Evaluation of alpha-synuclein RT-QuIC for an early and differential diagnosis of Lewy body disease

Synucleinopathies are a group of neurodegenerative diseases characterized by tissue deposition of insoluble aggregates of the protein α-synuclein. Currently, the clinical diagnosis of these diseases, including Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), is very challenging, especially at an early disease stage, due to the heterogeneous and often non-specific clinical manifestations. Therefore, identifying specific biomarkers to aid the diagnosis and improve the clinical management of patients with these disorders represents a primary goal in the field. Pursuing this aim, we applied the α-Syn Real-Time Quaking-Induced Conversion (RT-QuIC), an ultrasensitive technique able to detect minute amounts of amyloidogenic proteins, to a large cohort of 953 CSF samples from clinically well-characterized (“clinical” group), or neuropathologically verified (“NP” group) patients with parkinsonism or dementia. Of significance, we also studied patients with prodromal synucleinopathies (“prodromal” group), such as pure autonomic failure (PAF) (n = 28), isolated REM sleep behavior disorder (iRBD) (n = 18), and mild cognitive impairment due to probable Lewy body (LB) disease (MCI-LB) (n = 81). Our findings show that α-syn RT-QuIC can accurately detect α-Syn seeding activity across the whole spectrum of LB-related disorders (LBD), exhibiting a mean sensitivity of 95.2% in the “clinical” and “NP” group, while ranging between 89.3% (PAF) and 100% (RBD) in the “prodromal group”. Moreover, we observed 95.1% sensitivity and 96.6% specificity in the distinction between MCI-LB patients and cognitively unimpaired controls, demonstrating the solid diagnostic potential of α-Syn RT-QuIC in the early phase of the disease. Finally, 13.3% of MCI-AD patients also had a positive test, suggesting an underlying LB co-pathology. This work demonstrated that α-Syn RT-QuIC is an efficient assay for accurate and early diagnosis of LBD, which should be implemented for clinical management and recruitment for clinical trials in memory clinics.

High temporal resolution insights into early life histories: integrating histomorphometric, trace element and isotopic analyses of dental hard tissues in archaeological populations from Italy

Teeth, with their high mineralisation, incremental growth, and lack of remodelling, serve as biological archives that document an individual's development. This project aims to utilise the potential of teeth in bioarchaeological studies to achieve three primary objectives: 1) to investigate the application of histological and histochemical methods in reconstructing developmental bio-chronologies and early life histories; 2) to refine the temporal precision of isotopic analysis of dentine collagen by developing a novel protocol that integrates micro-sampling techniques with high-resolution histomorphometrics; and 3) to synthesise data from enamel and dentine for a comprehensive understanding of early life development and dietary transitions. This study adopts an integrated multidisciplinary bioarchaeological approach, conducting histomorphometric analysis on enamel and dentine across deciduous and permanent dentitions. It applies high-temporal resolution trace element analysis to enamel using LA-ICPMS and δ13C and δ15N isotope analyses through sequential micro-sampling to dentine of permanent teeth. Samples were selected from diverse archaeological contexts across the Italian peninsula, covering the Upper Palaeolithic, Copper Age, and Early Medieval periods, providing insight into diachronic variations in infant development and life history. Findings highlight the efficacy of histological and histochemical techniques in accurately determining growth rates, physiological stress, dietary shifts (particularly timing of weaning), and age at death in infant remains. The consistency and comparison between enamel and dentine underscores the enhanced insight obtained from integrating information from both tissues. Importantly, the newly proposed protocol significantly improves the temporal accuracy of dentine collagen analysis, facilitating precise chronological placement of the results over broad developmental associations. This study reaffirms the significance of teeth as valuable bioarchaeological instruments. By introducing and testing multidisciplinary methods, it provides deeper insights into early life history and cultural practices across diverse chronological contexts, highlighting the importance of advanced methodologies in extracting detailed, accurate, and nuanced information from past populations.