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.

Skin as a promising biomatrix for the early detection of misfolded proteins by RT-QuIC in neurodegenerative diseases

Real-Time Quaking-Induced Conversion (RT-QuIC) is an ultrasensitive assay capable of detecting pathological aggregates of misfolded proteins in biospecimens. In recent years, efforts have been made to find a more feasible and convenient biomatrix as an alternative to CSF, and skin biopsy may be a suitable candidate. This project aimed to evaluate the diagnostic performance of skin RT-QuIC in 3 different cohorts of patients: 1. Creutzfeldt-Jakob disease (CJD), 2. Lewy body disease (LBD), and 3. Isolated REM sleep behavior disorder (iRBD). We studied 71 punch skin samples of 35 patients with CJD, including five assessed in vitam, using 2 two different substrates: Bank vole 23-230 (Bv23-230) and Syrian hamster 23-231 (Ha23-231) recombinant prion protein. Skin prion RT-QuIC showed a 100% specificity with both substrates and a higher sensitivity with the Bv23-230 than Ha23-231 (87.5% vs. 65.6%, respectively). Forty-one patients underwent both lumbar puncture (LB) and skin biopsy; CSF and skin RT-QuIC showed a high level of concordance (38/41, 92.7%). Then, we analyzed samples taken in vitam (n=69) or postmortem (n=49) from patients with Parkinson’s disease (PD), dementia with Lewy bodies (DLB), incidental Lewy body pathology, and neurological controls. Skin α-syn RT-QuIC distinguished LBD patients with an overall accuracy of 94.1% in the two cohorts (sensitivity, 89.2%; specificity, 96.3%). Seventy-nine patients underwent both CSF and skin α-syn RT-QuIC, and the two assays yielded similar diagnostic accuracy (skin, 97.5%; CSF, 98.7%). Finally, we studied 91 iRBD patients and 41 control. In the skin, RT-QuIC showed a sensitivity of 76.9%, specificity of 97.6%, and 82.0% accuracy. 128 participants (88 patients plus 40 controls) underwent both CSF and skin RT-QuIC. The two protocols showed 99.2% of concordance. These works confirmed that skin punch biopsies might represent a valid and convenient alternative to CSF analysis for an early diagnosis of prion diseases and LB-related pathologies.

Atomic Force Microscopy Studies of the Amyloidogenic Processes of Intrinsically Unstructured Proteins related to Neurodegenerative Diseases

Protein aggregation and formation of insoluble aggregates in central nervous system is the main cause of neurodegenerative disease. Parkinson’s disease is associated with the appearance of spherical masses of aggregated proteins inside nerve cells called Lewy bodies. α-Synuclein is the main component of Lewy bodies. In addition to α-synuclein, there are more than a hundred of other proteins co-localized in Lewy bodies: 14-3-3η protein is one of them. In order to increase our understanding on the aggregation mechanism of α-synuclein and to study the effect of 14-3-3η on it, I addressed the following questions. (i) How α-synuclein monomers pack each other during aggregation? (ii) Which is the role of 14-3-3η on α-synuclein packing during its aggregation? (iii) Which is the role of 14-3-3η on an aggregation of α-synuclein “seeded” by fragments of its fibrils? In order to answer these questions, I used different biophysical techniques (e.g., Atomic force microscope (AFM), Nuclear magnetic resonance (NMR), Surface plasmon resonance (SPR) and Fluorescence spectroscopy (FS)).

Provenienza dei sedimenti arenitici nel bacino di Tracia (eo-oligocene, Turchia nord-occidentale e Grecia nord-orientale)

