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Vissers MFJM, Heuberger JAAC, Groeneveld GJ, Oude Nijhuis J, De Deyn PP, Hadi S, Harris J, Tsai RM, Cruz-Herranz A, Huang F, Tong V, Erickson R, Zhu Y, Scearce-Levie K, Hsiao-Nakamoto J, Tang X, Chang M, Fox BM, Pomponio RJ, Alonso-Alonso M, Zilberstein M, Atassi N, Troyer MD, Ho C. Safety, pharmacokinetics and target engagement of novel RIPK1 inhibitor SAR443060 (DNL747) for neurodegenerative disorders: Randomized, placebo-controlled, double-blind phase I/Ib studies in healthy subjects and patients. Clin Transl Sci 2022; 15:2010-2023. [PMID: 35649245 PMCID: PMC9372423 DOI: 10.1111/cts.13317] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 01/15/2023] Open
Abstract
RIPK1 is a master regulator of inflammatory signaling and cell death and increased RIPK1 activity is observed in human diseases, including Alzheimer’s disease (AD) and amyotrophic lateral sclerosis (ALS). RIPK1 inhibition has been shown to protect against cell death in a range of preclinical cellular and animal models of diseases. SAR443060 (previously DNL747) is a selective, orally bioavailable, central nervous system (CNS)–penetrant, small‐molecule, reversible inhibitor of RIPK1. In three early‐stage clinical trials in healthy subjects and patients with AD or ALS (NCT03757325 and NCT03757351), SAR443060 distributed into the cerebrospinal fluid (CSF) after oral administration and demonstrated robust peripheral target engagement as measured by a reduction in phosphorylation of RIPK1 at serine 166 (pRIPK1) in human peripheral blood mononuclear cells compared to baseline. RIPK1 inhibition was generally safe and well‐tolerated in healthy volunteers and patients with AD or ALS. Taken together, the distribution into the CSF after oral administration, the peripheral proof‐of‐mechanism, and the safety profile of RIPK1 inhibition to date, suggest that therapeutic modulation of RIPK1 in the CNS is possible, conferring potential therapeutic promise for AD and ALS, as well as other neurodegenerative conditions. However, SAR443060 development was discontinued due to long‐term nonclinical toxicology findings, although these nonclinical toxicology signals were not observed in the short duration dosing in any of the three early‐stage clinical trials. The dose‐limiting toxicities observed for SAR443060 preclinically have not been reported for other RIPK1‐inhibitors, suggesting that these toxicities are compound‐specific (related to SAR443060) rather than RIPK1 pathway‐specific.
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Affiliation(s)
- Maurits F J M Vissers
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | | | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Jerome Oude Nijhuis
- Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behavior, Department of Biomedical Sciences and Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Salah Hadi
- PRA Health Sciences, Groningen, The Netherlands
| | - Jeffrey Harris
- Denali Therapeutics Inc., South San Francisco, California, USA
| | - Richard M Tsai
- Denali Therapeutics Inc., South San Francisco, California, USA
| | | | - Fen Huang
- Denali Therapeutics Inc., South San Francisco, California, USA
| | - Vincent Tong
- Denali Therapeutics Inc., South San Francisco, California, USA
| | | | - Yuda Zhu
- Denali Therapeutics Inc., South San Francisco, California, USA
| | | | | | - Xinyan Tang
- Denali Therapeutics Inc., South San Francisco, California, USA
| | - Megan Chang
- Denali Therapeutics Inc., South San Francisco, California, USA
| | - Brian M Fox
- Denali Therapeutics Inc., South San Francisco, California, USA
| | | | | | | | | | | | - Carole Ho
- Denali Therapeutics Inc., South San Francisco, California, USA
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Tsai RM, Miller Z, Koestler M, Rojas JC, Ljubenkov PA, Rosen HJ, Rabinovici GD, Fagan AM, Cobigo Y, Brown JA, Jung JI, Hare E, Geldmacher DS, Natelson-Love M, McKinley EC, Luong PN, Chuu EL, Powers R, Mumford P, Wolf A, Wang P, Shamloo M, Miller BL, Roberson ED, Boxer AL. Reactions to Multiple Ascending Doses of the Microtubule Stabilizer TPI-287 in Patients With Alzheimer Disease, Progressive Supranuclear Palsy, and Corticobasal Syndrome: A Randomized Clinical Trial. JAMA Neurol 2020; 77:215-224. [PMID: 31710340 PMCID: PMC6865783 DOI: 10.1001/jamaneurol.2019.3812] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [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: 07/05/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
Abstract
Importance Basket-design clinical trials that allow investigation of treatment effects on different clinical syndromes that share the same molecular pathophysiology have not previously been attempted in neurodegenerative disease. Objective To assess the safety, tolerability, and pharmacodynamics of the microtubule stabilizer TPI-287 (abeotaxane) in Alzheimer disease (AD) or the 4-repeat tauopathies (4RT) progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). Design, Setting, and Participants Two parallel-design, double-blind, placebo-controlled phase 1 randomized clinical trials in AD and 4RT were conducted from December 20, 2013, through May 4, 2017, at the University of California, San Francisco, and University of Alabama at Birmingham. A total of 94 patients with clinically diagnosed AD (n = 39) and 4RT (n = 55) were screened; of these, 3 refused to participate, and 10 with AD and 11 with 4RT did not meet inclusion criteria. A total of 29 patients with AD, 14 with PSP, and 30 with β-amyloid-negative CBS (determined on positron emission tomography findings) were enrolled. Data were analyzed from December 20, 2013, through May 4, 2017, based on modified intention to treat. Interventions Randomization was 8:3 drug to placebo in 3 sequential dose cohorts receiving 2.0, 6.3, or 20.0 mg/m2 of intravenous TPI-287 once every 3 weeks for 9 