Natasha Z. Rabinowitz Steele

All Publications

• Disability experiences and quality of life in adolescent and young adult cancer survivors: a scoping review. Journal of cancer survivorship : research and practice Vongthavaravat, L. R., Chang, L. M., Steele, N. Z., McArthur, A. R. 2026

  Abstract

  This scoping literature review explored disability-related experiences among adolescent and young adult (AYA) cancer survivors [ages 15-39], including their knowledge of the Americans with Disabilities Act (ADA) and awareness of associated rights.Seven databases (PubMed, Academic Search Complete, MEDLINE, ERIC, SocINDEX with Full Text, Health Source: Nursing/Academic Edition, and APA PsychINFO) were searched for U.S. based literature (2010-2025) using relevant MeSH terms and boolean operators (e.g., "cancer surviv*" AND ("disab*" OR "impair*") AND ("young" OR "adolescent" OR "AYA"). Included studies focused on employment-related discrimination, cancer-related disclosure, psychosocial outcomes, and survivors' unmet disability-related needs. A narrative synthesis summarized key themes, with quantitative results tabulated and qualitative findings categorized.A total of 715 articles were screened, with 21 studies included for analysis. These studies highlight key gaps in legal awareness and support for adolescent and young adult (AYA) cancer survivors. Three main themes were identified: (1) employment, education, and workplace barriers, (2) legal, policy, and system-level barriers, and (3) psychosocial and identity-related challenges.AYA cancer survivors encounter barriers in daily life and navigate changes to their social identity that could be described as disability based on existing legal and social definitions. Despite growing research capturing the experiences of AYA survivors, there remains limited research addressing survivorship in relation to disability.Current survivorship literature lacks discussion of disability experiences of survivors and relevant disability support. Addressing this gap could better document the lived experiences of AYA survivors and design supportive services informed by disability law and policy.

  View details for DOI 10.1007/s11764-025-01964-5

  View details for PubMedID 41545670

  View details for PubMedCentralID 3675694

• Impact of Centers for Medicare & Medicaid Services Screening Mandate on Inpatient Z-Code Documentation of Social Drivers of Health. Journal of general internal medicine Santiago, C., Steele, N., Lee, J., Harris, A., Schulman, K., Collins, W., Hom, J. 2025

  View details for DOI 10.1007/s11606-025-09992-8

  View details for PubMedID 41269510

• Meeting Cancer Survivorship Needs in Hematological Malignancies Compared to Solid Malignancies: Experiences of a Primary Care-Based Survivorship Clinic Zhang, E., Steele, N., Ramachandran, M., Yurkiewicz, I. ELSEVIER. 2024: 3650-3651

  View details for DOI 10.1182/blood-2024-200624

  View details for Web of Science ID 001411861100019

• Addressing cancer survivorship needs in geriatric survivors: Feasibility of a primary care-based survivorship clinic. Ramachandran, M., Steele, N., Kim, J., Schapira, L., Yurkiewicz, I. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557403539

• Developing "The Health After Cancer Podcast" to amplify cancer survivors' voices through digital storytelling. Patient education and counseling Billman, E., Steele, N., Servino, K., Bumgardner, D., Walker, K., Smith, S. M., Schapira, L. 2024; 123: 108194

  Abstract

  Cancer survivors experience complex medical and psychosocial challenges after a cancer diagnosis, leading to unmet informational and emotional needs. There is a paucity of cancer survivorship educational resources co-created by survivors and medical professionals.Our aim was to create an educational resource for cancer survivors, caregivers, and medical professionals that would leverage digital storytelling to address survivorship topics.Our content and production team included cancer survivors, clinicians, educators, and design experts. All content was co-created by cancer survivors and medical experts.We conducted an environmental scan of existing cancer survivorship educational resources in academic and public domains. Applying human-centered design principles, we incorporated patient perspectives through advisory board meetings and focus groups and identified a podcast as the preferred medium. We selected content and speakers, produced the podcast, and developed a corresponding website.Based on patient recommendations, podcast episodes address mental health, fear of cancer recurrence, relationships, parenting, relating to a new body, care transitions for adult survivors of childhood cancer, disclosing health information, and financial burden of cancer. Podcast guests were invited based on lived or learned experience in these domains. Thirteen guests (survivors, experts) and four hosts (two cancer survivors, two oncologists) co-created 15 podcast episodes. Podcast guests found the storytelling experience to be powerful and therapeutic.Digital storytelling is a scalable and accessible educational tool for communicating complex survivorship concepts that can amplify survivors' voices and increase awareness among survivors and clinicians. Co-creation of educational resources for cancer survivorship by survivors and professionals is a feasible and innovative educational strategy.A podcast created by and for cancer survivors in partnership with medical experts highlights opportunities for peer-to-peer digital storytelling to foster community among survivors and caregivers.Podcast production was supported by the Stanford Comprehensive Cancer Center.

