiotracers in the positron emission tomography imaging of traumatic brain injury: FDG, tau, and amyloid imaging in mild traumatic brain injury and chronic traumatic encephalopathy. Eur J Nucl Med Mol Imaging 2020; 48:623-641. [DOI: 10.1007/s00259-020-04926-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
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Phelps A, Mez J, Stern RA, Alosco ML. Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework. Semin Neurol 2020; 40:439-449. [PMID: 32674182 DOI: 10.1055/s-0040-1713633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that has been neuropathologically diagnosed in contact and collision sport athletes, military veterans, and others with a history of exposure to repetitive head impacts (RHI). Identifying methods to diagnose and prevent CTE during life is a high priority. Timely diagnosis and implementation of treatment and preventative strategies for neurodegenerative diseases, including CTE, partially hinge upon early and accurate risk characterization. Here, we propose a framework of risk factors that influence the neuropathological development of CTE. We provide an up-to-date review of the literature examining cumulative exposure to RHI as the environmental trigger for CTE. Because not all individuals exposed to RHI develop CTE, the direct and/or indirect influence of nonhead trauma exposure characteristics (e.g., age, sex, race, genetics) on the pathological development of CTE is reviewed. We conclude with recommendations for future directions, as well as opinions for preventative strategies that could mitigate risk.
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Affiliation(s)
- Alyssa Phelps
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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40
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Mantyh WG, Spina S, Lee A, Iaccarino L, Soleimani-Meigooni D, Tsoy E, Mellinger TJ, Grant H, Vandevrede L, La Joie R, Lesman-Segev O, Gaus S, Possin KL, Grinberg LT, Miller BL, Seeley WW, Rabinovici GD. Tau Positron Emission Tomographic Findings in a Former US Football Player With Pathologically Confirmed Chronic Traumatic Encephalopathy. JAMA Neurol 2020; 77:517-521. [PMID: 31904765 DOI: 10.1001/jamaneurol.2019.4509] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Biomarkers for chronic traumatic encephalopathy (CTE) are currently lacking. The radiotracer fluorine F 18-labeled (18F)-flortaucipir (FTP) detects tau pathology in Alzheimer disease, and positron emission tomography (PET) with FTP shows elevated binding in individuals at risk for CTE. No study, however, has assessed the correlation between in vivo FTP PET and postmortem tau in CTE. Objective To assess the regional association between in vivo FTP binding and postmortem tau pathology in a patient with pathologically confirmed CTE. Design, Setting, and Participants A white male former National Football League player with 17 years of US football exposure was clinically diagnosed with traumatic encephalopathy syndrome at a neurology tertiary referral center. 18F-Fludeoxyglucose, carbon 11-labeled Pittsburgh compound B, and FTP PET were performed 52 months prior to death, and magnetic resonance imaging, 50 months prior to death. Brain images were assessed qualitatively for abnormalities blinded to autopsy data. Autopsy was performed using a neurodegenerative research protocol. The FTP standardized uptake value ratios (inferior cerebellar gray reference region) and W-score (age-adjusted z-score) maps were compared with phosphorylated tau immunohistochemical analysis with monoclonal antibody CP13. Main Outcomes and Measures Qualitative and quantitative comparisons between antemortem FTP PET and tau pathology at autopsy. Results Flortaucipir uptake was distributed in a patchy, frontotemporal-predominant pattern that overlapped with regions showing neurodegeneration on magnetic resonance imaging and hypometabolism on 18F-fludeoxyglucose PET. Pathological assessment revealed stage 4 CTE; limbic argyrophilic grain disease; stage 2 limbic-predominant, age-related transactive response DNA-binding protein 43 encephalopathy; and Braak neurofibrillary tangle stage 3. 18F-Flortaucipir W-maps matched areas of high postmortem tau burden in left fusiform and inferior temporal gyri and juxtacortical frontal white matter. High FTP W-scores with low tau burden were found in the basal ganglia, thalamus, motor cortex, and calcarine cortex. No regions with low FTP W-scores corresponded to areas with high pathological tau burden. A modest correlation, which did not reach statistical significance (ρ = 0.35, P = .17), was found between FTP standardized uptake value ratio and tau area fraction at the regional level. Conclusions and Relevance In this patient, FTP PET findings during life showed a modest correspondence with postmortem pathology in CTE. These findings suggest that FTP may have limited utility as a tau biomarker in CTE.