weeks, with an optional 6-week open-label extension. Main Outcomes and Measures Primary end points were safety and tolerability (maximal tolerated dose) of TPI-287. Secondary and exploratory end points included TPI-287 levels in cerebrospinal fluid (CSF) and changes on biomarker, clinical, and neuropsychology measures. Results A total of 68 participants (38 men [56%]; median age, 65 [range, 50-85] years) were included in the modified intention-to-treat analysis, of whom 26 had AD (14 women [54%]; median age, 63 [range, 50-76] years), and 42 had 4RT (16 women [38%]; median age, 69 [range, 54-83] years). Three severe anaphylactoid reactions occurred in TPI-287-treated patients with AD, whereas none were seen in patients with 4RT, leading to a maximal tolerated dose of 6.3 mg/m2 for AD and 20.0 mg/m2 for 4RT. More falls (3 in the placebo group vs 11 in the TPI-287 group) and a dose-related worsening of dementia symptoms (mean [SD] in the CDR plus NACC FTLD-SB [Clinical Dementia Rating scale sum of boxes with frontotemporal dementia measures], 0.5 [1.8] in the placebo group vs 0.7 [1.6] in the TPI-287 group; median difference, 1.5 [95% CI, 0-2.5]; P = .03) were seen in patients with 4RT. Despite undetectable TPI-287 levels in CSF, CSF biomarkers demonstrated decreased chitinase-3-like protein-1 (YKL-40) levels in the 4RT treatment arm (mean [SD], -8.4 [26.0] ng/mL) compared with placebo (mean [SD], 10.4 [42.3] ng/mL; median difference, -14.6 [95% CI, -30.0 to 0.2] ng/mL; P = .048, Mann-Whitney test). Conclusions and Relevance In this randomized clinical trial, TPI-287 was less tolerated in patients with AD than in those with 4RT owing to the presence of anaphylactoid reactions. The ability to reveal different tau therapeutic effects in various tauopathy syndromes suggests that basket trials are a valuable approach to tau therapeutic early clinical development. Trial Registration ClinicalTrials.gov identifiers: NCT019666666 and NCT02133846.
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Affiliation(s)
- Richard M. Tsai
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Zachary Miller
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Mary Koestler
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Julio C. Rojas
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Peter A. Ljubenkov
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Anne M. Fagan
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Jesse A. Brown
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Joo In Jung
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Emma Hare
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - David S. Geldmacher
- Alzheimer’s Disease Center, Department of Neurology, University of Alabama at Birmingham
| | - Marissa Natelson-Love
- Alzheimer’s Disease Center, Department of Neurology, University of Alabama at Birmingham
| | - Emily C. McKinley
- Alzheimer’s Disease Center, Department of Neurology, University of Alabama at Birmingham
| | - Phi N. Luong
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Emmeline L. Chuu
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Ryan Powers
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Paige Mumford
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Amy Wolf
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Ping Wang
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Merhdad Shamloo
- Wu Tsai Neurosciences Institute, Stanford University, Palo Alto, California
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
| | - Erik D. Roberson
- Alzheimer’s Disease Center, Department of Neurology, University of Alabama at Birmingham
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, Sandler Neurosciences Center, University of California, San Francisco
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Chen X, Li Y, Wang C, Tang Y, Mok SA, Tsai RM, Rojas JC, Karydas A, Miller BL, Boxer AL, Gestwicki JE, Arkin M, Cuervo AM, Gan L. Promoting tau secretion and propagation by hyperactive p300/CBP via autophagy-lysosomal pathway in tauopathy. Mol Neurodegener 2020; 15:2. [PMID: 31906970 PMCID: PMC6945522 DOI: 10.1186/s13024-019-0354-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The trans-neuronal propagation of tau has been implicated in the progression of tau-mediated neurodegeneration. There is critical knowledge gap in understanding how tau is released and transmitted, and how that is dysregulated in diseases. Previously, we reported that lysine acetyltransferase p300/CBP acetylates tau and regulates its degradation and toxicity. However, whether p300/CBP is involved in regulation of tau secretion and propagation is unknown. METHOD We investigated the relationship between p300/CBP activity, the autophagy-lysosomal pathway (ALP) and tau secretion in mouse models of tauopathy and in cultured rodent and human neurons. Through a high-through-put compound screen, we identified a new p300 inhibitor that promotes autophagic flux and reduces tau secretion. Using fibril-induced tau spreading models in vitro and in vivo, we examined how p300/CBP regulates tau propagation. RESULTS Increased p300/CBP activity was associated with aberrant accumulation of ALP markers in a tau transgenic mouse model. p300/CBP hyperactivation blocked autophagic flux and increased tau secretion in neurons. Conversely, inhibiting p300/CBP promoted autophagic flux, reduced tau secretion, and reduced tau propagation in fibril-induced tau spreading models in vitro and in vivo. CONCLUSIONS We report that p300/CBP, a lysine acetyltransferase aberrantly activated in tauopathies, causes impairment in ALP, leading to excess tau secretion. This effect, together with increased intracellular tau accumulation, contributes to enhanced spreading of tau. Our findings suggest that inhibition of p300/CBP as a novel approach to correct ALP dysfunction and block disease progression in tauopathy.
