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Item Globular glial tauopathies (GGT): consensus recommendations(Springer, 2013) Ahmed, Zeshan; Bigio, Eileen H.; Budka, Herbert; Dickson, Dennis W.; Ferrer, Isidro; Ghetti, Bernardino; Giaccone, Giorgio; Hatanpaa, Kimmo J.; Holton, Janice L.; Josephs, Keith A.; Powers, James; Spina, Salvatore; Takahashi, Hitoshi; White, Charles L., III; Revesz, Tamas; Kovacs, Gabor G.; Pathology and Laboratory Medicine, School of MedicineRecent studies have highlighted a group of 4-repeat (4R) tauopathies that are characterised neuropathologically by widespread, globular glial inclusions (GGIs). Tau immunohistochemistry reveals 4R immunoreactive globular oligodendroglial and astrocytic inclusions and the latter are predominantly negative for Gallyas silver staining. These cases are associated with a range of clinical presentations, which correlate with the severity and distribution of underlying tau pathology and neurodegeneration. Their heterogeneous clinicopathological features combined with their rarity and under-recognition have led to cases characterised by GGIs being described in the literature using various and redundant terminologies. In this report, a group of neuropathologists form a consensus on the terminology and classification of cases with GGIs. After studying microscopic images from previously reported cases with suspected GGIs (n = 22), this panel of neuropathologists with extensive experience in the diagnosis of neurodegenerative diseases and a documented record of previous experience with at least one case with GGIs, agreed that (1) GGIs were present in all the cases reviewed; (2) the morphology of globular astrocytic inclusions was different to tufted astrocytes and finally that (3) the cases represented a number of different neuropathological subtypes. They also agreed that the different morphological subtypes are likely to be part of a spectrum of a distinct disease entity, for which they recommend that the overarching term globular glial tauopathy (GGT) should be used. Type I cases typically present with frontotemporal dementia, which correlates with the fronto-temporal distribution of pathology. Type II cases are characterised by pyramidal features reflecting motor cortex involvement and corticospinal tract degeneration. Type III cases can present with a combination of frontotemporal dementia and motor neuron disease with fronto-temporal cortex, motor cortex and corticospinal tract being severely affected. Extrapyramidal features can be present in Type II and III cases and significant degeneration of the white matter is a feature of all GGT subtypes. Improved detection and classification will be necessary for the establishment of neuropathological and clinical diagnostic research criteria in the future.Item Antimicrobial susceptibility among gram-negative isolates collected in the USA between 2005 and 2011 as part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.)(Springer Nature, 2013-09-05) Denys, Gerald A.; Callister, Steven M.; Dowzicky, Michael J.; Pathology and Laboratory Medicine, School of MedicineBackground: The Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) was designed to monitor in vitro antimicrobial susceptibility to tigecycline and comparator agents. We present susceptibility data on Gram-negative organisms collected between 2005 and 2011 from nine United States census regions. Methods: T.E.S.T. was conducted using standardized CLSI methodologies or FDA-approved breakpoints. Results: Tigecycline was highly active (MIC90 ≤ 2 mg/L) against Enterobacteriaceae irrespective of species or region of collection (N = 25011). The isolates were also highly susceptible to the carbapenems when all regional data are combined, except for ESBL-producing Klebsiella pneumoniae (MIC90 16 mg/L) and Acinetobacter baumannii (MIC90 ≥ 32 mg/L). In addition, 883 (30%) of 2900 A. baumannii isolates were classified as multidrug-resistant (MDR): these MDR organisms were most susceptible to tigecycline (MIC90 2 mg/L) and minocycline (MIC90 8 mg/L) when all regional data are considered together. Susceptibility patterns also varied widely among the regions Conclusions: The findings highlight the importance of monitoring antimicrobial susceptibility