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Faust PL, McCreary M, Musacchio JB, Kuo SH, Vonsattel JPG, Louis ED. Pathologically based criteria to distinguish essential tremor from controls: analyses of the human cerebellum. Ann Clin Transl Neurol 2024. [PMID: 38644741 DOI: 10.1002/acn3.52068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE Essential tremor is among the most prevalent neurological diseases. Diagnosis is based entirely on neurological evaluation. Historically, there were few postmortem brain studies, hindering attempts to develop pathologically based criteria to distinguish essential tremor from control brains. However, an intensive effort to bank essential tremor brains over recent years has resulted in postmortem studies involving >200 brains, which have identified numerous degenerative changes in the essential tremor cerebellar cortex. Although essential tremor and controls have been compared with respect to individual metrics of pathology, there has been no overarching analysis to derive a combination of metrics to distinguish essential tremor from controls. We asked whether there is a constellation of pathological findings that separates essential tremor from controls, and how well that constellation performs. METHODS Analyses included 100 essential tremor brains from the essential tremor centralized brain repository and 50 control brains. A standard tissue block from the cerebellar cortex was used to quantify 11 metrics of pathological change. Three supervised classification algorithms were investigated, with data divided into training and validation samples. RESULTS Using three different algorithms, we illustrate the ability to correctly predict a diagnosis of essential tremor, with sensitivity and specificity >87%, and in the majority of situations, >90%. We also provide a web-based application that uses these metric values, and based on specified cutoffs, determines the likely diagnosis. INTERPRETATION These analyses set the stage for use of pathologically based criteria to distinguish clinically diagnosed essential tremor cases from controls, at the time of postmortem.
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Affiliation(s)
- Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Morgan McCreary
- Statistical Planning and Analysis Section, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Jessica B Musacchio
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
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2
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Louis ED, Martuscello RT, Gionco JT, Hartstone WG, Musacchio JB, Portenti M, McCreary M, Kuo SH, Vonsattel JPG, Faust PL. Histopathology of the cerebellar cortex in essential tremor and other neurodegenerative motor disorders: comparative analysis of 320 brains. Acta Neuropathol 2023; 145:265-283. [PMID: 36607423 PMCID: PMC10461794 DOI: 10.1007/s00401-022-02535-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 11/15/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
In recent years, numerous morphologic changes have been identified in the essential tremor (ET) cerebellar cortex, distinguishing ET from control brains. These findings have not been fully contextualized within a broader degenerative disease spectrum, thus limiting their interpretability. Building off our prior study and now doubling the sample size, we conducted comparative analyses in a postmortem series of 320 brains on the severity and patterning of cerebellar cortex degenerative changes in ET (n = 100), other neurodegenerative disorders of the cerebellum [spinocerebellar ataxias (SCAs, n = 47, including 13 SCA3 and 34 SCA1, 2, 6, 7, 8, 14); Friedreich's ataxia (FA, n = 13); multiple system atrophy (MSA), n = 29], and other disorders that may involve the cerebellum [Parkinson's disease (PD), n = 62; dystonia, n = 19] versus controls (n = 50). We generated data on 37 quantitative morphologic metrics, grouped into 8 broad categories: Purkinje cell (PC) loss, heterotopic PCs, PC dendritic changes, PC axonal changes (torpedoes), PC axonal changes (other than torpedoes), PC axonal changes (torpedo-associated), basket cell axonal hypertrophy, and climbing fiber-PC synaptic changes. Principal component analysis of z scored raw data across all diagnoses (11,651 data items) revealed that diagnostic groups were not uniform with respect to pathology. Dystonia and PD each differed from controls in only 4/37 and 5/37 metrics, respectively, whereas ET differed in 21, FA in 10, SCA3 in 10, MSA in 21, and SCA1/2/6/7/8/14 in 27. Pathological changes were generally on the milder end of the degenerative spectrum in ET, FA and SCA3, and on the more severe end of that spectrum in SCA1/2/6/7/8/14. Comparative analyses across morphologic categories demonstrated differences in relative expression, defining distinctive patterns of changes in these groups. In summary, we present a robust and reproducible method that identifies somewhat distinctive signatures of degenerative changes in the cerebellar cortex that mark each of these disorders.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-8813, USA.
| | - Regina T Martuscello
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - John T Gionco
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Whitney G Hartstone
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Jessica B Musacchio
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Marisa Portenti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Morgan McCreary
- Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-8813, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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3
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Kim SH, Farrell K, Cosentino S, Vonsattel JPG, Faust PL, Cortes EP, Bennet DA, Louis ED, Crary JF. Tau Isoform Profile in Essential Tremor Diverges From Other Tauopathies. J Neuropathol Exp Neurol 2021; 80:835-843. [PMID: 34363663 DOI: 10.1093/jnen/nlab073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patients with essential tremor (ET) frequently develop concurrent dementia, which is often assumed to represent co-morbid Alzheimer disease (AD). Autopsy studies have identified a spectrum of tau pathologies in ET and tau isoforms have not been examined in ET. We performed immunoblotting using autopsy cerebral cortical tissue from patients with ET (n = 13), progressive supranuclear palsy ([PSP], n = 10), Pick disease ([PiD], n = 2), and AD (n = 7). Total tau in ET samples was similar to that in PSP and PiD but was significantly lower than that in AD. Abnormal tau levels measured using the AT8 phospho-tau specific (S202/T205/S208) monoclonal antibody in ET were similar to those in PSP but were lower than in PiD and AD. In aggregates, tau with 3 microtubule-binding domain repeats (3R) was significantly higher in AD than ET, while tau with 4 repeats (4R) was significantly higher in PSP. Strikingly, the total tau without N-terminal inserts in ET was significantly lower than in PSP, PiD, and AD, but total tau with other N-terminal inserts was not. Monomeric tau with one insert in ET was similar to that in PSP and PiD was lower than in AD. Thus, ET brains exhibit an expression profile of tau protein isoforms that diverges from that of other tauopathies.
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Affiliation(s)
- Soong Ho Kim
- From the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, JFC).,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC)
| | - Kurt Farrell
- From the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC)
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York, USA (SC); G.H. Sergievsky Center, Columbia University Medical Center, New York, New York, USA (SC, JPV).,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA (SC, JPV)
| | - Jean-Paul G Vonsattel
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, New York, USA (SC); G.H. Sergievsky Center, Columbia University Medical Center, New York, New York, USA (SC, JPV).,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA (SC, JPV).,Department of Pathology & Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA (JPV, PLF)
| | - Phyllis L Faust
- Department of Pathology & Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA (JPV, PLF)
| | - Etty P Cortes
- From the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA (EC, JFC)
| | - David A Bennet
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA (DAB)
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA (EDL)
| | - John F Crary
- From the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, JFC).,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA (SHK, KF, EC, JFC).,Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA (EC, JFC)
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Pan MK, Li YS, Wong SB, Ni CL, Wang YM, Liu WC, Lu LY, Lee JC, Cortes EP, Vonsattel JPG, Sun Q, Louis ED, Faust PL, Kuo SH. Cerebellar oscillations driven by synaptic pruning deficits of cerebellar climbing fibers contribute to tremor pathophysiology. Sci Transl Med 2021; 12:12/526/eaay1769. [PMID: 31941824 DOI: 10.1126/scitranslmed.aay1769] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022]
Abstract
Essential tremor (ET) is one of the most common movement disorders and the prototypical disorder for abnormal rhythmic movements. However, the pathophysiology of tremor generation in ET remains unclear. Here, we used autoptic cerebral tissue from patients with ET, clinical data, and mouse models to report that synaptic pruning deficits of climbing fiber (CF)-to-Purkinje cell (PC) synapses, which are related to glutamate receptor delta 2 (GluRδ2) protein insufficiency, cause excessive cerebellar oscillations and might be responsible for tremor. The CF-PC synaptic pruning deficits were correlated with the reduction in GluRδ2 expression in the postmortem ET cerebellum. Mice with GluRδ2 insufficiency and CF-PC synaptic pruning deficits develop ET-like tremor that can be suppressed with viral rescue of GluRδ2 protein. Step-by-step optogenetic or pharmacological inhibition of neuronal firing, axonal activity, or synaptic vesicle release confirmed that the activity of the excessive CF-to-PC synapses is required for tremor generation. In vivo electrophysiology in mice showed that excessive cerebellar oscillatory activity is CF dependent and necessary for tremor and optogenetic-driven PC synchronization was sufficient to generate tremor in wild-type animals. Human validation by cerebellar electroencephalography confirmed that excessive cerebellar oscillations also exist in patients with ET. Our findings identify a pathophysiologic contribution to tremor at molecular (GluRδ2), structural (CF-to-PC synapses), physiological (cerebellar oscillations), and behavioral levels (kinetic tremor) that might have clinical applications for treating ET.
