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Paciente de 61 años con demencia con cuerpos de Lewy, que acude derivado por el servicio de neurología por posible deterioro cognitivo. Se trata de un paciente ficticio basado en mi experiencia durante la realización de las prácticas del máster. La demencia con cuerpos de Lewy es una enfermedad neurodegenerativa de inicio subagudo y curso evolutivo fluctuante que se desarrolla en la edad adulta. Es la segunda causa de demencia degenerativa más frecuente después de la enfermedad de Alzheimer. Los resultados de la evaluación revelan alteraciones en las praxias visuoconstructivas, en el de funcionamiento ejecutivo, en las funciones visuoperceptivas y visuoespaciales, y síntomas leves de ansiedad, depresión, apatía e irritabilidad. Así mismo se observan alteraciones en la atención sostenida, selectiva y alternante, la memoria de trabajo y la memoria visual, aunque estos resultados deben ser tomados con prudencia. El objetivo de la intervención es mejorar o mantener el funcionamiento cognitivo, la independencia y calidad de vida el mayor tiempo posible. Se realizarán 2 sesiones semanales de 60 durante 3 meses, donde se trabajarán tanto las funciones cognitivas alteradas como preservadas, así como los problemas emocionales y conductuales observados. Además, se trabajará también con la familia. 61-year-old patient with dementia with Lewy bodies, referred by the neurology department for possible cognitive impairment. This is a fictitious patient based on my experience during my master's internship. Dementia with Lewy bodies is a neurodegenerative disease with subacute onset and fluctuating course that develops in adulthood. It is the second most common cause of degenerative dementia after Alzheimer's disease. The results of the evaluation reveal alterations in visuoconstructive praxias, executive functioning, visuoperceptive and visuospatial functions, and mild symptoms of anxiety, depression, apathy and irritability. Alterations in sustained, selective and alternating attention, working memory and visual memory are also observed, although these results should be taken with caution. The aim of the intervention is to improve or maintain cognitive functioning, independence and quality of life as long as possible. There will be 2 weekly sessions of 60' during 3 months, where both altered and preserved cognitive functions will be worked on, as well as the emotional and behavioral problems observed. In addition, we will also work with the family. Pacient de 61 anys amb demència amb cossos de Lewy, que acudeix derivat pel servei de neurologia per possible deteriorament cognitiu. Es tracta d'un pacient fictici basat en la meva experiència durant la realització de les pràctiques de l'màster. La demència amb cossos de Lewy és una malaltia neurodegenerativa d'inici subagut i curs evolutiu fluctuant que es desenvolupa en l'edat adulta. És la segona causa de demència degenerativa més freqüent després de la malaltia d'Alzheimer. Els resultats de l'avaluació revelen alteracions en les pràxies visuoconstructives, al de funcionament executiu, en les funcions visuoperceptives i visuoespacials, i símptomes lleus d'ansietat, depressió, apatia i irritabilitat. Així mateix s'observen alteracions en l'atenció sostinguda, selectiva i alternant, la memòria de treball i la memòria visual, encara que aquests resultats s'han de prendre amb prudència. L'objectiu de la intervenció és millorar o mantenir el funcionament cognitiu, la independència i qualitat de vida el major temps possible. Es realitzaran 2 sessions setmanals de 60 durant 3 mesos, on es treballaran tant les funcions cognitives alterades com preservades, així com els problemes emocionals i conductuals observats. A més, es treballarà també amb la família.

Lewy body diseases (LBD) including dementia with Lewy bodies (DLB) and Parkinson disease (PD) are characterized by alpha-synuclein pathology. DLB is difficult to diagnose and peripheral biomarkers are urgently needed. Therefore, we analyzed the expression of five alpha-synuclein gene (SNCA) transcripts, SNCAtv1, SNCAtv2, SNCAtv3, SNCA126, and SNCA112, in 45 LBD and control temporal cortex samples and in the blood of 72 DLB, 59 PD, and 54 control subjects. The results revealed overexpression of SNCAtv1 and SNCA112 in DLB, and SNCAtv2 in PD temporal cortices. In DLB blood, diminution of all SNCA transcripts was observed. SNCAtv1 and SNCAtv2 were diminished in PD with disease onset before 70 years. SNCAtv3, driven by its own promoter, showed opposite expression in early DLB and PD, suggesting that its amount may be an early, DLB specific biomarker. Correlation between blood transcript levels and disease duration was positive in DLB and negative in PD, possibly reflecting differences in brain alpha-synuclein aggregation rates associated with differences in disease courses. In conclusion, SNCA transcripts showed a disease-specific increase in the brain and were diminished in blood of LBD patients. SNCAtv3 expression was decreased in early DLB and increased in early PD and could be a biomarker for early DLB diagnosis.

