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Top Ten Tips Palliative Care Clinicians Should Know About Delivering Specialty-Aligned Palliative Care
Leiter, Richard E. , Bischoff, Kara , Carey, Elise C. , Gelfand, Samantha L. , Iyer, Anand , Jain, Nelia , Kramer, Neha M. , Lally, Kate , Landzberg, Michael J., Lever, Natasha, Newport, Kristina , O’Donnell, Arden , Sciacca, Kate, Snaman, Jennifer M. , Tulsky, James A. , Rosa, William E. , Bischoff, Kara E , Iyer, Anand S , Tulsky, James A , Rosa, William E , Patel, Arpan , Lakin, Joshua R.

Journal of Palliative Medicine | March 31, 2023 | Volume: 26 | Issue: 10 | Pages: 1401-1407

10.1089/jpm.2023.0116 | PMID 37001173 Get It

Complexities of recapitulating polygenic effects in natural populations: replication of genetic effects on wing shape in artificially selected and wild-caught populations of Drosophila melanogaster
Pelletier, Katie , Mammel, Anna , Northrop‐Albrecht, Emmalee J. , Márquez, Eladio J. , Moscarella, Rosa A. , Dworkin, Ian , Northrop-Albrecht, Emmalee, Pitchers, William , Houle, David

GENETICS | March 24, 2023 | Volume: 224 | Issue: 3 | Pages: No page available

10.1093/genetics/iyad050 | PMID 36961731 Get It

Abstract Identifying the genetic architecture of complex traits is important to many geneticists, including those interested in human disease, plant and animal breeding, and evolutionary genetics. Advances in sequencing technology and statistical methods for genome-wide association studies have allowed for the identification of more variants with smaller effect sizes, however, many of these identified polymorphisms fail to be replicated in subsequent studies. In addition to sampling variation, this failure to replicate reflects the complexities introduced by factors including environmental variation, genetic background, and differences in allele frequencies among populations. Using Drosophila melanogaster wing shape, we ask if we can replicate allelic effects of polymorphisms first identified in a genome-wide association studies in three genes: dachsous, extra-macrochaete, and neuralized, using artificial selection in the lab, and bulk segregant mapping in natural populations. We demonstrate that multivariate wing shape changes associated with these genes are aligned with major axes of phenotypic and genetic variation in natural populations. Following seven generations of artificial selection along the dachsous shape change vector, we observe genetic differentiation of variants in dachsous and genomic regions containing other genes in the hippo signaling pathway. This suggests a shared direction of effects within a developmental network. We also performed artificial selection with the extra-macrochaete shape change vector, which is not a part of the hippo signaling network, but showed a largely shared direction of effects. The response to selection along the emc vector was similar to that of dachsous, suggesting that the available genetic diversity of a population, summarized by the genetic (co)variance matrix (G), influenced alleles captured by selection. Despite the success with artificial selection, bulk segregant analysis using natural populations did not detect these same variants, likely due to the contribution of environmental variation and low minor allele frequencies, coupled with small effect sizes of the contributing variants.
Anti–PD-1 and Extended Half-life IL2 Synergize for Treatment of Murine Glioblastoma Independent of Host MHC Class I Expression
Tritz, Zachariah P. , Ayasoufi, Katayoun , Wolf, Delaney M. , Owens, Carley A. , Malo, Courtney S. , Himes, Benjamin , Fain, Cori E. , Goddery, Emma N. , Yokanovich, Lila T. , Jin, Fang , Hansen, Michael J. , Wang, Chensu , Marcano, Rosa M. Diaz , Vile, Richard G. , Johnson, Aaron J. , Himes, Benjamin T , Parney, Ian F , Wang, Chensu , Moynihan, Kelly D , Irvine, Darrell J , Wittrup, K Dane , Diaz Marcano, Rosa M , Vile, Richard G , Johnson, Aaron J. , Ayasoufi, Katayoun , Parney, Ian F.