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Affiliation(s)
- Xu Chen
- Gladstone Institute of Neurological Disease, University of California, San Francisco, CA 94158 USA
- Department of Neurology, University of California, San Francisco, CA 94158 USA
| | - Yaqiao Li
- Gladstone Institute of Neurological Disease, University of California, San Francisco, CA 94158 USA
| | - Chao Wang
- Gladstone Institute of Neurological Disease, University of California, San Francisco, CA 94158 USA
- Department of Neurology, University of California, San Francisco, CA 94158 USA
| | - Yinyan Tang
- Small Molecule Discovery Center, Department of Pharmaceutical Chemistry, University of California, San Francisco, CA 94158 USA
| | - Sue-Ann Mok
- Institute for Neurodegenerative Disease, Department of Pharmaceutical Chemistry, Weill Institute for Neurosciences, University of California, San Francisco, CA 94158 USA
| | - Richard M. Tsai
- Department of Neurology, University of California, San Francisco, CA 94158 USA
- Memory and Aging Center, University of California, San Francisco, CA 94158 USA
| | - Julio C. Rojas
- Department of Neurology, University of California, San Francisco, CA 94158 USA
- Memory and Aging Center, University of California, San Francisco, CA 94158 USA
| | - Anna Karydas
- Department of Neurology, University of California, San Francisco, CA 94158 USA
- Memory and Aging Center, University of California, San Francisco, CA 94158 USA
| | - Bruce L. Miller
- Department of Neurology, University of California, San Francisco, CA 94158 USA
- Memory and Aging Center, University of California, San Francisco, CA 94158 USA
| | - Adam L. Boxer
- Department of Neurology, University of California, San Francisco, CA 94158 USA
- Memory and Aging Center, University of California, San Francisco, CA 94158 USA
| | - Jason E. Gestwicki
- Institute for Neurodegenerative Disease, Department of Pharmaceutical Chemistry, Weill Institute for Neurosciences, University of California, San Francisco, CA 94158 USA
| | - Michelle Arkin
- Small Molecule Discovery Center, Department of Pharmaceutical Chemistry, University of California, San Francisco, CA 94158 USA
| | - Ana Maria Cuervo
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461 USA
- Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - Li Gan
- Gladstone Institute of Neurological Disease, University of California, San Francisco, CA 94158 USA
- Department of Neurology, University of California, San Francisco, CA 94158 USA
- Helen and Robert Appel Alzheimer’s Disease Research Institute, Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065 USA
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4
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La Joie R, Visani AV, Baker SL, Brown JA, Bourakova V, Cha J, Chaudhary K, Edwards L, Iaccarino L, Janabi M, Lesman-Segev OH, Miller ZA, Perry DC, O'Neil JP, Pham J, Rojas JC, Rosen HJ, Seeley WW, Tsai RM, Miller BL, Jagust WJ, Rabinovici GD. Prospective longitudinal atrophy in Alzheimer's disease correlates with the intensity and topography of baseline tau-PET. Sci Transl Med 2020; 12:eaau5732. [PMID: 31894103 PMCID: PMC7035952 DOI: 10.1126/scitranslmed.aau5732] [Citation(s) in RCA: 293] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/13/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
β-Amyloid plaques and tau-containing neurofibrillary tangles are the two neuropathological hallmarks of Alzheimer's disease (AD) and are thought to play crucial roles in a neurodegenerative cascade leading to dementia. Both lesions can now be visualized in vivo using positron emission tomography (PET) radiotracers, opening new opportunities to study disease mechanisms and improve patients' diagnostic and prognostic evaluation. In a group of 32 patients at early symptomatic AD stages, we tested whether β-amyloid and tau-PET could predict subsequent brain atrophy measured using longitudinal magnetic resonance imaging acquired at the time of PET and 15 months later. Quantitative analyses showed that the global intensity of tau-PET, but not β-amyloid-PET, signal predicted the rate of subsequent atrophy, independent of baseline cortical thickness. Additional investigations demonstrated that the specific distribution of tau-PET signal was a strong indicator of the topography of future atrophy at the single patient level and that the relationship between baseline tau-PET and subsequent atrophy was particularly strong in younger patients. These data support disease models in which tau pathology is a major driver of local neurodegeneration and highlight the relevance of tau-PET as a precision medicine tool to help predict individual patient's progression and design future clinical trials.
