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Hessl D, Harvey D, Sansone S, Crestodina C, Chin J, Joshi R, Hagerman RJ, Berry‐Kravis E. Effects of mavoglurant on visual attention and pupil reactivity while viewing photographs of faces in Fragile X Syndrome. PLoS One 2019; 14:e0209984. [PMID: 30653533 PMCID: PMC6336311 DOI: 10.1371/journal.pone.0209984] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/14/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Numerous preclinical studies have supported the theory that enhanced activation of mGluR5 signaling, due to the absence or reduction of the FMR1 protein, contributes to cognitive and behavioral deficits in patients with fragile X syndrome (FXS). However multiple phase 2 controlled trials in patients with FXS have failed to demonstrate efficacy of compounds that negatively modulate mGluR5, including two phase 2b randomized controlled trials (RCT) of mavoglurant (AFQ056, Novartis Pharma AG), when the primary measures of interest were behavioral ratings. This has cast some doubt onto the translation of the mGluR5 theory from animal models to humans with the disorder. METHODS We evaluated social gaze behavior-a key phenotypic feature of the disorder-and sympathetic nervous system influence on pupil size using a previously-validated eye tracking paradigm as a biobehavioral probe, in 57 adolescent or adult patients with FXS at baseline and following three months of blinded treatment with one of three doses of mavoglurant or placebo, within the context of the AFQ056 RCTs. RESULTS Patients with FXS treated with mavoglurant demonstrated increased total absolute looking time and number of fixations to the eye region while viewing human faces relative to baseline, and compared to those treated with placebo. In addition, patients had greater pupil reactivity to faces relative to baseline following mavoglurant treatment compared to placebo. DISCUSSION The study shows that negative modulation of mGluR5 activity improves eye gaze behavior and alters sympathetically-driven reactivity to faces in patients with FXS, providing preliminary evidence of this drug's impact on behavior in humans with the disorder.
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Affiliation(s)
- David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, United States of America
| | - Stephanie Sansone
- MIND Institute, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Crystal Crestodina
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
| | - Jamie Chin
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
| | - Reshma Joshi
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
| | - Randi J. Hagerman
- MIND Institute, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Elizabeth Berry‐Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, United States of America
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Best Practices in Fragile X Syndrome Treatment Development. Brain Sci 2018; 8:brainsci8120224. [PMID: 30558274 PMCID: PMC6315698 DOI: 10.3390/brainsci8120224] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/14/2023] Open
Abstract
Preclinical studies using animal models of fragile X syndrome have yielded several agents that rescue a wide variety of phenotypes. However, translation of these treatments to humans with the disorder has not yet been successful, shedding light on a variety of limitations with both animal models and human trial design. As members of the Clinical Trials Committee of the National Fragile X Foundation, we have discussed a variety of recommendations at the level of preclinical development, transition from preclinical to human projects, family involvement, and multi-site trial planning. Our recommendations are made with the vision that effective new treatment will lie at the intersection of innovation, rigorous and reproducible research, and stakeholder involvement.
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Friedman L, Lorang E, Sterling A. The use of demonstratives and personal pronouns in fragile X syndrome and autism spectrum disorder. CLINICAL LINGUISTICS & PHONETICS 2018; 33:420-436. [PMID: 30346853 PMCID: PMC6481616 DOI: 10.1080/02699206.2018.1536727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Demonstratives (e.g. here, that, these) and personal pronouns are early developing components of language, which are often impaired in young children with autism spectrum disorder (ASD). Additionally, demonstrative and personal pronoun use are linked to joint attention and language ability early in life for individuals with ASD. Fragile X syndrome (FXS) is a genetic disorder with a significant amount of overlap in its behavioural phenotype with ASD. The present study examined demonstrative and personal pronoun production during a conversation sample in adolescent boys with ASD and adolescent boys with FXS with a co-diagnosis of ASD (FXS+ASD). Findings indicated that grammatical complexity was related to both qualitative and quantitative aspects of demonstrative and personal pronoun production in boys with ASD, while grammatical complexity was related to the total number of demonstratives and personal pronouns produced in the boys with FXS+ASD. ASD severity was not related to demonstrative or personal pronoun production in ASD, although it was negatively correlated with the total number of personal pronouns produced by the boys with FXS. Additionally, groups did not differ significantly in production of personal pronouns, but they did differ significantly in multiple aspects of demonstrative use. Findings suggest that these groups produce similar rates of personal pronouns in the school-age years, while production of demonstratives differentiates these groups. This study contributes to the knowledge of the language phenotypes of idiopathic ASD and FXS+ASD, and provides implications for intervention targets for school-age children with these disorders.
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Affiliation(s)
- Laura Friedman
- a Department of Communication Sciences and Disorders , University of Wisconsin at Madison , Madison , Wisconsin , USA
| | - Emily Lorang
- a Department of Communication Sciences and Disorders , University of Wisconsin at Madison , Madison , Wisconsin , USA
| | - Audra Sterling
- a Department of Communication Sciences and Disorders , University of Wisconsin at Madison , Madison , Wisconsin , USA
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Fletcher-Watson S, Hampton S. The potential of eye-tracking as a sensitive measure of behavioural change in response to intervention. Sci Rep 2018; 8:14715. [PMID: 30279422 PMCID: PMC6168486 DOI: 10.1038/s41598-018-32444-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/28/2018] [Indexed: 11/09/2022] Open
Abstract
One challenge to the development of effective interventions to support learning and behavioural change in neurodevelopmental disorders is a lack of suitable outcome measures. Eye-tracking has been used widely to chart cognitive development and clinically-relevant group differences in many populations. This proof-of-concept study investigates whether it also has the potential to act as a marker of treatment effects, by testing its sensitivity to differential change over a short period of exposure to an iPad app in typically developing children. The app targets a key skill in early social communication development, by rewarding attention to people, operationalised via a finger-tap on screen. We measured attention to images taken from the app, and a selection of matched stimuli to test generalisation of effects, at baseline and two weeks later. Children were assigned to either an app-exposure or no-app condition in the intervening period. The app exposure group showed increases in fixation on people for images from the app, and for distant-generalisation photographs, at high levels of complexity. We conclude that, with careful selection of stimuli, eye-tracking has the potential to make a valuable contribution to the range of outcome measures available for psycho-behavioural interventions in neurodevelopmental disorders.
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Affiliation(s)
- Sue Fletcher-Watson
- Patrick Wild Centre, Division of Psychiatry, The University of Edinburgh, Edinburgh, UK.
| | - Sarah Hampton
- Autism Research Centre, University of Cambridge, Cambridge, UK
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55
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Castagnola S, Delhaye S, Folci A, Paquet A, Brau F, Duprat F, Jarjat M, Grossi M, Béal M, Martin S, Mantegazza M, Bardoni B, Maurin T. New Insights Into the Role of Ca v2 Protein Family in Calcium Flux Deregulation in Fmr1-KO Neurons. Front Mol Neurosci 2018; 11:342. [PMID: 30319351 PMCID: PMC6170614 DOI: 10.3389/fnmol.2018.00342] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/30/2018] [Indexed: 12/31/2022] Open
Abstract
Fragile X syndrome (FXS), the most common form of inherited intellectual disability (ID) and a leading cause of autism, results from the loss of expression of the Fmr1 gene which encodes the RNA-binding protein Fragile X Mental Retardation Protein (FMRP). Among the thousands mRNA targets of FMRP, numerous encode regulators of ion homeostasis. It has also been described that FMRP directly interacts with Ca2+ channels modulating their activity. Collectively these findings suggest that FMRP plays critical roles in Ca2+ homeostasis during nervous system development. We carried out a functional analysis of Ca2+ regulation using a calcium imaging approach in Fmr1-KO cultured neurons and we show that these cells display impaired steady state Ca2+ concentration and an altered entry of Ca2+ after KCl-triggered depolarization. Consistent with these data, we show that the protein product of the Cacna1a gene, the pore-forming subunit of the Cav2.1 channel, is less expressed at the plasma membrane of Fmr1-KO neurons compared to wild-type (WT). Thus, our findings point out the critical role that Cav2.1 plays in the altered Ca2+ flux in Fmr1-KO neurons, impacting Ca2+ homeostasis of these cells. Remarkably, we highlight a new phenotype of cultured Fmr1-KO neurons that can be considered a novel cellular biomarker and is amenable to small molecule screening and identification of new drugs to treat FXS.
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Affiliation(s)
- Sara Castagnola
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France.,CNRS LIA "Neogenex", Valbonne, France
| | - Sébastien Delhaye
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France.,CNRS LIA "Neogenex", Valbonne, France
| | | | - Agnès Paquet
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France
| | - Frédéric Brau
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France
| | - Fabrice Duprat
- Université Côte d'Azur, INSERM, CNRS UMR7275, IPMC, Valbonne, France
| | - Marielle Jarjat
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France.,CNRS LIA "Neogenex", Valbonne, France
| | - Mauro Grossi
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France.,CNRS LIA "Neogenex", Valbonne, France
| | - Méline Béal
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France.,CNRS LIA "Neogenex", Valbonne, France
| | - Stéphane Martin
- Université Côte d'Azur, INSERM, CNRS UMR7275, IPMC, Valbonne, France
| | | | - Barbara Bardoni
- CNRS LIA "Neogenex", Valbonne, France.,Université Côte d'Azur, INSERM, CNRS UMR7275, IPMC, Valbonne, France
| | - Thomas Maurin
- Université Côte d'Azur, CNRS UMR7275, IPMC, Valbonne, France.,CNRS LIA "Neogenex", Valbonne, France
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Westmark PR, Dekundy A, Gravius A, Danysz W, Westmark CJ. Rescue of Fmr1 KO phenotypes with mGluR 5 inhibitors: MRZ-8456 versus AFQ-056. Neurobiol Dis 2018; 119:190-198. [PMID: 30125640 DOI: 10.1016/j.nbd.2018.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 12/23/2022] Open
Abstract
Metabotropic glutamate receptor 5 (mGluR5) is a drug target for central nervous system disorders such as fragile X syndrome that involve excessive glutamate-induced excitation. We tested the efficacy of a novel negative allosteric modulator of mGluR5 developed by Merz Pharmaceuticals, MRZ-8456, in comparison to MPEP and AFQ-056 (Novartis, a.k.a. mavoglurant) in both in vivo and in vitro assays in a mouse model of fragile X syndrome, Fmr1KO mice. The in vivo assays included susceptibility to audiogenic-induced seizures and pharmacokinetic measurements of drug availability. The in vitro assays included dose response assessments of biomarker expression and dendritic spine length and density in cultured primary neurons. Both MRZ-8456 and AFQ-056 attenuated wild running and audiogenic-induced seizures in Fmr1KO mice with similar pharmacokinetic profiles. Both drugs significantly reduced dendritic expression of amyloid-beta protein precursor (APP) and rescued the ratio of mature to immature dendritic spines. These findings demonstrate that MRZ-8456, a drug being developed for the treatment of motor complications of L-DOPA in Parkinson's disease and which completed a phase I clinical trial, is effective in attenuating both well-established (seizures and dendritic spine maturity) and exploratory biomarker (APP expression) phenotypes in a mouse model of fragile X syndrome.
