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Hashemi E, Narain Srivastava I, Aguirre A, Tilahan Yoseph E, Kaushal E, Awani A, Kyu. Ryu J, Akassoglou K, Talebian S, Chu P, Pisani L, Musolino P, Steinman L, Doyle K, Robinson WH, Sharpe O, Cayrol R, Orchard P, Lund T, Vogel H, Lenail M, Han MH, Bonkowsky JL, Van Haren KP. A novel mouse model of cerebral adrenoleukodystrophy highlights NLRP3 activity in lesion pathogenesis. bioRxiv 2023:2023.11.07.564025. [PMID: 37986739 PMCID: PMC10659266 DOI: 10.1101/2023.11.07.564025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Objective We sought to create and characterize a mouse model of the inflammatory, cerebral demyelinating phenotype of X-linked adrenoleukodystrophy (ALD) that would facilitate the study of disease pathogenesis and therapy development. We also sought to cross-validate potential therapeutic targets such as fibrin, oxidative stress, and the NLRP3 inflammasome, in post-mortem human and murine brain tissues. Background ALD is caused by mutations in the gene ABCD1 encoding a peroxisomal transporter. More than half of males with an ABCD1 mutation develop the cerebral phenotype (cALD). Incomplete penetrance and absence of a genotype-phenotype correlation imply a role for environmental triggers. Mechanistic studies have been limited by the absence of a cALD phenotype in the Abcd1-null mouse. Methods We generated a cALD phenotype in 8-week-old, male Abcd1-null mice by deploying a two-hit method that combines cuprizone (CPZ) and experimental autoimmune encephalomyelitis (EAE) models. We employed in vivo MRI and post-mortem immunohistochemistry to evaluate myelin loss, astrogliosis, blood-brain barrier (BBB) disruption, immune cell infiltration, fibrin deposition, oxidative stress, and Nlrp3 inflammasome activation in mice. We used bead-based immunoassay and immunohistochemistry to evaluate IL-18 in CSF and post-mortem human cALD brain tissue. Results MRI studies revealed T2 hyperintensities and post-gadolinium enhancement in the medial corpus callosum of cALD mice, similar to human cALD lesions. Both human and mouse cALD lesions shared common histologic features of myelin phagocytosis, myelin loss, abundant microglial activation, T and B-cell infiltration, and astrogliosis. Compared to wild-type controls, Abcd1-null mice had more severe cerebral inflammation, demyelination, fibrin deposition, oxidative stress, and IL-18 activation. IL-18 immunoreactivity co-localized with macrophages/microglia in the perivascular region of both human and mouse brain tissue. Interpretation This novel mouse model of cALD suggests loss of Abcd1 function predisposes to more severe cerebral inflammation, oxidative stress, fibrin deposition, and Nlrp3 pathway activation, which parallels the findings seen in humans with cALD. We expect this model to enable long-sought investigations into cALD mechanisms and accelerate development of candidate therapies for lesion prevention, cessation, and remyelination.
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Affiliation(s)
- Ezzat Hashemi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Isha Narain Srivastava
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Alejandro Aguirre
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ezra Tilahan Yoseph
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Esha Kaushal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Avni Awani
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jae Kyu. Ryu
- Gladstone Institute for Neurological Disease; San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF; San Francisco, CA USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; San Francisco, CA, USA
| | - Katerina Akassoglou
- Gladstone Institute for Neurological Disease; San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF; San Francisco, CA USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; San Francisco, CA, USA
| | - Shahrzad Talebian
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Pauline Chu
- Stanford Human Research Histology Core, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura Pisani
- Department of Radiology, Stanford University School of Medicine Stanford, CA, USA
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lawrence Steinman
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristian Doyle
- Department of Immunobiology, University of Arizona, Tucson, AZ, USA
| | - William H Robinson
- Department of Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Orr Sharpe
- Department of Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Romain Cayrol
- Department of Pathology, Clinical Department of Laboratory Medicine, University of Montreal, Quebec, Canada
| | - Paul Orchard
- Division of Pediatric Blood & Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Troy Lund
- Division of Pediatric Blood & Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Hannes Vogel
- Departments of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Lenail
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - May Htwe Han
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua Leith Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
- Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, Utah
- Primary Children’s Center for Personalized Medicine, Salt Lake City, Utah
| | - Keith P. Van Haren
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Cerebral palsy (CP) is not a disease, but a neurological syndrome, a combination of signs and symptoms, some of which may occur in neurodegenerative or metabolic disorders, particularly those with an onset in the first 2 years of life. There are many different causes of the syndrome. All children with CP should undergo brain MRI, even with an identified antenatal or perinatal insult. Children with CP should be referred to a paediatric neurologist or a clinical geneticist, or both, if appropriate and particularly in the absence of a known perinatal cerebral insult, with brain MRI that is reported to be normal, a progression in, or new, signs or where there is a reported 'family history of CP'. Finally, a few of the CP syndromes may be readily treatable and potentially prevent irreversible neurological and cognitive impairment.
