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Giusto E, Maistrello L, Iannotta L, Giusti V, Iovino L, Bandopadhyay R, Antonini A, Bubacco L, Barresi R, Plotegher N, Greggio E, Civiero L. Prospective Role of PAK6 and 14-3-3γ as Biomarkers for Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:495-506. [PMID: 38640169 DOI: 10.3233/jpd-230402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Parkinson's disease is a progressive neurodegenerative disorder mainly distinguished by sporadic etiology, although a genetic component is also well established. Variants in the LRRK2 gene are associated with both familiar and sporadic disease. We have previously shown that PAK6 and 14-3-3γ protein interact with and regulate the activity of LRRK2. Objective The aim of this study is to quantify PAK6 and 14-3-3γ in plasma as reliable biomarkers for the diagnosis of both sporadic and LRRK2-linked Parkinson's disease. Methods After an initial quantification of PAK6 and 14-3-3γ expression by means of Western blot in post-mortem human brains, we verified the presence of the two proteins in plasma by using quantitative ELISA tests. We analyzed samples obtained from 39 healthy subjects, 40 patients with sporadic Parkinson's disease, 50 LRRK2-G2019S non-manifesting carriers and 31 patients with LRRK2-G2019S Parkinson's disease. Results The amount of PAK6 and 14-3-3γ is significantly different in patients with Parkinson's disease compared to healthy subjects. Moreover, the amount of PAK6 also varies with the presence of the G2019S mutation in the LRRK2 gene. Although the generalized linear models show a low association between the presence of Parkinson's disease and PAK6, the kinase could be added in a broader panel of biomarkers for the diagnosis of Parkinson's disease. Conclusions Changes of PAK6 and 14-3-3γ amount in plasma represent a shared readout for patients affected by sporadic and LRRK2-linked Parkinson's disease. Overall, they can contribute to the establishment of an extended panel of biomarkers for the diagnosis of Parkinson's disease.
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Affiliation(s)
| | | | - Lucia Iannotta
- Department of Biology, University of Padova, Padova, Italy
| | | | | | - Rina Bandopadhyay
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK
| | - Angelo Antonini
- Padova Neuroscience Center, University of Padova, Padova, Italy
- Centro Studi per la Neurodegenerazione (CESNE), University of Padova, Padova, Italy
| | - Luigi Bubacco
- Department of Biology, University of Padova, Padova, Italy
- Centro Studi per la Neurodegenerazione (CESNE), University of Padova, Padova, Italy
| | | | - Nicoletta Plotegher
- Department of Biology, University of Padova, Padova, Italy
- Centro Studi per la Neurodegenerazione (CESNE), University of Padova, Padova, Italy
| | - Elisa Greggio
- Department of Biology, University of Padova, Padova, Italy
- Centro Studi per la Neurodegenerazione (CESNE), University of Padova, Padova, Italy
| | - Laura Civiero
- IRCCS San Camillo Hospital, Venice, Italy
- Department of Biology, University of Padova, Padova, Italy
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Sola D, Betancor M, Marco Lorente PA, Pérez Lázaro S, Barrio T, Sevilla E, Marín B, Moreno B, Monzón M, Acín C, Bolea R, Badiola JJ, Otero A. Diagnosis in Scrapie: Conventional Methods and New Biomarkers. Pathogens 2023; 12:1399. [PMID: 38133284 PMCID: PMC10746075 DOI: 10.3390/pathogens12121399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Scrapie, a naturally occurring prion disease affecting goats and sheep, comprises classical and atypical forms, with classical scrapie being the archetype of transmissible spongiform encephalopathies. This review explores the challenges of scrapie diagnosis and the utility of various biomarkers and their potential implications for human prion diseases. Understanding these biomarkers in the context of scrapie may enable earlier prion disease diagnosis in humans, which is crucial for effective intervention. Research on scrapie biomarkers bridges the gap between veterinary and human medicine, offering hope for the early detection and improved management of prion diseases.
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Affiliation(s)
- Diego Sola
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Marina Betancor
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Paula A. Marco Lorente
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Sonia Pérez Lázaro
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Tomás Barrio
- Unité Mixte de Recherche de l’Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement1225 Interactions Hôtes-Agents Pathogènes, École Nationale Vétérinaire de Toulouse, 31076 Toulouse, France
| | - Eloisa Sevilla
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Belén Marín
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Bernardino Moreno
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Marta Monzón
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Cristina Acín
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Rosa Bolea
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Juan J. Badiola
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
| | - Alicia Otero
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, Facultad de Veterinaria, IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain; (D.S.)
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Rajalingam P, de Souza A, Lee-Archer M, Dhakal M. Sporadic Creutzfeldt-Jakob disease in Northern Tasmania. J R Coll Physicians Edinb 2023; 53:35-39. [PMID: 36680361 DOI: 10.1177/14782715221150580] [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: 01/22/2023] Open
Abstract
Creutzfeldt-Jakob disease is a rare and incurable form of rapidly progressive neurodegenerative disease. The disease is fatal, and most patients die within 1 year of diagnosis. Clinical features include progressive cognitive dysfunction, delusions or hallucinations, cerebellar ataxia, myoclonus, visual disturbances, extrapyramidal signs and eventually akinetic mutism. Most patients present with varied clinical presentation, hence making it difficult to diagnose at an early stage. We report five cases of sporadic Creutzfeldt-Jakob disease presenting to a Tasmanian hospital in Australia over a period of 52 months. We highlight significant clinical features in all our patients including few atypical presentations, emphasise on relevant clinical biomarkers and illustrate characteristic abnormalities on electroencephalogram and neuroimaging.
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Affiliation(s)
- Priyanka Rajalingam
- Department of Medicine, Launceston General Hospital, Launceston, TAS, Australia
| | - Aaron de Souza
- Department of Medicine, Launceston General Hospital, Launceston, TAS, Australia
- Faculty of Medicine, Launceston Clinical School, University of Tasmania, Launceston, TAS, Australia
| | - Matthew Lee-Archer
- Department of Medicine, Launceston General Hospital, Launceston, TAS, Australia
- Faculty of Medicine, Launceston Clinical School, University of Tasmania, Launceston, TAS, Australia
| | - Mahesh Dhakal
- Department of Medicine, Launceston General Hospital, Launceston, TAS, Australia
- Faculty of Medicine, Launceston Clinical School, University of Tasmania, Launceston, TAS, Australia
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Mastrangelo A, Mammana A, Baiardi S, Tiple D, Colaizzo E, Rossi M, Vaianella L, Polischi B, Equestre M, Poleggi A, Capellari S, Ladogana A, Parchi P. Evaluation of the impact of CSF prion RT-QuIC and amended criteria on the clinical diagnosis of Creutzfeldt-Jakob disease: a 10-year study in Italy. J Neurol Neurosurg Psychiatry 2023; 94:121-129. [PMID: 36428087 DOI: 10.1136/jnnp-2022-330153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The introduction of the prion Real-Time Quaking-Induced Conversion assay (RT-QuIC) has led to a revision of the diagnostic criteria for sporadic Creutzfeldt-Jakob disease (sCJD).Validation studies are needed for the amended criteria, especially for their diagnostic value in the clinical setting. METHODS We studied 1250 patients with suspected CJD referred for diagnosis to two Italian reference centres between 2010 and 2020. Focusing on the first diagnostic assessment, we compared the diagnostic value of the old and the amended criteria and that of different combinations of clinical variables and biomarker results. RESULTS The studied cohort comprised 850 participants with CJD (297 definite sCJD, 151 genetic CJD, 402 probable sCJD) and 400 with non-CJD (61 with neuropathology). At first clinical evaluation, the sensitivity of the old criteria (76.8%) was significantly lower than that of the amended criteria (97.8%) in the definite CJD cohort with no difference between definite and probable sCJD cases. Specificity was ~94% for both criteria against the non-CJD cohort (82.0% against definite non-CJD group). Cerebrospinal fluid (CSF) RT-QuIC was highly sensitive (93.9%) and fully specific against definite non-CJD patients. Limiting the criteria to a positive RT-QuIC or/and the combination of a clinical course compatible with possible CJD with a positive MRI (Q-CM criteria) provided higher diagnostic accuracy than both the old and amended criteria, overcoming the suboptimal specificity of ancillary test results (ie, CSF protein 14-3-3). CONCLUSIONS CSF RT-QuIC is highly sensitive and specific for diagnosing CJD in vitam. The Q-CM criteria provide a high diagnostic value for CJD.
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Affiliation(s)
- Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Angela Mammana
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dorina Tiple
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Elisa Colaizzo
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Marcello Rossi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luana Vaianella
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Barbara Polischi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michele Equestre
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Anna Poleggi
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy .,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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Muacevic A, Adler JR, Rane R, Jain A, Waseem S. Rapidly Progressive Frontotemporal Dementia With Amyotrophic Lateral Sclerosis in an Elderly Female. Cureus 2022; 14:e32182. [PMID: 36605066 PMCID: PMC9810361 DOI: 10.7759/cureus.32182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/07/2022] Open
Abstract
A 69-year-old female with a family history significant for early onset dementia and a past medical history significant for coronary artery disease, primary hypertension, type two diabetes mellitus, and Crohn's disease presents to our facility with rapidly progressive cognitive decline, delusions, hallucinations, and ambulatory dysfunction over the past two months. Neurological examination was remarkable for bilateral horizontal nystagmus, tongue fasciculations, bilateral upper extremity incoordination, and bilateral lower extremity spasticity, atrophy, and weakness. Laboratory and microbiological testing were remarkable for low serum thiamine levels. Computed tomography (CT) of the head without contrast showed significant brain atrophy in the frontal and temporal regions as compared to a CT without contrast of the head 5 years prior. Magnetic resonance imaging (MRI) of the head with and without contrast showed significant atrophy in the frontal and temporal regions as well as the cerebellum. Follow-up electromyography was consistent with lower motor neuron disease. The patient was given adequate thiamine supplementation for her thiamine deficiency and discharged on donepezil with instructions to follow up with the amyotrophic lateral sclerosis clinic for further monitoring and initiation of riluzole.
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McNicholas K, François M, Liu JW, Doecke JD, Hecker J, Faunt J, Maddison J, Johns S, Pukala TL, Rush RA, Leifert WR. Salivary inflammatory biomarkers are predictive of mild cognitive impairment and Alzheimer's disease in a feasibility study. Front Aging Neurosci 2022; 14:1019296. [PMID: 36438010 PMCID: PMC9685799 DOI: 10.3389/fnagi.2022.1019296] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/26/2022] [Indexed: 09/10/2023] Open
Abstract
Alzheimer's disease (AD) is an insidious disease. Its distinctive pathology forms over a considerable length of time without symptoms. There is a need to detect this disease, before even subtle changes occur in cognition. Hallmark AD biomarkers, tau and amyloid-β, have shown promising results in CSF and blood. However, detecting early changes in these biomarkers and others will involve screening a wide group of healthy, asymptomatic individuals. Saliva is a feasible alternative. Sample collection is economical, non-invasive and saliva is an abundant source of proteins including tau and amyloid-β. This work sought to extend an earlier promising untargeted mass spectrometry study in saliva from individuals with mild cognitive impairment (MCI) or AD with age- and gender-matched cognitively normal from the South Australian Neurodegenerative Disease cohort. Five proteins, with key roles in inflammation, were chosen from this study and measured by ELISA from individuals with AD (n = 16), MCI (n = 15) and cognitively normal (n = 29). The concentrations of Cystatin-C, Interleukin-1 receptor antagonist, Stratifin, Matrix metalloproteinase 9 and Haptoglobin proteins had altered abundance in saliva from AD and MCI, consistent with the earlier study. Receiver operating characteristic analysis showed that combinations of these proteins demonstrated excellent diagnostic accuracy for distinguishing both MCI (area under curve = 0.97) and AD (area under curve = 0.97) from cognitively normal. These results provide evidence for saliva being a valuable source of biomarkers for early detection of cognitive impairment in individuals on the AD continuum and potentially other neurodegenerative diseases.