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Affiliation(s)
- Ming-Kai Pan
- Department of Medical Research, National Taiwan University Hospital, Taipei City 10002, Taiwan. .,Institute of Pharmacology, College of Medicine, National Taiwan University Hospital, Taipei City 10051, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei City 10051, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei City 10051, Taiwan.,Department of Neurology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
| | - Yong-Shi Li
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Shi-Bing Wong
- Department of Neurology, Columbia University, New York, NY 10032, USA.,Department of Pediatrics, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
| | - Chun-Lun Ni
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Yi-Mei Wang
- Department of Neurology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
| | - Wen-Chuan Liu
- Department of Medical Research, National Taiwan University Hospital, Taipei City 10002, Taiwan.,Institute of Pharmacology, College of Medicine, National Taiwan University Hospital, Taipei City 10051, Taiwan
| | - Liang-Yin Lu
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei City 10051, Taiwan
| | - Jye-Chang Lee
- Molecular Imaging Center, National Taiwan University, Taipei City 10051, Taiwan
| | - Etty P Cortes
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA
| | - Qian Sun
- Department of Neuroscience, Columbia University, New York, NY 10032, USA.,Department of Neurosciences, Case Western Reserve University, Cleveland, OH 44016, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06519, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT 06510, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY 10032, USA. .,Initiative of Columbia Ataxia and Tremor, New York, NY 10032, USA
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5
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Gosset P, Maxan A, Alpaugh M, Breger L, Dehay B, Tao Z, Ling Z, Qin C, Cisbani G, Fortin N, Vonsattel JPG, Lacroix S, Oueslati A, Bezard E, Cicchetti F. Evidence for the spread of human-derived mutant huntingtin protein in mice and non-human primates. Neurobiol Dis 2020; 141:104941. [PMID: 32422281 DOI: 10.1016/j.nbd.2020.104941] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/13/2020] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 02/05/2023] Open
Abstract
In recent years, substantial evidence has emerged to suggest that spreading of pathological proteins contributes to disease pathology in numerous neurodegenerative disorders. Work from our laboratory and others have shown that, despite its strictly genetic nature, Huntington's disease (HD) may be another condition in which this mechanism contributes to pathology. In this study, we set out to determine if the mutant huntingtin protein (mHTT) present in post-mortem brain tissue derived from HD patients can induce pathology in mice and/or non-human primates. For this, we performed three distinct sets of experiments where homogenates were injected into the brains of adult a) Wild-type (WT) and b) BACHD mice or c) non-human primates. Neuropathological assessments revealed that, while changes in the endogenous huntingtin were not apparent, mHTT could spread between cellular elements and brain structures. Furthermore, behavioural differences only occurred in the animal model of HD which already overexpressed mHTT. Taken together, our results indicate that mHTT derived from human brains has only a limited capacity to propagate between cells and does not depict prion-like characteristics. This contrasts with recent work demonstrating that other forms of mHTT - such as fibrils of a pathological polyQ length or fibroblasts and induced pluripotent stem cells derived from HD cases - can indeed disseminate disease throughout the brain in a prion-like fashion.
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Affiliation(s)
- Philippe Gosset
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada
| | - Alexander Maxan
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada
| | - Melanie Alpaugh
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada
| | - Ludivine Breger
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux CNRS UMR 5293, France
| | - Benjamin Dehay
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux CNRS UMR 5293, France
| | - Zhu Tao
- Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China
| | - Zhang Ling
- Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China
| | - Chuan Qin
- Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China.
| | - Giulia Cisbani
- University of Toronto, Department of Nutritional Sciences, Toronto, ON M5S 1A8, Canada
| | - Nadia Fortin
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada
| | | | - Steve Lacroix
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada; Département de Médicine Moléculaire, Université Laval, Québec, QC G1K 0A6, Canada
| | - Abid Oueslati
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada; Département de Médicine Moléculaire, Université Laval, Québec, QC G1K 0A6, Canada
| | - Erwan Bezard
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux CNRS UMR 5293, France
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC G1V 4G2, Canada; Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC G1K 0A6, Canada.
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Louis ED, Kuo SH, Wang J, Tate WJ, Pan MK, Kelly GC, Gutierrez J, Cortes EP, Vonsattel JPG, Faust PL. Cerebellar Pathology in Familial vs. Sporadic Essential Tremor. Cerebellum 2018; 16:786-791. [PMID: 28364185 DOI: 10.1007/s12311-017-0853-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Familial and sporadic essential tremor (ET) cases differ in several respects. Whether they differ with respect to cerebellar pathologic changes has yet to be studied. We quantified a broad range of postmortem features (Purkinje cell (PC) counts, PC axonal torpedoes, a host of associated axonal changes, heterotopic PCs, and hairy basket ratings) in 60 ET cases and 30 controls. Familial ET was defined using both liberal criteria (n = 27) and conservative criteria (n = 20). When compared with controls, ET cases had lower PC counts, more torpedoes, more heterotopic PCs, a higher hairy basket rating, an increase in PC axonal collaterals, an increase in PC thickened axonal profiles, and an increase in PC axonal branching. Familial and sporadic ET had similar postmortem changes, with few exceptions, regardless of the definition criteria. The PC counts were marginally lower in familial than sporadic ET (respective p values = 0.059 [using liberal criteria] and 0.047 [using conservative criteria]). The PC thickened axonal profile count was marginally lower in familial ET than sporadic ET (respective p values = 0.037 [using liberal criteria] and 0.17 [using conservative criteria]), and the PC axonal branching count was marginally lower in familial than sporadic ET (respective p values = 0.045 [using liberal criteria] and 0.079 [using conservative criteria]). After correction for multiple comparisons, however, there were no significant differences. Overall, familial and sporadic ET cases share very similar cerebellar postmortem features. These data indicate that pathological changes in the cerebellum are a part of the pathophysiological cascade of events in both forms of ET.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - William J Tate
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Ming-Kai Pan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Medical Research, National Taiwan University, Taipei, Taiwan
| | - Geoffrey C Kelly
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Jesus Gutierrez
- Department of Neurology, Yale School of Medicine, Yale University, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA
| | - Etty P Cortes
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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7
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Ma Q, Yang J, Milner TA, Vonsattel JPG, Palko ME, Tessarollo L, Hempstead BL. SorCS2-mediated NR2A trafficking regulates motor deficits in Huntington's disease. JCI Insight 2017; 2:88995. [PMID: 28469074 PMCID: PMC5414556 DOI: 10.1172/jci.insight.88995] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/15/2016] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
Motor dysfunction is a prominent and disabling feature of Huntington's disease (HD), but the molecular mechanisms that dictate its onset and progression are unknown. The N-methyl-D-aspartate receptor 2A (NR2A) subunit regulates motor skill development and synaptic plasticity in medium spiny neurons (MSNs) of the striatum, cells that are most severely impacted by HD. Here, we document reduced NR2A receptor subunits on the dendritic membranes and at the synapses of MSNs in zQ175 mice that model HD. We identify that SorCS2, a vacuolar protein sorting 10 protein-domain (VPS10P-domain) receptor, interacts with VPS35, a core component of retromer, thereby regulating surface trafficking of NR2A in MSNs. In the zQ175 striatum, SorCS2 is markedly decreased in an age- and allele-dependent manner. Notably, SorCS2 selectively interacts with mutant huntingtin (mtHTT), but not WT huntingtin (wtHTT), and is mislocalized to perinuclear clusters in striatal neurons of human HD patients and zQ175 mice. Genetic deficiency of SorCS2 accelerates the onset and exacerbates the motor coordination deficit of zQ175 mice. Together, our results identify SorCS2 as an interacting protein of mtHTT and demonstrate that impaired SorCS2-mediated NR2A subunit trafficking to dendritic surface of MSNs is, to our knowledge, a novel mechanism contributing to motor coordination deficits of HD.
