1
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Abiose O, Rutledge J, Moran‐Losada P, Belloy ME, Wilson EN, He Z, Trelle AN, Channappa D, Romero A, Park J, Yutsis MV, Sha SJ, Andreasson KI, Poston KL, Henderson VW, Wagner AD, Wyss‐Coray T, Mormino EC. Post-translational modifications linked to preclinical Alzheimer's disease-related pathological and cognitive changes. Alzheimers Dement 2024; 20:1851-1867. [PMID: 38146099 PMCID: PMC10984434 DOI: 10.1002/alz.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION In this study, we leverage proteomic techniques to identify communities of proteins underlying Alzheimer's disease (AD) risk among clinically unimpaired (CU) older adults. METHODS We constructed a protein co-expression network using 3869 cerebrospinal fluid (CSF) proteins quantified by SomaLogic, Inc., in a cohort of participants along the AD clinical spectrum. We then replicated this network in an independent cohort of CU older adults and related these modules to clinically-relevant outcomes. RESULTS We discovered modules enriched for phosphorylation and ubiquitination that were associated with abnormal amyloid status, as well as p-tau181 (M4: β = 2.44, p < 0.001, M7: β = 2.57, p < 0.001) and executive function performance (M4: β = -2.00, p = 0.005, M7: β = -2.39, p < 0.001). DISCUSSION In leveraging CSF proteomic data from individuals spanning the clinical spectrum of AD, we highlight the importance of post-translational modifications for early cognitive and pathological changes.
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Affiliation(s)
- Olamide Abiose
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Jarod Rutledge
- The Phil and Penny Knight Initiative for Brain ResilienceStanford UniversityStanfordCaliforniaUSA
- Department of GeneticsStanford UniversityStanfordCaliforniaUSA
| | - Patricia Moran‐Losada
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
- The Phil and Penny Knight Initiative for Brain ResilienceStanford UniversityStanfordCaliforniaUSA
| | - Michael E. Belloy
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Edward N. Wilson
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Zihuai He
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Center for Biomedical Informatics ResearchStanford University School of MedicineStanfordCaliforniaUSA
| | - Alexandra N. Trelle
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Divya Channappa
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - America Romero
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Jennifer Park
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Maya V. Yutsis
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Sharon J. Sha
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Katrin I. Andreasson
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
- Chan Zuckerberg BiohubSan FranciscoCaliforniaUSA
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
- The Phil and Penny Knight Initiative for Brain ResilienceStanford UniversityStanfordCaliforniaUSA
| | - Victor W. Henderson
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Department of Epidemiology & Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Anthony D. Wagner
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
- Department of PsychologyStanford UniversityStanfordCaliforniaUSA
| | - Tony Wyss‐Coray
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
- The Phil and Penny Knight Initiative for Brain ResilienceStanford UniversityStanfordCaliforniaUSA
| | - Elizabeth C. Mormino
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
- Wu Tsai Neurosciences InstituteStanford University School of MedicineStanfordCaliforniaUSA
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2
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Oh HSH, Rutledge J, Nachun D, Pálovics R, Abiose O, Moran-Losada P, Channappa D, Urey DY, Kim K, Sung YJ, Wang L, Timsina J, Western D, Liu M, Kohlfeld P, Budde J, Wilson EN, Guen Y, Maurer TM, Haney M, Yang AC, He Z, Greicius MD, Andreasson KI, Sathyan S, Weiss EF, Milman S, Barzilai N, Cruchaga C, Wagner AD, Mormino E, Lehallier B, Henderson VW, Longo FM, Montgomery SB, Wyss-Coray T. Organ aging signatures in the plasma proteome track health and disease. Nature 2023; 624:164-172. [PMID: 38057571 PMCID: PMC10700136 DOI: 10.1038/s41586-023-06802-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
Animal studies show aging varies between individuals as well as between organs within an individual1-4, but whether this is true in humans and its effect on age-related diseases is unknown. We utilized levels of human blood plasma proteins originating from specific organs to measure organ-specific aging differences in living individuals. Using machine learning models, we analysed aging in 11 major organs and estimated organ age reproducibly in five independent cohorts encompassing 5,676 adults across the human lifespan. We discovered nearly 20% of the population show strongly accelerated age in one organ and 1.7% are multi-organ agers. Accelerated organ aging confers 20-50% higher mortality risk, and organ-specific diseases relate to faster aging of those organs. We find individuals with accelerated heart aging have a 250% increased heart failure risk and accelerated brain and vascular aging predict Alzheimer's disease (AD) progression independently from and as strongly as plasma pTau-181 (ref. 5), the current best blood-based biomarker for AD. Our models link vascular calcification, extracellular matrix alterations and synaptic protein shedding to early cognitive decline. We introduce a simple and interpretable method to study organ aging using plasma proteomics data, predicting diseases and aging effects.