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Affiliation(s)
- Kym McNicholas
- Molecular Diagnostic Solutions Group, Human Health Program, CSIRO Health and Biosecurity, Adelaide, SA, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Maxime François
- Molecular Diagnostic Solutions Group, Human Health Program, CSIRO Health and Biosecurity, Adelaide, SA, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jian-Wei Liu
- CSIRO Land and Water, Black Mountain Research and Innovation Park, Canberra, ACT, Australia
| | - James D. Doecke
- Australian e-Health Research Centre, CSIRO, Herston, QLD, Australia
| | - Jane Hecker
- Department of Internal Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jeff Faunt
- Department of General Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John Maddison
- Aged Care Rehabilitation and Palliative Care, SA Health, Modbury Hospital, Modbury, SA, Australia
| | - Sally Johns
- Aged Care Rehabilitation and Palliative Care, SA Health, Modbury Hospital, Modbury, SA, Australia
| | - Tara L. Pukala
- School of Physical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | | | - Wayne R. Leifert
- Molecular Diagnostic Solutions Group, Human Health Program, CSIRO Health and Biosecurity, Adelaide, SA, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
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Sai T, Imai K, Tsuto K, Yamamoto A, Ioku T, Matsuo K. [A case of genetic Creutzfeldt-Jakob disease that required differential diagnosis of acute encephalopathy associated with Sjogren's syndrome]. Rinsho Shinkeigaku 2022; 62:198-204. [PMID: 35228466 DOI: 10.5692/clinicalneurol.cn-001672] [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: 06/14/2023]
Abstract
An 86-year-old female was admitted to our hospital with acute progressive gait disturbance and cognitive impairment. Brain MR diffusion weighted imaging revealed abnormal high signal intensities in the bilateral hemispheres, dominantly in the frontal lobe. We first suspected acute encephalopathy due to Creutzfeldt-Jakob disease (CJD) from her clinical information. At the same time, we could not negate the possibility of Sjögren's syndrome (SjS) -related encephalopathy based on the abnormal findings on brain MRI and positive anti-SS-A antibody in the serum. After consulting with an otorhinolaryngologist and a pathologist, biopsy of the salivary gland was performed with a strict precaution against infection of prion virus. Pathological examination of the biopsy specimen showed accumulation of many lymphocytes around the gland, which satisfied grade 4 in the Greenspan classification. A definite diagnosis of SjS was made based on the pathological findings, and intravenous high dose methylprednisolone followed by oral prednisolone were administered for suspected SjS-related encephalopathy. However, the neurological symptoms did not improve and we judged that SjS-related encephalopathy was unlikely. The poor response to steroid therapy and the presence of tau protein, strongly positive 14-3-3 protein and a codon 180: Val/Ile mutation in the cerebrospinal fluid finally led to a clinical diagnosis of genetic CJD. In-hospital cooperation in terms of infection prevention is important when performing invasive procedure in the case of suspected CJD to distinguish treatable encephalopathy.
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Affiliation(s)
- Toshi Sai
- Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
| | - Keisuke Imai
- Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
| | - Kazuma Tsuto
- Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
| | - Atsushi Yamamoto
- Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
| | - Testuya Ioku
- Department of Neurology and Stroke Treatment, Kyoto First Red Cross Hospital
| | - Koushun Matsuo
- Department of Neurology, Omihachiman Community Medical Center
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Altuna M, Ruiz I, Zelaya MV, Mendioroz M. Role of Biomarkers for the Diagnosis of Prion Diseases: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58040473. [PMID: 35454316 PMCID: PMC9030755 DOI: 10.3390/medicina58040473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Prion diseases are progressive and irreversible neurodegenerative disorders with a low incidence (1.5–2 cases per million per year). Genetic (10–15%), acquired (anecdotal) and sporadic (85%) forms of the disease have been described. The clinical spectrum of prion diseases is very varied, although the most common symptoms are rapidly progressive dementia, cerebellar ataxia and myoclonus. Mean life expectancy from the onset of symptoms is 6 months. There are currently diagnostic criteria based on clinical phenotype, as well as neuroimaging biomarkers (magnetic resonance imaging), neurophysiological tests (electroencephalogram and polysomnogram), and cerebrospinal fluid biomarkers (14-3-3 protein and real-time quaking-induced conversion (RT-QuIC)). The sensitivity and specificity of some of these tests (electroencephalogram and 14-3-3 protein) is under debate and the applicability of other tests, such as RT-QuIC, is not universal. However, the usefulness of these biomarkers beyond the most frequent prion disease, sporadic Creutzfeldt–Jakob disease, remains unclear. Therefore, research is being carried out on new, more efficient cerebrospinal fluid biomarkers (total tau, ratio total tau/phosphorylated tau and neurofilament light chain) and potential blood biomarkers (neurofilament light chain, among others) to try to universalize access to early diagnosis in the case of prion diseases.
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Affiliation(s)
- Miren Altuna
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau—Biomedical Research Institute Sant Pau—Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
- Centre of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- CITA-Alzheimer Foundation, 20009 Donostia-San Sebastián, Spain
- Correspondence: ; Tel.: +34-935-56-59-86; Fax: +34-935-56-56-02
| | - Iñigo Ruiz
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau—Biomedical Research Institute Sant Pau—Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - María Victoria Zelaya
- Department of Pathological Anatomy, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
| | - Maite Mendioroz
- Department of Neurology, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
- Neuroepigenetics Laboratory-Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA (Navarra Institute for Health Research), 31006 Pamplona, Spain
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9
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Kong Y, Chen Z, Zhang J, Wu L. Erythrocyte Indices in Creutzfeldt-Jakob Disease Predict Survival Time. Front Neurol 2022; 13:839081. [PMID: 35237232 PMCID: PMC8884143 DOI: 10.3389/fneur.2022.839081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/21/2022] [Indexed: 12/30/2022] Open
Abstract
Background Creutzfeldt–Jakob disease (CJD) is a devastating neurodegenerative disease caused by propagation of abnormally folded prion proteins (PrPSc). Some fluid biomarkers have been reported to be associated with disease duration in CJD. Based on studies which have found that prion protein (PrPC) played a role in erythrocytic hematopoiesis, we evaluated the association between peripheral red blood cell indices and survival time in CJD. Methods We retrospectively collected data on peripheral red blood cell indices, including red blood cell (RBC) count, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW), from 125 CJD patients. Cox proportional hazard models were generated to determine whether red cell indices correlated with survival time of patients with CJD. Results Of the 125 included participants, 70 (56%) were male, and the mean age at diagnosis (SD) was 60.3 (9.5) years. Hemoglobin levels (hazard ratio 1.710, 95% CI 1.124–2.600, p = 0.012) and HCT (hazard ratio 1.689, 95% CI 1.112–2.565, p=0.014) were significantly associated with survival time after controlling for sex, age, and Barthel Index. Red blood cell count, MCV, MCH, MCHC, and RDW were not associated with survival time before or after adjusting for covariates. Conclusions Our study found that Hb and HCT were significantly associated with survival time in patients with CJD. These results may inform evaluation of the mechanisms of interaction between prion disease and hematopoiesis, and indicate that Hb and HCT may be potential prognostic biomarkers.
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Affiliation(s)
- Yu Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Rübsamen N, Pape S, Konigorski S, Zapf A, Rücker G, Karch A. Diagnostic accuracy of cerebrospinal fluid biomarkers for the differential diagnosis of sporadic Creutzfeldt‐Jakob disease: a (network) meta‐analysis. Eur J Neurol 2022; 29:1366-1376. [DOI: 10.1111/ene.15258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Rübsamen
- Institute of Epidemiology and Social Medicine University of Münster Germany
| | - Stephanie Pape
- Institute of Epidemiology and Social Medicine University of Münster Germany
| | - Stefan Konigorski
- Molecular Epidemiology Research Group Max Delbrück Center (MDC) for Molecular Medicine in the Helmholtz Association Berlin Germany
- Digital Health and Machine Learning Research Group Hasso Plattner Institute for Digital Engineering Potsdam Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics Faculty of Medicine and Medical Center University of Freiburg Freiburg im Breisgau Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine University of Münster Germany
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O’Hara E, Herbst A, Kommadath A, Aiken JM, McKenzie D, Goodarzi N, Skinner P, Stothard P. Neural transcriptomic signature of chronic wasting disease in white-tailed deer. BMC Genomics 2022; 23:69. [PMID: 35062879 PMCID: PMC8783489 DOI: 10.1186/s12864-022-08306-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background The increasing prevalence and expanding geographical range of the chronic wasting disease (CWD) panzootic in cervids is threatening human, animal, environmental and economic health. The pathogenesis of CWD in cervids is, however, not well understood. We used RNA sequencing (RNA-seq) to compare the brain transcriptome from white-tailed deer (WTD; Odocoileus virginianus) clinically affected with CWD (n = 3) to WTD that tested negative (n = 8) for CWD. In addition, one preclinical CWD+ brain sample was analyzed by RNA-seq. Results We found 255 genes that were significantly deregulated by CWD, 197 of which were upregulated. There was a high degree of overlap in differentially expressed genes (DEGs) identified when using either/both the reference genome assembly of WTD for mapping sequenced reads to or the better characterized genome assembly of a closely related model species, Bos taurus. Quantitative PCR of a subset of the DEGs confirmed the RNA-seq data. Gene ontology term enrichment analysis found a majority of genes involved in immune activation, consistent with the neuroinflammatory pathogenesis of prion diseases. A metagenomic analysis of the RNA-seq data was conducted to look for the presence of spiroplasma and other bacteria in CWD infected deer brain tissue. Conclusions The gene expression changes identified highlight the role of innate immunity in prion infection, potential disease associated biomarkers and potential targets for therapeutic agents. An association between CWD and spiroplasma infection was not found. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-022-08306-0.
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Cazzaniga FA, Bistaffa E, De Luca CMG, Bufano G, Indaco A, Giaccone G, Moda F. Sporadic Creutzfeldt-Jakob disease: Real-Time Quaking Induced Conversion (RT-QuIC) assay represents a major diagnostic advance. Eur J Histochem 2021; 65. [PMID: 34657408 PMCID: PMC8529530 DOI: 10.4081/ejh.2021.3298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and fatal neurodegenerative disorder with an incidence of 1.5 to 2 cases per million population/year. The disease is caused by a proteinaceous infectious agent, named prion (or PrPSc), which arises from the conformational conversion of the cellular prion protein (PrPC). Once formed, PrPSc interacts with the normally folded PrPC coercing it to undergo similar structural rearrangement. The disease is highly heterogeneous from a clinical and neuropathological point of view. The origin of this variability lies in the aberrant structures acquired by PrPSc. At least six different sCJD phenotypes have been described and each of them is thought to be caused by a peculiar PrPSc strain. Definitive sCJD diagnosis requires brain analysis with the aim of identifying intracerebral accumulation of PrPSc which currently represents the only reliable biomarker of the disease. Clinical diagnosis of sCJD is very challenging and is based on the combination of several clinical, instrumental and laboratory tests representing surrogate disease biomarkers. Thanks to the advent of the ultrasensitive Real-Time Quaking-Induced Conversion (RT-QuIC) assay, PrPSc was found in several peripheral tissues of sCJD patients, sometimes even before the clinical onset of the disease. This discovery represents an important step forward for the clinical diagnosis of sCJD. In this manuscript, we present an overview of the current applications and future perspectives of RT-QuIC in the field of sCJD diagnosis.
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Affiliation(s)
| | - Edoardo Bistaffa
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan.
| | | | - Giuseppe Bufano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan, Italy.
| | - Antonio Indaco
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan.
| | - Giorgio Giaccone
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan, Italy.
| | - Fabio Moda
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Division of Neurology 5-Neuropathology, Milan, Italy.