  View details for DOI 10.1016/j.pec.2024.108194

  View details for PubMedID 38350208

• Cancer Survivorship at Stanford Cancer Institute JOURNAL OF CANCER SURVIVORSHIP Bock, K., Peltzer, J., Liu, W., Colgrove, Y., Smirnova, I., Siengsukon, C. 2024; 18 (1): 53-58

  Abstract

  The Stanford Cancer Survivorship Program is a key initiative of Stanford Cancer Institute. The program's mission is to improve the experience and outcomes of patients and family caregivers throughout all phases of the cancer trajectory by advancing survivorship research, clinical care, and education. The four pillars of the program include clinical care delivery with a focus on primary care-survivorship collaboration and expanding specialty services, education and training of healthcare professionals, transdisciplinary patient-oriented research, and community engagement. Cross-cutting areas of expertise include the following: (a) adolescents and young adults (AYAs), (b) mental health and patient self-management, (c) integration of primary care, and (d) postgraduate medical education. The clinical care model includes embedded survivorship clinics within disease groups in outpatient clinics, novel clinics designed to address unmet needs such as sexual health for women, and primary care-based faculty-led survivorship clinics for patients undergoing active cancer care requiring co-management, those who have completed active therapy and those at high risk for cancer due to genetic risk. Educational initiatives developed to date include an online course and medical textbook for primary care clinicians, a lecture series, monthly research team meetings, and rotations for medical trainees. Patient-facing activities include webinars and a podcast series designed to promote awareness, thus expanding the provision of expert-vetted information. Ongoing research focuses on oncofertility and family building after cancer, improving communication for AYAs, changing mindsets to improve quality of life through targeted digital interventions, increasing capacity to care for cancer survivors, and strengthening collaboration with community partners. IMPLICATIONS FOR CANCER SURVIVORS: Stanford's Cancer Survivorship Program includes a robust transdisciplinary and interdisciplinary research, training and clinical platform that is committed to advancing access and improving care for people living with and beyond cancer, through innovation in design and care delivery.

  View details for DOI 10.1007/s11764-023-01516-9

  View details for Web of Science ID 001161484400011

  View details for PubMedID 38183579

  View details for PubMedCentralID 9545782

• Cancer Survivorship at Stanford Cancer Institute. Journal of cancer survivorship : research and practice Smith, S. M., Steele, N., Kim, J., Yurkiewicz, I. R., Benedict, C., Trivedi, R., Heathcote, L. C., Simon, P. J., Bugos, K., Clayton, A., Palesh, O., Schapira, L. 2024

  Abstract

  The Stanford Cancer Survivorship Program is a key initiative of Stanford Cancer Institute. The program's mission is to improve the experience and outcomes of patients and family caregivers throughout all phases of the cancer trajectory by advancing survivorship research, clinical care, and education. The four pillars of the program include clinical care delivery with a focus on primary care-survivorship collaboration and expanding specialty services, education and training of healthcare professionals, transdisciplinary patient-oriented research, and community engagement. Cross-cutting areas of expertise include the following: (a) adolescents and young adults (AYAs), (b) mental health and patient self-management, (c) integration of primary care, and (d) postgraduate medical education. The clinical care model includes embedded survivorship clinics within disease groups in outpatient clinics, novel clinics designed to address unmet needs such as sexual health for women, and primary care-based faculty-led survivorship clinics for patients undergoing active cancer care requiring co-management, those who have completed active therapy and those at high risk for cancer due to genetic risk. Educational initiatives developed to date include an online course and medical textbook for primary care clinicians, a lecture series, monthly research team meetings, and rotations for medical trainees. Patient-facing activities include webinars and a podcast series designed to promote awareness, thus expanding the provision of expert-vetted information. Ongoing research focuses on oncofertility and family building after cancer, improving communication for AYAs, changing mindsets to improve quality of life through targeted digital interventions, increasing capacity to care for cancer survivors, and strengthening collaboration with community partners. IMPLICATIONS FOR CANCER SURVIVORS: Stanford's Cancer Survivorship Program includes a robust transdisciplinary and interdisciplinary research, training and clinical platform that is committed to advancing access and improving care for people living with and beyond cancer, through innovation in design and care delivery.