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Affiliation(s)
- Hamilton Se-Hwee Oh
- Graduate Program in Stem Cell and Regenerative Medicine, Stanford University, Stanford, CA, USA
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Jarod Rutledge
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Graduate Program in Genetics, Stanford University, Stanford, CA, USA
| | - Daniel Nachun
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Róbert Pálovics
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Olamide Abiose
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia Moran-Losada
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Divya Channappa
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Deniz Yagmur Urey
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University School of Engineering, Stanford, CA, USA
| | - Kate Kim
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yun Ju Sung
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Lihua Wang
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jigyasha Timsina
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Dan Western
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Menghan Liu
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Pat Kohlfeld
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - John Budde
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Edward N Wilson
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yann Guen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Taylor M Maurer
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Haney
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew C Yang
- Departments of Neurology and Anatomy, University of California San Francisco, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, Gladstone Institutes, San Francisco, CA, USA
- Bakar Aging Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael D Greicius
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Katrin I Andreasson
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Sanish Sathyan
- Departments of Medicine and Genetics, Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA
| | - Erica F Weiss
- Department of Neurology, Montefiore Medical Center, New York, NY, USA
| | - Sofiya Milman
- Departments of Medicine and Genetics, Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA
| | - Nir Barzilai
- Departments of Medicine and Genetics, Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Anthony D Wagner
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Elizabeth Mormino
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Victor W Henderson
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Frank M Longo
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen B Montgomery
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Tony Wyss-Coray
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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3
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Piehl N, van Olst L, Ramakrishnan A, Teregulova V, Simonton B, Zhang Z, Tapp E, Channappa D, Oh H, Losada PM, Rutledge J, Trelle AN, Mormino EC, Elahi F, Galasko DR, Henderson VW, Wagner AD, Wyss-Coray T, Gate D. Cerebrospinal fluid immune dysregulation during healthy brain aging and cognitive impairment. Cell 2022; 185:5028-5039.e13. [PMID: 36516855 PMCID: PMC9815831 DOI: 10.1016/j.cell.2022.11.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
Cerebrospinal fluid (CSF) contains a tightly regulated immune system. However, knowledge is lacking about how CSF immunity is altered with aging or neurodegenerative disease. Here, we performed single-cell RNA sequencing on CSF from 45 cognitively normal subjects ranging from 54 to 82 years old. We uncovered an upregulation of lipid transport genes in monocytes with age. We then compared this cohort with 14 cognitively impaired subjects. In cognitively impaired subjects, downregulation of lipid transport genes in monocytes occurred concomitantly with altered cytokine signaling to CD8 T cells. Clonal CD8 T effector memory cells upregulated C-X-C motif chemokine receptor 6 (CXCR6) in cognitively impaired subjects. The CXCR6 ligand, C-X-C motif chemokine ligand 16 (CXCL16), was elevated in the CSF of cognitively impaired subjects, suggesting CXCL16-CXCR6 signaling as a mechanism for antigen-specific T cell entry into the brain. Cumulatively, these results reveal cerebrospinal fluid immune dysregulation during healthy brain aging and cognitive impairment.
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Affiliation(s)
- Natalie Piehl
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lynn van Olst
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Abhirami Ramakrishnan
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Victoria Teregulova
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brooke Simonton
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ziyang Zhang
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emma Tapp
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Hamilton Oh
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA; Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, CA, USA; Graduate Program in Stem Cell and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | - Patricia M Losada
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Jarod Rutledge
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA; Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, CA, USA; Department of Genetics, Stanford University, Stanford, CA, USA
| | | | - Elizabeth C Mormino
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA; Department of Psychology, Stanford University, Stanford, CA, USA
| | - Fanny Elahi
- Departments of Neurology and Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, La Jolla, CA, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California at San Diego, La Jolla, CA, USA
| | - Victor W Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony D Wagner
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA; Department of Psychology, Stanford University, Stanford, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA; Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, CA, USA; The Phil and Penny Initiative for Brain Resilience, Stanford University, Stanford, CA, USA; Chemistry, Engineering, and Medicine for Human Health (ChEM-H), Stanford University, Stanford, CA, USA
| | - David Gate
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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4
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Wilson EN, Young CB, Benitez JAR, Vandijck M, Swarovski MS, Shahid M, Corso N, Kennedy G, Trelle AN, Channappa D, Belnap M, Lind B, Bastard NL, Quinn JF, Nairn AC, Kerchner GA, Sha S, Wagner AD, Henderson V, Longo FM, Wyss‐Coray T, Poston KL, Mormino EC, Andreasson KI. Diagnostic and Prognostic Performance of the Modified Lumipulse pTau 181 Assay in Plasma for Alzheimer’s Disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.060879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | - Marian Shahid
- Stanford University School of Medicine Stanford CA USA
| | | | | | | | | | | | - Betty Lind
- Oregon Health & Science University Portland OR USA
| | | | - Joseph F Quinn
- Oregon Health & Science University Portland OR USA
- VA Portland Health Care System Portland OR USA
| | | | | | - Sharon Sha
- Stanford University School of Medicine Stanford CA USA
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5