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Affiliation(s)
- Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Adrienne V Visani
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Suzanne L Baker
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Jesse A Brown
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Viktoriya Bourakova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jungho Cha
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kiran Chaudhary
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mustafa Janabi
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Orit H Lesman-Segev
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - David C Perry
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - James P O'Neil
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Julie Pham
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Richard M Tsai
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - William J Jagust
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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5
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Tsai RM, Bejanin A, Lesman-Segev O, LaJoie R, Visani A, Bourakova V, O'Neil JP, Janabi M, Baker S, Lee SE, Perry DC, Bajorek L, Karydas A, Spina S, Grinberg LT, Seeley WW, Ramos EM, Coppola G, Gorno-Tempini ML, Miller BL, Rosen HJ, Jagust W, Boxer AL, Rabinovici GD. 18F-flortaucipir (AV-1451) tau PET in frontotemporal dementia syndromes. Alzheimers Res Ther 2019; 11:13. [PMID: 30704514 PMCID: PMC6357510 DOI: 10.1186/s13195-019-0470-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The tau positron emission tomography (PET) ligand 18F-flortaucipir binds to paired helical filaments of tau in aging and Alzheimer's disease (AD), but its utility in detecting tau aggregates in frontotemporal dementia (FTD) is uncertain. METHODS We performed 18F-flortaucipir imaging in patients with the FTD syndromes (n = 45): nonfluent variant primary progressive aphasia (nfvPPA) (n = 11), corticobasal syndrome (CBS) (n = 10), behavioral variant frontotemporal dementia (bvFTD) (n = 10), semantic variant primary progressive aphasia (svPPA) (n = 2) and FTD associated pathogenic genetic mutations microtubule-associated protein tau (MAPT) (n = 6), chromosome 9 open reading frame 72 (C9ORF72) (n = 5), and progranulin (GRN) (n = 1). All patients underwent MRI and β-amyloid biomarker testing via 11C-PiB or cerebrospinal fluid. 18F-flortaucipir uptake in patients was compared to 53 β-amyloid negative normal controls using voxelwise and pre-specified region of interest approaches. RESULTS On qualitative assessment, patients with nfvPPA showed elevated 18F-flortacupir binding in the left greater than right inferior frontal gyrus. Patients with CBS showed elevated binding in frontal white matter, with higher cortical gray matter uptake in a subset of β-amyloid-positive patients. Five of ten patients with sporadic bvFTD demonstrated increased frontotemporal binding. MAPT mutation carriers had elevated 18F-flortaucipir retention primarily, but not exclusively, in mutations with Alzheimer's-like neurofibrillary tangles. However, tracer retention was also seen in patients with svPPA, and the mutations C9ORF72, GRN predicted to have TDP-43 pathology. Quantitative region-of-interest differences between patients and controls were seen only in inferior frontal gyrus in nfvPPA and left insula and bilateral temporal poles in MAPT carriers. No significant regional differences were found in CBS or sporadic bvFTD. Two patients underwent postmortem neuropathological examination. A patient with C9ORF72, TDP-43-type B pathology, and incidental co-pathology of scattered neurofibrillary tangles in the middle frontal, inferior temporal gyrus showed corresponding mild 18F-flortaucipir retention without additional uptake matching the widespread TDP-43 type B pathology. A patient with sporadic bvFTD demonstrated punctate inferior temporal and hippocampus tracer retention, corresponding to the area of severe argyrophilic grain disease pathology. CONCLUSIONS 18F-flortaucipir in patients with FTD and predicted tauopathy or TDP-43 pathology demonstrated limited sensitivity and specificity. Further postmortem pathological confirmation and development of FTD tau-specific ligands are needed.
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Affiliation(s)
- Richard M Tsai
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA.