  View details for DOI 10.1007/s11764-023-01523-w

  View details for PubMedID 38183579

  View details for PubMedCentralID 9545782

• A new model of cancer survivorship: Feasibility and findings of a survivorship-based primary care clinic led by a medical oncologist Yurkiewicz, I., Steele, N. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for Web of Science ID 001053772005197

• A new model of cancer survivorship: Feasibility and findings of a survivorship-based primary care clinic led by a medical oncologist. Yurkiewicz, I., Steele, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: e24043

  View details for DOI 10.1200/JCO.2023.41.16_suppl.e24043

  View details for Web of Science ID 001555447000007

• The Patient Resident NEW ENGLAND JOURNAL OF MEDICINE Rabinowitz Steele, N. Z. 2022; 386 (11): 1010-1011

  View details for DOI 10.1056/NEJMp2116289

  View details for Web of Science ID 000767893900001

  View details for PubMedID 35275479

• An Anomalous Cause of Pulmonary Hypertension. Annals of the American Thoracic Society Steele, N. Z., Luks, A. M. 2021; 18 (9): 1571-1576

  View details for DOI 10.1513/AnnalsATS.202102-113CC

  View details for PubMedID 34468285

• Applicability of the Zenith Inner Branched Arch Endograft JOURNAL OF ENDOVASCULAR THERAPY Burke, C. R., Kratzberg, J. A., Yoder, A. D., Steele, N. Z., Aldea, G. S., Sweet, M. P. 2020; 27 (2): 252–57

  Abstract

  Purpose: To evaluate the clinical and anatomical features of patients with arch pathology to better understand the applicability of the Zenith inner branched arch endograft (IBAE). Materials and Methods: A retrospective review was performed of 60 consecutive patients (mean age 62.5 years; 42 men) who presented with nonruptured aortic arch pathology at a single institution between 2009 and 2016. Patients were stratified into standard (no previous cardiac surgery, <80 years old, and no significant medical comorbidity), high (previous cardiac surgery or significant comorbidity), or prohibitive risk (turned down for operative intervention) for operative intervention. Anatomical measurements of the aorta were obtained on computed tomography scans; anatomical suitability was based on the device's instructions for use. Results: Overall, 27 (45%) patients had anatomy amenable to treatment with the existing IBAE. Inadequate proximal seal length and large ascending aortic diameters were the primary reasons for anatomical unsuitability. Shortening the inner curve seal zone from 25 to 15 mm and increasing the proximal seal zone diameter from 38 to 42 mm increased anatomical suitability to include 49 (82%) patients. Of these, 31 were in the high-risk cohort and 7 were deemed prohibitive risk; therefore, IBAE would have been strongly considered in these 38 patients. Conclusion: Based on anatomical criteria alone, nearly half of patients with aortic arch pathology have anatomy suitable to the Zenith IBAE in its current design. Arch branch vessel anatomy was not a limitation of the device. From a clinical standpoint, if endovascular repair were reserved for those at high or prohibitive risk for open repair, approximately 30% of patients would likely benefit from the IBAE in its current form.

