Joshua Bornhorst1, Jin Ye Yeo2
1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; 2JLPM Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. JLPM Editorial Office, AME Publishing Company. Email: jlpm@amegroups.com
Expert introduction
Prof. Joshua Bornhorst (Figure 1) obtained his BA at the Grinnell College (Chemistry) in 1997, his PhD in Biochemistry at the University of Colorado in 2002.
Prof. Bornhorst is board-certified by the Diplomat of the American Board of Clinical Chemistry. He currently holds the position of Assistant Professor of Department of Pathology and Laboratory Medicine (Associate on 9/1/24) and Co-Director of Clinical Immunoassay and Metals Section as a Mayo Clinic Consultant.
Prof. Bornhorst’s recent research lies in immunoassays and biomarkers for various neurological conditions such as Alzheimer’s disease and dementia, and has published more than 59 publications in PubMed indexed international peer-review journals. Prof. Bornhorst has been invited to give presentations in more than 40 domestic and international conferences.
Figure 1 Prof. Joshua Bornhorst
Interview
JLPM: What drove you into the field of laboratory medicine, particularly in the area of neurological conditions?
Prof. Bornhorst: As with many of us in laboratory medicine, it stemmed from a desire to immediately apply biochemical and scientific expertise to the area of clinical diagnostics. The area of neurological biomarker testing has exploded in the past few years, especially with the co-development of effective pharmaceutical treatment. My colleague, Dr. Alicia Algeciras-Schimnich, and I have been fortunate to be in a position where we have the patient base, the instrumentation, and the support of in-house neurologists to enable us to pursue advancements in blood-based biomarkers for Alzheimer’s Disease (AD).
JLPM: Could you provide a brief overview of the current publication landscape of immunoassays and biomarkers for Alzheimer’s disease and dementia?
Prof. Bornhorst: The very brief overview is one word— “fast”. New articles and advances in blood-based AD biomarkers seem to come out weekly. There is particular current excitement about p-Tau217 both in the scientific (1-4) and general press (5).
JLPM: In 2023, a workgroup of the National Institute of Aging and the Alzheimer’s Association proposed the incorporation of blood-based biomarkers for Alzheimer’s disease diagnostic criteria. What promise does this new incorporation bring to the diagnosis and treatment of Alzheimer’s disease?
Prof. Bornhorst: In the past month, these guidelines have been published (4).
Previously, characterization of the presence of AD pathology relied on positron emission tomography (PET) or cerebrospinal fluid (CSF)-based assays. These new criteria integrate AD blood-based biomarkers into the evaluation of AD pathology which may make diagnosis of AD more widely available and flexible for evaluating physicians.
One important concept is the categorization of certain core biomarkers in the evaluation for AD in the evaluation of symptomatic patients which may be sufficient to establish a diagnosis. According to the newly release criteria, these “Core 1” biomarkers “become abnormal early in the disease course and directly measure either amyloid plaques (amyloid beta) and/or phosphorylated tau (p-tau). These biomarkers include amyloid PET, CSF amyloid beta 42/40 ratio, CSF p-tau181/amyloid beta 42 ratio, CSF total (t)-tau/amyloid beta 42 ratio, and "accurate" plasma biomarkers, such as p-tau217.”
While formal clinical guidelines for the use of the biomarkers are currently being worked on, these biomarkers will assist in the clinical evaluation of AD. It should be noted that the performance of these biomarkers has not yet been evaluated in asymptomatic individuals.
JLPM: In your opinion, what aspects of laboratory medicine for Alzheimer’s disease and dementia do you believe have received insufficient attention?
Prof. Bornhorst: In coming years, as more patients are treated with disease-modifying drug therapies, monitoring of patient response over time will become more important. Currently, studies are being pursued to address this need.
JLPM: Could you share some ongoing projects you are currently involved in? What research gaps do you hope to address with these projects?
Prof. Bornhorst: We are investigating the effects of confounders such as chronic kidney disease (CKD) on plasma markers. The role of additional neurological biomarkers (both AD and non-AD related) such as neurofilament light chain (NfL) and orexin, are being further elucidated.
JLPM: Were there any significant challenges that you encountered in your research journey?
Prof. Bornhorst: Bridging the gap between assay manufacturers, clinical chemists, and treating physicians in order to match assays with relevant patient samples will continue to be paramount.
JLPM: How has your experience been as an Editorial Board Member of JLPM?
Prof. Bornhorst: This has given me exposure to new research, through the peer review process as well as a change to submit research of my own. It is also nice to be part of a prestigious group of editorial board members.
JLPM: As an Editorial Board Member, what are your expectations for JLPM?
Prof. Bornhorst: To attract quality research and perspectives and to grow in reputation and become PubMed Indexed.
Reference
Ashton NJ, Brum WS, Di Molfetta G, et al. Diagnostic Accuracy of a Plasma Phosphorylated Tau 217 Immunoassay for Alzheimer Disease Pathology. JAMA Neurol. 2024;81(3):255–263.
- Pontecorvo MJ, Lu M, Burnham, SC, et al. Association of Donanemab Treatment With Exploratory Plasma Biomarkers in Early Symptomatic Alzheimer Disease: A Secondary Analysis of the TRAILBLAZER-ALZ Randomized Clinical Trial. JAMA neurology. 2022;79(12), 1250–1259.
- Figdore DJ, Griswold M, Bornhorst JA, et al. Optimizing cutpoints for clinical interpretation of brain amyloid status using plasma p-tau217 immunoassays. Alzheimer's & dementia : the journal of the Alzheimer's Association. 2024;10.1002/alz.14140.
- Jack CR Jr, Andrews JS, Beach TG, et al. Revised criteria for diagnosis and staging of Alzheimer's disease: Alzheimer's Association Workgroup. Alzheimer's & dementia: the journal of the Alzheimer's Association. 2024;10.1002/alz.13859.
- LaMotte S. Alzheimer’s blood test catches 90% of early dementia cases, study finds. CNN. 2024. Available online: https://edition.cnn.com/2024/07/28/health/alzheimer-blood-test-p-tau-217-wellness/index.html