The Thrace Basin is the largest and thickest Tertiary sedimentary basin of the eastern Balkans region and constitutes an important hydrocarbon province. It is located between the Rhodope-Strandja Massif to the north and west, the Marmara Sea and Biga Peninsula to the south, and the Black Sea to the est. It consists of a complex system of depocenters and uplifts with very articulate paleotopography indicated by abrupt lateral facies variations. Its southeastern margin is widely deformed by the Ganos Fault, a segment of the North Anatolian strike-slip fault system . Most of the Thrace Basin fill ranges from the Eocene to the Late Oligocene. Maximum total thickness, including the Neogene-Quaternary succession, reaches 9.000 meters in a few narrow depocenters. This sedimentary succession consists mainly of basin plain turbiditic deposits with a significant volcaniclastic component which evolves upwards to shelf deposits and continental facies, with deltaic bodies prograding towards the basin center in the Oligocene. This work deals with the provenance of Eocene-Oligocene clastic sediments of the southern and western part of Thrace Basin in Turkey and Greece. Sandstone compositional data (78 gross composition analyses and 40 heavy minerals analyses) were used to understand the change in detrital modes which reflects the provenance and geodinamic evolution of the basin. Samples were collected at six localities, which are from west to est: Gökçeada, Gallipoli and South-Ganos (south of Ganos Fault), Alexandroupolis, Korudağ and North-Ganos (north of Ganos Fault). Petrologic (framework composition and heavy-mineral analyses) and stratigraphic-sedimentologic data, (analysis of sedimentologic facies associations along representative stratigraphic sections, paleocurrents) allowed discrimination of six petrofacies; for each petrofacies the sediment dispersal system was delineated. The Thrace Basin fill is made mainly of lithic arkoses and arkosic litharenites with variable amount of low-grade metamorphic lithics (also ophiolitic), neovolcanic lithics, and carbonate grains (mainly extrabasinal). Picotite is the most widespread heavy mineral in all petrofacies. Petrological data on analyzed successions show a complex sediment dispersal pattern and evolution of the basin, indicating one principal detrital input from a source area located to the south, along both the İzmir-Ankara and Intra-Pontide suture lines, and a possible secondary source area, represented by the Rhodope Massif to the west. A significant portion of the Thrace Basin sediments in the study area were derived from ophiolitic source rocks and from their oceanic cover, whereas epimetamorphic detrital components came from a low-grade crystalline basement. An important penecontemporaneous volcanic component is widespread in late Eocene-Oligocene times, indicating widespread post-collisional (collapse?) volcanism following the closure of the Vardar ocean. Large-scale sediment mass wasting from south to north along the southern margin of the Thrace Basin is indicated (i) in late Eocene time by large olistoliths of ophiolites and penecontemporaneous carbonates, and (ii) in the mid-Oligocene by large volcaniclastic olistoliths. The late Oligocene paleogeographic scenario was characterized by large deltaic bodies prograding northward (Osmancik Formation). This clearly indicates that the southern margin of the basin acted as a major sediment source area throughout its Eocene-Oligocene history. Another major sediment source area is represented by the Rhodope Massif, in particolar the Circum-Rhodopic belt, especially for plutonic and metamorphic rocks. Considering preexisting data on the petrologic composition of Thrace Basin, silicilastic sediments in Greece and Bulgaria (Caracciolo, 2009), a Rhodopian provenance could be considered mostly for areas of the Thrace Basin outside our study area, particularly in the northern-central portions of the basin. In summary, the most important source area for the sediment of Thrace Basin in the study area was represented by the exhumed subduction-accretion complex along the southern margin of the basin (Biga Peninsula and western-central Marmara Sea region). Most measured paleocurrent indicators show an eastward paleoflow but this is most likely the result of gravity flow deflection. This is possible considered a strong control due to the east-west-trending synsedimentary transcurrent faults which cuts the Thrace Basin, generating a series of depocenters and uplifts which deeply influenced sediment dispersal and the areal distribution of paleoenvironments. The Thrace Basin was long interpreted as a forearc basin between a magmatic arc to the north and a subduction-accretion complex to the south, developed in a context of northward subduction. This interpretation was challenged by more recent data emphasizing the lack of a coeval magmatic arc in the north and the interpretation of the chaotic deposit which outcrop south of Ganos Fault as olistoliths and large submarine slumps, derived from the erosion and sedimentary reworking of an older mélange unit located to the south (not as tectonic mélange formed in an accretionary prism). The present study corroborates instead the hypothesis of a post-collisional origin of the Thrace Basin, due to a phase of orogenic collapse, which generated a series of mid-Eocene depocenters all along the İzmir-Ankara suture (following closure of the Vardar-İzmir-Ankara ocean and the ensuing collision); then the slab roll-back of the remnant Pindos ocean played an important role in enhancing subsidence and creating additional accommodation space for sediment deposition.