Dementia with Lewy bodies (DLB) is a clinically heterogeneous disorder with a substantial burden on healthcare. Despite this, the genetic basis of the disorder is not well defined and its boundaries with other neurodegenerative diseases are unclear. Here, we performed whole exome sequencing of a cohort of 1118 Caucasian DLB patients, and focused on genes causative of monogenic neurodegenerative diseases. We analyzed variants in 60 genes implicated in DLB, Alzheimer’s disease, Parkinson’s disease, frontotemporal dementia, and atypical parkinsonian or dementia disorders, in order to determine their frequency in DLB. We focused on variants that have previously been reported as pathogenic, and also describe variants reported as pathogenic which remain of unknown clinical significance, as well as variants associated with strong risk. Rare missense variants of unknown significance were found in APP, CHCHD2, DCTN1, GRN, MAPT, NOTCH3, SQSTM1, TBK1 and TIA1. Additionally, we identified a pathogenic GRN p.Arg493* mutation, potentially adding to the diversity of phenotypes associated with this mutation. The rarity of previously reported pathogenic mutations in this cohort suggests that the genetic overlap of other neurodegenerative diseases with DLB is not substantial. Since it is now clear that genetics plays a role in DLB, these data suggest that other genetic loci play a role in this disease.

Altres ajuts: This work was supported by the Marató TV3 grant 1405/10. Altres ajuts: MSCBS/PI12-1702 Altres ajuts: MSCBS/PI15-216 Parkinson disease (PD) and dementia with Lewy bodies (DLB) are Lewy body diseases characterized by abnormal alpha-synuclein deposits and overlapping pathological features in the brain. Several studies have shown that glucocerebrosidase (GBA) deficiency is involved in the development of LB diseases. Here, we aimed to find out if this deficiency starts at the transcriptional level, also involves alternative splicing, and if GBA expression changes in brain are also detectable in blood of patients with LB diseases. The expression of three GBA transcript variants (GBAtv1, GBAtv2 and GBAtv5) was analyzed in samples from 20 DLB, 25 PD and 17 control brains and in blood of 20 DLB, 26 PD patients and 17 unaffected individuals. Relative mRNA expression was determined by real-time PCR. Expression changes were evaluated by the ΔΔCt method. In brain, specific expression profiles were identified in the temporal cortex of DLB and in the caudate nucleus of PD. In blood, significant GBA mRNA diminution was found in both DLB and PD patients. Early PD and early-onset DLB patients showed lowest GBA levels which were normal in PD patients with advanced disease and DLB patients who developed disease after 70 years of age. In conclusion, disease group specific GBA expression profiles were found in mostly affected areas of LBD. In blood, GBA expression was diminished in LB diseases, especially in patients with early onset DLB and in patients with early PD. Age of disease onset exerts an opposite effect on GBA expression in DLB and PD.

