Dégénérescence lobaire frontotemporale

La dégénérescence lobaire frontotemporale (DLFT), dégénérescence fronto-temporale (DFT) ou démence fronto-temporale (DFT) constitue un ensemble de maladies neurologiques causées par l'atrophie dégénérative focale d'un ou plusieurs lobes cérébraux. Les manifestations de ces maladies dépendent des parties du cerveau concernées par l'atrophie. Ces manifestations sont très différentes de la maladie d'Alzheimer même si l'évolution peut se faire vers une démence. L'autre point commun est le phénomène dégénératif et l'absence de traitement efficace. Le diagnostic se fait sur la clinique et l'imagerie médicale. L'examen anatomopathologique du cerveau est cependant le seul moyen de distinguer avec certitude les différents types de DLFT, car la corrélation demeure imprécise entre les symptômes, l'imagerie et les constatations neuropathologiques. Les limites entre les différentes pathologies sont encore floues. Ces maladies sont rarement héréditaires et quelques gènes commencent à être mis en évidence. Le premier cas a été décrit en 1892 par Arnold Pick. Cette entité a été nommée par Alois Alzheimer « maladie de Pick » en 1911. Il s'agit de la troisième cause de démences avant l'âge de 65 ans (après la maladie d'Alzheimer et les démences vasculaires). Sa prévalence (avant l'âge de 65 ans) est comprise entre 1 et 26 cas pour patients. L'âge de survenue est essentiellement entre 45 et 65 ans mais un tiers des cas surviennent après 65 ans. En 2023, une étude rétrospective européenne montre que le taux d’incidence s'établit à 2,36 cas pour patients-années en Europe avec un maximum du taux d'incidence à 71 ans. Les signes cliniques de DLFT sont variables et permettent de définir les différents phénotypes rencontrés. Certains patients ne peuvent d'ailleurs pas être classés au début de la maladie. Les critères de diagnostic de cette maladie ont fait l'objet d'un consensus. Avec ces éléments de diagnostic sont définis trois catégories. Celle-ci se manifeste par une modification progressive du caractère et du comportement.

Capturing the heterogeneity of alpha-synuclein pathology in synucleinopathies

Melek Firat Altay

Synucleinopathies such as Parkinson's disease, dementia with Lewy bodies and multiple system atrophy (MSA) are detrimental neurodegenerative diseases. Alpha-synuclein (aSyn), the main aggregating protein found in the pathological inclusions of these ailments, exists in numerous modified forms and conformations, leading to neuropathological heterogeneity in synucleinopathies. The functional, pathological and clinical implications of this heterogeneity remain unclear. Responding this knowledge gap requires the development of novel toolsets capable of capturing the biochemical and structural diversity of aSyn pathology in the brain and peripheral tissues.To address this challenge, we describe in Chapter 2 the development and characterisation of antibodies that cover all three regions and post-translational modifications (PTMs) of aSyn. We assess these antibodies through a comprehensive validation pipeline, and select the best performing antibody subset to capture the neuropathological diversity of aSyn across Lewy body diseases (LBDs). We demonstrate that these antibodies could be used to achieve an in-depth characterization of the biochemical and morphological diversity of aSyn aggregates in the neuronal and in vivo models of aSyn seeding. Our results suggest that aSyn pathology is rich in Serine 129 phosphorylation (pS129) and in previously under-described PTMs, including nitration and phosphorylation at Tyrosine 39 (nY39, pY39) and C-terminal tyrosine phosphorylations (pY133, pY136) across neuronal and glial populations in LBDs. We also report that aSyn is hyperphosphorylated in the cellular and in vivo seeding models. In Chapter 3, we demonstrate the power of our antibodies to achieve an unprecedented analysis of astrocytic aSyn pathology in LBDs. We characterise the biochemical properties, post-translational modifications and the aggregation state of astrocytic aSyn accumulations in the limbic regions across sporadic and familial LBDs. The astrocytic aSyn is revealed distinctively by antibodies against the late amino-terminus (N-terminus) and non-amyloid-beta component (NAC) region of aSyn, but not by the extreme N-terminal or carboxy-terminal (C-terminal) antibodies, suggesting that these aSyn species are truncated at both ends. The astrocytic aSyn accumulations are negative for the key markers of Lewy bodies (aSyn pS129, Amytracker, p62- and ubiquitin-positivity and proteinase K resistance), and positive for aSyn nY39 and pY39. These findings suggest that the astrocytic accumulations may be composed of non-fibrillar, possibly oligomeric conformers of aSyn. Chapter 4 focuses on deciphering the biochemical and morphological signatures of aSyn pathology in MSA. The antibodies described in Chapter 2 are applied to high and low pathology regions of MSA brains by immunohistochemistry (IHC). We also biochemically profile the aSyn species, and report an abundance of aSyn pS129-positive glial and neuronal inclusions that correspond to insoluble high molecular weight species by Western blot. We detect an enrichment of insoluble and truncated aSyn in the MSA cerebellum. By IHC, there is an enhancement of aSyn nY39, pY136 and of other aSyn PTMs.Collectively, the new tools and findings described here may pave the way for future studies elucidating the role of these neuronal and glial aSyn proteoforms in disease pathogenesis and propagation in synucleinopathies.

EPFL2022

TDP-43 extracted from frontotemporal lobar degeneration subject brains displays distinct aggregate assemblies and neurotoxic effects reflecting disease progression rates

Henning Paul-Julius Stahlberg, Amanda Jennifer Lewis, Tariq Afroz

Accumulation of abnormally phosphorylated TDP-43 (pTDP-43) is the main pathology in affected neurons of people with amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD). Morphological diversity and neuroanatomical distribution of pTDP-43 accumulations allowed classification of FTLD cases into at least four subtypes, which are correlated with clinical presentations and genetic causes. To understand the molecular basis of this heterogeneity, we developed SarkoSpin, a new method for biochemical isolation of pathological TDP-43. By combining SarkoSpin with mass spectrometry, we revealed proteins beyond TDP-43 that become abnormally insoluble in a disease subtype-specific manner. We show that pTDP-43 extracted from brain forms stable assemblies of distinct densities and morphologies that are associated with disease subtypes. Importantly, biochemically extracted pTDP-43 assemblies showed differential neurotoxicity and seeding that were correlated with disease duration of FTLD subjects. Our data are consistent with the notion that disease heterogeneity could originate from alternate pathological TDP-43 conformations, which are reminiscent of prion strains.

Springer Nature2018

Capturing the heterogeneity of alpha-synuclein pathology in synucleinopathies

Melek Firat Altay

EPFL2022