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Affiliation(s)
- Qian Ma
- Graduate Program of Neuroscience
| | - Jianmin Yang
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Teresa A Milner
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Laboratory of Neuroendocrinology, The Rockefeller University, New York, New York, USA
| | - Jean-Paul G Vonsattel
- The New York Brain Bank/Taub Institute Columbia University, Children's Hospital, New York, New York, USA
| | - Mary Ellen Palko
- Mouse Cancer Genetics Program, Center for Cancer Research, NCI, Frederick, Maryland, USA
| | - Lino Tessarollo
- Mouse Cancer Genetics Program, Center for Cancer Research, NCI, Frederick, Maryland, USA
| | - Barbara L Hempstead
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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8
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Kuo SH, Wang J, Tate WJ, Pan MK, Kelly GC, Gutierrez J, Cortes EP, Vonsattel JPG, Louis ED, Faust PL. Cerebellar Pathology in Early Onset and Late Onset Essential Tremor. Cerebellum 2017; 16:473-482. [PMID: 27726094 PMCID: PMC5336493 DOI: 10.1007/s12311-016-0826-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Early onset and late onset essential tremor (ET) cases differ in several respects. Whether they differ with respect to cerebellar pathologic changes remains to be determined. We quantified a broad range of postmortem features (Purkinje cell (PC) counts, PC axonal torpedoes and associated axonal changes, heterotopic PCs, and hairy basket ratings) in 30 ET cases with age of tremor onset <50 years, 30 ET cases with age of tremor onset ≥50 years, and 30 controls (total n = 90). We also used two alternative age of onset cut-points (<40 vs. ≥40 years, and <60 vs. ≥60 years) to define early onset vs. late onset ET. We found that ET cases with tremor onset <50 years and tremor onset ≥50 years had similar PC counts (8.78 ± 1.70 vs. 8.86 ± 1.24, p = 0.839), PC axonal torpedo counts (17.87 ± 18.27 [median =13.00] vs. 12.90 ± 10.60 [median =9.0], p = 0.486) and associated axonal pathology (all p values >0.05), heterotopic PC counts (9.90 ± 11.55 [median =6.00] vs. 5.40 ± 5.10 [median =3.50], p = 0.092), and hairy basket ratings (1.95 ± 0.62 [median =2.00] vs. 2.05 ± 0.92 [median =2.00], p = 0.314). When using the age of onset cut-points of 40 or 60 years, results were similar. Early onset and late onset ET cases share similar cerebellar postmortem features. These data do not support the notion that these age-of-onset related forms of ET represent distinct clinical-pathological entities.
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Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Neurological Institute, Columbia University, New York, NY, 10032, USA.
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - William J Tate
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Ming-Kai Pan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Medical Research, National Taiwan University, Taipei, Taiwan
| | - Geoffrey C Kelly
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Jesus Gutierrez
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Etty P Cortes
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
- Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
- Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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Barca E, Kleiner G, Tang G, Ziosi M, Tadesse S, Masliah E, Louis ED, Faust P, Kang UJ, Torres J, Cortes EP, Vonsattel JPG, Kuo SH, Quinzii CM. Decreased Coenzyme Q10 Levels in Multiple System Atrophy Cerebellum. J Neuropathol Exp Neurol 2016; 75:663-72. [PMID: 27235405 DOI: 10.1093/jnen/nlw037] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In familial and sporadic multiple system atrophy (MSA) patients, deficiency of coenzyme Q10 (CoQ10) has been associated with mutations in COQ2, which encodes the second enzyme in the CoQ10 biosynthetic pathway. Cerebellar ataxia is the most common presentation of CoQ10 deficiency, suggesting that the cerebellum might be selectively vulnerable to low levels of CoQ10 To investigate whether CoQ10 deficiency represents a common feature in the brains of MSA patients independent of the presence of COQ2 mutations, we studied CoQ10 levels in postmortem brains of 12 MSA, 9 Parkinson disease (PD), 9 essential tremor (ET) patients, and 12 controls. We also assessed mitochondrial respiratory chain enzyme activities, oxidative stress, mitochondrial mass, and levels of enzymes involved in CoQ biosynthesis. Our studies revealed CoQ10 deficiency in MSA cerebellum, which was associated with impaired CoQ biosynthesis and increased oxidative stress in the absence of COQ2 mutations. The levels of CoQ10 in the cerebella of ET and PD patients were comparable or higher than in controls. These findings suggest that CoQ10 deficiency may contribute to the pathogenesis of MSA. Because no disease modifying therapies are currently available, increasing CoQ10 levels by supplementation or upregulation of its biosynthesis may represent a novel treatment strategy for MSA patients.
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Affiliation(s)
- Emanuele Barca
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Giulio Kleiner
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Guomei Tang
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Marcello Ziosi
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Saba Tadesse
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Eliezer Masliah
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Elan D Louis
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Phyllis Faust
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Un J Kang
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Jose Torres
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Etty P Cortes
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Jean-Paul G Vonsattel
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Sheng-Han Kuo
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV)
| | - Catarina M Quinzii
- From the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York (EB, GK, GT, MZ, ST, UJK, S-HK, CMQ); UOC of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (EB); Department of Neuroscience and Pathology, University of California, San Diego, California (EM); Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut (EDL); Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut (EDL); Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York (PF, JT, EPC, J-PGV); and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York (JT, EPC, J-PGV).
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Choe M, Cortés E, Vonsattel JPG, Kuo SH, Faust PL, Louis ED. Purkinje cell loss in essential tremor: Random sampling quantification and nearest neighbor analysis. Mov Disord 2016; 31:393-401. [PMID: 26861543 DOI: 10.1002/mds.26490] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 06/10/2015] [Revised: 10/20/2015] [Accepted: 10/26/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Purkinje cell loss has been documented in some, although not all, postmortem studies of essential tremor. Hence, there is considerable controversy concerning the presence of Purkinje cell loss in this disease. To date, few studies have been performed. METHODS Over the past 8 years, we have assembled 50 prospectively studied cases and 25 age-matched controls; none were reported in our previous large series of 33 essential tremor and 21 controls. In addition to methods used in previous studies, the current study used a random sampling approach to quantify Purkinje cells along the Purkinje cell layer with a mean of 217 sites examined in each specimen, allowing for extensive sampling of the Purkinje cell layer within the section. For the first time, we also quantified the distance between Purkinje cell bodies-a nearest neighbor analysis. RESULTS In the Purkinje cell count data collected from fifteen 100 × fields, cases had lower counts than controls in all three counting criteria (cell bodies, nuclei, and nucleoli; all P < 0.001). Purkinje cell linear density was also lower in cases than controls (all P < 0.001). Purkinje cell linear density obtained by random sampling was similarly lower in cases than controls in all three counting criteria (cell bodies, nuclei, and nucleoli, all P ≤ 0.005). In agreement with the quantitative Purkinje cell counts, the mean distance from one Purkinje cell body to another Purkinje cell body along the Purkinje cell layer was greater in cases than controls (P = 0.002). CONCLUSIONS These data provide support for the neurodegeneration of cerebellar Purkinje cells in essential tremor.
