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Bastiaansen AEM, van Steenhoven RW, Te Vaarwerk ES, van der Flier WM, Teunissen C, de Graaff E, Nagtzaam MMP, Paunovic M, Franken SC, Schreurs MWJ, Leypoldt F, Smitt PAE, de Vries JM, Seelaar H, van Swieten J, Jan de Jong F, Pijnenburg YAL, Titulaer MJ. Antibodies Associated With Autoimmune Encephalitis in Patients With Presumed Neurodegenerative Dementia. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200137. [PMID: 37311646 PMCID: PMC10265404 DOI: 10.1212/nxi.0000000000200137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/08/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND & OBJECTIVES Autoimmune encephalitis (AIE) may present with prominent cognitive disturbances without overt inflammatory changes in MRI and CSF. Identification of these neurodegenerative dementia diagnosis mimics is important because patients generally respond to immunotherapy. The objective of this study was to determine the frequency of neuronal antibodies in patients with presumed neurodegenerative dementia and describe the clinical characteristics of the patients with neuronal antibodies. METHODS In this retrospective cohort study, 920 patients were included with neurodegenerative dementia diagnosis from established cohorts at 2 large Dutch academic memory clinics. In total, 1,398 samples were tested (both CSF and serum in 478 patients) using immunohistochemistry (IHC), cell-based assays (CBA), and live hippocampal cell cultures (LN). To ascertain specificity and prevent false positive results, samples had to test positive by at least 2 different research techniques. Clinical data were retrieved from patient files. RESULTS Neuronal antibodies were detected in 7 patients (0.8%), including anti-IgLON5 (n = 3), anti-LGI1 (n = 2), anti-DPPX, and anti-NMDAR. Clinical symptoms atypical for neurodegenerative diseases were identified in all 7 and included subacute deterioration (n = 3), myoclonus (n = 2), a history of autoimmune disease (n = 2), a fluctuating disease course (n = 1), and epileptic seizures (n = 1). In this cohort, no patients with antibodies fulfilled the criteria for rapidly progressive dementia (RPD), yet a subacute deterioration was reported in 3 patients later in the disease course. Brain MRI of none of the patients demonstrated abnormalities suggestive for AIE. CSF pleocytosis was found in 1 patient, considered as an atypical sign for neurodegenerative diseases. Compared with patients without neuronal antibodies (4 per antibody-positive patient), atypical clinical signs for neurodegenerative diseases were seen more frequently among the patients with antibodies (100% vs 21%, p = 0.0003), especially a subacute deterioration or fluctuating course (57% vs 7%, p = 0.009). DISCUSSION A small, but clinically relevant proportion of patients suspected to have neurodegenerative dementias have neuronal antibodies indicative of AIE and might benefit from immunotherapy. In patients with atypical signs for neurodegenerative diseases, clinicians should consider neuronal antibody testing. Physicians should keep in mind the clinical phenotype and confirmation of positive test results to avoid false positive results and administration of potential harmful therapy for the wrong indication.
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Affiliation(s)
- Anna E M Bastiaansen
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Robin W van Steenhoven
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Esmee S Te Vaarwerk
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Wiesje M van der Flier
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Charlotte Teunissen
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Esther de Graaff
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Mariska M P Nagtzaam
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Manuela Paunovic
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Suzanne C Franken
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Marco W J Schreurs
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Frank Leypoldt
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Peter A E Smitt
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Juna M de Vries
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Harro Seelaar
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - John van Swieten
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Frank Jan de Jong
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Yolande A L Pijnenburg
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Maarten J Titulaer
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands.
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Duggan MR, Parikh V. Microglia and modifiable life factors: Potential contributions to cognitive resilience in aging. Behav Brain Res 2021; 405:113207. [PMID: 33640394 PMCID: PMC8005490 DOI: 10.1016/j.bbr.2021.113207] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/11/2020] [Revised: 01/27/2021] [Accepted: 02/20/2021] [Indexed: 02/08/2023]
Abstract
Given the increasing prevalence of age-related cognitive decline, it is relevant to consider the factors and mechanisms that might facilitate an individual's resiliency to such deficits. Growing evidence suggests a preeminent role of microglia, the prime mediator of innate immunity within the central nervous system. Human and animal investigations suggest aberrant microglial functioning and neuroinflammation are not only characteristic of the aged brain, but also might contribute to age-related dementia and Alzheimer's Disease. Conversely, accumulating data suggest that modifiable lifestyle factors (MLFs), such as healthy diet, exercise and cognitive engagement, can reliably afford cognitive benefits by potentially suppressing inflammation in the aging brain. The present review highlights recent advances in our understanding of the role for microglia in maintaining brain homeostasis and cognitive functioning in aging. Moreover, we propose an integrated, mechanistic model that postulates an individual's resiliency to cognitive decline afforded by MLFs might be mediated by the mitigation of aberrant microglia activation in aging, and subsequent suppression of neuroinflammation.
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Affiliation(s)
- Michael R Duggan
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA, 19122, United States
| | - Vinay Parikh
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA, 19122, United States.
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Berek K, Hegen H, Auer M, Zinganell A, Di Pauli F, Deisenhammer F. Cerebrospinal fluid oligoclonal bands in Neuroborreliosis are specific for Borrelia burgdorferi. PLoS One 2020; 15:e0239453. [PMID: 32977328 PMCID: PMC7518929 DOI: 10.1371/journal.pone.0239453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) oligoclonal bands (OCB) occur in chronic or post-acute phase of inflammatory diseases of the central nervous system. Objective To determine whether CSF OCB in patients with neuroborreliosis (NB) are specific for borrelia burgdorferi senso lato. Methods We performed isoelectric focusing followed by immunoblotting in CSF of 10 NB patients and 11 controls (7 patients with multiple sclerosis, 2 patients with neuromyelitis optica spectrum disease, 1 patient with dementia and 1 patient with monoclonal gammopathy). Immunoblotting was performed using an uncoated as well as a borrelia antigen pre-coated nitrocellulose membrane (NCM). OCB were counted by visual inspection and photometric analysis. OCB were compared between uncoated und pre-coated NCM both in the NB and control group. For validation purposes inter-assay precision was determined by calculating the coefficient of variation (CV) Results Borrelia-specific OCB were found in the CSF of 9 NB patients and in none of the control subjects resulting in a sensitivity of 90% and a specificity of 100%. Number of NB specific OCB were 11±7 bands by photometric analyses compared to 9±5 bands by visual inspection. Validation experiments revealed an inconsistent inter-assay precision between visual and photometric analyses (NB uncoated: visual 28% versus photometric 14%, control subject uncoated: visual 16% versus photometric 24%). Conclusions In CSF samples with positive OCB, Borrelia-specific bands were detected in almost all NB patients and in none of the control subjects. Inconsistent inter-assay precision may be explained by a poor comparability of visual and photometric approach.
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Affiliation(s)
- Klaus Berek
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Zinganell
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Di Pauli
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
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Meudec L, Amode R, Brunet-Possenti F, Mignot S, Descamps V. Presence of anti-BP180 and anti-BP230 in the cerebrospinal fluid of patients with bullous pemphigoid and neurological disease: is there any intrathecal synthesis? Br J Dermatol 2019; 181:828-829. [PMID: 30883687 DOI: 10.1111/bjd.17882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- L Meudec
- Department of Dermatology , Hôpital Bichat, Paris, France
- Faculty of Medicine, Université Pierre et Marie Curie, Paris, France
| | - R Amode
- Department of Dermatology , Hôpital Bichat, Paris, France
- Faculty of Medicine, Université Paris Diderot, Paris, France
| | - F Brunet-Possenti
- Department of Dermatology , Hôpital Bichat, Paris, France
- Faculty of Medicine, Université Paris Diderot, Paris, France
| | - S Mignot
- Faculty of Medicine, Université Paris Diderot, Paris, France
- Department of Clinical Immunology, Hôpital Bichat, Paris, France
| | - V Descamps
- Department of Dermatology , Hôpital Bichat, Paris, France
- Faculty of Medicine, Université Paris Diderot, Paris, France
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5
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Messingham KN, Miller AD, Narayanan NS, Connell SJ, Fairley JA. Demographics and Autoantibody Profiles of Pemphigoid Patients with Underlying Neurologic Diseases. J Invest Dermatol 2019; 139:1860-1866.e1. [PMID: 30876802 PMCID: PMC6910721 DOI: 10.1016/j.jid.2019.01.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Bullous pemphigoid (BP) is an autoantibody-mediated blistering disease that is often associated with neurologic disease. BP antibodies target two epidermal adhesion molecules, known as BP180 and BP230. Homologues to these proteins are found in the brain, and it is hypothesized that neurologic disease leads to the production of autoantibodies that can cross-react with their cutaneous forms. To better understand the link between BP and neurologic disease, we evaluated primary demographic features (age, sex, race, ethnicity, and elapsed time between onset of skin symptoms and BP diagnosis), severity of BP, and IgG and IgE autoantibody levels in BP control individuals and patients with BP with preceding Parkinson disease, dementia, and stroke. The main findings of this study are that patients with BP with preceding neurologic disease have a shorter elapsed time between onset of skin disease and BP diagnosis and that patients with preceding Parkinson disease or dementia, but not stroke, are significantly older than patients with BP without neurologic disease. However, no significant differences in clinical presentation, BP severity scores, or autoantibody (IgG and IgE) responses were observed among the groups. These findings suggest that, despite the age difference, the clinical phenotype of BP is not affected by preceding neurologic disease.
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Affiliation(s)
| | - Adam D Miller
- Department of Dermatology, University of Iowa, Iowa City, Iowa, USA
| | | | - Samuel J Connell
- Department of Dermatology, University of Iowa, Iowa City, Iowa, USA
| | - Janet A Fairley
- Department of Dermatology, University of Iowa, Iowa City, Iowa, USA; Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA.