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Wilson EN, Young CB, Ramos Benitez J, Swarovski MS, Feinstein I, Vandijck M, Le Guen Y, Kasireddy NM, Shahid M, Corso NK, Wang Q, Kennedy G, Trelle AN, Lind B, Channappa D, Belnap M, Ramirez V, Skylar-Scott I, Younes K, Yutsis MV, Le Bastard N, Quinn JF, van Dyck CH, Nairn A, Fredericks CA, Tian L, Kerchner GA, Montine TJ, Sha SJ, Davidzon G, Henderson VW, Longo FM, Greicius MD, Wagner AD, Wyss-Coray T, Poston KL, Mormino EC, Andreasson KI. Performance of a fully-automated Lumipulse plasma phospho-tau181 assay for Alzheimer's disease. Alzheimers Res Ther 2022; 14:172. [PMID: 36371232 PMCID: PMC9652927 DOI: 10.1186/s13195-022-01116-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 09/02/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The recent promise of disease-modifying therapies for Alzheimer's disease (AD) has reinforced the need for accurate biomarkers for early disease detection, diagnosis and treatment monitoring. Advances in the development of novel blood-based biomarkers for AD have revealed that plasma levels of tau phosphorylated at various residues are specific and sensitive to AD dementia. However, the currently available tests have shortcomings in access, throughput, and scalability that limit widespread implementation. METHODS We evaluated the diagnostic and prognostic performance of a high-throughput and fully-automated Lumipulse plasma p-tau181 assay for the detection of AD. Plasma from older clinically unimpaired individuals (CU, n = 463) and patients with mild cognitive impairment (MCI, n = 107) or AD dementia (n = 78) were obtained from the longitudinal Stanford University Alzheimer's Disease Research Center (ADRC) and the Stanford Aging and Memory Study (SAMS) cohorts. We evaluated the discriminative accuracy of plasma p-tau181 for clinical AD diagnosis, association with amyloid β peptides and p-tau181 concentrations in CSF, association with amyloid positron emission tomography (PET), and ability to predict longitudinal cognitive and functional change. RESULTS The assay showed robust performance in differentiating AD from control participants (AUC 0.959, CI: 0.912 to 0.990), and was strongly associated with CSF p-tau181, CSF Aβ42/Aβ40 ratio, and amyloid-PET global SUVRs. Associations between plasma p-tau181 with CSF biomarkers were significant when examined separately in Aβ+ and Aβ- groups. Plasma p-tau181 significantly increased over time in CU and AD diagnostic groups. After controlling for clinical diagnosis, age, sex, and education, baseline plasma p-tau181 predicted change in MoCA overall and change in CDR Sum of Boxes in the AD group over follow-up of up to 5 years. CONCLUSIONS This fully-automated and available blood-based biomarker assay therefore may be useful for early detection, diagnosis, prognosis, and treatment monitoring of AD.
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Affiliation(s)
- Edward N. Wilson
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA
| | - Christina B. Young
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Javier Ramos Benitez
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Michelle S. Swarovski
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Igor Feinstein
- grid.168010.e0000000419368956Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA USA
| | | | - Yann Le Guen
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Nandita M. Kasireddy
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Marian Shahid
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Nicole K. Corso
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Qian Wang
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Gabriel Kennedy
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Alexandra N. Trelle
- grid.168010.e0000000419368956Psychology, Stanford University, Stanford, CA USA
| | - Betty Lind
- grid.410404.50000 0001 0165 2383Neurology, Portland VA Medical Center, Portland, OR USA ,grid.5288.70000 0000 9758 5690Neurology, Oregon Health & Science University, Portland, OR USA
| | - Divya Channappa
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Pathology, Stanford University, Stanford, CA USA
| | - Malia Belnap
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Veronica Ramirez
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Irina Skylar-Scott
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Kyan Younes
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Maya V. Yutsis
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | | | - Joseph F. Quinn
- grid.410404.50000 0001 0165 2383Neurology, Portland VA Medical Center, Portland, OR USA ,grid.5288.70000 0000 9758 5690Neurology, Oregon Health & Science University, Portland, OR USA
| | | | - Angus Nairn
- grid.47100.320000000419368710Psychiatry, Yale University, New Haven, CT USA
| | - Carolyn A. Fredericks
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Lu Tian
- grid.168010.e0000000419368956Biomedical Data Science, Stanford University, Stanford, CA USA
| | - Geoffrey A. Kerchner
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Thomas J. Montine
- grid.168010.e0000000419368956Pathology, Stanford University, Stanford, CA USA
| | - Sharon J. Sha
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA
| | - Guido Davidzon
- grid.168010.e0000000419368956Radiology, Stanford University, Stanford, CA USA
| | - Victor W. Henderson
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Epidemiology & Population Health, Stanford University, Stanford, CA USA
| | - Frank M. Longo
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA
| | - Michael D. Greicius
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA
| | - Anthony D. Wagner
- grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Psychology, Stanford University, Stanford, CA USA
| | - Tony Wyss-Coray
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA
| | - Kathleen L. Poston
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA
| | - Elizabeth C. Mormino
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA
| | - Katrin I. Andreasson
- grid.168010.e0000000419368956Neurology & Neurological Sciences, Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.499295.a0000 0004 9234 0175Chan Zuckerberg Biohub, San Francisco, CA 94158 USA
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6
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Napolioni V, Fredericks CA, Kim Y, Channappa D, Khan RR, Kim LH, Zafar F, Couthouis J, Davidzon GA, Mormino EC, Gitler AD, Montine TJ, Schüle B, Greicius MD. Phenotypic Heterogeneity among GBA p.R202X Carriers in Lewy Body Spectrum Disorders. Biomedicines 2022; 10:biomedicines10010160. [PMID: 35052839 PMCID: PMC8774039 DOI: 10.3390/biomedicines10010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
We describe the clinical and neuropathologic features of patients with Lewy body spectrum disorder (LBSD) carrying a nonsense variant, c.604C>T; p.R202X, in the glucocerebrosidase 1 (GBA) gene. While this GBA variant is causative for Gaucher's disease, the pathogenic role of this mutation in LBSD is unclear. Detailed neuropathologic evaluation was performed for one index case and a structured literature review of other GBA p.R202X carriers was conducted. Through the systematic literature search, we identified three additional reported subjects carrying the same GBA mutation, including one Parkinson's disease (PD) patient with early disease onset, one case with neuropathologically-verified LBSD, and one unaffected relative of a Gaucher's disease patient. Among the affected subjects carrying the GBA p.R202X, all males were diagnosed with Lewy body dementia, while the two females presented as PD. The clinical penetrance of GBA p.R202X in LBSD patients and families argues strongly for a pathogenic role for this variant, although presenting with a striking phenotypic heterogeneity of clinical and pathological features.