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Affiliation(s)
- Richard E Appleton
- The Roald Dahl EEG Unit, Neurophysiology Department, Alder Hey Children's Health Park, Liverpool, UK
| | - Rajat Gupta
- Department of Neurology, Birmingham Children's Hospital, Birmingham, UK
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Benjelloun FZM, Chabraoui L, Kriouile Y. [Overview of X-linked adrenoleukodystrophy in Morocco: results of the implementation of the program of clinical and biological diagnosis]. Pan Afr Med J 2018; 28:185. [PMID: 29599883 PMCID: PMC5871254 DOI: 10.11604/pamj.2017.28.185.11086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 10/15/2017] [Indexed: 01/23/2023] Open
Abstract
Introduction L'adrénoleucodystrophie liée à l'X (X-ALD) est une maladie neurodégénérative sévère, due à des mutations du gène ABCD1. Elle se manifeste par une atteinte du système nerveux central et périphérique, une insuffisance surrénalienne et une atteinte des testicules chez le garçon. Son diagnostic repose sur le dosage des Acides Gras à Très Longue Chaine. Le diagnostic précoce est d'une grande importance puisque il définit l'accessibilité aux traitements selon le stage de la maladie. Méthodes Nous avons mis en place un programme de diagnostic de l'X-ALD au Maroc au niveau de l'Hôpital d'enfants et du Laboratoire centrale des maladies héréditaires et du métabolisme de Rabat. Le programme s'articule sur trois axes à savoir : le recrutement des patients, le diagnostic et la sensibilisation. Le diagnostic s'effectue selon trois protocoles : un protocole pour les cas symptomatiques, un deuxième pour les cas asymptomatiques et un troisième pour les femmes hétérozygotes. Résultats Durant trois ans après la mise en place de notre programme de diagnostic de l'Adrénoleucodystrophie liée à l'X, nous avons diagnostiqué la maladie chez sept familles, avec neuf garçons et trois femmes hétérozygotes. Tous les enfants diagnostiqués présentaient la forme cérébrale démyélinisante. Toutes les femmes hétérozygotes étaient asymptomatiques. Une prise en charge thérapeutique a été mise place selon la symptomatologie de chaque cas. Conclusion l'X-ALD est une maladie rare. Notre programme de diagnostique a permis de diagnostiquer un nombre important de cas, ce qui montre son importance. Les compagnes de sensibilisation auprès des professionnels permettront de mieux comprendre la maladie et mieux la diagnostiquer et ainsi donner accès à un nombre plus élevé de patients.
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Affiliation(s)
- Fatima-Zohra Madani Benjelloun
- Unité de Neuropédiatrie, Service de Pédiatrie II, Hôpital d'Enfants de Rabat, Maroc.,Laboratoire de Biochimie, Centre d'Etude des Maladies Héréditaires du Métabolisme, CHU Ibn Sina Rabat, Maroc.,Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Layachi Chabraoui
- Laboratoire de Biochimie, Centre d'Etude des Maladies Héréditaires du Métabolisme, CHU Ibn Sina Rabat, Maroc.,Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Yamna Kriouile
- Unité de Neuropédiatrie, Service de Pédiatrie II, Hôpital d'Enfants de Rabat, Maroc.,Faculté de Médecine et de Pharmacie de Rabat, Maroc
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Eichler F, Ratai E, Carroll JJ, Masdeu JC. Inherited or acquired metabolic disorders. Handb Clin Neurol 2016; 135:603-36. [PMID: 27432685 DOI: 10.1016/B978-0-444-53485-9.00029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
This chapter starts with a description of imaging of inherited metabolic disorders, followed by a discussion on imaging of acquired toxic-metabolic disorders of the adult brain. Neuroimaging is crucial for the diagnosis and management of a number of inherited metabolic disorders. Among these, inherited white-matter disorders commonly affect both the nervous system and endocrine organs. Magnetic resonance imaging (MRI) has enabled new classifications of these disorders that have greatly enhanced both our diagnostic ability and our understanding of these complex disorders. Beyond the classic leukodystrophies, we are increasingly recognizing new hereditary leukoencephalopathies such as the hypomyelinating disorders. Conventional imaging can be unrevealing in some metabolic disorders, but proton magnetic resonance spectroscopy (MRS) may be able to directly visualize the metabolic abnormality in certain disorders. Hence, neuroimaging can enhance our understanding of pathogenesis, even in the absence of a pathologic specimen. This review aims to present pathognomonic brain MRI lesion patterns, the diagnostic capacity of proton MRS, and information from clinical and laboratory testing that can aid diagnosis. We demonstrate that applying an advanced neuroimaging approach enhances current diagnostics and management. Additional information on inherited and metabolic disorders of the brain can be found in Chapter 63 in the second volume of this series.