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Affiliation(s)
- Pamela R Westmark
- University of Wisconsin-Madison, Department of Neurology, Madison, WI, USA; University of Wisconsin-Madison, Department of Medicine, Madison, WI, USA
| | - Andrzej Dekundy
- Merz Pharmaceuticals GmbH, Eckenheimer Landstrasse 100, 60318 Frankfurt am Main, Germany
| | - Andreas Gravius
- Merz Pharmaceuticals GmbH, Eckenheimer Landstrasse 100, 60318 Frankfurt am Main, Germany
| | - Wojciech Danysz
- Merz Pharmaceuticals GmbH, Eckenheimer Landstrasse 100, 60318 Frankfurt am Main, Germany
| | - Cara J Westmark
- University of Wisconsin-Madison, Department of Neurology, Madison, WI, USA.
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Fragile X syndrome and fragile X-associated tremor ataxia syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2018; 147:377-391. [PMID: 29325626 DOI: 10.1016/b978-0-444-63233-3.00025-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fragile X-associated disorders encompass several conditions, which are caused by expansion mutations in the fragile X mental retardation 1 (FMR1) gene. Fragile X syndrome is the most common inherited etiology of intellectual disability and results from a full mutation or >200 CGG repeats in FMR1. It is associated with developmental delay, autism spectrum disorder, and seizures. Fragile X-associated tremor/ataxia syndrome is a progressive neurodegenerative disease that occurs in premutation carriers of 55-200 CGG repeats in FMR1 and is characterized by kinetic tremor, gait ataxia, parkinsonism, executive dysfunction, and neuropathy. Fragile X-associated primary ovarian insufficiency also occurs in premutation carrier women and manifests with infertility and early menopause. The diseases constituting fragile X-associated disorders differ mechanistically, due to the distinct molecular properties of premutation versus full mutations. Fragile X syndrome occurs when there is a lack of fragile X mental retardation protein (FMRP) due to FMR1 methylation and silencing. In fragile X-associated tremor ataxia syndrome, a toxic gain of function is postulated with the production of excess CGG repeat-containing FMR1 mRNA, abnormal translation of the repeat sequence leading to production of polyglycine, polyalanine, and other polypeptides and to outright deficits in translation leading to reduced FMRP at larger premutation sizes. The changes in underlying brain chemistry due to FMR1 mutations have led to therapeutic studies in these disorders, with some progress being made in fragile X syndrome. This paper also summarizes indications for testing, genetic counseling issues, and what the future holds for these disorders.
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59
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Conners FA, Tungate AS, Abbeduto L, Merrill EC, Faught GG. Growth and Decline in Language and Phonological Memory Over Two Years Among Adolescents With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 123:103-118. [PMID: 29480772 PMCID: PMC5858704 DOI: 10.1352/1944-7558-123.2.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Forty-two adolescents with Down syndrome (DS) ages 10 to 21 years completed a battery of language and phonological memory measures twice, 2 years apart. Individual differences were highly stable across two years. Receptive vocabulary scores improved, there was no change in receptive or expressive grammar scores, and nonword repetition scores declined. Digit memory and expressive vocabulary scores improved among younger adolescents, but generally held steady among older adolescents. These patterns may reveal key points in development at which interventions may be best applied. Further research is needed to understand specific processes in tasks that appear to be slowing or declining during adolescence. They may be important for understanding early aging and dementia in DS.
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Affiliation(s)
- Frances A Conners
- Frances A. Conners and Andrew S. Tungate, Department of Psychology, The University of Alabama
| | - Andrew S Tungate
- Frances A. Conners and Andrew S. Tungate, Department of Psychology, The University of Alabama
| | - Leonard Abbeduto
- Leonard Abbeduto, MIND Institute, and Department of Psychiatry and Behavioral Sciences, The University of California, Davis
| | - Edward C Merrill
- Edward C. Merrill and Gayle G. Faught, Department of Psychology, The University of Alabama
| | - Gayle G Faught
- Edward C. Merrill and Gayle G. Faught, Department of Psychology, The University of Alabama
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Channell MM, Loveall SJ, Conners FA, Harvey DJ, Abbeduto L. Narrative Language Sampling in Typical Development: Implications for Clinical Trials. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:123-135. [PMID: 29222570 PMCID: PMC6105083 DOI: 10.1044/2017_ajslp-17-0046] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 09/05/2017] [Indexed: 05/20/2023]
Abstract
PURPOSE This study examined cross-sectional age-related trajectories of expressive language variables (syntactic complexity, lexical diversity, unintelligibility, dysfluency, and talkativeness) derived from a narrative language sampling procedure. METHOD Narrative samples were analyzed from 103 typically developing individuals, ages 4-21 years. RESULTS Results showed that this procedure was effective for the entire age range, with participants producing an utterance on virtually every page of the wordless picture books used to prompt the narrative. Importantly, the cross-sectional trajectories for syntactic complexity and lexical diversity showed age-related increases through the age of 18 years, although measures of other dimensions of language showed different relationships with age. CONCLUSIONS These data inform developmental work and document the extent to which the narrative procedure can be used to characterize expressive language over a wide age range. This procedure has been proposed as an outcome measure for clinical trials and interventions involving individuals with intellectual and developmental disabilities. The present data document the developmental levels for which the procedure and metrics derived are appropriate.
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Effect of the mGluR5-NAM Basimglurant on Behavior in Adolescents and Adults with Fragile X Syndrome in a Randomized, Double-Blind, Placebo-Controlled Trial: FragXis Phase 2 Results. Neuropsychopharmacology 2018; 43:503-512. [PMID: 28816242 PMCID: PMC5770759 DOI: 10.1038/npp.2017.177] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 12/19/2022]
Abstract
Preclinical data suggest that inhibition of the metabotropic glutamate receptor 5 (mGluR5) receptor might hold therapeutic benefits in Fragile X syndrome (FXS). Treatment of Fmr1 knockout mice with mGluR5-negative allosteric modulators (NAMs) has been reported to correct a broad range of phenotypes related to FXS. The early short-term clinical trials with mGluR5 NAMs, including basimglurant, assessing the effects in individuals with FXS, were supportive of further exploration in larger, well-controlled trials. We evaluated basimglurant, a potent and selective mGluR5 NAM, in a 12-week, double-blind, parallel-group study of 183 adults and adolescents (aged 14-50, mean 23.4 years) with FXS. Individuals with an FMR1 full mutation were randomized to placebo or one of two doses of basimglurant. The primary efficacy endpoint was the change from baseline in behavioral symptoms using the Anxiety Depression and Mood Scale (ADAMS) total score. All treatment arms showed marked behavioral improvements from baseline to week 12 with less improvement in the basimglurant 1.5 mg arm than placebo; however, basimglurant 0.5 mg was inferior to placebo in the ADAMs total score. Treatment with basimglurant was overall well-tolerated. A higher incidence of adverse events classified as psychiatric disorders were reported in patients treated with basimglurant, including three patients with hallucinations or psychosis. In this phase 2 clinical trial, basimglurant did not demonstrate improvement over placebo. Evaluation of the overall risk-benefit in younger patient populations is an important consideration for the design of potential further investigations of efficacy with this class of medications.
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Abstract
We examined the reliability, validity and factor structure of the Eye Contact Avoidance Scale (ECAS), a new 15-item screening tool designed to measure eye contact avoidance in individuals with fragile X syndrome (FXS). Internal consistency of the scale was acceptable to excellent and convergent validity with the Social Responsiveness Scale, Second Edition (SRS-2) and the Anxiety, Depression, and Mood Scale (ADAMS) was good. Boys with a comorbid ASD diagnosis obtained significantly higher scores on the ECAS compared to boys without ASD, when controlling for communication ability. A confirmatory factor analysis indicated that a two-factor model (avoidance and aversion) provided an excellent fit to the data. The ECAS appears to be a promising reliable and valid tool that could be employed as an outcome measure in future pharmacological/behavioral treatment trials for FXS.
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McDuffie A, Banasik A, Bullard L, Nelson S, Feigles RT, Hagerman R, Abbeduto L. Distance delivery of a spoken language intervention for school-aged and adolescent boys with fragile X syndrome. Dev Neurorehabil 2018; 21:48-63. [PMID: 28956679 PMCID: PMC5986725 DOI: 10.1080/17518423.2017.1369189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A small randomized group design (N = 20) was used to examine a parent-implemented intervention designed to improve the spoken language skills of school-aged and adolescent boys with FXS, the leading cause of inherited intellectual disability. The intervention was implemented by speech-language pathologists who used distance video-teleconferencing to deliver the intervention. The intervention taught mothers to use a set of language facilitation strategies while interacting with their children in the context of shared story-telling. Treatment group mothers significantly improved their use of the targeted intervention strategies. Children in the treatment group increased the duration of engagement in the shared story-telling activity as well as use of utterances that maintained the topic of the story. Children also showed increases in lexical diversity, but not in grammatical complexity.