Cancer Immunology Research | March 15, 2023 | Volume: 11 | Issue: 6 | Pages: 763-776

10.1158/2326-6066.cir-22-0570 | PMID 36921098 Get It

Abstract Glioblastoma (GBM) is the most common malignant brain tumor in adults, responsible for approximately 225,000 deaths per year. Despite preclinical successes, most interventions have failed to extend patient survival by more than a few months. Treatment with anti—programmed cell death protein 1 (anti–PD-1) immune checkpoint blockade (ICB) monotherapy has been beneficial for malignant tumors such as melanoma and lung cancers but has yet to be effectively employed in GBM. This study aimed to determine whether supplementing anti–PD-1 ICB with engineered extended half-life IL2, a potent lymphoproliferative cytokine, could improve outcomes. This combination therapy, subsequently referred to as enhanced checkpoint blockade (ECB), delivered intraperitoneally, reliably cures approximately 50% of C57BL/6 mice bearing orthotopic GL261 gliomas and extends median survival of the treated cohort. In the CT2A model, characterized as being resistant to CBI, ECB caused a decrease in CT2A tumor volume in half of measured animals similar to what was observed in GL261-bearing mice, promoting a trending survival increase. ECB generates robust immunologic responses, features of which include secondary lymphoid organ enlargement and increased activation status of both CD4 and CD8 T cells. This immunity is durable, with long-term ECB survivors able to resist GL261 rechallenge. Through employment of depletion strategies, ECB's efficacy was shown to be independent of host MHC class I–restricted antigen presentation but reliant on CD4 T cells. These results demonstrate ECB is efficacious against the GL261 glioma model through an MHC class I–independent mechanism and supporting further investigation into IL2-supplemented ICB therapies for tumors of the central nervous system.
Embracing Monogenic Parkinson's Disease: The MJFF Global Genetic PD Cohort
Vollstedt, Eva‐Juliane , Schaake, Susen , Lohmann, Katja , Lesage, Suzanne , Tesson, Christelle , Wurster, Isabel , Hentati, F., Marder, Karen, Waters, Cheryl , Fahn, Stanley, Brüggemann, Norbert , Tolosa, Eduardo , Garrido, Alícia , Annesi, Grazia , Bozi, Maria , Ferreira, Joaquim J. , Guedes, Leonor Correia , Petrucci, Simona , Clark, Lorraine N. , Abramycheva, Natalya, Menéndez‐González, Manuel , Maestre, S. Jesús, Gómez‐Garre, Pilar , Mir, Pablo , Ran, Caroline , Kuo, Ming‐Che , Ross, Owen A. , Williams‐Gray, Caroline H. , Camacho, Marta , Cornejo‐Olivas, Mario , Torres-Ramírez, Luis , Wu, Yih‐Ru , Morgadinho, Ana , Berg, Daniela , Kuhlenbäumer, Gregor , Kühn, Andrea A. , Borngräber, Friederike , Michele, Giuseppe De , Rosa, Anna De , Zimprich, Alexander , Puschmann, Andreas , Mellick, George D. , Chase, Bruce A. , Markopoulou, Katerina , Satake, Wataru , Rossi, Malco , Lynch, Timothy , Olszewska, Diana A. , Lim, Shen‐Yang , Ahmad‐Annuar, Azlina , Tan, Ai Huey , Hanağası, Haşmet , Koziorowski, Dariusz , Ertan, Sibel , Genç, Gençer , Saunders‐Pullman, Rachel , Warrenburg, Bart van de, Bressman, Susan , Toft, Mathias , Appel‐Cresswell, Silke , Boon, Agnita J.W. , Krüger, Rejko , Sammler, Esther , Tumas, Vítor , Zhang, Baorong , Garraux, Gaëtan , Kim, Yun Joong , Winkelmann, Juliane , Sue, Carolyn M. , Tan, Eng‐King , Kostić, Vladimir , Arkadir, David , Martikainen, Mika H. , Brighina, Laura , Suchowersky, Oksana , Rieß, Olaf , Das, Parimal, Mollenhauer, Brit , Gatto, Emilia , Petersen, Maria Skaalum , Aasly, Jan , Aasly, Anna, Farrer, Matthew J. , Brockmann, Kathrin , Klein, Christine , Group, the MJFF Global Genetic Parkinson's Disease Study, Bardien, Soraya , Barrett, Matthew J. , Januário, Cristina , Sousa, Mário , Soto‐Beasley, Alexandra I. , May, Patrick , Mirelman, Anat , Brüggemann, Norbert , Borsche, Max , Tolosa, Eduardo , Ferreira, Joaquim J , Alvarez, Victoria , Mir, Pablo , Kuo, Ming-Che , Ross, Owen A , Nishioka, Kenya , Williams-Gray, Caroline H , Camacho, Marta , Cornejo-Olivas, Mario , Wu, Yih-Ru , Termsarasab, Pichet , Borngräber, Friederike , Zimprich, Alexander , Gambardella, Stefano , Chase, Bruce , Olszewska, Diana A , Tan, Ai Huey , Barkhuizen, Melinda , Appel-Cresswell, Silke , Skorvanek, Matej , Sammler, Esther M , Zhang, Baorong , Chung, Sun Ju , Puschmann, Andreas , Januário, Cristina , Klein, Christine , Bardien, Soraya , Toft, Mathias , Koziorowski, Dariusz , May, Patrick , Beasley, Alexandra I , Barrett, Matthew J , Sue, Carolyn M , Kühn, Andrea A , Padmanabhan, Shalini , Brice, Alexis , Vidailhet, Marie , Giladi, Nir , Kasten, Meike , Borsche, Max , Foroud, Tatiana , Gagliardi, Monica , Stefanis, Leonidas , Avenali, Micol , Fedotova, E. Yu. , Álvarez, Victoria , Belin, Andrea Carmine , Lin, Chin‐Hsien , Crosiers, David , Wszołek, Zbigniew K. , Jankovic, Joseph J. , Funayama, Manabu , Clarimón, Jordi , Lee‐Chen, Guey‐Jen , Pulkes, Teeratorn , Dorszewska, Jolanta , Carr, Jonathan , Ferese, Rosangela , Toda, Tatsushi , Merello, Marcelo , Al-Mubarak, Bashayer R , Aguiar, Patrícia de Carvalho , Pimentel, Márcia Mattos Gonçalves , Warrenburg, Bart P.C. van de , Lang, Anthony E. , Damásio, Joana , Klivènyi, Péter , Borges, Vanderci , Hertz, Jens Michael , Spitz, Mariana , Hattori, Nobutaka , Wu, Ruey‐Meei , Illarioshkin, Sergey Nikolaevich , Valente, Enza Maria , Alcalay, Roy N. , Thaler, Avner , Corvol, Jean‐Christophe , Group, the MJFF Global Genetic Parkinson's Disease Study

