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van der Zwet R, Koemans EA, Voigt S, van Dort R, Rasing I, Kaushik K, van Harten TW, Schipper MR, Terwindt GM, van Osch M, van Walderveen M, van Etten ES, Wermer M. Sensitivity of the Boston criteria version 2.0 in Dutch-type hereditary cerebral amyloid angiopathy. Int J Stroke 2024; 19:942-946. [PMID: 38444323 DOI: 10.1177/17474930241239801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND AIM The revised Boston criteria v2.0 for cerebral amyloid angiopathy (CAA) add two radiological markers to the existing criteria: severe visible perivascular spaces in the centrum semiovale and white matter hyperintensities (WMHs) in a multispot pattern. This study aims to determine the sensitivity of the updated criteria in mutation carriers with Dutch-type hereditary CAA (D-CAA) in an early and later disease stage. METHODS In this cross-sectional study, we included presymptomatic and symptomatic D-CAA mutation carriers from our prospective natural history study (AURORA) at the Leiden University Medical Center between 2018 and 2021. 3-Tesla scans were assessed for CAA-related magnetic resonance imaging (MRI) markers. We compared the sensitivity of the Boston criteria v2.0 to the previously used modified Boston criteria v1.5. RESULTS We included 64 D-CAA mutation carriers (mean age 49 years, 55% women, 55% presymptomatic). At least one white matter (WM) feature was seen in 55/64 mutation carriers (86%: 74% presymptomatic, 100% symptomatic). Fifteen (23%) mutation carriers, all presymptomatic, showed only WM features and no hemorrhagic markers. The sensitivity for probable CAA was similar between the new and the previous criteria: 11/35 (31%) in presymptomatic mutation carriers and 29/29 (100%) in symptomatic mutation carriers. The sensitivity for possible CAA in presymptomatic mutation carriers increased from 0/35 (0%) to 15/35 (43%) with the new criteria. CONCLUSION The Boston criteria v2.0 increase the sensitivity for detecting possible CAA in presymptomatic D-CAA mutation carriers and, therefore, improve the detection of the early phase of CAA.
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Affiliation(s)
- Rgj van der Zwet
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - E A Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R van Dort
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - I Rasing
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Kaushik
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - T W van Harten
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M R Schipper
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mjp van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maa van Walderveen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mjh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
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2
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van der Plas MC, Rasing I, Geraedts VJ, Tromp SC, Terwindt GM, van Dort R, Kaushik K, van Zwet EW, Tannemaat MR, Wermer MJH. Quantitative electroencephalography in cerebral amyloid angiopathy. Clin Neurophysiol 2024; 164:111-118. [PMID: 38861875 DOI: 10.1016/j.clinph.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/14/2024] [Accepted: 05/22/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE We investigated whether quantitative electroencephalography (qEEG) correlates with cognition and cortical superficial siderosis (cSS) in cerebral amyloid angiopathy. METHODS We included patients with sporadic (sCAA) and hereditary Dutch-type CAA (D-CAA). Spectral measures and the phase lag index (PLI) were analyzed on qEEG. Cognition was assessed with the MoCA and cSS presence was scored on 3T-MRI. Linear regression analyses were performed to investigate these qEEG measures and cognition. Independent samples T-tests were used to analyze the qEEG measure differences between participants with and without cSS. RESULTS We included 92 participants (44 D-CAA; 48 sCAA). A lower average peak frequency (β[95 %CI] = 0.986[0.252-1.721]; P = 0.009) and a higher spectral ratio (β[95 %CI] = -0.918[-1.761--0.075]; P = 0.033) on qEEG correlated with a lower MoCA score, irrespective of a history of symptomatic intracerebral hemorrhage (sICH). The PLI showed no correlation to the MoCA. qEEG slowing was not different in those with or without cSS. CONCLUSIONS Spectral qEEG (but not PLI) reflects cognitive performance in patients with CAA with and without a history of sICH. We found no association between qEEG slowing and cSS. SIGNIFICANCE qEEG could be a valuable biomarker, especially in challenging cognitive testing situations in CAA, and a potential predictive tool in future studies.
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Affiliation(s)
- M C van der Plas
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.
| | - I Rasing
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - V J Geraedts
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - S C Tromp
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - R van Dort
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - K Kaushik
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - E W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - M R Tannemaat
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - M J H Wermer
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Department of Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
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3
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Banerjee G, Collinge J, Fox NC, Lashley T, Mead S, Schott JM, Werring DJ, Ryan NS. Clinical considerations in early-onset cerebral amyloid angiopathy. Brain 2023; 146:3991-4014. [PMID: 37280119 PMCID: PMC10545523 DOI: 10.1093/brain/awad193] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) is an important cerebral small vessel disease associated with brain haemorrhage and cognitive change. The commonest form, sporadic amyloid-β CAA, usually affects people in mid- to later life. However, early-onset forms, though uncommon, are increasingly recognized and may result from genetic or iatrogenic causes that warrant specific and focused investigation and management. In this review, we firstly describe the causes of early-onset CAA, including monogenic causes of amyloid-β CAA (APP missense mutations and copy number variants; mutations of PSEN1 and PSEN2) and non-amyloid-β CAA (associated with ITM2B, CST3, GSN, PRNP and TTR mutations), and other unusual sporadic and acquired causes including the newly-recognized iatrogenic subtype. We then provide a structured approach for investigating early-onset CAA, and highlight important management considerations. Improving awareness of these unusual forms of CAA amongst healthcare professionals is essential for facilitating their prompt diagnosis, and an understanding of their underlying pathophysiology may have implications for more common, late-onset, forms of the disease.
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Affiliation(s)
- Gargi Banerjee
- MRC Prion Unit at University College London (UCL), Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - John Collinge
- MRC Prion Unit at University College London (UCL), Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
| | - Tammaryn Lashley
- The Queen Square Brain Bank for Neurological Disorders, Department of Clinical and Movement Disorders, UCL Queen Square Institute of Neurology, London, W1 1PJ, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Simon Mead
- MRC Prion Unit at University College London (UCL), Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Natalie S Ryan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
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4
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Hernandez-Guillamon M. Implications of a pathophysiological framework for cerebral amyloid angiopathy. Lancet Neurol 2023; 22:550-551. [PMID: 37236208 DOI: 10.1016/s1474-4422(23)00196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, 08035, Spain.
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5
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van Dijk SE, van der Grond J, Lak J, van den Berg-Huysmans A, Labadie G, Terwindt GM, Wermer MJH, Gurol ME, van Buchem MA, Greenberg SM, van Rooden S. Longitudinal Progression of Magnetic Resonance Imaging Markers and Cognition in Dutch-Type Hereditary Cerebral Amyloid Angiopathy. Stroke 2022; 53:2006-2015. [PMID: 35360926 PMCID: PMC9126261 DOI: 10.1161/strokeaha.121.035826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hemorrhagic and ischemic magnetic resonance imaging lesions as well as the more recently described decrease in vasomotor reactivity have been suggested as possible biomarkers for cerebral amyloid angiopathy (CAA). Analyses of these markers have been primarily cross-sectional during the symptomatic phase of the disease, with little data on their longitudinal progression, particularly in the presymptomatic phase of the disease when it may be most responsive to treatment. We used the unique opportunity provided by studying Dutch-type hereditary cerebral amyloid angiopathy (D-CAA) to determine longitudinal progression of CAA biomarkers during the presymptomatic as well as the symptomatic phase of the disease.
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Affiliation(s)
- Suzanne E van Dijk
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
| | - Jessie Lak
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
| | - Annette van den Berg-Huysmans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
| | - Gerda Labadie
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
| | - Gisela M Terwindt
- Department of Neurology,Leiden University Medical Center, Leiden, the Netherlands. (G.M.T., M.J.H.W.)
| | - Marieke J H Wermer
- Department of Neurology,Leiden University Medical Center, Leiden, the Netherlands. (G.M.T., M.J.H.W.)
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston (M.E.G., S.M.G.)
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston (M.E.G., S.M.G.)
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. (S.E.v.D., J.v.d.G., J.L., A.v.d.B-H, G.L., M.A.v.B., S.v.R)
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6
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Abondio P, Sarno S, Giuliani C, Laganà V, Maletta R, Bernardi L, Bruno F, Colao R, Puccio G, Frangipane F, Borroni B, Van Broeckhoven C, Luiselli D, Bruni A. Amyloid Precursor Protein A713T Mutation in Calabrian Patients with Alzheimer's Disease: A Population Genomics Approach to Estimate Inheritance from a Common Ancestor. Biomedicines 2021; 10:biomedicines10010020. [PMID: 35052700 PMCID: PMC8773445 DOI: 10.3390/biomedicines10010020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Mutation A713T in the amyloid precursor protein (APP) has been linked to cases of Alzheimer’s disease (AD), cerebral amyloid angiopathy (CAA) and cerebrovascular disease. Despite its rarity, it has been observed in several families from the same geographical area, in the Calabria region in Southern Italy. Genotyping of 720,000 genome-wide SNPs with the HumanOmniExpress BeadChip was performed for six patients that were representative of apparently unrelated Calabrian families, as well as a Belgian subject of Italian descent (all with the same A713T mutation and disease). Their genomic structure and genetic relationships were analyzed. Demographic reconstruction and coalescent theory were applied to estimate the time of the most recent common ancestor (tMRCA) among patients. Results show that all A713T carriers fell into the genetic variability of Southern Italy and were not more closely related to each other than to any other healthy Calabrian individual. However, five out of seven patients shared a 1.7 Mbp-long DNA segment centered on the A713T mutation, making it possible to estimate a tMRCA for its common origin in the Calabrian region dating back over 1000 years. The analysis of affected individuals with methodologies based on human population genomics thus provides informative insights in support of clinical observations and biomedical research.
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Affiliation(s)
- Paolo Abondio
- Laboratory of Molecular Anthropology, Center for Genome Biology, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (S.S.); (C.G.)
- Correspondence: (P.A.); (A.B.)
| | - Stefania Sarno
- Laboratory of Molecular Anthropology, Center for Genome Biology, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (S.S.); (C.G.)
| | - Cristina Giuliani
- Laboratory of Molecular Anthropology, Center for Genome Biology, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (S.S.); (C.G.)
| | - Valentina Laganà
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Raffaele Maletta
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Livia Bernardi
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Francesco Bruno
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Rosanna Colao
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Gianfranco Puccio
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Francesca Frangipane
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
| | - Barbara Borroni
- Department of Neurology, University of Brescia, 25121 Brescia, Italy;
| | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, Vlaams Instituut voor Biotechnologie, 2600 Antwerp, Belgium;
- Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Donata Luiselli
- Ancient DNA Laboratory, Department of Cultural Heritage, Ravenna Campus, University of Bologna, 48121 Ravenna, Italy;
| | - Amalia Bruni
- Regional Neurogenetic Center, Azianda Sanitaria Provinciale Catanzaro, 88046 Lamezia Terme, Italy; (V.L.); (R.M.); (L.B.); (F.B.); (R.C.); (G.P.); (F.F.)
- Correspondence: (P.A.); (A.B.)
