Guidelines. for collecting post mortem brain tissue of cases with psychiatric diseases within the network

Transcription

1 2005 Introduction Our goal is to collect post mortem brain tissue from patients with schizophrenia, depression (unipolar and bipolar), dementia as well as healthy controls. To address this, we developed guidelines referring to the special requirements of tissue from psychiatric cases. Keywords: Schizophrenia, depression, bipolar disorder post-mortem, brain tissue, ethical issues BrainNet Europe II Project Co-ordinator: Prof. Dr. Hans Kretzschmar Contact: Network of Excellence funded by the EC in the 6th Framework Program Life Science Content Demands of scientists to brain tissue...2 Identification of regions of interest...2 Ethical issues...5 Next steps...9

2 Demands of scientists to brain tissue Most of the scientist prefer to investigate frozen tissue for protein, RNA and receptor investigations (PCR, DNA-microarrays, In-Situ-hybridization, receptor autoradiography and biochemical analysis). However, post-mortem intervals should not be longer than 48 hours for these requirements. Therefore, we decided to collect two frozen samples from each brain region and one formalin-fixed and paraffin-embedded sample for immunohistochemistry and neuropathological staining in brains with post-mortem intervals until 48 hours. In each brain, Alzheimer-related changes should be investigated. Brains with longer post-mortem intervals should be formalin-fixed and embedded in celluidin for morphometry. Freezing will be carried out in liquid isopentane cooled in liquid nitrogen to avoid freezing artefacts. Fixations will be performed in 4% paraformaldehyde with consecutive paraffin-embedding. Identification of regions of interest According to the large amount of literature we identified brain regions which are supposed to be involved in the pathophysiology of psychiatric disorders. We considered functional and structural MRI studies as well as post-mortem investigations in schizophrenia, depression and dementia. Both hemispheres should be considered in psychiatric cases, because there may exist laterality changes in several brain regions. We identified several brain regions as well as body tissue for brain banking according to the atlas of Brodmann: Inventory of Sample Labels for Brain Bank (Each region: 2 frozen samples and 1 formalin-fixed, paraffin-embedded sample) Numbers are Brodmann-Areas A: 17, 18 B: 39 C: 10 D:

3 EE: 47 E: 11 F: 44, 45 G: 46 H: 38 I: 22 a = anterior J: 22 p = posterior K: 21 L: 1, 2, 3, 4, 7 M: 32, 24 a = anterior N: 23, 31 p = posterior O: Corpus callosum P: 20 PP: 28 / 34 Q: Thalamus: mediodorsal QX: Thalamus: medial Pulvinarregion * QY: RX: RY: S : anteriore Region N. caudatus dorsalis N. caudatus ventromedialis Putamen T: Globus pallidus TX: TY: TT: Capsula interna ventralis Capsula interna dorsalis Hippocamus TA: N. accumbens * U: Pons-Basis rostral V: Pons, caudal W: Medulla oblongata rostral X: Medulla oblongata caudal Y: Spinal cord 3 11

4 Cere-Verm. Lob. ant. (Cerebellum, Vermis, Lobus anterior) Cere-Verm. Lob. med. (Cerebellum, Vermis, Lobus medialis) Cere-Hemis Lob. post. (Cerebellum, Hemisphere, Lobus posterior) N. dentatus (Cerebellum) One sample of abdominal fat, liver, muscle (quadriceps femoris), CSF and Blood * take only one frozen sample due to small region size. Delineation of brain regions according to Brodmann: 4 11

5 Body tissue in the brain bank For biochemical investigations, we decided to collect CSF from all cases as well as blood for genetic investigations. For studies of the metabolic syndrome, which is associated with psychiatric diseases as well as antipsychotic medication, we will also collect tissue from liver, abdominal fat and muscle. Ethical issues We are planning to implement a local donor program in association with some local Mental Hospitals such as Merzig, Saarland, and Klingenmünster, Pfalz in collaboration with the Neuropathological Institute in Homburg. Thus, we have two different ways to get written consent from patients or relatives: Written consent of patients Old-age schizophrenic patients living in psychiatric hospitals may give their consent to post-mortem investigations prior to death. Additionally, relatives will be informed and caregivers should give their written consent. Psychiatrists should state that the patient has understood the content of the study. Written consent of relatives for informing the relatives after the patient s death have been developed. When a psychiatric case comes to autopsy in one of our associated institutes of pathology, the coordinator (Dr. A. Schmitt) will be immediately informed by the physicians. She will call the relatives and ask for verbal consent. If we get the consent, autopsy will be performed. Afterwards, written consent will be obtained from the relatives. They are informed, that they can refuse content at any time, that we follow the guidelines of data protection, that we will anonymize the data. We want to get exemption from professional discretion for analysis of medical records (clinical data). Relatives should give their written consent for the investigation of different tissue: brain, CSF, genetics, body tissue. We have developed an information sheet for relatives according to the guidelines of our ethic commission: Dear relatives, 5 11

