Long-term oral lithium treatment attenuates motor disturbance in tauopathy model mice: implications of autophagy promotion

Lithium, a drug used to treat bipolar disorders, has a variety of neuroprotective mechanisms including inhibition of glycogen synthase kinase-3 (GSK-3), a major tau kinase. Recently, it has been shown that, in various neurodegenerative proteinopathies, lithium could induce autophagy. To analyze how lithium is therapeutically beneficial in tauopathies, transgenic mice overexpressing human mutant tau (P301L) were treated with oral lithium chloride (LiCl) for 4 months starting at the age of 5 months. At first, we examined the effects of treatment on behavior (using a battery of behavioral tests), tau phosphorylation (by biochemical assays), and number of neurofibrillary tangles (NFTs) (by immunohistopathology). In comparison with control mice, LiCl-treated mice showed a significantly better score in the sensory motor tasks, as well as decreases in tau phosphorylation, soluble tau level, and number of NFTs. Next, we examined lithium effects on autophagy using an antibody against microtubule-associated protein 1 light chain 3 (LC3) as an autophagosome marker. The number of LC3-positive autophagosome-like puncta was increased in neurons of LiCl-treated mice. Neurons containing NFTs were completely LC3-negative, whereas LC3-positive autophagosome-like puncta contained phosphorylated-tau (p-tau). The protein level of p62 was decreased in LiCl-treated mice. These data suggested that oral long-term lithium treatment could attenuate p-tau-induced motor disturbance not only by inhibiting GSK-3 but also by enhancing autophagy in tauopathy model mice.

P1-07-15: The Reliability of Ki-67 Expression Assessment Using Core Needle Biopsy and Surgical Specimens of Invasive Breast Cancer: Can Ki-67 Change Predict Benefits of Preoperative Endocrine Therapy?

Background: The use of Ki-67 change as a predictive marker in breast cancer has been widely investigated in patients treated with preoperative endocrine therapy. It has been assumed that Ki-67 expression determined using core needle biopsy and surgical specimens of invasive breast cancer is concordant. Many studies have suggested the concordance of the results obtained using core needle biopsy and surgical specimens for expression of the estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor type2 (HER2) status in early-stage breast cancer. However, there was few study to compare Ki-67 expression in the core needle biopsy and surgical specimens. We conducted a retrospective study of Ki-67 expression assessment between the two types of specimens to answer this question.

Methods: A total of 269 patients underwent primary operations for early-stage breast cancer at Tokyo-West Tokushukai Hospital from August 2008 to May 2011. Among these patients, 169 patients who received core needle biopsy prior to operation were enrolled.

Patients with ductal carcinoma in situ and those with neoadjuvant chemotherapy were excluded. A cutoff value of 20% was used for Ki-67-positive criteria. We also examined ER, PgR, and HER2 expression and compared it with Ki-67 expression. Statistical significance for concordance rates between the two types of specimens was evaluated by Wilcoxon t-test. To evaluate the consequence of formalin and genetic heterogeneity, parameters such as operative method and tumor size were analyzed by χ2 analysis.

Results: The concordance rate between the two types of specimens for Ki-67 expression was 76%, and this was significantly lower than that for ER expression, which was 96%. The concordance rates for PgR and HER2 expression were 88% and 91%, respectively, and they were not significantly different from the rate for Ki-67 expression. 45 patients(34.6%) had received mastectomy in the Ki-67 concordant group, and 14 patients(34.1%) in the discordant group. 55 patients(42.0%) showed T2∼ tumor size in the concordant group, 13 patients(31.7%) in the discordant group. No significant differences of parameters such as operative method (mastectomy vs breast conserving surgery) and tumor size (T1 vs T2∼) were observed between the two patient groups.

Conclusion: The reliability of Ki-67 concordance rate assessment using core needle biopsy specimens was significantly lower than that of ER expression. A standard pathological assessment of Ki-67 expression might be needed for the possible use of Ki-67 as a predictive marker for preoperative endocrine therapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-07-15.

