TDP-43 in differential diagnosis of motor neuron disorders

Dennis W. Dickson, Keith A. Josephs, Catalina Amador

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Motor neuron disorders are clinically and pathologically heterogeneous. They can be classified into those that affect primarily upper motor neurons, lower motor neurons or both. The most common disorder to affect both upper and lower motor neurons is amyotrophic lateral sclerosis (ALS). Some forms of motor neuron disease (MND) affect primarily motor neurons in the spinal cord or brainstem, while others affect motor neurons at all levels of the neuraxis. A number of genetic loci have been identified for the various motor neuron disorders. Several of the MND genes encode for proteins important for cytoskeletal stability and axoplasmic transport. Despite these genetic advances, the relationship of the various motor neuron disorders to each other is unclear. Except for rare familial forms of ALS associated with mutations in superoxide dismutase type 1 (SOD1), which are associated with neuronal inclusions that contain SOD1, specific molecular or cellular markers that differentiate ALS from other motor neuron disorders have not been available. Recently, the TAR DNA binding protein 43 (TDP-43) has been shown to be present in neuronal inclusions in ALS, and it has been suggested that TDP-43 may be a specific marker for ALS. This pilot study aimed to determine the value of TDP-43 in the differential diagnosis of MND. Immunohistochemistry for TDP-43 was used to detect neuronal inclusions in the medulla of disorders affecting upper motor neurons, lower motor neurons or both. Medullary motor neuron pathology also was assessed in frontotemporal lobar degeneration (FTLD) that had no evidence of MND. TDP-43 immunoreactivity was detected in the hypoglossal nucleus in all cases of ALS, all cases of FTLD-MND and some of cases of primary lateral sclerosis (PLS). It was not detected in FTLD-PLS. Surprisingly, sparse TDP-43 immunoreactivity was detected in motor neurons in about 10% of FTLD that did not have clinical or pathologic features of MND. The results suggest that TDP-43 immunoreactivity is useful in differentiating FTLD-MND and ALS from other disorders associated with upper or lower motor neuron pathology. It also reveals subclinical MND in a subset of cases of FTLD without clinical or pathologic evidence of MND.

Original languageEnglish (US)
Pages (from-to)71-79
Number of pages9
JournalActa Neuropathologica
Volume114
Issue number1
DOIs
StatePublished - Jul 1 2007

Fingerprint

DNA-Binding Proteins
Motor Neurons
Motor Neuron Disease
Differential Diagnosis
Frontotemporal Lobar Degeneration
Amyotrophic Lateral Sclerosis
Motor Disorders
Pathology
Axonal Transport
Genetic Loci
Brain Stem
Spinal Cord

Keywords

  • Amyotrophic lateral sclerosis (ALS)
  • Frontotemporal lobar degeneration with ubiquitinated inclusions (FTLD-U)
  • Immunohistochemistry
  • Motor neuron disease (MND)
  • Primary lateral sclerosis
  • TARDNA binding protein 43 (TDP-43)

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Clinical Neurology
  • Cellular and Molecular Neuroscience

Cite this

TDP-43 in differential diagnosis of motor neuron disorders. / Dickson, Dennis W.; Josephs, Keith A.; Amador, Catalina.

In: Acta Neuropathologica, Vol. 114, No. 1, 01.07.2007, p. 71-79.

Research output: Contribution to journalArticle

Dickson, Dennis W. ; Josephs, Keith A. ; Amador, Catalina. / TDP-43 in differential diagnosis of motor neuron disorders. In: Acta Neuropathologica. 2007 ; Vol. 114, No. 1. pp. 71-79.
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