6 With deep compassion in your bereavement, we would like to address you for support. For a long time, we have been investigating causes of severe mental disorders like depression, dementia and schizophrenia. Nevertheless, there is still considerable lack of scientific information for efficient therapies. Biological material from patients deceased recently is extremely valuable to further research on these diseases. For this reason, we approach you to support our studies. Any additional knowledge about biological causes of mental disorders would advance our abilities to develop new treatment strategies that help to relieve the severe burden and symptoms of the diseases. The Brain Net Europe strongly encourages this project, conducted by Professor Dr. Peter Falkai, head of the Psychiatric Clinic at the University Hospital of Saarland, Homburg/Saar, Germany. The main goals of this project are investigations on depression/dementia/schizophrenia in affected patients. With your consent to involve your relative in this study you can contribute to improve the situation of patients in the future. Below we will give you some information about the Brain Net Europe project Mental Disorders and request your consent to our research plan. Contact Your relative has been accommodated to the (neuro)pathological institute for autopsy. Dr. x is psychiatrist at the University Hospital of Homburg/Saar and has called upon advice of the local pathologist. After your oral consent, the brain as well as tissue samples from liver, muscle, abdominal fat, blood and cerebrospinal fluid (CSF) are stored in the pathological institute. 6 11

7 The data will be collected according to the following procedure: Investigation of tissue: After your written consent the tissue will receive a code number and will be stored until investigation in the hospital of the University of Saarland, Homburg, Germany. In the European BrainNet, selected experts in their fields will apply different scientific methods such as molecular biology, histology, biochemistry and volume estimations for detailed investigations of the tissue, blood or CSF. Access to medical records After your written consent, medical records from your relative will be requested from hospitals, general practitioners and psychiatrists. For this reason, we ask you to exempt the medical staff from professional discretion. The relevant data concerning psychiatric and somatic diseases as well as family history of diseases will be collected by standardized interviews and labeled with the same code number as the tissue. In this way, all data are anonymized. What happens with the data in the Brain Net? All tissue preparations, cell cultures and medical data will be analyzed using the code number which precludes associations between data and individuals. Additionally, no list will be kept with the possibility of attributing of the code number to the name. Only the written consent form contains personal data, the name of your relative and your name. This form will not contain the code number. Therefore, no association between test results and personal data are possible. 7 11

8 The representative for data protection of the University of Saarland is Mr. Y. All criteria of data protection laws are fullfilled. The personal data will be stored at a spatially separated location without ability for the scientists to get information. In case of cancellation of your consent, the data will be erased. Anonymisation, analysis and storage The data from your relative about disease and treatment will be stored electronically by using the code number. To assure the personal integrity and anonymity of the deceased, the computer containing the data can be accessed only by staff involved in this project. Data entry will be performed by Dr. x and only anonymized data will be provided to the scientists with accreditation for the Brain Net Europe. Voluntariness The participation in this study is voluntary. You can give your consent to the single subjects of the written consent form by marking with a cross. If you refuse consent, you will not have any legal disadvantage. Additionally, you can cancel your consent any time without declaration of reasons. In this case, please inform us under the address provided in the letter head. Your written consent will then be removed and the name of your relative will be deleted in our list. If you have any questions please contact Dr. x Sincerely yours, Prof. Dr. Peter Falkai Dr. x 8 11

9 Figure 1: Dissection of the prefrontal cortex (BA46) Figure 2: Dissection of the thalamus (mediodorsal nucleus) 9 11

10 Next steps Next steps in our agenda are the development of guidelines for neuropathological standard investigations as well as identification of clinical data needed in the brain bank. Additionally, we are planning to publish our guidelines. We will be performing these steps in BrainNet Europe II Project Co-ordinator: Prof. Dr. Hans Kretzschmar Contact: Network of Excellence funded by the EC in the 6th Framework Program Life Science Author Dr. Andrea Schmitt Zentralinstitut für Seelische Gesundheit Mannheim Mannheim, Germany Phone: +49 (6211) Mail: Copyright: by author(s) Reproducing, redistributing, or making commercial use of this information is expected to adhere to the terms and conditions asserted by the copyright holder. All rights reserved Edited: Filename RNA isolation techniques 10 11