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Brandel JP. [Prion diseases or transmissible spongiform encephalopathies]. Rev Med Interne 2021; 43:106-115. [PMID: 34148672 DOI: 10.1016/j.revmed.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
Prion diseases or transmissible spongiform encephalopathies (TSEs) are human and animal diseases naturally or experimentally transmissible with a long incubation period and a fatal course without remission. The nature of the transmissible agent remains debated but the absence of a structure evoking a conventional microorganism led Stanley B. Prusiner to hypothesize that it could be an infectious protein (proteinaceous infectious particle or prion). The prion would be the abnormal form of a normal protein, cellular PrP (PrPc) which will change its spatial conformation and be converted into scrapie prion protein (PrPsc) with properties of partial resistance to proteases, aggregation and insolubility in detergents. No inflammatory or immune response are detected in TSEs which are characterized by brain damage combining spongiosis, neuronal loss, astrocytic gliosis, and deposits of PrPsc that may appear as amyloid plaques. Although the link between the accumulation of PrPsc and the appearance of lesions remains debated, the presence of PrPsc is constant during TSE and necessary for a definitive diagnosis. Even if they remain rare diseases (2 cases per million), the identification of kuru, at the end of the 1950s, of iatrogenic cases in the course of the 1970s and of the variant of Creutzfeldt-Jakob disease (CJD) in the mid-1990s explain the interest in these diseases but also the fears they can raise for public health. They remain an exciting research model because they belong both to the group of neurodegenerative diseases with protein accumulation (sporadic CJD), to the group of communicable diseases (iatrogenic CJD, variant of CJD) but also to the group of genetic diseases with a transmission Mendelian dominant (genetic CJD, Gerstmann-Straussler-Scheinker syndrome, fatal familial insomnia).
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Affiliation(s)
- J-P Brandel
- Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Inserm U1127/Institut du cerveau et de la moelle épinière (ICM), Groupe hospitalier Pitié-Salpêtrière, Centre national de référence des agents transmissibles non conventionnels, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Figgie MP, Appleby BS. Clinical Use of Improved Diagnostic Testing for Detection of Prion Disease. Viruses 2021; 13:v13050789. [PMID: 33925126 PMCID: PMC8146465 DOI: 10.3390/v13050789] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Prion diseases are difficult to recognize as many symptoms are shared among other neurologic pathologies and the full spectra of symptoms usually do not appear until late in the disease course. Additionally, many commonly used laboratory markers are non-specific to prion disease. The recent introduction of second-generation real time quaking induced conversion (RT-QuIC) has revolutionized pre-mortem diagnosis of prion disease due to its extremely high sensitivity and specificity. However, RT-QuIC does not provide prognostic data and has decreased diagnostic accuracy in some rarer, atypical prion diseases. The objective of this review is to provide an overview of the current clinical utility of fluid-based biomarkers, neurodiagnostic testing, and brain imaging in the diagnosis of prion disease and to suggest guidelines for their clinical use, with a focus on rarer prion diseases with atypical features. Recent advancements in laboratory-based testing and imaging criteria have shown improved diagnostic accuracy and prognostic potential in prion disease, but because these diagnostic tests are not sensitive in some prion disease subtypes and diagnostic test sensitivities are unknown in the event that CWD transmits to humans, it is important to continue investigations into the clinical utility of various testing modalities.
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Affiliation(s)
- Mark P. Figgie
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Brian S. Appleby
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
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15
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Solje E, Benussi A, Buratti E, Remes AM, Haapasalo A, Borroni B. State-of-the-Art Methods and Emerging Fluid Biomarkers in the Diagnostics of Dementia-A Short Review and Diagnostic Algorithm. Diagnostics (Basel) 2021; 11:diagnostics11050788. [PMID: 33925655 PMCID: PMC8145467 DOI: 10.3390/diagnostics11050788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
The most common neurodegenerative dementias include Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). The correct etiology-based diagnosis is pivotal for clinical management of these diseases as well as for the suitable timing and choosing the accurate disease-modifying therapies when these become available. Enzyme-linked immunosorbent assay (ELISA)-based methods, detecting altered levels of cerebrospinal fluid (CSF) Tau, phosphorylated Tau, and Aβ-42 in AD, allowed the wide use of this set of biomarkers in clinical practice. These analyses demonstrate a high diagnostic accuracy in AD but suffer from a relatively restricted usefulness due to invasiveness and lack of prognostic value. In recent years, the development of novel advanced techniques has offered new state-of-the-art opportunities in biomarker discovery. These include single molecule array technology (SIMOA), a tool for non-invasive analysis of ultra-low levels of central nervous system-derived molecules from biofluids, such as CSF or blood, and real-time quaking (RT-QuIC), developed to analyze misfolded proteins. In the present review, we describe the history of methods used in the fluid biomarker analyses of dementia, discuss specific emerging biomarkers with translational potential for clinical use, and suggest an algorithm for the use of new non-invasive blood biomarkers in clinical practice.
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Affiliation(s)
- Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, 70211 Kuopio, Finland;
- Neuro Center, Neurology, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy;
| | - Emanuele Buratti
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy;
| | - Anne M. Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, 90230 Oulu, Finland;
- Medical Research Center (MRC), Oulu University Hospital, 90220 Oulu, Finland
| | - Annakaisa Haapasalo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70211 Kuopio, Finland;
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy;
- Correspondence:
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Hermann P, Appleby B, Brandel JP, Caughey B, Collins S, Geschwind MD, Green A, Haïk S, Kovacs GG, Ladogana A, Llorens F, Mead S, Nishida N, Pal S, Parchi P, Pocchiari M, Satoh K, Zanusso G, Zerr I. Biomarkers and diagnostic guidelines for sporadic Creutzfeldt-Jakob disease. Lancet Neurol 2021; 20:235-246. [PMID: 33609480 DOI: 10.1016/s1474-4422(20)30477-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022]
Abstract
Sporadic Creutzfeldt-Jakob disease is a fatal neurodegenerative disease caused by misfolded prion proteins (PrPSc). Effective therapeutics are currently not available and accurate diagnosis can be challenging. Clinical diagnostic criteria use a combination of characteristic neuropsychiatric symptoms, CSF proteins 14-3-3, MRI, and EEG. Supportive biomarkers, such as high CSF total tau, could aid the diagnostic process. However, discordant studies have led to controversies about the clinical value of some established surrogate biomarkers. Development and clinical application of disease-specific protein aggregation and amplification assays, such as real-time quaking induced conversion (RT-QuIC), have constituted major breakthroughs for the confident pre-mortem diagnosis of sporadic Creutzfeldt-Jakob disease. Updated criteria for the diagnosis of sporadic Creutzfeldt-Jakob disease, including application of RT-QuIC, should improve early clinical confirmation, surveillance, assessment of PrPSc seeding activity in different tissues, and trial monitoring. Moreover, emerging blood-based, prognostic, and potentially pre-symptomatic biomarker candidates are under investigation.
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Affiliation(s)
- Peter Hermann
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Brian Appleby
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA; Departments of Neurology, Psychiatry, and Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jean-Philippe Brandel
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Steven Collins
- Australian National Creutzfeldt-Jakob disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | - Alison Green
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephane Haïk
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Franc Llorens
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Network Center For Biomedical Research Of Neurodegenerative Diseases, Institute Carlos III, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Simon Mead
- National Prion Clinic, University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Prion Unit at University College London, Institute of Prion Diseases, London, UK
| | - Noriyuki Nishida
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Suvankar Pal
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Piero Parchi
- Istituto di Ricovero e Cura e Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Katsuya Satoh
- Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Inga Zerr
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; German Center for Neurodegenerative Diseases, Göttingen, Germany
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Watson N, Brandel JP, Green A, Hermann P, Ladogana A, Lindsay T, Mackenzie J, Pocchiari M, Smith C, Zerr I, Pal S. The importance of ongoing international surveillance for Creutzfeldt-Jakob disease. Nat Rev Neurol 2021; 17:362-379. [PMID: 33972773 PMCID: PMC8109225 DOI: 10.1038/s41582-021-00488-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/04/2023]
Abstract
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, fatal and transmissible neurodegenerative disease associated with the accumulation of misfolded prion protein in the CNS. International CJD surveillance programmes have been active since the emergence, in the mid-1990s, of variant CJD (vCJD), a disease linked to bovine spongiform encephalopathy. Control measures have now successfully contained bovine spongiform encephalopathy and the incidence of vCJD has declined, leading to questions about the requirement for ongoing surveillance. However, several lines of evidence have raised concerns that further cases of vCJD could emerge as a result of prolonged incubation and/or secondary transmission. Emerging evidence from peripheral tissue distribution studies employing high-sensitivity assays suggests that all forms of human prion disease carry a theoretical risk of iatrogenic transmission. Finally, emerging diseases, such as chronic wasting disease and camel prion disease, pose further risks to public health. In this Review, we provide an up-to-date overview of the transmission of prion diseases in human populations and argue that CJD surveillance remains vital both from a public health perspective and to support essential research into disease pathophysiology, enhanced diagnostic tests and much-needed treatments.
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Affiliation(s)
- Neil Watson
- grid.4305.20000 0004 1936 7988National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jean-Philippe Brandel
- grid.411439.a0000 0001 2150 9058Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Alison Green
- grid.4305.20000 0004 1936 7988National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Peter Hermann
- grid.411984.10000 0001 0482 5331National Reference Centre for TSE, Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Anna Ladogana
- grid.416651.10000 0000 9120 6856Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Terri Lindsay
- grid.4305.20000 0004 1936 7988National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Janet Mackenzie
- grid.4305.20000 0004 1936 7988National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Maurizio Pocchiari
- grid.416651.10000 0000 9120 6856Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Colin Smith
- grid.4305.20000 0004 1936 7988National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Inga Zerr
- grid.411984.10000 0001 0482 5331National Reference Centre for TSE, Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Suvankar Pal
- grid.4305.20000 0004 1936 7988National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Litvinchuk AV, Zorina ES, Kopylov AT, Popova VO, Legina OK, Ronzhina NL, Verlov NA, Karlin JL, Lysenko VV, Ezhov VF, Naryzhny SN. Research of the Effect of Proton Radiation on the Brain Proteome of Mouse. BIOL BULL+ 2020. [DOI: 10.1134/s1062359020120055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abu-Rumeileh S, Baiardi S, Ladogana A, Zenesini C, Bartoletti-Stella A, Poleggi A, Mammana A, Polischi B, Pocchiari M, Capellari S, Parchi P. Comparison between plasma and cerebrospinal fluid biomarkers for the early diagnosis and association with survival in prion disease. J Neurol Neurosurg Psychiatry 2020; 91:1181-1188. [PMID: 32928934 DOI: 10.1136/jnnp-2020-323826] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy and the prognostic value of blood and cerebrospinal fluid (CSF) tests across prion disease subtypes. METHODS We used a single-molecule immunoassay to measure tau and neurofilament light chain (NfL) protein levels in the plasma and assessed CSF total(t)-tau, NfL and protein 14-3-3 levels in patients with prion disease (n=336), non-prion rapidly progressive dementias (n=106) and non-neurodegenerative controls (n=37). We then evaluated each plasma and CSF marker for diagnosis and their association with survival, taking into account the disease subtype, which is a strong independent prognostic factor in prion disease. RESULTS Plasma tau and NfL concentrations were higher in patients with prion disease than in non-neurodegenerative controls and non-prion rapidly progressive dementias. Plasma tau showed higher diagnostic value than plasma NfL, but a lower accuracy than the CSF proteins t-tau and 14-3-3. In the whole prion cohort, both plasma (tau and NfL) and CSF (t-tau, 14-3-3 and NfL) markers were significantly associated with survival and showed similar prognostic values. However, the intrasubtype analysis revealed that only CSF t-tau in sporadic Creutzfeldt-Jakob disease (sCJD) MM(V)1, plasma tau and CSF t-tau in sCJD VV2, and plasma NfL in slowly progressive prion diseases were significantly associated with survival after accounting for covariates. CONCLUSIONS Plasma markers have lower diagnostic accuracy than CSF biomarkers. Plasma tau and NfL and CSF t-tau are significantly associated with survival in prion disease in a subtype-specific manner and can be used to improve clinical trial stratification and clinical care.