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Affiliation(s)
- Matthew Choe
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Etty Cortés
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Chronic Disease Epidemiology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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11
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Louis ED, Lee M, Cortés E, Vonsattel JPG, Faust PL. Matching asymmetry of tremor with asymmetry of postmortem cerebellar hemispheric changes in essential tremor. Cerebellum 2015; 13:462-70. [PMID: 24756341 DOI: 10.1007/s12311-014-0560-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although the number of postmortem studies in essential tremor (ET) has grown in recent years, clinical-pathological correlations remain limited. We are unaware of a study that has assessed whether the pathological changes in ET, if asymmetric, lateralize to the cerebellar hemisphere that is ipsilateral to the arm with more severe action tremor, as one would predict if the lesions were tremor producing. We compared postmortem changes in the right vs. left cerebellar hemispheres in ET and examined how these correlated with asymmetry of tremor on neurological examination. Action tremor in each arm was quantified using a reliable and valid clinical rating scale. Cases were divided into three clinical groups: tremor more severe on right, tremor more severe on left, and tremor symmetric. Calbindin D28k immunohistochemistry was performed on 100 μm vibrotome sections from a standard tissue block of both right and left neocerebellums to quantify Purkinje cell linear density, torpedo counts, and a group of previously described changes in Purkinje cell axonal shape (thickened axonal profiles) and connectivity (axon recurrent collaterals, axonal branching, terminal axonal sprouting, arciform axons, extent of recurrent collateral plexus). ET cases were divided into three postmortem groups: findings greatest on right, findings greatest on left, and findings symmetric. In 18 (72.0 %) of 25 ET cases, clinical and pathological features were concordant (i.e., both clinically and pathologically right-predominant (one case), both clinically and pathologically left-predominant (five cases), or both clinically and pathologically symmetric (12 cases), p = 0.007). In the remaining seven (28.0 %) ET cases, clinical and pathological data were not concordant, and in none were they completely discordant (i.e., tremor was more severe on the right, and postmortem cerebellar changes were paradoxically more severe on the left or vice versa). Among the seven ET cases with >20 % side-to-side difference in tremor severity, six cases (85.7 %) had the expected pathological asymmetry, with quantified postmortem cerebellar changes more marked ipsilateral to the more clinically affected side. We also created continuous measures of asymmetry. For the entire sample, there was a positive correlation between the clinical asymmetry index and the pathological asymmetry index = 0.52, p = 0.01 (i.e., the right-left difference in clinical asymmetry was correlated with the right-left difference in postmortem changes). For the seven ET cases with clear clinical asymmetry, the correlation was even more robust (r = 0.78, p = 0.039). Clinical-pathological correlations are important in terms of understanding the significance of observed pathological changes. The correlation between clinical laterality or symmetry of tremor and pathological changes in the majority of ET cases provides additional evidence that the pathological changes in the cerebellum in ET are of patho-mechanistic importance.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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12
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Louis ED, Kuo SH, Vonsattel JPG, Faust PL. Torpedo formation and Purkinje cell loss: modeling their relationship in cerebellar disease. Cerebellum 2015; 13:433-9. [PMID: 24590661 DOI: 10.1007/s12311-014-0556-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Torpedo formation and Purkinje cell (PC) loss represent standard and inter-related cerebellar responses to injury. Surprisingly, the nature of their relationship has not been carefully characterized across a range of normal and disease states. Are brains with more torpedoes expected to have fewer PCs? We quantified torpedoes and PCs in four groups: essential tremor (ET), spinocerebellar ataxia (SCA), multiple system atrophy-cerebellar (MSA-C), and controls. Brains from 100 individuals (58 ET, 27 controls, 7 SCA, 8 MSA-C) were available at the New York Brain Bank. After complete neuropathological assessment, a standard parasagittal neocerebellar block was harvested; a 7-μm thick section was stained with Luxol fast blue/hematoxylin and eosin; and torpedoes and PCs were quantified. For a given PC count, SCA and MSA-C cases often had higher torpedo counts than ET cases or controls. Furthermore, the relationship between torpedo and PC counts was complex. The correlation between torpedo and PC counts was negative in ET cases (i.e., individuals with more torpedoes had fewer PCs [i.e., more PC loss]) whereas the relationship was positive in MSA-C cases (i.e., individuals with fewer PCs [i.e., more PC loss] had fewer torpedoes). Patients with SCA showed both patterns. When all diagnostic groups were combined, the correlation was best fit by a quadratic (i.e., parabolic) model rather than a simple linear model; this model incorporated data on the negative correlation in ET cases, the mixed results in SCA cases, and the positive correlation in MSA-C cases (r = 0.636). The relationship between torpedo and PC counts was complex and heterogeneous across a range of cerebellar disease states, and was best characterized by a quadratic rather than a simple model. With more severe cerebellar disease, torpedoes can be quite numerous and are likely a common feature of surviving PCs, but eventually, dramatic loss of PC leads to a paradoxical reduction in observable torpedoes.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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13
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Abstract
The basal ganglia are a highly interconnected set of subcortical nuclei and major atrophy in one or more regions may have major effects on other regions of the brain. Therefore, the striatum which is preferentially degenerated and receives projections from the entire cortex also affects the regions to which it targets, especially the globus pallidus and substantia nigra pars reticulata. Additionally, the cerebral cortex is itself severely affected as are many other regions of the brain, especially in more advanced cases. The cell loss in the basal ganglia and the cerebral cortex is extensive. The most important new findings in Huntington's disease pathology is the highly variable nature of the degeneration in the brain. Most interestingly, this variable pattern of pathology appears to reflect the highly variable symptomatology of cases with Huntington's disease even among cases possessing the same number of CAG repeats.
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Affiliation(s)
- Henry J Waldvogel
- Centre for Brain Research, Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand,
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Louis ED, Lee M, Babij R, Ma K, Cortés E, Vonsattel JPG, Faust PL. Reduced Purkinje cell dendritic arborization and loss of dendritic spines in essential tremor. ACTA ACUST UNITED AC 2014; 137:3142-8. [PMID: 25367027 DOI: 10.1093/brain/awu314] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Based on accumulating post-mortem evidence of abnormalities in Purkinje cell biology in essential tremor, we hypothesized that regressive changes in dendritic morphology would be apparent in the Purkinje cell population in essential tremor cases versus age-matched controls. Cerebellar cortical tissue from 27 cases with essential tremor and 27 age-matched control subjects was processed by the Golgi-Kopsch method. Purkinje cell dendritic anatomy was quantified using a Neurolucida microscopic system interfaced with a motorized stage. In all measures, essential tremor cases demonstrated significant reductions in dendritic complexity compared with controls. Median values in essential tremor cases versus controls were: 5712.1 versus 10 403.2 µm (total dendrite length, P=0.01), 465.9 versus 592.5 µm (branch length, P=0.01), 22.5 versus 29.0 (maximum branch order, P=0.001), and 165.3 versus 311.7 (number of terminations, P=0.008). Furthermore, the dendritic spine density was reduced in essential tremor cases (medians=0.82 versus 1.02 µm(-1), P=0.03). Our demonstration of regressive changes in Purkinje cell dendritic architecture and spines in essential tremor relative to control brains provides additional evidence of a pervasive abnormality of Purkinje cell biology in this disease, which affects multiple neuronal cellular compartments including their axon, cell body, dendrites and spines.
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Affiliation(s)
- Elan D Louis
- 1 GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA 2 Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA 3 Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA 4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Michelle Lee
- 1 GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Rachel Babij
- 1 GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA 2 Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Karen Ma
- 1 GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA 2 Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Etty Cortés
- 5 Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY 10032, USA
| | - Jean-Paul G Vonsattel
- 2 Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA 5 Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY 10032, USA
| | - Phyllis L Faust
- 5 Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY 10032, USA
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Louis RJ, Lee M, Kuo SH, Vonsattel JPG, Louis ED, Faust PL. Cellular density in the cerebellar molecular layer in essential tremor, spinocerebellar ataxia, and controls. Parkinsonism Relat Disord 2014; 20:1270-3. [PMID: 25218844 PMCID: PMC4253303 DOI: 10.1016/j.parkreldis.2014.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/29/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND It would be useful to identify additional postmortem markers of Purkinje cell loss in essential tremor (ET). In hereditary cerebellar ataxia, Purkinje cell loss has been reported to result in a secondary increase in the density of the remaining cell populations in the cerebellar molecular layer. However, this phenomenon has not been studied in ET. We quantified cerebellar molecular layer cellular density in 15 ET cases, 15 controls, and 7 spinocerebellar ataxia (SCA) cases (2:2:1 ratio). METHODS A standard neocerebellar tissue block was stained with Luxol fast blue Hematoxylin & Eosin. Within 5 selected fields, cell soma (e.g., stellate, basket, and glial cell bodies) were counted. Cellular density was the number of cells/cm(2). RESULTS The Purkinje cell count differed across the three groups (p < 0.001), with the highest counts in controls, intermediate counts in ET cases and lowest counts in SCA cases. ET cases and controls had similar molecular layer cellular density (p = 0.79) but SCA cases had higher values than both groups (p < 0.01). A robust inverse correlation between Purkinje cell count and molecular layer cellular density (i.e., brains with more Purkinje cell loss had higher molecular layer cellular density), observed in SCA and controls (r = -0.55, p = 0.008), was not observed in ET cases. DISCUSSION Although Purkinje cell counts were reduced in ET cases compared to controls, an increase in molecular layer cellular density was not evident in ET. The increase in molecular layer cellular density, observed in SCA cases, may require a more marked loss of PCs than occurs in ET.
