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Hermann P, Böhnke J, Bunck T, Goebel S, Jaeger VK, Karch A, Zerr I. Effect of SARS-CoV-2 Incidence and Immunisation Rates on Sporadic Creutzfeldt-Jakob Disease Incidence. Neuroepidemiology 2023; 58:64-69. [PMID: 38086343 DOI: 10.1159/000535112] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/30/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Recent case studies and media outlets have hypothesised an effect of SARS-CoV-2 infection and immunisation on the development or progression of neurodegenerative diseases such as Alzheimer's disease or sporadic Creutzfeldt-Jakob disease (sCJD). OBJECTIVES This study aims to identify potential associations of SARS-CoV-2 infections and SARS-CoV-2 immunisation with sCJD incidence, disease duration, and age of onset. METHOD We used data from a prospective sCJD surveillance study in Germany (2016-2022) and publicly available datasets of SARS-CoV-2 cases and vaccination numbers in Germany for the years 2020-2022. Associations of SARS-CoV-2 incidence and immunisation rates with sCJD incidence were assessed by comparing quarterly and annual cumulative sCJD incidences in the periods before (2016-2019) and during the pandemic (2020-2022). RESULTS We could not identify any time-related effect of SARS-CoV-2 incidence or immunisation rate on the sCJD incidence. Moreover, we did not find any sCJD incidence alterations before and during the SARS-CoV-2 pandemic on a federal or state level. The overall sCJD incidence was within expected ranges in the years 2020-2022. There were no changes in age of onset and clinical disease duration in these years. CONCLUSIONS We found no evidence supporting a short-term effect of the pandemic on sCJD incidence. However, considering the extended pre-clinical phase of sCJD, continued surveillance is needed to identify potential future incidence alterations.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Böhnke
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Timothy Bunck
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Goebel
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Veronika K Jaeger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases, Göttingen, Germany
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Thüne K, Schmitz M, Wiedenhöft J, Shomroni O, Göbel S, Bunck T, Younas N, Zafar S, Hermann P, Zerr I. Genetic Variants Associated with the Age of Onset Identified by Whole-Exome Sequencing in Fatal Familial Insomnia. Cells 2023; 12:2053. [PMID: 37626863 PMCID: PMC10453322 DOI: 10.3390/cells12162053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023] Open
Abstract
Fatal familial insomnia (FFI) is a rare autosomal-dominant inherited prion disease with a wide variability in age of onset. Its causes are not known. In the present study, we aimed to analyze genetic risk factors other than the prion protein gene (PRNP), in FFI patients with varying ages of onset. Whole-exome sequencing (WES) analysis was performed for twenty-five individuals with FFI (D178N-129M). Gene ontology enrichment analysis was carried out by Reactome to generate hypotheses regarding the biological processes of the identified genes. In the present study, we used a statistical approach tailored to the specifics of the data and identified nineteen potential gene variants with a potential effect on the age of onset. Evidence for potential disease modulatory risk loci was observed in two pseudogenes (NR1H5P, GNA13P1) and three protein coding genes (EXOC1L, SRSF11 and MSANTD3). These genetic variants are absent in FFI patients with early disease onset (19-40 years). The biological function of these genes and PRNP is associated with programmed cell death, caspase-mediated cleavage of cytoskeletal proteins and apoptotic cleavage of cellular proteins. In conclusions, our study provided first evidence for the involvement of genetic risk factors additional to PRNP, which may influence the onset of clinical symptoms in FFI.