Implementation of municipal mobility support services for older people who have stopped driving in Japan

OBJECTIVES

In a motorized society, increasing numbers of drivers and their family members will have to face the issue of driving cessation late in life due to dementia or age-related conditions. Mobility support for driving retirees should be considered from a public health perspective. Compared with alternative forms of transportation, relying on family members and friends, municipality-provided mobility support services would be more reliable and practical. The present study aimed to explore the provision of mobility support measures at the community level.

STUDY DESIGN

A cross-sectional study of all municipal governments in Japan.

METHODS

A nationwide survey was conducted using a postal self-administered questionnaire to explore the allocation of municipality-provided mobility support measures for two target groups: (1) healthy older residents and (2) older residents with dementia. The possible sociodemographic characteristics of municipalities affecting the implementation of such measures were examined.

RESULTS

Data from 1027 (56.8%) municipal governments were analysed. The present study demonstrated that mobility support measures for older residents, particularly dementia sufferers, were not sufficiently developed in municipalities. Moreover, the analyses showed that the following three characteristics of municipalities were related to the implementation of mobility support measures for healthy older residents: longer roads, low percentage of older residents per unit of road length, and low population density.

CONCLUSIONS

These findings provide insight into the possible incentives for implementing mobility support for healthy older residents, and indicate the prospective mobility needs of driving retirees, including dementia sufferers.

Milestones in PD genetics

Over the last 25 years, genetic findings have profoundly changed our views on the etiology of Parkinson's disease. Linkage studies and positional cloning strategies have identified mutations in a number of genes that cause several monogenic autosomal-dominant or autosomal-recessive forms of the disorder. Although most of these Mendelian forms of Parkinson's disease are rare, whole-genome association studies have more recently provided convincing evidence that low-penetrance variants in at least some of these, but also in several other genes, play a direct role in the etiology of the common sporadic disease as well. In addition, rare variants with intermediate-effect strengths in genes such as Gaucher's disease-associated glucocerebrosidase A have been discovered as important risk factors. "Next-generation" sequencing technologies are expected by some to identify many more of these variants. Thus, an increasingly complex network of genes contributing in different ways to disease risk and progression is emerging. These findings may provide the "genetic entry points" to identify molecular targets and readouts necessary to design rational disease-modifying treatments.

Extended-release pramipexole in advanced Parkinson disease: a randomized controlled trial

BACKGROUND

In advanced Parkinson disease (PD), immediate-release pramipexole, taken 3 times daily, improves symptoms and quality of life. A once-daily extended-release formulation may be an effective and simple alternative therapy.

METHODS

For a multicenter randomized, double-blind, parallel trial of extended- and immediate-release pramipexole vs placebo, patients experiencing motor fluctuations while taking levodopa underwent flexible study drug titration and then maintenance at optimized dosage (0.375-4.5 mg/day). The primary endpoint was a change in the Unified Parkinson's Disease Rating Scale (UPDRS) part II+III score at 18 weeks, with further assessments at 33 weeks in a subset of patients. Adverse events were recorded throughout.

RESULTS

Among 507 patients in the 18-week analyses, UPDRS II+III scores decreased (from baseline means of 40.0-41.7) by an adjusted mean of -11.0 for extended-release pramipexole and -12.8 for immediate-release pramipexole vs -6.1 for placebo (p = 0.0001 and p < 0.0001) and off-time decreased (from baseline means of 5.8-6.0 hours/day) by an adjusted mean of -2.1 and -2.5 vs -1.4 hours/day (p = 0.0199 and p < 0.0001). Other outcomes were largely corroborative, including a significant improvement in early morning off symptoms. Among 249 pramipexole patients completing 33 weeks, UPDRS II+III and off-time findings showed ≤10.1% change from 18-week values. Both formulations were well-tolerated.

CONCLUSIONS

Extended-release pramipexole significantly improved UPDRS score and off-time compared with placebo, with similar efficacy, tolerability, and safety of immediate-release pramipexole compared with placebo.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that the extended-release form of pramipexole, taken once daily, is efficacious as an adjunct to levodopa in advanced PD.