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Tran C, Hewson S, Steinberg SJ, Mercimek-Mahmutoglu S. Late-onset Zellweger spectrum disorder caused by PEX6 mutations mimicking X-linked adrenoleukodystrophy. Pediatr Neurol 2014; 51:262-5. [PMID: 25079577 DOI: 10.1016/j.pediatrneurol.2014.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/16/2014] [Accepted: 03/22/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Zellweger spectrum disorder is an autosomal recessively inherited multisystem disorder caused by one of the 13 different PEX gene defects resulting in defective peroxisomal assembly and multiple peroxisomal enzyme deficiencies. We report a new patient with late-onset Zellweger spectrum disorder mimicking X-linked adrenoleukodystrophy. PATIENT DESCRIPTION This 8.5-year-old boy with normal development until 6.5 years of age presented with bilateral sensorineural hearing loss during a school hearing test. He then developed acute-onset diplopia, clumsiness, and cognitive dysfunction at age 7 years. Magnetic resonance imaging of the brain revealed symmetric leukodystrophy, although without gadolinium enhancement. Elevated plasma very long chain fatty acid levels were suggestive of X-linked adrenoleukodystrophy, but his ABCD1 gene had normal coding sequence and dosage. Additional studies of cultured skin fibroblasts were consistent with Zellweger spectrum disorder. Molecular testing identified disease-causing compound heterozygous mutations in the PEX6 gene supporting the Zellweger spectrum disorder diagnosis in this patient. CONCLUSIONS We describe a new patient with late-onset Zellweger spectrum disorder caused by PEX6 mutations who presented with an acute neurodegenerative disease course mimicking X-linked adrenoleukodystrophy. This finding provides an additional reason that molecular confirmation is important for the genetic counseling and management of patients with a clinical and biochemical diagnosis of X-linked adrenoleukodystrophy.
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Affiliation(s)
- Christel Tran
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacy Hewson
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven J Steinberg
- Institute of Genetic Medicine and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saadet Mercimek-Mahmutoglu
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada; Genetics & Genome Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Santosh Rai PV, Suresh BV, Bhat IG, Sekhar M, Chakraborti S. Childhood adrenoleukodystrophy - Classic and variant - Review of clinical manifestations and magnetic resonance imaging. J Pediatr Neurosci 2014; 8:192-7. [PMID: 24470810 PMCID: PMC3888033 DOI: 10.4103/1817-1745.123661] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenoleukodystrophy (ALD) is a genetic disease associated with demyelination of the central nervous system, adrenal insufficiency, and accumulation of very long-chain fatty acids in tissue and body fluids. The attempt of this paper is to review the classical and not-so-classical MR imaging manifestations of adrenoleukodystrophy. A review of literature is done to describe the pathophysiology of the disease and the imaging differences between childhood and adult-onset of the disease. The literature is reviewed to explain the link with Addison's disease. In consensus the magnetic resonance imaging (MRI) findings of symmetrical occipital white matter lesions which progress in a rostro-caudal direction is the classical appearance of ALD. Familiarity with the clinico-pathologic manifestations and progressive MR imaging features of childhood cerebral X-linked ALD will be helpful in evaluating the affected patients.