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6
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Abstract
Emerging results support the concept that Alzheimer disease (AD) and age-related dementia are affected by the ability of the immune system to contain the brain's pathology. Accordingly, well-controlled boosting, rather than suppression of systemic immunity, has been suggested as a new approach to modify disease pathology without directly targeting any of the brain's disease hallmarks. Here, we provide a short review of the mechanisms orchestrating the cross-talk between the brain and the immune system. We then discuss how immune checkpoint blockade directed against the PD-1/PD-L1 pathways could be developed as an immunotherapeutic approach to combat this disease using a regimen that will address the needs to combat AD.
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7
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Julio TA, Vernal S, Massaro JD, Silva MC, Donadi EA, Moriguti JC, Roselino AM. Biological predictors shared by dementia and bullous pemphigoid patients point out a cross-antigenicity between BP180/BP230 brain and skin isoforms. Immunol Res 2018; 66:567-576. [PMID: 30220011 DOI: 10.1007/s12026-018-9028-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bullous pemphigoid (BP) following dementia diagnosis has been reported in the elderly. Skin and brain tissues express BP180 and BP230 isoforms. Dementia has been associated with rs6265 (Val66Met) polymorphism of the brain-derived neurotrophic factor (BDNF) gene and low serum BDNF. Here we investigated a possible cross-antigenicity between BP180/BP230 brain and skin isoforms. We assessed antibodies against BP180/BP230 and BDNF levels by ELISA and BDNF Val66Met SNP by PCR in three groups: 50 BP patients, 50 patients with dementia, and 50 elderly controls. Heatmap hierarchical clustering and data mining decision tree were used to analyze the patients' demographic and laboratorial data as predictors of dementia-BP association. Sixteen percent of BP patients with the lowest serological BDNF presented dementia-BP clinical association. Anti-BP180/230 positivity was unexpected observed among dementia patients (10%, 10%) and controls (14%, 1%). Indirect immunofluorescence using healthy human skin showed a BP pattern in two of 10 samples containing antibodies against BP180/BP230 obtained from dementia group but not in the control samples. Neither allelic nor genotypic BDNF Val66Met SNP was associated with dementia or with BP (associated or not with clinical manifestation of dementia). Heatmap analysis was able to differentiate the three studied groups and confirmed the ELISA results. The comprehensive data mining analysis revealed that BP patients and dementia patients shared biological predictors that justified the dementia-BP association. Autoantibodies against the BP180/BP230 brain isoforms produced by dementia patients could cross-react with the BP180/BP230 skin isoforms, which could justify cases of dementia preceding the BP disease.
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Affiliation(s)
- Tamiris A Julio
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirao Preto, São Paulo, 14049-900, Brazil
| | - Sebastian Vernal
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirao Preto, São Paulo, 14049-900, Brazil
| | - Juliana D Massaro
- Division of Clinical Immunology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Matheus C Silva
- Division of Clinical Immunology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Eduardo A Donadi
- Division of Clinical Immunology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Julio C Moriguti
- Division of Gerontology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Ana M Roselino
- Division of Dermatology, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirao Preto, São Paulo, 14049-900, Brazil.
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8
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Zheng M, Ujiie H, Muramatsu K, Sato-Matsumura KC, Maeda T, Ujiie I, Iwata H, Izumi K, Nishie W, Shimizu H. A possible association between BP230-type bullous pemphigoid and dementia: a report of two cases in elderly patients. Br J Dermatol 2018; 178:1449-1450. [PMID: 29278417 DOI: 10.1111/bjd.16249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M Zheng
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Muramatsu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - T Maeda
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - I Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - W Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
Dementia in general and Alzheimer’s disease in particular is increasingly seen in association with autoimmunity being causatively or supportively involved in the pathogenesis. Besides classic autoantibodies (AABs) present in dementia patients, there is the new autoantibody class called functional autoantibodies, which is directed against G-protein coupled receptors (GPCRs; GPCR-AABs) and are seen as pathogenic players. However, less is known about dementia patients’ burden with functional autoantibodies. We present here for the first time a study analyzing the prevalence of GPCR-AABs in patients with different dementia forms such as unclassified, Lewy body, vascular and Alzheimer’s dementia. We identified the GPCR-AABs’ specific targets on the receptors and introduced a neutralization strategy for GPCR-AABs. Patients with Alzheimer’s and vascular dementia carried GPCR-AABs targeting the first loop of the alpha1- and the second loop of the beta2-adrenergic receptors (α1-AABs; β2-AABs). Nearly all vascular dementia patients also carry autoantibodies targeting the endothelin A receptor (ETA-AABs). The majority of patients with Lewy body dementia lacked any of the GPCR-AABs. In vitro, the function of the dementia-associated GPCR-AABs could be neutralized by the aptamer BC007. Due to the presence of GPCR-AABs in dementia patients mainly in those suffering from Alzheimer’s and vascular dementia, the orchestra of immune players in these dementia forms, so far preferentially represented by the classic autoantibodies, should be supplemented by functional autoantibodies. As dementia-associated functional autoantibodies could be neutralized by the aptamer BC007, the first step was taken for a new in vivo treatment option in dementia patients who were positive for GPCR-AABs.
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Affiliation(s)
| | - Harald Prüss
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
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El-Agnaf O, Overk C, Rockenstein E, Mante M, Florio J, Adame A, Vaikath N, Majbour N, Lee SJ, Kim C, Masliah E, Rissman RA. Differential effects of immunotherapy with antibodies targeting α-synuclein oligomers and fibrils in a transgenic model of synucleinopathy. Neurobiol Dis 2017; 104:85-96. [PMID: 28476636 DOI: 10.1016/j.nbd.2017.05.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 11/17/2022] Open
Abstract
Disorders with progressive accumulation of α-synuclein (α-syn) are a common cause of dementia and parkinsonism in the aging population. Accumulation and propagation of α-syn play a role in the pathogenesis of these disorders. Previous studies have shown that immunization with antibodies that recognize C-terminus of α-syn reduces the intra-neuronal accumulation of α-syn and related deficits in transgenic models of synucleinopathy. These studies employed antibodies that recognize epitopes within monomeric and aggregated α-syn that were generated through active immunization or administered via passive immunization. However, it is possible that more specific effects might be achieved with antibodies recognizing selective species of the α-syn aggregates. In this respect we recently developed antibodies that differentially recognized various oligomers (Syn-O1, -O2, and -O4) and fibrilar (Syn-F1 and -F2) forms of α-syn. For this purpose wild-type α-syn transgenic (line 61) mice were immunized with these 5 different antibodies and neuropathologically and biochemically analyzed to determine which was most effective at reducing α-syn accumulation and related deficits. We found that Syn-O1, -O4 and -F1 antibodies were most effective at reducing accumulation of α-syn oligomers in multiple brain regions and at preventing neurodegeneration. Together this study supports the notion that selective antibodies against α-syn might be suitable for development new treatments for synucleinopathies such as PD and DLB.
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Affiliation(s)
- Omar El-Agnaf
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, PO Box 5825, Doha, Qatar; Life Sciences Division, College of Science and Engineering, Hamad Bin Khalifa University (HBKU), Education City, Qatar Foundation, PO Box 5825, Doha, Qatar
| | - Cassia Overk
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States
| | - Edward Rockenstein
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States
| | - Michael Mante
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States
| | - Jazmin Florio
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States
| | - Anthony Adame
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States
| | - Nishant Vaikath
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, PO Box 5825, Doha, Qatar
| | - Nour Majbour
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, PO Box 5825, Doha, Qatar
| | - Seung-Jae Lee
- Department of Biomedical Sciences and Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Changyoun Kim
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States
| | - Eliezer Masliah
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States; Department of Pathology, University of California, San Diego, La Jolla, CA 92093, United States
| | - Robert A Rissman
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, United States; Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, United States.
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11
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Abstract
Autoimmune dementia and encephalopathies (ADE) are complex disorders that can cause immune-mediated cognitive deficits and have confusing nomenclature. Presentation varies from acute limbic encephalitis to subacute or chronic disorders of cognition mimicking neurodegenerative dementia. It may occur as a paraneoplastic phenomenon or an idiopathic autoimmune phenomenon. The presence of a personal/family history of autoimmunity, inflammatory spinal fluid, serologic evidence of autoimmunity (neural or nonorgan-specific), or mesial temporal magnetic resonance imaging abnormalities are clues to diagnosis. Bedside cognitive assessment and/or detailed neuropsychologic testing are useful. Neural-specific autoantibodies, mostly discovered in the past two decades, may bind antigens on the cell surface (e.g., N-methyl-d-aspartate receptor autoantibodies) and are likely to be pathogenic, with treatment aimed at antibody-depleting agents often with success, while antibodies binding intracellular antigens (e.g., antineuronal nuclear autoantibody type 1 (ANNA1 or anti-Hu)) are a marker of a T-cell-mediated process and treated with T-cell-depleting immunotherapies, with variable responses. Detection and treatment of cancer (when present) are essential. High-dose corticosteroids are the initial treatment in most patients and may serve as a diagnostic test when the diagnosis is uncertain. Repeat cognitive testing after immunotherapy helps document objective improvements. Maintenance immunotherapy is recommended in those at risk for relapse. Prognosis is variable, but paraneoplastic ADE with antibodies to intracellular antigens have a worse prognosis. The field is still developing and future studies should provide guidelines for diagnosis and treatments.