Extended-release pramipexole in early Parkinson disease: a 33-week randomized controlled trial

OBJECTIVE

To assess the clinical efficacy of a novel once-daily extended-release (ER) formulation of the dopamine agonist pramipexole as monotherapy in patients with early Parkinson disease (PD) and establish its noninferiority vs standard immediate-release (IR) pramipexole.

METHODS

This was a multicenter, double-blind, parallel study of patients with early PD not receiving levodopa or dopamine agonists, randomly assigned to pramipexole IR, pramipexole ER, or placebo. Seven-week flexible titration was followed by 26-week maintenance, with levodopa permitted as rescue medication. The primary analysis was to test pramipexole ER noninferiority to pramipexole IR based on a change in the Unified Parkinson's Disease Rating Scale (UPDRS) part II+III score at 33 weeks, with noninferiority predefined as a treatment group difference for which the lower bound of the 95% confidence interval (CI) did not exceed -3 points.

RESULTS

Among 213 ER and 207 IR recipients, the adjusted mean 33-week UPDRS II+III change (excluding levodopa rescue effects) was -8.2 for ER and -8.7 for IR, a difference of -0.5 with a 95% CI of -2.3 to 1.3. Compared with placebo (n = 103), pramipexole ER and pramipexole IR were significantly superior on UPDRS II+III score, all key secondary outcomes, and almost all other endpoints. On the 39-item Parkinson Disease Questionnaire, superiority of pramipexole ER failed to reach statistical significance. Both formulations were equally safe and well-tolerated.

CONCLUSIONS

As monotherapy for early PD, pramipexole ER was noninferior to pramipexole IR and significantly more effective than placebo. Tolerability and safety did not differ between the formulations.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that pramipexole ER is not inferior to pramipexole IR in patients with early PD.

Posterior hypoperfusion in Parkinson's disease with and without dementia measured with arterial spin labeling MRI

PURPOSE

To determine whether quantitative arterial spin labeling (ASL) can be used to evaluate regional cerebral blood flow in Parkinson's disease with dementia (PDD) and without dementia (PD).

MATERIALS AND METHODS

Thirty-five PD patients, 11 PDD patients, and 35 normal controls were scanned by using a quantitative ASL method with a 3 Tesla MRI unit. Regional cerebral blood flow was compared in the posterior cortex using region-of-interest analysis.

RESULTS

PD and PDD patients showed lower regional cerebral blood flow in the posterior cortex than normal controls (P = 0.002 and P = 0.001, respectively, analysis of variance with a Bonferroni post hoc test).

CONCLUSION

This is the first study to detect hypoperfusion in the posterior cortex in PD and PDD patients using ASL perfusion MRI. Because ASL perfusion MRI is completely noninvasive and can, therefore, safely be used for repeated assessments, this method can be used to monitor treatment effects or disease progression in PD.

Rationale for delayed-start study of pramipexole in Parkinson's disease: the PROUD study

Perhaps the most important unmet need in Parkinson's disease (PD) is the ability to slow or prevent progression of the neurodegeneration that underlies the motor and nonmotor features of this disorder. Pramipexole, a dopamine agonist used for the symptomatic treatment of PD, has demonstrated neuroprotective properties in laboratory studies. The PRamipexole On Underlying Disease (PROUD) study is a randomized, double-blind clinical trial evaluating the ability of pramipexole to modify disease progression using a delayed-start design. PD patients (n = 535) with mean age 62.5 years, mean duration since diagnosis of 4.4 months, and mean total Unified Parkinson's disease Rating Scale (UPDRS) score of 24.5 were recruited. In Phase I, patients were randomly assigned to be titrated to 1.5 mg pramipexole or placebo and maintained on study drug for 6-9 months. In Phase II, all patients were titrated to 1.5 mg pramipexole and maintained on study drug until the end of the study at 15 months. No rescue medication was allowed in the protocol. The primary endpoint is the change in total UPDRS score (parts I-III) from baseline to 15 months. A range of secondary endpoints separately assess UPDRS subscales, quality of life, depression, and impulse control disorders. A sub-study examined dopamine transporter uptake scans at baseline and 15 months. The results of PROUD will provide insight into the potential for early versus delayed treatment with pramipexole to modify motor outcome at 15 months in recently diagnosed PD patients.