| | - Alexandre Bejanin
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Orit Lesman-Segev
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Renaud LaJoie
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Adrienne Visani
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Viktoriya Bourakova
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - James P O'Neil
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Mustafa Janabi
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Suzanne Baker
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Suzee E Lee
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - David C Perry
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Lynn Bajorek
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Anna Karydas
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Salvatore Spina
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Eliana M Ramos
- Departments of Psychiatry and Neurology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Giovanni Coppola
- Departments of Psychiatry and Neurology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California at Berkeley, Berkeley, USA
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, USA
| | - Adam L Boxer
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, University of California at San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, USA
- Helen Wills Neuroscience Institute, University of California at Berkeley, Berkeley, USA
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Rojas JC, Bang J, Lobach IV, Tsai RM, Rabinovici GD, Miller BL, Boxer AL. CSF neurofilament light chain and phosphorylated tau 181 predict disease progression in PSP. Neurology 2017; 90:e273-e281. [PMID: 29282336 DOI: 10.1212/wnl.0000000000004859] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the ability of CSF biomarkers to predict disease progression in progressive supranuclear palsy (PSP). METHODS We compared the ability of baseline CSF β-amyloid1-42, tau, phosphorylated tau 181 (p-tau), and neurofilament light chain (NfL) concentrations, measured by INNO-BIA AlzBio3 or ELISA, to predict 52-week changes in clinical (PSP Rating Scale [PSPRS] and Schwab and England Activities of Daily Living [SEADL]), neuropsychological, and regional brain volumes on MRI using linear mixed effects models controlled for age, sex, and baseline disease severity, and Fisher F density curves to compare effect sizes in 50 patients with PSP. Similar analyses were done using plasma NfL measured by single molecule arrays in 141 patients. RESULTS Higher CSF NfL concentration predicted more rapid decline (biomarker × time interaction) over 52 weeks in PSPRS (p = 0.004, false discovery rate-corrected) and SEADL (p = 0.008), whereas lower baseline CSF p-tau predicted faster decline on PSPRS (p = 0.004). Higher CSF tau concentrations predicted faster decline by SEADL (p = 0.004). The CSF NfL/p-tau ratio was superior for predicting change in PSPRS, compared to p-tau (p = 0.003) or NfL (p = 0.001) alone. Higher NfL concentrations in CSF or blood were associated with greater superior cerebellar peduncle atrophy (fixed effect, p ≤ 0.029 and 0.008, respectively). CONCLUSIONS Both CSF p-tau and NfL correlate with disease severity and rate of disease progression in PSP. The inverse correlation of p-tau with disease severity suggests a potentially different mechanism of tau pathology in PSP as compared to Alzheimer disease.
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Affiliation(s)
- Julio C Rojas
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jee Bang
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Iryna V Lobach
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard M Tsai
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gil D Rabinovici
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruce L Miller
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adam L Boxer
- From the Memory and Aging Center, Department of Neurology (J.C.R., R.M.T., G.D.R., B.L.M., A.L.B.), and Department of Epidemiology and Biostatistics, Division of Biostatistics (I.V.L.), University of California, San Francisco; and Department of Neurology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
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Shi Y, Yamada K, Liddelow SA, Smith ST, Zhao L, Luo W, Tsai RM, Spina S, Grinberg LT, Rojas JC, Gallardo G, Wang K, Roh J, Robinson G, Finn MB, Jiang H, Sullivan PM, Baufeld C, Wood MW, Sutphen C, McCue L, Xiong C, Del-Aguila JL, Morris JC, Cruchaga C, Fagan AM, Miller BL, Boxer AL, Seeley WW, Butovsky O, Barres BA, Paul SM, Holtzman DM. ApoE4 markedly exacerbates tau-mediated neurodegeneration in a mouse model of tauopathy. Nature 2017; 549:523-527. [PMID: 28959956 PMCID: PMC5641217 DOI: 10.1038/nature24016] [Citation(s) in RCA: 746] [Impact Index Per Article: 106.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 08/17/2017] [Indexed: 12/21/2022]
Abstract
APOE4 is the strongest genetic risk factor for late-onset Alzheimer disease. ApoE4 increases brain amyloid-β pathology relative to other ApoE isoforms. However, whether APOE independently influences tau pathology, the other major proteinopathy of Alzheimer disease and other tauopathies, or tau-mediated neurodegeneration, is not clear. By generating P301S tau transgenic mice on either a human ApoE knock-in (KI) or ApoE knockout (KO) background, here we show that P301S/E4 mice have significantly higher tau levels in the brain and a greater extent of somatodendritic tau redistribution by three months of age compared with P301S/E2, P301S/E3, and P301S/EKO mice. By nine months of age, P301S mice with different ApoE genotypes display distinct phosphorylated tau protein (p-tau) staining patterns. P301S/E4 mice develop markedly more brain atrophy and neuroinflammation than P301S/E2 and P301S/E3 mice, whereas P301S/EKO mice are largely protected from these changes. In vitro, E4-expressing microglia exhibit higher innate immune reactivity after lipopolysaccharide treatment. Co-culturing P301S tau-expressing neurons with E4-expressing mixed glia results in a significantly higher level of tumour-necrosis factor-α (TNF-α) secretion and markedly reduced neuronal viability compared with neuron/E2 and neuron/E3 co-cultures. Neurons co-cultured with EKO glia showed the greatest viability with the lowest level of secreted TNF-α. Treatment of P301S neurons with recombinant ApoE (E2, E3, E4) also leads to some neuronal damage and death compared with the absence of ApoE, with ApoE4 exacerbating the effect. In individuals with a sporadic primary tauopathy, the presence of an ε4 allele is associated with more severe regional neurodegeneration. In individuals who are positive for amyloid-β pathology with symptomatic Alzheimer disease who usually have tau pathology, ε4-carriers demonstrate greater rates of disease progression. Our results demonstrate that ApoE affects tau pathogenesis, neuroinflammation, and tau-mediated neurodegeneration independently of amyloid-β pathology. ApoE4 exerts a 'toxic' gain of function whereas the absence of ApoE is protective.