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Affiliation(s)
- Andrea McDuffie
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Amy Banasik
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Lauren Bullard
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Sarah Nelson
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Robyn Tempero Feigles
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Randi Hagerman
- MIND Institute, University of California, Sacramento, CA, USA,Department of Pediatrics, University of California, Sacramento CA, USA
| | - Leonard Abbeduto
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
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64
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Soorya L, Leon J, Trelles MP, Thurm A. Framework for assessing individuals with rare genetic disorders associated with profound intellectual and multiple disabilities (PIMD): the example of Phelan McDermid Syndrome. Clin Neuropsychol 2017; 32:1226-1255. [PMID: 29265961 DOI: 10.1080/13854046.2017.1413211] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Specialized strategies are needed to understand the complex neuropsychological impairments reported in individuals with profound intellectual and multiple disabilities (PIMD) associated with rare genetic disorders. METHODS This narrative review focuses on assessment of individuals with Phelan-McDermid Syndrome (PMS) as a condition commonly associated with PIMD. Published case series and prospective studies were reviewed to evaluate approaches to cognitive, language, motor/sensory, and behavioral domains. This review is framed using general principles for neuropsychological evaluation in PIMD. RESULTS Neuropsychological assessment domains and tools varied across published reports. Adaptive behavior measures, out-of-range developmental assessments, and social-communication measures were commonly used. Available findings were used to shape a recommended framework with potential to improve measurement of clinical outcomes and advance scientific discovery. CONCLUSIONS The recommended framework outlines an inter-disciplinary and multimodal neuropsychological assessment process relying on modified standardized assessments, functional assessments, and caregiver/informant reports when evaluating individuals with PIMD. Arrested development and skill variability/regression are also discussed as additional, important considerations in neuropsychological evaluation of individuals with PIMD and rare genetic disorders.
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Affiliation(s)
- Latha Soorya
- a Department of Psychiatry , Rush University Medical Center , Chicago , IL , USA
| | - Jill Leon
- b Intramural Research Program , National Institute of Mental Health , Bethesda , MD , USA
| | - M Pilar Trelles
- c Department of Psychiatry , Icahn School of Medicine , New York , NY , USA
| | - Audrey Thurm
- b Intramural Research Program , National Institute of Mental Health , Bethesda , MD , USA
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Zeidler S, de Boer H, Hukema RK, Willemsen R. Combination Therapy in Fragile X Syndrome; Possibilities and Pitfalls Illustrated by Targeting the mGluR5 and GABA Pathway Simultaneously. Front Mol Neurosci 2017; 10:368. [PMID: 29163043 PMCID: PMC5681991 DOI: 10.3389/fnmol.2017.00368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common monogenetic cause of intellectual disability and autism. The disorder is characterized by altered synaptic plasticity in the brain. Synaptic plasticity is tightly regulated by a complex balance of different synaptic pathways. In FXS, various synaptic pathways are disrupted, including the excitatory metabotropic glutamate receptor 5 (mGluR5) and the inhibitory γ-aminobutyric acid (GABA) pathways. Targeting each of these pathways individually, has demonstrated beneficial effects in animal models, but not in patients with FXS. This lack of translation might be due to oversimplification of the disease mechanisms when targeting only one affected pathway, in spite of the complexity of the many pathways implicated in FXS. In this report we outline the hypothesis that targeting more than one pathway simultaneously, a combination therapy, might improve treatment effects in FXS. In addition, we present a glance of the first results of chronic combination therapy on social behavior in Fmr1 KO mice. In contrast to what we expected, targeting both the mGluR5 and the GABAergic pathways simultaneously did not result in a synergistic effect, but in a slight worsening of the social behavior phenotype. This does implicate that both pathways are interconnected and important for social behavior. Our results underline the tremendous fine-tuning that is needed to reach the excitatory-inhibitory balance in the synapse in relation to social behavior. We believe that alternative strategies focused on combination therapy should be further explored, including targeting pathways in different cellular compartments or cell-types.
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Affiliation(s)
- Shimriet Zeidler
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Helen de Boer
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Renate K Hukema
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rob Willemsen
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
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Daunhauer LA, Gerlach-McDonald B, Will E, Fidler DJ. Performance and Ratings Based Measures of Executive Function in School-Aged Children with Down Syndrome. Dev Neuropsychol 2017; 42:351-368. [DOI: 10.1080/87565641.2017.1360303] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lisa A. Daunhauer
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado
| | - Brianne Gerlach-McDonald
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Will
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado
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67
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Pellerin D, Lortie A, Corbin F. Platelets as a surrogate disease model of neurodevelopmental disorders: Insights from Fragile X Syndrome. Platelets 2017; 29:113-124. [PMID: 28660769 DOI: 10.1080/09537104.2017.1317733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fragile X Syndrome (FXS) is the most common inherited form of intellectual disability and the leading monogenic cause of autism spectrum disorders (ASD). Despite a large number of therapeutics developed in past years, there is currently no targeted treatment approved for FXS. In fact, translation of the positive and very promising preclinical findings from animal models to human subjects has so far fallen short owing in part to the low predictive validity of the Fmr1 ko mouse, an overly simplistic model of the complex human disease. This issue stresses the critical need to identify new surrogate human peripheral cell models of FXS, which may in fact allow for the identification of novel and more efficient therapies. Of all described models, blood platelets appear to be one of the most promising and appropriate disease models of FXS, in part owing to their close biochemical similarities with neurons. Noteworthy, they also recapitulate some of FXS neuron's core molecular dysregulations, such as hyperactivity of the MAPK/ERK and PI3K/Akt/mTOR pathways, elevated enzymatic activity of MMP9 and decreased production of cAMP. Platelets might therefore help furthering our understanding of FXS pathophysiology and might also lead to the identification of disease-specific biomarkers, as was shown in several psychiatric disorders such as schizophrenia and Alzheimer's disease. Moreover, there is additional evidence suggesting that platelet signaling may assist with prediction of cognitive phenotype and could represent a potent readout of drug efficacy in clinical trials. Globally, given the neurobiological overlap between different forms of intellectual disability, platelets may be a valuable window to access the molecular underpinnings of ASD and other neurodevelopmental disorders (NDD) sharing similar synaptic plasticity defects with FXS. Platelets are indeed an attractive model for unraveling pathophysiological mechanisms involved in NDD as well as to search for diagnostic and therapeutic biomarkers.
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Affiliation(s)
- David Pellerin
- a Department of Biochemistry, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada.,b Department of Neurology and Neurosurgery, Faculty of Medicine , McGill University , Montreal , QC , Canada
| | - Audrey Lortie
- a Department of Biochemistry, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada
| | - François Corbin
- a Department of Biochemistry, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , QC , Canada
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Budimirovic DB, Berry-Kravis E, Erickson CA, Hall SS, Hessl D, Reiss AL, King MK, Abbeduto L, Kaufmann WE. Updated report on tools to measure outcomes of clinical trials in fragile X syndrome. J Neurodev Disord 2017; 9:14. [PMID: 28616097 PMCID: PMC5467057 DOI: 10.1186/s11689-017-9193-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Fragile X syndrome (FXS) has been the neurodevelopmental disorder with the most active translation of preclinical breakthroughs into clinical trials. This process has led to a critical assessment of outcome measures, which resulted in a comprehensive review published in 2013. Nevertheless, the disappointing outcome of several recent phase III drug trials in FXS, and parallel efforts at evaluating behavioral endpoints for trials in autism spectrum disorder (ASD), has emphasized the need for re-assessing outcome measures and revising recommendations for FXS. METHODS After performing an extensive database search (PubMed, Food and Drug Administration (FDA)/National Institutes of Health (NIH)'s www.ClinicalTrials.gov, etc.) to determine progress since 2013, members of the Working Groups who published the 2013 Report evaluated the available outcome measures for FXS and related neurodevelopmental disorders using the COSMIN grading system of levels of evidence. The latter has also been applied to a British survey of endpoints for ASD. In addition, we also generated an informal classification of outcome measures for use in FXS intervention studies as instruments appropriate to detect shorter- or longer-term changes. RESULTS To date, a total of 22 double-blind controlled clinical trials in FXS have been identified through www.ClinicalTrials.gov and an extensive literature search. The vast majority of these FDA/NIH-registered clinical trials has been completed between 2008 and 2015 and has targeted the core excitatory/inhibitory imbalance present in FXS and other neurodevelopmental disorders. Limited data exist on reliability and validity for most tools used to measure cognitive, behavioral, and other problems in FXS in these trials and other studies. Overall, evidence for most tools supports a moderate tool quality grading. Data on sensitivity to treatment, currently under evaluation, could improve ratings for some cognitive and behavioral tools. Some progress has also been made at identifying promising biomarkers, mainly on blood-based and neurophysiological measures. CONCLUSION Despite the tangible progress in implementing clinical trials in FXS, the increasing data on measurement properties of endpoints, and the ongoing process of new tool development, the vast majority of outcome measures are at the moderate quality level with limited information on reliability, validity, and sensitivity to treatment. This situation is not unique to FXS, since reviews of endpoints for ASD have arrived at similar conclusions. These findings, in conjunction with the predominance of parent-based measures particularly in the behavioral domain, indicate that endpoint development in FXS needs to continue with an emphasis on more objective measures (observational, direct testing, biomarkers) that reflect meaningful improvements in quality of life. A major continuous challenge is the development of measurement tools concurrently with testing drug safety and efficacy in clinical trials.