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12
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Abstract
BACKGROUND Increasing evidence suggests that gangliosides act as important mediators in both de- and remyelination. The scope of the present research was to investigate the presence of immunoglobulin (Ig) M antibodies against GM1, GD1b, and GQ1b gangliosides in the sera of patients with dementia and the possible connection with clinical parameters of the disease. METHOD This research topic demonstrates the investigation of 103 patients with dementia and 60 healthy individuals using enzyme-linked immunosorbent assay for the presence of 3 antiganglioside antibodies in their sera. RESULTS The authors report a positive connection between IgM anti-GM1 and the age (P = .005) and the severity of dementia (P = .005). Most of the patients who revealed increased IgM anti-GD1b levels had Alzheimer's disease (AD; P = .002). CONCLUSION This study indicates that elevated IgM anti-GM1 may be connected with the neurodegeneration in older patients with severe dementia and that AD may also be associated with increased IgM anti-GD1b levels.
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Affiliation(s)
- E Hatzifilippou
- First Department of Neurology, Laboratory of Neuroimmunology, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - E Koutsouraki
- First Department of Neurology, Laboratory of Neuroimmunology, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - V G Costa
- First Department of Neurology, Memory Clinic, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - S J Baloyannis
- First Department of Neurology, Laboratory of Neuroimmunology, Aristotle University, AHEPA Hospital, Thessaloniki, Greece First Department of Neurology, Memory Clinic, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
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13
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Ar'eva GT, Ar'ev AL. [Aging and periodontal diseases (review)]. Adv Gerontol 2014; 27:771-775. [PMID: 25946858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The review on associative communications of periodontal diseases, aging and age associated pathology is submitted. Uniform pathophysiological and pathogenetic mechanisms of these processes and their interrelation are analyzed. The question of existence of so-called periodontal-systemic connection is discussed. The conclusion about need of changing the paradigm of approach for diagnostics and treatment of patients with periodontal pathology from tightly specialized stomatologic into the interdisciplinary paradigm is drawn. It is especially important for the elderly patients having polymorbid pathology in association with inflammatory periodontal diseases.
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Sosvorova L, Vcelak J, Mohapl M, Vitku J, Bicikova M, Hampl R. Selected pro- and anti-inflammatory cytokines in cerebrospinal fluid in normal pressure hydrocephalus. Neuro Endocrinol Lett 2014; 35:586-593. [PMID: 25617881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Normal pressure hydrocephalus (NPH) is a treatable neurological syndrome developing in the elderly. It is characterized by balance impairment, urinary incontinence and dementia development caused by disorders in the cerebrospinal fluid (CSF) circulation. The diagnosis can be easily mistaken for other neurodegenerative diseases, which are often accompanied by inflammation and the production of cytokines. The aim of our study was to determine and compare selected CSF and plasma cytokines with respect to their informative value for laboratory diagnostics of NPH. METHODS The levels of IL-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, INF-γ, sCD40L and TNF-α were measured in the CSF and plasma in age-matched subjects with NPH (n=20) and controls (n=20) by multiplex assay. RESULTS CSF IL-1β, IL-6 and IL-10 were significantly increased on the 1st day of lumbar drainage in NPH (p<0.01). No significant changes were observed in the plasma. The CSF cytokines were one to three orders of magnitude higher compared to the plasma. CONCLUSION CSF can better show the neurodegenerative changes in the brain. The cytokines IL-1β, IL-6 and IL-10 may be helpful in NPH diagnostics.
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Affiliation(s)
- Lucie Sosvorova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic
| | - Josef Vcelak
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Milan Mohapl
- Department of Neurosurgery, Central Military Hospital, Prague, Czech Republic
| | - Jana Vitku
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic
| | - Marie Bicikova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic
| | - Richard Hampl
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic
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15
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Flanagan EP, McKeon A, Lennon VA, Boeve BF, Trenerry MR, Tan KM, Drubach DA, Josephs KA, Britton JW, Mandrekar JN, Lowe V, Parisi JE, Pittock SJ. Autoimmune dementia: clinical course and predictors of immunotherapy response. Mayo Clin Proc 2010; 85:881-97. [PMID: 20884824 PMCID: PMC2947960 DOI: 10.4065/mcp.2010.0326] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To define the diagnostic characteristics and predictors of treatment response in patients with suspected autoimmune dementia. PATIENTS AND METHODS Between January 1, 2002, and January 1, 2009, 72 consecutive patients received immunotherapy for suspected autoimmune dementia. Their baseline clinical, radiologic, and serologic characteristics were reviewed and compared between patients who were responsive to immunotherapy and those who were not. Patients were classified as responders if the treating physician had reported improvement after immunotherapy (documented in 80% by the Kokmen Short Test of Mental Status, neuropsychological testing, or both). RESULTS Initial immunotherapeutic regimens included methylprednisolone in 56 patients (78%), prednisone in 12 patients (17%), dexamethasone in 2 patients (3%), intravenous immune globulin in 1 patient (1%), and plasma exchange in 1 patient (1%). Forty-six patients (64%) improved, most in the first week of treatment. Thirty-five percent of these immunotherapy responders were initially diagnosed as having a neurodegenerative or prion disorder. Pretreatment and posttreatment neuropsychological score comparisons revealed improvement in almost all cognitive domains, most notably learning and memory. Radiologic or electroencephalographic improvements were reported in 22 (56%) of 39 patients. Immunotherapy responsiveness was predicted by a subacute onset (P<.001), fluctuating course (P<.001), tremor (P=.007), shorter delay to treatment (P=.005), seropositivity for a cation channel complex autoantibody (P=.01; neuronal voltage-gated potassium channel more than calcium channel or neuronal acetylcholine receptor), and elevated cerebrospinal fluid protein (>100 mg/dL) or pleocytosis (P=.02). Of 26 immunotherapy-responsive patients followed up for more than 1 year, 20 (77%) relapsed after discontinuing immunotherapy. CONCLUSION Identification of clinical and serologic clues to an autoimmune dementia allows early initiation of immunotherapy, and maintenance if needed, thus favoring an optimal outcome.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sean J. Pittock
- Individual reprints of this article are not available. Address correspondence to Sean J. Pittock, MD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905 ()
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16
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Katsel P, Tan W, Haroutunian V. Gain in brain immunity in the oldest-old differentiates cognitively normal from demented individuals. PLoS One 2009; 4:e7642. [PMID: 19865478 PMCID: PMC2764344 DOI: 10.1371/journal.pone.0007642] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [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: 07/06/2009] [Accepted: 10/04/2009] [Indexed: 11/18/2022] Open
Abstract
Background Recent findings suggest that Alzheimer's disease (AD) neuropathological features (neuritic plaques and NFTs) are not strongly associated with dementia in extreme old (over 90 years of age) and compel a search for neurobiological indices of dementia in this rapidly growing segment of the elderly population. We sought to characterize transcriptional and protein profiles of dementia in the oldest-old. Methods and Findings Gene and protein expression changes relative to non-demented age-matched controls were assessed by two microarray platforms, qPCR and Western blot in different regions of the brains of oldest-old and younger old persons who died at mild or severe stages of dementia. Our results indicate that: i) consistent with recent neuropathological findings, gene expression changes associated with cognitive impairment in oldest-old persons are distinct from those in cognitively impaired youngest-old persons; ii) transcripts affected in young-old subjects with dementia participate in biological pathways related to synaptic function and neurotransmission while transcripts affected in oldest-old subjects with dementia are associated with immune/inflammatory function; iii) upregulation of immune response genes in cognitively intact oldest-old subjects and their subsequent downregulation in dementia suggests a potential protective role of the brain immune-associated system against dementia in the oldest-old; iv) consistent with gene expression profiles, protein expression of several selected genes associated with the inflammatory/immune system in inferior temporal cortex is significantly increased in cognitively intact oldest-old persons relative to cognitively intact young-old persons, but impaired in cognitively compromised oldest-old persons relative to cognitively intact oldest-old controls. Conclusions These results suggest that disruption of the robust immune homeostasis that is characteristic of oldest-old individuals who avoided dementia may be directly associated with dementia in the oldest-old and contrast with the synaptic and neurotransmitter system failures that typify dementia in younger old persons.
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Affiliation(s)
- Pavel Katsel
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
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17
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Silverman JM, Beeri MS, Schmeidler J, Rosendorff C, Angelo G, Mavris RS, Grossman HT, Elder GA, Carrion-Baralt J, West R. C-reactive protein and memory function suggest antagonistic pleiotropy in very old nondemented subjects. Age Ageing 2009; 38:237-41. [PMID: 19147740 DOI: 10.1093/ageing/afn278] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jeremy M Silverman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
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18
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Wilson JS, Mruthinti S, Buccafusco JJ, Schade RF, Mitchell MB, Harrell DU, Gulati NK, Stephen Miller L. Anti-RAGE and Abeta immunoglobulin levels are related to dementia level and cognitive performance. J Gerontol A Biol Sci Med Sci 2009; 64:264-71. [PMID: 19196906 PMCID: PMC2655015 DOI: 10.1093/gerona/gln002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 04/03/2008] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood-based immunoglobulins (IgGs) may mark the presence of amyloid plaques characterizing the progression of Alzheimer's disease (AD). Previous studies suggest that anti-RAGE and anti-Abeta IgGs increase proportionately with accumulation of amyloid-beta (Abeta) peptides at receptor sites for advanced glycation end products (RAGE), within cortical areas of brain tissue. We assessed the relationship between these potential markers and an AD-type cognitive profile. We hypothesized that these specific IgG levels would be positively correlated with Clinical Dementia Rating (CDR) scores as well as index scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in domains associated with cortical function. METHODS Participants were 118 older adults (mean age = 74, standard deviation = 10.5) drawn from the community and local physician referrals. Participants were reassigned into five groups based on CDR. Blood IgG levels were determined through an affinity purification process. RESULTS Analysis of covariance analyses revealed that CDR scores were significantly related to anti-RAGE, F(4,106) = 12.93, p < .001, and anti-Abeta, F(4,106) = 17.08, p < .001, after controlling for age and total IgG levels. Regression analyses indicated significant variance accounted for by anti-RAGE and anti-Abeta above and beyond total IgG effects. Additional regression identified specific RBANS domains accounting for significant variance in anti-RAGE levels including language (t = -3.74, p < .001) and delayed memory (t = -2.31, p < .05), whereas language accounted for a significant amount of variance in anti-Abeta levels (t = -3.96, p < .001). CONCLUSIONS Anti-RAGE and anti-Abeta IgGs correlate strongly with global scores of dementia. Furthermore, they are associated with a profile of deficiency in domains associated with specific cortical function. Results suggest potential for anti-Abeta and anti-RAGE IgGs as blood biomarkers for AD.