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Affiliation(s)
- Yang Shi
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Kaoru Yamada
- Department of Neuropathology, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan
| | - Shane Antony Liddelow
- Department of Neurobiology, School of Medicine, Stanford University,
Stanford, CA, USA
- Department of Pharmacology and Therapeutics, The University of
Melbourne, Melbourne, Australia
| | - Scott T Smith
- Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA, USA
| | - Lingzhi Zhao
- Appel Alzheimer’s Disease Research Institute, Feil Family
Brain and Mind Research Institute, Weill Cornell Medical College of Cornell
University, New York, NY, USA
| | - Wenjie Luo
- Appel Alzheimer’s Disease Research Institute, Feil Family
Brain and Mind Research Institute, Weill Cornell Medical College of Cornell
University, New York, NY, USA
| | - Richard M. Tsai
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
| | - Lea T. Grinberg
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco,
CA, USA
| | - Julio C. Rojas
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
| | - Gilbert Gallardo
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Kairuo Wang
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Joseph Roh
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Grace Robinson
- Department of Ophthalmology, University of Missouri School of
Medicine, Columbia, Missouri, USA
| | - Mary Beth Finn
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Hong Jiang
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Patrick M Sullivan
- Department of Medicine, Duke University Medical Center, Durham
Veterans Health Administration Medical Center’s Geriatric Research,
Education and Clinical Center, Durham, NC, USA
| | - Caroline Baufeld
- Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA, USA
| | | | - Courtney Sutphen
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Lena McCue
- Division of Biostatistics, Washington University in St Louis, St
Louis, Missouri, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University in St Louis, St
Louis, Missouri, USA
| | - Jorge L. Del-Aguila
- Department of Psychiatry, Washington University School of Medicine,
660 S. Euclid Ave. B8134, St. Louis, MO, USA
| | - John C. Morris
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine,
660 S. Euclid Ave. B8134, St. Louis, MO, USA
- Department of Developmental Biology, Washington University School
of Medicine, 660 S. Euclid Ave., St. Louis, MO, USA
| | | | - Anne M. Fagan
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of
California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco,
CA, USA
| | - Oleg Butovsky
- Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA, USA
- Evergrande Center for Immunologic Diseases, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Ben A. Barres
- Department of Neurobiology, School of Medicine, Stanford University,
Stanford, CA, USA
| | - Steven M. Paul
- Appel Alzheimer’s Disease Research Institute, Feil Family
Brain and Mind Research Institute, Weill Cornell Medical College of Cornell
University, New York, NY, USA
- Voyager Therapeutics, Cambridge, MA, USA
| | - David M. Holtzman
- Department of Neurology, Hope Center for Neurological Disorders,
Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington
University School of Medicine, St. Louis, Missouri, USA
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Tsai RM, Boxer AL. Therapy and clinical trials in frontotemporal dementia: past, present, and future. J Neurochem 2016; 138 Suppl 1:211-21. [PMID: 27306957 DOI: 10.1111/jnc.13640] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 02/22/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia (FTD) is a common form of dementia with heterogeneous clinical presentations and distinct clinical syndromes. This article will review currently available therapies for FTD, its related disorders and their clinical evidence. It will also discuss recent advancements in FTD pathophysiology, treatment development, biomarker advancement and their relation to recently completed or currently ongoing clinical trials as well as future implications. Frontotemporal dementia (FTD) is a type of dementia with distinct clinical syndromes. Current treatments involve off-label use of medications for symptomatic management and cannot modify disease course. Advancements in FTD pathophysiology, genetics, and biomarkers have led to development of small molecules targeting the underlying pathology in hopes of achieving a disease-modifying effect. This article will review current therapies for FTD, discuss advancements in FTD pathophysiology, therapy development, biomarker advancement, their relation to recent clinical trials and future implications. This article is part of the Frontotemporal Dementia special issue.
