title: Neuropathologic analysis of Tyr69His TTR variant meningovascular amyloidosis with dementia.
abstract: Transthyretin/TTR gene mutations usually cause systemic amyloidotic diseases. Few TTR variants preferentially affect the central nervous system, manifesting as oculoleptomeningeal amyloidosis. Patients with TTR meningovascular amyloidosis often show dementia, however the neuropathologic features of dementia in these cases have not been elucidated. We report the neuropathologic findings from a brain autopsy of a 72-year-old man with the rare Tyr69His (Y69H) TTR gene variant, dementia and ataxia. Severe amyloid deposits were observed in the leptomeninges and in a subpial and subependymal distribution. Mass spectrometry analysis demonstrated that the amyloid deposits were comprised of over 80 % of the variant TTR. TTR was undetectable by mass spectrometry in the neocortex subjacent to the subpial amyloid deposits. Subpial TTR amyloid deposits were associated with brisk superficial reactive gliosis and siderosis in the neocortex and cerebellar cortex. Subependymal TTR amyloid deposits were associated with subjacent myelin pallor in the hippocampal outflow tract structures including the alveus, fimbria and fornix. Phospho-tau immunostains demonstrated transentorhinal-stage neurofibrillary degeneration (Braak stage II) which, in the absence of neocortical amyloid-beta and neuritic plaques, was indicative of primary age-related tauopathy (PART). However, distinctive phospho-tau aggregates were observed subjacent to the subpial TTR amyloid deposits in all regions of the neocortex, including the primary motor and striate cortices, suggesting a potential link between TTR amyloid and neocortical tauopathy. Our report reveals novel insights into the potential neuropathologic substrates of dementia in variant TTR amyloidosis that need to be investigated in larger autopsy series.
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Edwards Building, Room R-241, 300 Pasteur Drive, Stanford, CA, 94305, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ziskin
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Greicius
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Edwards Building, Room R-241, 300 Pasteur Drive, Stanford, CA, 94305, USA.
authors.forename: Wan
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Vincent Coates Foundation, Stanford University Mass Spectrometry, Stanford, CA, 94305, USA.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Okumu
authors.affiliation: Vincent Coates Foundation, Stanford University Mass Spectrometry, Stanford, CA, 94305, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Adams
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Edwards Building, Room R-241, 300 Pasteur Drive, Stanford, CA, 94305, USA. ploweyed@stanford.edu.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Plowey
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000235:genetics / Q000473:pathology; D004252:DNA Mutational Analysis; D003704:Dementia / Q000150:complications / Q000235:genetics / Q000473:pathology; D006639:Histidine / Q000235:genetics; D006801:Humans; D008297:Male; D011228:Prealbumin / Q000235:genetics*; D014443:Tyrosine / Q000235:genetics
chemical_list: D011228:Prealbumin; D014443:Tyrosine; D006639:Histidine