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Affiliation(s)
| | - Shyamala Mruthinti
- Charlie Norwood VA Medical Center, Augusta, Georgia
- Department of Pharmacology and Toxicology
| | - Jerry J. Buccafusco
- Charlie Norwood VA Medical Center, Augusta, Georgia
- Alzheimer's Research Center
| | - Rosann F. Schade
- Charlie Norwood VA Medical Center, Augusta, Georgia
- Alzheimer's Research Center
| | | | | | - Nidhi K. Gulati
- Department of Family Medicine, Medical College of Georgia, Augusta
- Georgia War Veterans Nursing Home, Department of Family Medicine, Augusta
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19
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Arneth B, Birklein F. High sensitivity of free lambda and free kappa light chains for detection of intrathecal immunoglobulin synthesis in cerebrospinal fluid. Acta Neurol Scand 2009; 119:39-44. [PMID: 18573131 DOI: 10.1111/j.1600-0404.2008.01058.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND So far, an inflammation of the central nervous system (CNS) is diagnosed by immunoglobulin measurement in cerebrospinal fluid (CSF) and serum as well as by determination of the oligoclonal bands. With the free kappa and lambda light chains, new markers to diagnose intrathecal synthesis are available. METHODS In addition to routine diagnostic tests and the assessment of standard parameters, free immunoglobulin light chains were measured in the CSF of patients with neurological disorders. RESULTS A significant agreement was found between an increase in free kappa light chain CSF serum quotients and results of the currently widely applied method of oligoclonal band measurement for the detection of intrathecal immunoglobulin synthesis. A sensitivity of 95% and 100% specificity for free kappa light chain concentrations at a cut-off of 0.41 mg/l was determined for free kappa light chains compared with oligoclonal bands. However, the free lambda light chains in 20 out of the 110 investigated samples were characterized by inconsistent behaviour. These otherwise unremarkable samples yielded increased CSF quotients, leading to the assumption that free lambda light chains represent a highly sensitive measure of intrathecal immunologlobulin synthesis. Thirteen of the 20 samples described above were obtained from patients with cerebral infarction, 4 samples derived from patients with cerebral paresis (primarily facial paresis), one sample was from a patient with multisystem atrophy and two were obtained from patients with migraine and neuralgia. CONCLUSION These findings suggest that the high sensitivity of lambda light chains for the detection intrathecal immunoglobulin synthesis may be of benefit in establishing clinical diagnoses.
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Affiliation(s)
- B Arneth
- Institute of Clinical Chemistry, University of Mainz, Germany.
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20
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Segerstrom SC, Schipper LJ, Greenberg RN. Caregiving, repetitive thought, and immune response to vaccination in older adults. Brain Behav Immun 2008; 22:744-52. [PMID: 18166335 PMCID: PMC2464708 DOI: 10.1016/j.bbi.2007.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 11/16/2007] [Accepted: 11/17/2007] [Indexed: 11/19/2022] Open
Abstract
Chronic stressors such as caregiving have been associated with reduced antibody production after vaccination and elevated interleukin (IL)-6 in older adults. However, individual differences in repetitive thought, that is, frequent or prolonged thought about oneself and one's world, can modify perception and effects of stress. For example, worry during stressful circumstances has been associated with poorer immune outcomes, whereas cognitive processing has been associated with better outcomes. The present study tested the relationship of caregiving and two types of repetitive thought, negative (e.g., worry) and neutral (e.g., reflection), to pre- and post-influenza vaccine antibody and IL-6. Dementia caregivers (n=14) and controls (n=30) were interviewed and had blood drawn pre- and post-vaccine in a multi-wave study. Multi-level models found that caregivers had higher IL-6 than controls after vaccination (t(23)=2.36, p<.05). There were several interactions between caregiver status and repetitive thought in predicting both depression and immune responses to vaccination. Among caregivers, negative repetitive thought predicted more depression and lower antibody titers, whereas neutral repetitive thought predicted less depression and higher antibody titers, but also higher post-vaccination IL-6. Among controls, negative repetitive thought predicted more depression but higher antibody titers, whereas neutral repetitive thought predicted less depression and lower post-vaccination IL-6. In mediational tests, depression did not account for the effects of repetitive thought. Results generally support beneficial effects of neutral repetitive thought and detrimental effects of negative repetitive thought, but those effects may be reduced or even reversed depending on life circumstances.
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Affiliation(s)
- Suzanne C Segerstrom
- Department of Psychology, University of Kentucky, 115 Kastle Hall, Lexington, KY 40506-0044, USA.
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21
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Abstract
The aim of this study was to evaluate the levels of anti-GM1 in demented patients, correlating them with the type and severity of dementia as well as with the eventually coexistent polyneuropathy. Anti-GM1 concentrations were measured in the sera of 33 demented patients with a male-to-female ratio of 1:2.7 (the mean age was 69.7 years for males and 70.1 years for females). Eighty-two percent of the patients revealed increased values of anti-GM1, but only 18.2% demonstrated polyneuropathies. Fifty-nine percent of the patients suffered from vascular dementia. The most severely demented patients demonstrated a Mini-Mental State Examination score of 5 to 23 out of 30 and revealed the most increased levels of anti-GM1 (>40 EU/mL). The findings of this study are indicative of a possible correlation between the levels of anti-GM1 and the severity of dementia, mainly of the vascular type.
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Affiliation(s)
- Eleni Hatzifilippou
- Neuroimmunological Laboratory of the 1st Department of Neurology Aristotelian University, AHEPA Hospital, Thessaloniki, Greece
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22
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Kanai Y, Akatsu H, Iizuka H, Morimoto C. Could serum antibody to poly(ADP-ribose) and/or histone H1 be marker for senile dementia of Alzheimer type? Ann N Y Acad Sci 2007; 1109:338-44. [PMID: 17785323 DOI: 10.1196/annals.1398.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Poly(ADP-ribosyl)ation has been focused on ischemic injury in the brain in relation to Alzheimer's disease (AD). We have measured IgG antibodies against poly adenosine diphosphate-ribose (pADPR) as well as histone H1 (H1) in 26 patients with either AD or with senile dementia of Alzheimer type (SDAT), and found that 80.7% (21/26) were positive for anti-pADPR IgG antibodies. Anti-H1 IgG antibodies were less positive (57.6%) (15/26) than anti-pADPR IgG antibodies, however, titers of both antibodies were well correlated (r = 0.768). Meanwhile, similar studies on 32 patients with systemic lupus erythematosus (SLE) who were positive for anti-pADPR antibody showed poor correlation (r = 0.184) and the difference in the correlation was statistically significant (r < 0.01). It is worthy of remark that anti-double-stranded (ds) DNA antibody, which is the hallmark of SLE, was negative in all dementia patients. Together with the findings that major subclass in dementia is both IgG1 and IgG2 and that in SLE was IgG2, the mode of production of anti-pADPR antibody in AD and SDAT is under different regulation mechanisms from that in SLE. Given the evidence that major target for ADP-ribosylation is H1 molecule, the association between anti-pADPR and anti-H1 in AD/SDAT makes sense and supports the concept that modification of proteins renders them immunogenic. Whatever the regulation is, parallel assay of two antibodies above would be of use not only for monitoring the disease process but also as a prodrome for possible subsets of SDAT and AD.
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Affiliation(s)
- Yoshiyuki Kanai
- Fukushimura Institute of Medical and Health Services for the Aged, 19-1, Noyori, Toyohashi, 441-8124, Japan.
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23
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Henkel AW, Dittrich PS, Groemer TW, Lemke EA, Klingauf J, Klafki HW, Lewczuk P, Esselmann H, Schwille P, Kornhuber J, Wiltfang J. Immune complexes of auto-antibodies against A beta 1-42 peptides patrol cerebrospinal fluid of non-Alzheimer's patients. Mol Psychiatry 2007; 12:601-10. [PMID: 17279093 DOI: 10.1038/sj.mp.4001947] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The diagnostic potential of large A beta-peptide binding particles (LAPs) in the cerebrospinal fluid (CSF) of Alzheimer's dementia (AD) patients and non-AD controls (nAD) was evaluated. LAPs were detected by confocal spectroscopy in both groups with high inter-individual variation in number. Molecular imaging by confocal microscopy revealed that LAPs are heterogeneous superaggregates that could be subdivided morphologically into four main types (LAP 1-4). LAP-4 type, resembling a 'large chain of pearls', was detected in 42.1% of all nAD controls but it was virtually absent in AD patients. LAP-4 type could be selectively removed by protein A beads, a clear indication that it contained immunoglobulins in addition to beta-amyloid peptides (A beta 1-42). We observed a close correlation between LAPs and immunoglobulin G (IgG) concentration in CSF in controls but not in AD patients. Double labeling of LAPs with anti-A beta and anti-IgG antibodies confirmed that LAP-4 type consisted of A beta and IgG aggregates. Our results assign a central role to the immune system in regulating A beta1-42 homeostasis by clustering this peptide in immunocomplexes.