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Voigt S, Amlal S, Koemans EA, Rasing I, van Etten ES, van Zwet EW, van Buchem MA, Terwindt GM, van Walderveen MA, Wermer MJ. Spatial and temporal intracerebral hemorrhage patterns in Dutch-type hereditary cerebral amyloid angiopathy. Int J Stroke 2021; 17:793-798. [PMID: 34791949 PMCID: PMC9373023 DOI: 10.1177/17474930211057022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim To investigate whether there is a topographical and temporal pattern of index
and recurrent intracerebral hemorrhages (ICH) in Dutch-type hereditary
Cerebral Amyloid Angiopathy (D-CAA) to increase our understanding on
CAA-related ICH development. Methods We included patients with DNA confirmed D-CAA or a history with ≥1 lobar ICH
and ≥1 first-degree relative with D-CAA. Topographical pattern was studied
by location (proportion frontal/parietal/temporal/occipital;
infra/supratentorial and occurrence ratios relative to lobe volume) and
volume of index and recurrent ICHs were determined on CT. Temporal pattern
was examined by time between recurrent ICHs was retrieved from medical
records. Results We included 72 patients with D-CAA (mean age at index ICH 55 years) with in
total 214 ICH. The median follow-up time was 7 years (range 0.8 to 28
years). All ICH were lobar and supratentorial. The index ICH was most
frequently located in the occipital lobe (34% vs. 22% in the other three
lobes; with index ICH occurrence ratios relative to lobe volume of 1.9 for
occipital, 1.0 for temporal, 1.2 for parietal, and 0.5 for frontal,
p = 0.001). In 16/47 (34%) patients with multiple ICH, the second ICH was
located in the same lobe as the index ICH. The median time-interval between
subsequent ICH was #1-2 ICH 27 months, #2-3 ICH 14 months, and #3-4 ICH 7
months (p = 0.6) There was no difference in volume between index and
recurrent ICHs. Conclusions We found that index and recurrent ICHs in D-CAA have a preference for the
occipital lobe and are least frequent in the frontal lobe, which adds to the
existing knowledge of histopathological studies on amyloid load in CAA.
Surprisingly, there was no acceleration in time nor gradual increase of
hematoma volume between subsequent ICHs.
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Affiliation(s)
- Sabine Voigt
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - Siham Amlal
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | | | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands
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Hamaguchi T, Kim JH, Hasegawa A, Goto R, Sakai K, Ono K, Itoh Y, Yamada M. Exogenous Aβ seeds induce Aβ depositions in the blood vessels rather than the brain parenchyma, independently of Aβ strain-specific information. Acta Neuropathol Commun 2021; 9:151. [PMID: 34507620 PMCID: PMC8431898 DOI: 10.1186/s40478-021-01252-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 02/08/2023] Open
Abstract
Little is known about the effects of parenchymal or vascular amyloid β peptide (Aβ) deposition in the brain. We hypothesized that Aβ strain-specific information defines whether Aβ deposits on the brain parenchyma or blood vessels. We investigated 12 autopsied patients with different severities of Aβ plaques and cerebral amyloid angiopathy (CAA), and performed a seeding study using an Alzheimer’s disease (AD) mouse model in which brain homogenates derived from the autopsied patients were injected intracerebrally. Based on the predominant pathological features, we classified the autopsied patients into four groups: AD, CAA, AD + CAA, and less Aβ. One year after the injection, the pathological and biochemical features of Aβ in the autopsied human brains were not preserved in the human brain extract-injected mice. The CAA counts in the mice injected with all four types of human brain extracts were significantly higher than those in mice injected with PBS. Interestingly, parenchymal and vascular Aβ depositions were observed in the mice that were injected with the human brain homogenate from the less Aβ group. The Aβ and CAA seeding activities, which had significant positive correlations with the Aβ oligomer ratio in the human brain extracts, were significantly higher in the human brain homogenate from the less Aβ group than in the other three groups. These results indicate that exogenous Aβ seeds from different Aβ pathologies induced Aβ deposition in the blood vessels rather than the brain parenchyma without being influenced by Aβ strain-specific information, which might be why CAA is a predominant feature of Aβ pathology in iatrogenic transmission cases. Furthermore, our results suggest that iatrogenic transmission of Aβ pathology might occur due to contamination of brain tissues from patients with little Aβ pathology, and the development of inactivation methods for Aβ seeding activity to prevent iatrogenic transmission is urgently required.
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Klotz S, Gelpi E. [Neuropathology of dementia]. Wien Med Wochenschr 2021; 171:257-273. [PMID: 34129141 PMCID: PMC8397629 DOI: 10.1007/s10354-021-00848-4] [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: 12/04/2020] [Accepted: 04/14/2021] [Indexed: 11/09/2022]
Abstract
Demenz ist die klinische Folge verschiedener neurologischer Erkrankungen mit einer Vielzahl von Ätiologien. Dabei ist die genaue Kenntnis der zugrunde liegenden pathologischen Veränderungen entscheidend für die passgenaue Versorgung der Patienten und für die Entwicklung geeigneter Krankheitsbiomarker. Eine definitive Diagnose vieler dieser Erkrankungen, insbesondere der neurodegenerativen Formen, kann nur nach gründlicher postmortaler neuropathologischer Untersuchung gestellt werden. Dies unterstreicht die Wichtigkeit der Durchführung einer Gehirnautopsie und die Relevanz einer engen Zusammenarbeit zwischen Klinikern, Neuroradiologen und Neuropathologen sowie mit Grundlagenforschern. Ziel der vorliegenden Arbeit ist es, einen kurzen Überblick über die Neuropathologie der Demenz mit Schwerpunkt auf neurodegenerative Erkrankungen zu geben, um die interdisziplinäre Zusammenarbeit weiter zu fördern.
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Affiliation(s)
- Sigrid Klotz
- Abteilung für Neuropathologie und Neurochemie, Universitätsklinik für Neurologie, Medizinischer Universitätscampus Wien, Ebene 4J, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Österreichisches Referenzzentrum zur Erfassung und Dokumentation menschlicher Prionen-Erkrankungen (ÖRPE), Wien, Österreich
| | - Ellen Gelpi
- Abteilung für Neuropathologie und Neurochemie, Universitätsklinik für Neurologie, Medizinischer Universitätscampus Wien, Ebene 4J, Währinger Gürtel 18-20, 1090, Wien, Österreich. .,Österreichisches Referenzzentrum zur Erfassung und Dokumentation menschlicher Prionen-Erkrankungen (ÖRPE), Wien, Österreich.
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Chatterjee P, Tegg M, Pedrini S, Fagan AM, Xiong C, Singh AK, Taddei K, Gardener S, Masters CL, Schofield PR, Multhaup G, Benzinger TLS, Morris JC, Bateman RJ, Greenberg SM, van Buchem MA, Stoops E, Vanderstichele H, Teunissen CE, Hankey GJ, Wermer MJH, Sohrabi HR, Martins RN. Plasma Amyloid-Beta Levels in a Pre-Symptomatic Dutch-Type Hereditary Cerebral Amyloid Angiopathy Pedigree: A Cross-Sectional and Longitudinal Investigation. Int J Mol Sci 2021; 22:ijms22062931. [PMID: 33805778 PMCID: PMC8000178 DOI: 10.3390/ijms22062931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 01/10/2023] Open
Abstract
Plasma amyloid-beta (Aβ) has long been investigated as a blood biomarker candidate for Cerebral Amyloid Angiopathy (CAA), however previous findings have been inconsistent which could be attributed to the use of less sensitive assays. This study investigates plasma Aβ alterations between pre-symptomatic Dutch-type hereditary CAA (D-CAA) mutation-carriers (MC) and non-carriers (NC) using two Aβ measurement platforms. Seventeen pre-symptomatic members of a D-CAA pedigree were assembled and followed up 3–4 years later (NC = 8; MC = 9). Plasma Aβ1-40 and Aβ1-42 were cross-sectionally and longitudinally analysed at baseline (T1) and follow-up (T2) and were found to be lower in MCs compared to NCs, cross-sectionally after adjusting for covariates, at both T1(Aβ1-40: p = 0.001; Aβ1-42: p = 0.0004) and T2 (Aβ1-40: p = 0.001; Aβ1-42: p = 0.016) employing the Single Molecule Array (Simoa) platform, however no significant differences were observed using the xMAP platform. Further, pairwise longitudinal analyses of plasma Aβ1-40 revealed decreased levels in MCs using data from the Simoa platform (p = 0.041) and pairwise longitudinal analyses of plasma Aβ1-42 revealed decreased levels in MCs using data from the xMAP platform (p = 0.041). Findings from the Simoa platform suggest that plasma Aβ may add value to a panel of biomarkers for the diagnosis of pre-symptomatic CAA, however, further validation studies in larger sample sets are required.
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Affiliation(s)
- Pratishtha Chatterjee
- Department of Biomedical Sciences, Macquarie University, North Ryde, NSW 2109, Australia; (P.C.); (H.R.S.)
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
| | - Michelle Tegg
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
| | - Steve Pedrini
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
| | - Anne M. Fagan
- Department of Neurology, Washington University, St. Louis, MO 63130, USA; (A.M.F.); (J.C.M.); (R.J.B.)
- Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO 63130, USA; (C.X.); (T.L.S.B.)
| | - Chengjie Xiong
- Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO 63130, USA; (C.X.); (T.L.S.B.)
- Division of Biostatistics, Washington University, St. Louis, MO 63130, USA
| | - Abhay K. Singh
- Macquarie Business School, Macquarie University, North Ryde, NSW 2109, Australia;
| | - Kevin Taddei
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
- Australian Alzheimer’s Research Foundation, Nedlands, WA 6009, Australia
| | - Samantha Gardener
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
| | - Colin L. Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia;
| | - Peter R. Schofield
- Neuroscience Research Australia, Sydney, NSW 2031, Australia;
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Gerhard Multhaup
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC H3G 1Y6, Canada;
| | - Tammie L. S. Benzinger
- Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO 63130, USA; (C.X.); (T.L.S.B.)
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, MO 63130, USA; (A.M.F.); (J.C.M.); (R.J.B.)
- Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO 63130, USA; (C.X.); (T.L.S.B.)
| | - Randall J. Bateman
- Department of Neurology, Washington University, St. Louis, MO 63130, USA; (A.M.F.); (J.C.M.); (R.J.B.)
- Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO 63130, USA; (C.X.); (T.L.S.B.)
| | - Steven M. Greenberg
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA 02114, USA;
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | | | | | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, 1007 MB Amsterdam, The Netherlands;
| | - Graeme J. Hankey
- Faculty of Health and Medical Sciences, Medical School, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Marieke J. H. Wermer
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Hamid R. Sohrabi
- Department of Biomedical Sciences, Macquarie University, North Ryde, NSW 2109, Australia; (P.C.); (H.R.S.)
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
- Australian Alzheimer’s Research Foundation, Nedlands, WA 6009, Australia
- Centre for Healthy Ageing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA 6150, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA 6009, Australia
| | - Ralph N. Martins
- Department of Biomedical Sciences, Macquarie University, North Ryde, NSW 2109, Australia; (P.C.); (H.R.S.)
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (M.T.); (S.P.); (K.T.); (S.G.)
- Australian Alzheimer’s Research Foundation, Nedlands, WA 6009, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA 6009, Australia
- The KaRa Institute of Neurological Disease, Macquarie Park, NSW 2113, Australia
- Correspondence: ; Tel.: +61-8-6304-5456; Fax: +61-8-6304-5851
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Cerebral amyloid angiopathy is associated with decreased functional brain connectivity. NEUROIMAGE-CLINICAL 2020; 29:102546. [PMID: 33421870 PMCID: PMC7806879 DOI: 10.1016/j.nicl.2020.102546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/20/2020] [Accepted: 12/20/2020] [Indexed: 01/23/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is a major cause of intracerebral hemorrhage and neurological decline in the elderly. CAA results in focal brain lesions, but the influence on global brain functioning needs further investigation. Here we study functional brain connectivity in patients with Dutch type hereditary CAA using resting state functional MRI. Twenty-four DNA-proven Dutch CAA mutation carriers (11 presymptomatic, 13 symptomatic) and 29 age-matched control subjects were included. Using a set of standardized networks covering the entire cortex, we assessed both within- and between-network functional connectivity. We investigated group differences using general linear models corrected for age, sex and gray matter volume. First, all mutation carriers were contrasted against control subjects and subsequently presymptomatic- and symptomatic mutation carriers against control subjects separately, to assess in which stage of the disease differences could be found. All mutation carriers grouped together showed decreased connectivity in the medial and lateral visual networks, default mode network, executive control and bilateral frontoparietal networks. Symptomatic carriers showed diminished connectivity in all but one network, and between the left and right frontoparietal networks. Presymptomatic carriers also showed diminished connectivity, but only in the frontoparietal left network. In conclusion, global brain functioning is diminished in patients with CAA, predominantly in symptomatic CAA and can therefore be considered to be a late consequence of the disease.