Objectives: The goal of this study was to assess mitochondrial function, energy and purine metabolism, protein synthesis machinery from the nucleolus to the ribosome, inflammation, and expression of newly identified ectopic olfactory and taste receptors in the frontal cortex of typical cases of Dementia with Lewy Bodies (DLB) and cases with rapid clinical course (rpDLB: 2 years or less) compared with middle-aged non-affected individuals, in order to learn about the biochemical abnormalities underlying Lewy body pathology. Methods: RT-qPCR, mitochondrial enzymatic assays, and analysis of β-amyloid, tau and synuclein species were used. Results: The main alterations in DLB and rpDLB, which are more marked in the rapidly progressive forms, include: i) deregulated expression of several mRNAs and proteins of mitochondrial subunits, and reduced activity of complexes I, II, III and IV of the mitochondrial respiratory chain; ii) reduced expression of selected molecules involved in energy metabolism and increased expression of enzymes involved in purine metabolism; iii) abnormal expression of nucleolar proteins, rRNA18S, genes encoding ribosomal proteins and initiation factors of the transcription at the ribosome; iv) discrete inflammation; and v) marked deregulation of brain olfactory and taste receptors (ORs and TASRs, respectively). Severe mitochondrial dysfunction involving activity of four complexes, minimal inflammatory responses, and dramatic altered expression of ORs and TASRs discriminate DLB from Alzheimer’s disease. Altered solubility and aggregation of α-synuclein, increased β-amyloid bound to membranes and absence of soluble tau oligomers are common in DLB and rpDLB. Low levels of soluble β-amyloid are found in DLB. However, increased soluble β-amyloid 1-40 and β-amyloid 1-42, and increased TNFα mRNA and protein expression, distinguish rpDLB. Conclusions: Molecular alterations in frontal cortex in DLB involve key biochemical pathways such as mitochondria and energy metabolism, protein synthesis, purine metabolism, among others and are accompanied by discrete innate inflammatory response.Rapid DLB can be distinguished from DLB by increased levels of β-amyloid species and TNF-α mRNA brain expression, being both factors harmful to nerve cells

Graphical abstract, Highlights • Sensitive detection of total iron content from cells, rodent and human brain extracts. • There are regional differences in iron concentrations in rodent and human brain. • Iron dyshomeostasis in the substantia nigra correlates with Lewy body disease. • Iron imaging studies may aid in clinical diagnosis and/or serve as biomarker for disease progression., Iron levels in the healthy human brain are known to be high in certain areas such as the substantia nigra (SN), and increase further with age. In addition, there is some evidence for a further increase in iron load in the SN of Parkinsońs disease (PD) patients as compared to controls, which correlates with motor disability. Here, we have analyzed total iron levels in cells as well as mouse and human brain samples by atomic absorption spectroscopy (AAS). Our data indicate that iron load is more pronounced in cells with dopaminergic features. Moreover, region-specific differences in iron load reflecting those in the human brain were detected in rodent brains as well. Whilst altered iron load was not observed in other regions also affected in PD patients, we report a significant increase in iron load in the SN of Lewy body disease patients as compared to Alzheimeŕs disease (AD) patients or controls, which correlates with neurodegeneration in this brain area.

[eng] Mitochondria dysfunction is documented in the substantia nigra in Parkinson's disease (PD), a region which plays a central role in the characteristic motor manifestations of the disease. Mitochondria! dysfunction is a cause of neuron energy exhaustion, oxidative stress and dopaminergic cell death. However, little is known about mitochondria! dysfunction in other brain regions in PD, the impairment of which is causative of other symptoms such as cognitive impairment and, in some cases, dementia. The present study was undertaken to analyse mitochondria! function in the frontal cortex area 8 and angular gyrus. On the other hand, protein synthesis has also been shown to play role in neurodegenerative diseases which leads to neuronal atrophy. It is reported that significant percentage of protein synthesis results in the generation of defective ribosomal products, occurring as the result of faulty coding/or transfer within the ribosomal complex. The present study was undertaken to analyse impairment of ribosomal subunits in substantia nigra, frontal cortex area 8, angular gyrus, and precuneus. The frozen human post-mortem brain samples obtained following generous donation after informed consent, and stored at the Institute of Neuropathology Brain Bank (a branch of the HUB-ICO-IDIBELL brain bank). The study contemplates different stages of disease progression, according to the findings of the neuropathological study, and includes expression levels of mRNA and protein of selected subunits of the mitochondria! complexes and ribosomal subunits, and also enzymatic activities of each one of these complexes compared to those seen in age-matched controls processed in parallel. Results show altered activity of selected complexes of the respiratory chain thus supporting the concept that mitochondria! alterations in PD are not restricted to the substantia nigra but they rather represent a more widespread region-dependent alteration in PD. On the other hand the results of ribosomal proteins show disease-dependent differences in ribosomal protein gene expression.