Fluid-structure interaction by a coupled lattice Boltzmann-finite element approach

In this thesis, a strategy to model the behavior of fluids and their interaction with deformable bodies is proposed. The fluid domain is modeled by using the lattice Boltzmann method, thus analyzing the fluid dynamics by a mesoscopic point of view. It has been proved that the solution provided by this method is equivalent to solve the Navier-Stokes equations for an incompressible flow with a second-order accuracy. Slender elastic structures idealized through beam finite elements are used. Large displacements are accounted for by using the corotational formulation. Structural dynamics is computed by using the Time Discontinuous Galerkin method. Therefore, two different solution procedures are used, one for the fluid domain and the other for the structural part, respectively. These two solvers need to communicate and to transfer each other several information, i.e. stresses, velocities, displacements. In order to guarantee a continuous, effective, and mutual exchange of information, a coupling strategy, consisting of three different algorithms, has been developed and numerically tested. In particular, the effectiveness of the three algorithms is shown in terms of interface energy artificially produced by the approximate fulfilling of compatibility and equilibrium conditions at the fluid-structure interface. The proposed coupled approach is used in order to solve different fluid-structure interaction problems, i.e. cantilever beams immersed in a viscous fluid, the impact of the hull of the ship on the marine free-surface, blood flow in a deformable vessels, and even flapping wings simulating the take-off of a butterfly. The good results achieved in each application highlight the effectiveness of the proposed methodology and of the C++ developed software to successfully approach several two-dimensional fluid-structure interaction problems.

Role of nuclear redox control, intra-population heterogeneity and oxygen tension in human amniotic fluid stem cells aging

Amniotic fluid stem cells (hAFSC) are emerging as a potential therapeutic approach for various disorders. The low number of available hAFSC requires their ex vivo expansion prior to clinical use, however, during their in vitro culture, hAFSC quickly reach replicative senescence. The principal aim of this study was to investigate the aging process occurring during in vitro expansion of hAFSC, focusing on the redox control that has been reported to be affected in premature and physiological aging. My results show that a strong heterogeneity is present among samples that reflects their different behaviour in culture. I identified three proteins, namely Nox4, prelamin A and PML, which expression increases during hAFSC aging process and could be used as new biomarkers to screen the samples. Furthermore, I found that Nox4 degradation is regulated by sumoylation via proteasome and involves interactions with PML bodies and prelamin A. Since various studies revealed that donor-dependent differences could be explained by cell-to-cell variation within each patient, I studied in deep this phenomenon. I showed that the heterogeneity among samples is also accompanied by a strong intra-population heterogeneity. Separation of hAFSC subpopulations from the same donor, using Celector® technology, showed that an enrichment in the last eluted fraction could improve hAFSC application in regenerative medicine. One of the other problems is that nowadays hAFSC are expanded under atmospheric O2 concentration, which is higher than the O2 tension in their natural niches. This higher O2 concentration might cause environmental stress to the in vitro cultured hAFSCs and accelerate their aging process. Here, I showed that prolonged low oxygen tension exposure preserves different hAFSC stemness properties. In conclusion, my study pointed different approaches to improve in vitro hAFSC expansion and manipulation with the purpose to land at stem cell therapy.