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Affiliation(s)
- Richard M Tsai
- Assistant Adjunct Professor of Neurology, University of California San Francisco Department of Neurology, San Francisco, California, USA
| | - Adam L Boxer
- Associate Professor of Neurology, University of California San Francisco Department of Neurology, San Francisco, California, USA
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9
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Tsai RM, Lobach I, Bang J, Whitwell JL, Senjem ML, Jack CR, Rosen H, Miller B, Boxer AL. Clinical correlates of longitudinal brain atrophy in progressive supranuclear palsy. Parkinsonism Relat Disord 2016; 28:29-35. [PMID: 27132501 DOI: 10.1016/j.parkreldis.2016.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/25/2016] [Accepted: 04/08/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There are no effective treatments for progressive supranuclear palsy (PSP). Volumetric MRI (vMRI) may be a useful surrogate outcome measure in PSP clinical trials. The goal of the study was to evaluate the potential of vMRI to correlate with clinical outcomes from an international clinical trial population. METHODS PSP patients (n = 198) from the AL-108-231 trial who had high quality vMRI and Progressive Supranuclear Palsy Rating Scale (PSPRS), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Schwab and England Activities of Daily Living (SEADL), Color Trails Test, Geriatric Depression Screen (GDS) and one year Clinician Global Impression of Change (CGIC) data from the baseline and 52 week visits were included. Linear regression was used to relate baseline values and annual clinical rating scale changes to annual regional vMRI changes (whole brain, ventricular, midbrain and superior cerebellar peduncle volumes). RESULTS Effect sizes (Cohen's d) measuring disease progression over one year were largest for vMRI (midbrain [1.27] and ventricular volume [1.31]) but similar to PSPRS (1.26). After multiple comparison adjustment, annual changes in PSPRS, RBANS, SEADL, Color Trails Test, GDS and one year CGIC were modestly correlated with annual vMRI changes (p < 0.05). Baseline neuropsychological status on RBANS (p = 0.019) and Color Trails (p < 0.01) predicted annual midbrain atrophy rates. CONCLUSION Standard vMRI measurements are sensitive to disease progression in large, multicenter PSP clinical trials, but are not well correlated with clinical changes. vMRI changes may be useful as supportive endpoints in PSP trials.
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Affiliation(s)
- Richard M Tsai
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA.
| | - Iryna Lobach
- Department of Epidemiology and Biostatistics, Division of Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Jee Bang
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
| | | | | | | | - Howard Rosen
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
| | - Adam L Boxer
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
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10
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Wang HF, Tan L, Cao L, Zhu XC, Jiang T, Tan MS, Liu Y, Wang C, Tsai RM, Jia JP, Yu JT. Application of the IWG-2 Diagnostic Criteria for Alzheimer’s Disease to the ADNI. J Alzheimers Dis 2016; 51:227-36. [PMID: 26836176 DOI: 10.3233/jad-150824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, China
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, China
| | - Lei Cao
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, China
| | - Xi-Chen Zhu
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, China
| | - Meng-Shan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, China
| | - Ying Liu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, China
| | - Chong Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, China
| | - Richard M. Tsai
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jian-Ping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, China
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, China
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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11
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Rojas JC, Karydas A, Bang J, Tsai RM, Blennow K, Liman V, Kramer JH, Rosen H, Miller BL, Zetterberg H, Boxer AL. Plasma neurofilament light chain predicts progression in progressive supranuclear palsy. Ann Clin Transl Neurol 2016; 3:216-25. [PMID: 27042681 PMCID: PMC4774256 DOI: 10.1002/acn3.290] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/22/2015] [Accepted: 12/31/2015] [Indexed: 12/12/2022] Open
Abstract
Objective Blood‐based biomarkers for neurodegenerative conditions could improve diagnosis and treatment development. Neurofilament light chain (NfL), a marker of axonal injury, is elevated in cerebrospinal fluid (CSF) of patients with progressive supranuclear palsy (PSP). The goal of this study was to determine the diagnostic and prognostic value of plasma NfL in patients with PSP. Methods Plasma NfL was measured with ultrasensitive digital immunoassay‐based technology at baseline and 1‐year follow‐up in a pilot cohort of 15 PSP patients and 12 healthy controls, and a validation cohort of 147 PSP patients. Mixed linear models tested the ability of plasma NfL to predict neurological, cognitive and functional decline, and brain atrophy. Results Baseline mean plasma NfL levels were elevated in PSP patients (31 ± 4 pg/mL, vs. control, 17.5 ± 1 pg/mL, P < 0.05) and this difference persisted at follow‐up. A cutoff value of 20 pg/mL related to the diagnosis of PSP with a sensitivity of 0.80 and specificity of 0.83 (positive likelihood ratio = 4.7 and a negative likelihood radio of 0.24). Patients with higher NfL levels had more severe neurological (PSPRS, −36.9% vs. −28.9%, P = 0.04), functional (SEADL, −38.2% vs. −20%, P = 0.03), and neuropsychological (RBANS, −23.9% vs. −12.3%, P = 001) deterioration over 1 year. Higher baseline NfL predicted greater whole‐brain and superior cerebellar peduncle volume loss. Plasma and CSF NfL were significantly correlated (r = 0.74, P = 0.002). Interpretation Plasma NfL is elevated in PSP and could be of value as a biomarker both to assist clinical diagnosis and to monitor pharmacodynamic effects on the neurodegenerative process in clinical trials.