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Affiliation(s)
- Dejan B. Budimirovic
- Departments of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute and Child Psychiatry, Johns Hopkins University School of Medicine, 716 N. Broadway, Baltimore, MD 21205 USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, 1725 West Harrison, Suite 718, Chicago, IL 60612 USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Scott S. Hall
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Allan L. Reiss
- Division of Interdisciplinary Brain Sciences, Departments of Psychiatry and Behavioral Sciences, Radiology and Pediatrics, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - Margaret K. King
- Autism & Developmental Medicine Institute, Geisinger Health System, Present address: Novartis Pharmaceuticals Corporation, US Medical, One Health Plaza, East Hanover, NJ 07936 USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Walter E. Kaufmann
- Center for Translational Research, Greenwood Genetic Center, 113 Gregor Mendel Circle, Greenwood, SC 29646 USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115 USA
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Thurman AJ, Kover ST, Ted Brown W, Harvey DJ, Abbeduto L. Noncomprehension Signaling in Males and Females With Fragile X Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1606-1621. [PMID: 28586922 PMCID: PMC5544413 DOI: 10.1044/2016_jslhr-l-15-0358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/10/2016] [Accepted: 12/05/2016] [Indexed: 05/25/2023]
Abstract
Purpose This study used a prospective longitudinal design to evaluate the trajectory and predictors of noncomprehension signaling in male and female youth with fragile X syndrome (FXS). Method A direction-following task in which some of the directions were inadequate was administered. Participants were 52 youth (36 boys, 16 girls) with FXS. Upon study entry, participants ranged from 10 to 16 years. The average number of annual assessments per participant was 3.65 (range = 1-4), providing 198 data points for analysis. Results Participants with FXS were less likely to signal noncomprehension than younger, typically developing, cognitively matched children. The average rate of change in noncomprehension signaling was not significantly different from 0 for either boys or girls, suggesting a plateau. Both FMRP and nonverbal IQ were significant independent predictors of noncomprehension signaling for boys. Variability in noncomprehension signaling among girls was not explained by any of the predictors, but trends similar to those observed for boys were observed. Conclusions Noncomprehension signaling appears to be an area of weakness for individuals with FXS. Because the failure to signal noncomprehension can have negative, cumulative effects on comprehension, the results suggest a need for interventions targeting the requisite cognitive skills.
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Affiliation(s)
- Angela John Thurman
- MIND Institute, University of California Davis, Sacramento
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento
| | - Sara T. Kover
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - W. Ted Brown
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island
| | | | - Leonard Abbeduto
- MIND Institute, University of California Davis, Sacramento
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento
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Deacon RMJ, Hurley MJ, Rebolledo CM, Snape M, Altimiras FJ, Farías L, Pino M, Biekofsky R, Glass L, Cogram P. Retracted: Nrf2: a novel therapeutic target in fragile X syndrome is modulated by NNZ2566. GENES BRAIN AND BEHAVIOR 2017; 16:739. [DOI: 10.1111/gbb.12373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. M. J. Deacon
- Biomedicine Division, Centre for Systems Biotechnology; Fraunhofer Research Foundation; Santiago Chile
- Gen.DDI Ltd; London UK
- Laboratory of Molecular Neuropsychiatry, Institute of Cognitive and Translational Neuroscience (INCyT); INECO Foundation, Favaloro University, National Scientific and Technical Research Council; Buenos Aires Argentina
| | - M. J. Hurley
- Laboratory of Molecular Neuropsychiatry, Institute of Cognitive and Translational Neuroscience (INCyT); INECO Foundation, Favaloro University, National Scientific and Technical Research Council; Buenos Aires Argentina
- Division of Brain Sciences, Centre for Neuroinflammation and Neurodegeneration; Imperial College; London UK
| | | | - M. Snape
- AMO Pharmaceuticals Ltd; Huntingdon UK
| | - F. J. Altimiras
- Biomedicine Division, Centre for Systems Biotechnology; Fraunhofer Research Foundation; Santiago Chile
- Facultad de Ingeniería y Ciencias; Universidad Adolfo Ibañez; Santiago Chile
| | - L. Farías
- Biomedicine Division, Centre for Systems Biotechnology; Fraunhofer Research Foundation; Santiago Chile
- Facultad de Ingeniería y Ciencias; Universidad Adolfo Ibañez; Santiago Chile
| | - M. Pino
- Biomedicine Division, Centre for Systems Biotechnology; Fraunhofer Research Foundation; Santiago Chile
| | | | - L. Glass
- Neuren Pharmaceuticals; Bethesda MD USA
| | - P. Cogram
- Biomedicine Division, Centre for Systems Biotechnology; Fraunhofer Research Foundation; Santiago Chile
- Laboratory of Molecular Neuropsychiatry, Institute of Cognitive and Translational Neuroscience (INCyT); INECO Foundation, Favaloro University, National Scientific and Technical Research Council; Buenos Aires Argentina
- Institute Of Ecology and Biodiversity (IEB), Faculty of Science, University of Chile; Santiago Chile
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Esbensen AJ, Hooper SR, Fidler D, Hartley SL, Edgin J, d'Ardhuy XL, Capone G, Conners FA, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017. [PMID: 28452584 DOI: 10.1352/1944-7558-122.2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
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Affiliation(s)
- Anna J Esbensen
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Stephen R Hooper
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Deborah Fidler
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Sigan L Hartley
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Jamie Edgin
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Xavier Liogier d'Ardhuy
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - George Capone
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Frances A Conners
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Carolyn B Mervis
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Leonard Abbeduto
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Michael Rafii
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Sharon J Krinsky-McHale
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
| | - Tiina Urv
- Anna J. Esbensen, Cincinnati Children's Hospital Medical Center; Stephen R. Hooper, University of North Carolina - Chapel Hill; Deborah Fidler, Colorado State University; Sigan L. Hartley, University of Wisconsin - Madison; Jamie Edgin, University of Arizona; Xavier Liogier d'Ardhuy, Roche Innovation Center Basel; George Capone, Kennedy Krieger Institute; Frances A. Conners, University of Alabama; Carolyn B. Mervis, University of Louisville; Leonard Abbeduto, MIND Institute, University of California, Davis School of Medicine; Michael Rafii, University of Southern California and University of California, San Diego; Sharon J. Krinsky-McHale, New York State Institute for Basic Research in Developmental Disabilities and Columbia University Medical Center; Tiina Urv, Eunice Kennedy Shriver National Institute of Child Health and Human Development; and Outcome Measures Working Group. Note: Outcome Measures Working Group Participants: Cognition Working Group-Leonard Abbeduto, Frances Conners, Jamie Edgin, Michael Harpold, Stephen Hooper, Sharon J. Krinsky-McHale, Nancy Raitano Lee, Xavier Liogier d'Ardhuy, Carolyn Mervis, Roger Reeves, Michael Ropacki, Paul Wang; Behavior Working Group-George Capone, Elisabeth Dykens, Anna Esbensen, Deborah Fidler, Sigan Hartley, Seth Keller, Michael Rafii, Sara Weir
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Esbensen AJ, Hooper SR, Fidler D, Hartley S, Edgin J, d’Ardhuy XL, Capone G, Conners F, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:247-281. [PMID: 28452584 PMCID: PMC5424621 DOI: 10.1352/1944-7558-122.3.247] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard Abbeduto
- MIND Institute, University of California, Davis School of Medicine
| | | | | | - Tiina Urv
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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73
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Çaku A, Seidah NG, Lortie A, Gagné N, Perron P, Dubé J, Corbin F. New insights of altered lipid profile in Fragile X Syndrome. PLoS One 2017; 12:e0174301. [PMID: 28334053 PMCID: PMC5363930 DOI: 10.1371/journal.pone.0174301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/07/2017] [Indexed: 01/15/2023] Open
Abstract
Background Fragile X Syndrome (FXS) is the main genetic cause of autism and intellectual deficiency resulting the absence of the Fragile X Mental Retardation Protein (FMRP). Clinical picture is characterized by cognitive impairment associated with a broad spectrum of psychiatric comorbidities including autism spectrum disorders and attention-deficit/hyperactivity disorders. Some of these disorders have been associated with lipid abnormalities and lower cholesterol levels. Since lipids are important for neuronal development, we aim to investigate the lipid profile of French Canadian-FXS individuals and to identify the altered components of cholesterol metabolism as well as their association with clinical profile. Methods Anthropometric data were collected from 25 FXS individuals and 26 controls. Lipid assessment included: total cholesterol (TC), triglycerides, LDL, HDL, ApoB, ApoA1, PCSK9, Lp(a) and lipoprotein electrophoresis. Aberrant and adaptive behaviour of affected individuals was respectively assessed by the ABC-C and ABAS questionnaires. Results FXS participants had a higher body mass index as compared to controls while 38% of them had TC<10th percentile. Lower levels of LDL, HDL and apoA1 were observed in FXS group as compared to controls. However, PCSK9 levels did not differ between the two groups. As expected, PCSK9 levels correlated with total cholesterol (rs = 0.61, p = 0.001) and LDL (rs = 0.46, p = 0.014) in the control group, while no association was present in the FXS group. An inverse relationship was observed between total cholesterol and aberrant behaviour as determined by ABC-C total score. Conclusion Our results showed the presence of hypocholesterolemia in French Canadian-FXS population, a condition that seems to influence their clinical phenotype. We identified for the first time a potential underlying alteration of PCSK9 function in FXS that could result from the absence of FMRP. Further investigations are warranted to better understand the association between cholesterol metabolism, PCSK9, FMRP and clinical profile.
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Affiliation(s)
- Artuela Çaku
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Québec, Canada
- * E-mail:
| | - Nabil G. Seidah
- Nabil G. Seidah, Laboratory of Biochemical Neuroendocrinology, Clinical Research Institute, affiliated to the Université de Montréal, Montréal, Québec, Canada
| | - Audrey Lortie
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Nancy Gagné
- Department of Paediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Patrice Perron
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean Dubé
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Francois Corbin
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Québec, Canada
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74
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Sethna F, Feng W, Ding Q, Robison AJ, Feng Y, Wang H. Enhanced expression of ADCY1 underlies aberrant neuronal signalling and behaviour in a syndromic autism model. Nat Commun 2017; 8:14359. [PMID: 28218269 PMCID: PMC5321753 DOI: 10.1038/ncomms14359] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/20/2016] [Indexed: 12/14/2022] Open
Abstract
Fragile X syndrome (FXS), caused by the loss of functional FMRP, is a leading cause of autism. Neurons lacking FMRP show aberrant mRNA translation and intracellular signalling. Here, we identify that, in Fmr1 knockout neurons, type 1 adenylyl cyclase (Adcy1) mRNA translation is enhanced, leading to excessive production of ADCY1 protein and insensitivity to neuronal stimulation. Genetic reduction of Adcy1 normalizes the aberrant ERK1/2- and PI3K-mediated signalling, attenuates excessive protein synthesis and corrects dendritic spine abnormality in Fmr1 knockout mice. Genetic reduction of Adcy1 also ameliorates autism-related symptoms including repetitive behaviour, defective social interaction and audiogenic seizures. Moreover, peripheral administration of NB001, an experimental compound that preferentially suppresses ADCY1 activity over other ADCY subtypes, attenuates the behavioural abnormalities in Fmr1 knockout mice. These results demonstrate a connection between the elevated Adcy1 translation and abnormal ERK1/2 signalling and behavioural symptoms in FXS. Fragile X syndrome (FXS) is a leading cause of autism and neurons lacking FMRP show aberrant mRNA translation and intracellular signalling. Here, the authors show that neurons from Fmr1 knockout mice have increased levels of ADCY1 protein, producing abnormal ERK1/2 signalling, dysregulated protein synthesis and behavioural symptoms associated with FXS.