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Affiliation(s)
- Valerio Napolioni
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
- Correspondence: ; Tel.: +1-(669)-287-2586
| | - Carolyn A. Fredericks
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
| | - Yongha Kim
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
| | - Divya Channappa
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.C.); (F.Z.); (T.J.M.); (B.S.)
| | - Raiyan R. Khan
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
| | - Lily H. Kim
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
| | - Faria Zafar
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.C.); (F.Z.); (T.J.M.); (B.S.)
| | - Julien Couthouis
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.C.); (A.D.G.)
| | - Guido A. Davidzon
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Elizabeth C. Mormino
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
| | - Aaron D. Gitler
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.C.); (A.D.G.)
| | - Thomas J. Montine
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.C.); (F.Z.); (T.J.M.); (B.S.)
| | - Birgitt Schüle
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.C.); (F.Z.); (T.J.M.); (B.S.)
| | - Michael D. Greicius
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.A.F.); (Y.K.); (R.R.K.); (L.H.K.); (E.C.M.); (M.D.G.)
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7
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Gate D, Tapp E, Leventhal O, Shahid M, Nonninger TJ, Yang AC, Strempfl K, Unger MS, Fehlmann T, Oh H, Channappa D, Henderson VW, Keller A, Aigner L, Galasko DR, Davis MM, Poston KL, Wyss-Coray T. CD4 + T cells contribute to neurodegeneration in Lewy body dementia. Science 2021; 374:868-874. [PMID: 34648304 PMCID: PMC9122025 DOI: 10.1126/science.abf7266] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Recent studies indicate that the adaptive immune system plays a role in Lewy body dementia (LBD). However, the mechanism regulating T cell brain homing in LBD is unknown. Here, we observed T cells adjacent to Lewy bodies and dopaminergic neurons in post-mortem LBD brains. Single-cell RNA sequencing of cerebrospinal fluid (CSF) identified upregulated expression of C-X-C Motif Chemokine Receptor 4 (CXCR4) in CD4+ T cells in LBD. CSF protein levels of the CXCR4 ligand, C-X-C Motif Chemokine Ligand 12 (CXCL12) were associated with neuroaxonal damage in LBD. Furthermore, we observed clonal expansion and upregulated Interleukin 17A expression by CD4+ T cells stimulated with a phosphorylated α-synuclein epitope. Thus, CXCR4-CXCL12 signaling may represent a mechanistic target for inhibiting pathological interleukin-17-producing T cell trafficking in LBD. The immune system is implicated in the neurodegenerative process of Lewy body dementia.
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Affiliation(s)
- David Gate
- Department of Neurology, Northwestern University, Chicago, IL, USA.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Emma Tapp
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Olivia Leventhal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Marian Shahid
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Tim J Nonninger
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Andrew C Yang
- Department of Bioengineering, Stanford University, Stanford, CA, USA.,Chemistry, Engineering, and Medicine for Human Health (ChEM-H), Stanford University, Stanford, CA, USA
| | - Katharina Strempfl
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.,QPS Austria GmbH, Parkring 12, 8074 Grambach, Austria
| | - Michael S Unger
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Tobias Fehlmann
- Chair for Clinical Bioinformatics, Saarland University, Saarbrucken, Germany
| | - Hamilton Oh
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Victor W Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Andreas Keller
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Chair for Clinical Bioinformatics, Saarland University, Saarbrucken, Germany
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mark M Davis
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford, CA, USA.,Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.,Chemistry, Engineering, and Medicine for Human Health (ChEM-H), Stanford University, Stanford, CA, USA
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8
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Yang AC, Kern F, Losada PM, Agam MR, Maat CA, Schmartz GP, Fehlmann T, Stein JA, Schaum N, Lee DP, Calcuttawala K, Vest RT, Berdnik D, Lu N, Hahn O, Gate D, McNerney MW, Channappa D, Cobos I, Ludwig N, Schulz-Schaeffer WJ, Keller A, Wyss-Coray T. Publisher Correction: Dysregulation of brain and choroid plexus cell types in severe COVID-19. Nature 2021; 598:E4. [PMID: 34625744 PMCID: PMC8500262 DOI: 10.1038/s41586-021-04080-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew C Yang
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA, USA.,ChEM-H, Stanford University, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Fabian Kern
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Patricia M Losada
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Maayan R Agam
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina A Maat
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Georges P Schmartz
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Tobias Fehlmann
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Julian A Stein
- Institute for Neuropathology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
| | - Nicholas Schaum
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Davis P Lee
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kruti Calcuttawala
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ryan T Vest
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniela Berdnik
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Nannan Lu
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Oliver Hahn
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - David Gate
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - M Windy McNerney
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Inma Cobos
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicole Ludwig
- Department of Human Genetics, Saarland University, Homburg, Germany
| | - Walter J Schulz-Schaeffer
- Institute for Neuropathology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
| | - Andreas Keller
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA. .,Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany.
| | - Tony Wyss-Coray
- ChEM-H, Stanford University, Stanford, CA, USA. .,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA. .,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA. .,Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, CA, USA.