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Affiliation(s)
- A W Henkel
- Department of Psychiatry and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany
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24
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Weeraratna AT, Kalehua A, DeLeon I, Bertak D, Maher G, Wade MS, Lustig A, Becker KG, Wood W, Walker DG, Beach TG, Taub DD. Alterations in immunological and neurological gene expression patterns in Alzheimer's disease tissues. Exp Cell Res 2006; 313:450-61. [PMID: 17188679 PMCID: PMC2565515 DOI: 10.1016/j.yexcr.2006.10.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [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: 08/11/2006] [Revised: 09/28/2006] [Accepted: 10/02/2006] [Indexed: 11/18/2022]
Abstract
Microarray technology was utilized to isolate disease-specific changes in gene expression by sampling across inferior parietal lobes of patients suffering from late onset AD or non-AD-associated dementia and non-demented controls. Primary focus was placed on understanding how inflammation plays a role in AD pathogenesis. Gene ontology analysis revealed that the most differentially expressed genes related to nervous system development and function and neurological disease followed by genes involved in inflammation and immunological signaling. Pathway analysis also implicated a role for chemokines and their receptors, specifically CXCR4 and CCR3, in AD. Immunohistological analysis revealed that these chemokine receptors are upregulated in AD patients. Western analysis demonstrated an increased activation of PKC, a downstream mediator of chemokine receptor signaling, in the majority of AD patients. A very specific cohort of genes related to amyloid beta accumulation and clearance were found to be significantly altered in AD. The most significantly downregulated gene in this data set was the endothelin converting enzyme 2 (ECE2), implicated in amyloid beta clearance. These data were subsequently confirmed by real-time PCR and Western blot analysis. Together, these findings open up new avenues of investigation and possible therapeutic strategies targeting inflammation and amyloid clearance in AD patients.
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Affiliation(s)
- Ashani T. Weeraratna
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
| | - Audrey Kalehua
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
| | - Isoke DeLeon
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
| | - Dorothy Bertak
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
| | - Gregory Maher
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
| | - Michael S. Wade
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
| | | | - Kevin G. Becker
- Research Resources Branch, National Institute of Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - William Wood
- Research Resources Branch, National Institute of Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | | | | | - Dennis D. Taub
- Laboratory of Immunology, National Institutes of Health, Baltimore, MD 21224, USA
- Corresponding author. Clinical Immunology Section, Laboratory of Immunology, National Institute of Aging-Intramural Research Program, National Institutes of Health, 5600 Nathan Shock Drive, Room 4C02, Baltimore, MD 21224, USA. Fax: +1 410 558 8284. E-mail address: (D.D. Taub)
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25
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Parachikova A, Agadjanyan MG, Cribbs DH, Blurton-Jones M, Perreau V, Rogers J, Beach TG, Cotman CW. Inflammatory changes parallel the early stages of Alzheimer disease. Neurobiol Aging 2006; 28:1821-33. [PMID: 17052803 PMCID: PMC2198930 DOI: 10.1016/j.neurobiolaging.2006.08.014] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [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: 04/25/2006] [Revised: 08/21/2006] [Accepted: 08/30/2006] [Indexed: 12/29/2022]
Abstract
Alzheimer disease (AD) is the most prominent cause of dementia in the elderly. To determine changes in the AD brain that may mediate the transition into dementia, the gene expression of approximately 10,000 full-length genes was compared in mild/moderate dementia cases to non-demented controls that exhibited high AD pathology. Including this latter group distinguishes this work from previous studies in that it allows analysis of early cognitive loss. Compared to non-demented high-pathology controls, the hippocampus of AD cases with mild/moderate dementia had increased gene expression of the inflammatory molecule major histocompatibility complex (MHC) II, as assessed with microarray analysis. MHC II protein levels were also increased and inversely correlated with cognitive ability. Interestingly, the mild/moderate AD dementia cases also exhibited decreased number of T cells in the hippocampus and the cortex compared to controls. In conclusion, transition into AD dementia correlates with increased MHC II(+) microglia-mediated immunity and is paradoxically paralleled by a decrease in T cell number, suggesting immune dysfunction.
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Affiliation(s)
- A Parachikova
- Institute for Brain Aging & Dementia, University of California, 1113 Gillespie Neuroscience Research Facility, Irvine, CA 92697-4540, USA.
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26
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Abstract
Many viruses cause encephalitis, but understanding the mechanisms by which viral infection leads to encephalopathy or dementia remain elusive. In many cases, inflammation generated by the host's attempt to combat the infection is itself implicated as a primary factor in causing neuronal dysfunction or degeneration. In this review, we outline the current state of knowledge regarding the pathophysiology of CNS (central nervous system) injury in viral infection. We focus our review on the neuropathogenesis of HIV type 1 (HIV-1)-associated dementia, because, within this class of infection, it is the best studied. We will also discuss the key similarities and differences in the pathological mechanisms of other important viral encephalitides. Understanding these mechanisms should ultimately enable development of immunomodulatory therapies for treating these infections, as well as other neuro-inflammatory conditions.
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Affiliation(s)
- Tongguang Wang
- Department of Neurology, Johns Hopkins University, 600 N. Wolfe St, Baltimore, MD 21287, USA
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27
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Abstract
Cognitive impairment in the elderly, caused by either normal ageing process or dementia, is an increasing problem in developed countries that has enormous social and economic considerations. Research investigating the genetic basis of cognition is a new and rapidly developing field that may aid in the development of new treatments for age-related cognitive deficit. Over the past 6 years, a number of quantitative trait loci (QTLs) have been associated with cognitive functioning in humans including loci within the genes catechol-o-methyltransferase, brain-derived neurotrophic factor, muscle segment homeobox 1, serotonin transporter 2A (HTR2A), cholinergic muscarinic receptor 2, cathepsin D, metabotrophic glutamate receptor and most recently the class II human leukocyte antigens. Unfortunately, inconsistency within the literature, which is a hallmark of almost all association studies investigating complex diseases and traits, is casting doubt as to which genes are truly associated with cognition and which are a result of Type 2 error. This review will highlight implicated intelligence QTLs, examine the probable reasons for the current discrepancies between reports and discuss the potential advantages that may be procured from the study of cognitive genetics.
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Affiliation(s)
- A Payton
- Centre for Integrated Genomic Medical Research, Stopford building, University of Manchester, Oxford road, Manchester, UK.
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28
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Foureur N, Mignot S, Senet P, Verpillat P, Picard-Dahan C, Crickx B, Labarre C, Nicaise-Roland P, Descamps V. Corrélation entre présence d’anticorps anti-antigène de type 2 de la pemphigoïde et démence chez les sujets âgés sans manifestation clinique de pemphigoïde. Ann Dermatol Venereol 2006; 133:439-43. [PMID: 16760830 DOI: 10.1016/s0151-9638(06)70935-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pemphigoid is a form of auto-immune bullous dermatosis characterised by the production of antibodies directed against components of hemidesmosomes in the basal membrane. The physiopathological process responsible for unmasking of these antigens is unknown. Pemphigoid is more common in elderly subjects and is most often seen in debilitated subjects. The prevalence of pemphigoid anti-pemphigoid antibodies (anti-PB) is not known in the elderly population presenting no dermatological signs evocative of the disease. We studied the prevalence of anti-PBAg2 antibodies in elderly subjects with no signs of pemphigoid as well as in the correlation between the presence of these antibodies and diagnosis of dementia. PATIENTS AND METHODS Elderly subjects (aged over 69 years) with no signs of pemphigoid were recruited consecutively in dermatology and geriatrics departments (138 subjects). Details of concomitant medication were recorded for all subjects and clinical examination was performed with calculation of MMS (Mini Mental Score). The subjects were then divided into two groups based on MMS score. The first group comprised subjects without dementia (MMS > 24) while the second comprised subjects with dementia. Serum anti-PBAg2 antibodies were determined by ELISA and indirect immunofluorescence with confirmation by Western blot. Antinuclear antibodies, used as a control for non-specific immune response, were assayed in all serum samples. The prevalence of these antibodies was compared between the two groups. RESULTS The two groups were comparable in terms of age, sex and presence of dermatological diseases (ulcers, bedsores, erysipelas). Each group comprised 69 subjects. The overall presence of anti-PBAg2 antibodies in subjects with no signs are suggestive of pemphigoid was 3.6%. Presence of anti-PBAg2 antibodies was associated with diagnosis of dementia (p=0.04; 0% and 7% in groups 1 and 2, respectively). No correlation was seen between the presence of anti-PBAg2 antibodies and concomitant medication or dermatological disease. The overall prevalence of antinuclear antibodies was 14.5% and the figure was similar between the two groups. DISCUSSION The presence of anti-PBAg2 could be associated with the diagnosis of dementia in elderly subjects.
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Affiliation(s)
- N Foureur
- Service de Gérontologie, Hôpital Charles Foix, Assistance Publique, Hôpitaux de Paris, Ivry-sur-Seine
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29
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Wilson AM, Ryan MC, Boyle AJ. The novel role of C-reactive protein in cardiovascular disease: risk marker or pathogen. Int J Cardiol 2006; 106:291-7. [PMID: 16337036 DOI: 10.1016/j.ijcard.2005.01.068] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Revised: 01/19/2005] [Accepted: 01/19/2005] [Indexed: 11/18/2022]
Abstract
C-reactive protein (CRP) is a non-specific biomarker of inflammation. Recent research has shown that inflammation is an important step in the genesis of atherosclerosis, and is involved in the development of unstable plaques. Measurement of serum levels of CRP using a high sensitivity assay (hsCRP) can demonstrate subclinical inflammatory states, which may reflect vascular inflammation. Clinical studies have shown that elevated hsCRP levels in healthy populations predict vascular events such as myocardial infarction (MI) and stroke as well as the development of diabetes. In patients with acute coronary syndromes, higher hsCRP levels are associated with adverse outcomes and subsequent vascular events. There is data to suggest that aspirin, angiotensin converting enzyme (ACE) inhibitors and HMG Co-A reductase inhibitors (statins), which all reduce vascular event rates, also reduce serum levels of hsCRP and therefore hsCRP levels may potentially guide therapy. As well as having a critical role in risk prediction, recent evidence has emerged implicating CRP directly in atherogenesis. CRP has been found in human atherosclerotic plaque and CRP has been shown to cause endothelial cell dysfunction, oxidant stress and intimal hypertrophy in experimental models. We review the postulated roles of CRP in atherogenesis and prediction of vascular events, as well as discussing current recommendations for CRP testing in patients.