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Affiliation(s)
- Samir Abu-Rumeileh
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Simone Baiardi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Anna Ladogana
- Dipartimento di Neuroscienze, Istituto Superiore di Sanità, Roma, Italy
| | - Corrado Zenesini
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Anna Poleggi
- Dipartimento di Neuroscienze, Istituto Superiore di Sanità, Roma, Italy
| | - Angela Mammana
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Barbara Polischi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Sabina Capellari
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy .,Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
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Ascari LM, Rocha SC, Gonçalves PB, Vieira TCRG, Cordeiro Y. Challenges and Advances in Antemortem Diagnosis of Human Transmissible Spongiform Encephalopathies. Front Bioeng Biotechnol 2020; 8:585896. [PMID: 33195151 PMCID: PMC7606880 DOI: 10.3389/fbioe.2020.585896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
Transmissible spongiform encephalopathies (TSEs), also known as prion diseases, arise from the structural conversion of the monomeric, cellular prion protein (PrPC) into its multimeric scrapie form (PrPSc). These pathologies comprise a group of intractable, rapidly evolving neurodegenerative diseases. Currently, a definitive diagnosis of TSE relies on the detection of PrPSc and/or the identification of pathognomonic histological features in brain tissue samples, which are usually obtained postmortem or, in rare cases, by brain biopsy (antemortem). Over the past two decades, several paraclinical tests for antemortem diagnosis have been developed to preclude the need for brain samples. Some of these alternative methods have been validated and can provide a probable diagnosis when combined with clinical evaluation. Paraclinical tests include in vitro cell-free conversion techniques, such as the real-time quaking-induced conversion (RT-QuIC), as well as immunoassays, electroencephalography (EEG), and brain bioimaging methods, such as magnetic resonance imaging (MRI), whose importance has increased over the years. PrPSc is the main biomarker in TSEs, and the RT-QuIC assay stands out for its ability to detect PrPSc in cerebrospinal fluid (CSF), olfactory mucosa, and dermatome skin samples with high sensitivity and specificity. Other biochemical biomarkers are the proteins 14-3-3, tau, neuron-specific enolase (NSE), astroglial protein S100B, α-synuclein, and neurofilament light chain protein (NFL), but they are not specific for TSEs. This paper reviews the techniques employed for definite diagnosis, as well as the clinical and paraclinical methods for possible and probable diagnosis, both those in use currently and those no longer employed. We also discuss current criteria, challenges, and perspectives for TSE diagnosis. An early and accurate diagnosis may allow earlier implementation of strategies to delay or stop disease progression.
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Affiliation(s)
- Lucas M. Ascari
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephanie C. Rocha
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscila B. Gonçalves
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tuane C. R. G. Vieira
- Institute of Medical Biochemistry Leopoldo de Meis, National Institute of Science and Technology for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yraima Cordeiro
- Faculty of Pharmacy, Pharmaceutical Biotechnology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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21
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Zhang YL, Wu XM, Chen Y, Gu WP, Lu W. Could Sporadic Creutzfeldt-Jakob Disease Be Underdiagnosed in China? Experience From Four Cases. Front Neurol 2020; 11:763. [PMID: 32849219 PMCID: PMC7399133 DOI: 10.3389/fneur.2020.00763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Creutzfeldt-Jakob Disease (CJD) is a rapidly progressive neurodegenerative disease caused by the misfolded version of the cellular prion protein. Here we report four cases of sporadic CJD (sCJD) and describe the diagnostic methods available in order avoid missed or delayed recognition of CJD in China. Case presentation: We report four patients diagnosed with sCJD between March 2018 and December 2019 at Xiangya Hospital and the Second Xiangya Hospital of Central South University. All patients were admitted to the hospital because of a progressive cognitive decline. Although their routine tests and biochemical indicators in the cerebrospinal fluid (CSF), as well as computed tomography (CT) imaging, did not reveal any apparent abnormalities, the presence of “cortical ribboning” was incidentally found on diffusion-weighted imaging (DWI). The patients were subsequently diagnosed with CJD based on positive testing for 14-3-3 protein in their CSF, and the presence of periodic sharp and slow wave complexes (PSWCs) on their electroencephalograms (EEG). Additionally, two of patients was confirmed pathological examination of cerebral biopsies demonstrating neuronal loss, gliosis, and spongiform changes. Conclusions: CJD is a rare disease and is easily misdiagnosed by clinician in China due to a lack of recognition and awareness of CJD. Based on our experience described in this report, enhanced vigilance for CJD is required for patients with rapidly progressive dementia in China and other developing countries. DWI, EEG and detection of 14-3-3 protein in CSF should be performed in order to achieve a timely diagnosis of CJD.
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Affiliation(s)
- Yi-Liu Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Mei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Ping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wen-Ping Gu
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Wei Lu
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22
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Falgàs N, Ruiz‐Peris M, Pérez‐Millan A, Sala‐Llonch R, Antonell A, Balasa M, Borrego‐Écija S, Ramos‐Campoy O, Augé JM, Castellví M, Tort‐Merino A, Olives J, Fernández‐Villullas G, Blennow K, Zetterberg H, Bargalló N, Lladó A, Sánchez‐Valle R. Contribution of CSF biomarkers to early-onset Alzheimer's disease and frontotemporal dementia neuroimaging signatures. Hum Brain Mapp 2020; 41:2004-2013. [PMID: 31944489 PMCID: PMC7267898 DOI: 10.1002/hbm.24925] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/11/2019] [Accepted: 01/04/2020] [Indexed: 12/19/2022] Open
Abstract
Prior studies have described distinct patterns of brain gray matter and white matter alterations in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), as well as differences in their cerebrospinal fluid (CSF) biomarkers profiles. We aim to investigate the relationship between early-onset AD (EOAD) and FTLD structural alterations and CSF biomarker levels. We included 138 subjects (64 EOAD, 26 FTLD, and 48 controls), all of them with a 3T MRI brain scan and CSF biomarkers available (the 42 amino acid-long form of the amyloid-beta protein [Aβ42], total-tau protein [T-tau], neurofilament light chain [NfL], neurogranin [Ng], and 14-3-3 levels). We used FreeSurfer and FSL to obtain cortical thickness (CTh) and fraction anisotropy (FA) maps. We studied group differences in CTh and FA and described the "AD signature" and "FTLD signature." We tested multiple regression models to find which CSF-biomarkers better explained each disease neuroimaging signature. CTh and FA maps corresponding to the AD and FTLD signatures were in accordance with previous literature. Multiple regression analyses showed that the biomarkers that better explained CTh values within the AD signature were Aβ and 14-3-3; whereas NfL and 14-3-3 levels explained CTh values within the FTLD signature. Similarly, NfL levels explained FA values in the FTLD signature. Ng levels were not predictive in any of the models. Biochemical markers contribute differently to structural (CTh and FA) changes typical of AD and FTLD.
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Affiliation(s)
- Neus Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
- Atlantic Fellow for Equity in Brain HealthGlobal Brain Health Institute, University of CaliforniaSan FranciscoCalifornia
| | - Mariona Ruiz‐Peris
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
- Department of BiomedicineUniversity of BarcelonaBarcelonaSpain
| | - Agnès Pérez‐Millan
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
- Department of BiomedicineUniversity of BarcelonaBarcelonaSpain
| | | | - Anna Antonell
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Mircea Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
- Senior Atlantic Fellow for Equity inBrain Health, Global Brain Health InstituteTrinity College DublinIreland
| | - Sergi Borrego‐Écija
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Oscar Ramos‐Campoy
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Josep Maria Augé
- Biochemistry and Molecular Genetics Department, Hospital Clínic de BarcelonaBarcelonaSpain
| | - Magdalena Castellví
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Adrià Tort‐Merino
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Jaume Olives
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Guadalupe Fernández‐Villullas
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute ofNeuroscience and Physiology, The Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute ofNeuroscience and Physiology, The Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUniversity College LondonLondonUK
- UK Dementia Research Institute at UCLLondonUK
| | - Núria Bargalló
- Radiology Service, Hospital ClínicMRI imaging platform. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
| | - Albert Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
| | - Raquel Sánchez‐Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, University of BarcelonaBarcelonaSpain
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23
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Lee SM, Hyeon JW, Kim SJ, Kim H, Noh R, Kim S, Lee YS, Kim SY. Sensitivity and specificity evaluation of multiple neurodegenerative proteins for Creutzfeldt-Jakob disease diagnosis using a deep-learning approach. Prion 2020; 13:141-150. [PMID: 31306078 PMCID: PMC6650195 DOI: 10.1080/19336896.2019.1639482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) can only be confirmed by abnormal protease-resistant prion protein accumulation in post-mortem brain tissue. The relationships between sCJD and cerebrospinal fluid (CSF) proteins such as 14–3-3, tau, and α-synuclein (a-syn) have been investigated for their potential value in pre-mortem diagnosis. Recently, deep-learning (DL) methods have attracted attention in neurodegenerative disease research. We established DL-aided pre-mortem diagnostic methods for CJD using multiple CSF biomarkers to improve their discriminatory sensitivity and specificity. Enzyme-linked immunosorbent assays were performed on phospho-tau (p-tau), total-tau (t-tau), a-syn, and β-amyloid (1–42), and western blot analysis was performed for 14–3-3 protein from CSF samples of 49 sCJD and 256 non-CJD Korean patients, respectively. The deep neural network structure comprised one input, five hidden, and one output layers, with 20, 40, 30, 20 and 12 hidden unit numbers per hidden layer, respectively. The best performing DL model demonstrated 90.38% accuracy, 83.33% sensitivity, and 92.5% specificity for the three-protein combination of t-tau, p-tau, and a-syn, and all other patients in a separate CSF set (n = 15) with other neuronal diseases were correctly predicted to not have CJD. Thus, DL-aided pre-mortem diagnosis may provide a suitable tool for discriminating CJD patients from non-CJD patients.
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Affiliation(s)
- Sol Moe Lee
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea.,b Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences , Seoul National University , Seoul , South Korea
| | - Jae Wook Hyeon
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Soo-Jin Kim
- b Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences , Seoul National University , Seoul , South Korea
| | - Heebal Kim
- b Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences , Seoul National University , Seoul , South Korea
| | - Ran Noh
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Seonghan Kim
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Yeong Seon Lee
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
| | - Su Yeon Kim
- a Division of Bacterial Disease Research, Center for Infectious Diseases Research , Korea National Institute of Health, Centers for Disease Control and Prevention , Cheongju-si , Chungcheongbuk-do , South Korea
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24
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Abu-Rumeileh S, Baiardi S, Polischi B, Mammana A, Franceschini A, Green A, Capellari S, Parchi P. Diagnostic value of surrogate CSF biomarkers for Creutzfeldt-Jakob disease in the era of RT-QuIC. J Neurol 2019; 266:3136-3143. [PMID: 31541342 DOI: 10.1007/s00415-019-09537-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/22/2022]
Abstract
Prion real-time quaking-induced conversion (RT-QuIC) is emerging as the most potent assay for the in vivo diagnosis of Creutzfeldt-Jakob disease (CJD), but its full application, especially as a screening test, is limited by suboptimal substrate availability, reagent costs, and incomplete assay standardization. Therefore, the search for the most informative cerebrospinal fluid (CSF) surrogate biomarker is still of primary importance. We compared the diagnostic accuracy of CSF protein 14-3-3, measured with both western blot (WB) and enzyme-linked immunosorbent assay (ELISA), total (t)-tau and neurofilament light chain protein (NfL) alone or in combination with RT-QuIC in 212 subjects with rapidly progressive dementia in which we reached a highly probable clinical diagnosis at follow-up or a definite neuropathological diagnosis. T-tau performed best as surrogate CSF biomarker for the diagnosis of CJD (91.3% sensitivity and 78.9% specificity). The 14-3-3 ELISA assay demonstrated a slightly higher diagnostic value compared to the WB analysis (76.9% vs. 72.2%), but both methods performed worse than the t-tau assay. NfL was the most sensitive biomarker for all sCJD subtypes (> 95%), including those with low values of t-tau or 14-3-3, but showed the lowest specificity (43.1%). When ELISA-based biomarkers were adopted as screening tests followed by RT-QuIC, t-tau correctly excluded a higher number of non-CJD cases compared to NfL and 14-3-3 ELISA. Our study showed that among the CSF surrogate biomarkers of potential application for the clinical diagnosis of CJD, t-tau performs best either alone or as screening test followed by RT-QuIC as a second-level confirmatory test.