  View details for DOI 10.1177/1526602820909487

  View details for Web of Science ID 000523901600015

  View details for PubMedID 32186260

• Dementia assessment and management in primary care settings: a survey of current provider practices in the United States BMC HEALTH SERVICES RESEARCH Bernstein, A., Rogers, K. M., Possin, K. L., Steele, N. Z. R., Ritchie, C. S., Kramer, J. H., Geschwind, M., Higgins, J. J., Wohlgemuth, J., Pesano, R., Miller, B. L., Rankin, K. P. 2019; 19 (1): 919

  Abstract

  Primary care providers (PCPs) are typically the first to screen and evaluate patients for neurocognitive disorders (NCDs), including mild cognitive impairment and dementia. However, data on PCP attitudes and evaluation and management practices are sparse. Our objective was to quantify perspectives and behaviors of PCPs and neurologists with respect to NCD evaluation and management.A cross-sectional survey with 150 PCPs and 50 neurologists in the United States who evaluated more than 10 patients over age 55 per month. The 51-item survey assessed clinical practice characteristics, and confidence, perceived barriers, and typical practices when diagnosing and managing patients with NCDs.PCPs and neurologists reported similar confidence and approaches to general medical care and laboratory testing. Though over half of PCPs performed cognitive screening or referred patients for cognitive testing in over 50% of their patients, only 20% reported high confidence in interpreting results of cognitive tests. PCPs were more likely to order CT scans than MRIs, and only 14% of PCPs reported high confidence interpreting brain imaging findings, compared to 70% of specialists. Only 21% of PCPs were highly confident that they correctly recognized when a patient had an NCD, and only 13% were highly confident in making a specific NCD diagnosis (compared to 72 and 44% for neurologists, both p < 0.001). A quarter of all providers identified lack of familiarity with diagnostic criteria for NCD syndromes as a barrier to clinical practice.This study demonstrates how PCPs approach diagnosis and management of patients with NCDs, and identified areas for improvement in regards to cognitive testing and neuroimaging. This study also identified all providers' lack of familiarity with published diagnostic criteria for NCD syndromes. These findings may inform the development of new policies and interventions to help providers improve the efficacy of their decision processes and deliver better quality care to patients with NCDs.

  View details for DOI 10.1186/s12913-019-4603-2

  View details for Web of Science ID 000501014400011

  View details for PubMedID 31783848

  View details for PubMedCentralID PMC6884754

• Primary Care Provider Attitudes and Practices Evaluating and Managing Patients with Neurocognitive Disorders JOURNAL OF GENERAL INTERNAL MEDICINE Bernstein, A., Rogers, K. M., Possin, K. L., Steele, N. Z. R., Ritchie, C. S., Miller, B. L., Rankin, K. P. 2019; 34 (9): 1691–92