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Bruni AC, Bernardi L, Gabelli C. From beta amyloid to altered proteostasis in Alzheimer's disease. Ageing Res Rev 2020; 64:101126. [PMID: 32683041 DOI: 10.1016/j.arr.2020.101126] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/27/2020] [Accepted: 07/13/2020] [Indexed: 12/14/2022]
Abstract
Alzheimer's disease (AD) is an age related neurodegenerative disorder causing severe disability and important socio-economic burden, but with no cure available to date. To disentangle this puzzling disease genetic studies represented an important way for the comprehension of pathogenic mechanisms. Abnormal processing and accumulation of amyloid-β peptide (Aβ) has been considered the main cause and trigger factor of the disease. The amyloid cascade theory has fallen into crisis because the failure of several anti-amyloid drugs trials and because of the simple equation AD = abnormal Aβ deposition is not always the case. We now know that multiple neurodegenerative diseases share common pathogenic mechanisms leading to accumulation of misfolded protein species. Genome Wide Association studies (GWAS) led to the identification of large numbers of DNA common variants (SNPs) distributed on different chromosomes and modulating the Alzheimer's risk. GWAS genes fall into several common pathways such as immune system and neuroinflammation, lipid metabolism, synaptic dysfunction and endocytosis, all of them addressing to novel routes for different pathogenic mechanisms. Other hints could be derived from epidemiological and experimental studies showing some lifestyles may have a major role in the pathogenesis of many age-associated diseases by modifying cell metabolism, proteostasis and microglia mediated neuroinflammation.
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Affiliation(s)
- Amalia C Bruni
- Regional Neurogenetic Centre, ASP Catanzaro, Lamezia Terme (CZ), Italy.
| | - Livia Bernardi
- Regional Neurogenetic Centre, ASP Catanzaro, Lamezia Terme (CZ), Italy
| | - Carlo Gabelli
- Regional Brain Aging Centre, Azienda Ospedale Università Di Padova, Padova Italy
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van Etten ES, Kaushik K, van Zwet EW, Voigt S, van Walderveen MAA, van Buchem MA, Terwindt GM, Wermer MJH. Sensitivity of the Edinburgh Criteria for Lobar Intracerebral Hemorrhage in Hereditary Cerebral Amyloid Angiopathy. Stroke 2020; 51:3608-3612. [PMID: 33148142 DOI: 10.1161/strokeaha.120.031264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Edinburgh computed tomography and genetic criteria enable diagnosis of cerebral amyloid angiopathy (CAA) associated lobar intracerebral hemorrhage (ICH) but have not been validated in living patients. We assessed the sensitivity of the Edinburgh criteria in patients with acute lobar ICH due to Dutch-type hereditary CAA; a genetic and pure form of CAA. METHODS We retrospectively analyzed computed tomography-scans from a cohort of consecutive Dutch-type hereditary CAA patients who presented with ≥1 episode(s) of acute lobar ICH at the Leiden University Medical Center. Presence of subarachnoid hemorrhage (SAH) and finger-like projections (FLP) were determined. Association of SAH and FLP with ICH volume was analyzed using multivariate linear regression. RESULTS We included 55 Dutch-type hereditary CAA patients (mean age 56 years, 55% men) with a total of 107 episodes of acute lobar ICH. SAH was present in 82/107 (76%) and FLP in 62/107 (58%), resulting in a sensitivity of 76% for SAH and 58% for FLP. In 56 (52%), both markers were present. Nineteen (18%) lobar ICH showed no SAH extension or FLP. ICH volume was significantly associated with presence of SAH (median volume 4 versus 28 mL; P=0.001) and presence of FLP (median volume 7 versus 39 mL; P<0.001). With an ICH volume of ≥40 mL, the sensitivity of the presence of both SAH and FLP was >81% (95% CI, 70%-92%), whereas in ICH volumes <15 mL the sensitivity was <50%. CONCLUSIONS The computed tomography-based Edinburgh criteria seem to be a sensitive diagnostic test for CAA-associated lobar ICH, although they should be used with caution in small-sized lobar ICH.
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Affiliation(s)
- Ellis S van Etten
- Department of Neurology (E.S.v.E., K.K., S.V., G.M.T., M.J.H.W.), Leiden University Medical Center, Leiden, the Netherlands
| | - Kanishk Kaushik
- Department of Neurology (E.S.v.E., K.K., S.V., G.M.T., M.J.H.W.), Leiden University Medical Center, Leiden, the Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences (E.W.v.Z.), Leiden University Medical Center, Leiden, the Netherlands
| | - Sabine Voigt
- Department of Neurology (E.S.v.E., K.K., S.V., G.M.T., M.J.H.W.), Leiden University Medical Center, Leiden, the Netherlands
| | | | - Mark A van Buchem
- Department of Radiology (M.A.A.v.W., M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology (E.S.v.E., K.K., S.V., G.M.T., M.J.H.W.), Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology (E.S.v.E., K.K., S.V., G.M.T., M.J.H.W.), Leiden University Medical Center, Leiden, the Netherlands
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14
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Koemans EA, Voigt S, Rasing I, van Etten ES, van Zwet EW, van Walderveen MAA, Wermer MJH, Terwindt GM. Migraine With Aura as Early Disease Marker in Hereditary Dutch-Type Cerebral Amyloid Angiopathy. Stroke 2020; 51:1094-1099. [PMID: 32114932 DOI: 10.1161/strokeaha.119.028170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose- To determine whether migraine, which has often been described as an inaugural manifestation in monogenic cerebrovascular syndromes, is associated with cerebral amyloid pathology, we assessed migraine and its correlation with magnetic resonance imaging markers in Hereditary Dutch-Type Cerebral Amyloid Angiopathy (D-CAA or Hereditary Cerebral Hemorrhage With Amyloidosis-Dutch type). Methods- All D-CAA mutation carriers who visited our clinic between 2012 and 2018 were included. Migraine was diagnosed by an interview and classified according to the International Classification of Headache Disorders. Magnetic resonance imaging scans were scored for intracerebral hemorrhage (ICH) location(s) and presence of cortical superficial siderosis. Kaplan Meier survival analysis was used for age of ICH onset in carriers with and without migraine. Correlation with ICH location(s) and cortical superficial siderosis were calculated with Poisson regression analysis adjusted for confounders. Results- We included 86 D-CAA mutation carriers (57% women, mean age 57 years), 48 (56%) suffered from migraine, all with aura. Prevalence was higher than expected compared with the general population (women, P<0.05; men, P<0.001). Migraine was the inaugural symptom in 77% and an isolated symptom in 35% of the carriers. Carriers with and without migraine did not differ for age of first ICH, cortical superficial siderosis prevalence, or occipital ICH. Time between migraine onset and first ICH was 8.5 years. Aura attacks lasting ≥60 minutes signaled acute ICH in 55%. Conclusions- Migraine with aura is an important, often inaugural, symptom in D-CAA. Aura attacks lasting ≥60 minutes may signal acute ICH in D-CAA. Migraine with aura may be regarded as an early marker of disease in hereditary CAA preceding the occurrence of symptomatic ICH by several years.
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Affiliation(s)
- Emma A Koemans
- From the Department of Neurology (E.A.K., S.V., I.R., E.S.v.E., M.J.H.W., G.M.T.), Leiden University Medical Center, the Netherlands
| | - Sabine Voigt
- From the Department of Neurology (E.A.K., S.V., I.R., E.S.v.E., M.J.H.W., G.M.T.), Leiden University Medical Center, the Netherlands
| | - Ingeborg Rasing
- From the Department of Neurology (E.A.K., S.V., I.R., E.S.v.E., M.J.H.W., G.M.T.), Leiden University Medical Center, the Netherlands
| | - Ellis S van Etten
- From the Department of Neurology (E.A.K., S.V., I.R., E.S.v.E., M.J.H.W., G.M.T.), Leiden University Medical Center, the Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences (E.W.v.Z.), Leiden University Medical Center, the Netherlands
| | | | - Marieke J H Wermer
- From the Department of Neurology (E.A.K., S.V., I.R., E.S.v.E., M.J.H.W., G.M.T.), Leiden University Medical Center, the Netherlands
| | - Gisela M Terwindt
- From the Department of Neurology (E.A.K., S.V., I.R., E.S.v.E., M.J.H.W., G.M.T.), Leiden University Medical Center, the Netherlands
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15
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Greenberg SM, Bacskai BJ, Hernandez-Guillamon M, Pruzin J, Sperling R, van Veluw SJ. Cerebral amyloid angiopathy and Alzheimer disease - one peptide, two pathways. Nat Rev Neurol 2020; 16:30-42. [PMID: 31827267 PMCID: PMC7268202 DOI: 10.1038/s41582-019-0281-2] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/22/2022]
Abstract
The shared role of amyloid-β (Aβ) deposition in cerebral amyloid angiopathy (CAA) and Alzheimer disease (AD) is arguably the clearest instance of crosstalk between neurodegenerative and cerebrovascular processes. The pathogenic pathways of CAA and AD intersect at the levels of Aβ generation, its circulation within the interstitial fluid and perivascular drainage pathways and its brain clearance, but diverge in their mechanisms of brain injury and disease presentation. Here, we review the evidence for and the pathogenic implications of interactions between CAA and AD. Both pathologies seem to be driven by impaired Aβ clearance, creating conditions for a self-reinforcing cycle of increased vascular Aβ, reduced perivascular clearance and further CAA and AD progression. Despite the close relationship between vascular and plaque Aβ deposition, several factors favour one or the other, such as the carboxy-terminal site of the peptide and specific co-deposited proteins. Amyloid-related imaging abnormalities that have been seen in trials of anti-Aβ immunotherapy are another probable intersection between CAA and AD, representing overload of perivascular clearance pathways and the effects of removing Aβ from CAA-positive vessels. The intersections between CAA and AD point to a crucial role for improving vascular function in the treatment of both diseases and indicate the next steps necessary for identifying therapies.
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Affiliation(s)
- Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Brian J Bacskai
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeremy Pruzin
- Center for Alzheimer Research and Treatment, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa Sperling
- Center for Alzheimer Research and Treatment, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susanne J van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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16
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The Amyloid-Tau-Neuroinflammation Axis in the Context of Cerebral Amyloid Angiopathy. Int J Mol Sci 2019; 20:ijms20246319. [PMID: 31847365 PMCID: PMC6941131 DOI: 10.3390/ijms20246319] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is typified by the cerebrovascular deposition of amyloid. Currently, there is no clear understanding of the mechanisms underlying the contribution of CAA to neurodegeneration. Despite the fact that CAA is highly associated with the accumulation of Aβ, other types of amyloids have been shown to associate with the vasculature. Interestingly, in many cases, vascular amyloidosis has been associated with an active immune response and perivascular deposition of hyperphosphorylated tau. Despite the fact that in Alzheimer’s disease (AD) a major focus of research has been the understanding of the connection between parenchymal amyloid plaques, tau aggregates in the form of neurofibrillary tangles (NFTs), and immune activation, the contribution of tau and neuroinflammation to neurodegeneration associated with CAA remains understudied. In this review, we discussed the existing evidence regarding the amyloid diversity in CAA and its relation to tau pathology and immune response, as well as the possible contribution of molecular and cellular mechanisms, previously associated with parenchymal amyloid in AD and AD-related dementias, to the pathogenesis of CAA. The detailed understanding of the “amyloid-tau-neuroinflammation” axis in the context of CAA could open the opportunity to develop therapeutic interventions for dementias associated with CAA that are currently being proposed for AD and AD-related dementias.