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Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40139, Bologna, Italy
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40139, Bologna, Italy
| | - Barbara Polischi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139, Bologna, Italy
| | - Angela Mammana
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139, Bologna, Italy
| | | | - Alison Green
- The National CJD Research and Surveillance Unit, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40139, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139, Bologna, Italy
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139, Bologna, Italy. .,Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, 40139, Bologna, Italy.
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25
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Abstract
Prions diseases are uniformly fatal neurodegenerative diseases that occur in sporadic, genetic, and acquired forms. Acquired prion diseases, caused by infectious transmission, are least common. Most prion diseases are not infectious, but occur spontaneously through misfolding of normal prion proteins or genetic mutations in the prion protein gene. Although most prion diseases are not caused by infection, they can be transmitted accidentally. Certain infection control protocols should be applied when handling central nervous system and other high-risk tissues. New diagnostic methods are improving premortem and earlier diagnosis. Treatment trials have not shown improved survival, but therapies may be available soon.
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Affiliation(s)
- Boon Lead Tee
- Global Brain Health Institute, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94518, USA; Department of Neurology, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Zhong Yang Road, Hualien City, Hualien County 97002, Taiwan
| | - Erika Mariana Longoria Ibarrola
- Global Brain Health Institute, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94518, USA; Dementia Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Av. Insurgentes Sur 3877, Col. La Fama, Del. Tlalpan, Ciudad de México. C.P. 14269, Mexico
| | - Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158, USA.
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26
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Staffaroni AM, Kramer AO, Casey M, Kang H, Rojas JC, Orrú CD, Caughey B, Allen IE, Kramer JH, Rosen HJ, Blennow K, Zetterberg H, Geschwind MD. Association of Blood and Cerebrospinal Fluid Tau Level and Other Biomarkers With Survival Time in Sporadic Creutzfeldt-Jakob Disease. JAMA Neurol 2019; 76:969-977. [PMID: 31058916 PMCID: PMC6503575 DOI: 10.1001/jamaneurol.2019.1071] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/20/2019] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Fluid biomarkers that can predict survival time in sporadic Creutzfeldt-Jakob disease (sCJD) will be critical for clinical care and for treatment trials. OBJECTIVE To assess whether plasma and cerebrospinal fluid (CSF) biomarkers are associated with survival time in patients with sCJD. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal cohort study, data from 193 patients with probable or definite sCJD who had codon 129 genotyping referred to a tertiary national referral service in the United States were collected from March 2004 to January 2018. Participants were evaluated until death or censored at the time of statistical analysis (range, 0.03-38.3 months). We fitted Cox proportional hazard models with time to event as the outcome. Fluid biomarkers were log-transformed, and models were run with and without nonfluid biomarkers of survival. Five patients were excluded because life-extending measures were performed. MAIN OUTCOMES AND MEASURES Biomarkers of survival included sex, age, codon 129 genotype, Barthel Index, Medical Research Council Prion Disease Rating Scale, 8 CSF biomarkers (total tau [t-tau] level, phosphorylated tau [p-tau] level, t-tau:p-tau ratio, neurofilament light [NfL] level, β-amyloid 42 level, neuron-specific enolase level, 14-3-3 test result, and real-time quaking-induced conversion test), and 3 plasma biomarkers (t-tau level, NfL level, and glial fibrillary acidic protein level). RESULTS Of the 188 included participants, 103 (54.8%) were male, and the mean (SD) age was 63.8 (9.2) years. Plasma t-tau levels (hazard ratio, 5.8; 95% CI, 2.3-14.8; P < .001) and CSF t-tau levels (hazard ratio, 1.6; 95% CI, 1.2-2.1; P < .001) were significantly associated with survival after controlling for codon 129 genotype and Barthel Index, which are also associated with survival time. Plasma and CSF t-tau levels were correlated (r = 0.74; 95% CI, 0.50-0.90; P < .001). Other fluid biomarkers associated with survival included plasma NfL levels, CSF NfL levels, t-tau:p-tau ratio, 14-3-3 test result, and neuron-specific enolase levels. In a restricted subset of 23 patients with data for all significant biomarkers, the hazard ratio for plasma t-tau level was more than 40% larger than any other biomarkers (hazard ratio, 3.4; 95% CI, 1.8-6.4). CONCLUSIONS AND RELEVANCE Cerebrospinal fluid and plasma tau levels, along with several other fluid biomarkers, were significantly associated with survival time in patients with sCJD. The correlation between CSF and plasma t-tau levels and the association of plasma t-tau level with survival time suggest that plasma t-tau level may be a minimally invasive fluid biomarker in sCJD that could improve clinical trial stratification and guide clinical care.
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Affiliation(s)
- Adam M. Staffaroni
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Abigail O. Kramer
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Psychology, Palo Alto University, Palo Alto, California
| | - Megan Casey
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Huicong Kang
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Neurology, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Julio C. Rojas
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Christina D. Orrú
- Rocky Mountain Laboratories, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, Montana
| | - Byron Caughey
- Rocky Mountain Laboratories, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, Montana
| | - I. Elaine Allen
- Department of Biostatistics and Epidemiology, University of California, San Francisco
| | - Joel H. Kramer
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Howard J. Rosen
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute, University College London, London, United Kingdom
| | - Michael D. Geschwind
- UCSF Memory and Aging Center, Department of Neurology, University of California, San Francisco
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27
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Brandel JP, Culeux A, Grznarova K, Levavasseur E, Lamy P, Privat N, Welaratne A, Denouel A, Laplanche JL, Haik S. Amplification techniques and diagnosis of prion diseases. Rev Neurol (Paris) 2019; 175:458-463. [PMID: 31296398 DOI: 10.1016/j.neurol.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
Protein misfolding cyclic amplification assay (PMCA) and real-time quaking-induced conversion (RT-QuIC) are two amplification techniques based on the ability of PrPsc to induce a conformational change in PrP allowing the detection of minute amounts of PrPsc in body fluids or tissues. PMCA and RT-QuIC have different ability to amplify PrPsc from sporadic, variant and genetic forms of Creutzfeldt-Jakob disease (CJD). PMCA readily amplifies PrPsc from variant CJD (vCJD) tissue while RT-QuIC easily amplifies PrPsc from sporadic CJD (sCJD) patient tissues. In terms of diagnosis, this implies the possibility of distinguishing vCJD from sCJD and explains the wider use of RT-QuIC given the respective frequencies of vCJD and sCJD. The sensitivity values of RT-QuIC for the diagnosis of sCJD are comparable or higher than those of the other tests (EEG, MRI, detection of 14-3-3 or tau proteins in cerebrospinal fluid) but with a specificity close to 100%. These new diagnostic methods could also be useful for the diagnosis of other neurodegenerative diseases.
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Affiliation(s)
- J-P Brandel
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, Cellule Nationale de Référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - A Culeux
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - K Grznarova
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - E Levavasseur
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - P Lamy
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - N Privat
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - A Welaratne
- AP-HP, Cellule Nationale de Référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - A Denouel
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - J-L Laplanche
- AP-HP, Service de Biochimie et Biologie Moléculaire, Hôpital Lariboisière, Université Paris Descartes, 2, rue Ambroise-Paré 75010 Paris, France
| | - S Haik
- Sorbonne Université, Inserm, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, 47, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, Cellule Nationale de Référence des maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
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28
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Baldacci F, Lista S, Palermo G, Giorgi FS, Vergallo A, Hampel H. The neuroinflammatory biomarker YKL-40 for neurodegenerative diseases: advances in development. Expert Rev Proteomics 2019; 16:593-600. [PMID: 31195846 DOI: 10.1080/14789450.2019.1628643] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Neuroinflammation is a common pathophysiological mechanism in neurodegenerative diseases (ND). Cerebrospinal fluid (CSF) YKL-40 has recently been candidated as a neuroinflammatory biomarker of ND. Areas covered: We provide an update on the role of CSF YKL-40 as a pathophysiological biomarker of ND. YKL-40 may discriminate Alzheimer's disease (AD) from controls and may predict the progression from the early preclinical to the late dementia stage. In genetic AD, YKL-40 increases decades before the clinical onset. It does not seem a specific biomarker of a certain ND although sporadic Creutzfeldt-Jacob disease shows the highest YKL-40 concentrations. YKL-40 may discriminate between amyotrophic lateral sclerosis (ALS) and ALS-mimics. YKL-40 is potentially associated with the rate of ALS progression. YKL-40 correlates with biomarkers of neuronal injury, large axonal damage and synaptic disruption in various ND. It is not associated with the presence of the APOE-ε4 allele whereas possibly linked to aging, female sex, Hispanic ethnicity and some genetic variants of the chitinase-3-like 1 locus. Expert opinion: There is growing evidence expanding the relevance of CSF YKL-40 as a pathophysiological biomarker for ND. Patients showing high YKL-40 levels might benefit from targeted clinical trials that use compounds acting against neuroinflammatory mechanisms, independently of the initial clinical diagnosis of ND.
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Affiliation(s)
- Filippo Baldacci
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.,b Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital , F-75013, Paris , France.,c Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital , F-75013, Paris , France.,d Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP , Boulevard de l'hôpital , F-75013, Paris , France
| | - Simone Lista
- b Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital , F-75013, Paris , France.,c Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital , F-75013, Paris , France.,d Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP , Boulevard de l'hôpital , F-75013, Paris , France
| | - Giovanni Palermo
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Filippo Sean Giorgi
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Andrea Vergallo
- b Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital , F-75013, Paris , France.,c Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital , F-75013, Paris , France.,d Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP , Boulevard de l'hôpital , F-75013, Paris , France
| | - Harald Hampel
- b Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital , F-75013, Paris , France
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Review: Fluid biomarkers in the human prion diseases. Mol Cell Neurosci 2018; 97:81-92. [PMID: 30529227 DOI: 10.1016/j.mcn.2018.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/27/2023] Open
Abstract
The human prion diseases are a diverse set of often rapidly progressive neurodegenerative conditions associated with abnormal forms of the prion protein. We review work to establish diagnostic biomarkers and assays that might fill other important roles, particularly those that could assist the planning and interpretation of clinical trials. The field now benefits from highly sensitive and specific diagnostic biomarkers using cerebrospinal fluid: detecting by-products of rapid neurodegeneration or specific functional properties of abnormal prion protein, with the second generation real time quaking induced conversion (RT-QuIC) assay being particularly promising. Blood has been a more challenging analyte, but has now also yielded valuable biomarkers. Blood-based assays have been developed with the potential to screen for variant Creutzfeldt-Jakob disease, although it remains uncertain whether these will ever be used in practice. The very rapid neurodegeneration of prion disease results in strong signals from surrogate protein markers in the blood that reflect neuronal, axonal, synaptic or glial pathology in the brain: notably the tau and neurofilament light chain proteins. We discuss early evidence that such tests, applied alongside robust diagnostic biomarkers, may have potential to add value as clinical trial outcome measures, predictors of future disease course (including for asymptomatic individuals at high risk of prion disease), and as rapidly accessible and sensitive markers to aid early diagnosis.
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Abstract
The diagnosis of sporadic Creutzfeldt-Jakob disease (CJD) can be difficult, but the real-time quaking-induced conversion (RT-QuIC) assays have made a considerable impact on its clinical diagnosis. This technique exploits the ability of the misfolded pathological form of prion protein (PrPSc) found in cerebrospinal fluid (CSF) to induce conversion of normal PrP to the misfolded form, which subsequently aggregates. The formation of these aggregates of misfolded PrP is monitored in real time using fluorescent dyes. The current sensitivity of CSF RT-QuIC undertaken at the UK National CJD Research & Surveillance Unit is 92% and the specificity is 100%. The interpretation of the RT-QuIC traces is affected by the presence of raised CSF red and white cells counts and elevated total protein concentrations. We recommend that CSF samples for RT-QuIC analysis are clear and colourless with a white cell count of <10 x10^6/L and have a total protein concentration of <1 g/L.