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Affiliation(s)
- Ferzin Sethna
- Genetics Program, Michigan State University, East Lansing, Michigan 48824, USA
| | - Wei Feng
- Department of Pharmacology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | - Qi Ding
- Department of Physiology, Michigan State University, East Lansing, Michigan 48824, USA
| | - Alfred J Robison
- Department of Physiology, Michigan State University, East Lansing, Michigan 48824, USA.,Neuroscience Program, Michigan State University, East Lansing, Michigan 48824, USA
| | - Yue Feng
- Department of Pharmacology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | - Hongbing Wang
- Department of Physiology, Michigan State University, East Lansing, Michigan 48824, USA.,Neuroscience Program, Michigan State University, East Lansing, Michigan 48824, USA
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Westmark CJ. Commentary: Depletion of the Fragile X Mental Retardation Protein in Embryonic Stem Cells Alters the Kinetics of Neurogenesis. Front Mol Neurosci 2017; 10:29. [PMID: 28223919 PMCID: PMC5293769 DOI: 10.3389/fnmol.2017.00029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cara J Westmark
- Department of Neurology, University of Wisconsin Madison, WI, USA
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76
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Bullard L, McDuffie A, Abbeduto L. Distance delivery of a parent-implemented language intervention for young boys with fragile X syndrome. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2017; 2:10.1177/2396941517728690. [PMID: 30417116 PMCID: PMC6223638 DOI: 10.1177/2396941517728690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND In addition to significant cognitive delays, boys with fragile X syndrome display phenotypic characteristics that include delays in language, inattention, social anxiety, and escape-maintained challenging behaviors. Despite these challenges, families affected by fragile X syndrome often have limited access to center-based intervention programs. METHODS The present study utilized a multiple baseline design across participants to examine the preliminary effectiveness of a 12-week, parent-implemented spoken language intervention for three 5- to 7-year-old boys with fragile X syndrome. The goal of the intervention was to teach the biological mothers of each boy to use a set of verbally responsive language support strategies while participating in shared book reading activities with her child. All aspects of the intervention, including pre- and post-treatment measures, were delivered into the family's home via distance video teleconferencing. RESULTS Results from this study provide preliminary support for the efficacy of this parent-implemented language intervention approach by demonstrating generalized improvements in both targeted maternal strategy use and measures of child spoken language. CONCLUSIONS The present study expands upon prior language intervention research utilizing distance delivery of services for families affected by fragile X syndrome. Additionally, the study provides early support for the feasibility of collecting pre- and post-treatment assessments at a distance.
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Westmark CJ, Chuang SC, Hays SA, Filon MJ, Ray BC, Westmark PR, Gibson JR, Huber KM, Wong RKS. APP Causes Hyperexcitability in Fragile X Mice. Front Mol Neurosci 2016; 9:147. [PMID: 28018172 PMCID: PMC5156834 DOI: 10.3389/fnmol.2016.00147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/01/2016] [Indexed: 01/06/2023] Open
Abstract
Amyloid-beta protein precursor (APP) and metabolite levels are altered in fragile X syndrome (FXS) patients and in the mouse model of the disorder, Fmr1KO mice. Normalization of APP levels in Fmr1KO mice (Fmr1KO /APPHET mice) rescues many disease phenotypes. Thus, APP is a potential biomarker as well as therapeutic target for FXS. Hyperexcitability is a key phenotype of FXS. Herein, we determine the effects of APP levels on hyperexcitability in Fmr1KO brain slices. Fmr1KO /APPHET slices exhibit complete rescue of UP states in a neocortical hyperexcitability model and reduced duration of ictal discharges in a CA3 hippocampal model. These data demonstrate that APP plays a pivotal role in maintaining an appropriate balance of excitation and inhibition (E/I) in neural circuits. A model is proposed whereby APP acts as a rheostat in a molecular circuit that modulates hyperexcitability through mGluR5 and FMRP. Both over- and under-expression of APP in the context of the Fmr1KO increases seizure propensity suggesting that an APP rheostat maintains appropriate E/I levels but is overloaded by mGluR5-mediated excitation in the absence of FMRP. These findings are discussed in relation to novel treatment approaches to restore APP homeostasis in FXS.
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Affiliation(s)
- Cara J. Westmark
- Department of Neurology, University of Wisconsin-Madison, MadisonMadison, WI, USA
| | - Shih-Chieh Chuang
- Department of Physiology and Pharmacology, State University of New York Downstate Medical CenterBrooklyn, NY, USA
| | - Seth A. Hays
- Department of Neuroscience, University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Mikolaj J. Filon
- Department of Neurology, University of Wisconsin-Madison, MadisonMadison, WI, USA
| | - Brian C. Ray
- Department of Neurology, University of Wisconsin-Madison, MadisonMadison, WI, USA
| | - Pamela R. Westmark
- Department of Medicine, University of Wisconsin-Madison, MadisonMadison, WI, USA
| | - Jay R. Gibson
- Department of Neuroscience, University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Kimberly M. Huber
- Department of Neuroscience, University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Robert K. S. Wong
- Department of Physiology and Pharmacology, State University of New York Downstate Medical CenterBrooklyn, NY, USA
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Davenport MH, Schaefer TL, Friedmann KJ, Fitzpatrick SE, Erickson CA. Pharmacotherapy for Fragile X Syndrome: Progress to Date. Drugs 2016; 76:431-45. [PMID: 26858239 DOI: 10.1007/s40265-016-0542-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To date, no drug is approved for the treatment of Fragile X Syndrome (FXS) although many drugs are used to manage challenging behaviors from a symptomatic perspective in this population. While our understanding of FXS pathophysiology is expanding, efforts to devise targeted FXS-specific treatments have had limited success in placebo-controlled trials. Compounds aimed at rectifying excessive glutamate and deficient gamma-aminobutyric acid (GABA) neurotransmission, as well as other signaling pathways known to be affected by Fragile X Mental Retardation Protein (FMRP) are under various phases of development in FXS. With the failure of several metabotropic glutamate receptor subtype 5 (mGlur5) selective antagonists under clinical investigation, no clear single treatment appears to be greatly effective. These recent challenges call into question various aspects of clinical study design in FXS. More objective outcome measures are under development and validation. Future trials will likely be aimed at correcting multiple pathways known to be disrupted by the loss of FMRP. This review offers a brief summary of the prevalence, phenotypic characteristics, genetic causes and molecular functions of FMRP in the brain (as these have been extensively reviewed elsewhere), discusses the most recent finding in FXS drug development, and summarizes FXS trials utilizing symptomatic treatment.
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Affiliation(s)
- Matthew H Davenport
- Division of Child and Adolescent Psychiatry (MLC 4002), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Tori L Schaefer
- Division of Child and Adolescent Psychiatry (MLC 4002), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA
| | - Katherine J Friedmann
- Division of Child and Adolescent Psychiatry (MLC 4002), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA
| | | | - Craig A Erickson
- Division of Child and Adolescent Psychiatry (MLC 4002), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
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Westmark CJ, Sokol DK, Maloney B, Lahiri DK. Novel roles of amyloid-beta precursor protein metabolites in fragile X syndrome and autism. Mol Psychiatry 2016; 21:1333-41. [PMID: 27573877 PMCID: PMC5580495 DOI: 10.1038/mp.2016.134] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/20/2016] [Accepted: 06/23/2016] [Indexed: 01/17/2023]
Abstract
Fragile X syndrome (FXS) is the most common form of inherited intellectual disability and is associated with up to 5% of autism cases. Several promising drugs are in preclinical testing for FXS; however, bench-to-bedside plans for the clinic are severely limited due to lack of validated biomarkers and outcome measures. Published work from our laboratories has demonstrated altered levels of amyloid-beta (Aβ) precursor protein (APP) and its metabolites in FXS and idiopathic autism. Westmark and colleagues have focused on β-secretase (amyloidogenic) processing and the accumulation of Aβ peptides in adult FXS models, whereas Lahiri and Sokol have studied α-secretase (non-amyloidogenic or anabolic) processing and altered levels of sAPPα and Aβ in pediatric autism and FXS. Thus, our groups have hypothesized a pivotal role for these Alzheimer's disease (AD)-related proteins in the neurodevelopmental disorders of FXS and autism. In this review, we discuss the contribution of APP metabolites to FXS and autism pathogenesis as well as the potential use of these metabolites as blood-based biomarkers and therapeutic targets. Our future focus is to identify key underlying mechanisms through which APP metabolites contribute to FXS and autism condition-to-disease pathology. Positive outcomes will support utilizing APP metabolites as blood-based biomarkers in clinical trials as well as testing drugs that modulate APP processing as potential disease therapeutics. Our studies to understand the role of APP metabolites in developmental conditions such as FXS and autism are a quantum leap for the neuroscience field, which has traditionally restricted any role of APP to AD and aging.
