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Amyloid Fibrils03:03

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Amyloid fibrils are aggregates of misfolded proteins.  Under most circumstances, misfolded proteins are either refolded by chaperone proteins or degraded by the proteasome. However, in the case of a mutation or a disease, these proteins can accumulate to form large clusters and often further assemble to form elongated fibers, called fibrils. 
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Amyloid-Related Imaging Abnormalities: An Update.

Michelle Roytman1, Faizullah Mashriqi2, Khaled Al-Tawil2

  • 1Department of Radiology, Neuroradiology Division, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY.

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PubMed
Summary
This summary is machine-generated.

Amyloid-related imaging abnormalities (ARIA) are MRI findings in Alzheimer disease (AD) patients treated with amyloid-beta immunotherapies. Understanding ARIA is crucial for managing these novel AD treatments.

Keywords:
ARIAARIA-EARIA-HAlzheimer diseaseMRIamyloid betaamyloid-related imaging abnormalitiesedemahemosiderin

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Area of Science:

  • Neurology
  • Radiology
  • Pharmacology

Background:

  • Amyloid-related imaging abnormalities (ARIA) encompass MRI findings in Alzheimer disease (AD) patients undergoing amyloid-beta (Aβ) immunotherapy.
  • ARIA presents as edema/effusion (ARIA-E) or microhemorrhages/siderosis (ARIA-H).
  • ARIA incidence is higher in APOE ε4 carriers and with higher immunotherapy doses, often occurring early and resolving spontaneously.

Purpose of the Study:

  • To review the pathophysiologic mechanisms, MRI findings, and grading of ARIA.
  • To summarize Aβ immunotherapies relevant to ARIA.
  • To equip radiologists to manage patients receiving targeted AD therapies.

Main Methods:

  • Literature review of ARIA in the context of Aβ immunotherapies for AD.
  • Analysis of MRI findings and categorization of ARIA subtypes (ARIA-E and ARIA-H).
  • Summary of current and investigational Aβ-targeting treatments.

Main Results:

  • ARIA is a spectrum of MRI findings associated with Aβ immunotherapies.
  • ARIA-E shows dose-dependence, while ARIA-H is also observed.
  • ARIA recognition impacts patient selection, monitoring, and treatment continuation.

Conclusions:

  • Radiologists will encounter ARIA more frequently with expanded use of Aβ immunotherapies.
  • Understanding ARIA's mechanisms and imaging is vital for optimal patient management.
  • This knowledge aids in informed decision-making regarding AD immunotherapy.