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Affiliation(s)
- William G Mantyh
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Alex Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - David Soleimani-Meigooni
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Taylor J Mellinger
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Harli Grant
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Lawren Vandevrede
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Orit Lesman-Segev
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Stephanie Gaus
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,Department of Pathology, University of California, San Francisco, San Francisco
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,Department of Pathology, University of California, San Francisco, San Francisco
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco.,Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco.,Associate Editor
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Vasilevskaya A, Taghdiri F, Burke C, Tarazi A, Naeimi SA, Khodadadi M, Goswami R, Sato C, Grinberg M, Moreno D, Wennberg R, Mikulis D, Green R, Colella B, Davis KD, Rusjan P, Houle S, Tator C, Rogaeva E, Tartaglia MC. Interaction of APOE4 alleles and PET tau imaging in former contact sport athletes. Neuroimage Clin 2020; 26:102212. [PMID: 32097865 PMCID: PMC7037542 DOI: 10.1016/j.nicl.2020.102212] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Genetic polymorphisms like apolipoprotein E (APOE) and microtubule-associated protein tau (MAPT) genes increase the risk of neurodegeneration. METHODS 38 former players (age 52.63±14.02) of contact sports underwent neuroimaging, biofluid collection, and comprehensive neuropsychological assessment. The [F-18]AV-1451 tracer signal was compared in the cortical grey matter between APOE4 allele carriers and non-carriers as well as carriers of MAPT H1H1 vs non-H1H1. Participants were then divided into the high (N = 13) and low (N = 13) groups based on cortical PET tau standard uptake value ratios (SUVRs) for comparison. FINDINGS Cortical grey matter PET tau SUVR values were significantly higher in APOE4 carriers compared to non-carriers (p = 0.020). In contrast, there was no significant difference in SUVR between MAPT H1H1 vs non-H1H1 carrier genes (p = 1.00). There was a significantly higher APOE4 allele frequency in the high cortical grey matter PET tau group, comparing to low cortical grey matter PET tau group (p = 0.048). No significant difference in neuropsychological function was found between APOE4 allele carriers and non-carriers. INTERPRETATION There is an association between higher cortical grey matter tau burden as seen with [F-18]AV-1451 PET tracer SUVR, and the APOE4 allele in former professional and semi-professional players at high risk of concussions. APOE4 allele may be a risk factor for tau accumulation in former contact sports athletes at high risk of neurodegeneration. FUNDING Toronto General and Western Hospital Foundations; Weston Brain Institute; Canadian Consortium on Neurodegeneration in ageing; Krembil Research Institute. There was no role of the funders in this study.
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Affiliation(s)
- Anna Vasilevskaya
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Charles Burke
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; School of Medicine & Dentistry, Western University, Windsor, ON, Canada
| | - Apameh Tarazi
- Division of Neurology, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Seyed Ali Naeimi
- Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Mozghan Khodadadi
- Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Ruma Goswami
- Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada
| | - Mark Grinberg
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada
| | - Richard Wennberg
- Division of Neurology, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - David Mikulis
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Robin Green
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Department of Rehabilitation Sciences, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Brenda Colella
- Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Department of Rehabilitation Sciences, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Karen D Davis
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Department of Surgery, University of Toronto, 149 College St., Toronto, ON, M5T 1P5, Canada
| | - Pablo Rusjan
- Research Imaging Centre, Campbell Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada
| | - Sylvain Houle
- Research Imaging Centre, Campbell Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada
| | - Charles Tator
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada; Department of Medicine, Division of Neurology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Maria C Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard avenue, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Canadian Concussion Center, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada.
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