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Affiliation(s)
- Andrew M Wilson
- University of Melbourne, Department of Medicine, St Vincent's Hospital, Princes St., Fitzroy, Melbourne, Victoria 3065, Australia.
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30
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Leonard BE, Myint A. Changes in the immune system in depression and dementia: causal or coincidental effects? Dialogues Clin Neurosci 2006; 8:163-74. [PMID: 16889103 PMCID: PMC3181774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Epidemiological studies show that there is a correlation between chronic depression and the likelihood of dementia in later life. There is evidence that inflammatory changes in the brain are pathological features of both depression and dementia. This suggests that an increase in inflammation-induced apoptosis, together with a reduction in the synthesis of neurotrophic factors caused by a rise in brain glucocorticoids, may play a role in the pathology of these disorders. A reduction in the neuroprotective components of the kynurenine pathway such as kynurenic acid, and an increase in the neurodegenerative components, 3-hydroxykynurenine and quinolinic acid, contribute to the pathological changes. Such changes are postulated to cause neuronal damage, and thereby predispose chronically depressed patients to dementia.
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Affiliation(s)
- Brian E Leonard
- Department of Pharmacology, National University of Ireland, Galway.
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31
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Tanskanen M, Lindsberg PJ, Tienari PJ, Polvikoski T, Sulkava R, Verkkoniemi A, Rastas S, Paetau A, Kiuru-Enari S. Cerebral amyloid angiopathy in a 95+ cohort: complement activation and apolipoprotein E (ApoE) genotype. Neuropathol Appl Neurobiol 2005; 31:589-99. [PMID: 16281907 DOI: 10.1111/j.1365-2990.2005.00652.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is growing evidence that in Alzheimer's disease (AD) amyloid beta-protein (Abeta) triggers a chronic inflammatory reaction in cerebral amyloid plaques, including complement proteins. Abeta also accumulates cerebrovascularly in age- and AD-associated cerebral amyloid angiopathy (CAA). We investigated complement proteins in CAA in a population-based series using histological and immunohistochemical staining methods. The 74 subjects, aged 95 years or more, had undergone clinical neurological examination and apolipoprotein E (ApoE) genotyping. The brains had been studied for AD post-mortem, allowing us to relate the histopathological findings to clinical and genetic conditions. CAA with congophilic amyloid was found in 36/74 individuals (48.6%). The vascular amyloid deposits immunoreacted with antibodies to Abeta and complements 3d (C3d) and 9 (C9). The positivity in complement stains increased with growing severity of CAA (P = 0.001). The presence of CAA associated with ApoE epsilon4 (P = 0.0005) and overrepresentation of epsilon4 among those with moderate or severe vs. mild CAA (P = 0.03) was demonstrated. The presence of CAA associated with dementia (P = 0.01), which was contributed by both epsilon4+ (P = 0.02) and epsilon4- (P = 0.06) subjects. Our study shows that complement proteins are deposited in the affected vessels in Abeta-associated CAA. They may solely represent the cerebral Abeta- burden associated to inflammatory stimuli, or signal a contribution in the clearance of cerebral Abeta, thereby contributing to the events associated with evolution of clinical dementia. Our results demonstrate a strong association between CAA and ApoE epsilon4 as well as dementia and suggest that the contribution of CAA to dementia is largely independent of ApoE epsilon4.
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Affiliation(s)
- M Tanskanen
- Department of Pathology, University of Helsinki, Helsinki University Central Hospital, Finland.
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Kiialainen A, Hovanes K, Paloneva J, Kopra O, Peltonen L. Dap12 and Trem2, molecules involved in innate immunity and neurodegeneration, are co-expressed in the CNS. Neurobiol Dis 2005; 18:314-22. [PMID: 15686960 DOI: 10.1016/j.nbd.2004.09.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Revised: 09/07/2004] [Accepted: 09/13/2004] [Indexed: 10/26/2022] Open
Abstract
Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) is a recessively inherited disease characterized by early onset dementia associated with bone cysts. Our group has recently established the molecular background of PLOSL by identifying mutations in DAP12 and TREM2 genes. To understand how loss of function of the immune cell activating DAP12/TREM2 signaling complex leads to dementia and loss of myelin, we have analyzed here Dap12 and Trem2 expression in the mouse CNS. We show that Dap12 and Trem2 are expressed from embryonic stage to adulthood, and demonstrate a highly similar expression pattern. In addition, we identify microglial cells and oligodendrocytes as the major Dap12/Trem2-producing cells in the CNS and, consequently, as the predominant cell types involved in PLOSL pathogenesis. These findings provide a good starting point for the study of the molecular mechanisms of this inherited dementia and new evidence for the involvement of the immune system in neuronal degeneration.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/immunology
- Adaptor Proteins, Signal Transducing/metabolism
- Animals
- Animals, Newborn
- Antigens, Differentiation/metabolism
- Biomarkers
- Cells, Cultured
- Central Nervous System/embryology
- Central Nervous System/immunology
- Central Nervous System/metabolism
- Dementia/immunology
- Dementia/metabolism
- Dementia/physiopathology
- Demyelinating Diseases/immunology
- Demyelinating Diseases/metabolism
- Demyelinating Diseases/physiopathology
- Gene Expression Regulation, Developmental/physiology
- Immunity, Innate/immunology
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/immunology
- Membrane Glycoproteins/metabolism
- Mice
- Mice, Inbred C57BL
- Microglia/metabolism
- Neurodegenerative Diseases/immunology
- Neurodegenerative Diseases/metabolism
- Neurodegenerative Diseases/physiopathology
- Oligodendroglia/metabolism
- Rats
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Receptors, Immunologic/metabolism
- Syndrome
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Affiliation(s)
- Anna Kiialainen
- Department of Molecular Medicine, National Public Health Institute, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
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Miida T, Hirayama S, Nakamura Y. Cholesterol-independent effects of statins and new therapeutic targets: ischemic stroke and dementia. J Atheroscler Thromb 2005; 11:253-64. [PMID: 15557707 DOI: 10.5551/jat.11.253] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or "statins", are used as cholesterol-lowering agents worldwide. Statins inhibit cholesterol biosynthesis, leading to enhanced uptake of low-density lipoprotein (LDL) from the circulation via LDL receptors. This strong cholesterol-lowering action contributes to the beneficial effects of statins. For example, large clinical trials have demonstrated that statins significantly reduce cardiovascular risk. Recent research has shown that statins have other multiple actions involved in endothelial function, cell proliferation, inflammatory response, immunological reactions, platelet function, and lipid oxidation. These "pleiotropic actions" of statins probably provide a significant contribution to the reduction of cardiovascular events. This review summarizes the pleiotropic actions of statins in both basic and clinical studies. It also considers the potential for statin therapy in the treatment of stroke and dementia.
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Affiliation(s)
- Takashi Miida
- Division of Clinical Preventive Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan.
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35
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Suzuki M, Kanamori M, Nagasawa S, Saruhara T. [Behavioral, stress and immunological evaluation methods of music therapy in elderly patients with senile dementia]. Nihon Ronen Igakkai Zasshi 2005; 42:74-82. [PMID: 15732365 DOI: 10.3143/geriatrics.42.74] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The purpose of this study was to clarify the efficacy of behavioral, stress and immunological evaluation methods in music therapy (MT) with elderly patients with senile dementia. The MT group consisted of 8 elderly patients with dementia and the control group included 8 similarly matched patients. A total of 25 sessions of music therapy were conducted for one hour, twice each week for three months. The Mini-Mental State Exam (MMSE), Gottfries-Brane-Steen Scale (GBS), and Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) were used to evaluate behavioral changes. Saliva Chromogranin A (Cg A) and Immunoglobulin A (Ig A) were used to assess changes in stress and immunological status, respectively. The results of the study were as follows: 1. In GBS, the mean score of "different symptoms common in dementia" improved significantly after MT. 2. The mean Behave-AD score of "paranoid and delusional ideation" was also significantly improved (p<0.05) after the intervention. 3. In the 25th session, mean saliva Cg A was significantly decreased after MT (p<0.05). IgA was slightly increased prior to intervention. Our results suggest that a combination of behavioral, stress and immunological evaluation methods were valuable for assessing changes that occurred during MT for elderly patients with dementia.
