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Sporadic amyotrophic lateral sclerosis of long duration is associated with relatively mild TDP-43 pathology

Recently, sporadic amyotrophic lateral sclerosis (SALS), a fatal neurological disease, has been shown to be a multisystem proteinopathy of TDP-43 in which both neurons and glial cells in the central nervous system are widely affected. In general, the natural history of SALS is short (

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Published in:Acta neuropathologica 2009, Vol.117 (1), p.45-53
Main Authors: Nishihira, Yasushi, Tan, Chun-Feng, Hoshi, Yasuhiro, Iwanaga, Keisuke, Yamada, Megumi, Kawachi, Izumi, Tsujihata, Mitsuhiro, Hozumi, Isao, Morita, Takashi, Onodera, Osamu, Nishizawa, Masatoyo, Kakita, Akiyoshi, Takahashi, Hitoshi
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container_title Acta neuropathologica
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creator Nishihira, Yasushi
Tan, Chun-Feng
Hoshi, Yasuhiro
Iwanaga, Keisuke
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Kawachi, Izumi
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Hozumi, Isao
Morita, Takashi
Onodera, Osamu
Nishizawa, Masatoyo
Kakita, Akiyoshi
Takahashi, Hitoshi
description Recently, sporadic amyotrophic lateral sclerosis (SALS), a fatal neurological disease, has been shown to be a multisystem proteinopathy of TDP-43 in which both neurons and glial cells in the central nervous system are widely affected. In general, the natural history of SALS is short (
doi_str_mv 10.1007/s00401-008-0443-6
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In general, the natural history of SALS is short (&lt;5 years). However, it is also known that a few patients may survive for 10 years or more, even without artificial respiratory support (ARS). In the present study using TDP-43 immunohistochemistry, we examined various regions of the nervous system in six patients with SALS of long duration (10–20 years) without ARS, in whom lower motor-predominant disease with Bunina bodies and ubiquitinated inclusions (UIs) in the affected lower motor neurons was confirmed. One case also showed UIs in the hippocampal dentate granule cells (UDG). In all cases, except one with UDG, the occurrence of TDP-43-immunoreactive (ir) neuronal cytoplasmic inclusions (NCIs) was confined to a few regions in the spinal cord and brainstem, including the anterior horns. In one case with UDG, TDP-43-ir NCIs were also detected in the substantia nigra, and some regions of the cerebrum, including the hippocampal dentate gyrus (granule cells). The number of neurons displaying NCIs in each region was very small (1–3 per region, except the dentate gyrus). On the other hand, the occurrence of TDP-43-ir glial cytoplasmic inclusions (GCIs) was more widespread in the central nervous system, including the cerebral white matter. Again, however, the number of glial cells displaying GCIs in each region was very small (1–3 per region). In conclusion, compared to the usual form of SALS, TDP-43 pathology shown in SALS of long duration was apparently mild in degree and limited in distribution, corresponding to the relatively benign clinical courses observed. 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In general, the natural history of SALS is short (&lt;5 years). However, it is also known that a few patients may survive for 10 years or more, even without artificial respiratory support (ARS). In the present study using TDP-43 immunohistochemistry, we examined various regions of the nervous system in six patients with SALS of long duration (10–20 years) without ARS, in whom lower motor-predominant disease with Bunina bodies and ubiquitinated inclusions (UIs) in the affected lower motor neurons was confirmed. One case also showed UIs in the hippocampal dentate granule cells (UDG). In all cases, except one with UDG, the occurrence of TDP-43-immunoreactive (ir) neuronal cytoplasmic inclusions (NCIs) was confined to a few regions in the spinal cord and brainstem, including the anterior horns. In one case with UDG, TDP-43-ir NCIs were also detected in the substantia nigra, and some regions of the cerebrum, including the hippocampal dentate gyrus (granule cells). The number of neurons displaying NCIs in each region was very small (1–3 per region, except the dentate gyrus). On the other hand, the occurrence of TDP-43-ir glial cytoplasmic inclusions (GCIs) was more widespread in the central nervous system, including the cerebral white matter. Again, however, the number of glial cells displaying GCIs in each region was very small (1–3 per region). In conclusion, compared to the usual form of SALS, TDP-43 pathology shown in SALS of long duration was apparently mild in degree and limited in distribution, corresponding to the relatively benign clinical courses observed. It is now apparent that SALS of long duration is actually part of a TDP-43 proteinopathy spectrum.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>18923836</pmid><doi>10.1007/s00401-008-0443-6</doi><tpages>9</tpages></addata></record>
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subjects Aged
Alzheimer's disease
Amyotrophic lateral sclerosis
Amyotrophic Lateral Sclerosis - metabolism
Amyotrophic Lateral Sclerosis - pathology
Anterior Horn Cells - metabolism
Anterior Horn Cells - pathology
Anterior Horn Cells - ultrastructure
Autopsies
Autopsy
Brain - metabolism
Brain - pathology
Brain research
Brain Stem - metabolism
Brain Stem - pathology
Cerebrum - metabolism
Cerebrum - pathology
Dementia
Dentate Gyrus - metabolism
Dentate Gyrus - pathology
Disease
DNA-Binding Proteins - metabolism
Dysphagia
Dyspnea
Female
Hippocampus - metabolism
Hippocampus - pathology
Humans
Immunohistochemistry
Inclusion Bodies - metabolism
Inclusion Bodies - pathology
Male
Medicine
Medicine & Public Health
Microscopy, Immunoelectron
Middle Aged
Nervous system
Neuroglia - metabolism
Neuroglia - pathology
Neurology
Neurons
Neurons - metabolism
Neurons - pathology
Neurosciences
Original Paper
Pathology
Research centers
Spinal Cord - metabolism
Spinal Cord - pathology
Substantia Nigra - metabolism
Substantia Nigra - pathology
Time Factors
Ubiquitin - metabolism
title Sporadic amyotrophic lateral sclerosis of long duration is associated with relatively mild TDP-43 pathology
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