1
|
Watanabe M, Nakamura K, Saito R, Takeuchi A, Takahashi T, Kitamoto T, Onodera O, Kakita A. V180I genetic Creutzfeldt-Jakob disease: Severe degeneration of the inferior olivary nucleus in an autopsied patient with identification of the M2T prion strain. Neuropathology 2023; 43:479-485. [PMID: 37165430 DOI: 10.1111/neup.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/12/2023]
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) with a V180I mutation (V180I gCJD) is the most common type of gCJD in Japan, characterized by an older age at onset, slower progression, and moderate to severe cortical degeneration with spongiform changes and sparing of the brainstem and cerebellum. Degeneration of the inferior olivary nucleus (IO) is rarely observed in patients with CJD but is known to occur in fatal familial insomnia (FFI) and MM2-thalamic-type sporadic CJD (sCJD-MM2T) involving type 2 prion protein (M2T prion). Here we report on an 81-year-old Japanese woman who initially developed depressive symptoms followed by progressive cognitive impairment, myoclonus, and hallucinations and died after a clinical course of 23 months. Insomnia was not evident. Genetic analysis of the prion protein (PrP) identified a V180I mutation with methionine/valine heterozygosity at codon 129. Pathologic analysis demonstrated extensive spongiform degeneration, neuronal loss in the cortices, and weak synaptic-type PrP deposition. Except for IO degeneration, the clinicopathologic features and Western blotting PrP band pattern were compatible with those of previously reported V180I gCJD cases. Quantitative analysis revealed that the neuronal density of the IO, especially in the dorsal area, was considerably reduced to the same extent as that of a patient with sCJD-MM2T but preserved in other patients with V180I gCJD and sCJD-MM1 (this patient, 2.3 ± 0.53/mm2 ; a patient with sCJD-MM2T, 4.2 ± 2; a patient with V180I gCJD, 60.5 ± 9.3; and a patient with sCJD-MM1, 84.5 ± 17.9). Use of the protein misfolding cyclic amplification (PMCA) method confirmed the presence of the M2T prion strain, suggesting that the latter might be associated with IO degeneration in V180I gCJD. Autopsy studies are necessary to better understand the nature of CJD, since even if patients present with the common clinical picture, pathologic analysis might provide new insights, as was the case here.
Collapse
Affiliation(s)
- Midori Watanabe
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
- Undergraduate Course, Niigata University School of Medicine, Niigata, Japan
| | - Kosei Nakamura
- Department of Neurology, NHO Nishiniigata Chuo Hospital, Niigata, Japan
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Rie Saito
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Atsuko Takeuchi
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Takahashi
- Department of Neurology, NHO Nishiniigata Chuo Hospital, Niigata, Japan
| | - Tetsuyuki Kitamoto
- Department of Neurological Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| |
Collapse
|
2
|
Matsubayashi T, Sanjo N. Systematic Review of Clinical and Pathophysiological Features of Genetic Creutzfeldt-Jakob Disease Caused by a Val-to-Ile Mutation at Codon 180 in the Prion Protein Gene. Int J Mol Sci 2022; 23:15172. [PMID: 36499498 PMCID: PMC9737045 DOI: 10.3390/ijms232315172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) is a subtype of genetic prion diseases (gPrDs) caused by the accumulation of mutated pathological prion proteins (PrPSc). gCJD has a phenotypic similarity with sporadic CJD (sCJD). In Japan, gCJD with a Val to Ile substitution at codon 180 (V180I-gCJD) is the most frequent gPrD, while the mutation is extremely rare in countries other than Japan and Korea. In this article, we aim to review previously elucidated clinical and biochemical features of V180I-gCJD, expecting to advance the understanding of this unique subtype in gCJD. Compared to classical sCJD, specific clinical features of V180I-gCJD include older age at onset, a relatively slow progression of dementia, and a lower positivity for developing myoclonus, cerebellar, pyramidal signs, and visual disturbance. Diffuse edematous ribboning hyperintensity of the cerebral cortex, without occipital lobes in diffusion-weighted magnetic resonance imaging, is also specific. Laboratory data reveal the low positivity of PrPSc in the cerebrospinal fluid and periodic sharp wave complexes on an electroencephalogram. Most patients with V180I-gCJD have been reported to have no family history, probably due to the older age at onset, and clinical and biochemical features indicate the specific phenotype associated with the prion protein gene mutation.