Movement Disorders | January 24, 2023 | Volume: 38 | Issue: 2 | Pages: 286-303

10.1002/mds.29288 | PMID 36692014 Get It

AbstractBackgroundAs gene‐targeted therapies are increasingly being developed for Parkinson's disease (PD), identifying and characterizing carriers of specific genetic pathogenic variants is imperative. Only a small fraction of the estimated number of subjects with monogenic PD worldwide are currently represented in the literature and availability of clinical data and clinical trial‐ready cohorts is limited.ObjectiveThe objectives are to (1) establish an international cohort of affected and unaffected individuals with PD‐linked variants; (2) provide harmonized and quality‐controlled clinical characterization data for each included individual; and (3) further promote collaboration of researchers in the field of monogenic PD.MethodsWe conducted a worldwide, systematic online survey to collect individual‐level data on individuals with PD‐linked variants in SNCA, LRRK2, VPS35, PRKN, PINK1, DJ‐1, as well as selected pathogenic and risk variants in GBA and corresponding demographic, clinical, and genetic data. All registered cases underwent thorough quality checks, and pathogenicity scoring of the variants and genotype–phenotype relationships were analyzed.ResultsWe collected 3888 variant carriers for our analyses, reported by 92 centers (42 countries) worldwide. Of the included individuals, 3185 had a diagnosis of PD (ie, 1306 LRRK2, 115 SNCA, 23 VPS35, 429 PRKN, 75 PINK1, 13 DJ‐1, and 1224 GBA) and 703 were unaffected (ie, 328 LRRK2, 32 SNCA, 3 VPS35, 1 PRKN, 1 PINK1, and 338 GBA). In total, we identified 269 different pathogenic variants; 1322 individuals in our cohort (34%) were indicated as not previously published.ConclusionsWithin the MJFF Global Genetic PD Study Group, we (1) established the largest international cohort of affected and unaffected individuals carrying PD‐linked variants; (2) provide harmonized and quality‐controlled clinical and genetic data for each included individual; (3) promote collaboration in the field of genetic PD with a view toward clinical and genetic stratification of patients for gene‐targeted clinical trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
The Signal Transduction Pathway of CD23 (FcεRIIb) Targets IκB Kinase
Ten, Rosa, McKinstry, Melissa J., Trushin, Sergey A., Asin, Susana , Payá, Carlos V.

The Journal of Immunology | January 2, 2023 | Volume: 163 | Issue: 7 | Pages: 3851-3857

10.4049/jimmunol.163.7.3851 Get It

Abstract Alveolar macrophages play a crucial role in initiating the inflammatory response in allergic asthma through the cross-linking of the low affinity IgE receptors (FcεRIIb or CD23) by IgE-allergen immunocomplexes. We have previously shown that CD23 cross-linking in monocytes and U937 cells targets IκBα, leading to the activation of the transcription factor NF-κB. We demonstrate in this paper that CD23-initiated signaling in U937 cells leads to hyperphosphorylation of IκBα at Ser32/Ser36 residues. Overexpression of a dominant-negative IκBα transgene containing mutations at Ser32/Ser36 completely inhibits degradation of IκBα, NF-κB activation, and gene transcription that follows CD23 cross-linking. Investigation of the second messengers mediating the CD23-dependent activation of NFκB demonstrates that IκB kinases (IKKs) but not p90rsk are selectively activated following CD23 cross-linking and mediates the phosphorylation of IκBα. Cotransfection experiments with an IKKβ negative dominant completely inhibit CD23 induced NFκB activation. Furthermore, the activation of tyrosine kinase(s) by CD23 is required for the induction of IKK activity, IκBα degradation, and NF-κB nuclear translocation. Taken together, our results show that CD23 cross-linking in the monocytic lineage induces tyrosine kinase activation followed by activation of IKK, which phosphorylates IκBα at the N-terminal domain (Ser32/Ser36), inducing its degradation, NF-κB activation and gene transcription.
Eosinophil cationic protein cDNA. Comparison with other toxic cationic proteins and ribonucleases.
Barker, R L, Loegering, D A, Ten, Rosa, Hamann, K J , Pease, Larry R. , Gleich, G.J.

