Wild-type Transthyretin Amyloid Deposition in an Ascending Aortic Aneurysm

Amyloid deposition in aortic tissue is associated with increased stiffness. We report a patient with ascending aortic aneurysm and chronic abdominal aortic dissection who had significant wild-type transthyretin amyloid deposition on surgical pathology. The patient did not have cardiac involvement on further workup.

A study concept of expeditious clinical enrollment for genetic modifier studies in Charcot-Marie-Tooth neuropathy 1A

BACKGROUND

Caused by duplications of the gene encoding peripheral myelin protein 22 (PMP22), Charcot-Marie-Tooth disease type 1A (CMT1A) is the most common hereditary neuropathy. Despite this shared genetic origin, there is considerable variability in clinical severity. It is hypothesized that genetic modifiers contribute to this heterogeneity, the identification of which may reveal novel therapeutic targets. In this study, we present a comprehensive analysis of clinical examination results from 1564 CMT1A patients sourced from a prospective natural history study conducted by the RDCRN-INC (Inherited Neuropathy Consortium). Our primary objective is to delineate extreme phenotype profiles (mild and severe) within this patient cohort, thereby enhancing our ability to detect genetic modifiers with large effects.

METHODS

We have conducted large-scale statistical analyses of the RDCRN-INC database to characterize CMT1A severity across multiple metrics.

RESULTS

We defined patients below the 10th (mild) and above the 90th (severe) percentiles of age-normalized disease severity based on the CMT Examination Score V2 and foot dorsiflexion strength (MRC scale). Based on extreme phenotype categories, we defined a statistically justified recruitment strategy, which we propose to use in future modifier studies.

INTERPRETATION

Leveraging whole genome sequencing with base pair resolution, a future genetic modifier evaluation will include single nucleotide association, gene burden tests, and structural variant analysis. The present work not only provides insight into the severity and course of CMT1A, but also elucidates the statistical foundation and practical considerations for a cost-efficient and straightforward patient enrollment strategy that we intend to conduct on additional patients recruited globally.

Brain complexity increases in mania

An important challenge in measuring whole brain activation is to develop a measure that could distinguish between normal and abnormal mood states. The application of chaos theory and non-linear dynamics to problems in biological sciences has resulted in a growing body of advancements and the notion of brain as a complex, non-linear system has attracted physicists, mathematicians, biologists and psychologists alike. To search for a correlation between alterations in chaotic brain states and mood disorders, we compared the fractal dimension of the electroencephalographic (EEG) signal in patients going through a manic episode of bipolar mood disorder (BMD) type I to a control group of healthy adults and showed that the EEG fractal dimension is significantly augmented in our patients. Thus, for the first time, we draw a clear objective distinction between normal and abnormal mood and associated brain states.