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Affiliation(s)
- Cara J. Westmark
- University of Wisconsin, Department of Neurology, Madison, WI, USA
| | - Deborah K. Sokol
- Indiana University School of Medicine, Department of Psychiatry, Institute of Psychiatric Research, Indianapolis, IN USA
| | - Bryan Maloney
- Indiana University School of Medicine, Department of Psychiatry, Institute of Psychiatric Research, Indianapolis, IN USA
| | - Debomoy K. Lahiri
- Indiana University School of Medicine, Department of Psychiatry, Institute of Psychiatric Research, Indianapolis, IN USA
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81
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Schwartz L, Holland A, Dykens E, Strong T, Roof E, Bohonowych J. Prader-Willi syndrome mental health research strategy workshop proceedings: the state of the science and future directions. Orphanet J Rare Dis 2016; 11:131. [PMID: 27682995 PMCID: PMC5041278 DOI: 10.1186/s13023-016-0504-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/17/2016] [Indexed: 01/02/2023] Open
Abstract
Abstract This paper reports on the ‘Prader-Willi Syndrome (PWS) Mental Health Research Strategy Workshop’ that took place in March 2015. PWS is characterized by a complex phenotype affecting multiple systems with a high prevalence of maladaptive behaviours, and neuropsychiatric illness. Prader Willi syndrome results from the absence of paternally derived alleles located at the imprinted chromosomal locus, 15q11–13. The goal of the workshop was to highlight the state of the science of the mental health of people with this rare neurodevelopmental disorder. Mental ill health and maladaptive behaviors significantly impact quality of life for persons with PWS and their caregivers. Effective treatments and further research into this area are critically needed. Methods A multidisciplinary group of scientists and health care professionals were brought together to discuss the mental health and behavioral needs of people with PWS. The workshop strategy was to integrate established work on PWS with other relevant areas of study. The meeting also focused on two neurobiological systems that research had suggested were relevant to understanding the broader mental health aspects of PWS: the autonomic nervous system and oxytocin/vasopressin pathways. Other relevant topics were considered and recommendations made. Results The workshop presentations and working group discussions revealed that no one approach was sufficient to fully conceptualize the mental health challenges in PWS. Workshop discussions pointed to the need for theoretically informed studies focused on clinical characterization, measurement, and the probing of specific neurobiological systems through pharmaceutical or other interventions. Future studies in this area should explore the use of advanced neuroimaging protocols, as well as molecular studies using iPS cells in order to create more informed theories. Conclusions Within this framework, workshop participants identified and prioritized key research questions, and highlighted current opportunities. Recommendations were made with respect to the development of specific resources and tools for furthering mental health research such as The Global PWS Registry, the development of effective endpoints, the use of animal models and iPS cells to aid understanding of the neurobiological underpinnings. Additionally, collaborative opportunities across disciplines and syndromes were highlighted and targeted research initiatives focused on psychological/behavioral interventions modified for use in PWS were recommended.
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Affiliation(s)
- Lauren Schwartz
- Department of Rehabilitation Medicine, University of Washington, 1959 N.E. Pacific St, Box 356490, Seattle, WA, 98195, USA.
| | - Anthony Holland
- Department of Psychiatry, Cambridge Intellectual and Developmental Disabilities Research Group, University of Cambridge, Cambridge, UK
| | - Elisabeth Dykens
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
| | - Theresa Strong
- Foundation for Prader-Willi Research, Los Angeles, CA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Roof
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
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Kaufmann WE, Stallworth JL, Everman DB, Skinner SA. Neurobiologically-based treatments in Rett syndrome: opportunities and challenges. Expert Opin Orphan Drugs 2016; 4:1043-1055. [PMID: 28163986 PMCID: PMC5214376 DOI: 10.1080/21678707.2016.1229181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022]
Abstract
Introduction: Rett syndrome (RTT) is an X-linked neurodevelopmental disorder that primarily affects females, typically resulting in a period of developmental regression in early childhood followed by stabilization and severe chronic cognitive, behavioral, and physical disability. No known treatment exists beyond symptomatic management, and while insights into the genetic cause, pathophysiology, neurobiology, and natural history of RTT have been gained, many challenges remain. Areas covered: Based on a comprehensive survey of the primary literature on RTT, this article describes and comments upon the general and unique features of the disorder, genetic and neurobiological bases of drug development, and the history of clinical trials in RTT, with an emphasis on drug trial design, outcome measures, and implementation. Expert opinion: Neurobiologically based drug trials are the ultimate goal in RTT, and due to the complexity and global nature of the disorder, drugs targeting both general mechanisms (e.g., growth factors) and specific systems (e.g., glutamate modulators) could be effective. Trial design should optimize data on safety and efficacy, but selection of outcome measures with adequate measurement properties, as well as innovative strategies, such as those enhancing synaptic plasticity and use of biomarkers, are essential for progress in RTT and other neurodevelopmental disorders.
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Affiliation(s)
- Walter E Kaufmann
- Center for Translational Research, Greenwood Genetic Center, Greenwood, SC, USA; Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | | | - David B Everman
- Center for Translational Research, Greenwood Genetic Center , Greenwood , SC , USA
| | - Steven A Skinner
- Center for Translational Research, Greenwood Genetic Center , Greenwood , SC , USA
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Pellerin D, Çaku A, Fradet M, Bouvier P, Dubé J, Corbin F. Lovastatin corrects ERK pathway hyperactivation in fragile X syndrome: potential of platelet’s signaling cascades as new outcome measures in clinical trials. Biomarkers 2016; 21:497-508. [DOI: 10.3109/1354750x.2016.1160289] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Field T, Brewster SJ, Towne M, Campion MW. Emerging Genetic Counselor Roles within the Biotechnology and Pharmaceutical Industries: as Industry Interest Grows in Rare Genetic Disorders, How are Genetic Counselors Joining the Discussion? J Genet Couns 2016; 25:708-19. [PMID: 27017827 DOI: 10.1007/s10897-016-9946-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 03/17/2016] [Indexed: 11/25/2022]
Abstract
Traditionally, the biotechnology and pharmaceutical industry (BPI) has focused drug development at the mass-market level targeting common medical issues. However, a recent trend is the development of therapies for orphan or rare disorders, including many genetic disorders. Developing treatments for genetic disorders requires an understanding of the needs of the community and translating genomic information to clinical and non-clinical audiences. The core skills of genetic counselors (GCs) include a deep knowledge of genetics and ability to communicate complex information to a broad audience, making GCs a choice fit for this shift in drug development. To date there is limited data defining the roles GCs hold within this industry. This exploratory study aimed to define the roles and motivation of GCs working in BPI, assess job satisfaction, and identify translatable skills and current gaps in GC training programs. The authors surveyed 26 GCs working in BPI in the United States; 79 % work for companies focused on rare disorders. GC positions in BPI are growing, with 57 % of respondents being the first GC in their role. GCs in BPI continue to utilize core genetic counseling competencies, though 72 % felt their training did not fully prepare them for BPI. These data suggest opportunities for exposure to BPI in GC training to better prepare future generations of GCs for these career opportunities. GC satisfaction was high in BPI, notably in areas traditionally reported as less satisfying on the National Society for Genetic Counselors Professional Status Survey: salary and advancement opportunities. BPI's growing interest in rare disorders represents a career opportunity for GCs, addressing both historic areas of dissatisfaction for GCs and BPI's genomic communication needs.
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Affiliation(s)
- Tessa Field
- Boston University School of Medicine, Boston, MA, USA.
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Normal Performance of Fmr1 Mice on a Touchscreen Delayed Nonmatching to Position Working Memory Task. eNeuro 2016; 3:eN-CFN-0143-15. [PMID: 27022628 PMCID: PMC4800045 DOI: 10.1523/eneuro.0143-15.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/21/2022] Open
Abstract
Fragile X syndrome is a neurodevelopmental disorder characterized by mild-to-severe cognitive deficits. The complete absence of Fmr1 and its protein product in the mouse model of fragile X (Fmr1 KO) provides construct validity. A major conundrum in the field is the remarkably normal performance of Fmr1 mice on cognitive tests in most reports. One explanation may be insufficiently challenging cognitive testing procedures. Here we developed a delayed nonmatching to position touchscreen task to test the hypothesis that paradigms placing demands on working memory would reveal robust and replicable cognitive deficits in the Fmr1 KO mouse. We first tested Fmr1 KO mice (Fmr1) and their wild-type (WT) littermates in a simple visual discrimination task, followed by assessment of reversal learning. We then tested Fmr1 and WT mice in a new touchscreen nonmatch to position task and subsequently challenged their working memory abilities by adding delays, representing a higher cognitive load. The performance by Fmr1 KO mice was equal to WTs on both touchscreen tasks. Last, we replicated previous reports of normal performance by Fmr1 mice on Morris water maze spatial navigation and reversal. These results indicate that, while the Fmr1 mouse model effectively recapitulates many molecular and cellular aspects of fragile X syndrome, the cognitive profile of Fmr1 mice generally does not recapitulate the primary cognitive deficits in the human syndrome, even when diverse and challenging tasks are imposed.
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A Novel Analog Reasoning Paradigm: New Insights in Intellectually Disabled Patients. PLoS One 2016; 11:e0149717. [PMID: 26918704 PMCID: PMC4771701 DOI: 10.1371/journal.pone.0149717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 02/04/2016] [Indexed: 12/05/2022] Open
Abstract
Background Intellectual Disability (ID) is characterized by deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, and learning. As new avenues are emerging for treatment of genetically determined ID (such as Down’s syndrome or Fragile X syndrome), it is necessary to identify objective reliable and sensitive outcome measures for use in clinical trials. Objective We developed a novel visual analogical reasoning paradigm, inspired by the Progressive Raven’s Matrices, but appropriate for Intellectually Disabled patients. This new paradigm assesses reasoning and inhibition abilities in ID patients. Methods We performed behavioural analyses for this task (with a reaction time and error rate analysis, Study 1) in 96 healthy controls (adults and typically developed children older than 4) and 41 genetically determined ID patients (Fragile X syndrome, Down syndrome and ARX mutated patients). In order to establish and quantify the cognitive strategies used to solve the task, we also performed an eye-tracking analysis (Study 2). Results Down syndrome, ARX and Fragile X patients were significantly slower and made significantly more errors than chronological age-matched healthy controls. The effect of inhibition on error rate was greater than the matrix complexity effect in ID patients, opposite to findings in adult healthy controls. Interestingly, ID patients were more impaired by inhibition than mental age-matched healthy controls, but not by the matrix complexity. Eye-tracking analysis made it possible to identify the strategy used by the participants to solve the task. Adult healthy controls used a matrix-based strategy, whereas ID patients used a response-based strategy. Furthermore, etiologic-specific reasoning differences were evidenced between ID patients groups. Conclusion We suggest that this paradigm, appropriate for ID patients and developmental populations as well as adult healthy controls, provides an objective and quantitative assessment of visual analogical reasoning and cognitive inhibition, enabling testing for the effect of pharmacological or behavioural intervention in these specific populations.
