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Revisiting protein aggregation as pathogenic in sporadic Parkinson and Alzheimer diseases.

Espay, AJ; Vizcarra, JA; Marsili, L; Lang, AE; Simon, DK; Merola, A; Josephs, KA; Fasano, A; Morgante, F; Savica, R; et al. Espay, AJ; Vizcarra, JA; Marsili, L; Lang, AE; Simon, DK; Merola, A; Josephs, KA; Fasano, A; Morgante, F; Savica, R; Greenamyre, JT; Cambi, F; Yamasaki, TR; Tanner, CM; Gan-Or, Z; Litvan, I; Mata, IF; Zabetian, CP; Brundin, P; Fernandez, HH; Standaert, DG; Kauffman, MA; Schwarzschild, MA; Sardi, SP; Sherer, T; Perry, G; Leverenz, JB (2019) Revisiting protein aggregation as pathogenic in sporadic Parkinson and Alzheimer diseases. Neurology, 92 (7). pp. 329-337. ISSN 1526-632X https://doi.org/10.1212/WNL.0000000000006926
SGUL Authors: Morgante, Francesca

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Abstract

The gold standard for a definitive diagnosis of Parkinson disease (PD) is the pathologic finding of aggregated α-synuclein into Lewy bodies and for Alzheimer disease (AD) aggregated amyloid into plaques and hyperphosphorylated tau into tangles. Implicit in this clinicopathologic-based nosology is the assumption that pathologic protein aggregation at autopsy reflects pathogenesis at disease onset. While these aggregates may in exceptional cases be on a causal pathway in humans (e.g., aggregated α-synuclein in SNCA gene multiplication or aggregated β-amyloid in APP mutations), their near universality at postmortem in sporadic PD and AD suggests they may alternatively represent common outcomes from upstream mechanisms or compensatory responses to cellular stress in order to delay cell death. These 3 conceptual frameworks of protein aggregation (pathogenic, epiphenomenon, protective) are difficult to resolve because of the inability to probe brain tissue in real time. Whereas animal models, in which neither PD nor AD occur in natural states, consistently support a pathogenic role of protein aggregation, indirect evidence from human studies does not. We hypothesize that (1) current biomarkers of protein aggregates may be relevant to common pathology but not to subgroup pathogenesis and (2) disease-modifying treatments targeting oligomers or fibrils might be futile or deleterious because these proteins are epiphenomena or protective in the human brain under molecular stress. Future precision medicine efforts for molecular targeting of neurodegenerative diseases may require analyses not anchored on current clinicopathologic criteria but instead on biological signals generated from large deeply phenotyped aging populations or from smaller but well-defined genetic-molecular cohorts.

Item Type: Article
Additional Information: Copyright © 2019 American Academy of Neurology
Keywords: Alzheimer Disease, Amyloid beta-Peptides, Brain, Causality, Humans, Parkinson Disease, Protein Aggregation, Pathological, alpha-Synuclein, Brain, Humans, Parkinson Disease, Alzheimer Disease, Causality, alpha-Synuclein, Amyloid beta-Peptides, Protein Aggregation, Pathological, Alzheimer Disease, Amyloid beta-Peptides, Brain, Causality, Humans, Parkinson Disease, Protein Aggregation, Pathological, alpha-Synuclein, 1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Sciences, Neurology & Neurosurgery
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Neurology
ISSN: 1526-632X
Language: eng
Dates:
DateEvent
12 February 2019Published
14 December 2018Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
KL2 TR001996NCATS NIH HHSUNSPECIFIED
PubMed ID: 30745444
Web of Science ID: WOS:000465406800006
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111652
Publisher's version: https://doi.org/10.1212/WNL.0000000000006926

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