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Schouten TM, de Vos F, van Rooden S, Bouts MJRJ, van Opstal AM, Feis RA, Terwindt GM, Wermer MJH, van Buchem MA, Greenberg SM, de Rooij M, Rombouts SARB, van der Grond J. Multiple Approaches to Diffusion Magnetic Resonance Imaging in Hereditary Cerebral Amyloid Angiopathy Mutation Carriers. J Am Heart Assoc 2019; 8:e011288. [PMID: 30717612 PMCID: PMC6405585 DOI: 10.1161/jaha.118.011288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/13/2018] [Indexed: 01/04/2023]
Abstract
Background Cerebral amyloid angiopathy ( CAA ) is a major cause of lobar intracerebral hemorrhage in elderly adults; however, presymptomatic diagnosis of CAA is difficult. Hereditary cerebral hemorrhage with amyloidosis-Dutch type ( HCHWA -D) is a rare autosomal-dominant disease that leads to pathology similar to sporadic CAA . Presymptomatic HCHWA -D mutation carriers provide a unique opportunity to study CAA -related changes before any symptoms have occurred. In this study we investigated early CAA -related alterations in the white matter. Methods and Results We investigated diffusion magnetic resonance imaging ( dMRI ) data for 15 symptomatic and 11 presymptomatic HCHWA -D mutation carriers and 30 noncarrier control participants using 4 different approaches. We looked at (1) the relation between age and global dMRI measures for mutation carriers versus controls, (2) voxel-wise d MRI , (3) independent component-clustered dMRI measures, and (4) structural connectomics between presymptomatic or symptomatic carriers and controls. Fractional anisotropy decreased, and mean diffusivity and peak width of the skeletonized mean diffusivity increased significantly over age for mutation carriers compared with controls. In addition, voxel-wise and independent component-wise fractional anisotropy, and mean diffusivity, and structural connectomics were significantly different between HCHWA -D patients and control participants, mainly in the periventricular frontal and occipital regions and in the occipital lobe. We found no significant differences between presymptomatic carriers and control participants. Conclusions The d MRI technique is sensitive in detecting alterations in symptomatic HCHWA -d carriers but did not show alterations in presymptomatic carriers. This result indicates that d MRI may be less suitable for identifying early white matter changes in CAA .
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Affiliation(s)
- Tijn M. Schouten
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
- Institute of PsychologyLeiden UniversityLeidenthe Netherlands
| | - Frank de Vos
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
- Institute of PsychologyLeiden UniversityLeidenthe Netherlands
| | - Sanneke van Rooden
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
| | - Mark J. R. J. Bouts
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
- Institute of PsychologyLeiden UniversityLeidenthe Netherlands
| | - Anna M. van Opstal
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Rogier A. Feis
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
| | - Gisela M. Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Mark A. van Buchem
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | - Mark de Rooij
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
- Institute of PsychologyLeiden UniversityLeidenthe Netherlands
| | - Serge A. R. B. Rombouts
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
- Institute of PsychologyLeiden UniversityLeidenthe Netherlands
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18
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Søndergaard CB, Nielsen JE, Hansen CK, Christensen H. Hereditary cerebral small vessel disease and stroke. Clin Neurol Neurosurg 2017; 155:45-57. [PMID: 28254515 DOI: 10.1016/j.clineuro.2017.02.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/31/2017] [Accepted: 02/20/2017] [Indexed: 12/31/2022]
Abstract
Cerebral small vessel disease is considered hereditary in about 5% of patients and is characterized by lacunar infarcts and white matter hyperintensities on MRI. Several monogenic hereditary diseases causing cerebral small vessel disease and stroke have been identified. The purpose of this systematic review is to provide a guide for determining when to consider molecular genetic testing in patients presenting with small vessel disease and stroke. CADASIL, CARASIL, collagen type IV mutations (including PADMAL), retinal vasculopathy with cerebral leukodystrophy, Fabry disease, hereditary cerebral hemorrhage with amyloidosis, and forkhead box C1 mutations are described in terms of genetics, pathology, clinical manifestation, imaging, and diagnosis. These monogenic disorders are often characterized by early-age stroke, but also by migraine, mood disturbances, vascular dementia and often gait disturbances. Some also present with extra-cerebral manifestations such as microangiopathy of the eyes and kidneys. Many present with clinically recognizable syndromes. Investigations include a thorough family medical history, medical history, neurological examination, neuroimaging, often supplemented by specific examinations e.g of the of vision, retinal changes, as well as kidney and heart function. However molecular genetic analysis is the final gold standard of diagnosis. There are increasing numbers of reports on new monogenic syndromes causing cerebral small vessel disease. Genetic counseling is important. Enzyme replacement therapy is possible in Fabry disease, but treatment options remain overall very limited.
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Affiliation(s)
| | - Jørgen Erik Nielsen
- Department of Cellular and Molecular Medicine, Section of Neurogenetics, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Denmark
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van Etten ES, Verbeek MM, van der Grond J, Zielman R, van Rooden S, van Zwet EW, van Opstal AM, Haan J, Greenberg SM, van Buchem MA, Wermer MJH, Terwindt GM. β-Amyloid in CSF: Biomarker for preclinical cerebral amyloid angiopathy. Neurology 2016; 88:169-176. [PMID: 27903811 DOI: 10.1212/wnl.0000000000003486] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate CSF biomarkers in presymptomatic and symptomatic mutation carriers with hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D), a model for sporadic cerebral amyloid angiopathy, and to determine the earliest deposited form of β-amyloid (Aβ). METHODS HCHWA-D mutation carriers and controls were enrolled in the cross-sectional EDAN (Early Diagnosis of Amyloid Angiopathy Network) study. The HCHWA-D group was divided into symptomatic carriers with a previous intracerebral hemorrhage and presymptomatic carriers. CSF concentrations of Aβ40, Aβ42, total tau, and phosphorylated tau181 proteins were compared to those of controls of a similar age. Correlations between CSF biomarkers, MRI markers, and age were investigated with multivariate linear regression analyses. RESULTS We included 10 symptomatic patients with HCHWA-D (mean age 55 ± 6 years), 5 presymptomatic HCHWA-D carriers (mean age 36 ± 13 years), 31 controls <50 years old (mean age 31 ± 7 years), and 50 controls ≥50 years old (mean age 61 ± 8 years). After correction for age, CSF Aβ40 and Aβ42 were significantly decreased in symptomatic carriers vs controls (median Aβ40 1,386 vs 3,867 ng/L, p < 0.001; median Aβ42 289 vs 839 ng/L, p < 0.001) and in presymptomatic carriers vs controls (median Aβ40 3,501 vs 4,684 ng/L, p = 0.011; median Aβ42 581 vs 1,058 ng/L, p < 0.001). Among mutation carriers, decreasing CSF Aβ40 was associated with higher lobar microbleed count (p = 0.010), increasing white matter hyperintensity volume (p = 0.008), and presence of cortical superficial siderosis (p = 0.02). CONCLUSIONS Decreased levels of CSF Aβ40 and Aβ42 occur before HCHWA-D mutation carriers develop clinical symptoms, implicating vascular deposition of both Aβ species as early steps in cerebral amyloid angiopathy pathogenesis. CSF Aβ40 and Aβ42 may serve as preclinical biomarkers of cerebral amyloid angiopathy pathology.
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Affiliation(s)
- Ellis S van Etten
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston.
| | - Marcel M Verbeek
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Jeroen van der Grond
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Ronald Zielman
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Sanneke van Rooden
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Erik W van Zwet
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Anna M van Opstal
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Joost Haan
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Mark A van Buchem
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Marieke J H Wermer
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
| | - Gisela M Terwindt
- From the Departments of Neurology (E.S.v.E., R.Z., J.H., M.J.H.W., G.M.T.), Radiology (J.v.d.G., S.v.R., A.M.v.O., M.A.v.B.), and Biostatistics (E.W.v.Z.), Leiden University Medical Center; Departments of Neurology and Laboratory Medicine (M.M.V.), Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen; Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands; and J. Philip Kistler Stroke Research Center (S.M.G.), Massachusetts General Hospital, Boston
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van Etten ES, Gurol ME, van der Grond J, Haan J, Viswanathan A, Schwab KM, Ayres AM, Algra A, Rosand J, van Buchem MA, Terwindt GM, Greenberg SM, Wermer MJH. Recurrent hemorrhage risk and mortality in hereditary and sporadic cerebral amyloid angiopathy. Neurology 2016; 87:1482-1487. [PMID: 27590282 DOI: 10.1212/wnl.0000000000003181] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/16/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D), a monogenetic disease model for the sporadic variant of amyloid angiopathy (sCAA), has a comparable recurrent intracerebral hemorrhage (ICH) risk and mortality after a first symptomatic ICH. METHODS We included patients with HCHWA-D from the Leiden University Medical Center and patients with sCAA from the Massachusetts General Hospital in a cohort study. Baseline characteristics, hemorrhage recurrence, and short- and long-term mortality were compared. Hazard ratios (HRs) adjusted for age and sex were calculated with Cox regression analyses. RESULTS We included 58 patients with HCHWA-D and 316 patients with sCAA. Patients with HCHWA-D had fewer cardiovascular risk factors (≥1 risk factor 24% vs 70% in sCAA) and were younger at the time of presenting hemorrhage (mean age 54 vs 72 years in sCAA). Eight patients (14%) with HCHWA-D and 46 patients (15%) with sCAA died before 90 days. During a mean follow-up time of 5 ± 4 years (total 1,550 person-years), the incidence rate of recurrent ICH in patients with HCHWA-D was 20.9 vs 8.9 per 100 person-years in sCAA. Patients with HCHWA-D had a long-term mortality of 8.2 vs 8.4 per 100 person-years in patients with sCAA. After adjustments, patients with HCHWA-D had a higher risk of recurrent ICH (HR 2.8; 95% confidence interval 1.6-4.9; p < 0.001) and a higher long-term mortality (HR 2.8; 95% confidence interval 1.5-5.2; p = 0.001). CONCLUSIONS Patients with HCHWA-D have worse long-term prognosis after a first ICH than patients with sCAA. The absence of cardiovascular risk factors in most patients with HCHWA-D suggests that vascular amyloid is responsible for the recurrent hemorrhages. HCHWA-D is therefore a pure form of cerebral amyloid angiopathy with an accelerated clinical course and provides a good model to study the pathophysiology and future therapeutic interventions of amyloid-related hemorrhages.