  View details for DOI 10.1007/s11606-019-05013-7

  View details for Web of Science ID 000483539200010

  View details for PubMedID 31044411

  View details for PubMedCentralID PMC6712190

• Genetic variation across RNA metabolism and cell death gene networks is implicated in the semantic variant of primary progressive aphasia SCIENTIFIC REPORTS Bonham, L. W., Steele, N. Z. R., Karch, C. M., Broce, I., Geier, E. G., Wen, N. L., Momeni, P., Hardy, J., Miller, Z. A., Gorno-Tempini, M., Hess, C. P., Lewis, P., Miller, B. L., Seeley, W. W., Manzoni, C., Desikan, R. S., Baranzini, S. E., Ferraris, R., Yokoyama, J. S., Hernandez, D. G., Nalls, M. A., Rohrer, J. D., Ramasamy, A., Kwok, J. J., Dobson-Stone, C., Schofield, P. R., Halliday, G. M., Hodges, J. R., Piguet, O., Bartley, L., Thompson, E., Haan, E., Hernandez, Ruiz, A., Boada, M., Borroni, B., Padovani, A., Cruchaga, C., Cairns, N. J., Benussi, L., Binetti, G., Ghidoni, R., Forloni, G., Albani, D., Galimberti, D., Fenoglio, C., Serpente, M., Scarpini, E., Clarimon, J., Lleo, A., Blesa, R., Waldo, M., Nilsson, K., Nilsson, C., Mackenzie, I. A., Hsiung, G. R., Mann, D. A., Grafman, J., Morris, C. M., Attems, J., Griffiths, T. D., McKeith, I. G., Thomas, A. J., Pietrini, P., Huey, E. D., Wassermann, E. M., Baborie, A., Jaros, E., Tierney, M. C., Pastor, P., Razquin, C., Ortega-Cubero, S., Alonso, E., Perneczky, R., Diehl-Schmid, J., Alexopoulos, P., Kurz, A., Rainero, Rubino, E., Pinessi, L., Rogaeva, E., St George-Hyslop, P., Rossi, G., Tagliavini, F., Giaccone, G., Rowe, J. B., Schlachetzki, J. M., Uphill, J., Collinge, J., Mead, S., Danek, A., Van Deerlin, V. M., Grossman, M., Trojanowski, J. Q., van der Zee, J., Cruts, M., Van Broeckhoven, C., Cappa, S. F., Leber, Hannequin, D., Golfier, Vercelletto, M., Brice, A., Nacmias, B., Sorbin, S., Bagnoli, S., Piaceri, Nielsen, J. E., Hjermind, L. E., Riemenschneider, M., Mayhaus, M., Ibach, B., Gasparoni, G., Pichler, S., Gu, W., Rossor, M. N., Fox, N. C., Warren, J. D., Spillantini, M. G., Morriss, H. R., Rizzu, P., Heutink, P., Snowden, J. S., Rollinson, S., Richardson, A., Gerhard, A., Bruni, A. C., Maletta, R., Frangipane, F., Cupidi, C., Bernardi, L., Anfossi, M., Gallo, M., Conidi, M. E., Smirne, N., Rademakers, R., Baker, M., Dickson, D. W., Graff-Radford, N. R., Petersen, R. C., Knopman, D., Josephs, K. A., Boeve, B. F., Parisi, J. E., Karydas, A. M., Rosen, H., van Swieten, J. C., Dopper, E. P., Seelaar, H., Pijnenburg, Y. L., Scheltens, P., Logroscino, G., Capozzo, R., Novelli, Puca, A. A., Franceschi, M., Postiglione, A., Milan, G., Sorrentino, P., Kristiansen, M., Chian, H., Graff, C., Pasquier, F., Rollin, A., Deramecourt, Lebouvier, T., Kapogiannis, D., Ferrucci, L., Pickering-Brown, S., Singleton, A. B., Int FTD-Genomics Consortium 2019; 9: 10854

  Abstract

  The semantic variant of primary progressive aphasia (svPPA) is a clinical syndrome characterized by neurodegeneration and progressive loss of semantic knowledge. Unlike many other forms of frontotemporal lobar degeneration (FTLD), svPPA has a highly consistent underlying pathology composed of TDP-43 (a regulator of RNA and DNA transcription metabolism). Previous genetic studies of svPPA are limited by small sample sizes and a paucity of common risk variants. Despite this, svPPA's relatively homogenous clinicopathologic phenotype makes it an ideal investigative model to examine genetic processes that may drive neurodegenerative disease. In this study, we used GWAS metadata, tissue samples from pathologically confirmed frontotemporal lobar degeneration, and in silico techniques to identify and characterize protein interaction networks associated with svPPA risk. We identified 64 svPPA risk genes that interact at the protein level. The protein pathways represented in this svPPA gene network are critical regulators of RNA metabolism and cell death, such as SMAD proteins and NOTCH1. Many of the genes in this network are involved in TDP-43 metabolism. Contrary to the conventional notion that svPPA is a clinical syndrome with few genetic risk factors, our analyses show that svPPA risk is complex and polygenic in nature. Risk for svPPA is likely driven by multiple common variants in genes interacting with TDP-43, along with cell death,x` working in combination to promote neurodegeneration.

  View details for DOI 10.1038/s41598-019-46415-1

  View details for Web of Science ID 000477698600012

  View details for PubMedID 31350420

  View details for PubMedCentralID PMC6659677

• Frequency of frontotemporal dementia gene variants in C9ORF72, MAPT, and GRN in academic versus commercial laboratory cohorts. Advances in genomics and genetics Steele, N. Z., Bright, A. R., Lee, S. E., Fong, J. C., Bonham, L. W., Karydas, A., Karbassi, I. D., Pribadi, M., Meservey, M. A., Gallen, M. C., Ramos, E. M., Liaquat, K., Hoffman, C. C., Krasner, M. R., Dodge, W., L Miller, B., Coppola, G., Rankin, K. P., Yokoyama, J. S., Higgins, J. J. 2018; 8: 23-33

