Bettencourt, C

Cao, LX

Chan, DKY

Huang, Y

Li, QX

Milward, AE

Wang, G

English

UCL Discovery

TYPE EditorialPUBLISHED 27 October 2023DOI 10.3389/fneur.2023.1322200OPEN ACCESSEDITED AND REVIEWED BYHuifang Shang,Sichuan University, China*CORRESPONDENCEYue Huangyue.huang@ncrcnd.org.cnRECEIVED 15 October 2023ACCEPTED 16 October 2023PUBLISHED 27 October 2023CITATIONHuang Y, Li Q-X, Cao L-X, Wang G, Chan DKY,Bettencourt C and Milward AE (2023) Editorial:Human brain banking – Bridging brain healthand precision neurology.Front. Neurol. 14:1322200.doi: 10.3389/fneur.2023.1322200COPYRIGHT© 2023 Huang, Li, Cao, Wang, Chan,Bettencourt and Milward. This is anopen-access article distributed under the termsof the Creative Commons Attribution License(CC BY). The use, distribution or reproductionin other forums is permitted, provided theoriginal author(s) and the copyright owner(s)are credited and that the original publication inthis journal is cited, in accordance withaccepted academic practice. No use,distribution or reproduction is permitted whichdoes not comply with these terms.Editorial: Human brain banking –Bridging brain health andprecision neurologyYue Huang1,2,3*, Qiao-Xin Li4, Ling-Xiao Cao1,2, Gang Wang5,Daniel Kam Yin Chan6, Conceicao Bettencourt7 andAdrienne E. Milward81Human Brain and Tissue Bank, China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital, Capital Medical University, Beijing, China, 2Department of Neurology, BeijingTiantan Hospital, Capital Medical University, Beijing, China, 3Department of Pharmacology, Faculty ofMedicine and Health, School of Biomedical Sciences, UNSW Sydney, Sydney, NSW, Australia, 4NationalDementia Diagnostics Laboratory, The Florey Institute, University of Melbourne, Parkville, VIC, Australia,5School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China, 6Department ofAged Care and Rehabilitation, Bankstown Hospital, Faculty of Medicine and Health, UNSW Sydney,Sydney, NSW, Australia, 7Department of Neurodegenerative Disease and Queen Square Brain Bank,Queen Square Institute of Neurology, University College London, London, United Kingdom, 8School ofMedical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, AustraliaKEYWORDShuman brain banking, brain health, precision neurology, neurogenetics, neuropathology,biomarkersEditorial on the Research TopicHuman brain banking – Bridging brain health and precision neurologyMaintaining brain health and promoting precision neurology are endeavors withdifferent perspectives but sharing the same goal of combatting brain disorders. Precisionneurology is an off-shoot of precisionmedicine, an initiative announced by President Obamain 2015 to develop prevention and treatment strategies that take individual variabilityinto account (1). Advances in neurogenetics, neuroimaging, neuropathology and otherareas are now positioning neurology as a new frontier of precision medicine. As just oneexample, precision neurology is now being trialed to differentiate AD, Lewy body diseaseand mild cognitive impairment to support more precise diagnosis and targeted therapiesby developing workflows that combine surveys on variables such as health behaviors with:(i) neurologic and neuropsychological assessments; (ii) neuroimaging biomarkers (MRI,amyloid PET) and (iii) whole genome sequencing (2).Precision neurology focuses on the heterogeneity of disease phenotypes. The WorldHealth Organization considers the complementary field of brain health from the perspectiveof optimizing lifelong brain functioning across cognitive, sensory, social-emotional,behavioral and motor domains. Optimal brain health is defined by the American HeartAssociation/American Stroke Association as the ability to function adaptively in theenvironment, reflected in competencies across the domains of thinking, moving and feeling(3). Maintaining optimal brain health across the lifespan is central to achieving a sustainablesocioeconomic future for humankind.Neurological diseases are a leading cause of all-age mortality and disability worldwide,second only to cardiovascular disease (4), with over one in four people developing brainFrontiers inNeurology 01 frontiersin.orgHuang et al. 10.3389/fneur.2023.1322200diseases such as dementia or stroke during their lifetime (5).Preventing overt brain diseases affecting normal brain function isfundamental to maintaining brain health (4).For example, in this topic, Hu et al. show multiple braindomains (e.g. perception, mood, attention, pain) can be affectedin movement disorders, highlighting the need to considerthe complex relationships between brain health and precisionneurology in clinical practice, with individual variations acrossexperiential domains potentially influencing both symptoms andtreatment outcomes.As this topic demonstrates, other studies are consolidatingfoundations for preventive and therapeutic advances in precisionneurology, including genome-wide association studies (GWAS)and genome sequencing (gene panel, whole-exome or whole-genome sequencing) that open the way for incorporating geneticvariants into the diagnosis and prognosis of both rare andcommon neurological diseases and into clinical trials of therapeuticinterventions based on the patient’s genetic variants. The excellenttreatment outcome by Wang et al. for a patient with levodopa-resistant dopa-responsive dystonia with an atypical mutationillustrates the potential value of applying precision medicine inneurology—precision neurology.Fortunately, while treatment resistance is common inneurological conditions, there is often a prodromal period wheninterventions can be implemented to prevent or delay disease, ifmarkers of early changes can be identified. Analysis combiningPET imaging for Aβ aggregates and CSF biomarker data fromthe Alzheimer’s Disease Neuroimaging Initiative (ADNI) byXiang et al. suggests deficiencies in confrontation naming andsemantic fluency reflect abnormal brain Aβ deposition, whichmay serve as a clinical red flag for brain health maintenance.The potential for precise early intervention is increasing withadvances in monitoring Aβ and other biomarkers