Importance Mutations in leucine-rich repeat kinase 2 ( LRRK2 ) are the most common cause of genetic Parkinson disease (PD) known to date. The clinical features of manifesting LRRK2 mutation carriers are generally indistinguishable from those of patients with sporadic PD. However, some PD cases associated with LRRK2 mutations lack Lewy bodies (LBs), a neuropathological hallmark of PD. We investigated whether the presence or absence of LBs correlates with different clinical features in LRRK2 -related PD. Observations We describe genetic, clinical, and neuropathological findings of 37 cases of LRRK2 -related PD including 33 published and 4 unpublished cases through October 2013. Among the different mutations, the LRRK2 p.G2019S mutation was most frequently associated with LB pathology. Nonmotor features of cognitive impairment/dementia, anxiety, and orthostatic hypotension were correlated with the presence of LBs. In contrast, a primarily motor phenotype was associated with a lack of LBs. Conclusions and Relevance To our knowledge, this is the first report of clinicopathological correlations in a series of LRRK2 -related PD cases. Findings from this selected group of patients with PD demonstrated that parkinsonian motor features can occur in the absence of LBs. However, LB pathology in LRRK2 -related PD may be a marker for a broader parkinsonian symptom complex including cognitive impairment.

Previous studies have demonstrated the presence of hemoglobin α-chain and β-chain in neurons of the rodent and human brain thus indicating that hemoglobin is a normal component of nerve cells and that hemoglobin may play a role in intraneuronal oxygen homeostasis. Progressing with these studies, hemoglobin expression has been examined in selected cell population in the brains of Alzheimer's disease (AD), argyrophilic grain disease (AGD), Parkinson's disease (PD) and Dementia with Lewy bodies (DLB). Double labeling immunofluorescence and confocal microscopy revealed reduced hemoglobin α-chain and β-chain in practically all neurons with small amounts of granular or punctuate hyperphosphorylated tau deposits and in neurons with tangles in the hippocampus and frontal cortex in AD and in the hippocampus in AGD; in ballooned neurons containing αB-crystallin in the amygdala in AD and AGD; and in about 80% of neurons with punctuate α-synuclein deposits and in neurons with Lewy bodies in the substantia nigra pars compacta and in vulnerable neurons of the medulla oblongata in PD and DLB; and in neurons with Lewy bodies in the frontal cortex in DLB. Hemoglobin immunoreactivity was also observed in the core of neuritic plaques and in diffuse plaques, but not in dystrophic neurites. Loss of hemoglobin was specific as neuroglobin was present equally in neurons with and without abnormal protein inclusions, and erythropoietin receptor was expressed equally in neurons without and in neurons with abnormal protein aggregates in AD, AGD, PD, and DLB.