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Affiliation(s)
- Alison J E Green
- Centre for Clinical Brain Sciences, The National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
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31
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Abstract
Sporadic Creutzfeldt-Jakob disease (CJD), the most common human prion disease, is generally regarded as a spontaneous neurodegenerative illness, arising either from a spontaneous PRNP somatic mutation or a stochastic PrP structural change. Alternatively, the possibility of an infection from animals or other source remains to be completely ruled out. Sporadic CJD is clinically characterized by rapidly progressive dementia with ataxia, myoclonus, or other neurologic signs and, neuropathologically, by the presence of aggregates of abnormal prion protein, spongiform change, neuronal loss, and gliosis. Despite these common features the disease shows a wide phenotypic variability which was recognized since its early descriptions. In the late 1990s the identification of key molecular determinants of phenotypic expression and the availability of a large series of neuropathologically verified cases led to the characterization of definite clinicopathologic and molecular disease subtypes and to an internationally recognized disease classification. By showing that these disease subtypes correspond to specific agent strain-host genotype combinations, recent transmission studies have confirmed the biologic basis of this classification. The introduction of brain magnetic resonance imaging techniques such as fluid-attenuated inversion recovery and diffusion-weighted imaging sequences and cerebrospinal fluid biomarker assays for the detection of brain-derived proteins as well as real-time quaking-induced conversion assay, allowing the specific detection of prions in accessible biologic fluids and tissues, has significantly contributed to the improved accuracy of the clinical diagnosis of sporadic CJD in recent years.
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Affiliation(s)
- Inga Zerr
- Department of Neurology, University Hospital, Georg-August-University, Goettingen, Germany.
| | - Piero Parchi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna and IRCCS Institute of Neurological Sciences, Bologna, Italy
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Oliver M, Dyke L, Rico A, Madruga M, Parellada J, Carlan SJ. Rapidly Progressing Sporadic Creutzfeldt-Jakob Disease Presenting as a Stroke. Case Rep Neurol 2018; 10:261-265. [PMID: 30323754 PMCID: PMC6180273 DOI: 10.1159/000492613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 01/30/2023] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, fatal human prion disease that is characterized by progressive dementia and neurologic degeneration. It can mimic multiple other neurological disorders, and a high index of clinical suspicion is necessary to make a diagnosis. A 74-year-old woman with a 3-month history of a stroke and progressive neurologic deterioration was found to have sCJD. She expired within a week of her diagnosis. Autopsy revealed spongiform encephalopathy consistent with prion disease, and genetic analysis revealed 129 polymorphism and no pathologic mutation, confirming the diagnosis of nonfamilial human prion disease. No pathologic evidence of a stroke was found. Awareness of the disease by clinicians is important not only at the time of initial presentation but also during the following months. Since there is no treatment, invasive medical procedures should be limited to only those that are required for either diagnosis or hospice care.
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Affiliation(s)
- Maxim Oliver
- Department of Medicine, Orlando Regional Healthcare, Orlando, Florida, USA
| | - Lisa Dyke
- Department of Medicine, Orlando Regional Healthcare, Orlando, Florida, USA
| | - Alex Rico
- Department of Medicine, Orlando Regional Healthcare, Orlando, Florida, USA
| | - Mario Madruga
- Department of Medicine, Orlando Regional Healthcare, Orlando, Florida, USA
| | - Jorge Parellada
- Department of Medicine, Orlando Regional Healthcare, Orlando, Florida, USA
| | - Steve J Carlan
- Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, Florida, USA
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Hermann P, Laux M, Glatzel M, Matschke J, Knipper T, Goebel S, Treig J, Schulz-Schaeffer W, Cramm M, Schmitz M, Zerr I. Validation and utilization of amended diagnostic criteria in Creutzfeldt-Jakob disease surveillance. Neurology 2018; 91:e331-e338. [DOI: 10.1212/wnl.0000000000005860] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/16/2018] [Indexed: 12/17/2022] Open
Abstract
ObjectiveTo validate an amended protocol for clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) including real-time quaking-induced conversion (RT-QuIC) and to observe its use in CJD surveillance.MethodsIn the framework of a prospective epidemiologic study, all neuropathologically confirmed cases with sCJD who received CSF RT-QuIC analysis during diagnostic workup (n = 65) and a control group of individuals without CJD (n = 118) were selected to investigate the accuracy of an amended diagnostic protocol. The patients had been referred to the German National Reference Center for Transmissible Spongiform Encephalopathies. The influence of the amended protocol on incidence figures was evaluated in the context of 3 years of surveillance activity (screened cases using 14-3-3 test n = 18,789, highly suspicious cases of CJD n = 704). Annual incidences were calculated with current criteria and the amended protocol.ResultsThe amended protocol showed a sensitivity of 97% and a specificity of 99%. When it was applied to all suspected cases who were referred to the reference center, the assessed incidence of CJD increased from 1.7 to 2.2 per million in 2016.ConclusionCJD surveillance remains challenging because information from external health care institutions can be limited. RT-QuIC shows excellent diagnostic accuracy when applied in the clinical setting to symptomatic patients. Data for RT-QuIC alone when applied as a general screening test are not available yet. We propose an amended research protocol that improves early and accurate clinical diagnosis of sCJD during surveillance activities. The use of this protocol will probably lead to a significant increase of the incidence rate.Classification of evidenceThis study provides Class III evidence that for patients with suspected sCJD, criteria for clinical diagnosis plus the CSF RT-QuIC accurately identifies patients with sCJD (sensitivity 97%, specificity 99%).
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Abu-Rumeileh S, Capellari S, Parchi P. Rapidly Progressive Alzheimer’s Disease: Contributions to Clinical-Pathological Definition and Diagnosis. J Alzheimers Dis 2018; 63:887-897. [DOI: 10.3233/jad-171181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Piero Parchi
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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35
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Abstract
Protein amplification techniques exploit the ability of PrPTSE to induce a conformational change in prion protein (PrP) in a continuous fashion, so that the small amount of PrPTSE found in tissues and biologic fluids in prion diseases can be amplified to a point where they are detectable by conventional laboratory techniques. The most widely used protein aggregation assays are protein misfolding cyclic amplification assay (PMCA) and real-time quaking-induced conversion (RT-QuIC). These assays have been used extensively in both animal and human prion disease in studies ranging from the development of diagnostics, understanding disease transmission potential, to investigating mechanisms underlying neurodegeneration. In human prion disease, cerebrospinal fluid (CSF) RT-QuIC analysis has been shown to be a highly sensitive and specific test for sporadic Creutzfeldt-Jakob disease (sCJD) and has now been included in the diagnostic criteria. It is also a useful investigation for some genetic forms of prion disease where other cerebrospinal fluid tests may be negative. PMCA shows great potential for the diagnosis of variant CJD (vCJD) and has the ability to distinguish vCJD from sCJD, which may become increasingly important with emergence of a patient with neuropathologically confirmed vCJD associated with PRNP codon129MV, which indicates that a new wave of vCJD cases is likely and that these may be difficult to distinguish from sCJD.
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Affiliation(s)
- Alison J E Green
- National CJD Research and Surveillance Unit, University of Edinburgh, Edinburgh, United Kingdom.
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Knight R. Infectious and Sporadic Prion Diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 150:293-318. [PMID: 28838665 DOI: 10.1016/bs.pmbts.2017.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Prion diseases are progressive fatal encephalopathies characterized by a neurodegenerative pathology, the tissue deposition of abnormally folded prion protein and, in general, potential transmissibility. Creutzfeldt-Jakob disease (CJD) is the commonest human prion disease and occurs in three principal forms: sporadic (idiopathic), acquired (infectious), and inherited (genetic). This chapter concerns the sporadic and acquired forms. Sporadic CJD occurs worldwide and affects mainly the middle aged and elderly. There are recognized genetic risk factors-most importantly the PRNP-129 polymorphism. The acquired forms of CJD consist of iatrogenic CJD (accidental transmission of CJD via medical or surgical procedures) and variant CJD (vJCD) (which originated as a zoonosis via bovine spongiform encephalopathy (BSE)-contamination of human food). The main causes of iatrogenic CJD are cadaveric-derived human growth hormone treatment and dura mater surgical grafts. The PRNP-129 polymorphism has important effects on iatrogenic infection, including overall susceptibility and incubation period. vCJD, resulting from dietary exposure to BSE, has affected mostly the United Kingdom, followed by France. All tested cases were originally PRNP-129MM, although two MV cases have been identified recently (one possible; one definite). vCJD has been secondarily transmitted via blood transfusion and a blood product. There is continuing concern over secondary transmission since there is evidence-from lymphoreticular tissue studies-of extensive subclinical infection in the UK general population, although a further recent study has caused uncertainty over the significance of the previous studies. While definitive diagnosis of CJD is pathological, recent developments in protein amplification and detection have led to significantly better clinical diagnosis.
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Affiliation(s)
- Richard Knight
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
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37
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Brett FM, Looby S, Chalissery A, Chen D, Heaney C, Heffernan J, Cunningham F, Howley R, Loftus T, Kearney H, Farrell MA. Brain biopsies requiring Creutzfeldt-Jakob disease precautions in the Republic of Ireland 2005-2016. Ir J Med Sci 2017; 187:515-520. [PMID: 28803271 DOI: 10.1007/s11845-017-1673-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
AIMS Creutzfeldt-Jakob disease (CJD) risk precautions are required when performing brain biopsies on patients with a dementing illness and in 'risk' groups. The impact on a diagnostic neuropathology service is considerable. We sought to determine if better case selection might reduce the necessity for application of CJD risk precautions. METHODS We reviewed the clinical information, contributory investigations and final neuropathologic diagnosis in a cohort of patients (n = 21), referred to the National CJD Surveillance Centre between January 1, 2005, and December 31, 2016. RESULTS Of this 21-patient cohort, five were positive for CJD, four belonged to the 'at risk of CJD' category requiring brain surgery, while the remaining 12 were referred to the National CJD Surveillance Unit with CJD as part of their differential diagnosis. CJD was confirmed in 5/21 (three sporadic [s]CJD, one variant [v]CJD and one iatrogenic [i] CJD). CJD was clinically probable in 4/5 proven CJD patients (80%). The patients (n = 4) in the 'at risk of CJD' group were diagnosed with tumour (n = 2), inflammation (n = 1) and non-specific changes (n = 1). Of the remaining 12 patients (in whom CJD was included in the differential diagnosis), the final neuropathologic diagnoses included tumour (n = 2), neurodegenerative (n = 2), inflammatory (n = 1), metabolic (n = 2), vascular (n = 2) and non-specific gliosis (n = 3). CONCLUSIONS More often than not, the clinical suspicion of CJD was not borne out by the final neuropathological diagnosis. Failure by clinicians to adhere to the recommended CJD investigation algorithm impacts adversely on the neuropathology workload and causes unnecessary concern among operating theatre, laboratory and nursing personnel.
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Affiliation(s)
- F M Brett
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland.
| | - S Looby
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - A Chalissery
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - D Chen
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - C Heaney
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - J Heffernan
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - F Cunningham
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - R Howley
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - T Loftus
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - H Kearney
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
| | - M A Farrell
- Department of Clinical Neurological Sciences, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland
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Brett FM, Chen D, Loftus T, Langan Y, Looby S, Hutchinson S. Intravascular large B-cell lymphoma presenting clinically as rapidly progressive dementia. Ir J Med Sci 2017; 187:319-322. [PMID: 28726030 DOI: 10.1007/s11845-017-1653-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/23/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND In patients presenting with rapidly progressive dementia, prion disease may enter the differential diagnosis. The commonest malignancies masquerading as prion disease are primary CNS lymphoma and intravascular large B-cell lymphoma, both rare and difficult to diagnose without brain biopsy. CASE PRESENTATION This 82-year-old lady with a past history of hypertension, presented with rapidly progressive cognitive impairment and ataxia. The possibility of sCJD was raised. Brain biopsy was carried out. Western blot for prion protein was negative. Brain biopsy showed intravascular large B-cell lymphoma. She died shortly afterwards. CONCLUSION The clinical presentation of intravascular large B-cell lymphoma is diverse. Patients may present as in this case with dementia, seizures, and myoclonus leading to a clinical diagnosis of sCJD. The diagnosis here was made at biopsy but is made at autopsy in over 50% of cases.