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McDuffie A, Thurman AJ, Hagerman RJ, Abbeduto L. Symptoms of Autism in Males with Fragile X Syndrome: A Comparison to Nonsyndromic ASD Using Current ADI-R Scores. J Autism Dev Disord 2016; 45:1925-37. [PMID: 24414079 DOI: 10.1007/s10803-013-2013-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Symptoms of autism are frequent in males with fragile X syndrome (FXS), but it is not clear whether symptom profiles differ from those of nonsyndromic ASD. Using individual item scores from the Autism Diagnostic Inventory-Revised, we examined which current symptoms of autism differed in boys with FXS relative to same-aged boys diagnosed with nonsyndromic ASD. In addition, different subsamples of participants were matched on autism diagnostic status and severity of autism symptoms. Between-group comparisons revealed that boys with FXS showed significantly less impairment in Social Smiling than did age-, diagnostic-, and severity-matched boys with nonsyndromic ASD. Severity-matched boys with FXS showed more impairment in complex mannerisms than did boys with nonsyndromic ASD. Behavioral differences between FXS and nonsyndromic ASD may be of theoretical importance in understanding the causes and correlates of ASD in FXS and in developing and implementing appropriate treatments.
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Affiliation(s)
- Andrea McDuffie
- MIND Institute, University of California, Davis, 2825 50th Street, Room 2274, Sacramento, CA, 95817, USA,
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Abstract
OBJECTIVE Fragile X syndrome (FXS) is the most common inherited form of intellectual disability. The objective of this study was to determine the relative importance that caregivers place on improving different phenotypic traits observed in males with FXS to better understand the greatest medical needs for developing and evaluating FXS treatments. METHOD Fragile X syndrome caregivers (n = 614) compared hypothetical treatments in a discrete-choice experiment. The treatments varied in their effects on 6 outcomes associated with FXS: learning and applying new skills, explaining needs, controlling behavior, taking part in new social activities, caring for oneself, and paying attention. The relative importance was calculated for improving severe or moderate levels of disability and transformed to a 10-point scale. Relative importance was also quantified by patient age group (child, adolescent, and adult). RESULTS Most important to caregivers were controlling behavior (10.0) and caring for oneself (9.9). Least important was taking part in new social activities (4.2). A partial improvement in controlling behavior or self-care was more important than full resolution of the least important disabilities. This was consistent across age groups. Improvements from severe to moderate disability were more important than from moderate to no disability. CONCLUSION Caregivers expressed strong preferences for improvement in self-care and behavioral control, independent of the age of the individual with FXS. These data may be helpful when designing studies to test the efficacy of FXS treatments because small treatment effects on very important outcomes may be valued more than large treatment effects on less valued outcomes.
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Bailey DB, Berry-Kravis E, Wheeler A, Raspa M, Merrien F, Ricart J, Koumaras B, Rosenkranz G, Tomlinson M, von Raison F, Apostol G. Mavoglurant in adolescents with fragile X syndrome: analysis of Clinical Global Impression-Improvement source data from a double-blind therapeutic study followed by an open-label, long-term extension study. J Neurodev Disord 2015; 8:1. [PMID: 26855682 PMCID: PMC4743124 DOI: 10.1186/s11689-015-9134-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/09/2015] [Indexed: 01/16/2023] Open
Abstract
Background A phase II randomized, placebo-controlled, double-blind study and subsequent open-label extension study evaluated the efficacy, safety, and tolerability of mavoglurant (AFQ056), a selective metabotropic glutamate receptor subtype-5 antagonist, in treating behavioral symptoms in adolescent patients with fragile X syndrome (FXS). A novel method was applied to analyze changes in symptom domains in patients with FXS using the narratives associated with the clinician-rated Clinical Global Impression-Improvement (CGI-I) scale. Methods In the core study, patients were randomized to receive mavoglurant (25, 50, or 100 mg BID) or placebo over 12 weeks. In the extension, patients received 100 mg BID mavoglurant (or the highest tolerated dose) for up to 32 months. Global improvement, as a measure of treatment response, was assessed using the CGI-I scale. Investigators assigning CGI-I scores of 1 (very much improved), 2 (much improved), 6 (much worse), or 7 (very much worse) were provided a standard narrative template to collect further information about the changes observed in patients. Investigator feedback was coded and clustered into categories of improvement or worsening to identify potential areas of improvement with mavoglurant. Treatment effect in each category was characterized using the Cochran–Mantel–Haenszel test. Results A total of 134 and 103 patients had reached 2 weeks or more of core and extension study treatment, respectively, by the pre-assigned cutoff date for investigator feedback. In the core study, 34 CGI-I scores of 1 or 2 were reported in 28 patients; one patient scored 6. Analysis of the CGI-I narratives did not indicate greater treatment response in patients receiving mavoglurant compared with placebo in any specific improvement domain. There were 54 CGI-I scores of 1 or 2 in 47 patients in the extension study. The most frequently reported categories of improvement were behavior and mood (79.3 and 76.6 % in core and extension studies, respectively), engagement (75.9 and 78.7 %), and communication (69.0 and 61.7 %). Conclusions A method was established to capture and categorize FXS symptoms using CGI-I narratives. Although this method did not show benefit of drug over placebo, narratives from investigators were mostly based on parental report and thus do not represent a completely objective alternative assessment. Trial registration The studies described are registered at ClinicalTrials.gov with clinical trial identifier numbers NCT01357239 and NCT01433354.
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Affiliation(s)
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Neurological Sciences, and Biochemistry, Rush University Medical Centre, Chicago, IL 60612 USA
| | - Anne Wheeler
- RTI International, Research Triangle Park, Durham, NC USA
| | - Melissa Raspa
- RTI International, Research Triangle Park, Durham, NC USA
| | - Florence Merrien
- Neuroscience Development, Novartis Pharma AG, Basel, Switzerland
| | | | - Barbara Koumaras
- Neurodegeneration Global Development, Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | - Gerd Rosenkranz
- Neuroscience Development, Novartis Pharma AG, Basel, Switzerland
| | - Mark Tomlinson
- Neuroscience Development, Novartis Pharma AG, Basel, Switzerland
| | | | - George Apostol
- Neuroscience Development, Novartis Pharma AG, Basel, Switzerland
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Haberl MG, Zerbi V, Veltien A, Ginger M, Heerschap A, Frick A. Structural-functional connectivity deficits of neocortical circuits in the Fmr1 (-/y) mouse model of autism. SCIENCE ADVANCES 2015; 1:e1500775. [PMID: 26702437 PMCID: PMC4681325 DOI: 10.1126/sciadv.1500775] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/13/2015] [Indexed: 05/13/2023]
Abstract
Fragile X syndrome (FXS), the most common inherited form of intellectual disability disorder and a frequent cause of autism spectrum disorder (ASD), is characterized by a high prevalence of sensory symptoms. Perturbations in the anatomical connectivity of neocortical circuits resulting in their functional defects have been hypothesized to contribute to the underlying etiology of these disorders. We tested this idea by probing alterations in the functional and structural connectivity of both local and long-ranging neocortical circuits in the Fmr1 (-/y) mouse model of FXS. To achieve this, we combined in vivo ultrahigh-field diffusion tensor magnetic resonance imaging (MRI), functional MRI, and viral tracing approaches in adult mice. Our results show an anatomical hyperconnectivity phenotype for the primary visual cortex (V1), but a disproportional low connectivity of V1 with other neocortical regions. These structural data are supported by defects in the structural integrity of the subcortical white matter in the anterior and posterior forebrain. These anatomical alterations might contribute to the observed functional decoupling across neocortical regions. We therefore identify FXS as a "connectopathy," providing a translational model for understanding sensory processing defects and functional decoupling of neocortical areas in FXS and ASD.
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Affiliation(s)
- Matthias G. Haberl
- INSERM, Neurocentre Magendie, Physiopathologie de la plasticité neuronale, U862, 33077 Bordeaux, France
- University of Bordeaux, Neurocentre Magendie, Physiopathologie de la plasticité neuronale, U862, 33076 Bordeaux, France
- Institute of NeuroInformatics, University of Zurich, 8057 Zurich, Switzerland
| | - Valerio Zerbi
- Biomedical MR Research Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6500 Nijmegen, Netherlands
| | - Andor Veltien
- Biomedical MR Research Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6500 Nijmegen, Netherlands
| | - Melanie Ginger
- INSERM, Neurocentre Magendie, Physiopathologie de la plasticité neuronale, U862, 33077 Bordeaux, France
- University of Bordeaux, Neurocentre Magendie, Physiopathologie de la plasticité neuronale, U862, 33076 Bordeaux, France
| | - Arend Heerschap
- Biomedical MR Research Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6500 Nijmegen, Netherlands
| | - Andreas Frick
- INSERM, Neurocentre Magendie, Physiopathologie de la plasticité neuronale, U862, 33077 Bordeaux, France
- University of Bordeaux, Neurocentre Magendie, Physiopathologie de la plasticité neuronale, U862, 33076 Bordeaux, France
- Corresponding author. E-mail:
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91
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Channell MM, McDuffie AS, Bullard LM, Abbeduto L. Narrative language competence in children and adolescents with Down syndrome. Front Behav Neurosci 2015; 9:283. [PMID: 26578913 PMCID: PMC4626566 DOI: 10.3389/fnbeh.2015.00283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/08/2015] [Indexed: 01/15/2023] Open
Abstract
This study was designed to examine the narrative language abilities of children and adolescents with Down syndrome (DS) in comparison to same-age peers with fragile X syndrome (FXS) and younger typically developing (TD) children matched by nonverbal cognitive ability levels. Participants produced narrative retells from a wordless picture book. Narratives were analyzed at the macrostructural (i.e., their internal episodic structure) and the microstructural (i.e., rate of use of specific word categories) levels. Mean length of utterance (MLU), a microstructural metric of syntactic complexity, was used as a control variable. Participants with DS produced fewer episodic elements in their narratives (i.e., their narratives were less fully realized) than the TD participants, although MLU differences accounted for the macrostructural differences between participant groups. At the microstructural level, participants with DS displayed a lower rate of verb use than the groups with FXS and typical development, even after accounting for MLU. These findings reflect both similarities and differences between individuals with DS or FXS and contribute to our understanding of the language phenotype of DS. Implications for interventions to promote language development and academic achievement are discussed.