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Affiliation(s)
- Ellis S van Etten
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - M Edip Gurol
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jeroen van der Grond
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joost Haan
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristin M Schwab
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alison M Ayres
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ale Algra
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mark A van Buchem
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Gisela M Terwindt
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marieke J H Wermer
- From the Departments of Neurology (E.S.v.E., J.H., G.M.T., M.J.H.W.), Radiology (J.v.d.G., M.A.v.B.), and Clinical Epidemiology (A.A.), Leiden University Medical Center; Department of Neurology (J.H.), Alrijne Hospital; Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Hemorrhagic Stroke Research Program (M.E.G., A.V., K.M.S., A.M.A., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center; and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
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Klohs J, Deistung A, Ielacqua GD, Seuwen A, Kindler D, Schweser F, Vaas M, Kipar A, Reichenbach JR, Rudin M. Quantitative assessment of microvasculopathy in arcAβ mice with USPIO-enhanced gradient echo MRI. J Cereb Blood Flow Metab 2016; 36:1614-24. [PMID: 26661253 PMCID: PMC5010097 DOI: 10.1177/0271678x15621500] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/06/2015] [Indexed: 01/04/2023]
Abstract
Magnetic resonance imaging employing administration of iron oxide-based contrast agents is widely used to visualize cellular and molecular processes in vivo. In this study, we investigated the ability of [Formula: see text] and quantitative susceptibility mapping to quantitatively assess the accumulation of ultrasmall superparamagnetic iron oxide (USPIO) particles in the arcAβ mouse model of cerebral amyloidosis. Gradient-echo data of mouse brains were acquired at 9.4 T after injection of USPIO. Focal areas with increased magnetic susceptibility and [Formula: see text] values were discernible across several brain regions in 12-month-old arcAβ compared to 6-month-old arcAβ mice and to non-transgenic littermates, indicating accumulation of particles after USPIO injection. This was concomitant with higher [Formula: see text] and increased magnetic susceptibility differences relative to cerebrospinal fluid measured in USPIO-injected compared to non-USPIO-injected 12-month-old arcAβ mice. No differences in [Formula: see text] and magnetic susceptibility were detected in USPIO-injected compared to non-injected 12-month-old non-transgenic littermates. Histological analysis confirmed focal uptake of USPIO particles in perivascular macrophages adjacent to small caliber cerebral vessels with radii of 2-8 µm that showed no cerebral amyloid angiopathy. USPIO-enhanced [Formula: see text] and quantitative susceptibility mapping constitute quantitative tools to monitor such functional microvasculopathies.
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Affiliation(s)
- Jan Klohs
- Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Giovanna D Ielacqua
- Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland
| | - Aline Seuwen
- Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland
| | - Diana Kindler
- Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA MRI Clinical and Translational Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Markus Vaas
- Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Anja Kipar
- Laboratory for Animal Model Pathology, Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany Abbe School of Photonics, Friedrich Schiller University Jena, Jena, Germany Center of Medical Optics and Photonics, Friedrich Schiller University Jena, Jena, Germany Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Markus Rudin
- Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
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Osk Snorradottir A, Isaksson HJ, Kaeser SA, Skodras AA, Olafsson E, Palsdottir A, Thor Bragason B. Parenchymal cystatin C focal deposits and glial scar formation around brain arteries in Hereditary Cystatin C Amyloid Angiopathy. Brain Res 2015; 1622:149-62. [DOI: 10.1016/j.brainres.2015.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 01/07/2023]
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Conidi ME, Bernardi L, Puccio G, Smirne N, Muraca MG, Curcio SAM, Colao R, Piscopo P, Gallo M, Anfossi M, Frangipane F, Clodomiro A, Mirabelli M, Vasso F, Cupidi C, Torchia G, Di Lorenzo R, Mandich P, Confaloni A, Maletta RG, Bruni AC. Homozygous carriers of APP A713T mutation in an autosomal dominant Alzheimer disease family. Neurology 2015; 84:2266-73. [PMID: 25948718 DOI: 10.1212/wnl.0000000000001648] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/23/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report, for the first time, a large autosomal dominant Alzheimer disease (AD) family in which the APP A713T mutation is present in the homozygous and heterozygous state. To date, the mutation has been reported as dominant, and in the heterozygous state associated with familial AD and cerebrovascular lesions. METHODS The family described here has been genealogically reconstructed over 6 generations dating back to the 19th century. Plasma β-amyloid peptide was measured. Sequencing of causative AD genes was performed. RESULTS Twenty-one individuals, all but 1 born from 2 consanguineous unions, were studied: 8 were described as affected through history, 5 were studied clinically and genetically, and 8 were asymptomatic at-risk subjects. The A713T mutation was detected in the homozygous state in 3 patients and in the heterozygous state in 8 subjects (6 asymptomatic and 2 affected). CONCLUSIONS Our findings, also supported by the β-amyloid plasma assay, confirm (1) the pathogenic role of the APP A713T mutation, (2) the specific phenotype (AD with cerebrovascular lesions) associated with this mutation, and (3) the large span of age at onset, not influenced by APOE, TOMM40, and TREM2 genes. No substantial differences concerning clinical phenotype were evidenced between heterozygous and homozygous patients, in line with the classic definition of dominance. Therefore, in this study, AD followed the classic definition of a dominant disease, contrary to that reported in a previously described AD family with recessive APP mutation. This confirms that genetic AD may be considered a disease with dominant and recessive traits of inheritance.
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Affiliation(s)
- Maria E Conidi
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Livia Bernardi
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Gianfranco Puccio
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Nicoletta Smirne
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Maria G Muraca
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Sabrina A M Curcio
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Rosanna Colao
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Paola Piscopo
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Maura Gallo
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Maria Anfossi
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Francesca Frangipane
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Alessandra Clodomiro
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Maria Mirabelli
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Franca Vasso
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Chiara Cupidi
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Giusi Torchia
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Raffaele Di Lorenzo
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Paola Mandich
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Annamaria Confaloni
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Raffaele G Maletta
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy
| | - Amalia C Bruni
- From the Regional Neurogenetic Centre (M.E.C., L.B., G.P., N.S., M.G.M., S.A.M.C., R.C., M.G., M.A., F.F., A. Clodomiro, M.M., F.V., C.C., G.T., R.D.L., R.G.M., A.C.B.), ASP Catanzaro, Lamezia Terme; Department of Cell Biology and Neurosciences (P.P., A. Confaloni), National Institute of Health, Rome; and DINOGMI (P.M.), Università degli studi di Genova, Italy.
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Abstract
An increasing number of hereditary neurodegenerative diseases, including autosomal-dominant Alzheimer disease (AD), familial autosomal-dominant frontotemporal dementia (FTD), and heritable Lewy body disease (LBD) have been defined at the molecular level in recent years, making it possible to determine the genotype before the onset of symptoms. The identification of deterministic genes for these common adult-onset genetic diseases is moving the field of genetic counseling toward a new and challenging direction. With the identification of genes associated with AD and FTD, there is considerable interest in the clinical application of genetic information in genetic counseling and testing. Progress in the genetics of dementing disorders and the availability of clinical tests for practicing physicians therefore increases the need for a better understanding of the multifaceted issues associated with genetic testing. The aims of this systematic review are: (1) to underline the need to consider a genetic etiology of AD, FTD, and LBD; (2) to provide clinicians with information necessary to effectively translate genetic diagnosis into clinical practice; and (3) to highlight gaps and uncertainties in the field which will need to be addressed by future research.
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Greenberg SM, Al-Shahi Salman R, Biessels GJ, van Buchem M, Cordonnier C, Lee JM, Montaner J, Schneider JA, Smith EE, Vernooij M, Werring DJ. Outcome markers for clinical trials in cerebral amyloid angiopathy. Lancet Neurol 2014; 13:419-28. [PMID: 24581702 PMCID: PMC4085787 DOI: 10.1016/s1474-4422(14)70003-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Efforts are underway for early-phase trials of candidate treatments for cerebral amyloid angiopathy, an untreatable cause of haemorrhagic stroke and vascular cognitive impairment. A major barrier to these trials is the absence of consensus on measurement of treatment effectiveness. A range of potential outcome markers for cerebral amyloid angiopathy can be measured against the ideal criteria of being clinically meaningful, closely representative of biological progression, efficient for small or short trials, reliably measurable, and cost effective. In practice, outcomes tend either to have high clinical salience but low statistical efficiency, and thus more applicability for late-phase studies, or greater statistical efficiency but more limited clinical meaning. The most statistically efficient markers might be those that are potentially reversible with treatment, although their clinical significance remains unproven. Many of the candidate outcomes for cerebral amyloid angiopathy trials are probably applicable also to other small-vessel brain diseases.
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Affiliation(s)
- Steven M Greenberg
- Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Geert Jan Biessels
- Brain Centre Rudolf Magnus, University Medical Center of Utrecht, Utrecht, Netherlands
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Charlotte Cordonnier
- Department of Neurology, Universite Lille Nord de France EA 1046, Lille University Hospital, Lille, France
| | - Jin-Moo Lee
- Department of Neurology, Department of Radiology, and Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO, USA
| | - Joan Montaner
- Department of Neurology, Vall d'Hebron University Hospital and Research Institute, Autonomus University of Barcelona, Barcelona, Spain
| | - Julie A Schneider
- Department of Pathology and Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Meike Vernooij
- Department of Radiology and Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
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Kamp JA, Moursel LG, Haan J, Terwindt GM, Lesnik Oberstein SA, van Duinen SG, van Roon-Mom WM. Amyloid β in hereditary cerebral hemorrhage with amyloidosis-Dutch type. Rev Neurosci 2014; 25:641-51. [DOI: 10.1515/revneuro-2014-0008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/17/2014] [Indexed: 12/23/2022]
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Nicholson AM, Wold LA, Walsh DM, Ferreira A. β-Amyloid carrying the Dutch mutation has diverse effects on calpain-mediated toxicity in hippocampal neurons. Mol Med 2012; 18:178-85. [PMID: 22160219 DOI: 10.2119/molmed.2011.00366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/28/2011] [Indexed: 11/06/2022] Open
Abstract
Hereditary cerebral hemorrhage with amyloidosis-Dutch type is a disorder associated with a missense mutation (E693Q) in the β-amyloid (Aβ)-coding region of the amyloid precursor protein (APP). This familial disease is characterized by cognitive deficits secondary to intracerebral hemorrhage and, in some cases, progressive Alzheimer's disease (AD)-like dementia. Although this mutation was the first ever reported in the human APP gene, little is known about the molecular mechanisms underlying the direct toxic effects of this mutated Aβ on central neurons. In the present study, we assessed the role of calpain-mediated toxicity in such effects using an AD primary culture model system. Our results showed that Dutch mutant Aβ (E22Q) induced calpain-mediated cleavage of dynamin 1 and a significant decrease in synaptic contacts in mature hippocampal cultures. These synaptic deficits were similar to those induced by wild-type (WT) Aβ. In contrast, calpain-mediated tau cleavage leading to the generation of a 17-kDa neurotoxic fragment, as well as neuronal death, were significantly reduced in E22Q Aβ-treated neurons when compared with WT Aβ-treated ones. This complex regulation of the calpain-mediated toxicity pathway by E22Q Aβ could have some bearing in the pathobiology of this familial AD form.
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Affiliation(s)
- Alexandra M Nicholson
- Department of Cell and Molecular Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Hsu MJ, Sheu JR, Lin CH, Shen MY, Hsu CY. Mitochondrial mechanisms in amyloid beta peptide-induced cerebrovascular degeneration. Biochim Biophys Acta Gen Subj 2010; 1800:290-6. [DOI: 10.1016/j.bbagen.2009.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 08/06/2009] [Accepted: 08/11/2009] [Indexed: 01/19/2023]
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Wyatt A, Yerbury J, Poon S, Dabbs R, Wilson M. Chapter 6: The chaperone action of Clusterin and its putative role in quality control of extracellular protein folding. Adv Cancer Res 2010; 104:89-114. [PMID: 19878774 DOI: 10.1016/s0065-230x(09)04006-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The function(s) of clusterin may depend upon its topological location. A variety of intracellular "isoforms" of clusterin have been reported but further work is required to better define their identity. The secreted form of clusterin has a potent ability to inhibit both amorphous and amyloid protein aggregation. In the case of amorphous protein aggregation, clusterin forms stable, soluble high-molecular-weight complexes with misfolded client proteins. Clusterin expression is increased during many types of physiological and pathological stresses and is thought to function as an extracellular chaperone (EC). The pathology of a variety of serious human diseases is thought to arise as a consequence of the inappropriate aggregation of specific extracellular proteins (e.g., Abeta peptide in Alzheimer's disease and beta(2)-microglobulin in dialysis-related amyloidosis). We have proposed that together with other abundant ECs (e.g., haptoglobin and alpha(2)-macroglobulin), clusterin forms part of a previously unknown quality-control (QC) system for protein folding that mediates the recognition and disposal of extracellular misfolded proteins via receptor-mediated endocytosis and lysosomal degradation. Characterizing the mechanisms of this extracellular QC system will thus have major implications for our understanding of diseases of this type and may eventually lead to the development of new therapies.