The Journal of Immunology | December 31, 2022 | Volume: 143 | Issue: 3 | Pages: 952-955

10.4049/jimmunol.143.3.952 Get It

Abstract Human eosinophil granules contain several basic proteins including eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN) and major basic protein (MBP). ECP and MBP are potent helminthotoxins while EDN is less so. Both ECP and EDN possess neurotoxic and ribonuclease activities. A clone representing ECP mRNA was isolated from an eosinophil lambda ZAP cDNA library. The cDNA sequence codes for a preprotein of 160 amino acids and a protein of 133 amino acids, the amino terminus of which is identical to the known partial amino acid sequence of ECP. The ECP nucleotide sequence shows similarity to EDN, rat pancreatic ribonuclease, and human angiogenin; all are members of the ribonuclease gene superfamily. Although the deduced amino acid sequence of ECP shares identical active site and substrate binding site residues with EDN, angiogenin, and human pancreatic ribonuclease, the ribonuclease activity of ECP is 50 to 100 times less than that of EDN possibly because of the lack of a positively charged residue at human pancreatic ribonuclease position 122. The calculated isoelectric point (10.8), electronic charge (14.5), and cationic charge distribution of ECP are different from those of EDN but similar to those of MBP, which may account in part for the greater helminthotoxic activity of ECP when compared to EDN. These data suggest that ECP and EDN are derived from a common ancestral ribonuclease gene and that ECP has evolved into a potent helminthotoxin similar in some respects to MBP, while losing much of its ribonuclease activity.
APOE2 Exacerbates TDP‐43 Related Toxicity in the Absence of Alzheimer Pathology
Meneses, Axel , Li, Zonghua , O’Leary, Justin , Li, Fuyao , Nakamura, M. , Kurti, Aishe, Heckman, Michael G. , White, Launia J. , Xie, Manling , Chen, Yixing , Finch, NiCole A., Lim, Melina J., Delenclos, Marion , DeTure, Michael , Martin, Nicholas B. , Ikezu, Tadafumi C. , Blitterswijk, Marka van , Wu, Long‐Jun , McLean, Pamela J. , Rademakers, Rosa , Ross, Owen A. , Bu, Guojun , Zhao, Na , Meneses, Axel D , Li, Zonghua , O'Leary, Justin, Li, Fuyao , Chen, Kai , Murakami, Aya , Qiao, Wenhui , Heckman, Michael G , White, Launia, DeTure, Michael A, Linares, Cynthia , van Blitterswijk, Marka M, Ross, Owen A , Dickson, Dennis W , Zhao, Na , van Blitterswijk, Marka , Wu, Long-Jun , Bu, Guojun , Chen, Yixing , Xie, Manling , McLean, Pamela J , Koga, Shunsuke , Chen, Kai , Dickson, Dennis W.

Annals of Neurology | December 22, 2022 | Volume: 93 | Issue: 4 | Pages: 830-843

10.1002/ana.26580 | PMID 36546684 Get It

ObjectiveRecent evidence supports a link between increased TDP‐43 burden and the presence of an APOE4 gene allele in Alzheimer's disease (AD); however, it is difficult to conclude the direct effect of APOE on TDP‐43 pathology due to the presence of mixed AD pathologies. The goal of this study is to address how APOE isoforms impact TDP‐43 pathology and related neurodegeneration in the absence of typical AD pathologies.MethodsWe overexpressed human TDP‐43 via viral transduction in humanized APOE2, APOE3, APOE4 mice, and murine Apoe‐knockout (Apoe‐KO) mice. Behavior tests were performed across ages. Animals were harvested at 11 months of age and TDP‐43 overexpression‐related neurodegeneration and gliosis were assessed. To further address the human relevance, we analyzed the association of APOE with TDP‐43 pathology in 160 postmortem brains from autopsy‐confirmed amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration with motor neuron disease (FTLD‐MND) in the Mayo Clinic Brain Bank.ResultsWe found that TDP‐43 overexpression induced motor function deficits, neuronal loss, and gliosis in the motor cortex, especially in APOE2 mice, with much milder or absent effects in APOE3, APOE4, or Apoe‐KO mice. In the motor cortex of the ALS and FTLD‐MND postmortem human brains, we found that the APOE2 allele was associated with more severe TDP‐43‐positive dystrophic neurites.InterpretationOur data suggest a genotype‐specific effect of APOE on TDP‐43 proteinopathy and neurodegeneration in the absence of AD pathology, with the strongest association seen with APOE2. ANN NEUROL 2023;93:830–843
Plasma levels of an N‐terminal tau fragment predict core AD and neurodegenerative biomarkers in autosomal dominant Alzheimer’s disease: Findings from DIAN
Ostaszewski, Beth L., Fitzpatrick, Colleen , Fagan, Anne M. , Farlow, Martin R. , Schofield, Peter W., Perrin, Richard J. , Johnson, Keith A., Chhatwal, Jasmeer P. , Network, Dominantly Inherited Alzheimer, Schultz, Stephanie A. , Liu, Lei , Xiong, Chengjie , Noble, James M. , Rosa-Neto, Pedro , Schofield, Peter W., Morris, John C. , Jucker, Mathias , Jack, Clifford R. , Karch, Celeste M. , Gordon, Brian A. , Johnson, Keith A. , McDade, Eric , Sperling, Reisa Anne , Bateman, Randall J. , Selkoe, Dennis J. , Network, Dominantly Inherited Alzheimer

