Hereditary and sporadic beta-amyloidoses.

Cerebral amyloidoses are chronic, progressive neurodegenerative diseases that are caused by the aggregation and deposition of misfolded proteins in the central nervous system, and lead to cognitive deficits, stroke, and focal neurological dysfunction including cerebellar and extrapyramidal signs. Among them, beta-amyloidoses are a heterogenous set of conditions characterised by the deposition of beta-amyloid protein in brain parenchyma and/or vessel walls that lead to the development of two main clinico-pathological entities: Alzheimer's disease and cerebral amyloid angiopathy, which may be sporadic or familial, and may also co-exist in the same patient. The aim of this review is to describe the most important differences in the pathways leading to parenchymal and cerebrovascular beta-amyloidoses, and the main clinical, neuropathological and biochemical characteristics of the two conditions. It also discusses the phenotypes associated with a series of familial and sporadic beta-amyloidoses in more detail in order to highlight the clinical and neuropathological features that may help to distinguish the different forms of disease

Comparison of Hay and Haylage from Permanent Alpine Meadows in Winter Dairy Cow Diets

In an Alpine environment, diets based on local forage resources are needed to maintain the link with the territory and confer special characteristics to typical cheeses. Harvesting at a late stage of maturity, high mechanical losses, and frequent rainfall often make the hay that is harvested of a poor quality. The aim of this study was to evaluate the effects of 2 different conservation methods (late hay, LH, vs. early haylage, ES) of natural permanent meadows on milk production in dairy cows, on the chemical and microbiological characteristics of the milk, and on the quality of the cheese over the winter period. Haylage and hay were harvested from the same permanent meadow at the Vittorino Vezzani experimental farm in Sauze d'Oulx (45 degrees 02'N, 6 degrees 53'E, Italy). The ES forage was cut 4 wk earlier than traditional hay, wilted for 30 h, baled at a dry matter (DM) content of about 50%, wrapped with 6 layers of stretch film, and stored in a protected area. The LH forage was harvested later, when the weather conditions were favorable and, after a 3-d wilting, it was baled and stored indoors. After an 8-mo storage period, the ES had a greater crude protein concentration, organic matter digestibility, and net energy for lactation than LH and a lower neutral detergent fiber and acid detergent fiber. Forty multiparous lactating Aosta Red Pied cows were used in a 19-d period crossover design to assess the nutritional value of the stored forages. The diets included ES fed ad libitum and 3.5 kg of DM per cow of concentrate or LH fed ad libitum and 5.1 kg of DM per cow of concentrate. The dietary DM was 90.1% for the LH and 59.9% for the ES. The diets contained 12.6 and 13.0% crude protein and 48.6 and 48.0% neutral detergent fiber, for the LH and ES, respectively. The forage intake was greater in the ES treatment than in the LH treatment. The ES treatment produced more milk (1.7 kg/d) and more 3.5% fat-corrected milk (1.5 kg/d) than the cows on the LH treatment. The milk fat and protein concentrations were similar in both diets, resulting in a greater protein yield in the ES treatment. The lactose, pH, total bacterial count, and somatic cell count were not different for the treatments. The clostridial spores did not differ between the treatments from preharvest forage to cheese, and no differences were found in terms of cheese quality after maturation. Conserving forage as wrapped bale silage combined with an earlier harvesting date than traditional hay resulted in a suitable method to improve forage quality without increasing the risk of clostridial contamination in the milk and cheeses

A novel missense mutation in PSEN2 gene associated with a clinical phenotype of frontotemporal dementia

Background: In Familial Alzheimer's disease defects in three genes - the amyloid precursors protein (APP) gene on chromosome 21, the presenilin 1 (PSEN1) gene on chromosome 14 and the presenilin 2 (PSEN2) on chromosome 1- have been identified. More than 160 pathogenic missense mutations have been described in PSEN1, with wide clinic phenotypic variability. In PSEN2 only 11 missense mutations are known, in two of which (M239V and T122R) the clinical phenotype may be frontotemporal dementia-like. Methods: We present a novel PSEN2 mutation (Y231C) in an Italian patient who seven years ago, at age 55, manifested mood and behavioural disorders characterized by apathia, delusions, physical aggressive behaviour and psychomotor agitation. Language disturbances appeared one year later and mild memory loss three years later. The neuropsychological pattern suggested a main dysfunction in posterior temporal and parietal cortex. MRI showed diffuse atrophy, especially in posterior regions. Results: The genetic study showed an A-to-G mutation in exon seven of PSEN2 gene, resulting in tyrosine to cysteine substitution at residue 231. Conclusions: This new mutation confirms the variability of the phenotypes associated with PSEN2 mutations and justified the analysis of this gene in behavioural disturbances associated with degenerative dementia, at least in Italy in which PSEN2 mutations seems more frequent than in other countries

Clinical phenotypic variability in an Italian family bearing the IVS6+ 5_8delGTGA mutation in PGRN gene