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Affiliation(s)
- Amy Wyatt
- School of Biological Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia
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Revesz T, Holton JL, Lashley T, Plant G, Frangione B, Rostagno A, Ghiso J. Genetics and molecular pathogenesis of sporadic and hereditary cerebral amyloid angiopathies. Acta Neuropathol 2009; 118:115-30. [PMID: 19225789 PMCID: PMC2844092 DOI: 10.1007/s00401-009-0501-8] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 02/10/2009] [Accepted: 02/11/2009] [Indexed: 11/30/2022]
Abstract
In cerebral amyloid angiopathy (CAA), amyloid fibrils deposit in walls of arteries, arterioles and less frequently in veins and capillaries of the central nervous system, often resulting in secondary degenerative vascular changes. Although the amyloid-beta peptide is by far the commonest amyloid subunit implicated in sporadic and rarely in hereditary forms of CAA, a number of other proteins may also be involved in rare familial diseases in which CAA is also a characteristic morphological feature. These latter proteins include the ABri and ADan subunits in familial British dementia and familial Danish dementia, respectively, which are also known under the umbrella term BRI2 gene-related dementias, variant cystatin C in hereditary cerebral haemorrhage with amyloidosis of Icelandic-type, variant transthyretins in meningo-vascular amyloidosis, disease-associated prion protein (PrP(Sc)) in hereditary prion disease with premature stop codon mutations and mutated gelsolin (AGel) in familial amyloidosis of Finnish type. In this review, the characteristic morphological features of the different CAAs is described and the implication of the biochemical, genetic and transgenic animal data for the pathogenesis of CAA is discussed.
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Affiliation(s)
- Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, Queen Square, London WC1N3BG, UK.
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van Rooden S, van der Grond J, van den Boom R, Haan J, Linn J, Greenberg SM, van Buchem MA. Descriptive analysis of the Boston criteria applied to a Dutch-type cerebral amyloid angiopathy population. Stroke 2009; 40:3022-7. [PMID: 19556530 DOI: 10.1161/strokeaha.109.554378] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Validation of the Boston criteria for the in vivo diagnosis of cerebral amyloid angiopathy (CAA) is challenging, because noninvasive diagnostic tests do not exist. Hereditary cerebral hemorrhage with amyloidosis-Dutch type is an accepted monogenetic model of CAA and diagnosis can be made with certainty based on DNA analysis. The aim of this study was to analyze and refine the existing Boston criteria in patients with hereditary cerebral hemorrhage with amyloidosis-Dutch type. METHODS We performed T2*-weighted MRI in 27 patients with hereditary cerebral hemorrhage with amyloidosis-Dutch type to assess the presence and location of microbleeds, intracranial hemorrhages, and superficial siderosis. Using the Boston criteria, subjects were categorized as having: no hemorrhages, possible CAA, probable CAA, and hemorrhagic lesions not qualifying for CAA. The sensitivity of the Boston criteria was calculated separately using intracranial hemorrhages only and using intracranial hemorrhages and microbleeds. RESULTS The sensitivity of the Boston criteria for probable CAA increased from 48% to 63% when microbleeds were included. For symptomatic subjects only, the sensitivity was 100%. No hemorrhages were identified in the deep white matter, basal ganglia, thalamus, or brainstem. Superficial siderosis, observed in 6 patients, did not increase the sensitivity of the Boston criteria in our study group. CONCLUSIONS Our data show that using T2*-weighted MRI and including microbleeds increase the sensitivity of the Boston criteria. The exclusion of hemorrhages in the deep white matter, basal ganglia, thalamus, and brainstem does not lower the sensitivity of the Boston criteria.
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Affiliation(s)
- Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Kumar-Singh S. Hereditary and sporadic forms of abeta-cerebrovascular amyloidosis and relevant transgenic mouse models. Int J Mol Sci 2009; 10:1872-1895. [PMID: 19468344 PMCID: PMC2680652 DOI: 10.3390/ijms10041872] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 04/14/2009] [Accepted: 04/20/2009] [Indexed: 12/28/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) refers to the specific deposition of amyloid fibrils in the leptomeningeal and cerebral blood vessel walls, often causing secondary vascular degenerative changes. Although many kinds of peptides are known to be deposited as vascular amyloid, amyloid-beta (Abeta)-CAA is the most common type associated with normal aging, sporadic CAA, Alzheimer's disease (AD) and Down's syndrome. Moreover, Abeta-CAA is also associated with rare hereditary cerebrovascular amyloidosis due to mutations within the Abeta domain of the amyloid precursor protein (APP) such as Dutch and Flemish APP mutations. Genetics and clinicopathological studies on these familial diseases as well as sporadic conditions have already shown that CAA not only causes haemorrhagic and ischemic strokes, but also leads to progressive dementia. Transgenic mouse models based on familial AD mutations have also successfully reproduced many of the features found in human disease, providing us with important insights into the pathogenesis of CAA. Importantly, such studies have pointed out that specific vastopic Abeta variants or an unaltered Abeta42/Abeta40 ratio favor vascular Abeta deposition over parenchymal plaques, but higher than critical levels of Abeta40 are also observed to be anti-amyloidogenic. These data would be important in the development of therapies targeting amyloid in vessels.
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Affiliation(s)
- Samir Kumar-Singh
- Neurodegenerative Brain Diseases Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerpen - CDE, Universiteitsplein 1, B-2610, Antwerpen, Belgium; E-Mail:
; Tel. +3232651002; Fax: +3232651012
- Laboratory of Neurogenetics, Institute Born Bunge, University of Antwerp, Antwerpen, Belgium
- University of Antwerp, Antwerpen, Belgium
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Thal DR, Griffin WST, de Vos RAI, Ghebremedhin E. Cerebral amyloid angiopathy and its relationship to Alzheimer's disease. Acta Neuropathol 2008; 115:599-609. [PMID: 18369648 DOI: 10.1007/s00401-008-0366-2] [Citation(s) in RCA: 231] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 03/11/2008] [Accepted: 03/11/2008] [Indexed: 12/29/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by the deposition of the amyloid beta-protein (A beta) within cerebral vessels. The involvement of different brain areas in CAA follows a hierarchical sequence similar to that of Alzheimer-related senile plaques. Alzheimer's disease patients frequently exhibit CAA. The expansion of CAA in AD often shows the pattern of full-blown CAA. The deposition of A beta within capillaries distinguishes two types of CAA. One with capillary A beta-deposition is characterized by a strong association with the apolipoprotein E (APOE) epsilon 4 allele and by its frequent occurrence in Alzheimer's disease cases whereas the other one lacking capillary A beta-deposits is not associated with APOE epsilon 4. Capillary CAA can be seen in every stage of CAA or AD-related A beta-deposition. AD cases with capillary CAA show more widespread capillary A beta-deposition than non-demented cases as well as capillary occlusion. In a mouse model of CAA, capillary CAA was associated with capillary occlusion and cerebral blood flow disturbances. Thus, blood flow alterations with subsequent hypoperfusion induced by CAA-related capillary occlusion presumably point to a second mechanism in which A beta adversely affects the brain in AD in addition to its direct neurotoxic effects.
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Affiliation(s)
- Dietmar Rudolf Thal
- Laboratory of Neuropathology, Institute of Pathology, University of Ulm, Albert-Einstein-Allee 7, 89081 Ulm, Germany.
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Nishitsuji K, Tomiyama T, Ishibashi K, Kametani F, Ozawa K, Okada R, Maat-Schieman ML, Roos RAC, Iwai K, Mori H. Cerebral vascular accumulation of Dutch-type Abeta42, but not wild-type Abeta42, in hereditary cerebral hemorrhage with amyloidosis, Dutch type. J Neurosci Res 2008; 85:2917-23. [PMID: 17628026 DOI: 10.1002/jnr.21413] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hereditary cerebral hemorrhage with amyloidosis, Dutch type (HCHWA-D), is an autosomal dominant disorder caused by the Dutch mutation (E693Q) in the beta-amyloid precursor protein. This mutation produces an aberrant amyloid beta (Abeta) species (AbetaE22Q) and causes severe meningocortical vascular Abeta deposition. We analyzed the Abeta composition of the vascular amyloid in the brains of HCHWA-D patients. Immunohistochemistry demonstrated that the vascular amyloid contained both Abeta40 and Abeta42, with a high Abeta40/Abeta42 ratio. In Western blotting of cerebral microvessel fractions isolated from the brains, both wild-type and Dutch-type Abeta40 were observed as major species. Reverse-phase HPLC-mass spectrometric analysis of the fractions revealed both wild-type and Dutch-type Abeta38 as the other main components of the vascular amyloid. Moreover, we detected peaks corresponding to Dutch-type Abeta42 but not to wild-type Abeta42. These results suggest a pathogenic role for the mutant Abeta42 in addition to the mutant Abeta40 in the cerebral amyloid angiopathy of HCHWA-D.
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Affiliation(s)
- Kazuchika Nishitsuji
- Department of Neuroscience, Osaka City University Graduate School of Medicine, Osaka, Japan
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35
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Bai Y, Markham K, Chen F, Weerasekera R, Watts J, Horne P, Wakutani Y, Bagshaw R, Mathews PM, Fraser PE, Westaway D, St. George-Hyslop P, Schmitt-Ulms G. The in Vivo Brain Interactome of the Amyloid Precursor Protein. Mol Cell Proteomics 2008; 7:15-34. [DOI: 10.1074/mcp.m700077-mcp200] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Yerbury JJ, Poon S, Meehan S, Thompson B, Kumita JR, Dobson CM, Wilson MR. The extracellular chaperone clusterin influences amyloid formation and toxicity by interacting with prefibrillar structures. FASEB J 2007; 21:2312-22. [PMID: 17412999 DOI: 10.1096/fj.06-7986com] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clusterin is an extracellular chaperone present in all disease-associated extracellular amyloid deposits, but its roles in amyloid formation and protein deposition in vivo are poorly understood. The current study initially aimed to characterize the effects of clusterin on amyloid formation in vitro by a panel of eight protein substrates. Two of the substrates (Alzheimer's beta peptide and a PI3-SH3 domain) were then used in further experiments to examine the effects of clusterin on amyloid cytotoxicity and to probe the mechanism of clusterin action. We show that clusterin exerts potent effects on amyloid formation, the nature and extent of which vary greatly with the clusterin:substrate ratio, and provide evidence that these effects are exerted via interactions with prefibrillar species that share common structural features. Proamyloidogenic effects of clusterin appear to be restricted to conditions in which the substrate protein is present at a very large molar excess; under these same conditions, clusterin coincorporates with substrate protein into insoluble aggregates. However, when clusterin is present at much higher but still substoichiometric levels (e.g., a molar ratio of clusterin:substrate=1:10), it potently inhibits amyloid formation and provides substantial cytoprotection. These findings suggest that clusterin is an important element in the control of extracellular protein misfolding.
