[en] [en] OBJECTIVE: To investigate whether the occurrence or clearance of microhemorrhages in cerebral amyloid angiopathy (CAA)-related vascular inflammation can be modified by immunosuppressive treatment.
METHODS: Clinical and radiologic follow-up for more than 5 years of a patient with histopathologically confirmed CAA-related vascular inflammation treated with a prolonged and tapered regimen of IV cyclophosphamide and oral steroids.
RESULTS: Under long-term immunosuppressive treatment, a reduced number of cortical micobleeds was observed on repeat MRIs because of both the prevention of new microbleeds and the clearance of those existing at baseline.
CONCLUSIONS: Sustained immunosuppression should be considered and systematically investigated as a treatment option for cortical microbleeds in CAA and related inflammatory phenotypes.
CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence. This is a single observational study without controls.
Disciplines :
Neurologie
Auteur, co-auteur :
Traschütz, Andreas; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
Tzaridis, Theophilos; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
Penner, Arndt-Hendrik; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
Kuchelmeister, Klaus; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
Urbach, Horst; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
Hattingen, Elke; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
HENEKA, Michael ; Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany, Department of Neuroradiology (H.U.), University of Freiburg, Germany, and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany
Co-auteurs externes :
yes
Langue du document :
Anglais
Titre :
Reduction of microbleeds by immunosuppression in a patient with Aβ-related vascular inflammation.
Curtis RE, Boice JD Jr, Stovall M, et al. Risk of leukemia after chemotherapy and radiation treatment for breast cancer. N Engl J Med 1992;326:1745-1751.
Scolding NJ, Joseph F, Kirby PA, et al. Abeta-related angiitis: primary angiitis of the central nervous system associated with cerebral amyloid angiopathy. Brain 2005;128:500-515.
Eng JA, Frosch MP, Choi K, Rebeck GW, Greenberg SM. Clinical manifestations of cerebral amyloid angiopathyrelated inflammation. Ann Neurol 2004;55:250-256.
Salvarani C, Hunder GG, Morris JM, Brown RD Jr, Christianson T, Giannini C. Ab-related angiitis: comparison with CAA without inflammation and primary CNS vasculitis. Neurology 2013;81:1596-1603.
Kinnecom C, Lev MH, Wendell L, et al. Course of cerebral amyloid angiopathy-related inflammation. Neurology 2007;68:1411-1416.
Piazza F, Greenberg SM, Savoiardo M, et al. Anti-amyloid b autoantibodies in cerebral amyloid angiopathy-related inflammation: implications for amyloid-modifying therapies. Ann Neurol 2013;73:449-458.
Cupps TR, Edgar LC, Fauci AS. Suppression of human B lymphocyte function by cyclophosphamide. J Immunol 1982;128:2453-2457.
Lee CY, Landreth GE. The role of microglia in amyloid clearance from the AD brain. J Neural Transm 2010;117: 949-960.
Heneka MT, Kummer MP, Stutz A, et al. NLRP3 is activated in Alzheimer's disease and contributes to pathology in APP/PS1 mice. Nature 2013;493:674-678.
Yamada M, Itoh Y, Shintaku M, et al. Immune reactions associated with cerebral amyloid angiopathy. Stroke 1996; 27:1155-1162.
Maat-Schieman ML, van Duinen SG, Rozemuller AJ, Haan J, Roos RA. Association of vascular amyloid beta and cells of the mononuclear phagocyte system in hereditary cerebral hemorrhage with amyloidosis (Dutch) and Alzheimer disease. J Neuropathol Exp Neurol 1997;56: 273-284.
Winkelstein A. Mechanisms of immunosuppression: effects of cyclophosphamide on cellular immunity. Blood 1973;41:273-284.
McBride WH, Hoon DB, Jung T, Naungayan J, Nizze A, Morton DL. Cyclophosphamide-induced alterations in human monocyte functions. J Leukoc Biol 1987;42: 659-666.
Heneka MT, Carson MJ, El Khoury J, et al. Neuroinflammation in Alzheimer's disease. Lancet Neurol 2015; 14:388-405.