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Affiliation(s)
- Ravi J Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michelle Lee
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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Lin CY, Louis ED, Faust PL, Koeppen AH, Vonsattel JPG, Kuo SH. Abnormal climbing fibre-Purkinje cell synaptic connections in the essential tremor cerebellum. ACTA ACUST UNITED AC 2014; 137:3149-59. [PMID: 25273997 DOI: 10.1093/brain/awu281] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Structural changes in Purkinje cells have been identified in the essential tremor cerebellum, although the mechanisms that underlie these changes remain poorly understood. Climbing fibres provide one of the major excitatory inputs to Purkinje cells, and climbing fibre-Purkinje cell connections are essential for normal cerebellar-mediated motor control. The distribution of climbing fibre-Purkinje cell synapses on Purkinje cell dendrites is dynamically regulated and may be altered in disease states. The aim of the present study was to examine the density and distribution of climbing fibre-Purkinje cell synapses using post-mortem cerebellar tissue of essential tremor cases and controls. Using vesicular glutamate transporter type 2 immunohistochemistry, we labelled climbing fibre-Purkinje cell synapses of 12 essential tremor cases and 13 age-matched controls from the New York Brain Bank. Normally, climbing fibres form synapses mainly on the thick, proximal Purkinje cell dendrites in the inner portion of the molecular layer, whereas parallel fibres form synapses on the thin, distal Purkinje cell spiny branchlets. We observed that, compared with controls, essential tremor cases had decreased climbing fibre-Purkinje cell synaptic density, more climbing fibres extending to the outer portion of the molecular layer, and more climbing fibre-Purkinje cell synapses on the thin Purkinje cell spiny branchlets. Interestingly, in essential tremor, the increased distribution of climbing fibre-Purkinje cell synapses on the thin Purkinje cell branchlets was inversely associated with clinical tremor severity, indicating a close relationship between the altered distribution of climbing fibre-Purkinje cell connections and tremor. These findings suggest that abnormal climbing fibre-Purkinje cell connections could be of importance in the pathogenesis of essential tremor.
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Affiliation(s)
- Chi-Ying Lin
- 1 Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elan D Louis
- 1 Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA 2 GH Sergievsky Centre, Columbia University, New York, NY, USA 3 Taub Institute for Research of Alzheimer's disease and the Aging Brain, Columbia University, New York, NY, USA 4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- 5 Department of Pathology and Cell Biology, Columbia University Medical Centre and the New York Presbyterian Hospital, New York, NY, USA
| | - Arnulf H Koeppen
- 6 Neurology and Research Services, Veterans Affairs Medical Centre, Albany, NY, USA 7 Departments of Neurology and Pathology, Albany Medical College, Albany, NY, USA
| | - Jean-Paul G Vonsattel
- 3 Taub Institute for Research of Alzheimer's disease and the Aging Brain, Columbia University, New York, NY, USA 5 Department of Pathology and Cell Biology, Columbia University Medical Centre and the New York Presbyterian Hospital, New York, NY, USA
| | - Sheng-Han Kuo
- 1 Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Cortes Ramirez EP, Vonsattel JPG. The Neuropathology of Neurodegenerative Dementias. Dementia 2014. [DOI: 10.1093/med/9780199928453.003.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pan JJ, Lee M, Honig LS, Vonsattel JPG, Faust PL, Louis ED. Alzheimer's-related changes in non-demented essential tremor patients vs. controls: links between tau and tremor? Parkinsonism Relat Disord 2014; 20:655-8. [PMID: 24679899 DOI: 10.1016/j.parkreldis.2014.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In addition to tremor, patients with essential tremor (ET) may exhibit non-motor features, including a range of cognitive deficits. Several prospective, population-based epidemiological studies have reported an association between ET and incident dementia, especially Alzheimer's disease (AD). Moreover, in a brain repository-based study, a larger than expected proportion of ET patients also developed pathological changes characteristic of progressive supranuclear palsy, further suggesting a link between ET and tau pathology. METHODS We selected a group of ET patients that were free of dementia clinically and without AD on postmortem examination. Our hypothesis was that neuronal tauopathic burden would be higher in the brains of these ET patients compared to controls. We compared Braak stage for neuronal tangles and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) scores for neuritic plaques in the two groups. RESULTS The two groups were similar in age (82.6 ± 6.0 vs. 80.4 ± 8.1, p = 0.22). The 40 ET patients had a higher Braak neurofibrillary stage than 32 controls (means: 2.2 ± 1.2 vs. 1.2 ± 1.1; medians: 2.0 vs. 1.0, p < 0.001). Meanwhile, CERAD scores for neuritic plaques were similar in patients and controls (means: 0.6 ± 0.9 vs. 0.5 ± 0.6; medians: 0.0 vs. 0.0, p = 0.83). CONCLUSION While ET itself is not a tauopathy (i.e., a neurodegenerative disorder among whose main features are accumulation of hyperphosphorylated tau protein), ET may predispose individuals to accumulate more widespread cellular tau aggregates, and thus tau could play a central role in the cognitive impairment that can accompany ET.
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Affiliation(s)
- Jie J Pan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michelle Lee
- G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lawrence S Honig
- G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Elan D Louis
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Babij R, Lee M, Cortés E, Vonsattel JPG, Faust PL, Louis ED. Purkinje cell axonal anatomy: quantifying morphometric changes in essential tremor versus control brains. ACTA ACUST UNITED AC 2013; 136:3051-61. [PMID: 24030953 DOI: 10.1093/brain/awt238] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Growing clinical, neuro-imaging and post-mortem data have implicated the cerebellum as playing an important role in the pathogenesis of essential tremor. Aside from a modest reduction of Purkinje cells in some post-mortem studies, Purkinje cell axonal swellings (torpedoes) are present to a greater degree in essential tremor cases than controls. Yet a detailed study of more subtle morphometric changes in the Purkinje cell axonal compartment has not been undertaken. We performed a detailed morphological analysis of the Purkinje cell axonal compartment in 49 essential tremor and 39 control brains, using calbindin D28k immunohistochemistry on 100-µm cerebellar cortical vibratome tissue sections. Changes in axonal shape [thickened axonal profiles (P = 0.006), torpedoes (P = 0.038)] and changes in axonal connectivity [axonal recurrent collaterals (P < 0.001), axonal branching (P < 0.001), terminal axonal sprouting (P < 0.001)] were all present to an increased degree in essential tremor cases versus controls. The changes in shape and connectivity were significantly correlated [e.g. correlation between thickened axonal profiles and recurrent collaterals (r = 0.405, P < 0.001)] and were correlated with tremor duration among essential tremor cases with age of onset >40 years. In essential tremor cases, thickened axonal profiles, axonal recurrent collaterals and branched axons were 3- to 5-fold more frequently seen on the axons of Purkinje cells with torpedoes versus Purkinje cells without torpedoes. We document a range of changes in the Purkinje cell axonal compartment in essential tremor. Several of these are likely to be compensatory changes in response to Purkinje cell injury, thus illustrating an important feature of Purkinje cells, which is that they are relatively resistant to damage and capable of mobilizing a broad range of axonal responses to injury. The extent to which this plasticity of the Purkinje cell axon is partially neuroprotective or ultimately ineffective at slowing further cellular changes and cell death deserves further study in essential tremor.