Collapse
Affiliation(s)
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan
| |
Collapse
|
3
|
Kunieda K, Hayashi Y, Yamada M, Waza M, Yaguchi T, Fujishima I, Shimohata T. Serial evaluation of swallowing function in a long-term survivor of V180I genetic Creutzfeldt-Jakob disease. Prion 2021; 14:180-184. [PMID: 32627665 PMCID: PMC7518740 DOI: 10.1080/19336896.2020.1787090] [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: 11/06/2022] Open
Abstract
Swallowing function in long-term survivors with Creutzfeldt-Jakob disease (CJD) remains unknown. Herein, we demonstrated serial evaluation of swallowing function in a case with V180I genetic CJD (gCJD) using videofluoroscopic examination of swallowing (VF). A 69-year-old woman was admitted to our hospital because of bradykinesia and memory disturbances 4 months after the onset of symptoms. Neurological examination revealed dementia, bradykinesia and frontal signs. Diffusion-weighted MRI revealed bilateral cortical hyperintensity in the frontal, temporal, and parietal cortices, and PRNP gene analysis indicated a V180I mutation. Her dysphagia gradually progressed, and she received percutaneous gastrostomy 42 months after the onset. VF was performed at 27, 31, 39, and 79 months after the onset. Although bolus transport from oral cavity to pharynx gradually worsened and initiation of the pharyngeal swallow was gradually delayed, the pharyngeal swallowing function was preserved even at 72 months after onset. MRI revealed no apparent atrophy of brainstem, and single photon emission computed tomography showed preserved regional cerebral blood flow in the brainstem. These findings suggest that the pathophysiology of dysphagia in a long-term survivor of V180I gCJD is that of pseudobulbar palsy, likely owing to preserved brainstem function even in the akinetic mutism state.
Collapse
Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan.,Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital , Shizuoka, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Megumi Yamada
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Masahiro Waza
- Department of Neurology, Kakamigahara Rehabilitation Hospital , Kakamigahara, Japan
| | - Tomonori Yaguchi
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital , Shizuoka, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine , Gifu, Japan
| |
Collapse
|
4
|
Tokumaru AM, Saito Y, Murayma S. Diffusion-Weighted Imaging is Key to Diagnosing Specific Diseases. Magn Reson Imaging Clin N Am 2021; 29:163-183. [PMID: 33902901 DOI: 10.1016/j.mric.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article reviews diseases for which persistent signal abnormalities on diffusion-weighted imaging are the key to their diagnosis. Specifically, updated knowledge regarding the neuroimaging patterns of the following diseases is summarized: sporadic Creutzfeldt-Jakob disease, neuronal intranuclear inclusion disease, and hereditary diffuse leukoencephalopathy with axonal spheroids-colony-stimulating factor receptors/adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. In addition, their differential diagnoses; clinical manifestations; and pathologic, genetic, and imaging correlates are discussed.
Collapse
Affiliation(s)
- Aya Midori Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Yuko Saito
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shigeo Murayma
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka-fu 565-0871, Japan
| |
Collapse
|
5
|
Nomura T, Iwata I, Naganuma R, Matsushima M, Satoh K, Kitamoto T, Yabe I. A patient with spastic paralysis finally diagnosed as V180I genetic Creutzfeldt-Jakob disease 9 years after onset. Prion 2020; 14:226-231. [PMID: 32938301 PMCID: PMC7518757 DOI: 10.1080/19336896.2020.1823179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 12/03/2022] Open
Abstract
Genetic Creutzfeldt-Jakob disease (gCJD) with a mutation in codon 180 of the prion protein gene (V180I gCJD) is the most common form of gCJD in Japan, but only a few cases have been reported in Europe and the United States. It is clinically characterized by occurring in the elderly and presenting as slowly progressive dementia, although it generally shows less cerebellar and pyramidal symptoms than sporadic CJD. Here, we report a patient with V180I gCJD who initially presented with slowly progressive spastic paralysis with neither cerebrospinal fluid (CSF) nor magnetic resonance imaging (MRI) abnormalities. His symptoms progressed gradually, and after 9 years, he displayed features more typical of CJD. Diffusion-weighted MRI revealed high-intensity signals in the cortical gyrus, and there was a marked increase of 14-3-3 protein and total tau protein in the CSF, but he was negative for the real-time quaking-induced conversion assay. Although the time course was more consistent with Gerstmann-Sträussler-Scheinker disease than CJD, genetic testing revealed V180I gCJD. This is the first report of a patient with V180I gCJD who initially presented with spastic paralysis, and also the first to reveal that it took 9 years from disease onset for cortical dysfunction to develop and for MRI and CSF abnormalities to be detectable. In conclusion, we should screen for V180I gCJD in elderly patients presenting with slowly progressive spastic paralysis.