in biofluids atthe pre-symptomatic stage (6).Other organs contribute to brain health (7–12) andneurological diseases can have systemic sequelae e.g.,cardiovascular, immune, gastrointestinal or kidney effects (9–14).Hu et al. report on systematic problems, notably gastrointestinal,cardiovascular, urinary and sexual abnormalities, that can co-exist with movement disorders. The prevalence of comorbiditywith brain disorders in the elderly underlines the value of bothmaintaining general wellbeing for brain health and consideringcausal directionality of comorbidities.Despite advances in neuroimaging and other technologies,neuropathology remains essential for correlating observationsin living patients with neuropathological features essential fordefinitive diagnosis and subtype delineation in many neurologicalconditions, notable examples including neurodegenerative diseasesand chronic traumatic encephalopathy (15, 16).If precision neurology and brain health are viewed as two sidesof a coin, human brain banking is the edge that connects the twosides. Human brain banks are now being seen as core researchfacilities that support both clinical and fundamental researchers(16–18). Building a strong human brain bank to achieve the goals ofprecision neurology and brain health optimization will be assistedby prospective longitudinal observation of living donors with orwithout brain disease. This also provides opportunities for brainhealth promotion and management.Maintaining brain health and consenting to become abrain donor are voluntary choices relying strongly on thewillingness of participants. Complementing this, optimizationof brain health requires correlating postmortem brain datawith individual variations interrogated by precision neurology,studies resting largely on contributions from clinical andresearch professionals and encompassing individual behaviors,lifestyle choices, environmental exposures, clinicopathological andgenomic factors and biomarker analyses.Senesi et al. in this topic compare levels of CSF biomarkers forCreutzfeld-Jakob disease (CJD) in specimens from cases confirmedpost-mortem as CJD or non-CJD, to determine the optimalcutpoints of an automated immunoassay for pre-mortem CJDdiagnosis. This work illustrates the importance of definitive post-mortem brain assessment in developing clinical applications ofprecision neurology.Human brain banking enables cataloging and study ofdistinctive characteristics of individual brains, facilitatingdevelopment of novel technologies for understanding the brain inhealth and disease. The collection of high-quality brain specimenssupported by “gold-standard” postmortem diagnostic data andrich clinical and pre-clinical information that includes participanthealth monitoring, genomics information and neuroimaging andother biomarker studies will form the foundations upon whichsuccessful implementation of precision neurology and brain healthoptimization across the lifespan will ultimately depend.This topic aims to bring together researchers across thesefields and raise awareness of the importance of human brainbanking in precision neurology brain health optimization. It drawsattention to the need for promoting and monitoring brain health—and individual factors which affect it—in partnership with livingbrain donors. This implicitly requires strengthening national andinternational policies to increase investment in brain banking sothe aims of precision neurology and brain health optimizationthroughout the lifespan can be achieved throughout the world.Author contributionsYH: Conceptualization, Funding acquisition, Writing—original draft, Writing—review & editing. Q-XL: Validation,Conceptualization, Writing—review & editing. L-XC: Writing—original draft, Project administration. GW: Writing—review &editing, Conceptualization, Validation. DC: Writing—review &editing, Validation. CB: Funding acquisition, Writing—review& editing, Validation. AM: Validation, Writing—review &editing, Conceptualization.FundingThe author(s) declare financial support was receivedfor the research, authorship, and/or publication of thisarticle. This work was supported by the National NaturalScience Foundation of China (NSFC, 82071417, YH). Thefunder supported human brain banking related research.CB was supported by Alzheimer’s Research UK (ARUK-RF2019B-005) and Multiple System Atrophy Trust. TheFrontiers inNeurology 02 frontiersin.orgHuang et al. 10.3389/fneur.2023.1322200funders played no role in the design, conduct, or reportingof this manuscript.Conflict of interestThe authors declare that the research was conductedin the absence of any commercial or financial relationshipsthat could be construed as a potential conflictof interest.The author(s) declared that they were an editorialboard member of Frontiers, at the time of submission.This had no impact on the peer review process and thefinal decision.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteed orendorsed by the publisher.References1. Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med.(2015) 372:793–5. doi: 10.1056/NEJMp15005232. Shulman J, Vanegas-Arroyave N, Fong J, Elsea S, Lin C-i, SaadeH, et al. Precision neurology for dementia (P2-6.002). Neurology. (2023)100:4045. doi: 10.1212/WNL.00000000002037063. Gorelick PB, Furie KL, Iadecola C, Smith EE, Waddy SP, Lloyd-Jones DM,et al. Defining optimal brain health in adults: a presidential advisory from theAmerican Heart Association/American Stroke Association. Stroke. (2017) 48:e284–303. doi: 10.1161/STR.00000000000001484. Ding C, Wu Y, Chen X, Chen Y, Wu Z, Lin Z, et al. Global, regional,and national burden and attributable risk factors of neurological disorders:the Global Burden of Disease study 1990-2019. Front Public Health. (2022)10:952161. doi: 10.3389/fpubh.2022.9521615. 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Editorial: Human brain banking – Bridging brain health and precision neurology

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Editorial: Human brain banking – Bridging brain health and precision neurology

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