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Affiliation(s)
- Rachel Babij
- 1 GH Sergievsky Centre, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Louis ED, Babij R, Lee M, Cortés E, Vonsattel JPG. Quantification of cerebellar hemispheric purkinje cell linear density: 32 ET cases versus 16 controls. Mov Disord 2013; 28:1854-9. [PMID: 23925732 DOI: 10.1002/mds.25629] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [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: 02/15/2013] [Revised: 04/10/2013] [Accepted: 05/13/2013] [Indexed: 11/12/2022] Open
Abstract
Although essential tremor (ET) is among the most prevalent neurological diseases, its precise pathogenesis is not understood. Purkinje cell loss has been observed in some studies and is the focus of interest and debate. Expressing these data as Purkinje cells/layer length allows one to adjust for the inherent curved nature of the cerebellar folia. Capitalizing on the Essential Tremor Centralized Brain Repository, we quantified Purkinje cell linear density in cases versus controls. Free-floating 100-μm parasagittal cerebellar hemispheric sections were subjected to rabbit polyclonal anti-Calbindin D28k antibody, and 10 random fields/brain were selected for quantification of Purkinje cells/mm(-1) Purkinje cell layer. Purkinje cell linear density was lower in 32 ET cases than in16 controls (1.14 ± 0.32 vs. 1.35 ± 0.31/mm(-1) , P = 0.03). Purkinje cell linear density was inversely associated with torpedo count (r = -0.38, P = 0.028). The current sample of ET cases demonstrates a reduction in Purkinje cell number relative to that of controls. Greater Purkinje cell axonal remodeling (torpedoes) was found in individuals who had the most Purkinje cell drop out. The role of Purkinje cell loss in the pathogenesis of this disorder merits additional study.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Louis ED, Bain PG, Hallett M, Jankovic J, Vonsattel JPG. What is It? Difficult to Pigeon Hole Tremor: a Clinical-Pathological Study of a Man with Jaw Tremor. Tremor Other Hyperkinet Mov (N Y) 2013; 3. [PMID: 23864988 PMCID: PMC3712322 DOI: 10.7916/d8rn36j6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/17/2013] [Indexed: 12/01/2022]
Abstract
Background The phenomenology of tremor is broad and its classification is complicated. Furthermore, the full range of tremor phenomenology with respect to specific neurological and neurodegenerative diseases has not been fully elaborated. Case Report This right-handed man had a chief complaint of jaw tremor, which began approximately 20 years prior to death at age 101 years. He had been diagnosed with essential tremor (ET) by a local doctor. His examination at age 100 years was notable for marked jaw tremor at rest in the absence of other clear features of parkinsonism, mild kinetic tremor of the hands and, in the last year of life, a score of 22/41 on a cognitive screen. A senior movement disorder neurologist raised doubt about the “ET” diagnosis. The history and videotaped examination were reviewed by three additional senior tremor experts, who raised a number of diagnostic possibilities. A complete postmortem examination was performed by a senior neuropathologist, and was notable for the presence of tufted astrocytes, AT8-labeled glial cytoplasmic inclusions, and globose neuronal tangles. These changes were widespread and definitive. A neuropathological diagnosis of progressive supranuclear palsy was assigned. Discussion This case presents with mixed and difficult to clinically classify tremor phenomenology and other neurological findings. The postmortem diagnosis was not predicted based on the clinical features, and it is possible that it does not account for all of the features. The case raises many interesting issues and provides a window into the complexity of the interpretation, nosology, and classification of tremor phenomenology.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America ; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Louis ED, Babij R, Cortés E, Vonsattel JPG, Faust PL. The inferior olivary nucleus: a postmortem study of essential tremor cases versus controls. Mov Disord 2013; 28:779-86. [PMID: 23483605 DOI: 10.1002/mds.25400] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/04/2013] [Accepted: 01/10/2013] [Indexed: 01/02/2023] Open
Abstract
The pathogenesis of essential tremor is poorly understood. Historically, it has been hypothesized that the inferior olivary nucleus plays an important role in the generation of tremor in essential tremor, yet a detailed, controlled, anatomic-pathological study of that brain region has yet to be conducted. A detailed postmortem study was undertaken of the microscopic changes in the inferior olivary nucleus of 14 essential tremor cases versus 15 age-matched controls at the Essential Tremor Centralized Brain Repository. A series of metrics was used to quantify microscopic neuronal and glial changes in the inferior olivary nucleus and its input and output tracts. Olivary linear neuronal density also was assessed. Cases and controls did not differ from one another with respect to any of the assessed metrics (P values ranged from 0.23 to 1.0). Olivary linear neuronal density also was similar in cases and controls (P = 0.62). Paddle-shaped neurons, a morphologic shape change in olivary neurons, which, to our knowledge, have not been previously recognized, occurred to an equal degree in essential tremor cases and controls (P = 0.89) and were correlated with several markers of neuronal loss and gliosis. A systematic postmortem study of the microscopic changes in the inferior olivary nucleus did not detect any differences between cases and controls. These data, along with positron emission tomography data, which have failed to identify any metabolic abnormality of the olive, indicate that, if the olive is involved in essential tremor, then there is no clearly identifiable structural or metabolic correlate.
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Affiliation(s)
- Elan D Louis
- G H Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Kuo SH, Tang G, Ma K, Babij R, Cortes E, Vonsattel JPG, Faust PL, Sulzer D, Louis ED. Macroautophagy abnormality in essential tremor. PLoS One 2012; 7:e53040. [PMID: 23300858 PMCID: PMC3531444 DOI: 10.1371/journal.pone.0053040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022] Open
Abstract
Macroautophagy is a cellular mechanism for the clearance of protein aggregates and damaged organelles. Impaired macroautophagy has been observed in neurodegenerative disorders. We investigated the macroautophagy pathway in essential tremor (ET) cases compared to age-matched controls. We analyzed microtubule-associated protein light chain 3-II (LC3-II), S6K, phosphorylated S6K, beclin-1, and mitochondrial membrane proteins levels by Western blot in the post-mortem cerebellum of 10 ET cases and 11 controls. We also performed immunohistochemistry in 12 ET cases and 13 controls to quantify LC3 clustering in Purkinje cells (PCs). LC3-II protein levels were significantly lower in ET cases vs. controls on Western blot (0.84±0.14 vs. 1.00±0.14, p = 0.02), and LC3-II clustering in PCs by immunohistochemistry was significantly lower in ET cases vs. controls (2.03±3.45 vs. 8.80±9.81, p = 0.03). In ET cases, disease duration was inversely correlated with LC3-II protein level (r = −0.64, p = 0.046). We found that mitochondrial membrane proteins were accumulated in ET (TIM23: 1.36±0.11 in ET cases vs. 1.00±0.08 in controls, p = 0.02; TOMM20: 1.63±0.87 in ET cases vs. 1.00±0.14 in controls, p = 0.03). Beclin-1, which is involved in macroautophagy, was strikingly deficient in ET (0.42±0.13 vs. 1.00±0.35, p<0.001). Decreased macroautophagy was observed in the ET cerebellum, and this could be due to a decrease in beclin-1 levels, which subsequently lead to mitochondrial accumulation as a result of autophagic failure. This provides a possible means by which perturbed macroautophagy could contribute to PC pathology in ET.
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Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Guomei Tang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Karen Ma
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Rachel Babij
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Etty Cortes
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, United States of America
| | - Jean-Paul G. Vonsattel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, United States of America
| | - Phyllis L. Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, United States of America
| | - David Sulzer
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Elan D. Louis
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
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Thenganatt MA, Alcalay RN, Vonsattel JPG, Greene PE. Somatic mitochondrial DNA mutations and parkinsonism. Ann Neurol 2012; 72:823; author reply 823-4. [DOI: 10.1002/ana.23740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 07/21/2012] [Accepted: 08/03/2012] [Indexed: 11/10/2022]
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Ma K, Babij R, Cortés E, Vonsattel JPG, Louis ED. Cerebellar pathology of a dual clinical diagnosis: patients with essential tremor and dystonia. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-107-6707. [PMID: 23439731 PMCID: PMC3535836 DOI: 10.7916/d8jd4vj5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/01/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Clinical studies have implicated the cerebellum in the pathogenesis of essential tremor (ET), and recent postmortem studies have identified structural changes in the ET cerebellum. While the basal ganglia have traditionally been implicated in dystonia, cerebellar involvement has been suggested as well, and a recent study showed Purkinje cell (PC) loss. We conducted a detailed postmortem examination of the brain in four individuals with clinical diagnoses of ET and dystonia, and hypothesized that pathological changes in the cerebellum would be greater in these four ET cases than in published ET cases without dystonia. METHODS After a complete neuropathological assessment, a standard parasagittal neocerebellar tissue block was harvested in each brain. One 7-µm thick section was stained with luxol fast blue/hematoxylin and eosin, and one section with the Bielschowsky method. We quantified PCs, torpedoes, heterotopic PCs, PC dendritic swellings, and basket cell changes. RESULTS Two ET+dystonia cases had more microscopic changes in the cerebellum than published ET cases; the other two cases had similar changes to published ET cases. DISCUSSION This is the first report that uses human autopsy tissue to study patients with both ET and dystonia. The findings were heterogeneous. Additional studies, with larger samples, are needed.