Collapse
Affiliation(s)
- Taichi Nomura
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ikuko Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ryoji Naganuma
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Katsuya Satoh
- Department of Molecular Microbiology and Immunology, Graduate School of Biomedical Sciences Nagasaki University, Nagasaki, Japan
| | - Tetsuyuki Kitamoto
- Center for Prion Diseases, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
6
|
Hayashi Y, Iwasaki Y, Waza M, Kato S, Akagi A, Kimura A, Inuzuka T, Satoh K, Kitamoto T, Yoshida M, Shimohata T. Clinicopathological findings of a long-term survivor of V180I genetic Creutzfeldt-Jakob disease. Prion 2020; 14:109-117. [PMID: 32178563 PMCID: PMC7153845 DOI: 10.1080/19336896.2020.1739603] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The clinical characteristics of genetic Creutzfeldt-Jakob disease (gCJD) with a V180I mutation in the PRNP gene (V180I gCJD) are unique: elderly-onset, gradual progression, sporadic fashion, and cortical oedematous hyper-intensity on diffusion-weighted MRI (DW-MRI). This phenotype may become a potential target of future clinical therapeutic trials. The average disease duration of V180I gCJD patients is 23–27 months; however, considerably long-term survivors are also reported. The factors influencing survival and the clinicopathological characteristics of long-term survivors remain unknown. Herein, we report clinicopathological findings of a long-term survivor of V180I gCJD. A 78-year old woman was admitted to our hospital due to dementia and left hand tremor approximately 1.5 months after symptom onset. Neurological examination revealed dementia, frontal signs, and left hand tremor at admission. She had no family history of dementia or other neurological disease. DW-MRI revealed cortical oedematous hyper-intensities in the bilateral frontal lobes and the right temporal and parietal lobes. PRNP gene analysis indicated a V180I mutation with methionine homozygosity at codon 129. The symptoms gradually progressed, and she died of aspiration pneumonia 61 months after symptom onset. Neuropathological examination revealed severe cerebral atrophy with moderate to severe gliosis, but the brainstem was well preserved. Various-sized and non-confluent vacuole type spongiform changes were extensively observed in the cerebral cortices. Prion protein (PrP) immunostaining revealed weak and synaptic-type PrP deposits in the cerebral cortices. We consider that long-term tube feeding, and very mild brainstem involvement may be associated with the long-term survival of our V180I gCJD patient.