patterns and implementing effective methods to curb increased resistance and also confirm that additional studies to determine the efficacy of tigecycline in vivo, especially for treating infections with MDR organisms, are warranted.Item The placenta findings from an XYY abortus: a case report(Springer Nature, 2013-10-01) Fan, Rong; Pathology and Laboratory Medicine, School of MedicineIntroduction: The placenta morphology from an XYY pregnancy abortus has not been reported in the medical literature. This case report consists of the first detailed documentation. The reported case is also highly unusual because the mother had two prior pregnancies with fetuses being confirmed to have Zellweger syndrome and one prior molar pregnancy. Case presentation: A 43-year-old Caucasian woman presented for induction of labor secondary to diagnosis of XYY chromosomes by chorionic villus sample. Conclusions: This is the first detailed observation of placenta morphology in an XYY abortus. Although not highly specific, the observation is very unique and should prompt further investigation of karyotyping of the fetus or infant because an XYY individual may be viable and grow to adulthood. The association of an XYY abortus and prior pregnancies with Zellweger syndrome and one prior molar pregnancy is also highly notable.Item Role of sortase in Streptococcus mutans under the effect of nicotine(Springer Nature, 2013) Li, Ming-Yun; Huang, Rui-Jie; Zhou, Xue-Dong; Gregory, Richard L.; Pathology and Laboratory Medicine, School of MedicineStreptococcus mutans is a common Gram-positive bacterium and plays a significant role in dental caries. Tobacco and/or nicotine have documented effects on S. mutans growth and colonization. Sortase A is used by many Gram-positive bacteria, including S. mutans, to facilitate the insertion of certain cell surface proteins, containing an LPXTGX motif such as antigen I/II. This study examined the effect of nicotine on the function of sortase A to control the physiology and growth of S. mutans using wild-type S. mutans NG8, and its isogenic sortase-defective and -complemented strains. Briefly, the strains were treated with increasing amounts of nicotine in planktonic growth, biofilm metabolism, and sucrose-induced and saliva-induced antigen I/II-dependent biofilm formation assays. The strains exhibited no significant differences with different concentrations of nicotine in planktonic growth assays. However, they had significantly increased (P≤0.05) biofilm metabolic activity (2- to 3-fold increase) as the concentration of nicotine increased. Furthermore, the sortase-defective strain was more sensitive metabolically to nicotine than the wild-type or sortase-complemented strains. All strains had significantly increased sucrose-induced biofilm formation (2- to 3-fold increase) as a result of increasing concentrations of nicotine. However, the sortase-defective strain was not able to make as much sucrose- and saliva-induced biofilm as the wild-type NG8 did with increasing nicotine concentrations. These results indicated that nicotine increased metabolic activity and sucrose-induced biofilm formation. The saliva-induced biofilm formation assay and qPCR data suggested that antigen I/II was upregulated with nicotine but biofilm was not able to be formed as much as wild-type NG8 without functional sortase A.Item Type V Collagen Induced Tolerance Suppresses Collagen Deposition, TGF-β and Associated Transcripts in Pulmonary Fibrosis(Public Library of Science, 2013-10-21) Vittal, Ragini; Mickler, Elizabeth A.; Fisher, Amanda J.; Zhang, Chen; Rothhaar, Katia; Gu, Hongmei; Brown, Krista M.; Emtiazdjoo, Amir; Lott, Jeremy M.; Frye, Sarah B.; Smith, Gerald N.; Sandusky, George E.; Cummings, Oscar W.; Wilkes, David S.; Pathology and Laboratory Medicine, School of MedicineRationale: Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by progressive scarring and matrix deposition. Recent reports highlight an autoimmune component in IPF pathogenesis. We have reported anti-col(V) immunity in IPF patients. The objective of our study was to determine the specificity of col(V) expression profile and anti-col(V) immunity relative to col(I) in clinical IPF and the efficacy of nebulized col(V) in pre-clinical IPF models. Methods: Col(V) and col(I) expression profile was analyzed in normal human and IPF tissues. C57-BL6 mice were intratracheally instilled with bleomycin (0.025 U) followed by col(V) nebulization at pre-/post-fibrotic stage and analyzed for systemic and local responses. Results: Compared to normal lungs, IPF lungs had higher protein and transcript expression of the alpha 1 chain of col(V) and col(I). Systemic anti-col(V) antibody concentrations, but not of anti-col(I), were higher in IPF patients. Nebulized col(V), but not col(I), prevented bleomycin-induced fibrosis, collagen deposition, and myofibroblast differentiation. Col(V) treatment suppressed systemic levels of anti-col(V) antibodies, IL-6 and TNF-α; and local Il-17a transcripts. Compared to controls, nebulized col(V)-induced tolerance abrogated antigen-specific proliferation in mediastinal lymphocytes and production of IL-17A, IL-6, TNF-α and IFN-γ. In a clinically relevant established fibrosis model, nebulized col(V) decreased collagen deposition. mRNA array revealed downregulation of genes specific to fibrosis (Tgf-β, Il-1β, Pdgfb), matrix (Acta2, Col1a2, Col3a1, Lox, Itgb1/6, Itga2/3) and members of the TGF-β superfamily (Tgfbr1/2, Smad2/3, Ltbp1, Serpine1, Nfkb/Sp1/Cebpb). Conclusions: Anti-col(V) immunity is pathogenic in IPF, and col(V)-induced tolerance abrogates bleomycin-induced fibrogenesis and down regulates TGF- β-related signaling pathways.Item TMEM106B is a genetic modifier of frontotemporal lobar degeneration with C9orf72 hexanucleotide repeat expansions(Springer, 2014) Gallagher, Michael D.; Suh, Eunran; Grossman, Murray; Elman, Lauren; McCluskey, Leo; Van Swieten, John C.; Al-Sarraj, Safa; Neumann, Manuela; Gelpi, Ellen; Ghetti, Bernardino; Rohrer, Jonathan D.; Halliday, Glenda; Van Broeckhoven, Christine; Seilhean, Danielle; Shaw, Pamela J.; Frosch, Matthew P.; International Collaboration for Frontotemporal Lobar Degeneration; Trojanowski, John Q.; Lee, Virginia M. Y.; Van Deerlin, Vivianna; Chen-Plotkin, Alice S.; Pathology and Laboratory Medicine, School of MedicineHexanucleotide repeat expansions in chromosome 9 open reading frame 72 (C9orf72) have recently been linked to frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS), and may be the most common genetic cause of both neurodegenerative diseases. Genetic variants at TMEM106B influence risk for the most common neuropathological subtype of FTLD, characterized by inclusions of TAR DNA binding protein of 43kDa (FTLD-TDP). Previous reports have shown that TMEM106B is a genetic modifier of FTLD-TDP caused by progranulin (GRN) mutations, with the major (risk) allele of rs1990622 associating with earlier age at onset of disease. Here we report that rs1990622 genotype affects age at death in a single-site discovery cohort of FTLD patients with C9orf72 expansions (n=14), with the major allele correlated with later age at death (p=0.024). We replicate this modifier effect in a 30-site international neuropathological cohort of FTLD-TDP patients with C9orf72 expansions (n=75), again finding that the major allele associates with later age at death (p=0.016), as well as later age at onset (p=0.019). In contrast, TMEM106B genotype does not affect age at onset or death in 241 FTLD-TDP cases negative for GRN mutations or C9orf72 expansions. Thus, TMEM106B is a genetic modifier of FTLD with C9orf72 expansions. Intriguingly, the genotype that confers increased risk for developing FTLD-TDP (major, or T, allele of rs1990622) is associated with later age at onset and death in C9orf72 expansion carriers, providing an example of sign epistasis in human neurodegenerative disease.Item Amyloid peptides ABri and ADan show differential neurotoxicity in transgenic Drosophila models of familial British and Danish dementia(Springer Nature, 2014-01-09) Marcora, María S.; Fernández-Gamba, Agata C.; Avendaño, Luz A.; Rotondaro, Cecilia; Podhajcer, Osvaldo L.; Vidal, Rubén; Morelli, Laura; Ceriani, María F.; Castaño, Eduardo M.; Pathology and Laboratory Medicine, School of MedicineBackground: Familial British and Familial Danish dementias (FBD and FDD, respectively) are associated with mutations in the BRI2 gene. Processing of the mutated BRI2 protein leads to the accumulation in the brain of the 34-mer