  Abstract

  Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia, and elucidating its genetic underpinnings is critical. FTLD research centers typically recruit patient cohorts that are limited by the center's specialty and the ways in which its geographic location affects the ethnic makeup of research participants. Novel sources of data are needed to get population estimates of the contribution of variants in known FTLD-associated genes.We compared FLTD-associated genetic variants in microtubule-associated protein tau (MAPT), progranulin (GRN), and chromosome nine open reading frame 72 (C9ORF72) from an academic research cohort and a commercial clinical genetics laboratory. Pathogenicity was assessed using guidelines of the American College of Medical Genetics and Genomics and a rule-based DNA variant assessment system. We conducted chart reviews on patients with novel or rare disease-associated variants.A total of 387 cases with FTLD-associated variants from the commercial (n=2,082) and 78 cases from the academic cohort (n=2,089) were included for analysis. In the academic cohort, the most frequent pathogenic variants were C9ORF72 expansions (63%, n=49), followed by GRN (26%, n=20) and MAPT (11%, n=9). Each gene's contribution to disease was similarly ranked in the commercial laboratory but differed in magnitude: C9ORF72 (89%, n=345), GRN (6%, n=24), and MAPT (5%, n=19). Of the 37 unique GRN/MAPT variants identified, only six were found in both cohorts. Clinicopathological data from patients in the academic cohort strengthened classification of two novel GRN variant as pathogenic (p.Pro166Leufs*2, p.Gln406*) and one GRN variant of unknown significance as a possible rare risk variant (p.Cys139Arg).Differences in gene frequencies and identification of unique pathogenic alleles in each cohort demonstrate the importance of data sharing between academia and community laboratories. Using shared data sources with well-characterized clinical phenotypes for individual variants can enhance interpretation of variant pathogenicity and inform clinical management of at-risk patients and families.

  View details for DOI 10.2147/AGG.S164047

  View details for PubMedID 31031559

  View details for PubMedCentralID PMC6483103

• Protein network analysis reveals selectively vulnerable regions and biological processes in FTD NEUROLOGY-GENETICS Bonham, L. W., Steele, N. Z. R., Karch, C. M., Manzoni, C., Geier, E. G., Wen, N., Ofori-Kuragu, A., Momeni, P., Hardy, J., Miller, Z. A., Hess, C. P., Lewis, P., Miller, B. L., Seeley, W. W., Baranzini, S. E., Desikan, R. S., Ferrari, R., Yokoyama, J. S., Int FTD-Genomics Consortium IFGC 2018; 4 (5): e266

  Abstract

  The neuroanatomical profile of behavioral variant frontotemporal dementia (bvFTD) suggests a common biological etiology of disease despite disparate pathologic causes; we investigated the genetic underpinnings of this selective regional vulnerability to identify new risk factors for bvFTD.We used recently developed analytical techniques designed to address the limitations of genome-wide association studies to generate a protein interaction network of 63 bvFTD risk genes. We characterized this network using gene expression data from healthy and diseased human brain tissue, evaluating regional network expression patterns across the lifespan as well as the cell types and biological processes most affected in bvFTD.We found that bvFTD network genes show enriched expression across the human lifespan in vulnerable neuronal populations, are implicated in cell signaling, cell cycle, immune function, and development, and are differentially expressed in pathologically confirmed frontotemporal lobar degeneration cases. Five of the genes highlighted by our differential expression analyses, BAIAP2, ERBB3, POU2F2, SMARCA2, and CDC37, appear to be novel bvFTD risk loci.Our findings suggest that the cumulative burden of common genetic variation in an interacting protein network expressed in specific brain regions across the lifespan may influence susceptibility to bvFTD.

