Coexistence of Huntington's disease and amyotrophic lateral sclerosis: a clinicopathologic study.
We report a retrospective case series of four patients with genetically confirmed Huntington's disease (HD) and sporadic amyotrophic lateral sclerosis (ALS), examining the brain and spinal cord in two cases. Neuropathological assessment included a polyglutamine recruitment method to detect sites of active polyglutamine aggregation, and biochemical and immunohistochemical assessment of TDP-43 pathology. The clinical sequence of HD and ALS varied, with the onset of ALS occurring after the mid-50's in all cases. Neuropathologic features of HD and ALS coexisted in both cases examined pathologically: neuronal loss and gliosis in the neostriatum and upper and lower motor neurons, with Bunina bodies and ubiquitin-immunoreactive skein-like inclusions in remaining lower motor neurons. One case showed relatively early HD pathology while the other was advanced. Expanded polyglutamine-immunoreactive inclusions and TDP-43-immunoreactive inclusions were widespread in many regions of the CNS, including the motor cortex and spinal anterior horn. Although these two different proteinaceous inclusions coexisted in a small number of neurons, the two proteins did not co-localize within inclusions. The regional distribution of TDP-43-immunoreactive inclusions in the cerebral cortex partly overlapped with that of expanded polyglutamine-immunoreactive inclusions. In the one case examined by TDP-43 immunoblotting, similar TDP-43 isoforms were observed as in ALS. Our findings suggest the possibility that a rare subset of older HD patients is prone to develop features of ALS with an atypical TDP-43 distribution that resembles that of aggregated mutant huntingtin. Age-dependent neuronal dysfunction induced by mutant polyglutamine protein expression may contribute to later-life development of TDP-43 associated motor neuron disease in a small subset of patients with HD.
Department of Neurology, University of Michigan Health System, Ann Arbor, 48109-2200, USA.
Mari
M
Tada
Elizabeth A
EA
Coon
Alexander P
AP
Osmand
Patricia A
PA
Kirby
Wayne
W
Martin
Marguerite
M
Wieler
Atsushi
A
Shiga
Hiroe
H
Shirasaki
Masayoshi
M
Tada
Takao
T
Makifuchi
Mitsunori
M
Yamada
Akiyoshi
A
Kakita
Masatoyo
M
Nishizawa
Hitoshi
H
Takahashi
Henry L
HL
Paulson
D000328:Adult; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000473:pathology; D001921:Brain / Q000378:metabolism / Q000473:pathology; D004268:DNA-Binding Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000150:complications* / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009457:Neuroglia / Q000473:pathology; D009474:Neurons / Q000473:pathology; D010455:Peptides / Q000378:metabolism; D012189:Retrospective Studies; D013116:Spinal Cord / Q000378:metabolism / Q000473:pathology
D004268:DNA-Binding Proteins; D010455:Peptides; C097188:polyglutamine