amyloid Bri (ABri) and amyloid Dan (ADan) peptides, accompanied by neurofibrillary tangles. Recently, transgenic mice successfully reproduced different aspects of FDD, while modeling of FBD in vivo has been more difficult. In this work we have modeled FBD and FDD in Drosophila and tested the hypothesis that ABri and ADan are differentially neurotoxic. Results: By using site-directed insertion, we generated transgenic lines carrying ABri, ADan, Bri2-23 (the normal product of wild-type BRI2 processing) and amyloid-β (Aβ) 1-42 as a well-characterized neurotoxic peptide, alone or with a His-tag. Therefore, we avoided random insertion effects and were able to compare levels of accumulation accurately. Peptides were expressed with the GAL4-Upstream Activating Sequence (UAS) system using specific drivers. Despite low levels of expression, toxicity in the eye was characterized by mild disorganization of ommatidia and amyloid peptides accumulation. The highest toxicity was seen for ADan, followed by Aβ42 and ABri. Pan-neuronal expression in the CNS revealed an age-dependent toxicity of amyloid peptides as determined by the ability of flies to climb in a geotaxis paradigm when compared to Bri2-23. This effect was stronger for ADan, detected at 7 days post-eclosion, and followed by ABri and Aβ42, whose toxicity became evident after 15 and 21 days, respectively. Histological analysis showed mild vacuolization and thioflavine-S-negative deposits of amyloid peptides. In contrast, the over-expression of amyloid peptides in the specific subset of lateral neurons that control circadian locomotor activity showed no toxicity. Conclusions: Our results support the differential neurotoxicity of ADan and ABri in the Drosophila eye and CNS at low expression levels. Such differences may be partially attributed to rates of aggregation and accumulation. In the CNS, both peptides appear to be more neurotoxic than wild-type Aβ42. These Drosophila models will allow a systematic and unambiguous comparison of differences and similarities in the mechanisms of toxicity of diverse amyloid peptides associated with dementia.Item Correlation of BAG-3 and Heat Shock Protein 70 with CD30 expression in T-cell Lymphomas(Springer Nature, 2014-02-04) Jiang, L.; Zhao, Z.; Menke, D. M.; Rizzo, K. A.; Pathology and Laboratory Medicine, School of MedicineT-cell lymphomas are aggressive lymphomas with decreased prognosis and resistance to therapy. BAG-3 and heat shock protein 70 (HSP70) function in chemotherapeutic resistance and cellular survival. Expression of BAG-3 has not been investigated in T cell lymphomas. We investigated fifty cases including benign, systemic and cutaneous T cell lymphomas. Benign T cells were negative for BAG-3 and HSP70 immunohistochemical staining. BAG-3 expression correlated with increased HSP70 expression in a subset of systemic T cell lymphoma cases co-expressing the CD30 antigen. Correlation between BAG-3, HSP70 and CD30 expression was not seen in cutaneous T cell lymphoma cases. However, these cases showed a significant increase in BAG-3 staining when compared to CD30 negative systemic T cell lymphoma cases. The differential protein expression profile of BAG-3 and HSP70 may indicate a specific role for these proteins and the ubiquitin-proteasome system/autophagy in T cell lymphomas which may help guide future targeted therapy.Item The radiogenomic and spatiogenomic landscapes of glioblastoma and their relationship to oncogenic drivers(Springer Nature, 2025-03-01) Fathi Kazerooni, Anahita; Akbari, Hamed; Hu, Xiaoju; Bommineni, Vikas; Grigoriadis, Dimitris; Toorens, Erik; Sako, Chiharu; Mamourian, Elizabeth; Ballinger, Dominique; Sussman, Robyn; Singh, Ashish; Verginadis, Ioannis I.; Dahmane, Nadia; Koumenis, Constantinos; Binder, Zev A.; Bagley, Stephen J.; Mohan, Suyash; Hatzigeorgiou, Artemis; O'Rourke, Donald M.; Ganguly, Tapan; De, Subhajyoti; Bakas, Spyridon; Nasrallah, MacLean P.; Davatzikos, Christos; Pathology and Laboratory Medicine, School of MedicineBackground: Glioblastoma is a highly heterogeneous brain tumor, posing challenges for precision therapies and patient stratification in clinical trials. Understanding how genetic mutations influence tumor imaging may improve patient management and treatment outcomes. This