Alzheimer's & Dementia | December 20, 2022 | Volume: 18 | Issue: S6 | Pages: No page available

10.1002/alz.069285 Get It

AbstractBackgroundBlood based biomarkers that predict cognitive decline and Alzheimer’s disease (AD) pathology have the potential to accelerate AD therapeutic development and improve clinical care. Prior work suggests that plasma biomarkers of tau pathology (particularly post‐translational modifications of tau) may be highly useful in diagnosis and risk stratification for AD‐related neurodegeneration and cognitive decline. Levels of tau species lacking truncation of the N‐terminal region, particularly plasma and cerebrospinal fluid (CSF) levels of N‐terminal tau fragment 1 (NT1), have previously been shown to predict cognitive decline, neurodegeneration, and tau pathology in preclinical and symptomatic late‐onset AD. Here we examined plasma NT1 as a possible predictor of cognitive, clinical, pathologic, and neurodegenerative trajectories in autosomal dominant AD (ADAD) using data from the Dominantly Inherited Alzheimer Network Observational Study (DIAN‐Obs).MethodsAssociations between plasma NT1 levels and Mini‐Mental State Exam (MMSE), Clinical Dementia Rating SumBox® (CDR‐SB), hippocampal volume (HV), estimated years to symptom onset (EYO), Pittsburgh‐Compound‐B PET, and CSF Aβ42, and p‐tau181 were assessed using linear regression (150 pathogenic variant carriers, 81 non‐carriers; mean[SD] carrier age = 40.1 [10.4] years and EYO = ‐5.4 [10.4]). Plasma NT1 was measured using the Quanterix HD‐X platform. PET, MRI, clinical, and biofluid measures were derived using previously described procedures in DIAN‐Obs.ResultsCross‐sectional plasma NT1 levels in ADAD carriers were significantly associated with MMSE, CDR‐SB, HV, and p‐tau181 even after adjusting for EYO (Table 1; Figure 1). NT1 levels statistically diverged between carriers and non‐carriers 6.8 years before estimated symptom onset (Figure 2). In contrast, plasma NT1 levels were not significantly correlated with measures of β‐amyloid pathology after adjusting for EYO.ConclusionPlasma NT1 levels mirrored changes in clinical, cognitive, and neurodegenerative measures in ADAD, particularly in late asymptomatic and early symptomatic phases of disease. NT1 levels correlated with CSF measures of tau pathology, but NT1 levels were not strongly associated with CSF or PET measures of β‐amyloid pathology, unlike some previously‐studied plasma tau measures. Together with previous supportive findings in preclinical and symptomatic sporadic AD, these results suggest that plasma NT1 may be a useful biomarker of AD‐related tau pathology and neurodegeneration across a broad spectrum of disease.
Progressive white matter injury in autosomal dominant Alzheimer’s disease is strongly associated with cerebral microbleeds and neurodegeneration
Shirzadi, Zahra , Yau, Wai‐Ying Wendy , Preboske, Gregory M., Farlow, Martin R. , Fagan, Anne M. , Fitzpatrick, Colleen , Salloway, Stephen , Perrin, Richard J. , Graff‐Radford, Neill R. , Koeppe, Robert, Chui, Helena C., Mori, Hiroshi , Johnson, Keith A., Greenberg, Steven M. , Chhatwal, Jasmeer P. , Investigators, DIAN, Schultz, Stephanie A. , Joseph‐Mathurin, Nelly , Kantarci, Kejal , Jack, Clifford R. , Hassenstab, Jason , Jucker, Mathias , Morris, John C. , Xiong, Chengjie , Karch, Celeste M. , Levey, Allan I. , Gordon, Brian A. , Schofield, Peter William , McDade, Eric , Xiong, Chengjie , Cruchaga, Carlos , Allegri, Ricardo , Fox, Nick C. , Goate, Alison , Noble, James M. , Chui, Helena C. , Berman, Sarah , Sánchez‐Valle, Raquel , Lee, Jae‐Hong , Rosa-Neto, Pedro , Benzinger, Tammie L.S. , Sohrabi, Hamid R. , Martins, Ralph N. , Schultz, Aaron P. , Bateman, Randall J. , Johnson, Keith A. , Sperling, Reisa Anne , Investigators, DIAN