  View details for DOI 10.1212/NXG.0000000000000266

  View details for Web of Science ID 000447372900002

  View details for PubMedID 30283816

  View details for PubMedCentralID PMC6167176

• Insulin-Like Growth Factor Binding Protein 2 Is Associated With Biomarkers of Alzheimer's Disease Pathology and Shows Differential Expression in Transgenic Mice FRONTIERS IN NEUROSCIENCE Bonham, L. W., Geier, E. G., Steele, N. Z. R., Holland, D., Miller, B. L., Dale, A. M., Desikan, R. S., Yokoyama, J. S., Alzheimers Dis Neuroimaging Initia 2018; 12: 476

  Abstract

  There is increasing evidence that metabolic dysfunction plays an important role in Alzheimer's disease (AD). Brain insulin resistance and subsequent impairment of insulin and insulin-like growth factor (IGF) signaling are associated with the neurodegenerative and clinical features of AD. Nevertheless, how the brain insulin/IGF signaling system is altered in AD and the effects of these changes on AD pathobiology are not well understood. IGF binding protein 2 (IGFBP-2) is an abundant cerebral IGF signaling protein and there is early evidence suggesting it associates with AD biomarkers. We evaluated the relationship between protein levels of IGFBP-2 with cerebrospinal fluid (CSF) biomarkers and neuroimaging markers of AD progression in 300 individuals from across the AD spectrum. CSF IGFBP-2 levels were correlated with CSF tau levels and brain atrophy in non-hippocampal regions. To further explore the role of IGFBP2 in tau pathobiology, we evaluated the expression of IGFBP2 in different human and mouse brain cell types and brain tissue from two transgenic mouse models: the P301L-tau model of tauopathy and TASTPM model of AD. We observed significant differential expression of IGFBP2 in both transgenic mouse models relative to wild-type mice in cortex but not in hippocampus. In both humans and mice, IGFBP2 is most highly expressed in astrocytes. Taken together, our findings suggest that IGFBP-2 may be linked to tau pathology and provides further evidence for a relationship between metabolic dysregulation and neurodegeneration. Our results also raise the possibility that this relationship may extend beyond neurons.

  View details for DOI 10.3389/fnins.2018.00476

  View details for Web of Science ID 000438754300002

  View details for PubMedID 30061810

  View details for PubMedCentralID PMC6055061

• The Brain Health Assessment for Detecting and Diagnosing Neurocognitive Disorders JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Possin, K. L., Moskowitz, T., Erlhoff, S. J., Rogers, K. M., Johnson, E. T., Steele, N. Z. R., Higgins, J. J., Stiver, J., Alioto, A. G., Farias, S. T., Miller, B. L., Rankin, K. P. 2018; 66 (1): 150–56

  Abstract

  Brief cognitive screens lack the sensitivity to detect mild cognitive impairment (MCI) or support differential diagnoses. The objective of this study was to validate the 10-minute, tablet-based University of California, San Francisco (UCSF) Brain Health Assessment (BHA) to overcome these limitations.Cross-sectional.UCSF Memory and Aging Center.Older adults (N = 347) (neurologically healthy controls (n = 185), and individuals diagnosed with MCI (n = 99), dementia (n = 42), and as normal with concerns (n = 21)).The BHA includes subtests of memory, executive function and speed, visuospatial skills, and language and an optional informant survey. Participants completed the Montreal Cognitive Assessment (MoCA) and criterion-standard neuropsychological tests. Standardized structural 3T brain magnetic resonance imaging was performed in 145 participants.At a fixed 85% specificity rate, the BHA had 100% sensitivity to dementia and 84% to MCI; the MoCA had 75% sensitivity to dementia and 25% to MCI. The BHA had 83% sensitivity to MCI likely due to AD and 88% to MCI unlikely due to AD, and the MoCA had 58% sensitivity to MCI likely AD and 24% to MCI unlikely AD. The BHA subtests demonstrated moderate to high correlations with the criterion-standard tests from their respective cognitive domains. Memory test performance correlated with medial temporal lobe volumes; executive and speed with frontal, parietal, and basal ganglia volumes; and visuospatial with right parietal volumes.The BHA had excellent combined sensitivity and specificity to detect dementia and MCI, including MCI due to diverse etiologies. The subtests provide efficient, valid measures of neurocognition that are critical in making a differential diagnosis.