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Affiliation(s)
- Justin J Yerbury
- School of Biological Sciences, University of Wollongong, Wollongong, Australia
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37
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Abstract
Genetic predisposition to stroke has been proven in animal models and in humans. Unraveling the genetic factors that play a role in common stroke is very difficult, as the causation of stroke is multifactorial (a combination of environmental and genetic risk factors) and the genetic part is very complex (polygenic, multiple genes play a role). Many common risk factors for stroke like diabetes and arterial hypertension are partly inherited, so many genetic loci contribute more or less to the stroke phenotype. Recent knowledge is increased for monogenic forms of stroke, such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and the amyloid angiopathies. These disorders can serve as models to study environmental or genetic factors that contribute also to the common forms of stroke. Animal model of stroke can also provide valuable information on genetic factors involved in stroke predisposition. In this review, the focus lies on monogenic forms of stroke that can serve as models to study the more common phenotypes.
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Affiliation(s)
- Martijn Tonk
- Department of Neurology, Leiden University Medical Centre, The Netherlands
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Revesz T, Holton JL, Lashley T, Plant G, Rostagno A, Ghiso J, Frangione B. Sporadic and familial cerebral amyloid angiopathies. Brain Pathol 2006; 12:343-57. [PMID: 12146803 PMCID: PMC8095796 DOI: 10.1111/j.1750-3639.2002.tb00449.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is the term used to describe deposition of amyloid in the walls of arteries, arterioles and, less often, capillaries and veins of the central nervous system. CAAs are an important cause of cerebral hemorrhage and may also result in ischemic lesions and dementia. A number of amyloid proteins are known to cause CAA. The most common sporadic CAA, caused by A beta deposition, is associated with aging and is a common feature of Alzheimer disease (AD). CAA occurs in several familial conditions, including hereditary cerebral hemorrhage with amyloidosis of Icelandic type caused by deposition of mutant cystatin C, hereditary cerebral hemorrhage with amyloidosis Dutch type and familial AD with deposition of either A beta variants or wild-type A beta, the transthyretin-related meningo-vascular amyloidoses, gelsolin as well as familial prion disease-related CAAs and the recently described BRI2 gene-related CAAs in familial British dementia and familial Danish dementia. This review focuses on the morphological, biochemical, and genetic aspects as well as the clinical significance of CAAs with special emphasis on the BRI2 gene-related cerebrovascular amyloidoses. We also discuss data relevant to the pathomechanism of the different forms of CAA with an emphasis on the most common A beta-related types.
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Affiliation(s)
- Tamas Revesz
- Queen Square Brain Bank, Department of Molecular Pathogenesis, University College London, UK.
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Iwata A, Browne KD, Chen XH, Yuguchi T, Smith DH. Traumatic brain injury induces biphasic upregulation of ApoE and ApoJ protein in rats. J Neurosci Res 2006; 82:103-14. [PMID: 16118797 DOI: 10.1002/jnr.20607] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Apolipoproteins play an important role in cell repair and have been found to increase shortly after traumatic brain injury (TBI). In addition, apolipoproteins reduce amyloid-beta (Abeta) accumulation in models of Alzheimer's disease. Considering that TBI induces progressive neurodegeneration including Abeta accumulation, we explored potential long-term changes in the gene and protein expression of apolipoproteins E and J (ApoE and J) over 6 months after injury. Anesthetized male Sprague-Dawley rats were subjected to parasagittal fluid-percussion brain injury and their brains were evaluated at 2, 4, 7, 14 days, and 1 and 6 months after TBI. In situ hybridization, Western blot, and immunohistochemical analysis demonstrated that although there was a prolonged upregulation in both the gene expression and protein concentration of ApoE and J after injury, these responses were uncoupled. Upregulation of ApoE and J mRNA expression lasted from 4 days to 1 month after injury. In contrast, a biphasic increase in protein concentration and number of immunoreactive cells for ApoE and ApoJ was observed, initially peaking at 2 days (i.e., before increased mRNA expression), returning to baseline by 2 weeks and then gradually increasing through 6 months postinjury. In addition, ApoE and J were found to colocalize with Abeta accumulation in neurons and astrocytes at 1-6 months after injury. Collectively, these data suggest that ApoE and J play a role in the acute sequelae of brain trauma and reemerge long after the initial insult, potentially to modulate progressive neurodegenerative changes.
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Affiliation(s)
- Akira Iwata
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6316, USA
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40
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Palsdottir A, Snorradottir AO, Thorsteinsson L. Hereditary cystatin C amyloid angiopathy: genetic, clinical, and pathological aspects. Brain Pathol 2006; 16:55-9. [PMID: 16612982 PMCID: PMC8095917 DOI: 10.1111/j.1750-3639.2006.tb00561.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hereditary cystatin C amyloid angiopathy (HCCAA) is a rare, fatal amyloid disease in young people in Iceland caused by a mutation in cystatin C, which is an inhibitor of several cysteine proteinases, such as cathepsins S, B, and K. The same mutation in cystatin C, L68Q, has been found in all patients examined so far pointing to a common founder. Most of the families can be traced to a region in the northwest of Iceland, around Breidafjordur bay. Mutated cystatin C forms amyloid, predominantly in brain arteries and arterioles, but also to a lesser degree in tissues outside the central nervous system such as skin, lymph nodes, testis, spleen, submandibular salivary glands, and adrenal cortex. The amyloid deposition in the vessel walls causes thickening of the walls leading to occlusion or rupture and resulting in brain hemorrhage. Although the amyloid can be detected outside the brain, the clinical manifestation is restricted to the brain, and usually consists of repeated hemorrhages leading to paralysis. Sometimes the initial signs of hemorrhage are dementia and personality changes.
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Affiliation(s)
- A Palsdottir
- Institute for Experimental Pathology, Reykjavik, University of Iceland.
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Abstract
Background and Purpose—
This review considers the current state of knowledge of genetic factors underlying vascular cognitive impairment (VCI).
Summary of Review—
We argue here that genes conferring susceptibility to VCI must be of 2 nonmutually exclusive classes: (1) genes that confer susceptibility to cerebrovascular disease, and (2) genes that determine brain tissue responses to cerebrovascular disease (ie, render parenchymal tissue more or less susceptible to injury or able to repair itself after injury). Although some progress has been made in identifying genes of the first class, little has been done to explore genes of the second class. Evidence for the existence of such genes is presented. We discuss the advantages and disadvantages of different forms of cerebrovascular disease for studying these genes, and different study designs that might be used.
Conclusion—
The most critical challenge for genetic studies of VCI is to identify quantifiable phenotypes that can be reliably and effectively determined in large samples of subjects.
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Affiliation(s)
- Gabrielle G Leblanc
- The Neurogenetics Group, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA.
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42
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Herzig MC, Winkler DT, Burgermeister P, Pfeifer M, Kohler E, Schmidt SD, Danner S, Abramowski D, Stürchler-Pierrat C, Bürki K, van Duinen SG, Maat-Schieman MLC, Staufenbiel M, Mathews PM, Jucker M. Aβ is targeted to the vasculature in a mouse model of hereditary cerebral hemorrhage with amyloidosis. Nat Neurosci 2004; 7:954-60. [PMID: 15311281 DOI: 10.1038/nn1302] [Citation(s) in RCA: 290] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Accepted: 07/12/2004] [Indexed: 11/09/2022]
Abstract
The E693Q mutation in the amyloid beta precursor protein (APP) leads to cerebral amyloid angiopathy (CAA), with recurrent cerebral hemorrhagic strokes and dementia. In contrast to Alzheimer disease (AD), the brains of those affected by hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D) show few parenchymal amyloid plaques. We found that neuronal overexpression of human E693Q APP in mice (APPDutch mice) caused extensive CAA, smooth muscle cell degeneration, hemorrhages and neuroinflammation. In contrast, overexpression of human wild-type APP (APPwt mice) resulted in predominantly parenchymal amyloidosis, similar to that seen in AD. In APPDutch mice and HCHWA-D human brain, the ratio of the amyloid-beta40 peptide (Abeta40) to Abeta42 was significantly higher than that seen in APPwt mice or AD human brain. Genetically shifting the ratio of AbetaDutch40/AbetaDutch42 toward AbetaDutch42 by crossing APPDutch mice with transgenic mice producing mutated presenilin-1 redistributed the amyloid pathology from the vasculature to the parenchyma. The understanding that different Abeta species can drive amyloid pathology in different cerebral compartments has implications for current anti-amyloid therapeutic strategies. This HCHWA-D mouse model is the first to develop robust CAA in the absence of parenchymal amyloid, highlighting the key role of neuronally produced Abeta to vascular amyloid pathology and emphasizing the differing roles of Abeta40 and Abeta42 in vascular and parenchymal amyloid pathology.
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Affiliation(s)
- Martin C Herzig
- Department of Cellular Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, D-72076 Tübingen, Germany
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43
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Päiviö A, Jarvet J, Gräslund A, Lannfelt L, Westlind-Danielsson A. Unique Physicochemical Profile of β-Amyloid Peptide Variant Aβ1–40E22G Protofibrils: Conceivable Neuropathogen in Arctic Mutant Carriers. J Mol Biol 2004; 339:145-59. [PMID: 15123427 DOI: 10.1016/j.jmb.2004.03.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Revised: 02/11/2004] [Accepted: 03/12/2004] [Indexed: 11/19/2022]
Abstract
A new early-onset form of Alzheimer's disease (AD) was described recently where a point mutation was discovered in codon 693 of the beta-amyloid (Abeta) precursor protein gene, the Arctic mutation. The mutation translates into a single amino acid substitution, glutamic acid-->glycine, in position 22 of the Abeta peptide. The mutation carriers have lower plasma levels of Abeta than normal, while in vitro studies show that Abeta1-40E22G protofibril formation is significantly enhanced. We have explored the nature of the Abeta1-40E22G peptide in more detail, in particular the protofibrils. Using size-exclusion chromatography (SEC) and circular dichroism spectroscopy (CD) kinetic and secondary structural characteristics were compared with other Abeta1-40 peptides and the Abeta12-28 fragment, all having single amino acid substitutions in position 22. We have found that Abeta1-40E22G protofibrils are a group of comparatively stabile beta-sheet-containing oligomers with a heterogeneous size distribution, ranging from >100 kDa to >3000 kDa. Small Abeta1-40E22G protofibrils are generated about 400 times faster than large ones. Salt promotes their formation, which significantly exceeds all the other peptides studied here, including the Dutch mutation Abeta1-40E22Q. Position 22 substitutions had significant effects on aggregation kinetics of Abeta1-40 and in Abeta12-28, although the qualitative aspects of the effects differed between the native peptide and the fragment, as no protofibrils were formed by the fragments. The rank order of protofibril formation of Abeta1-40 and its variants was the same as the rank order of the length of the nucleation/lag phase of the Abeta12-28 fragments, E22V>E22A?E22G>E22Q?E22, and correlated with the degree of hydrophobicity of the position 22 substituent. The molecular mass of peptide monomers and protofibrils were estimated better in SEC studies using linear rather than globular calibration standards. The characteristics of the Abeta1-40E22G suggest an important role for the peptide in the neuropathogenesis in the Arctic form of AD.
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Affiliation(s)
- A Päiviö
- Department of NEUROTEC, Geriatric Medicine, Karolinska Institutet, Novum KFC, SE-141 86 Huddinge, Sweden
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44
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Bornebroek M, De Jonghe C, Haan J, Kumar-Singh S, Younkin S, Roos R, Van Broeckhoven C. Hereditary cerebral hemorrhage with amyloidosis Dutch type (AbetaPP 693): decreased plasma amyloid-beta 42 concentration. Neurobiol Dis 2004; 14:619-23. [PMID: 14678776 DOI: 10.1016/j.nbd.2003.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D) is a rare autosomal dominant disorder caused by an amyloid-beta precursor protein (AbetaPP) 693 mutation that clinically leads to recurrent hemorrhagic strokes and dementia. The disease is pathologically characterised by the deposition of Abeta in cerebral blood vessels and as plaques in the brain parenchyma. This study measured the Abeta40 and Abeta42 concentration in plasma of Dutch AbetaPP693 mutation carriers and controls. We found that the Abeta40 concentration was not different between AbetaPP693 mutation carriers and controls. However, the Abeta42 concentration was significantly decreased in the mutation carriers. No correlation exists between the APOE(epsilon)4 allele and the plasma of Abeta40 and Abeta42 levels in HCHWA-D patients. This finding contrasted with the increased concentrations found in Alzheimer's disease. Therefore it is suggested that the Dutch AbetaPP693 mutation located within the Abeta coding region of the AbetaPP gene has a different effect not only on clinical and pathological expression but also on Abeta processing.
