Acta Neuropathologica

, Volume 119, Issue 4, pp 389–408 | Cite as

Protein coding of neurodegenerative dementias: the neuropathological basis of biomarker diagnostics

  • Gabor G. KovacsEmail author
  • Gergő Botond
  • Herbert Budka


Neuropathological diagnosis of neurodegenerative dementias evolved by adapting the results of neuroanatomy, biochemistry, and cellular and molecular biology. Milestone findings of intra- and extracellular argyrophilic structures, visualizing protein deposition, initiated a protein-based classification. Widespread application of immunohistochemical and biochemical investigations revealed that (1) there are modifications of proteins intrinsic to disease (species that are phosphorylated, nitrated, oligomers, proteinase-resistant, with or without amyloid characteristics; cleavage products), (2) disease forms characterized by the accumulation of a single protein only are rather the exception than the rule, and (3) some modifications of proteins elude present neuropathological diagnostic procedures. In this review, we summarize how neuropathology, together with biochemistry, contributes to disease typing, by demonstrating a spectrum of disorders characterized by the deposition of various modifications of various proteins in various locations. Neuropathology may help to elucidate how brain pathologies alter the detectability of proteins in body fluids by upregulation of physiological forms or entrapment of different proteins. Modifications of at least the five most relevant proteins (amyloid-β, prion protein, tau, α-synuclein, and TDP-43), aided by analysis of further “attracted” proteins, are pivotal to be evaluated simultaneously with different methods. This should complement the detection of biomarkers associated with pathogenetic processes, and also neuroimaging and genetic analysis, in order to obtain a highly personalized diagnostic profile. Defining clusters of patients based on the patterns of protein deposition and immunohistochemically or biochemically detectable modifications of proteins (“codes”) may have higher prognostic predictive value, may be useful for monitoring therapy, and may open new avenues for research on pathogenesis.


Neurodegenerative disease Tau α-Synuclein TDP-43 Prion protein Amyloid-β (Aβ) FUS Protein code Biomarker 



This study was supported by EU FP6 Projects, BNEII No LSHM-CT-2004-503039 and Neuroscreen LSHB-CZ-2006-037719 contract No. 037719.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Gabor G. Kovacs
    • 1
    Email author
  • Gergő Botond
    • 1
  • Herbert Budka
    • 1
  1. 1.Institute of NeurologyMedical University of ViennaViennaAustria

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