Symptomatic amyloid-related imaging abnormalities in an APOE ε4/ε4 patient treated with aducanumab.
Symptomatic amyloid-related imaging abnormalities in an APOE ε4/ε4 patient treated with aducanumab.
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DOI：
10.1002/dad2.12101
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Boxer AL
中科院分区：
文献类型：
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作者：
VandeVrede L;Gibbs DM;Koestler M;La Joie R;Ljubenkov PA;Provost K;Soleimani-Meigooni D;Strom A;Tsoy E;Rabinovici GD;Boxer AL
淀粉样蛋白相关成像异常(ARIA)是一种常见的淀粉样靶向抗体的剂量依赖性效应，与载脂蛋白E(ApoE)ε4等位基因密切相关。我们描述了一位66岁的白人男性(APOEε4/ε4)的临床过程和治疗，该患者参加了一项观察性研究，包括淀粉样蛋白和tau正电子发射断层扫描，他通过Engage临床试验接受了阿杜卡努单抗治疗。急性症状包括头痛和脑病，磁共振成像显示ARIA-E和ARIA-H。恶性高血压和癫痫样活动用尼卡地平和左乙拉西坦治疗。随后的临床/影像恶化促使甲基强的松龙疗程。症状和ARIA-E缓解超过6个月，而ARIA-H持续存在。定量分析间期淀粉样蛋白PET显示，先前存在的区域信号减少，但信号在后面增加；而tau PET显示整体信号增加。在1例APOEε4/ε4患者中，心绞痛症状伴有恶性高血压和癫痫样活动，脉冲类固醇逆转了水肿。来自较大队列的研究可能阐明ARIA的最佳治疗和病理生理学。
Amyloid‐related imaging abnormalities (ARIA) are a common, dose‐dependent effect of amyloid‐targeting antibodies, strongly associated with the apolipoprotein E (APOE) ε4 allele. We describe the clinical course and management of a 66‐year‐old white male (APOE ε4/ε4) enrolled in an observational study that included amyloid and tau positron emission tomography (PET), who received aducanumab through the ENGAGE clinical trial. Acute symptoms included headache and encephalopathy, and magnetic resonance imaging revealed ARIA‐E and ARIA‐H. Malignant hypertension and epileptiform activity were treated with nicardipine and levetiracetam. Subsequent clinical/imaging worsening prompted a course of methylprednisolone. Symptoms and ARIA‐E resolved over 6 months, while ARIA‐H persisted. Quantitative analysis of interval amyloid PET showed reduced signal in pre‐existing areas but increased signal posteriorly; while tau PET showed increased signal overall. In an APOE ε4/ε4 patient, ARIA symptoms were accompanied by malignant hypertension and epileptiform activity, and pulsed steroids reversed edema. Studies from larger cohorts may clarify the optimal treatment and pathophysiology of ARIA.