  View details for DOI 10.1111/jgs.15208

  View details for Web of Science ID 000422998600024

  View details for PubMedID 29355911

  View details for PubMedCentralID PMC5889617

• Fine-mapping of the human leukocyte antigen locus as a risk factor for Alzheimer disease: A case-control study PLOS MEDICINE Steele, N. Z. R., Carr, J. S., Bonham, L. W., Geier, E. G., Damotte, V., Miller, Z. A., Desikan, R. S., Boehme, K. L., Mukherjee, S., Crane, P. K., Kauwe, J. S. K., Kramer, J. H., Miller, B. L., Coppola, G., Hollenbach, J. A., Huang, Y., Yokoyama, J. S. 2017; 14 (3): e1002272

  Abstract

  Alzheimer disease (AD) is a progressive disorder that affects cognitive function. There is increasing support for the role of neuroinflammation and aberrant immune regulation in the pathophysiology of AD. The immunoregulatory human leukocyte antigen (HLA) complex has been linked to susceptibility for a number of neurodegenerative diseases, including AD; however, studies to date have failed to consistently identify a risk HLA haplotype for AD. Contributing to this difficulty are the complex genetic organization of the HLA region, differences in sequencing and allelic imputation methods, and diversity across ethnic populations.Building on prior work linking the HLA to AD, we used a robust imputation method on two separate case-control cohorts to examine the relationship between HLA haplotypes and AD risk in 309 individuals (191 AD, 118 cognitively normal [CN] controls) from the San Francisco-based University of California, San Francisco (UCSF) Memory and Aging Center (collected between 1999-2015) and 11,381 individuals (5,728 AD, 5,653 CN controls) from the Alzheimer's Disease Genetics Consortium (ADGC), a National Institute on Aging (NIA)-funded national data repository (reflecting samples collected between 1984-2012). We also examined cerebrospinal fluid (CSF) biomarker measures for patients seen between 2005-2007 and longitudinal cognitive data from the Alzheimer's Disease Neuroimaging Initiative (n = 346, mean follow-up 3.15 ± 2.04 y in AD individuals) to assess the clinical relevance of identified risk haplotypes. The strongest association with AD risk occurred with major histocompatibility complex (MHC) haplotype A*03:01~B*07:02~DRB1*15:01~DQA1*01:02~DQB1*06:02 (p = 9.6 x 10-4, odds ratio [OR] [95% confidence interval] = 1.21 [1.08-1.37]) in the combined UCSF + ADGC cohort. Secondary analysis suggested that this effect may be driven primarily by individuals who are negative for the established AD genetic risk factor, apolipoprotein E (APOE) ɛ4. Separate analyses of class I and II haplotypes further supported the role of class I haplotype A*03:01~B*07:02 (p = 0.03, OR = 1.11 [1.01-1.23]) and class II haplotype DRB1*15:01- DQA1*01:02- DQB1*06:02 (DR15) (p = 0.03, OR = 1.08 [1.01-1.15]) as risk factors for AD. We followed up these findings in the clinical dataset representing the spectrum of cognitively normal controls, individuals with mild cognitive impairment, and individuals with AD to assess their relevance to disease. Carrying A*03:01~B*07:02 was associated with higher CSF amyloid levels (p = 0.03, β ± standard error = 47.19 ± 21.78). We also found a dose-dependent association between the DR15 haplotype and greater rates of cognitive decline (greater impairment on the 11-item Alzheimer's Disease Assessment Scale cognitive subscale [ADAS11] over time [p = 0.03, β ± standard error = 0.7 ± 0.3]; worse forgetting score on the Rey Auditory Verbal Learning Test (RAVLT) over time [p = 0.02, β ± standard error = -0.2 ± 0.06]). In a subset of the same cohort, dose of DR15 was also associated with higher baseline levels of chemokine CC-4, a biomarker of inflammation (p = 0.005, β ± standard error = 0.08 ± 0.03). The main study limitations are that the results represent only individuals of European-ancestry and clinically diagnosed individuals, and that our study used imputed genotypes for a subset of HLA genes.We provide evidence that variation in the HLA locus-including risk haplotype DR15-contributes to AD risk. DR15 has also been associated with multiple sclerosis, and its component alleles have been implicated in Parkinson disease and narcolepsy. Our findings thus raise the possibility that DR15-associated mechanisms may contribute to pan-neuronal disease vulnerability.

  View details for DOI 10.1371/journal.pmed.1002272

  View details for Web of Science ID 000397906100024

  View details for PubMedID 28350795

  View details for PubMedCentralID PMC5369701