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Affiliation(s)
- P V Santosh Rai
- Department of Radiodiagnosis, Kasturba Medical College Mangalore, Unit of Manipal University, Manipal, Karnataka, India
| | - B V Suresh
- Department of Neurology, Kasturba Medical College Mangalore, Unit of Manipal University, Manipal, Karnataka, India
| | - I G Bhat
- Department of Neurology, Kasturba Medical College Mangalore, Unit of Manipal University, Manipal, Karnataka, India
| | - Mithun Sekhar
- Department of Radiodiagnosis, Kasturba Medical College Mangalore, Unit of Manipal University, Manipal, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Pathology, Kasturba Medical College Mangalore, Unit of Manipal University, Manipal, Karnataka, India
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McKinney AM, Nascene D, Miller WP, Eisengart J, Loes D, Benson M, Tolar J, Orchard PJ, Ziegler RS, Zhang L, Provenzale J. Childhood cerebral X-linked adrenoleukodystrophy: diffusion tensor imaging measurements for prediction of clinical outcome after hematopoietic stem cell transplantation. AJNR Am J Neuroradiol 2013; 34:641-9. [PMID: 22899791 DOI: 10.3174/ajnr.a3232] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI in cerebral X-linked adrenoleukodystrophy may demonstrate abnormalities in both affected and nonaffected WM; these values have not been studied serially after hematopoietic stem cell transplantation. The purpose of this study was to study pretransplant and posttransplant DTI parameters serially and ultimately to determine the ability of pretransplant DTI parameters to predict clinical outcome after HSCT in children with ALD. MATERIALS AND METHODS Eight patients with posterior-pattern cerebral ALD underwent DTI at 3T before HSCT (T0), at 30-60 days (T1), 90-120 days (T2), 180 days (T3), and 1 year (T4) after HSCT. FA and MD were serially measured in 19 regions, and these measurements were compared with those in control patients. MR imaging severity (Loes) scores were recorded. Correlations were performed between DTI parameters and Loes scores, neurologic function scores, and several neuropsychologic scores. RESULTS Both FA and MD in subjects differed significantly from that in controls at nearly every time point within cerebellar WM, callosal splenium, and parieto-occipital WM; FA alone was significantly different at each time point within the optic radiations, lateral geniculate, and the Meyer loop (P < .05). Loes scores at T0 correlated strongly with each clinical score at T4 (r = 0.771-0.986, P < .05). The only significant DTI correlation at T0 with a clinical score at T4 was callosal body FA with adaptive function (r = 0.976, P < .001). Correlating the change in DTI values with change in NFS (change between T0 and T4) showed that only ΔMD within the optic radiations correlated strongly with ΔNFS (r = 0.903, P < .05). CONCLUSIONS DTI values at T0 were generally poor predictors of outcome at 1 year, whereas Loes scores were generally good predictors. ΔMD within the optic radiations strongly correlates with ΔNFS over that year. In addition, certain normal-appearing regions, such as cerebellar WM, may have DTI abnormalities before HSCT that persist after HSCT.
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Affiliation(s)
- A M McKinney
- Department of Radiology, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota, USA.
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Kemp S, Berger J, Aubourg P. X-linked adrenoleukodystrophy: Clinical, metabolic, genetic and pathophysiological aspects. Biochim Biophys Acta Mol Basis Dis 2012; 1822:1465-74. [DOI: 10.1016/j.bbadis.2012.03.012] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/08/2012] [Accepted: 03/20/2012] [Indexed: 12/28/2022]
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Abstract
X-linked Adrenoleukodystrophy (ALD) is the most common of the peroxisomal disorder and is associated with functional defect of the very long chain fatty acid (VLCFA) oxidation leading to the accumulation of VLCFA in the white matter and adrenal cortex. Retrospective evaluation of medical records of ALD patients were carried out. In all the 5 patients the duration of the symptoms varied from 1-7 years. Most of them presented with Addisonian crisis (4/5) and hyperpigmentation (5/5), white half of them (3/5) had neurological symptoms. All patients had biochemical evidence of the adrenal insufficiency. All siblings of patients should be screened for the possibility of ALD with VLCFA.
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Affiliation(s)
- Shrikrishna V Acharya
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India.
