Toshiki Mizuno

High Striatal Amyloid β-Peptide Deposition Across Different Autosomal Alzheimer Disease Mutation Types

BACKGROUND Supported by compelling genetic data regarding early-onset familial Alzheimer disease (AD), the amyloid beta-peptide (Abeta)-centric theory holds that Abeta is involved in the pathogenesis of sporadic AD. Mutations in the amyloid precursor protein (APP), presenilin 1 (PSEN1), and presenilin 2 (PSEN2) genes lead to increased Abeta levels before symptoms arise. OBJECTIVES To evaluate the pattern of Pittsburgh Compound B (PiB) retention in subjects with different autosomal dominant mutations associated with familial AD vs that in healthy age-matched control subjects and subjects with probable sporadic AD, to correlate Abeta burden as measured by PiB with available clinical and cognitive data, and to compare the regional brain patterns of PiB retention and fluorodeoxyglucose F 18 (FDG) uptake. DESIGN Correlation analysis of positron emission tomography (PET) imaging studies. SETTING Academic research. PARTICIPANTS Seven PSEN1 mutation carriers and 1 APP mutation carrier underwent PiB and FDG PET imaging. Amyloid beta-peptide burden and FDG uptake were established using standardized uptake values normalized to pons. MAIN OUTCOME MEASURE Primary outcomes were PET results, which were compared with those of a well-characterized cohort of 30 healthy control subjects and 30 subjects with probable sporadic AD. RESULTS All mutation carriers had high PiB retention in the striatum, with some also having cortical PiB retention in ventrofrontal and posterior cingulate/precuneus areas. The striatal pattern of PiB retention was similar in the PSEN1 and APP mutation carriers. Neither striatal nor cortical Abeta burden was related to cognitive status. CONCLUSIONS Consistent with previous studies, the pattern of Abeta deposition in familial AD differs from that in sporadic AD, with higher striatal and somewhat lower cortical PiB retention in familial AD. The pattern and degree of Abeta deposition were not associated with mutation type nor cognitive status.

Microbleeds in Alzheimer Disease Are More Related to Cerebral Amyloid Angiopathy than Cerebrovascular Disease

Cerebral amyloid angiopathy (CAA) is one of the cardinal pathological features in the vascular components of Alzheimer’s disease (AD). CAA itself results in disrupted microvasculature, mainly in the cerebral cortex, eventually leading to a brain cortical or subcortical hemorrhage in a population of elderly people, but clinically overt brain hemorrhages are not so frequent in AD patients. Here we assessed 50 AD patients and 26 controls to detect latent brain hemorrhages with gradient-echo T2*-weighted images, a sensitive magnetic resonance imaging technique to detect hemosiderin components in the brain. Microbleeds, demarcated as low-intensity spots in T2*-weighted images, were detected in 16.7% of AD patients without cerebrovascular disease (CVD) and in 12.5% of those with CVD, while no microbleeding was detected in the control subjects. No significant difference was observed between the microbleed-positive group and the microbleed-negative counterpart in their clinical background, such as hypertension, the use of antiplatelet drugs and smoking. In addition, white matter high intensities in the T2-weighted image were significantly more confluent in the microbleed-positive AD group than its negative counterpart. In conclusion, our evaluation of AD brains revealed that latent microbleeds in AD patients are more frequent than in normal controls. Microbleeds not being related to common hemorrhagic risk factors, but being significantly related to white matter pathologies suggested that microbleeds in AD may be associated with CAA, but not with hypertension or CVD.

Age-Dependent Change in the Levels of Aβ40 and Aβ42 in Cerebrospinal Fluid from Control Subjects, and a Decrease in the Ratio of Aβ42 to Aβ40 Level in Cerebrospinal Fluid from Alzheimer’s Disease Patients

In order to address an age-dependent alteration in the concentration of β-amyloid polypeptides (Aβs) within the central nervous system and its probable predisposition to amyloidgenesis in Alzheimer’s disease (AD), we measured two species of soluble Aβs, Aβ40 and Aβ42, in cerebrospinal fluids (CSF) from randomly selected Japanese control subjects at various ages (n = 33) and then compared these data with those of probable Japanese AD patients (n = 23). CSF concentrations of Aβ40 and Aβ42 peptides were age-dependent (ANOVA, Bonferroni’s multiple comparison; p < 0.01 and p < 0.05, respectively) and were lower in the infant than in adults. From mid-20, the Aβ40 concentrations were decreasing while Aβ42 were rather stable. Aβs in CSF from AD patients (n = 23), whose ε4 allele frequency of the apolipoprotein E gene was higher than in controls (n = 83, p < 0.03), were not statistically different from those of age-matched controls (n = 13). A linear relationship was detected between the Aβ40 concentration and the Mini-Mental State Examination score (p < 0.05). The ratio of the Aβ42 to the Aβ40 level measured in the AD CSF samples was approximately 38% decreased compared to age-matched controls (p < 0.05). These data suggest that the physiological metabolism of soluble Aβs in the brain is regulated in an age-dependent manner, and that the ratio of Aβ42 to Aβ40 level in the CSF would be a useful marker for monitoring progression of AD.