Clinical efficacy of istradefylline (KW-6002) in Parkinson's disease: a randomized, controlled study

The objectives of this study were to evaluate the efficacy of istradefylline at an oral dose of 20 mg or 40 mg once daily for 12 weeks in Parkinson's disease (PD) patients with motor complications on levodopa therapy based on the change in the daily OFF time compared with placebo and to assess the safety at these doses. A total of 363 subjects were randomly assigned to receive 20 mg/day istradefylline (n = 119), 40 mg/day istradefylline (n = 125), or placebo (n = 119). The primary outcome variable was the change from baseline at endpoint in daily OFF time based on patients' ON/OFF diaries. At endpoint, the daily OFF time reduced from baseline by 1.31 hours for 20 mg/day istradefylline (P = 0.013 as compared to the placebo), 1.58 hours for 40 mg/day istradefylline (P < 0.001), and 0.66 hours for placebo; istradefylline significantly reduced the daily OFF time compared with placebo. The UPDRS Part III subscale score (ON state) reduced by 5.7 at endpoint in both istradefylline groups and 3.7 in the placebo group (P = 0.006 for 20 mg/day and P = 0.006 for 40 mg/day group as compared with placebo). The most commonly reported drug-related treatment emergent adverse event (TEAE) was dyskinesia, which occurred in 2.5% (3/119) of subjects receiving placebo, 8.5% (10/118) receiving 20 mg/day istradefylline, and 6.4% (8/125) receiving 40 mg/day istradefylline. We conclude that istradefylline at 20 mg and 40 mg once daily is effective in relieving wearing-off fluctuations of PD patients. In addition, istradefylline was well tolerated at both doses.

Ectopic expression of α-synuclein affects the migration of neural stem cells in mouse subventricular zone

α-Synuclein (α-syn) is a key protein in Parkinson's disease (PD), and its abnormal accumulation is implicated only not in the loss of dopaminergic neurons in the substantia nigra but also in impairment of olfactory bulb (OB) in PD. Olfactory dysfunction could arise from these OB changes as an early symptom in PD. We reported previously the impairment of neuronal stem cell (NSC) proliferation in the subventricular zone, which is upstream of OB in PD models. Reduction of NSC generation could potentially lead to olfactory dysfunction, which is commonly associated with and precedes the motor symptoms by several years in PD. Here, we investigated neurosphere formation in vitro and migration of NSCs in vivo after transduction of α-syn-encoding retroviral vector to characterize the function of α-syn in NSC. Over-expression of α-syn caused less effective formation of neurospheres and induced morphological changes. Fluorescence-activated cell sorting showed diminished NSC cell cycle progression induced by over-expression of α-syn. Intriguingly, suppression of NSC migration along the rostral migratory stream was observed when the α-syn-encoding vector was directly injected into the subventricular zone of mice in vivo. These results indicate that α-syn affects the generation of NSC and suggest that this protein could serve as a tool for the design of potentially useful therapy for PD patients.

No evidence for pathogenic role of GIGYF2 mutation in Parkinson disease in Japanese patients

Grb10-Interacting GYF Protein-2 (GIGYF2) is a candidate gene for PARK11 locus. To date, seven different GIGYF2 missense mutations have been identified in patients with familial Parkinson disease (PD) of European descent. To clarify the pathogenic role of GIGYF2 in PD, we analyzed the frequency of GIGYF2 mutations in 389 Japanese patients with PD (including 93 patients with late-onset familial PD, 276 with sporadic PD, and 20 with a single heterozygous mutation in the PD-associated genes), and 336 Japanese normal controls, by direct sequencing and/or high-resolution melting analysis. None of the reported GIGYF2 mutations or digenic mutations were detected. Two novel non-synonymous variants were identified (p.Q1211delQ and p.H1023Q), however, we could not determine their roles in PD. In summary, we found no evidence for PD-associated roles of GIGYF2 mutations. Our data suggest that GIGYF2 is unlikely to play a major role in PD in Japanese patients, similar to other populations.