Alzheimer's & Dementia | December 20, 2022 | Volume: 18 | Issue: S6 | Pages: No page available

10.1002/alz.066715 Get It

AbstractBackgroundWhite matter (WM) injury visible on MRI is a common finding in Alzheimer’s disease (AD) and is often attributed to small vessel ischemic changes secondary to increased systemic vascular risk. Increased WM injury has been associated with the progression of Autosomal Dominant AD (ADAD), though ADAD pathogenic variant carriers are relatively young and may not have elevated vascular risk factors. We hypothesized that WM injury in ADAD may reflect worsening of cerebral amyloid angiopathy (CAA) and neurodegeneration. Here we examine this hypothesis using cross‐sectional and longitudinal data from the Dominantly Inherited Alzheimer Network observational study (DIAN).MethodMRI data from ADAD pathogenic variant carriers (n=223) and non‐carriers (n=136) were used in the present study (Table 1). We extracted FreeSurfer‐based WM lesion (WML) volume from T1‐weighted images (hypointensities). Cortical microbleed (CMB) burden was assessed visually on susceptibility weighted/T2*‐weighted gradient echo images by experienced radiologists (blineded to the mutation status) at the Mayo Clinic in Rochester. Linear regression models compared WML volume at baseline in people with and without CMB. Linear mixed effect models assessed the relationships between longitudinal WML and both CMBs and FreeSurfer‐based total gray matter (GM) volume. Models were corrected for age and estimated years to symptom onset (EYO).ResultGreater baseline WML volume was seen in ADAD carriers vs. non‐carriers, particularly close to the age of estimated symptom onset. Baseline WML volume was greater in carriers with CMBs compared to those without (t=2.9, p=0.003, Figure 1). Longitudinal increase in WML amongst ADAD pathogenic variant carriers with CMBs was estimated to be 214 mm3/year greater than that amongst carriers without CMBs (t=4.1, p<0.001, Figure 2). Independent of this CMB effect, decreasing GM volume was strongly associated with increasing longitudinal WML volume (t=‐6.2, p<0.001, Figure 3). Similar analyses in the non‐carrier group yielded no significant findings.ConclusionConsistent with prior reports, WML volume was increased in ADAD pathogenic variant carriers. However, the results here suggest WML in ADAD may not solely be due to small vessel ischemic changes, but rather may be a result of worsening CAA and more rapid neurodegeneration.
AD‐causing variants that affect PSEN1 transmembrane domains are associated with faster neurodegeneration and cognitive decline compared to those affecting cytoplasmic domains
Fagan, Anne M. , Chen, Charles D., Fitzpatrick, Colleen , Chui, Helena C., Mori, Hiroshi , Johnson, Keith A., Farlow, Martin R. , Farrell, Michelle E. , Graff‐Radford, Neill R. , Perrin, Richard J. , Salloway, Stephen , Shirzadi, Zahra , Chhatwal, Jasmeer P. , Schultz, Stephanie A. , Allegri, Ricardo , Schultz, Aaron P. , Goate, Alison , Levey, Allan I. , Hanseeuw, Bernard , Koeppe, Robert A. , Gordon, Brian A. , Cruchaga, Carlos , Karch, Celeste M. , Xiong, Chengjie , Jack, Clifford R. , McDade, Eric , Chui, Helena C. , Lee, Jae‐Hong , Noble, James M. , Hassenstab, Jason , Xiong, Chengjie , Morris, John C. , Johnson, Keith A. , Liu, Lei , Jucker, Mathias , Joseph‐Mathurin, Nelly , Fox, Nick C. , Schofield, Peter R. , Martins, Ralph N. , Sánchez‐Valle, Raquel , Berman, Sarah , Rosa-Neto, Pedro , Benzinger, Tammie L.S. , Bateman, Randall J. , Sperling, Reisa Anne