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Affiliation(s)
- F M Brett
- Department of Clinical Neurological Sciences, RCSI, Dublin 9, Ireland. .,Department of Clinical Neurological Sciences, Beaumont Hospital, Dublin, Ireland.
| | - D Chen
- Department of Clinical Neurological Sciences, RCSI, Dublin 9, Ireland
| | - T Loftus
- Department of Clinical Neurological Sciences, RCSI, Dublin 9, Ireland
| | - Y Langan
- Department of Neurology, St James Hospital, Dublin, Ireland
| | - S Looby
- Department of Clinical Neurological Sciences, RCSI, Dublin 9, Ireland
| | - S Hutchinson
- Department of Neurology, St James Hospital, Dublin, Ireland
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Prion-specific and surrogate CSF biomarkers in Creutzfeldt-Jakob disease: diagnostic accuracy in relation to molecular subtypes and analysis of neuropathological correlates of p-tau and Aβ42 levels. Acta Neuropathol 2017; 133:559-578. [PMID: 28205010 PMCID: PMC5348556 DOI: 10.1007/s00401-017-1683-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 01/28/2023]
Abstract
The differential diagnosis of Creutzfeldt-Jakob disease (CJD) from other, sometimes treatable, neurological disorders is challenging, owing to the wide phenotypic heterogeneity of the disease. Real-time quaking-induced prion conversion (RT-QuIC) is a novel ultrasensitive in vitro assay, which, at variance with surrogate neurodegenerative biomarker assays, specifically targets the pathological prion protein (PrPSc). In the studies conducted to date in CJD, cerebrospinal fluid (CSF) RT-QuIC showed good diagnostic sensitivity (82–96%) and virtually full specificity. In the present study, we investigated the diagnostic value of both prion RT-QuIC and surrogate protein markers in a large patient population with suspected CJD and then evaluated the influence on CSF findings of the CJD type, and the associated amyloid-β (Aβ) and tau neuropathology. RT-QuIC showed an overall diagnostic sensitivity of 82.1% and a specificity of 99.4%. However, sensitivity was lower in CJD types linked to abnormal prion protein (PrPSc) type 2 (VV2, MV2K and MM2C) than in typical CJD (MM1). Among surrogate proteins markers (14-3-3, total (t)-tau, and t-tau/phosphorylated (p)-tau ratio) t-tau performed best in terms of both specificity and sensitivity for all sCJD types. Sporadic CJD VV2 and MV2K types demonstrated higher CSF levels of p-tau when compared to other sCJD types and this positively correlated with the amount of tiny tau deposits in brain areas showing spongiform change. CJD patients showed moderately reduced median Aβ42 CSF levels, with 38% of cases having significantly decreased protein levels in the absence of Aβ brain deposits. Our results: (1) support the use of both RT-QuIC and t-tau assays as first line laboratory investigations for the clinical diagnosis of CJD; (2) demonstrate a secondary tauopathy in CJD subtypes VV2 and MV2K, correlating with increased p-tau levels in the CSF and (3) provide novel insight into the issue of the accuracy of CSF p-tau and Aβ42 as markers of brain tauopathy and β-amyloidosis.
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Llorens F, Kruse N, Karch A, Schmitz M, Zafar S, Gotzmann N, Sun T, Köchy S, Knipper T, Cramm M, Golanska E, Sikorska B, Liberski PP, Sánchez-Valle R, Fischer A, Mollenhauer B, Zerr I. Validation of α-Synuclein as a CSF Biomarker for Sporadic Creutzfeldt-Jakob Disease. Mol Neurobiol 2017; 55:2249-2257. [PMID: 28321768 PMCID: PMC5840235 DOI: 10.1007/s12035-017-0479-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/02/2017] [Indexed: 01/15/2023]
Abstract
The analysis of cerebrospinal fluid (CSF) biomarkers gains importance in the differential diagnosis of prion diseases. However, no single diagnostic tool or combination of them can unequivocally confirm prion disease diagnosis. Electrochemiluminescence (ECL)-based immunoassays have demonstrated to achieve high diagnostic accuracy in a variety of sample types due to their high sensitivity and dynamic range. Quantification of CSF α-synuclein (a-syn) by an in-house ECL-based ELISA assay has been recently reported as an excellent approach for the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD), the most prevalent form of human prion disease. In the present study, we validated a commercially available ECL-based a-syn ELISA platform as a diagnostic test for correct classification of sCJD cases. CSF a-syn was analysed in 203 sCJD cases with definite diagnosis and in 445 non-CJD cases. We investigated reproducibility and stability of CSF a-syn and made recommendations for its analysis in the sCJD diagnostic workup. A sensitivity of 98% and a specificity of 97% were achieved when using an optimal cut-off of 820 pg/mL a-syn. Moreover, we were able to show a negative correlation between a-syn levels and disease duration suggesting that CSF a-syn may be a good prognostic marker for sCJD patients. The present study validates the use of a-syn as a CSF biomarker of sCJD and establishes the clinical and pre-analytical parameters for its use in differential diagnosis in clinical routine. Additionally, the current test presents some advantages compared to other diagnostic approaches: it is fast, economic, requires minimal amount of CSF and a-syn levels are stable along disease progression.
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Affiliation(s)
- Franc Llorens
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.
| | - Niels Kruse
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Matthias Schmitz
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Saima Zafar
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Nadine Gotzmann
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Ting Sun
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Silja Köchy
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Tobias Knipper
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Maria Cramm
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Ewa Golanska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Pawel P Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Raquel Sánchez-Valle
- Creutzfeldt-Jakob disease unit. Alzheimer's disease and other cognitive disorders unit. Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andre Fischer
- German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
| | - Brit Mollenhauer
- Institute for Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Paracelsus-Elena Klinik, Center for Parkinsonism and Movement Disorders, Kassel, Germany.,Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Inga Zerr
- Clinical Dementia Center, Department of Neurology, University Medical Center Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Göttingen, Robert Koch Stasse 40, 37075, Göttingen, Germany
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Qavi AH, Imran TF, Hasan Z, Ilyas F, Ghani U, Assad S, Hasan S. Serial Magnetic Resonance Imaging in Creutzfeldt-Jakob Disease: a Case Report and Literature Review. Cureus 2017; 9:e1095. [PMID: 28413741 PMCID: PMC5392034 DOI: 10.7759/cureus.1095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, invariably fatal brain disorder. CJD usually appears in later life and runs a rapid course. Typically, the onset of symptoms occurs about age 60 and about 90% of individuals die within one year. We report a case of 67-year-old male presented with progressive aphasia, confusion, dysphagia and inability to carry out activities of daily life (ADLs) over a period of three to four weeks. The patient had past medical history of chronic atrial fibrillation and hypertension. Prior to admission, the patient was treated for ischemic stroke of left basal ganglia but continued to have worsening encephalopathy. The spinal tap revealed a 14-3-3 protein level of thirteen times the upper limit of normal; electroencephalogram (EEG) showed a diffuse slowing of the background and periodic sharp waves with greater involvement of the left hemisphere. Diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) at the time of admission showed extensive signal abnormality in the basal ganglia bilaterally and in the cerebral cortex bilaterally, particularly over the left cerebral hemisphere. The persistence of the MRI findings over several weeks was concerning for spongiform encephalopathy. The probable diagnosis of Creutzfeldt-Jakob disease was made based on these imaging findings taken together with the patient's clinical signs and symptoms of a rapidly progressive encephalopathy. The patient was able to have some quality time with his family as the diagnosis was made earlier than perhaps otherwise and expired peacefully after comfort care measures were chosen. Serial MRI may serve as a clue to the early diagnosis of CJD and potentially provide a better quality of life for the patients.
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Affiliation(s)
- Ahmed H Qavi
- Department of Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY, USA
| | - Tasnim F Imran
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Zachariah Hasan
- Department of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Fariha Ilyas
- Department of Medicine, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Usman Ghani
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Assad
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shabih Hasan
- Department of Neurology, Inova Fairfax Hospital, Falls Church, VA, United States
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Tang YF, Zhang YB, Feng XD, Lin SH, Qiao N, Sun ZY, Zhou WP. Role of 14-3-3 proteins in human diseases. Shijie Huaren Xiaohua Zazhi 2017; 25:509-520. [DOI: 10.11569/wcjd.v25.i6.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
14-3-3 proteins are a family of highly conserved small proteins. By interacting with target proteins, 14-3-3 proteins are involved in regulating multiple cellular processes, such as signal transduction, cell cycle regulation, apoptosis, cellular metabolism, cytoskeleton organization and malignant transformation. Mounting evidence suggests that 14-3-3 proteins play an important role in a wide variety of human diseases, such as human cancers and nervous system diseases. This review aims to summarize the current knowledge on the expression, regulation and biological function of 14-3-3 to highlight the role of 14-3-3 proteins in human diseases.
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Gaudino S, Gangemi E, Colantonio R, Botto A, Ruberto E, Calandrelli R, Martucci M, Vita MG, Masullo C, Cerase A, Colosimo C. Neuroradiology of human prion diseases, diagnosis and differential diagnosis. Radiol Med 2017; 122:369-385. [PMID: 28110369 DOI: 10.1007/s11547-017-0725-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 01/14/2023]
Abstract
Human transmissible spongiform encephalopathies (TSEs), or prion diseases, are invariably fatal conditions associated with a range of clinical presentations. TSEs are classified as sporadic [e.g. sporadic Creutzfeldt-Jakob disease (sCJD), which is the most frequent form], genetic (e.g. Gerstmann-Straussler-Scheinker disease, fatal familial insomnia, and inherited CJD), and acquired or infectious (e.g. Kuru, iatrogenic CJD, and variant CJD). In the past, brain imaging played a supporting role in the diagnosis of TSEs, whereas nowadays magnetic resonance imaging (MRI) plays such a prominent role that MRI findings have been included in the diagnostic criteria for sCJD. Currently, MRI is required for all patients with a clinical suspicion of TSEs. Thus, MRI semeiotics of TSEs should become part of the cultural baggage of any radiologist. The purposes of this update on the neuroradiology of CJD are to (i) review the pathophysiology and clinical presentation of TSEs, (ii) describe both typical and atypical MRI findings of CJD, and (iii) illustrate diseases mimicking CJD, underlining the MRI key findings useful in the differential diagnosis.
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Affiliation(s)
- Simona Gaudino
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Emma Gangemi
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Raffaella Colantonio
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Annibale Botto
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Emanuela Ruberto
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Rosalinda Calandrelli
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Matia Martucci
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Maria Gabriella Vita
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Masullo
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alfonso Cerase
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Università Senese, "Santa Maria alle Scotte" University and NHS Hospital, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Cesare Colosimo
- Department of Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, School of Medicine, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
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Neurofilaments in blood and CSF for diagnosis and prediction of onset in Creutzfeldt-Jakob disease. Sci Rep 2016; 6:38737. [PMID: 27929120 PMCID: PMC5144074 DOI: 10.1038/srep38737] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022] Open
Abstract
While cerebrospinal fluid (CSF) biomarkers for Creutzfeldt-Jakob disease (CJD) are established and partly included in the diagnostic criteria, no blood biomarkers are available. Here, we assessed the utility of serum neurofilament light chain (NF-L) and tau protein in comparison to CSF markers (NF-L and phosphorylated NF heavy chain (pNF-H), tau, S100B, 14-3-3) and prion conversion assay (real-time quaking induced conversion (RT-QuIC)) for sporadic and genetic CJD. Importantly, a Gerstmann-Sträussler-Scheinker mutation carrier in the asymptomatic phase and at disease onset was included as well. Both NF-L and tau were markedly increased in CJD serum, reaching similar or even better performance as in CSF (sensitivity and specificity for serum NF-L 100% and 85.5%, and for serum tau 84.6% and 96.2%, respectively). Serum S100B showed high sensitivity as well (84.2%), but lower specificity (63%). CSF neurofilaments were increased before symptom onset, while prion seeding assay was negative. Just before a clinical diagnosis could be made, all CSF markers and NF-L in the serum were increased and CSF prion conversion assay was positive. The data suggest that neurofilaments are sensitive and specific blood markers for the diagnosis of genetic and sporadic CJD and might represent promising tools to predict disease onset.