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9
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Yang AC, Kern F, Losada PM, Agam MR, Maat CA, Schmartz GP, Fehlmann T, Stein JA, Schaum N, Lee DP, Calcuttawala K, Vest RT, Berdnik D, Lu N, Hahn O, Gate D, McNerney MW, Channappa D, Cobos I, Ludwig N, Schulz-Schaeffer WJ, Keller A, Wyss-Coray T. Dysregulation of brain and choroid plexus cell types in severe COVID-19. Nature 2021; 595:565-571. [PMID: 34153974 PMCID: PMC8400927 DOI: 10.1038/s41586-021-03710-0] [Citation(s) in RCA: 340] [Impact Index Per Article: 113.3] [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] [Received: 10/20/2020] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Abstract
Although SARS-CoV-2 primarily targets the respiratory system, patients with and survivors of COVID-19 can suffer neurological symptoms1-3. However, an unbiased understanding of the cellular and molecular processes that are affected in the brains of patients with COVID-19 is missing. Here we profile 65,309 single-nucleus transcriptomes from 30 frontal cortex and choroid plexus samples across 14 control individuals (including 1 patient with terminal influenza) and 8 patients with COVID-19. Although our systematic analysis yields no molecular traces of SARS-CoV-2 in the brain, we observe broad cellular perturbations indicating that barrier cells of the choroid plexus sense and relay peripheral inflammation into the brain and show that peripheral T cells infiltrate the parenchyma. We discover microglia and astrocyte subpopulations associated with COVID-19 that share features with pathological cell states that have previously been reported in human neurodegenerative disease4-6. Synaptic signalling of upper-layer excitatory neurons-which are evolutionarily expanded in humans7 and linked to cognitive function8-is preferentially affected in COVID-19. Across cell types, perturbations associated with COVID-19 overlap with those found in chronic brain disorders and reside in genetic variants associated with cognition, schizophrenia and depression. Our findings and public dataset provide a molecular framework to understand current observations of COVID-19-related neurological disease, and any such disease that may emerge at a later date.
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Affiliation(s)
- Andrew C Yang
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA, USA
- ChEM-H, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Fabian Kern
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Patricia M Losada
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Maayan R Agam
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina A Maat
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Georges P Schmartz
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Tobias Fehlmann
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Julian A Stein
- Institute for Neuropathology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
| | - Nicholas Schaum
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Davis P Lee
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kruti Calcuttawala
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ryan T Vest
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniela Berdnik
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Nannan Lu
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Oliver Hahn
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - David Gate
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - M Windy McNerney
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Inma Cobos
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicole Ludwig
- Department of Human Genetics, Saarland University, Homburg, Germany
| | - Walter J Schulz-Schaeffer
- Institute for Neuropathology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
| | - Andreas Keller
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany.
| | - Tony Wyss-Coray
- ChEM-H, Stanford University, Stanford, CA, USA.
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
- Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, CA, USA.
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10
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Oh H, Leventhal O, Channappa D, Henderson VW, Wyss-Coray T, Lehallier B, Gate D. Methods to investigate intrathecal adaptive immunity in neurodegeneration. Mol Neurodegener 2021; 16:3. [PMID: 33482851 PMCID: PMC7824942 DOI: 10.1186/s13024-021-00423-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/29/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) provides basic mechanical and immunological protection to the brain. Historically, analysis of CSF has focused on protein changes, yet recent studies have shed light on cellular alterations. Evidence now exists for involvement of intrathecal T cells in the pathobiology of neurodegenerative diseases. However, a standardized method for long-term preservation of CSF immune cells is lacking. Further, the functional role of CSF T cells and their cognate antigens in neurodegenerative diseases are largely unknown. Results We present a method for long-term cryopreservation of CSF immune cells for downstream single cell RNA and T cell receptor sequencing (scRNA-TCRseq) analysis. We observe preservation of CSF immune cells, consisting primarily of memory CD4+ and CD8+ T cells. We then utilize unbiased bioinformatics approaches to quantify and visualize TCR sequence similarity within and between disease groups. By this method, we identify clusters of disease-associated, antigen-specific TCRs from clonally expanded CSF T cells of patients with neurodegenerative diseases. Conclusions Here, we provide a standardized approach for long-term storage of CSF immune cells. Additionally, we present unbiased bioinformatic approaches that will facilitate the discovery of target antigens of clonally expanded T cells in neurodegenerative diseases. These novel methods will help improve our understanding of adaptive immunity in the central nervous system. Supplementary Information The online version contains supplementary material available at 10.1186/s13024-021-00423-w.
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Affiliation(s)
- Hamilton Oh
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Olivia Leventhal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Victor W Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - David Gate
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.