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Affiliation(s)
- Julio C Rojas
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Anna Karydas
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Jee Bang
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Richard M Tsai
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Victor Liman
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Joel H Kramer
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Howard Rosen
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Bruce L Miller
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden; Department of Molecular Neuroscience UCL Institute of Neurology Queen Square London United Kingdom
| | - Adam L Boxer
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
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12
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Tsai RM, Leong JK, Dutt S, Chang CC, Lee AK, Chao SZ, Yokoyama JS, Tse M, Kramer JH, Miller BL, Rosen HJ. The Chinese Verbal Learning Test specifically assesses hippocampal state. Am J Alzheimers Dis Other Demen 2014; 30:412-6. [PMID: 25270640 DOI: 10.1177/1533317514552667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
BACKGROUND Recently, the Chinese Verbal Learning Test (ChVLT) was developed to assess episodic memory in Chinese speakers. The goal of this analysis was to determine whether memory consolidation as measured by the ChVLT was specifically associated with hippocampal volume in patients with cognitive impairment. METHODS We administered the ChVLT to 22 Chinese-speaking patients with mild cognitive impairment and 9 patients with dementia and obtained hippocampal and cortical volumes from T1-weighted magnetic resonance imaging. RESULTS Linear regression revealed that hippocampal volume explained 9.9% of the variance in delayed memory (P = .018) after controlling for the effects of age, education, immediate recall after the last learning trial, overall level of cognitive impairment, and volumes of other cortical regions. CONCLUSION These results indicate that the ChVLT is specifically correlated with hippocampal volume, supporting its utility for detecting hippocampal disease and monitoring hippocampal state over time.
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Affiliation(s)
- Richard M Tsai
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Josiah K Leong
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Shubir Dutt
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Chiung Chih Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaoshiung Medical Center and Chang Gung University College of Medicine, Kaoshiung, Taiwan
| | - Allen K Lee
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Steven Z Chao
- Department of Neurology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jennifer S Yokoyama
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Marian Tse
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Joel H Kramer
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Howard J Rosen
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA UCSF Memory and Aging Center, San Francisco, CA, USA
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Abstract
OPINION STATEMENT Frontotemporal dementia (FTD) encompasses a spectrum of neurodegenerative diseases with heterogeneous clinical presentations and two predominant types of underlying neuropathology. FTD typically comprises three distinct clinical syndromes: behavioral variant frontotemporal dementia (bvFTD), semantic variant primary progressive aphasia (svPPA), and nonfluent variant primary progressive aphasia (nfvPPA). FTD also frequently overlaps both clinically and neuropathologically with three other neurodegenerative syndromes: corticobasal syndrome (CBS), progressive supranuclear palsy (PSP), and amyotrophic lateral sclerosis (ALS). Each syndrome can be associated with one or more underlying neuropathological diagnoses and are referred to as frontotemporal lobar degeneration (FTLD). Although the various FTD syndromes can substantially differ in terms of clinical symptoms and underlying pathology, the symptoms can be broadly categorized into behavioral, cognitive and motor domains. Currently there are no Food and Drug Administration (FDA) approved therapies for the above syndromes except riluzole for ALS. FTD treatment strategies generally rely on off-label use of medications for symptomatic management, and most therapies lack quality evidence from randomized, placebo-controlled clinical trials. For behavioral symptoms, selective serotonin reuptake inhibitors may be effective, while case reports hint at possible efficacy with antipsychotics or anti-epileptics, but use of these latter agents is limited due to concerns regarding side effects. There are no effective therapies for cognitive complaints in FTD, which frequently involve executive function, memory, and language. Motor difficulties associated with FTD may present with parkinsonian symptoms or motor neuron disease, for which riluzole is indicated as therapy. Compared to idiopathic Parkinson's disease, FTD-related atypical parkinsonism is generally not responsive to dopamine replacement therapies, but a small percentage of patients may experience improvement with a trial of carbidopa-levodopa. Physical and occupational therapy remain an important corner stone of motor symptom management in FTD. Speech therapy may also help patients manage symptoms associated with aphasia, apraxia, and dysarthria. Recent advances in the understanding of FTLD pathophysiology and genetics have led to development of potentially disease-modifying therapies as well as symptomatic therapies aimed at ameliorating social and behavioral deficits.
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Affiliation(s)
- Richard M Tsai
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94115, USA,
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14
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Abstract
There are currently no effective Food and Drug Administration-approved treatments for atypical parkinsonian disorders such as progressive supranuclear palsy, corticobasal degeneration, dementia with Lewy bodies, or multiple system atrophy. Previous treatment trials for these disorders were focused on symptomatic support and did not affect disease progression. Recent breakthroughs in neuropathology and pathophysiology have allowed a new understanding of these disorders and investigation into potentially disease modifying therapies. Randomized, placebo-controlled clinical trials of these disorders will be reviewed here. Suggestions for future therapeutic targets and clinical trial design (with a focus on progressive supranuclear palsy) will also be provided.
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Affiliation(s)
- Richard M Tsai
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Adam L Boxer
- Department of Neurology, University of California San Francisco, San Francisco, California
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