Four-point correlation function of a passive scalar field in rapidly fluctuating turbulence: Numerical analysis of an exact closure equation

A numerical analysis is made on the four-point correlation function in a similarity range of a model of two-dimensional passive scalar field ψ advected by a turbulent velocity field with infinitely small correlation time. The model yields an exact closure equation for the four-point correlation Ψ{4} of ψ, which may be casted into the form of an eigenvalue problem in the similarity range. The analysis of the eigenvalue problem gives not only the scale dependence of Ψ{4} , but also the dependence on the configuration of the four points. The numerical analysis gives S4(R)∝R{ζ{4}} in the similarity range in which S2(R)∝R{ζ{2}} , where S_{N} is the structure function defined by S{N}(R)≡⟨[ψ(x+R)-ψ(x)]{N} and ζ{4}≠2ζ{2} . The estimate of ζ_{4} by the numerical analysis of the eigenvalue problem is in good agreement with numerical simulations so far reported. The agreement supports the idea of universality of the exponent ζ{4} in the sense that ζ_{4} is insensitive to conditions of ψ outside the similarity range. The numerical analysis also shows that the correlation C(R,r)≡[ψ(x+R)-ψ(x)]{2}[ψ(x+r)-ψ(x)]{2}> is stronger than that given by the joint-normal approximation, and scales like C(R,r)∝(r/R){χ} for r/R<<1 with R and r in the similarity range, where χ is a constant depending on the angle between R and r .

Unique activation status of peripheral blood mononuclear cells at acute phase of Kawasaki disease

Although Kawasaki disease (KD) is characterized by a marked activation of the immune system with elevations of serum proinflammatory cytokines and chemokines at acute phase, the major sources for these chemical mediators remain controversial. We analysed the activation status of peripheral blood mononuclear cells (PBMCs) by flow cytometry, DNA microarray and quantitative reverse transcription-polymerase chain reaction. The proportions of CD69+ cells in both natural killer cells and gammadeltaT cells at acute-phase KD were significantly higher than those at convalescent-phase KD. Microarray analysis revealed that five genes such as NAIP, IPAF, S100A9, FCGR1A and GCA up-regulated in acute-phase KD and the pathways involved in acute phase KD were related closely to the innate immune system. The relative expression levels of damage-associated molecular pattern molecule (DAMP) (S100A9 and S100A12) genes in PBMCs at acute-phase KD were significantly higher than those at convalescent-phase KD, while those of TNFA, IL1B and IL6 genes were not significantly different between KD patients and healthy controls. Intracellular production of tumour necrosis factor-alpha, interleukin-10 and interferon-gamma in PBMCs was not observed in KD patients. The present data have indicated that PBMCs showed a unique activation status with high expression of DAMP genes but low expression of proinflammatory cytokine genes, and that the innate immune system appears to play a role in the pathogenesis and pathophysiology of KD.

Expanding the clinical phenotype of SNCA duplication carriers

SNCA duplication is a recognized cause of familial Parkinson's disease (PD). We aimed to explore the genetic and clinical variability in the disease manifestation. Molecular characterization was performed using real-time PCR, SNP arrays, and haplotype analysis. We further studied those patients who were found to harbor SNCA duplication with olfactory function tests, polysomnography, and PET. We identified four new families and one sporadic patient with SNCA duplication. Eleven symptomatic patients from these four families presented with parkinsonism, of which three subsequently developed dementia. The lifetime estimate of overall penetrance was 43.8%. FDG-PET study of symptomatic patients showed hypometabolism in the occipital lobe, whereas asymptomatic carriers of SNCA duplication demonstrated normal glucose metabolism. Symptomatic patients showed abnormal olfactory function and polysomnography and asymptomatic carriers showed normal results. The clinical features of SNCA duplication include parkinsonism with or without dementia. Asymptomatic carriers displayed normal test results with the eldest individual aged 79 years; thus, even a carrier of SNCA duplication may escape the development of PD. This difference in age-associated penetrance may be due to the genetic background or environmental exposures. Further studies of SNCA duplication carriers will help identify disease-modifiers and may open novel avenues for future treatment.