Genetic and environmental factors associated with the risk of cognitive decline and dementia

AD is the most common age related neurodegenerative disease in the industrialized world. Clinically AD is defined as a progressing decline of cognitive functions. Neuropathologically, AD is characterized by the aggregation of b-amyloid (Ab) peptide in the form of extracellular senile plaques, and hyperphosphorlylated tau protein in the form of intracellular neurofibrillary tangles. These neuropathological hallmarks are often accompanied by abundant microvascular damage and pronounced inflammation of the affected brain regions. In this thesis we investigated several aspects of AD focusing on the genetic aspect. We confirmed that Alpha 1 antichymotrypsin (ACT), an acute phase protein, was associated to AD subjects, being plasma levels higher in AD cases than controls. In addition, in a GWA study we demonstrated that two different gene, Clusterin and CR1 were strongly associated to AD. A single gene association not explain such a complex disease like AD. The goal should be to created a network of genetic, phenotypic and clinical data associated to AD. We used a new algorithm, the ANNs, aimed to map variables and search for connectivity among variables. We found specific variables associated to AD like cholesterol levels, the presence of variation in HMGCR enzyme and the age. Other factors such as the BMI, the amount of HDL and blood folate levels were also associated with AD. Pathogen infections, above all viral infections, have been previously associated to AD. The hypothesis suggests that virus and in particular herpes virus could enter the brain when an individual becomes older, perhaps because of a decline in the immune system. Our new hypothesis is that the presence of SNPs in our GWA gene study results in a genetic signature that might affect individual brain susceptibility to infection by herpes virus family during aging.

Longitudinal evolution of cognitive functions in patients with multiple system atrophy: a prospective study

Introduction and Background: Multiple system atrophy (MSA) is a sporadic, adult-onset, progressive neurodegenerative disease characterized clinically by parkinsonism, cerebellar ataxia, and autonomic failure. We investigated cognitive functions longitudinally in a group of probable MSA patients, matching data with sleep parameters. Patients and Methods: 10 patients (7m/3f) underwent a detailed interview, a general and neurological examination, laboratory exams, MRI scans, a cardiovascular reflexes study, a battery of neuropsychological tests, and video-polysomnographic recording (VPSG). Patients were revaluated (T1) a mean of 16±5 (range: 12-28) months after the initial evaluation (T0). At T1, the neuropsychological assessment and VPSG were repeated. Results: The mean patient age was 57.8±6.4 years (range: 47-64) with a mean age at disease onset of 53.2±7.1 years (range: 43-61) and symptoms duration at T0 of 60±48 months (range: 12-144). At T0, 7 patients showed no cognitive deficits while 3 patients showed isolated cognitive deficits. At T1, 1 patient worsened developing multiple cognitive deficits from a normal condition. At T0 and T1, sleep efficiency was reduced, REM latency increased, NREM sleep stages 1-2 slightly increased. Comparisons between T1 and T0 showed a significant worsening in two tests of attention and no significant differences of VPSG parameters. No correlation was found between neuropsychological results and VPSG findings or RBD duration. Discussion and Conclusions: The majority of our patients do not show any cognitive deficits at T0 and T1, while isolated cognitive deficits are present in the remaining patients. Attention is the cognitive function which significantly worsened. Our data confirm the previous findings concerning the prevalence, type and the evolution of cognitive deficits in MSA. Regarding the developing of a condition of dementia, our data did not show a clear-cut diagnosis of dementia. We confirm a mild alteration of sleep structure. RBD duration does not correlate with neuropsychological findings.

Continuous-Flow Magnetic Separation with Permanent Magnets for Water Treatment

More efficient water treatment technologies would decrease the water bodies’ pollution and the actual intake of water resource. The aim of this thesis is an in-depth analysis of the magnetic separation of pollutants from water by means of a continuous-flow magnetic filter subjected to a field gradient produced by permanent magnets. This technique has the potential to improve times and efficiencies of both urban wastewater treatment plants and drinking water treatment plants. It might also substitute industrial wastewater treatments. This technique combines a physico-chemical phase of adsorption and a magnetic phase of filtration, having the potential to bond magnetite with any conventional adsorbent powder. The removal of both Magnetic Activated Carbons (MACs) and zeolite-magnetite mix with the addition of a coagulant was investigated. Adsorption tests of different pollutants (surfactants, endocrine disruptors, Fe(III), Mn(II), Ca(II)) on these adsorbents were also performed achieving good results. The numerical results concerning the adsorbent removals well reproduced the experimental ones obtained from two different experimental setups. In real situations the treatable flow rates are up to 90 m3/h (2000 m3/d).