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Affiliation(s)
- Mizue Suzuki
- School of Nursing, Mie Prefectural College of Nursing
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36
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Bruni AC, Kawarai T, Spillantini MG, St-George Hyslop PH, Leotta A, Lio S, Foncin JF, El Hachimi KH. Démence fronto-temporale familiale avec inclusions marquées par l’anti-ubiquitine dans le tronc cérébral. Rev Neurol (Paris) 2004; 160:1171-9. [PMID: 15602363 DOI: 10.1016/s0035-3787(04)71162-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Fronto-temporal dementias (FTD) were described a century ago on the macroscopic basis of frontal and/or temporal lobe atrophy. Progress in neuropathology, immunohistochemistry, biochemistry and genetics has since shown that they are heterogeneous entities, encompassing many different diseases with similar clinical presentations. A few, such as tauopathies due to mutations of the gene coding for tau protein (MAPtau form a well-defined group. Definition and grouping of other types of FTD is still problematic. MATERIAL AND METHOD We studied a family where the mother and 4/8 children were affected with FTD. Clinical presentation was typical of FTD. Onset was ill-defined with early (at age 40 years or less) personality changes. The clinical course was protracted (about 30 years). For a long period, the patients were able to live in the community in spite of obvious signs such as hyperorality and loss of verbal initiative; operative orientation as to place was preserved for a long time: a mute patient was still able to drive. Signs of extrapyramidal or motoneuron involvement were not observed. RESULTS The genetic study failed to detect any mutation in MAPtau; the lod score for flanking markers was positive but not significant. Biochemical study showed no qualitative abnormality in tau protein. Neuropathological study of one affected subject showed brain atrophy (962 g), with elective frontal lobe involvement. Cortical nerve cell loss was more marked in superficial layers and in frontal areas; glia was inconspicuous; pseudolaminar spongiosis was present in the more severely affected zones. No argentophilic "Pick bodies" were seen; ubiquitin-positive, tau-negative round inclusions were present in the cytoplasm of fascia dentata neurones. "Tangles" were mostly restricted to the entorhinal cortex, partly correlated with tau immunoreactivity, but better with ubiquitin immunoreactivity. Large, ovoid or reniform, moderately dense, spongy, granular or filamentous argentophilic cytoplasmic nerve cell inclusions were observed. They were ubiquitin-positive, but did not react with other antibodies, particularly anti-tau. They were present in swollen nerve cells in the deeper cortical layers but were most conspicuous in the brain stem: in the magnocellular reticular nuclei (e.g. nucleus centralis pontis), in the pes pontis, in the inferior olive and in motor nuclei, especially in the trigeminal motor nucleus. They were not associated with nerve cell loss, atrophy nor pycnosis. Cerebellar relay nuclei neurones were swollen, and their cytoplasm contained argentophilic filaments. CONCLUSION In our opinion, "ubiquitinopathy" would be non-specific and "Motor Neuron Disease-Inclusion Dementia" (MNDID) would not be satisfactory as a diagnosis for the present cases of FTD. Hopefully, progress in genetics may allow a causal, and thence definitive, classification.
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Affiliation(s)
- A C Bruni
- Centro Regionale di Neurogenetica, Lamezia Terme CZ, Italie
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37
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Sjögren M, Folkesson S, Blennow K, Tarkowski E. Increased intrathecal inflammatory activity in frontotemporal dementia: pathophysiological implications. J Neurol Neurosurg Psychiatry 2004; 75:1107-11. [PMID: 15258209 PMCID: PMC1739153 DOI: 10.1136/jnnp.2003.019422] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Immunological mechanisms may be part of the pathophysiological mechanisms in frontotemporal dementia (FTD), but hitherto only vague evidence of such mechanisms has been presented. The aim of this study was to compare the cerebrospinal fluid (CSF) levels of the pro-inflammatory cytokines interleukin (IL)-1beta and tumour necrosis factor (TNF)-alpha, and the anti-inflammatory cytokine transforming growth factor (TGF)-beta in patients with FTD and normal controls. Furthermore, serum levels of TNF-alpha, TGF-beta, and IL-1beta were measured in FTD patients. METHODS The CSF levels of IL-1beta, TNFalpha, and TGF-beta were measured using ELISA in 19 patients with FTD and 24 sex and age matched healthy controls. RESULTS The CSF levels of TNF-alpha (FTD 0.6 pg/mL (median: lower, upper quartile 0.3, 0.7); controls: 0.0 pg/mL (0.0, 0.0); p = 0.008) and TGF-beta (FTD 266 pg/mL (157, 371), controls: 147 pg/mL (119, 156); p = 0.0001) were significantly increased in FTD patients compared with controls. No correlations were found between CSF and serum levels of the cytokines. In the controls, but not in the FTD patients, a positive correlation was found between the CSF levels of TGF-beta and age (r = 0.42, p < 0.05). No correlation was found between any of the cytokines and degree of brain atrophy or white matter changes. No differences between the groups were found for age, gender, or CSF/serum albumin ratio. CONCLUSIONS The results suggest an increased intrathecal production of both pro- and anti-inflammatory cytokines in FTD. As no correlations were found with the albumin ratio, and no correlations between CSF and serum levels of the cytokines were found, these changes in the CSF cannot be explained by a systemic overproduction of cytokines.
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Affiliation(s)
- M Sjögren
- Institute of Clinical Neuroscience, Göteborg University, Sweden.
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Janssen JC, Godbolt AK, Ioannidis P, Thompson EJ, Rossor MN. The prevalence of oligoclonal bands in the CSF of patients with primary neurodegenerative dementia. J Neurol 2004; 251:184-8. [PMID: 14991353 DOI: 10.1007/s00415-004-0296-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2003] [Revised: 06/20/2003] [Accepted: 09/18/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recent guidelines from the United States and Europe on the diagnosis and management of dementia include advice that younger patients with dementia should undergo CSF examination, which frequently includes analysis for oligoclonal bands (OCB). The presence of CNS specific OCB has traditionally been considered suggestive of an inflammatory aetiology, although the interpretation of such a finding in the presence of a normal CSF white cell count and protein is more difficult. METHODS We reviewed retrospectively the prevalence of OCB, determined using agarose isoelectric focusing, in a series of 131 well characterised patients with a final diagnosis of a degenerative dementia who had undergone CSF examination. RESULTS The mean age of the patients was 60.0 (SD 8.4) years. Seventy (53%) patients had Alzheimer's disease (AD), forty seven (36 %) had frontotemporal lobar degeneration (FTLD), seven (5%) had Dementia with Lewy bodies and the remaining seven (5%) patients had other rarer neurodegenerative dementias. Neuropathological examination had been performed in fifteen (11%) patients. CNS specific OCB were present in nine (7%) patients in this cohort, all of whom had normal CSF white cell counts: four AD patients (a prevalence of 6%), four FTLD patients (a prevalence of 9%), and one patient with Creutzfeldt-Jakob disease (a prevalence of 25%). Investigation of these patients, including two with neuropathologically verified AD and one with post-mortem confirmed CJD, did not reveal an alternative aetiology for their dementia. CONCLUSION A central immune response can occur in primary neurodegenerative dementias, albeit uncommonly.
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Affiliation(s)
- J C Janssen
- Dementia Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, UK
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Abstract
Alzheimer's disease (AD) is a progressive degenerative disease of the brain and the most frequent cause of dementia among elderly. The etiology of AD is still obscure, but genetic and environmental factors appear to play differential roles in the disease. Several evidence suggest that inflammation or altered immune responses may play an important role in this disease. The following topics will be discussed: (1) the association of inflammation with brain degenerative processes in AD; (2) the influence of cytokine gene polymorphism upon the risk of developing AD and/or the age at onset of manifestation clinical dementia; (3) the effects of gene allele variations upon the phenotype of immune molecules in the blood and brain of AD patients; (4) the association of genetic variations in some of this molecules with the progression of the disease and cognitive decline.
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Affiliation(s)
- Federico Licastro
- Department of Experimental Pathology, University of Bologna, Via S. Giacomo 14, 40126, Bologna, Italy.
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Abstract
Hyperhomocysteinemia is an established risk factor for atherosclerosis, thrombosis and other vascular diseases. Homocysteine auto-oxidation is considered to be crucially involved in the pathogenesis of these diseases. However, the question remains to be elucidated whether vitamin deficiency and homocysteine accumulation are causal for disease development or rather comprise a secondary phenomenon. Most diseases accompanied by hyperhomocysteinemia are also associated with ongoing activation of the immune system. In vitro experiments show homocysteine to accumulate in stimulated peripheral blood mononuclear cells. In patients with coronary heart disease, with rheumatoid arthritis and in patients with dementia, an association between cellular immune activation and homocysteine metabolism is found. Homocysteine concentrations not only correlate inversely with folate concentrations, they also show a positive relationship with concentrations of immune activation markers like neopterin. Moreover, in patients with various kinds of dementia, increased concentrations of serum peroxides, homocysteine and neopterin correlate with each other. Studies support a role of immune system activation in the development of hyperhomocysteinemia. Stimulation and proliferation of immune cells may lead to the production of reactive oxygen species that may oxidize antioxidants and oxidation-sensitive B-vitamins. An enhanced demand for antioxidants as well as folate and vitamin B12 may develop, together with hyperhomocysteinemia, despite sufficient dietary intake.
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Dale RC, Church AJ, Surtees RAH, Thompson EJ, Giovannoni G, Neville BGR. Post-streptococcal autoimmune neuropsychiatric disease presenting as paroxysmal dystonic choreoathetosis. Mov Disord 2002; 17:817-20. [PMID: 12210883 DOI: 10.1002/mds.10169] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Paroxysmal dystonic choreoathetosis (PDC) is an episodic, non-kinesogenic, extrapyramidal movement disorder. It is postulated that PDC is an ion channel disorder. We describe a sporadic case of paroxysmal dystonic choreoathetosis occurring after streptococcal pharyngitis. The episodes were characterized by abrupt-onset dystonic posturing, choreoathetosis, visual hallucinations and behavioral disturbance. Each episode lasted between 10 minutes and 4 hours, and occurred up to 4 times per day. In between attacks, examination was normal. The episodes waxed and waned in frequency during a 6-month illness. Magnetic resonance imaging of the brain was normal. Post-streptococcal neuropsychiatric disease has a proposed autoimmune etiology, which is supported by the presence of serum antibasal ganglia antibodies. Western immunoblotting of this case's serum demonstrated antibody binding to a basal ganglia antigens of molecular weight 80 kDa and 95 kDa. Immunohistochemistry examination demonstrated specific antibody binding to large striatal neurones. We propose that autoantibodies produced in post-streptococcal neuropsychiatric disease cause alteration in neurotransmission, possibly secondary to ion channel binding.