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11
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Trelle AN, Carr VA, Wilson EN, Swarovski MS, Hunt MP, Toueg TN, Tran TT, Channappa D, Corso NK, Thieu MK, Jayakumar M, Nadiadwala A, Guo W, Tanner NJ, Bernstein JD, Litovsky CP, Guerin SA, Khazenzon AM, Harrison MB, Rutt BK, Deutsch GK, Chin FT, Davidzon GA, Hall JN, Sha SJ, Fredericks CA, Andreasson KI, Kerchner GA, Wagner AD, Mormino EC. Association of CSF Biomarkers With Hippocampal-Dependent Memory in Preclinical Alzheimer Disease. Neurology 2021; 96:e1470-e1481. [PMID: 33408146 DOI: 10.1212/wnl.0000000000011477] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine whether memory tasks with demonstrated sensitivity to hippocampal function can detect variance related to preclinical Alzheimer disease (AD) biomarkers, we examined associations between performance in 3 memory tasks and CSF β-amyloid (Aβ)42/Aβ40 and phosopho-tau181 (p-tau181) in cognitively unimpaired older adults (CU). METHODS CU enrolled in the Stanford Aging and Memory Study (n = 153; age 68.78 ± 5.81 years; 94 female) completed a lumbar puncture and memory assessments. CSF Aβ42, Aβ40, and p-tau181 were measured with the automated Lumipulse G system in a single-batch analysis. Episodic memory was assayed using a standardized delayed recall composite, paired associate (word-picture) cued recall, and a mnemonic discrimination task that involves discrimination between studied "target" objects, novel "foil" objects, and perceptually similar "lure" objects. Analyses examined cross-sectional relationships among memory performance, age, and CSF measures, controlling for sex and education. RESULTS Age and lower Aβ42/Aβ40 were independently associated with elevated p-tau181. Age, Aβ42/Aβ40, and p-tau181 were each associated with (1) poorer associative memory and (2) diminished improvement in mnemonic discrimination performance across levels of decreased task difficulty (i.e., target-lure similarity). P-tau mediated the effect of Aβ42/Aβ40 on memory. Relationships between CSF proteins and delayed recall were similar but nonsignificant. CSF Aβ42 was not significantly associated with p-tau181 or memory. CONCLUSIONS Tests designed to tax hippocampal function are sensitive to subtle individual differences in memory among CU and correlate with early AD-associated biomarker changes in CSF. These tests may offer utility for identifying CU with preclinical AD pathology.
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Affiliation(s)
- Alexandra N Trelle
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA.
| | - Valerie A Carr
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Edward N Wilson
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Michelle S Swarovski
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Madison P Hunt
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Tyler N Toueg
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Tammy T Tran
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Divya Channappa
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Nicole K Corso
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Monica K Thieu
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Manasi Jayakumar
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Ayesha Nadiadwala
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Wanjia Guo
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Natalie J Tanner
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Jeffrey D Bernstein
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Celia P Litovsky
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Scott A Guerin
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Anna M Khazenzon
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Marc B Harrison
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Brian K Rutt
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Gayle K Deutsch
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Frederick T Chin
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Guido A Davidzon
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Jacob N Hall
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Sharon J Sha
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Carolyn A Fredericks
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Katrin I Andreasson
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Geoffrey A Kerchner
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Anthony D Wagner
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
| | - Elizabeth C Mormino
- From the Department of Psychology (A.N.T., V.A.C., M.P.H., T.T.T., M.K.T., M.J., W.G., N.J.T., J.D.B., C.P.L., S.A.G., A.M.K., M.B.H., A.D.W.), Stanford University; and Department of Neurology and Neurological Sciences (E.N.W., M.S.S., T.N.T., D.C., N.K.C., A.N., G.K.D., J.N.H., S.J.S., C.A.F., K.I.A., G.A.K., E.C.M.) and Division of Nuclear Medicine & Molecular Imaging Division, Department of Radiology (B.K.R., F.T.C., G.A.D.), Stanford Medical School, CA
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Wilson EN, Swarovski MS, Linortner P, Shahid M, Zuckerman AJ, Wang Q, Channappa D, Minhas PS, Mhatre SD, Plowey ED, Quinn JF, Zabetian CP, Tian L, Longo FM, Cholerton B, Montine TJ, Poston KL, Andreasson KI. Soluble TREM2 is elevated in Parkinson's disease subgroups with increased CSF tau. Brain 2020; 143:932-943. [PMID: 32065223 PMCID: PMC7089668 DOI: 10.1093/brain/awaa021] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/26/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease is the second most common neurodegenerative disease after Alzheimer's disease and affects 1% of the population above 60 years old. Although Parkinson's disease commonly manifests with motor symptoms, a majority of patients with Parkinson's disease subsequently develop cognitive impairment, which often progresses to dementia, a major cause of morbidity and disability. Parkinson's disease is characterized by α-synuclein accumulation that frequently associates with amyloid-β and tau fibrils, the hallmarks of Alzheimer's disease neuropathological changes; this co-occurrence suggests that onset of cognitive decline in Parkinson's disease may be associated with appearance of pathological amyloid-β and/or tau. Recent studies have highlighted the appearance of the soluble form of the triggering receptor expressed on myeloid cells 2 (sTREM2) receptor in CSF during development of Alzheimer's disease. Given the known association of microglial activation with advancing Parkinson's disease, we investigated whether CSF and/or plasma sTREM2 differed between CSF biomarker-defined Parkinson's disease participant subgroups. In this cross-sectional study, we examined 165 participants consisting of 17 cognitively normal elderly subjects, 45 patients with Parkinson's disease with no cognitive impairment, 86 with mild cognitive impairment, and 17 with dementia. Stratification of subjects by CSF amyloid-β and tau levels revealed that CSF sTREM2 concentrations were elevated in Parkinson's disease subgroups with a positive tau CSF biomarker signature, but not in Parkinson's disease subgroups with a positive CSF amyloid-β biomarker signature. These findings indicate that CSF sTREM2 could serve as a surrogate immune biomarker of neuronal injury in Parkinson's disease.