Cerebral white matter damage in frontotemporal dementia assessed by diffusion tensor tractography

IntroductionWe used diffusion tensor imaging (DTI) to study white matter integrity in patients with frontotemporal dementia (FTD).MethodsThe subjects comprised 20 patients (9 men, 11 women) with FTD and 17 age-matched healthy controls (9 men, 8 women). Based on the data obtained from DTI, we performed tractography of the major cerebral pathways, including the pyramidal tracts, genu and splenium of the corpus callosum (CC), bilateral arcuate fasciculi (AF), inferior longitudinal fasciculi (ILF) and uncinate fasciculi (UF). We measured the values of fractional anisotropy (FA) in each fiber and statistically compared the findings in patients with those in controls.ResultsWe found a significant decrease in FA values in the selected association fibers as well as anterior fibers of the CC in the patients with FTD. The greatest decrease in mean FA of the UF was seen in advanced FTD. On the other hand, there were no significant differences in FA in the bilateral pyramidal tracts.ConclusionThe features of FTD from the view point of cerebral white matter damage were revealed by tractography based on DTI. DTI is therefore considered to be a useful method, and may provide clues to elucidating the pathogenesis of FTD.

Local tissue anisotropy decreases in cerebellopetal fibers and pyramidal tract in multiple system atrophy

BackgroundOne of the cardinal features in multiple system atrophy (MSA) is the white matter pathology: loss of myelin, astrocytosis, and glial cytoplasmic inclusions. The pathological changes of tissue microstructure can modify the diffusion behavior of water molecules, which can be assessed by diffusion tensor imaging (DTI).Objectives To explore the hypothesis of white matter degeneration in MSA.MethodsWe studied 11 patients with clinically probable MSA and 10 age–matched controls. DTI was performed in both groups to measure fractional anisotropy (FA) in various regions of interest: the inferior cerebellar peduncle (ICP), middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), basis pontis, internal capsule, and corpus callosum.ResultsFA values in SCP and corpus callosum showed no significant difference between the MSA group and controls. By contrast, FA values decreased in the MSA group in the MCP, basis pontis and internal capsule. In addition, FA values in the MCP were negatively correlated with ataxia severity in the MSA group.ConclusionThe areas showing decreased tissue anisotropy in DTI corresponded well with pathologically vulnerable areas in MSA. In addition, the local tissue anisotropy of MCP decreased in accordance with functional disability. These observations implied that DTI is a feasible method for in vivo evaluation of the white matter pathology in MSA.

Extracellular neurosin degrades α-synuclein in cultured cells

Neurosin, also called kallikrein 6, is a trypsin-like serine protease predominantly expressed in the central nervous system. Neurosin may degrade alpha-synuclein, a major component of the Lewy bodies commonly observed in dopaminergic neurons of patients with sporadic Parkinsons disease. In the present study, we investigated the localization and proteolytic activity of human neurosin using cultured cells to elucidate the physiological role of this enzyme at the cellular level. Heterologous expression of pre-pro-neurosin was localized to the endoplasmic reticulum and secreted. The proteolytic activity of neurosin was analyzed by zymography and fluorescent substrate, and showed that extracellular neurosin had protease activity but intracellular neurosin did not. We also coexpressed alpha-synuclein with neurosin and demonstrated that alpha-synuclein was not cleaved within cells, but extracellular alpha-synuclein was degraded by secreted neurosin. These findings suggest that neurosin targets the extracellular alpha-synuclein.