Collapse
Affiliation(s)
- Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasushi Iwasaki
- Autopsy Center of Prion Disease, Institute for Medical Sciences of Aging, Aichi Medical University, Nagakute, Japan
| | - Masahiro Waza
- Department of Neurology, Kakamigahara Rehabilitation Hospital, Kakamigahara, Japan
| | - Shinei Kato
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akio Akagi
- Autopsy Center of Prion Disease, Institute for Medical Sciences of Aging, Aichi Medical University, Nagakute, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Inuzuka
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Neurology, Gifu Municipal Hospital, Gifu, Japan
| | - Katsuya Satoh
- Department of Locomotive Rehabilitation Sciences, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Tetsuyuki Kitamoto
- Division of CJD Science and Technology, Department of Prion Research, Center for Translational and Advanced Animal Research on Human Diseases, Tohoku University School of Medicine, Sendai, Japan
| | - Mari Yoshida
- Autopsy Center of Prion Disease, Institute for Medical Sciences of Aging, Aichi Medical University, Nagakute, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
7
|
Tomizawa Y, Taniguchi D, Furukawa Y. Genetic Creutzfeldt-Jakob disease mimicking dementia with Lewy bodies: Clinical and radiological findings. J Neurol Sci 2020; 409:116604. [PMID: 31805431 DOI: 10.1016/j.jns.2019.116604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Yuji Tomizawa
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daisuke Taniguchi
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiaki Furukawa
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
| |
Collapse
|
8
|
Iwasaki Y, Mori K, Ito M, Kawai Y. A case of V180I genetic Creutzfeldt-Jakob disease presenting with conspicuous facial mimicry. Prion 2019; 13:151-155. [PMID: 31387445 PMCID: PMC6746545 DOI: 10.1080/19336896.2019.1651181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Although there have been no reports of facial mimicry in patients with Creutzfeldt-Jakob disease (CJD), we encountered a patient with genetic CJD with prion protein gene codon 180 mutation (V180I gCJD) who apparently showed this interesting clinical finding. The patient was an 87-year-old Japanese woman, and the first observed CJD symptom was poor spontaneity. She gradually showed cognitive dysfunction and subsequently gait disturbance. A prion protein gene analysis revealed a V180I mutation with methionine homozygosity at codon 129. Facial mimicry was observed 7 months after disease onset and continued for approximately 9 months. Pathological laughing and startle reaction were also observed during approximately the same period, whereas myoclonus was observed at a later stage, 12 months after disease onset, and was very mild in degree. Electroencephalography studies showed a diffuse slow basic pattern without periodic sharp wave complexes. Diffusion-weighted magnetic resonance imaging showed extensive hyperintensity in the cerebral cortex, and there was also hyperintensity with edematous swelling in the same regions on T2-weighted and fluid-attenuated inversion recovery images. On the basis of the magnetic resonance imaging findings and the findings of previous case reports of V180I gCJD, we speculate that the characteristic extensive cerebrocortical involvement observed in V180I gCJD was implicated in the pathogenesis of the facial mimicry observed in this case.
Collapse
Affiliation(s)
- Yasushi Iwasaki
- a Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University , Nagakute , Japan.,b Department of Neurology, Oyamada Memorial Spa Hospital , Yokkaichi , Japan
| | - Keiko Mori
- b Department of Neurology, Oyamada Memorial Spa Hospital , Yokkaichi , Japan
| | - Masumi Ito
- b Department of Neurology, Oyamada Memorial Spa Hospital , Yokkaichi , Japan
| | - Yoshinari Kawai
- b Department of Neurology, Oyamada Memorial Spa Hospital , Yokkaichi , Japan
| |
Collapse
|
9
|
Baiardi S, Rossi M, Capellari S, Parchi P. Recent advances in the histo-molecular pathology of human prion disease. Brain Pathol 2019; 29:278-300. [PMID: 30588685 DOI: 10.1111/bpa.12695] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Prion diseases are progressive neurodegenerative disorders affecting humans and other mammalian species. The term prion, originally put forward to propose the concept that a protein could be infectious, refers to PrPSc , a misfolded isoform of the cellular prion protein (PrPC ) that represents the pathogenetic hallmark of these disorders. The discovery that other proteins characterized by misfolding and seeded aggregation can spread from cell to cell, similarly to PrPSc , has increased interest in prion diseases. Among neurodegenerative disorders, however, prion diseases distinguish themselves for the broader phenotypic spectrum, the fastest disease progression and the existence of infectious forms that can be transmitted through the exposure to diseased tissues via ingestion, injection or transplantation. The main clinicopathological phenotypes of human prion disease include Creutzfeldt-Jakob disease, by far the most common, fatal insomnia, variably protease-sensitive prionopathy, and Gerstmann-Sträussler-Scheinker disease. However, clinicopathological manifestations extend even beyond those predicted by this classification. Because of their transmissibility, the phenotypic diversity of prion diseases can also be propagated into syngenic hosts as prion strains with distinct characteristics, such as incubation period, pattern of PrPSc distribution and regional severity of histopathological changes in the brain. Increasing evidence indicates that different PrPSc conformers, forming distinct ordered aggregates, encipher the phenotypic variants related to prion strains. In this review, we summarize the most recent advances concerning the histo-molecular pathology of human prion disease focusing on the phenotypic spectrum of the disease including co-pathologies, the characterization of prion strains by experimental transmission and their correlation with the physicochemical properties of PrPSc aggregates.
Collapse
Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| |
Collapse
|