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Affiliation(s)
- Katrin Thüne
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Goettingen, Germany
| | - Matthias Schmitz
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Goettingen, Germany
| | - John Wiedenhöft
- Scientific Core Facility Medical Biometry and Statistical Bioinformatics, University Medical Center Goettingen, 37075 Goettingen, Germany;
| | - Orr Shomroni
- NGS-Core Unit for Integrative Genomics, Institute of Human Genetics, University Medical Center Goettingen, 37075 Goettingen, Germany;
| | - Stefan Göbel
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
| | - Timothy Bunck
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
| | - Neelam Younas
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
| | - Saima Zafar
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
| | - Peter Hermann
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
| | - Inga Zerr
- Department of Neurology, National Reference Center for Human Spongiform Encephalopathies, University Medical Center, Georg-August University, 37075 Goettingen, Germany; (K.T.); (S.G.); (T.B.); (N.Y.); (S.Z.); (P.H.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Goettingen, Germany
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Schmitz M, Silva Correia S, Hermann P, Maass F, Goebel S, Bunck T, Correia A, Lingor P, Fischer A, Zerr I. Detection of Prion Protein Seeding Activity in Tear Fluids. N Engl J Med 2023; 388:1816-1817. [PMID: 37163630 DOI: 10.1056/nejmc2214647] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Andre Fischer
- German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Inga Zerr
- University Medical Center, Göttingen, Germany
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Hermann P, Schmitz M, Cramm M, Goebel S, Bunck T, Schütte-Schmidt J, Schulz-Schaeffer W, Stadelmann C, Matschke J, Glatzel M, Zerr I. Application of real-time quaking-induced conversion in Creutzfeldt-Jakob disease surveillance. J Neurol 2023; 270:2149-2161. [PMID: 36624183 PMCID: PMC9829526 DOI: 10.1007/s00415-022-11549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Evaluation of the application of CSF real-time quaking-induced conversion in Creutzfeldt-Jakob disease surveillance to investigate test accuracy, influencing factors, and associations with disease incidence. METHODS In a prospective surveillance study, CSF real-time quaking-induced conversion was performed in patients with clinical suspicion of prion disease (2014-2022). Clinically or histochemically characterized patients with sporadic Creutzfeldt-Jakob disease (n = 888) and patients with final diagnosis of non-prion disease (n = 371) were included for accuracy and association studies. RESULTS The overall test sensitivity for sporadic Creutzfeldt-Jakob disease was 90% and the specificity 99%. Lower sensitivity was associated with early disease stage (p = 0.029) and longer survival (p < 0.001). The frequency of false positives was significantly higher in patients with inflammatory CNS diseases (3.7%) than in other diagnoses (0.4%, p = 0.027). The incidence increased from 1.7 per million person-years (2006-2017) to 2.0 after the test was added to diagnostic the criteria (2018-2021). CONCLUSION We validated high diagnostic accuracy of CSF real-time quaking-induced conversion but identified inflammatory brain disease as a potential source of (rare) false-positive results, indicating thorough consideration of this condition in the differential diagnosis of Creutzfeldt-Jakob disease. The surveillance improved after amendment of the diagnostic criteria, whereas the incidence showed no suggestive alterations during the COVID-19 pandemic.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany.
| | - Matthias Schmitz
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Göttingen, Germany
| | - Maria Cramm
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | - Stefan Goebel
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | - Timothy Bunck
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | - Julia Schütte-Schmidt
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | | | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Zerr
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Göttingen, Germany