Evaluation of Factors Associated With Elevated Levels of Platelet-Derived Microparticles in the Acute Phase of Cerebral Infarction

Background: Platelet-derived microparticles (PDMPs) have attracted attention as blood coagulation-promoting, endothelial cell-activating factors. The objective of this study was to determine the parameters associated with elevated PDMP levels and examine their relationship with atherosclerotic lesions of main intracranial and extracranial arteries. Participants and Methods: Participants included a control group (C) of 61 patients with no apparent cerebral vascular lesions and 110 patients with acute-phase cerebral infarction, consisting of a small-vessel occlusion group (S) of 34 patients, a large-artery atherosclerosis group (L) of 41 patients, a cardioembolism group (CE) of 20 patients, and a stroke of undetermined etiology group (U) of 15 patients. Platelet-derived microparticle levels were measured using enzyme-linked immunosorbent assay (ELISA) at the time of admission, and the patients were reclassified into group CP (control level PDMPs), consisting of 70 patients with control PDMP levels, and group HP (high PDMPs), consisting of 40 patients with elevated PDMP levels. All patients underwent cranial magnetic resonance (MR) and carotid ultrasound examinations. Results: Platelet-derived microparticle levels were significantly higher in groups S and L than in group C (P < .01). Concomitant intima-media thickness (IMT; odds ratio [OR] = 1.29, P < .05) and concomitant intracranial stenosis (OR = 3.95, P < .01) were significantly correlated with elevated PDMP levels. Fibrinogen and high-sensitivity CRP levels were significantly higher in group HP than in group CP. Conclusion: Alterations in PDMP levels correlated with the presence of atherothrombotic lesions, and PDMP levels are expected to be useful as a clinical indicator, reflecting the presence of intracranial atherosclerotic lesions in the acute phase of cerebral infarction.

Decreased Cerebrospinal Fluid Levels of Neurosin (KLK6), an Aging‐Related Protease, as a Possible New Risk Factor for Alzheimer's Disease

Abstract: Neurosin is a kallikrein‐like serine protease expressed preferentially in the human brain. It is localized in senile plaques and neurofibrillary tangles in the brains of individuals with Alzheimers disease (AD) and in Lewy bodies in patients with Parkinsons disease. Neurosin is present in the cerebrospinal fluid (CSF) as a proenzyme and does not show any enzymatic activity. We have developed a sandwich ELISA system using monoclonal and polyclonal antibodies against human neurosin and have measured neurosin levels in the CSF from AD and non‐CNS disease patients. Both male and female patients with peripheral neuropathy showed statistically positive correlations between CSF neurosin concentrations and age (males, n= 52, r= 0.482, p < 0.005; females, n= 43, r= 0.365, p < 0.005). In contrast, such positive correlation was not observed in the CSF from patients with AD. Further, some such patients showed extremely low levels of CSF neurosin. Our results suggest that neurosin is an aging‐related protease and that a decreased CSF concentration of neurosin may be a risk factor for developing AD.

Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts

IntroductionIt is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography is of clinical value in assessing aphasia.MethodsThirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index was calculated for both FA and number of fibers.ResultsFA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls. Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83 and specificity of 0.86.ConclusionsAsymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the fate of vascular aphasia.

Cleavage of normal and pathological forms of α-synuclein by neurosin in vitro

Neurosin is one of the serine proteases predominantly expressed in the central nervous system. Neurosin is presumed to play an important role in the degradation of alpha-synuclein (alpha-syn), since a previous study showed that neurosin degrades alpha-syn, inhibits polymerization of alpha-syn in vitro, and exists in Lewy bodies. However, the details of alpha-syn degradation by neurosin are little known. We investigated neurosin-mediated cleavage of alpha-syn by immunoblotting and liquid chromatography-ion trap mass spectrometry (LC/MS/MS). We also compared alpha-syn degradation by neurosin between phosphorylated and non-phosphorylated forms of alpha-syn, and between mutant and wild-type alpha-syn. Neurosin cleaved alpha-syn at specific sites. The major cleavage site was localized between Lys80 and Thr81 within the NAC region (E61 to V95), which is important for alpha-syn aggregation, and accordingly may preclude alpha-syn polymerization. Meanwhile, alternative, minor forms of processing also occur. They conserve the NAC region with truncation of the C-terminal region, and accordingly may contribute to alpha-syn polymerization. Phosphorylated alpha-syn was more resistant to degradation by neurosin than non-phosphorylated alpha-syn. The A30P mutant was more resistant to degradation than the wild-type and other alpha-syn mutants. This resistance to neurosin-mediated degradation of phosphorylated alpha-syn and the A30P mutant, which are, respectively, posttranslational and genetic factors related to the development of Parkinsons disease (PD), provides supporting evidence that neurosin is involved in the pathogenesis of PD.