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Llorens F, Kruse N, Schmitz M, Gotzmann N, Golanska E, Thüne K, Zejneli O, Kanata E, Knipper T, Cramm M, Lange P, Zafar S, Sikorska B, Liberski PP, Mitrova E, Varges D, Schmidt C, Sklaviadis T, Mollenhauer B, Zerr I. Evaluation of α‐synuclein as a novel cerebrospinal fluid biomarker in different forms of prion diseases. Alzheimers Dement 2016; 13:710-719. [DOI: 10.1016/j.jalz.2016.09.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/15/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Franc Llorens
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
| | - Niels Kruse
- Institute for Neuropathology University Medical Center Göttingen Göttingen Germany
| | - Matthias Schmitz
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
| | - Nadine Gotzmann
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
| | - Ewa Golanska
- Department of Molecular Pathology and Neuropathology Medical University of Lodz Lodz Poland
| | - Katrin Thüne
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
| | - Orgeta Zejneli
- Laboratory of Pharmacology, School of Health Sciences, Department of Pharmacy Aristotle University of Thessaloniki Thessaloniki Greece
| | - Eirini Kanata
- Laboratory of Pharmacology, School of Health Sciences, Department of Pharmacy Aristotle University of Thessaloniki Thessaloniki Greece
| | - Tobias Knipper
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
| | - Maria Cramm
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
| | - Peter Lange
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
| | - Saima Zafar
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology Medical University of Lodz Lodz Poland
| | - Pawel P. Liberski
- Department of Molecular Pathology and Neuropathology Medical University of Lodz Lodz Poland
| | - Eva Mitrova
- Department of Prion Diseases Slovak Medical University Bratislava Bratislava Slovakia
| | - Daniela Varges
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
| | - Christian Schmidt
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
| | - Theodoros Sklaviadis
- Laboratory of Pharmacology, School of Health Sciences, Department of Pharmacy Aristotle University of Thessaloniki Thessaloniki Greece
| | - Brit Mollenhauer
- Institute for Neuropathology University Medical Center Göttingen Göttingen Germany
- Paracelsus‐Elena Klinik Center for Parkinsonism and Movement Disorders Kassel Germany
- Department of Neurosurgery University Medical Center Göttingen Göttingen Germany
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center University Medical Center Göttingen Göttingen Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Göttingen Germany
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Schmitz M, Llorens F, Pracht A, Thom T, Correia Â, Zafar S, Ferrer I, Zerr I. Regulation of human cerebrospinal fluid malate dehydrogenase 1 in sporadic Creutzfeldt-Jakob disease patients. Aging (Albany NY) 2016; 8:2927-2935. [PMID: 27852982 PMCID: PMC5191879 DOI: 10.18632/aging.101101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022]
Abstract
The identification of reliable diagnostic biomarkers in differential diagnosis of neurodegenerative diseases is an ongoing topic. A previous two-dimensional proteomic study on cerebrospinal fluid (CSF) revealed an elevated level of an enzyme, mitochondrial malate dehydrogenase 1 (MDH1), in sporadic Creutzfeldt-Jakob disease (sCJD) patients. Here, we could demonstrate the expression of MDH1 in neurons as well as in the neuropil. Its levels are lower in sCJD brains than in control brains. An examination of CSF-MDH1 in sCJD patients by ELISA revealed a significant elevation of CSF-MDH1 levels in sCJD patients (independently from the PRNP codon 129 MV genotype or the prion protein scrapie (PrPSc) type) in comparison to controls. In combination with total tau (tau), CSF-MDH1 detection exhibited a high diagnostic accuracy for sCJD diagnosis with a sensitivity of 97.5% and a specificity of 95.6%. A correlation study of MDH1 level in CSF with other neurodegenerative marker proteins revealed a significant positive correlation between MDH1 concentration with tau, 14-3-3 and neuron specific enolase level. In conclusion, our study indicated the potential of MDH1 in combination with tau as an additional biomarker in sCJD improving diagnostic accuracy of tau markedly.
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Affiliation(s)
- Matthias Schmitz
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE) – Göttingen Campus, Göttingen, Germany
| | - Franc Llorens
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE) – Göttingen Campus, Göttingen, Germany
| | - Alexander Pracht
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Thom
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ângela Correia
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Saima Zafar
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE) – Göttingen Campus, Göttingen, Germany
| | - Isidre Ferrer
- Institute of Neuropathology, Bellvitge University Hospital, CIBERNED, Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain
| | - Inga Zerr
- From the Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE) – Göttingen Campus, Göttingen, Germany
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Cerebrospinal Fluid Biomarkers in the Diagnosis of Creutzfeldt-Jakob Disease in Slovak Patients: over 10-Year Period Review. Mol Neurobiol 2016; 54:5919-5927. [PMID: 27665282 DOI: 10.1007/s12035-016-0128-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
Creutzfeldt-Jakob disease is a rare, but rapidly progressive, up to now untreatable and fatal neurodegenerative disorder. Clinical diagnosis of Creutzfeldt-Jakob disease (CJD) is difficult; however, it can be facilitated by suitable biomarkers. Aim of the present study is to compare levels of cerebrospinal fluid biomarkers (total tau protein, phosphorylated-tau protein, protein 14-3-3 and amyloid beta) in Slovak population of CJD suspect cases, retrospectively in over a 10-year period. One thousand three hundred sixty-four CSF samples from patients with suspect CJD, forming a homogenous group in terms of geographical as well as of equal transport conditions, storage and laboratory processing, were analysed. Definite diagnosis of Creutzfeldt-Jakob disease was confirmed in 101 patients with genetic form, and 60 patients with its sporadic form of the disease. Specificity of protein 14-3-3 and total tau in both forms CJD was similar (87 % for P14-3-3/85 % for total tau), sensitivity to P 14-3-3 and total tau was higher in sporadic Creutzfeldt-Jakob disease (sCJD) (90/95 %) than in genetic Creutzfeldt-Jakob disease (gCJD) (89/74 %). As expected, the total tau levels were significantly higher in CJD patients than in controls, but there was also significant difference between gCJD and sCJD (levels in gCJD were lower; p = 0.003). There was no significant difference in p-tau and Aβ 1-42 levels neither between both CJD forms nor between CJD patients and control group.
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McGuire LI, Poleggi A, Poggiolini I, Suardi S, Grznarova K, Shi S, de Vil B, Sarros S, Satoh K, Cheng K, Cramm M, Fairfoul G, Schmitz M, Zerr I, Cras P, Equestre M, Tagliavini F, Atarashi R, Knox D, Collins S, Haïk S, Parchi P, Pocchiari M, Green A. Cerebrospinal fluid real-time quaking-induced conversion is a robust and reliable test for sporadic creutzfeldt-jakob disease: An international study. Ann Neurol 2016; 80:160-5. [PMID: 27130376 PMCID: PMC4982084 DOI: 10.1002/ana.24679] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022]
Abstract
Real-time quaking-induced conversion (RT-QuIC) has been proposed as a sensitive diagnostic test for sporadic Creutzfeldt-Jakob disease; however, before this assay can be introduced into clinical practice, its reliability and reproducibility need to be demonstrated. Two international ring trials were undertaken in which a set of 25 cerebrospinal fluid samples were analyzed by a total of 11 different centers using a range of recombinant prion protein substrates and instrumentation. The results show almost complete concordance between the centers and demonstrate that RT-QuIC is a suitably reliable and robust technique for clinical practice. Ann Neurol 2016;80:160-165.
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Affiliation(s)
- Lynne I McGuire
- National CJD Research & Surveillance Unit, Western General Hospital, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Anna Poleggi
- Department of Neurological Sciences, National Institute of Health, Rome, Italy
| | - Ilaria Poggiolini
- Institute of Neurological Sciences, Scientific Institute for Research, Hospitalization and Health Care, Bologna, Italy
| | - Silvia Suardi
- Department of Neurodegenerative Diseases, Scientific Institute for Research, Hospitalization and Health Care, Carlo Besta Neurological Institute, Milan, Italy
| | - Katarina Grznarova
- Sorbonne Universities, Pierre and Marie Curie University, Brain and Spine Institute, Paris, France
- National Reference Centre for Unconventional Transmissible Agents, Paris, France
| | - Song Shi
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Bart de Vil
- Department of Neurology, Institute of Born Bunge, University of Antwerp, Antwerp, Belgium
| | - Shannon Sarros
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katsuya Satoh
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keding Cheng
- Prion Laboratory Section, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Maria Cramm
- Department of Neurology, University Medical Center and German Center for Neurodegenerative Diseases, University of Göttingen, Göttingen, Germany
| | - Graham Fairfoul
- National CJD Research & Surveillance Unit, Western General Hospital, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Matthias Schmitz
- Department of Neurology, University Medical Center and German Center for Neurodegenerative Diseases, University of Göttingen, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center and German Center for Neurodegenerative Diseases, University of Göttingen, Göttingen, Germany
| | - Patrick Cras
- Department of Neurology, Institute of Born Bunge, University of Antwerp, Antwerp, Belgium
| | - Michele Equestre
- Department of Neurological Sciences, National Institute of Health, Rome, Italy
| | - Fabrizio Tagliavini
- Department of Neurodegenerative Diseases, Scientific Institute for Research, Hospitalization and Health Care, Carlo Besta Neurological Institute, Milan, Italy
| | - Ryuichiro Atarashi
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - David Knox
- Prion Laboratory Section, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Steven Collins
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Stéphane Haïk
- Sorbonne Universities, Pierre and Marie Curie University, Brain and Spine Institute, Paris, France
- National Reference Centre for Unconventional Transmissible Agents, Paris, France
- APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Piero Parchi
- Institute of Neurological Sciences, Scientific Institute for Research, Hospitalization and Health Care, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maurizio Pocchiari
- Department of Neurological Sciences, National Institute of Health, Rome, Italy
| | - Alison Green
- National CJD Research & Surveillance Unit, Western General Hospital, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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CSF Tau proteins reduce misdiagnosis of sporadic Creutzfeldt–Jakob disease suspected cases with inconclusive 14-3-3 result. J Neurol 2016; 263:1847-61. [DOI: 10.1007/s00415-016-8209-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
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50
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Soomro S, Mohan C. Biomarkers for sporadic Creutzfeldt-Jakob disease. Ann Clin Transl Neurol 2016; 3:465-72. [PMID: 27547775 PMCID: PMC4892001 DOI: 10.1002/acn3.304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/27/2023] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare but fatal type of spongiform encephalopathy with unknown cause. Unfortunately, definitive diagnosis of this disease can only be done by examination of postmortem brain tissue. Presumptive diagnosis is done through a combination of clinical manifestations, radiology results, and cerebrospinal fluid (CSF) testing for CSF 14-3-3. Even with these guidelines, premortem diagnosis of sCJD can be unreliable with high rates of misdiagnosis. This calls for more reliable biomarkers of the disease, allowing for better diagnosis as well as understanding the pathogenesis of sCJD. This review compiles potential genetic, protein, biomolecular, and imaging biomarker studies for sCJD since 2010, highlighting the promise of proteins, cytokines, and composite biomarkers for improving the diagnosis as well as understanding the pathogenesis of this mysterious ailment.
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Affiliation(s)
- Sanam Soomro
- Department of Biomedical EngineeringUniversity of HoustonHoustonTexas77204
| | - Chandra Mohan
- Department of Biomedical EngineeringUniversity of HoustonHoustonTexas77204
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