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Hermann P, Villar-Piqué A, Schmitz M, Schmidt C, Varges D, Goebel S, Bunck T, Lindemann H, Bogner C, Santana I, Baldeiras I, Riggert J, Zerr I, Llorens F. Plasma Lipocalin 2 in Alzheimer’s disease: potential utility in the differential diagnosis and relationship with other biomarkers. Alzheimers Res Ther 2022; 14:9. [PMID: 35027079 PMCID: PMC8759265 DOI: 10.1186/s13195-021-00955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022]
Abstract
Background Lipocalin-2 is a glycoprotein that is involved in various physiological and pathophysiological processes. In the brain, it is expressed in response to vascular and other brain injury, as well as in Alzheimer’s disease in reactive microglia and astrocytes. Plasma Lipocalin-2 has been proposed as a biomarker for Alzheimer’s disease but available data is scarce and inconsistent. Thus, we evaluated plasma Lipocalin-2 in the context of Alzheimer’s disease, differential diagnoses, other biomarkers, and clinical data. Methods For this two-center case-control study, we analyzed Lipocalin-2 concentrations in plasma samples from a cohort of n = 407 individuals. The diagnostic groups comprised Alzheimer’s disease (n = 74), vascular dementia (n = 28), other important differential diagnoses (n = 221), and healthy controls (n = 84). Main results were validated in an independent cohort with patients with Alzheimer’s disease (n = 19), mild cognitive impairment (n = 27), and healthy individuals (n = 28). Results Plasma Lipocalin-2 was significantly lower in Alzheimer’s disease compared to healthy controls (p < 0.001) and all other groups (p < 0.01) except for mixed dementia (vascular and Alzheimer’s pathologic changes). Areas under the curve from receiver operation characteristics for the discrimination of Alzheimer’s disease and healthy controls were 0.783 (95%CI: 0.712–0.855) in the study cohort and 0.766 (95%CI: 0.627–0.905) in the validation cohort. The area under the curve for Alzheimer’s disease versus vascular dementia was 0.778 (95%CI: 0.667–0.890) in the study cohort. In Alzheimer’s disease patients, plasma Lipocalin2 did not show significant correlation with cerebrospinal fluid biomarkers of neurodegeneration and AD-related pathology (total-tau, phosphorylated tau protein, and beta-amyloid 1-42), cognitive status (Mini Mental Status Examination scores), APOE genotype, or presence of white matter hyperintensities. Interestingly, Lipocalin 2 was lower in patients with rapid disease course compared to patients with non-rapidly progressive Alzheimer’s disease (p = 0.013). Conclusions Plasma Lipocalin-2 has potential as a diagnostic biomarker for Alzheimer’s disease and seems to be independent from currently employed biomarkers. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00955-9.
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Emdina A, Hermann P, Varges D, Nuhn S, Goebel S, Bunck T, Maass F, Schmitz M, Llorens F, Kruse N, Lingor P, Mollenhauer B, Zerr I. Baseline Cerebrospinal Fluid α-Synuclein in Parkinson's Disease Is Associated with Disease Progression and Cognitive Decline. Diagnostics (Basel) 2022; 12:diagnostics12051259. [PMID: 35626415 PMCID: PMC9140902 DOI: 10.3390/diagnostics12051259] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
Biomarkers are increasingly recognized as tools in the diagnosis and prognosis of neurodegenerative diseases. No fluid biomarker for Parkinson’s disease (PD) has been established to date, but α-synuclein, a major component of Lewy bodies in PD and dementia with Lewy bodies (DLB), has become a promising candidate. Here, we investigated CSF α-synuclein in patients with PD (n = 28), PDD (n = 8), and DLB (n = 5), applying an electrochemiluminescence immunoassay. Median values were non-significantly (p = 0.430) higher in patients with PDD and DLB (287 pg/mL) than in PD (236 pg/mL). A group of n = 36 primarily non-demented patients with PD and PDD was clinically followed for up to two years. A higher baseline α-synuclein was associated with increases in Hoehn and Yahr classifications (p = 0.019) and Beck Depression Inventory scores (p < 0.001) as well as worse performance in Trail Making Test A (p = 0.017), Trail Making Test B (p = 0.043), and the Boston Naming Test (p = 0.002) at follow-up. Surprisingly, higher levels were associated with a better performance in semantic verbal fluency tests (p = 0.046). In summary, CSF α-synuclein may be a potential prognostic marker for disease progression, affective symptoms, and executive cognitive function in PD. Larger-scaled studies have to validate these findings and the discordant results for single cognitive tests in this exploratory investigation.