Alzheimer's & Dementia | December 20, 2022 | Volume: 18 | Issue: S4 | Pages: No page available

10.1002/alz.067186 Get It

AbstractBackgroundRates of cognitive and biomarker change in Autosomal Dominant Alzheimer disease (ADAD) vary substantially across individuals. Prior cross‐sectional work suggests that the location of the pathogenic variant within PSEN1, specifically whether the underlying variant affects transmembrane (TM) or cytoplasmic (CY) domains in PSEN1, may be a key determinant in these differential rates of progression. Here we use longitudinal data from the Dominantly Inherited Alzheimer Network observational study (DIAN‐Obs) to examine whether variants affecting TM versus CY domains in PSEN1 have differential rates of change in key cognitive and neurodegenerative markers, and whether these differences are relevant to ADAD clinical trials.MethodsUsing longitudinal clinical, cognitive, and MRI data from PSEN1 pathogenic variant carriers [TM group N=76 and CY group N=44; Table 1], we assessed rates of change in Mini‐Mental State Exam (MMSE), Clinical Dementia Rating® Sum of Boxes (CDR®‐SOB), and hippocampal volume (HV) using linear mixed effects models accounting for disease stage (estimated years to symptom onset [EYO]). We further assessed how PSEN1 mutation location (TM versus CY) impacts sample size and detectable effect size in a potential ADAD clinical trial (modeled as a 4‐year trial with annual assessments; 80% power; α = 0.05).ResultsPSEN1 TM and PSEN1 CY groups did not differ on baseline age, EYO, or CDR®. The PSEN1 TM group had significantly greater rates of change on MMSE (B[SE] = ‐0.42[0.1], p=0.002), CDR®‐SOB (B[SE] = 0.23[0.1], p=0.001), and HV atrophy (B[SE] = ‐58.93[14.3], p=0.0006 compared to the PSEN1 CY group (Fig.1). Consistent with these differential rates of change, power analyses indicated the required sample size to detect a 30% treatment effect on MMSE or HV would be reduced by 59.6% for MMSE and 91.0% for HV for a trial population comprised of PSEN1 TM versus CY carriers (Fig.2).ConclusionsIndividuals who had a variant affecting the transmembrane domains of PSEN1 had greater rates of cognitive decline and neurodegeneration compared to those with variants affecting cytoplasmic domains. In addition to having implications for ADAD pathophysiology, these results suggest that incorporating information regarding the location of PSEN1 variants may be beneficial in analyzing and designing stratification approaches for ADAD trials.