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Affiliation(s)
- Marjolijn Bornebroek
- Department of Neurology K5Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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45
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Sanders A, Jeremy Craven C, Higgins LD, Giannini S, Conroy MJ, Hounslow AM, Waltho JP, Staniforth RA. Cystatin forms a Tetramer through Structural Rearrangement of Domain-swapped Dimers prior to Amyloidogenesis. J Mol Biol 2004; 336:165-78. [PMID: 14741212 DOI: 10.1016/j.jmb.2003.12.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The cystatins were the first amyloidogenic proteins to be shown to oligomerize through a 3D domain swapping mechanism. Here we show that, under conditions leading to the formation of amyloid deposits, the domain-swapped dimer of chicken cystatin further oligomerizes to a tetramer, prior to fibrillization. The tetramer has a very similar circular dichroism and fluorescence signature to the folded monomer and dimer structures, but exhibits some loss of dispersion in the 1H-NMR spectrum. 8-Anilino-1-naphthalene sulfonate fluorescence enhancement indicates an increase in the degree of disorder. While the dimerization reaction is bimolecular and most likely limited by the availability of a predominantly unfolded form of the monomer, the tetramerization reaction is first-order. The tetramer is formed slowly (t(1/2)=six days at 85 degrees C), dimeric cystatin is the precursor to tetramer formation, and thus the rate is limited by structural rearrangement within the dimer. Some higher-order oligomerization events parallel tetramer formation while others follow from the tetrameric form. Thus, the tetramer is a transient intermediate within the pathway of large-scale oligomerization.
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Affiliation(s)
- Anna Sanders
- Department of Molecular Biology and Biotechnology, University of Sheffield, Firth Court, Western Bank, Sheffield S10 2TN, UK
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46
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Revesz T, Ghiso J, Lashley T, Plant G, Rostagno A, Frangione B, Holton JL. Cerebral Amyloid Angiopathies: A Pathologic, Biochemical, and Genetic View. J Neuropathol Exp Neurol 2003; 62:885-98. [PMID: 14533778 DOI: 10.1093/jnen/62.9.885] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Amyloid deposition can take place in the walls of arteries, arterioles, and, less often, capillaries and veins of the central nervous system, a phenomenon known as cerebral amyloid angiopathy (CAA). The major clinicopathological manifestations of CAA include cerebral hemorrhage, ischemic lesions, and dementia. CAA may be classified according to the amyloid protein deposited. In the most common form, sporadic CAA, and in CAA related to sporadic Alzheimer disease (AD). A beta deposition is characteristic. CAA can also be severe in variants of familial AD caused by mutations of the amyloid-beta precursor protein or presenilin-1 genes in which deposition of A beta variants and/or wild-type A beta occurs. Other amyloid proteins involved in familial CAAs include 1) the mutant cystatin C (ACys) in hereditary cerebral hemorrhage with amyloidosis of Icelandic type, 2) variant transthyretins (ATTR) in meningo-vascular amyloidoses, 3) mutated gelsolin (AGel) in familial amyloidosis of Finnish type, 4) disease-associated prion protein (PrP(Sc)) in a variant of the Gerstmann-Sträussler-Scheinker syndrome, and 5) ABri and ADan in CAAs observed in the recently described BRI2 gene-related dementias, familial British dementia and familial Danish dementia, respectively. This review addresses issues related to the correlation between morphology, biochemistry, and genetics, and briefly discusses both the pathogenesis and animal models of CAAs.
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Affiliation(s)
- Tamas Revesz
- Queen Square Brain Bank, Department of Molecular Neuroscience and Division of Neuropathology, Institute of Neurology, University College London, London, United Kingdom.
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47
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Kumar-Singh S, Julliams A, Nuydens R, Ceuterick C, Labeur C, Serneels S, Vennekens K, Van Osta P, Geerts H, De Strooper B, Van Broeckhoven C. In vitro studies of Flemish, Dutch, and wild-type beta-amyloid provide evidence for two-staged neurotoxicity. Neurobiol Dis 2002; 11:330-40. [PMID: 12505425 DOI: 10.1006/nbdi.2002.0529] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mutations in the beta-amyloid (Abeta) sequence of the amyloid precursor protein gene (APP) present with variable disease phenotypes. While patients with the Dutch APP mutation (E693Q) have predominantly hemorrhagic strokes, Flemish APP (A692G) patients develop both strokes and Alzheimer's disease (AD). To determine whether these diverse clinical and pathological presentations are due to mutant Abeta or APP, we studied the effect of Flemish, Dutch, and wild-type Abeta/APP on phosphorylation of specific tau epitopes observed in AD. No effect was observed in differentiated SH-SY5Y cells either stably expressing APP or treated with synthetic Abeta(12-42). However, we did observe a paradoxical temporal difference in the neurotoxic potential of mutant and wild-type Abeta. While long 24-h incubation at physiological levels of Abeta (2 microM) showed a higher amount of apoptosis for Dutch Abeta, a short 2-h incubation showed elevated apoptosis for Flemish and wild-type Abeta. The altered aggregating properties of Abeta, with Dutch Abeta aggregating faster and Flemish Abeta slower than wild type, elucidated a discrete two-phase Abeta neurotoxicity. We propose here that, at least in vitro, Abeta might be neurotoxic in an initial phase due to its soluble oligomeric or other early toxic Abeta intermediate(s), which is perhaps distinct from the late neurotoxicity incurred by aggregated larger assemblies of Abeta.
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Affiliation(s)
- Samir Kumar-Singh
- Department of Molecular Genetics, Flanders Interuniversity Institute for Biotechnology, Born-Bunge Foundation, University of Antwerp, B-2610 Antwerp, Belgium
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48
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Olson JM, Goddard KAB, Dudek DM. A second locus for very-late-onset Alzheimer disease: a genome scan reveals linkage to 20p and epistasis between 20p and the amyloid precursor protein region. Am J Hum Genet 2002; 71:154-61. [PMID: 12016588 PMCID: PMC384972 DOI: 10.1086/341034] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2002] [Accepted: 04/01/2002] [Indexed: 11/03/2022] Open
Abstract
We used a covariate-based linkage method to reanalyze genome scan data from affected sibships collected by the Alzheimer Disease (AD) Genetics Initiative of the National Institute of Mental Health. As reported in an earlier article, the amyloid-beta precursor protein (APP) region is strongly linked to affected sib pairs of the oldest current age (i.e., age either at last exam or at death) who lack E4 alleles at the apolipoprotein E (ApoE) locus. We now report that a region on 20p shows the same pattern. A model that includes current age and the number of E2 alleles as covariates gives a LOD score of 4.1. The signal on 20p is near the location of the gene coding for cystatin-C, previously shown to be associated with late-onset AD and to codeposit with APP in the brains of patients with AD. Two-locus analysis provides evidence of strong epistasis between 20p and the APP region, limited to the oldest age group and to those lacking ApoE4 alleles. We speculate that high-risk polymorphisms in both regions produce a biological interaction between these two proteins that increases susceptibility to a very-late-onset form of AD.
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Affiliation(s)
- Jane M Olson
- Department of Epidemiology and Biostatistics, Rammelkamp Center for Education and Research, MetroHealth Campus, Case Western Reserve University, Cleveland, OH 44109-1998, USA.
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49
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de Leeuw FE, de Groot JC, Oudkerk M, Witteman JCM, Hofman A, van Gijn J, Breteler MMB. Hypertension and cerebral white matter lesions in a prospective cohort study. Brain 2002; 125:765-72. [PMID: 11912110 DOI: 10.1093/brain/awf077] [Citation(s) in RCA: 384] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
White matter lesions are frequently found on cerebral MRI scans of elderly people and are thought to be important in the pathogenesis of dementia. Hyper tension has been associated with the presence of white matter lesions but this has been investigated almost exclusively in cross-sectional studies. We studied prospectively the association of these lesions with the duration and treatment of hypertension. We randomly sampled 1077 subjects aged between 60 and 90 years from two prospective population-based studies. One-half of the study subjects had their blood pressure measured between 1975 and 1978 and the other half between 1990 and 1993. All subjects underwent 1.5 T MRI scanning; white matter lesions in the subcortical and periventricular regions were rated separately. Subjects with hypertension had increased rates of both types of white matter lesion. Duration of hypertension was associated with both periventricular and subcortical white matter lesions. This relationship was influenced strongly by age. For participants with >20 years of hypertension and aged between 60 and 70 years at the time of follow-up, the relative risks for subcortical and periventricular white matter lesions were 24.3 [95% confidence interval (CI) 5.1-114.8] and 15.8 (95% CI 3.4-73.5), respectively, compared with normotensive subjects. Subjects with successfully treated hypertension had only moderately increased rates of subcortical white matter lesions and periventricular white matter lesions (relative risk 3.3, 95% CI 1.3-8.4 and 2.6, 95% CI 1.0-6.8, respectively) compared with normotensive subjects. For poorly controlled hypertensives, these relative risks were 8.4 (95% CI 3.1-22.6) and 5.8 (95% CI 2.1-16.0), respectively. In conclusion, we found a relationship between long-standing hypertension and the presence of white matter lesions. Our findings are consistent with the view that effective treatment may reduce the rates of both types of white matter lesion. Adequate treatment of hypertension may therefore prevent white matter lesions and the associated cognitive decline.
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Affiliation(s)
- F-E de Leeuw
- Department of Epidemiology and Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Natté R, Maat-Schieman ML, Haan J, Bornebroek M, Roos RA, van Duinen SG. Dementia in hereditary cerebral hemorrhage with amyloidosis-Dutch type is associated with cerebral amyloid angiopathy but is independent of plaques and neurofibrillary tangles. Ann Neurol 2001; 50:765-72. [PMID: 11761474 DOI: 10.1002/ana.10040] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cerebral amyloid angiopathy is frequently found in demented and nondemented elderly persons, but its contribution to the causation of dementia is unknown. Therefore, we investigated the relation between the amount of cerebral amyloid angiopathy and the presence of dementia in 19 patients with hereditary cerebral hemorrhage with amyloidosis-Dutch type. The advantage of studying hereditary cerebral hemorrhage in amyloidosis-Dutch type is that patients with this disease consistently have severe cerebral amyloid angiopathy with minimal neurofibrillary pathology. The amount of cerebral amyloid angiopathy, as quantified by computerized morphometry, was strongly associated with the presence of dementia independent of neurofibrillary pathology, plaque density, or age. The number of cortical amyloid beta-laden severely stenotic vessels, vessel-within-vessel configurations, and cerebral amyloid angiopathy-associated microvasculopathies was associated with the amount of cerebral amyloid angiopathy and dementia. A semiquantitative score, based on the number of amyloid beta-laden severely stenotic vessels, completely separated demented from nondemented patients. These results suggest that extensive (more than 15 amyloid beta-laden severely stenotic vessels in five frontal cortical sections) cerebral amyloid angiopathy alone is sufficient to cause dementia in hereditary cerebral hemorrhage with amyloidosis-Dutch type. This may have implications for clinicopathological correlations in Alzheimer's disease and other dementias with cerebral amyloid angiopathy.
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Affiliation(s)
- R Natté
- Department of Neurology, Leiden University Medical Center, The Netherlands.
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