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Affiliation(s)
- Anna Emdina
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Peter Hermann
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
- Correspondence: ; Tel.: +49-551-398-955
| | - Daniela Varges
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Sabine Nuhn
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Stefan Goebel
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Timothy Bunck
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Fabian Maass
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Matthias Schmitz
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
| | - Franc Llorens
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08908 Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Niels Kruse
- Department of Neuropathology, University Medical Centre Göttingen, 37075 Göttingen, Germany;
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany;
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
- Paracelsus-Elena-Klinik, 34128 Kassel, Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany; (A.E.); (D.V.); (S.N.); (S.G.); (T.B.); (F.M.); (M.S.); (F.L.); (B.M.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
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Hermann P, Canaslan S, Villar-Piqué A, Bunck T, Goebel S, Llorens F, Schmitz M, Zerr I. Plasma neurofilament light chain as a biomarker for Fatal Familial Insomnia. Eur J Neurol 2022; 29:1841-1846. [PMID: 35212083 DOI: 10.1111/ene.15302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fatal Familial Insomnia is a rare hereditary prion disease associated with the D178N-129M PRNP mutation. Early diagnosis is difficult because the clinical syndrome may overlap with affective disorders. In addition, most known cerebrospinal fluid biomarkers for prion diseases and magnetic resonance imaging do not show a good diagnostic accuracy for Fatal Familial Insomnia. In this context, data on plasma biomarkers are scarce. METHODS We analyzed levels of neurofilament light chain, glial fibrillary acidic protein, chitinase-3-like protein 1, calcium-binding protein B, and total Tau protein in six serial plasma samples from a patient with Fatal Familial Insomnia. Subsequently, plasma neurofilament light chain was analyzed in n=25 patients and n=19 controls. The diagnostic accuracy and associations with disease stage and duration were explored. RESULTS Among all biomarker candidates in the case study, only neurofilament light chain levels showed a constant evolution and increased over time. It discriminated Fatal Familial Insomnia from controls with an area under the curve of 0.992 (95%CI:0.974 to 1) in the case-control study. Higher concentrations were associated with methionine homozygosity at Codon 129 PRNP (p=0.006), shorter total disease duration (rho=-0.467, p=0.019, 95%CI:-0.790 to -0.015), and shorter time from sampling to death (rho=-0.467, p=0.019, 95%CI -0.773 to -0.019). CONCLUSION Plasma neurofilament light chain may be a valuable minimal-invasive diagnostic biomarker for Fatal Familial Insomnia after clinical onset. Most important, stage-related increase and association with disease duration indicate potential as a prognostic marker and as a surrogate marker in clinical trials.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Sezgi Canaslan
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Anna Villar-Piqué
- Bellvitge Biomedical Research Institute (IDIBELL), 08908, Hospitalet de Llobregat, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases, Instituto de Salud Carlos III, CIBERNED, 28031, Madrid, Spain
| | - Timothy Bunck
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Stefan Goebel
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Franc Llorens
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany.,Bellvitge Biomedical Research Institute (IDIBELL), 08908, Hospitalet de Llobregat, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases, Instituto de Salud Carlos III, CIBERNED, 28031, Madrid, Spain
| | - Matthias Schmitz
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)-Göttingen campus, 37075, Göttingen, Germany
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Hermann P, Haller P, Goebel S, Bunck T, Schmidt C, Wiltfang J, Zerr I. Total and Phosphorylated Cerebrospinal Fluid Tau in the Differential Diagnosis of Sporadic Creutzfeldt-Jakob Disease and Rapidly Progressive Alzheimer’s Disease. Viruses 2022; 14:v14020276. [PMID: 35215868 PMCID: PMC8874601 DOI: 10.3390/v14020276] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
Background: CSF total-tau (t-tau) became a standard cerebrospinal fluid biomarker in Alzheimer’s disease (AD). In parallel, extremely elevated levels were observed in Creutzfeldt-Jakob disease (CJD). Therefore, tau is also considered as an alternative CJD biomarker, potentially complicating the interpretation of results. We investigated CSF t-tau and the t-tau/phosphorylated tau181 ratio in the differential diagnosis of sCJD and rapidly-progressive AD (rpAD). In addition, high t-tau concentrations and associated tau-ratios were explored in an unselected laboratory cohort. Methods: Retrospective analyses included n = 310 patients with CJD (n = 205), non-rpAD (n = 65), and rpAD (n = 40). The diagnostic accuracies of biomarkers were calculated and compared. Differential diagnoses were evaluated in patients from a neurochemistry laboratory with CSF t-tau >1250 pg/mL (n = 199 out of 7036). Results: CSF t-tau showed an AUC of 0.942 in the discrimination of sCJD from AD and 0.918 in the discrimination from rpAD. The tau ratio showed significantly higher AUCs (p < 0.001) of 0.992 versus non-rpAD and 0.990 versus rpAD. In the neurochemistry cohort, prion diseases accounted for only 25% of very high CSF t-tau values. High tau-ratios were observed in CJD, but also in non-neurodegenerative diseases. Conclusions: CSF t-tau is a reliable biomarker for sCJD, but false positive results may occur, especially in rpAD and acute encephalopathies. The t-tau/p-tau ratio may improve the diagnostic accuracy in centers where specific biomarkers are not available.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
- Correspondence: ; Tel.: +49-551-39-8955
| | - Philip Haller
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Stefan Goebel
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Timothy Bunck
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Christian Schmidt
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
- Neurosciences and Signaling Group, Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Inga Zerr
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, 37075 Göttingen, Germany; (P.H.); (S.G.); (T.B.); (C.S.); (I.Z.)