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Affiliation(s)
- Edward N Wilson
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Michelle S Swarovski
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Patricia Linortner
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Marian Shahid
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Abigail J Zuckerman
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Qian Wang
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Divya Channappa
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Pathology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Paras S Minhas
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Siddhita D Mhatre
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Edward D Plowey
- Pathology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Joseph F Quinn
- Neurology, Oregon Health and Sciences University, Portland, OR, USA
- Neurology, Portland VA Medical Center, Portland, OR, USA
| | - Cyrus P Zabetian
- VA Puget Sound Health Care System, Seattle, WA, USA
- Neurology, University of Washington, Seattle, WA, USA
| | - Lu Tian
- Biomedical Data Science and Statistics, Stanford University, Stanford, CA, USA
| | - Frank M Longo
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Brenna Cholerton
- Pathology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Thomas J Montine
- Pathology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Kathleen L Poston
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Neurosurgery, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Katrin I Andreasson
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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13
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Gate D, Saligrama N, Leventhal O, Yang AC, Unger MS, Middeldorp J, Chen K, Lehallier B, Channappa D, De Los Santos MB, McBride A, Pluvinage J, Elahi F, Tam GKY, Kim Y, Greicius M, Wagner AD, Aigner L, Galasko DR, Davis MM, Wyss-Coray T. Clonally expanded CD8 T cells patrol the cerebrospinal fluid in Alzheimer's disease. Nature 2020; 577:399-404. [PMID: 31915375 PMCID: PMC7445078 DOI: 10.1038/s41586-019-1895-7] [Citation(s) in RCA: 454] [Impact Index Per Article: 113.5] [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] [Received: 05/30/2018] [Accepted: 12/02/2019] [Indexed: 11/08/2022]
Abstract
Alzheimer's disease is an incurable neurodegenerative disorder in which neuroinflammation has a critical function1. However, little is known about the contribution of the adaptive immune response in Alzheimer's disease2. Here, using integrated analyses of multiple cohorts, we identify peripheral and central adaptive immune changes in Alzheimer's disease. First, we performed mass cytometry of peripheral blood mononuclear cells and discovered an immune signature of Alzheimer's disease that consists of increased numbers of CD8+ T effector memory CD45RA+ (TEMRA) cells. In a second cohort, we found that CD8+ TEMRA cells were negatively associated with cognition. Furthermore, single-cell RNA sequencing revealed that T cell receptor (TCR) signalling was enhanced in these cells. Notably, by using several strategies of single-cell TCR sequencing in a third cohort, we discovered clonally expanded CD8+ TEMRA cells in the cerebrospinal fluid of patients with Alzheimer's disease. Finally, we used machine learning, cloning and peptide screens to demonstrate the specificity of clonally expanded TCRs in the cerebrospinal fluid of patients with Alzheimer's disease to two separate Epstein-Barr virus antigens. These results reveal an adaptive immune response in the blood and cerebrospinal fluid in Alzheimer's disease and provide evidence of clonal, antigen-experienced T cells patrolling the intrathecal space of brains affected by age-related neurodegeneration.
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Affiliation(s)
- David Gate
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, USA.
| | - Naresha Saligrama
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Olivia Leventhal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew C Yang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Chemistry, Engineering and Medicine for Human Health, Stanford University, Stanford, CA, USA
| | - Michael S Unger
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jinte Middeldorp
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Translational Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Kelly Chen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark B De Los Santos
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Alisha McBride
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, USA
| | - John Pluvinage
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA, USA
- Stem Cell Biology and Regenerative Medicine Graduate Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Fanny Elahi
- Department of Neurology, Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
| | - Grace Kyin-Ye Tam
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Functional Imaging in Neuropsychiatric Disorders Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yongha Kim
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Functional Imaging in Neuropsychiatric Disorders Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Greicius
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Functional Imaging in Neuropsychiatric Disorders Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony D Wagner
- Department of Psychology, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Douglas R Galasko
- Department of Neurosciences, University of California at San Diego, La Jolla, CA, USA
| | - Mark M Davis
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, USA.
- Chemistry, Engineering and Medicine for Human Health, Stanford University, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
- Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, CA, USA.
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Khan RR, Napolioni V, Altmann A, Seeley WW, Montine TJ, Coppola G, Chen JA, Plowey ED, Channappa D, Gitler AD, Couthouis J, Flanagan ME, Greicius MD. [O1–03–06]: IDENTIFICATION OF AN
ITGA7
VARIANT ASSOCIATED WITH ALZHEIMER's DISEASE AND MULTIPLE OTHER NEURODEGENERATIVE DISEASES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Aaron D. Gitler
- Stanford University School of MedicineStanfordCAUSA
- Interdepartmental Program in BioinformaticsUniversity of California, Los AngelesLos AngelesCAUSA
| | - Julien Couthouis
- Stanford University School of MedicineStanfordCAUSA
- Semel Institute for Neuroscience and Behavior at UCLALos AngelesCAUSA
| | - Margaret E. Flanagan
- Stanford University School of MedicineStanfordCAUSA
- University of California, San FranciscoSan FranciscoCAUSA
| | - Michael D. Greicius
- Stanford University School of MedicineStanfordCAUSA
- Translational Imaging GroupCentre for Medical Image ComputingUniversity College LondonLondonUnited Kingdom
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15
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Wong P, Li L, Chea J, Delgado MK, Crow D, Poku E, Szpikowska B, Bowles N, Channappa D, Colcher D, Wong JYC, Shively JE, Yazaki PJ. PET imaging of 64Cu-DOTA-scFv-anti-PSMA lipid nanoparticles (LNPs): Enhanced tumor targeting over anti-PSMA scFv or untargeted LNPs. Nucl Med Biol 2017; 47:62-68. [PMID: 28126683 DOI: 10.1016/j.nucmedbio.2017.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/24/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Single chain (scFv) antibodies are ideal targeting ligands due to their modular structure, high antigen specificity and affinity. These monovalent ligands display rapid tumor targeting but have limitations due to their fast urinary clearance. METHODS An anti-prostate membrane antigen (PSMA) scFv with a site-specific cysteine was expressed and evaluated in a prostate cancer xenograft model by Cu-64 PET imaging. To enhance tumor accumulation, the scFv-cys was conjugated to the co-polymer DSPE-PEG-maleimide that spontaneously assembled into a homogeneous multivalent lipid nanoparticle (LNP). RESULTS The targeted LNP exhibited a 2-fold increase in tumor uptake compared to the scFv alone using two different thiol ester chemistries. The anti-PSMA scFv-LNP exhibited a 1.6 fold increase in tumor targeting over the untargeted LNP. CONCLUSIONS The targeted anti-PSMA scFv-LNP showed enhanced tumor accumulation over the scFv alone or the untargeted DOTA-micelle providing evidence for the development of this system for drug delivery. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Anti-tumor scFv antibody fragments have not achieved their therapeutic potential due to their fast blood clearance. Conjugation to an LNP enables multivalency to the tumor antigen as well as increased molecular size for chemotherapy drug delivery.