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Affiliation(s)
- Karen Ma
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
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Louis ED, Ma K, Babij R, Cortés E, Liem RK, Vonsattel JPG, Faust PL. Neurofilament protein levels: quantitative analysis in essential tremor cerebellar cortex. Neurosci Lett 2012; 518:49-54. [PMID: 22561033 DOI: 10.1016/j.neulet.2012.04.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/29/2012] [Accepted: 04/25/2012] [Indexed: 12/11/2022]
Abstract
Essential tremor (ET) is among the most prevalent neurological diseases. A substantial increase in the number of Purkinje cell axonal swellings (torpedoes) has been identified in ET brains. We recently demonstrated that torpedoes in ET contain an over-accumulation of disorganized neurofilament (NF) proteins. This now raises the question whether NF protein composition and/or phosphorylation state in cerebellar tissue might differ between ET cases and controls. We used a Western blot analysis to compare the levels and phosphorylation state of NF proteins and α-internexin in cerebellar tissue from 47 ET cases versus 26 controls (2:1 ratio). Cases and controls did not differ with respect to the cerebellar levels of NF-light (NF-L), NF-medium (NF-M), NF-heavy (NF-H), or α-internexin. However, SMI-31 levels (i.e., phosphorylated NF-H) and SMI-32 levels (i.e., non-phosphorylated NF-H) were significantly higher in ET cases than controls (1.28±0.47 vs. 1.06±0.32, p=0.02; and 1.38±0.75 vs. 1.00±0.42, p=0.006). Whether the abnormal phosphorylation state that we observed is a cause of defective axonal transport and/or function of NFs in ET is not known. NF abnormalities have been demonstrated in several neurodegenerative diseases. Regardless of whether these protein aggregates are the cause or consequence of these diseases, NF abnormalities have been shown to be an important factor in the cellular disruption observed in several neurodegenerative diseases. Therefore, further analyses of these NF abnormalities and their mechanisms are important to enhance our understanding of disease pathogenesis in ET.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Poulopoulos M, Cortes E, Vonsattel JPG, Fahn S, Waters C, Cote LJ, Moskowitz C, Honig LS, Clark LN, Marder KS, Alcalay RN. Clinical and pathological characteristics of LRRK2 G2019S patients with PD. J Mol Neurosci 2011; 47:139-43. [PMID: 22194196 DOI: 10.1007/s12031-011-9696-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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: 10/11/2011] [Accepted: 12/12/2011] [Indexed: 11/24/2022]
Abstract
The objective of this study is to describe the neuropathologic findings in three LRRK2 G2019S carriers with Parkinson's disease (PD). We cross-referenced a list of 956 PD individuals that had been previously genotyped in clinical studies at Columbia University, with 282 subjects with a parkinsonian syndrome who came to autopsy in our brain bank since 1991. We found three autopsies of G2019S mutation carriers. Pathological analyses of the samples were blind to the genetic findings. We retrospectively reviewed the clinical records of the three patients. All three had a clinical and pathological diagnosis of PD. Cognitive impairment was a late feature in two out of three patients. Cortical involvement varied significantly: one had diffuse Lewy body (LB) pathology, tau inclusions, and amyloid pathology consistent with advanced Alzheimer's disease; one had diffuse cortical LB; and one had only brainstem predominant LB pathology. Cognitive impairment may be a long-term complication in G2019S mutation carriers. However, the extent of cortical involvement is variable. Larger longitudinal follow-up of LRRK2 G2019S mutation carriers is required to assess for risk factors for cortical involvement and dementia.
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Affiliation(s)
- Markos Poulopoulos
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Kuo SH, Erickson-Davis C, Gillman A, Faust PL, Vonsattel JPG, Louis ED. Increased number of heterotopic Purkinje cells in essential tremor. J Neurol Neurosurg Psychiatry 2011; 82:1038-40. [PMID: 20802031 PMCID: PMC3856652 DOI: 10.1136/jnnp.2010.213330] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Recent postmortem studies reveal degenerative changes, including Purkinje cell (PC) loss, in most brains from individuals with essential tremor (ET). Heterotopic PCs (HPCs) (ie, PC bodies displaced into the molecular layer) may be found in neurodegenerative diseases with PC loss. HPCs have been observed in ET but no quantitative case control analysis has been performed. METHODS HPCs were counted in 35 ET brains and 32 control brains (including 21 non-diseased controls and 11 diseased controls with progressive supranuclear palsy (PSP)) using a standard 20 × 25 mm cerebellar cortical section stained with a modified Bielscholwsky method. RESULTS The median number of HPCs per section was three times higher in 35 ET cases (median 3, mean ± SD 3.8 ± 3.6, range 0-14) versus 32 controls (median 1, mean ± SD 1.6 ± 1.7, range 0-5) (p = 0.007). The number of HPCs was similarly low in the 21 non-diseased controls and 12 PSP brains (median 1 in each group) (p = 0.04 and p = 0.01 compared with ET). In ET, the number of HPCs was inversely related to the number of PCs (Spearman's rho -0.36, p = 0.038) (ie, cases with more HPCs had fewer PCs). CONCLUSION PC heterotopia, which occurs in cerebellar degenerative disorders, is also a feature of ET. These findings further contribute to our understanding of the postmortem changes in this common neurological disease.
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Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, USA
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Louis ED, Faust PL, Ma KJ, Yu M, Cortes E, Vonsattel JPG. Torpedoes in the Cerebellar Vermis in Essential Tremor Cases vs. Controls. Cerebellum 2011; 10:812-9. [PMID: 21656041 DOI: 10.1007/s12311-011-0291-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Louis ED, Asabere N, Agnew A, Moskowitz CB, Lawton A, Cortes E, Faust PL, Vonsattel JPG. Rest tremor in advanced essential tremor: a post-mortem study of nine cases. J Neurol Neurosurg Psychiatry 2011; 82:261-5. [PMID: 20802027 DOI: 10.1136/jnnp.2010.215681] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rest tremor may occur in as many as 30% of essential tremor (ET) patients. It is not clear whether this tremor is a sentinel marker for brainstem Lewy body pathology. Here we report the clinical and post-mortem findings of nine ET cases with upper-extremity rest tremor in the absence of other parkinsonian features. METHODS All brains had a complete neuropathological assessment. Tissue sections from the brainstem and basal ganglia were immunostained with α-synuclein antibody. RESULTS All cases had longstanding ET (median duration=42 years) with moderate to severe arm tremor. Rest tremor involved both arms in seven (77.8%) cases and one arm in two cases. The rest tremor score was correlated with the total action tremor score (r=0.69, p=0.04). The number of torpedoes was elevated, and Purkinje cells, reduced. Post-mortem changes in the substantia nigra pars compacta (SNc), caudate, putamen and globus pallidum were minimal, and neither Lewy bodies nor Lewy neurites were evident. CONCLUSIONS In nine ET brains with upper-extremity rest tremor, neither Lewy body-containing neurons nor Lewy neurites were found on α-synuclein immunostained sections, and other pathological changes in the basal ganglia were minimal. These data support the notion that isolated rest tremor in longstanding ET is not the expression of underlying Lewy body pathology in the SNc.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA 10032, USA.
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Louis ED, Erickson-Davis C, Pahwa R, Lyons KE, Garber A, Moskowitz CB, Lawton A, Faust PL, Vonsattel JPG. Essential tremor with ubiquitinated Purkinje cell intranuclear inclusions. Acta Neuropathol 2010; 119:375-7. [PMID: 20107820 DOI: 10.1007/s00401-010-0641-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/11/2010] [Accepted: 01/13/2010] [Indexed: 11/30/2022]
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Louis ED, Faust PL, Vonsattel JPG, Honig LS, Henchcliffe C, Pahwa R, Lyons KE, Rios E, Erickson-Davis C, Moskowitz CB, Lawton A. Older onset essential tremor: More rapid progression and more degenerative pathology. Mov Disord 2010; 24:1606-12. [PMID: 19526587 DOI: 10.1002/mds.22570] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There are few data on rate of progression in essential tremor (ET). To quantify the rate of tremor progression in a cross-sectional sample of 348 ET cases in an epidemiological study; characterize the relationship between age of tremor onset and rate of tremor progression in that sample; and characterize the relationship between age of tremor onset, rate of tremor progression, and severity of underlying brain changes in 9 cases from a brain repository. Rate of tremor progression was defined as tremor severity / duration. The degeneration index = number of torpedoes per section / Purkinje cell linear density. In the epidemiological study, older age of tremor onset was associated with faster rate of tremor progression (P < 0.001). In the brain repository, older age of tremor onset was associated with higher degeneration index (P = 0.037), and higher degeneration index was associated with faster rate of tremor progression (P = 0.018). In a large clinical sample, older age of onset was associated with more rapid tremor progression. In a brain bank, older age of onset was associated with more degenerative pathology in the cerebellum. As in several neurodegenerative disorders, in older onset cases, it is possible that the disease advances more rapidly.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, Columbia University, New York, New York, USA.