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Schmahmann JD, Smith EE, Eichler FS, Filley CM. Cerebral white matter: neuroanatomy, clinical neurology, and neurobehavioral correlates. Ann N Y Acad Sci 2008; 1142:266-309. [PMID: 18990132 DOI: 10.1196/annals.1444.017] [Citation(s) in RCA: 332] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Lesions of the cerebral white matter (WM) result in focal neurobehavioral syndromes, neuropsychiatric phenomena, and dementia. The cerebral WM contains fiber pathways that convey axons linking cerebral cortical areas with each other and with subcortical structures, facilitating the distributed neural circuits that subserve sensorimotor function, intellect, and emotion. Recent neuroanatomical investigations reveal that these neural circuits are topographically linked by five groupings of fiber tracts emanating from every neocortical area: (1) cortico-cortical association fibers; (2) corticostriatal fibers; (3) commissural fibers; and cortico-subcortical pathways to (4) thalamus and (5) pontocerebellar system, brain stem, and/or spinal cord. Lesions of association fibers prevent communication between cortical areas engaged in different domains of behavior. Lesions of subcortical structures or projection/striatal fibers disrupt the contribution of subcortical nodes to behavior. Disconnection syndromes thus result from lesions of the cerebral cortex, subcortical structures, and WM tracts that link the nodes that make up the distributed circuits. The nature and the severity of the clinical manifestations of WM lesions are determined, in large part, by the location of the pathology: discrete neurological and neuropsychiatric symptoms result from focal WM lesions, whereas cognitive impairment across multiple domains--WM dementia--occurs in the setting of diffuse WM disease. We present a detailed review of the conditions affecting WM that produce these neurobehavioral syndromes, and consider the pathophysiology, clinical effects, and broad significance of the effects of aging and vascular compromise on cerebral WM, in an attempt to help further the understanding, diagnosis, and treatment of these disorders.
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Affiliation(s)
- Jeremy D Schmahmann
- Ataxia Unit, Cognitive/Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
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Abstract
Although the genetics and biochemistry of leukodystrophies have been extensively explored, the immune response in these disorders has received relatively little attention. Both the disease course and its response to treatment may be highly dependent on the immune system. In this review, we compare three common leukodystrophies, each with a different immune response: (1) X-linked adrenoleukodystrophy, which demonstrates a severe, lymphocytic inflammatory response; (2) metachromatic leukodystrophy, which yields a histiocytic response; and (3) vanishing white-matter disease, in which no inflammation is typically seen. We highlight the biochemical, pathologic, and clinical differences, while focusing on the immune response in each disease. We also review the response of leukodystrophies to immunomodulatory therapies and interventions such as hematopoietic stem-cell transplantation. Future studies may delineate specific inflammatory markers as possible candidates for therapeutic intervention.
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Affiliation(s)
- Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Kim JH, Kim HJ. Childhood X-linked Adrenoleukodystrophy: Clinical-Pathologic Overview and MR Imaging Manifestations at Initial Evaluation and Follow-up. Radiographics 2005; 25:619-31. [PMID: 15888613 DOI: 10.1148/rg.253045118] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
X-linked adrenoleukodystrophy (ALD) is a rare metabolic disorder caused by peroxisomal enzyme failure. Several phenotypes can be distinguished on the basis of clinical onset and manifestations. Childhood cerebral X-linked ALD is the most severe phenotype, resulting in rapid neurologic deterioration and early death. Patients with this disease may be hospitalized with far-advanced central nervous system (CNS) lesions or may complain of symptoms similar to those of certain psychiatric disorders, possibly leading to a wrong diagnosis. Although the general prognosis for patients with childhood cerebral X-linked ALD is still poor, new treatment modalities have been introduced, some of which are helpful in relieving clinical symptoms and prolonging life. With the introduction of these new therapies and increased clinical detection of childhood cerebral X-linked ALD, brain magnetic resonance (MR) imaging has become an essential tool for initial and follow-up evaluation. MR imaging allows early detection of CNS lesions and helps differentiate childhood cerebral X-linked ALD from other disorders. The characteristic MR imaging features of childhood cerebral X-linked ALD have been well documented, although most radiologists have limited experience with serial follow-up MR imaging in this context. Familiarity with the clinical-pathologic manifestations and progressive MR imaging features of childhood cerebral X-linked ALD will be helpful in evaluating affected patients.
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Affiliation(s)
- Ji Hyung Kim
- Department of Diagnostic Radiology, Konyang University Hospital, 685 Gasuwon-dong, Seo-gu, Daejeon City 302-718, South Korea.
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Abstract
Recently, diffusion tensor imaging is attracting the biomedical researchers for its application in depiction of fiber tracts based on diffusion anisotropy. In this paper, we briefly describe the basic theory of diffusion tensor MR imaging, the determination process of diffusion tensor, and the basic concepts of diffusion tensor visualization techniques. Several results of clinical application in our institute are also introduced. Finally, the limitations, advantages and disadvantages of the techniques are discussed for further application of diffusion tensor visualization.
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Affiliation(s)
- Yoshitaka Masutani
- Image Computing and Analysis Laboratory, Department of Radiology, University of Tokyo (UT-RAD/ICAL), 7-3-1 Hongo Bunkyo-Ku, Tokyo 113-8655, Japan
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Affiliation(s)
- Elias R Melhem
- Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287-2182, USA
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