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Affiliation(s)
- Russell C Dale
- Department of Neurology, Great Ormond Street Hospital NHS Trust and Institute of Child Health, London, United Kingdom.
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Abstract
The aim of this study was to investigate two putative pathophysiological aspects of the common neurodegenerative disorder frontotemporal dementia (FTD). To this end, cerebrospinal fluid (CSF) levels of tau (total tau) and the light subtype of the neurofilament proteins (NFL) were studied in patients with FTD (n=16) and in age-matched controls (n=16). In addition, serum was analysed for IgG and IgM antibodies to the most common gangliosides and sulfatide in FTD patients (n=13) and in age-matched controls (n=20). The CSF-NFL levels were increased in FTD (1606+/-1151 pg/ml, mean+/-S.D.; P<0.001) compared with controls (308+/-203 pg/ml), whereas the CSF-tau levels were normal. In serum, autoantibody IgG-GA1 was significantly increased in FTD (P<0.05) compared with controls. No correlations were found between the effect parameters and demographic variables in any group. The results of this study suggest that cytoskeleton proteins other than tau are also involved in the pathophysiology of FTD and that autoimmunity may be part of the pathophysiological processes in FTD, as it is believed to be in Alzheimer's disease.
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Affiliation(s)
- M Sjögren
- Institute of Clinical Neuroscience, Psychiatry Section, Göteborg University, Sahlgrenska University Hospital, SE 431 80, Mölndal, Sweden.
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Abstract
Neurologic disorders are among the most prominent clinical manifestations associated with the antiphospholipid syndrome. Such neurologic disorders are predominantly related to focal central nervous system thrombo-occlusive events. This review summarizes the latest data regarding the clinical aspects of stroke and other neurologic manifestations associated with antiphospholipid antibodies.
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Affiliation(s)
- D Tanne
- Acute Stroke Unit and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.
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Rolland F, Chevrollier JP. [Depression, anti-thyroid antibodies and Hashimoto encephalopathy]. Encephale 2001; 27:137-42. [PMID: 11407265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Psychiatric manifestations are infrequent or rarely described in Hashimoto's encephalopathy. It usually begins like a subacute diffuse encephalopathy with confusion, tremor and other neurologic symptoms. A relapsing course is characteristic. Neither biologic nor clinical symptoms are specific but high antithyroid antibodies levels are characteristic. The diagnosis can be seriously delayed by the fact that the different symptoms implicate approaches by psychiatrists, neurologists or endocrinologists. There are two clinical types. The one presented here evaluates progressively to dementia with psychotic episodes, confusion and seizures. An early steroid treatment makes the symptoms regress without aftereffects. We have analysed the clinical and biological findings of a woman who has been admitted to different neurologic and psychiatric departments before her diagnosis was made. First clinical presentation and evolution were that of a depression. Each time the antidepressive treatment was stopped, depression relapsed in spite of an appropriate steroid treatment. Literature shows that a close link exists between depression and antithyroid antibodies whatever thyroid status. This link does still exist after adjustment of psycho-social determinants of depression. The decrease of those antibodies only reflects the decrease of inflammation. So, for the psychiatrist it is important to diagnose Hashimoto's encephalopathy without delay, especially when psychiatric manifestations are in the foreground. Furthermore, a psychiatric report should systematically be added to the clinical and biological findings in order to make a better approach of the existing links between depression and other manifestations of the disease.
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Affiliation(s)
- F Rolland
- Institut de Psychiatrie et de Psychologie médicale, CHU Brugmann, Université Libre de Bruxelles, Belgique
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Rösler N, Wichart I, Jellinger KA. Intra vitam lumbar and post mortem ventricular cerebrospinal fluid immunoreactive interleukin-6 in Alzheimer's disease patients. Acta Neurol Scand 2001; 103:126-30. [PMID: 11227132 DOI: 10.1034/j.1600-0404.2001.103002126.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In view of contradictory findings in previous studies, to examine the diagnostic value of interleukin-6 measurements in cerebrospinal fluid (CSF) of Alzheimer's disease patients. MATERIAL AND METHODS Interleukin-6-immunoreactivity (IL-6-IR) was measured in 169 intra vitam lumbar and 21 post mortem ventricular CSF samples of patients with probable and neuropathologically confirmed Alzheimer's disease (AD), non-AD dementias (NAD), neurological disorders without cognitive impairment (OND) and controls (CON) using a specific sandwich enzyme immunoassay. RESULTS Intra vitam lumbar samples had significantly elevated (P < 0.03) IL-6-IR not only in the AD, but also in the NAD and OND group compared with controls. AD patients with late onset (> 65 years) had slightly (P > 0.05) higher values than patients with early onset (< 65 years). In post mortem ventricular fluid, differences among groups did not reach significance (P > 0.05). CONCLUSION We conclude that elevations of CSF IL-6-IR can not serve as a diagnostic marker of the disease, but, hypothetically, could reflect presence or activity of IL-6 mediated immunological phenomena in single AD patients.
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Affiliation(s)
- N Rösler
- Ludwig Boltzmann Institute of Clinical Neurobiology, Vienna, Austria
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Abstract
Antiphospholipid antibodies (aPLAb) may cause both focal ischemic and diffuse brain damage and may be associated with dementia. We have examined the relationship of aPLAb to dementia in the elderly. Blood samples were obtained from 87 consecutive patients with dementia (74 +/- 11 years old) and 69 controls (78 +/- 9 years old), residents of an old age home who were not overtly demented. Levels of aPLAb were measured by a standardized ELISA, utilizing cardiolipin as antigen, and we considered levels above 20 IgG antiphospholipid units (GPLU) as significantly elevated. We found that 5 of the 87 demented patients (6%), but none of the 69 controls, had significantly elevated aPLAb levels (p = 0.03, one-tailed Fisher's exact test). All the patients with high aPLAb levels were diagnosed clinically as having dementia of the Alzheimer type, except for 1 who had mixed dementia, and none had features of an immune-mediated disease. Thus, a small but significant number of patients with dementia have high levels of aPLAb. The role of the aPLAb in these patients, with apparently diffuse brain disease, is currently unknown.
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Affiliation(s)
- A Mosek
- Department of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel
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Affiliation(s)
- D Giulian
- Alzheimer's Disease Research Center, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Kucerová-Pospísilová Z, Ditrich O. The serological surveillance of several groups of patients using antigens of Encephalitozoon hellem and E. cuniculi antibodies to microsporidia in patients. Folia Parasitol (Praha) 1998; 45:108-12. [PMID: 9684320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study was undertaken to attempt to identify correlations between microsporidial seroprevalence data in man, clinical diseases and groups of people at the risk of HIV/AIDS infection. Groups of patients were selected according to the predilection of members of the genus Encephalitozoon for nervous and kidney tissue. Female prostitutes and alcohol and intravenous drug abusers were selected as groups at risk of HIV/AIDS infections. A total of 401 samples of human sera were examined for the presence of antimicrosporidial IgG antibodies by ELISA test with a titre of 600 considered borderline positivity. The highest occurrence of antimicrosporidial antibodies was found in the groups of alcohol abusers (16% from 43 patients), intravenous drug abusers (11% from 9 patients) and prostitutes (10% from 80 women) for E. cuniculi antigen and in the groups of psychiatric patients (14% from 44 patients), malaria patients (11% from 38 patients) and alcohol abusers (7% from 43 patients) for E. hellem antigen. The occurrence of specific antibodies of the six examined diagnostic units (glomerulonephritis chronica, pyelonephritis chronica, schizophrenia, dementia, multiple sclerosis and cerebral stroke) was statistically significant only in patients with pyelonephritis chronica and dementia (p < 0.05). No cases of microsporidial infection were found among the female prostitutes by parasitological examination, although one case of giardiasis was identified. Sera of patients with high anti-E. cuniculi and anti-E. hellem antibodies (titres in ELISA of 600 and above) were confirmed by Western blot using E. cuniculi and E. hellem polypeptides, respectively. These results suggest that the examined patients could show residual antibodies from past or latent infections.
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Affiliation(s)
- Z Kucerová-Pospísilová
- Institute of Parasitology, Academy of Sciences of the Czech Republic, Ceské Budĕjovice, Czech Republic.
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Trojanowski JQ, Lee VM. Aggregation of neurofilament and alpha-synuclein proteins in Lewy bodies: implications for the pathogenesis of Parkinson disease and Lewy body dementia. Arch Neurol 1998; 55:151-2. [PMID: 9482355 DOI: 10.1001/archneur.55.2.151] [Citation(s) in RCA: 198] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- J Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA
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Bosman GJ, Van der Linden PA, Bartholomeus IG, De Man AJ, De Grip WJ, Van Kalmthout PJ. Erythrocyte aging in the demented elderly: a fluctuating process? Mech Ageing Dev 1998; 100:53-8. [PMID: 9509394 DOI: 10.1016/s0047-6374(97)00117-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Measurement of erythrocyte aging parameters in patients with dementia indicates that an Alzheimer-related disturbance of the erythrocyte aging process may not be detectable until in the more advanced stages of the disease. Also, a strong fluctuation in the values of erythrocyte aging parameters, over a period of 15 months, was observed in patients with dementia, but not in age-matched control donors. This fluctuation was independent of the type and stage of dementia, and its cause remains to be elucidated. Such variability hampers the use of erythrocyte aging characteristics for the diagnosis of dementia. On the other hand, the aging-related erythrocyte IgG content may be a sensitive biomarker for disturbed systemic homeostasis in the elderly.
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Affiliation(s)
- G J Bosman
- Department of Biochemistry, Faculty of Medicine, University of Nijmegen, The Netherlands.
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