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Faust PL, Vonsattel JPG, Louis ED. Classic essential tremor changes following cerebellar hemorrhage. Neurology 2009; 73:1427-8; author reply 1428. [PMID: 19858470 PMCID: PMC2847459 DOI: 10.1212/wnl.0b013e3181bd1f58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Louis ED, Faust PL, Vonsattel JPG, Honig LS, Rajput A, Rajput A, Pahwa R, Lyons KE, Ross WG, Elble RJ, Erickson-Davis C, Moskowitz CB, Lawton A. Torpedoes in Parkinson's disease, Alzheimer's disease, essential tremor, and control brains. Mov Disord 2009; 24:1600-5. [PMID: 19526585 PMCID: PMC2736313 DOI: 10.1002/mds.22567] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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] [Indexed: 11/08/2022] Open
Abstract
Purkinje cell axonal swellings ("torpedoes"), described in several cerebellar disorders as well as essential tremor (ET), have not been quantified in common neurodegenerative conditions. The aim of this study was to quantify torpedoes Parkinson's disease (PD) and Alzheimer's disease (AD) compared with ET and control brains. Brains included 40 ET cases (34 cerebellar ET, 6 Lewy body variant of ET) and age-matched comparison brains (21 AD, 14 PD/diffuse Lewy body disease, 25 controls). Torpedoes were counted in 20 x 25 mm cerebellar cortical sections stained with Luxol Fast Blue/Hematoxylin and Eosin. The median number of torpedoes in cerebellar ET (12) was 12x higher than that of controls (1) and nearly 2.5x higher than in AD (5) or PD/DLBD (5) (all P < or = 0.005). Furthermore, in a logistic regression model that adjusted for age and Alzheimer's-type changes, each torpedo more than doubled the odds of having cerebellar ET (Odds ratio(cerebellar ET vs. control) = 2.57, P = 0.006), indicating that the association between increased torpedoes and cerebellar ET was independent of these Alzheimer's-type changes. Although torpedoes are increased in AD and PD, as well as cerebellar ET, the magnitude of increase in cerebellar ET is greater, and cannot be accounted for by concomitant AD or PD pathology.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, Columbia University, New York, New York, USA.
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Louis ED, Faust PL, Vonsattel JPG, Erickson-Davis C. Purkinje cell axonal torpedoes are unrelated to advanced aging and likely reflect cerebellar injury. Acta Neuropathol 2009; 117:719-21. [PMID: 19360423 DOI: 10.1007/s00401-009-0534-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/31/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JPG, Mayeux R. Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol 2008; 63:494-506. [PMID: 18300306 DOI: 10.1002/ana.21326] [Citation(s) in RCA: 387] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine incidence rates and antecedents of mild cognitive impairment (MCI) and Alzheimer's disease (AD) among diverse elders without dementia at the initial visit, and to examine the characteristics of elders with MCI who reverted to normal on follow-up examination. METHODS A total of 2,364 Caribbean Hispanic, black, or non-Hispanic white subjects, aged 65 or older, who were free of dementia at initial evaluation were followed up every 18 to 24 months. Incidence rate of MCI and AD was determined by examination of neurological, medical, psychiatric, and neuropsychological function. RESULTS Over 10,517 person-years, 21% of normal elderly subjects progressed to MCI (annual incidence rate, 5.1%; 95% confidence interval, 4.6-5.6%). Of those with MCI initially, 21.8% were subsequently diagnosed with AD (annual incidence rate, 5.4%; 95% confidence interval, 4.7-6.3%), 47% remained unchanged, and 31% reverted to normal. Those with MCI were 2.8 times more likely to experience development of AD than normal elderly subjects. MCI with impairment in memory and at least one other cognitive domain was associated with greatest risk for progression to AD and was also least likely to revert to normal at follow-up. Consistent diagnosis of MCI or incident probable or possible AD was 60% sensitive and 94% specific for the pathological diagnosis of AD. INTERPRETATION Impaired memory and language were useful predictors of transition to AD. Reversion to normal from MCI was frequent, but those with impairment in more than one cognitive domain were more likely to progress or remain impaired than those with single-domain impairment. Clinical diagnosis of MCI does not always predict AD neuropathology.
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Affiliation(s)
- Jennifer J Manly
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
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Abstract
Huntington's disease like-2 (HDL-2) neurodegeneration is a recently described autosomal dominant disorder with features similar to Huntington's disease (HD). Only one case report has described neuropathology from an affected patient. We describe the clinical presentation and illustrate the pathology in two additional molecularly confirmed patients, compare these with the previously published case, and contrast them with HD. We examined two patients with HDL-2. Their charts were reviewed, their brains were examined using standard neuropathology techniques, including immunoperoxidase stains, and their diagnoses were confirmed with a PCR-based assay for repeat length. The first patient presented with obsessive suspiciousness, while the second had depression and decreased visual acuity. Both patients developed increased tone and cogwheel rigidity, but neither developed choreoathetosis. Extensive degeneration affected the caudate nucleus and putamen, especially dorsally and laterally. In addition, the first patient showed lateral temporal, lateral frontal, and orbitofrontal cortical atrophy, while the second patient displayed marked degeneration in the occipital and parietal cortices. Neither patient showed significant changes in the cerebellum or brainstem. Both cases had ubiquitin-immunoreactive neuronal intranuclear inclusions (NII). The patients with of HDL-2 reviewed here were remarkable for significant frontal inhibition with parkinsonism, a lack of choreiform movements, and African ancestry. Pathologically, HDL-2 is similar to HD in its effect on the neostriatum but may differ, at least in some cases, in its degree of focal cortical involvement, including the occipital lobe.
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Affiliation(s)
- Penny E Greenstein
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology, Columbia Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Russell L Margolis
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey T Joseph
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Biswas SC, Shi Y, Vonsattel JPG, Leung CL, Troy CM, Greene LA. Bim is elevated in Alzheimer's disease neurons and is required for beta-amyloid-induced neuronal apoptosis. J Neurosci 2007; 27:893-900. [PMID: 17251431 PMCID: PMC6672914 DOI: 10.1523/jneurosci.3524-06.2007] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The molecules that mediate neuron death in Alzheimer's disease (AD) are largely unknown. We report that beta-amyloid (Abeta), a death-promoting peptide implicated in the pathophysiology of AD, induces the proapoptotic protein Bcl-2 interacting mediator of cell death (Bim) in cultured hippocampal and cortical neurons. We further find that Bim is an essential mediator of Abeta-induced neurotoxicity. Our examination of postmortem AD human brains additionally reveals upregulation of Bim in vulnerable entorhinal cortical neurons, but not in cerebellum, a region usually unaffected by AD. Accumulating evidence links inappropriate induction/activation of cell cycle-related proteins to AD, but their roles in the disease have been unclear. We find that the cell cycle molecule cyclin-dependent kinase 4 (cdk4) and its downstream effector B-myb, are required for Abeta-dependent Bim induction and death in cultured neurons. Moreover, neurons that overexpress Bim in AD brains also show elevated levels of the cell cycle-related proteins cdk4 and phospho-Rb. Our observations indicate that Bim is a proapoptotic effector of Abeta and of dysregulated cell cycle proteins in AD and identify both Bim and cell cycle elements as potential therapeutic targets.
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Affiliation(s)
- Subhas C Biswas
- Department of Pathology, Center for Neurobiology and Behavior and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Abstract
Pathologic findings, including cerebellar changes and brainstem Lewy bodies, distinguished 10 essential tremor (ET) cases from 12 controls. Numbers of torpedoes (p = 0.009) and Bergmann glia (p = 0.046) were increased in cases. Six cases (60%) had Lewy bodies vs 2 controls (16.7%) (odds ratio 7.5, 95% CI 1.04 to 54.1; p = 0.035). Four of these six had an atypical distribution of brainstem Lewy bodies. ET may be pathologically heterogeneous.
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Affiliation(s)
- E D Louis
- GH Sergievsky Center, Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Abstract
Synaptic damage and loss are factors that affect the degree of dementia experienced in Alzheimer disease (AD) patients. Multicolor DiOlistic labeling of the hippocampus has been undertaken which allows the full dendritic arbor of targeted neurons to be imaged. Using this labeling technique the neuronal morphology of two transgenic mouse lines (J20 and APP/PS1) expressing mutant forms of the Amyloid Precursor Protein (APP), at various ages, have been visualized and compared to Wild Type (WT) littermate controls. Swollen bulbous dystrophic neurites with loss of spines were apparent in the transgenic animals. Upon quantification, statistically significant reductions in the number of spines and total dendrite area was observed in both transgenic mouse lines at 11 months of age. Similar morphological abnormalities were seen in human AD hippocampal tissue both qualitatively and quantitatively. Immunohistochemistry and DiOlistic labeling was combined so that Abeta plaques were imaged in relation to the dendritic trees. No preferential localization of these abnormal dystrophic neurites was seen in regions with plaques. DiI labeled reative astrocytes were often apparent in close proximity to A beta plaques.
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Affiliation(s)
- Donna L Moolman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Department of Pathology, Columbia University, New York, NY 10032, USA
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