[cat] L'objectiu general d'aquest treball és el d'aprofundir en l'estudi de les sinucleïnopaties, principalment a nivell bioquímic, en les interaccions de l'alfa-sinucleïna amb altres proteïnes del cervell humà per tal d'estudiar l'efecte de la unió en aquestes patologies. També hem volgut comprovar la similitud de les sinucleïnopaties humanes amb un model animal transgènic per a la forma humana mutada de l'alfa-sinucleïna. D'altra banda i també relacionat amb aquestes neurodegenarions, s'ha estudiat de quina manera resultaven afectats diferents marcadors de l'estrès oxidatiu, que se sap juga un important paper en el desenvolupament d'aquestes patologies. Mitjançant estudis d'immunoprecipitació i de pull-down en cervell humà s'ha trobat interacció de l'alfa-sinucleïna amb les proteïnes sinàptiques rab3a i rabfilina a córtex de la sinucleïnopatia anomenada Demència amb cossos de Lewy (DLBD), i no en cervells control. Donada la interacció anòmala amb aquestes proteïnes sinàptiques podem afirmar que a DLBDs la transmissió sinàptica es troba alterada, i una de les causes és la interacció anòmala de l'alfa-sinucleïna amb rab3a i rabfilina. Aquest tipus d'interacció també s'ha estudiat a l'MSA o Atròfia Sistèmica Múltiple, una sinucleïnopatia que té afectat sobretot el cerebel, i no el córtex, com les DLBDs. Doncs, tot i estar classificada com a sinucleïnopatia a part, hem observat la mateixa interacció anòmala tan a cerebel com escorça de pacients d'MSA, suggerint-se un mecanisme comú de neurodegeneració per a totes les sinucleïnopaties. Paral.lelament també hem estudiat la via de transducció glutamatèrgica a pacients amb DLBDs, i s'ha trobat que en condicions normals exiteix interacció de l'alfa-sinucleïna amb un efector del receptors metabotròpics del glutmat tipus I, com és la PLC-beta-1. Al mateix temps, i a través d'estudis de solubilitat, s'han observat canvis en la solubilitat de PLC-beta-1 en aquestes patologies, tal com succeeix amb l'alfa-sinucleïna. Quan s'han estudiat marcadors d'estrès oxidatiu per una forma primerenca de la malaltia de Parkinson s'han trobat alterats a córtex d'aquest pacients, quan la patología, en els primers estadis només es detecta fins ara a substància negra. Per tant, l'estrès oxidatiu a córtex d'una forma pre-clínica de la malaltia de Parkinson, ja té un paper en el desenvolupament d'estadis posterior de la malaltia, com podrien ser les DLBDs., [eng] The aim of this work is to study alpha-synuclein interactions in human brain to deep on the knowledge of a group of neurodegenerative diseases called synucleinopathies in which alpha-synuclein accumulates in the form of Lewy bodies. In human cortex we found alpha-synuclein interactions with the synaptic proteins rab3a and rabphilin in Dementia with Lewy Bodies (DLBDs) patients, and not in control brains. This interaction is corroborated in transgenic mice expressing human A30P human mutated alpha-synuclein. When a different synucleipathy , like Multiple Systemic Atrophy (MSA), is studied we found the same anomalous interaction even different areas were affected, cerebellum vs cortex in the case of MSA and DLBDs, indicating a common neurodegenerative mechanism for the synucleinopathies group. Also in DLBDs we studied the glutamatergic signal transduction pathway immunoprecipitating alpha-synuclein from brain cortex and we found that PLC-beta-1, an effector of the metabotropic glutamate receptors (mGLuR1) binds to alpha-synuclein only in control conditions and not in DLBDs. At the same time PLC-beta-1 showed changes in solubility like alpha-synuclein in DLBDs. So, the results presented here indicate a kind of relation between alpha-synuclein and PLC-beta-1 in DLBDs which damage can affect the mGLuR1 transduction pathway which is altered in cortex from DLBDs. The other factor studied in this work is the oxidative stress effect in brain cortex from early stages Parkinson's disease (PD) patients. We found an increase of the oxidative stress markers used in this work indicating that oxidative stress in cortex from PD patients starts at early stages in human cortex, even though in early stages only the substantia nigra seems to be affected. This markers of oxidative stress were also studied in Alzheimer's disease (AD) obtaining similar results. Finally another point of this work is the study of the Amyloid Precursor Protein (A-beta-PP) mRNA isoforms in human cortex from DLBDs. We found a relative increase of the isoforms contained the Kunitz Protease Inhibitor, implicating A-beta-PP the isoforms processing in the developing of DLBDs

The present study investigates global transcriptional changes in frontal cortex area 8 in incidental Lewy Body disease (iLBD), Parkinson disease (PD) and Dementia with Lewy bodies (DLB). We identified different co-expressed gene sets associated with disease stages, and gene ontology categories enriched in gene modules and differentially expressed genes including modules or gene clusters correlated to iLBD comprising upregulated dynein genes and taste receptors, and down-regulated innate inflammation. Focusing on DLB, we found modules with genes significantly enriched in functions related to RNA and DNA production, mitochondria and energy metabolism, purine metabolism, chaperone and protein folding system, and synapses and neurotransmission (particularly the GABAergic system). The expression of more than fifty selected genes was assessed with RT-qPCR. Our findings provide, for the first time, evidence of molecular cortical alterations in iLBD and involvement of several key metabolic pathways and gene hubs in DLB which may underlie cognitive impairment and dementia. Key words: Lewy body diseases, dementia with Lewy bodies, cerebral cortex, transcriptome, mitochondria, synapses, neurotransmission, GABA, purine metabolism, chaperones, dynein, axonema, taste receptors.