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Affiliation(s)
- Patty Wong
- Department of Radiation Oncology, City of Hope Medical Center, City of Hope, Duarte, CA, 91010-3000, USA
| | - Lin Li
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Junie Chea
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Melissa K Delgado
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Desiree Crow
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Erasmus Poku
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Barbara Szpikowska
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Nicole Bowles
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Divya Channappa
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - David Colcher
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope Medical Center, City of Hope, Duarte, CA, 91010-3000, USA
| | - John E Shively
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Paul J Yazaki
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA.
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16
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Yazaki PJ, Lee B, Channappa D, Cheung CW, Crow D, Chea J, Poku E, Li L, Andersen JT, Sandlie I, Orcutt KD, Wittrup KD, Shively JE, Raubitschek A, Colcher D. A series of anti-CEA/anti-DOTA bispecific antibody formats evaluated for pre-targeting: comparison of tumor uptake and blood clearance. Protein Eng Des Sel 2012; 26:187-93. [PMID: 23175797 DOI: 10.1093/protein/gzs096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A series of anti-tumor/anti-chelate bispecific antibody formats were developed for pre-targeted radioimmunotherapy. Based on the anti-carcinoembryonic antigen humanized hT84.66-M5A monoclonal antibody and the anti-DOTA C8.2.5 scFv antibody fragment, this cognate series of bispecific antibodies were radioiodinated to determine their tumor targeting, biodistribution and pharmacokinetic properties in a mouse xenograft tumor model. The in vivo biodistribution studies showed that all the bispecific antibodies exhibited specific high tumor uptake but the tumor targeting was approximately one-half of the parental anti-CEA mAb due to faster blood clearance. Serum stability and FcRn studies showed no apparent reason for the faster blood clearance. A dual radiolabel biodistribution study revealed that the (111)In-DOTA bispecific antibody had increased liver and spleen uptake, not seen for the (125)I-version due to metabolism and release of the radioiodine from the cells. These data suggest increased clearance of the antibody fusion formats by the mononuclear phagocyte system. Importantly, a pre-targeted study showed specific tumor uptake of (177)Lu-DOTA and a tumor : blood ratio of 199 : 1. This pre-targeted radiotherapeutic and substantial reduction in the radioactive exposure to the bone marrow should enhance the therapeutic potential of RIT.
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Affiliation(s)
- Paul J Yazaki
- Department of Cancer Immunotherapeutics & Tumor Immunology, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA.
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Abstract
BACKGROUND Previously, concomitant antireflux surgery was performed in all neurologically impaired children undergoing gastrostomy tube placement in our department. This fundoplication procedure, not necessarily performed for symptomatic gastroesophageal reflux, increased the postoperative complications. This practice was changed and fundoplication was offered to only those children who had clear surgical indications for an antireflux procedure on follow-up after a feeding gastrostomy. METHODS In the period from 1996 to 2007, all children who underwent gastrostomy with fundoplication were compared with those in whom feeding gastrostomy alone was done. The clinical symptoms, investigations and indications for gastrostomy and fundoplication were recorded. The children who underwent gastrostomy were followed up for symptoms of gastroesophageal reflux and the need for subsequent fundoplication was studied. The complications directly related to surgery were also studied and statistically analyzed. RESULTS A total of 137 children had gastrostomy insertion, 60 of whom underwent fundoplication. Of these 60 children, 45 had concomitant fundoplication and gastrostomy. In the patients who had gastrostomy alone, a subsequent fundoplication procedure was required only in 17.1% (14 of 82). The complication rate as well as the severity of complications directly related to surgery was found to be higher in the gastrostomy+fundoplication group (18 of 60) compared with those who had only gastrostomy (12 of 82) (p=0.036). CONCLUSION Prophylactic fundoplication may not be necessary in neurologically impaired children undergoing gastrostomy for feeding purposes. It increases the postoperative morbidity compared to gastrostomy alone in this group of children. It should be offered selectively to children continuing to have reflux-related complications after gastrostomy. The technical difficulties with a pre-existing gastrostomy can be overcome in the hands of experienced laparoscopic surgeons.
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Affiliation(s)
- N Viswanath
- Waikato Hospital, Department of Paediatric Surgery, Hamilton, New Zealand
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