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
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Abstract
sCJD patients were significantly more likely than the general population to be physicians. We investigated sporadic Creutzfeldt-Jakob disease (sCJD) among physicians in Germany by analyzing occupational information of patients with sCJD recorded by the German CJD Surveillance Unit (1993–2005; 1,250 patients, of whom 4 [0.32%] were physicians) and the National Reference Center for Human Spongiform Encephalopathies (2006–2016; 1,491 patients, of whom 13 [0.87%] were physicians). Among the physicians, we did not identify any neurologists, neurosurgeons, psychiatrists, or pathologists. A cumulative sum test showed an increase in reported physicians over time. Data for 2017–2018 indicated an increased rate of physicians among all notified sCJD cases (5/239 [2.1%]) when we used the total population of Germany as control group. Our data suggest the possibility of an increased risk for sCJD among physicians in Germany. However, we can only speculate about the reasons, and larger multinational studies are needed to replicate the finding and to clarify whether this finding is a general or a country-specific phenomenon.
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Villar-Piqué A, Schmitz M, Hermann P, Goebel S, Bunck T, Varges D, Ferrer I, Riggert J, Llorens F, Zerr I. Plasma YKL-40 in the spectrum of neurodegenerative dementia. J Neuroinflammation 2019; 16:145. [PMID: 31299989 PMCID: PMC6624942 DOI: 10.1186/s12974-019-1531-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background Increased plasma YKL-40 has been reported in Alzheimer’s disease (AD), but its levels in other neurodegenerative diseases are unknown. Here, we aimed to investigate plasma YKL-40 in the spectrum of neurodegenerative dementias. Methods YKL-40 was quantified in the plasma of 315 cases, including healthy controls (HC), neurological disease controls (ND), AD, vascular dementia (VaD), frontotemporal dementia (FTD), sporadic Creutzfeldt-Jakob disease (CJD) and Lewy body dementia (LBD). Diagnostic accuracy in the differential diagnostic context and influence of age and gender was assessed. Results Highest YKL-40 levels were detected in CJD, followed by LBD, VaD, AD, FTD, ND and HC. YKL-40 was associated to age but not to sex. After controlling for age, YKL-40 was significantly elevated in CJD compared to HC (p < 0.001), ND, AD and VaD (p < 0.01) and in LBD compared to HC (p < 0.05). In CJD, YKL-40 concentrations were significantly higher at late disease stages. Conclusions Plasma YKL-40 is significantly elevated in CJD regardless of clinical and genetic parameters, with moderate diagnostic accuracy in the discrimination from control cases. Our study discards a potential use of this biomarker in the differential diagnostic context but opens the possibility to be explored as a marker for CJD monitoring.
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Affiliation(s)
- Anna Villar-Piqué
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany.
| | - Matthias Schmitz
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Peter Hermann
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany
| | - Stefan Goebel
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany
| | - Timothy Bunck
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany
| | - Daniela Varges
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany
| | - Isidre Ferrer
- Network Center for Biomedical Research in Neurodegenerative Diseases, (CIBERNED), Institute Carlos III, Ministry of Health, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.,Department of Pathology and Experimental Therapeutics, University of Barcelona, Hospitalet de Llobregat, Spain
| | - Joachim Riggert
- Department of Transfusion Medicine, University Medical School, Göttingen, Germany
| | - Franc Llorens
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany. .,Network Center for Biomedical Research in Neurodegenerative Diseases, (CIBERNED), Institute Carlos III, Ministry of Health, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical School, Robert Koch 40, 37075, Göttingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
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