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3.2.4. Departament of Neuropathology
Neuropathology of neurodegenerative disorders is a specialty in continuous progress with capacity for contrasting clinical judgment and performance of any diagnostic test, including the most recent biomarkers, with the final diag- nosis that is still neuropathology (“gold standard”). However, in the field of basic research, neuropathology plays an additional role, providing critical information about the molecular components of the characteristic lesions of each disease, the pathogenic mechanisms and the potential biomarkers.
The post-mortem neuropathological findings observed in donations of brain tis- sue from patients with neurodegenerative diseases, especially in the case of dementias, have allowed to know in recent decades the epidemiological reality of these diseases in the population, and among other evidences, have revealed the high prevalence of combined pathology (mainly Alzheimer’s pathology, Vas- cular pathology, Lewy pathology, and TDP-43 pathology).
The neuropathology of dementia landscape has dramatically changed in recent years. The incorporation to the neuropathological diagnosis of new antibodies for immunostaining and new molecular techniques has helped establishing the boundaries and internal heterogeneity of entities such as dementia with Lewy bodies and frontotemporal dementia, and has also led to the discovery of new entities in this area (DFT-TDP. DFT-FUS, etc.). The neuropathological study of an increasing number of patients with neurodegenerative pathology has allowed identifying new genetic causes of these diseases, thus helping to define new molecular targets for possible therapeutic approaches. In addition, the defini- tion of diagnostic criteria from large series of brains (in biobanks of neurologi- cal tissue or brain banks) has allowed us to address the problem of combined and mixed pathology, specifically regarding Alzheimer’s disease. The evolution of the diagnostic criteria themselves (e.g. the new criteria for the diagnostic classification of Alzheimer’s disease proposed by the National Institute of Aging - Alzheimer’s Association, 2012) and molecular techniques are converting the histological diagnosis into an fundamental element in the process of classify- ing dementias, definitive or quasi-definitive in some cases, but partial or prob- abilistic in many others. As repeatedly demonstrated in clinical-pathological sessions, made possible in most cases thanks to the donation of brain tissue by patients or their families and the close collaboration of clinicians, the final classification of a case requires the integration of all clinical, neuroradiological, neuropathological and molecular information, when available.
Thanks to the joint work of neuropathologists from various continents, all of them associated with brain tissue donation programs, in recent years the pre- cise characterization of histological brain lesions that until now had not been interpreted as defined pathological entities has been achieved. This has led to the description of new tauopathies, such as PART (Primary Age Related Tauop- athy) and ARTAG (Aging-Related Tau Astrogliopathy) and of a new entity with TDP pathology, LATE (Limbic-Predominant age-related TDP-43 encephalopathy), all of which occur frequently in combination with the most prevalent patholo-
3. Scientific activity
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