study investigates the relationship between imaging features, spatial patterns of tumor location, and genetic alterations in IDH-wildtype glioblastoma, as well as the likely sequence of mutational events. Methods: We conducted a retrospective analysis of 357 IDH-wildtype glioblastomas with pre-operative multiparametric MRI and targeted genetic sequencing data. Radiogenomic signatures and spatial distribution maps were generated for key mutations in genes such as EGFR, PTEN, TP53, and NF1 and their corresponding pathways. Machine and deep learning models were used to identify imaging biomarkers and stratify tumors based on their genetic profiles and molecular heterogeneity. Results: Here, we show that glioblastoma mutations produce distinctive imaging signatures, which are more pronounced in tumors with less molecular heterogeneity. These signatures provide insights into how mutations affect tumor characteristics such as neovascularization, cell density, invasion, and vascular leakage. We also found that tumor location and spatial distribution correlate with genetic profiles, revealing associations between tumor regions and specific oncogenic drivers. Additionally, imaging features reflect the cross-sectionally inferred evolutionary trajectories of glioblastomas. Conclusions: This study establishes clinically accessible imaging biomarkers that capture the molecular composition and oncogenic drivers of glioblastoma. These findings have potential implications for noninvasive tumor profiling, personalized therapies, and improved patient stratification in clinical trials.Item Computational pathology assessments of cardiac stromal remodeling: Clinical correlates and prognostic implications in heart transplantation(Elsevier, 2024-12-28) Peyster, Eliot G.; Yuan, Cai; Arabyarmohammadi, Sara; Lal, Priti; Feldman, Michael D.; Fu, Pingfu; Margulies, Kenneth B.; Madabhushi, Anant; Pathology and Laboratory Medicine, School of MedicineBackground: The hostile immune environment created by allotransplantation can accelerate pathologic tissue remodeling. Both overt and indolent inflammatory insults propel this remodeling, but there is a paucity of tools for monitoring the speed and severity of remodeling over time. Methods: This retrospective cohort consisted of n = 2,167 digitized heart transplant biopsy slides along with records of prior inflammatory events and future allograft outcomes (cardiac death or allograft vasculopathy). Utilizing computational pathology analysis, biopsy images were analyzed to identify the pathologic stromal changes associated with future allograft loss or vasculopathy. Biopsy images were then analyzed to assess which historical inflammatory events drive progression of these pathologic stromal changes. Results: The top 5 features of pathologic stromal remodeling most associated with adverse allograft outcomes were also strongly associated with histories of both overt and indolent inflammatory events. Compared to controls, a history of high-grade or treated rejection was significantly associated with progressive pathologic remodeling and future adverse outcomes (32.9% vs 5.1%, p < 0.001). A history of recurrent low-grade rejection and Quilty lesions was also significantly associated with pathologic remodeling and adverse outcomes vs controls (12.7% vs 5.1%, p = 0.047). A history of high-grade or treated rejection in the absence of recurrent low-grade rejection history was not associated with pathologic remodeling or adverse outcomes (7.1% vs 5.1%, p = 0.67). Conclusions: A history of both traditionally treated and traditionally ignored alloimmune responses can predispose patients to pathologic allograft remodeling and adverse outcomes. Computational pathology analysis of allograft stroma yields translationally relevant biomarkers, identifying accelerated remodeling before adverse outcomes occur. Data availability: The data that support the findings of this study are presented in the manuscript and extended data sections. Unprocessed raw data are available from the corresponding author upon reasonable request. Source code for the stromal feature analysis pipeline is hosted on GitHub and freely available: https://github.service.emory.edu/CYUAN31/Pathomics_StromalBioMarker_in_Myocardium.git.