Background Frontotemporal dementia (FTD) is a complex presenile disorder characterized by behavioural changes and executive functions, expression of fronto-temporal degeneration. Hereditary FTD accounts for 20-30% of cases and, in the past decade, mutations in the microtubule associated protein tau (MAPT)gene were identified as a main genetic causes of familial FTD. In 2006, mutations in the gene encoding progranulin (PGRN) were reported, to account for a wide part of the familial FTD cases. Clinically, an high phenotypic variability within and among the kindreds is reported in the familial FTD associated with PGRN mutations and occasionally the memory deficits are the first symptoms, resembling Alzheimer's disease (AD). We report an Italian family with dementia associated with a PGRN mutation characterized by a deletion of 4 base pairs inside the intron 6 of the gene, leading to haploin sufficiency In our kindred, all three affected patients carried the mutation, but presented very different clinical phenotypes, evoking FTD, AD and rapidly-progressive dementia mimicking prion disease. Methods Informations on the members of the first, second and third generations were obtained conducting interviews with relatives, while for the three patients studied, the clinical evidence of dementia symptoms and their characterization was documented directly with sequential neurological examinations, cognitive assessments and neuroimaging. Blood sample collection and DNA extraction from peripheral blood lymphocytes for genetic analysis were performed after written informed consent of the patients. Results In our pedigree, the PGRN mutated patients are affected by dementia with three different clinical pictures: FTD, AD and rapidly progressive dementia mimicking prion disease. Neuropsychological examinations supported these diagnoses, documenting generalized deficits of cortical functions in AD patient and deficits in executive functions and in language in FTD patient. Regarding neuroimaging, in the same two cases MRI results do not correspond to the clinical diagnosis. Conclusions These findings confirms the marked heterogeneity of the clinico-radiological features in patients with PGNR mutations and underline the need of considering mutations of this gene as causes of familial dementing diseases with atypical or uncommon features or discrepancies between the clinical and the neuroimaging findings

Brainstem Sparing in Human Prion Disease: Sleep and Autonomic Function in a Long Survival Case Report

Abstract Background: The prion diseases are characterized by sleep disruption, with FFI typically characterized also by severe autonomic dysfunction and sympathetic hyperactivity. We report the results of an extensive neurophysiological and autonomic assessment in a CJD patient carrying the D178 mutation with the uncommon homozygosity for valine at codon 129. Results: A 47years old female presented with a memory impairment followed by progressive cognitive deficits and ataxia. The clinical picture slowly worsened to a state of akinetic mutism in about 2 years, and the patient died six years after the onset of symptoms. Repeated PSG and long-term actigraphic recordings, showed a peculiar, previously undescribed, pattern characterized by conservation of a rudimental circadian and ultradian rhythm, despite dramatic sleep micro-structure deterioration. We also observed a normal autonomic physiological response to orthostatic challenge and normal dynamic autonomic modulation during wake and sleep. The post-mortem brain pathology study, showed that neuronal loss was substantial in the cerebral cortex, diencephalon and thalami, but not in brainstem nuclei. Conclusions: We hypothesize that, despite a dramatic neurological picture (i.e. akinetic mutism) and a severe sleep micro-structural alteration, the persistence of an autonomic modulation and the persistence of a rudimental circadian and ultradian oscillation, are related to the relatively conserved anatomo-functional integrity of foundamental neuronal systems in the brainstem

Phase II study of ACNU in non-small-cell lung cancer: EORTC study 08872

A total of 62 patients with metastatic or locally advanced non-small-cell lung cancer were entered in a phase II study of ACNU. Initially, the drug was given i. v. at a dose of 100 mg/m2 every 6 weeks, but due to observed haematological side effects in chemotherapy-pretreated patients, the dose was lowered in this group to 75 mg/m2. We observed one complete response in a subject exhibiting multiple lung metastases and a partial response in two patients, one showing brain metastases and one who experienced local disease recurrence. The toxicity of ACNU mainly consisted of bone marrow suppression especially thrombocytopenia, with one toxic death occurring due to intracerebral haemorrhage. We concluded that at this dose and on this schedule, ACNU has limited activity in non-small-cell lung cancer

Tau mutations serve as a novel risk factor for cancer

In addition to its well-recognized role in neurodegeneration, tau participates in maintenance of genome stability and chromosome integrity. In particular, peripheral cells from patients affected by frontotemporal lobar degeneration carrying a mutation in tau gene (genetic tauopathies), as well as cells from animal models, show chromosome numerical and structural aberrations, chromatin anomalies, and a propensity toward abnormal recombination. As genome instability is tightly linked to cancer development, we hypothesized that mutated tau may be a susceptibility factor for cancer. Here we conducted a retrospective cohort study comparing cancer incidence in families affected by genetic tauopathies to control families. Additionally, we carried out a bioinformatics analysis to highlight pathways associated with the tau protein interactome. We report that the risk of developing cancer is significantly higher in families affected by genetic tauopathies, and a high proportion of tau protein interactors are involved in cellular processes particularly relevant to cancer. These findings disclose a novel role of tau as a risk factor for cancer, providing new insights in the various pathological roles of mutated tau

Systemic Therapy of Bronchioloalveolar Carcinoma: Results of the First IASLC/ASCO Consensus Conference on Bronchioloalveolar Carcinoma

Introduction:Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma of the lung with unique pathological, clinical, and molecular characteristics.Methods:This consensus conference group reviewed studies performed specifically in BAC and data from patients with BAC who were included in clinical trials of all non–small-cell lung cancer (NSCLC) subtypes.Results:Although BAC as defined by the World Health Organization represents less than 5% of adenocarcinomas, as many as 20% of adenocarcinomas have BAC features. These latter tumors are more likely to have mutations in the epidermal growth factor receptor (EGFR) gene and to be sensitive to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. Although most patients are men and have a history of smoking cigarettes, proportionally more are women and never smokers. Patients with BAC are routinely treated with drugs and regimens appropriate for patients with all subtypes of adenocarcinoma of the lung; four studies have been performed specifically in this disease.Conclusions:There is insufficient evidence to confirm or refute the assertion that the sensitivity of BAC to chemotherapy is different from that of other lung cancer histologic types. The unique clinical and molecular characteristics associated with BAC led this panel to conclude that future clinical trials should be designed specifically for persons with BAC. Recommendations for trial design and research questions are proposed