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Affiliation(s)
- Marie Moore Channell
- MIND Institute, University of California, Davis Davis, CA, USA ; Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign Champaign, IL, USA
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Hall SS, Frank MC, Pusiol GT, Farzin F, Lightbody AA, Reiss AL. Quantifying naturalistic social gaze in fragile X syndrome using a novel eye tracking paradigm. Am J Med Genet B Neuropsychiatr Genet 2015; 168:564-72. [PMID: 26079280 PMCID: PMC5759950 DOI: 10.1002/ajmg.b.32331] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/22/2015] [Indexed: 02/02/2023]
Abstract
A hallmark behavioral feature of fragile X syndrome (FXS) is the propensity for individuals with the syndrome to exhibit significant impairments in social gaze during interactions with others. However, previous studies employing eye tracking methodology to investigate this phenomenon have been limited to presenting static photographs or videos of social interactions rather than employing a real-life social partner. To improve upon previous studies, we used a customized eye tracking configuration to quantify the social gaze of 51 individuals with FXS and 19 controls, aged 14-28 years, while they engaged in a naturalistic face-to-face social interaction with a female experimenter. Importantly, our control group was matched to the FXS group on age, developmental functioning, and degree of autistic symptomatology. Results showed that participants with FXS spent significantly less time looking at the face and had shorter episodes (and longer inter-episodes) of social gaze than controls. Regression analyses indicated that communication ability predicted higher levels of social gaze in individuals with FXS, but not in controls. Conversely, degree of autistic symptoms predicted lower levels of social gaze in controls, but not in individuals with FXS. Taken together, these data indicate that naturalistic social gaze in FXS can be measured objectively using existing eye tracking technology during face-to-face social interactions. Given that impairments in social gaze were specific to FXS, this paradigm could be employed as an objective and ecologically valid outcome measure in ongoing Phase II/Phase III clinical trials of FXS-specific interventions.
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Affiliation(s)
- Scott S. Hall
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | - Michael C. Frank
- Department of Psychology, Stanford University, Stanford, California
| | - Guido T. Pusiol
- Department of Psychology, Stanford University, Stanford, California
| | - Faraz Farzin
- Department of Psychology, Stanford University, Stanford, California
| | - Amy A. Lightbody
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | - Allan L. Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford, California
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Green T, Barnea-Goraly N, Raman M, Hall SS, Lightbody AA, Bruno JL, Quintin EM, Reiss AL. Specific effect of the fragile-X mental retardation-1 gene (FMR1) on white matter microstructure. Br J Psychiatry 2015; 207:143-8. [PMID: 25792692 PMCID: PMC4523928 DOI: 10.1192/bjp.bp.114.151654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fragile-X syndrome (FXS) is a neurodevelopmental disorder associated with intellectual disability and neurobiological abnormalities including white matter microstructural differences. White matter differences have been found relative to neurotypical individuals. AIMS To examine whether FXS white matter differences are related specifically to FXS or more generally to the presence of intellectual disability. METHOD We used voxel-based and tract-based analytic approaches to compare individuals with FXS (n = 40) with gender- and IQ-matched controls (n = 30). RESULTS Individuals with FXS had increased fractional anisotropy and decreased radial diffusivity values compared with IQ-matched controls in the inferior longitudinal, inferior fronto-occipital and uncinate fasciculi. CONCLUSIONS The genetic variation associated with FXS affects white matter microstructure independently of overall IQ. White matter differences, found in FXS relative to IQ-matched controls, are distinct from reported differences relative to neurotypical controls. This underscores the need to consider cognitive ability differences when investigating white matter microstructure in neurodevelopmental disorders.
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Affiliation(s)
| | | | | | | | | | | | | | - Allan L. Reiss
- Correspondence: Allan L. Reiss, Center for Interdisciplinary Brain Sciences Research, 401 Quarry Road, MC 5795, Stanford, CA 94305, USA.
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Kurtz PF, Chin MD, Robinson AN, O'Connor JT, Hagopian LP. Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:150-166. [PMID: 26183339 DOI: 10.1016/j.ridd.2015.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/16/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.
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Affiliation(s)
- Patricia F Kurtz
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | | | - Ashley N Robinson
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julia T O'Connor
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Louis P Hagopian
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
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95
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Curie A, Yang K, Kirsch I, Gollub RL, des Portes V, Kaptchuk TJ, Jensen KB. Placebo Responses in Genetically Determined Intellectual Disability: A Meta-Analysis. PLoS One 2015; 10:e0133316. [PMID: 26226597 PMCID: PMC4520690 DOI: 10.1371/journal.pone.0133316] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/25/2015] [Indexed: 12/01/2022] Open
Abstract
Background Genetically determined Intellectual Disability (ID) is an intractable condition that involves severe impairment of mental abilities such as learning, reasoning and predicting the future. As of today, little is known about the placebo response in patients with ID. Objective To determine if placebo response exists in patients with genetically determined ID. Data sources and Study selection We searched Medline/PubMed, EMBASE, CENTRAL and PsycINFO to find all placebo-controlled double-blind randomized clinical trials (RCTs) in patients with genetically determined ID, published up to April 2013, focusing on core ID symptoms. Data extraction and synthesis Two investigators extracted outcome data independently. Main outcomes and measures Bias-corrected standardized mean difference (Hedge’s g) was computed for each outcome measure, using the Comprehensive Meta-Analysis software. A priori defined patient sub-groups were analyzed using a mixed-effect model. The relationship between pre-defined continuous variable moderators (age, IQ, year of publication and trial duration) and effect size was analyzed using meta-regression Results Twenty-two placebo-controlled double-blind RCTs met the inclusion criteria (n = 721, mean age = 17.1 years, 62% men, mean trial duration = 35 weeks). There was a significant overall placebo response from pre- to post-treatment in patients with ID (g = 0.468, p = 0.002), both for “subjective outcomes” (a third-person’s evaluation of the patient) (g = 0.563, p = 0.022) and “objective outcomes” (direct evaluation of the patient’s abilities) (g = 0.434, p = 0.036). Individuals with higher IQ had higher response to placebo (p = 0.02) and no placebo response was observed in ID patients with comorbid dementia. A significant effect of age (p = 0.02) was found, indicating higher placebo responses in treatment of younger patients. Conclusions and relevance Results suggest that patients with genetically determined ID improve in the placebo arm of RCTs. Several mechanisms may contribute to placebo effects in ID, including expectancy, implicit learning and “placebo-by-proxy” induced by clinicians/family members. As the condition is refractory, there is little risk that improvements are explained by spontaneous remission. While new avenues for treatment of genetically determined ID are emerging, our results demonstrate how contextual factors can affect clinical outcomes and emphasize the importance of being vigilant on the role of placebos when testing novel treatments in ID.
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Affiliation(s)
- Aurore Curie
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
- L2C2, Institut des Sciences Cognitives, CNRS UMR5304, Bron, France
- Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital Femmes Mères Enfants, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon1, Lyon, France
- EPICIME-CIC1407/INSERM, Bron, France
- * E-mail:
| | - Kathy Yang
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
- School of Psychology, Plymouth University, Plymouth, United Kingdom
| | - Randy L. Gollub
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
| | - Vincent des Portes
- L2C2, Institut des Sciences Cognitives, CNRS UMR5304, Bron, France
- Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital Femmes Mères Enfants, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon1, Lyon, France
| | - Ted J. Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
| | - Karin B. Jensen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Gross C, Hoffmann A, Bassell GJ, Berry-Kravis EM. Therapeutic Strategies in Fragile X Syndrome: From Bench to Bedside and Back. Neurotherapeutics 2015; 12:584-608. [PMID: 25986746 PMCID: PMC4489963 DOI: 10.1007/s13311-015-0355-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Fragile X syndrome (FXS), an inherited intellectual disability often associated with autism, is caused by the loss of expression of the fragile X mental retardation protein. Tremendous progress in basic, preclinical, and translational clinical research has elucidated a variety of molecular-, cellular-, and system-level defects in FXS. This has led to the development of several promising therapeutic strategies, some of which have been tested in larger-scale controlled clinical trials. Here, we will summarize recent advances in understanding molecular functions of fragile X mental retardation protein beyond the well-known role as an mRNA-binding protein, and will describe current developments and emerging limitations in the use of the FXS mouse model as a preclinical tool to identify therapeutic targets. We will review the results of recent clinical trials conducted in FXS that were based on some of the preclinical findings, and discuss how the observed outcomes and obstacles will inform future therapy development in FXS and other autism spectrum disorders.
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Affiliation(s)
- Christina Gross
- />Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Anne Hoffmann
- />Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612 USA
| | - Gary J. Bassell
- />Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Elizabeth M. Berry-Kravis
- />Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, IL 60612 USA
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Dölen G. Oxytocin: parallel processing in the social brain? J Neuroendocrinol 2015; 27:516-35. [PMID: 25912257 DOI: 10.1111/jne.12284] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/29/2015] [Accepted: 04/07/2015] [Indexed: 12/31/2022]
Abstract
Early studies attempting to disentangle the network complexity of the brain exploited the accessibility of sensory receptive fields to reveal circuits made up of synapses connected both in series and in parallel. More recently, extension of this organisational principle beyond the sensory systems has been made possible by the advent of modern molecular, viral and optogenetic approaches. Here, evidence supporting parallel processing of social behaviours mediated by oxytocin is reviewed. Understanding oxytocinergic signalling from this perspective has significant implications for the design of oxytocin-based therapeutic interventions aimed at disorders such as autism, where disrupted social function is a core clinical feature. Moreover, identification of opportunities for novel technology development will require a better appreciation of the complexity of the circuit-level organisation of the social brain.
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Affiliation(s)
- Gül Dölen
- Department of Neuroscience, Brain Science Institute, Wendy Klag Center for Developmental Disabilities and Autism, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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98
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Schaefer TL, Davenport MH, Erickson CA. Emerging pharmacologic treatment options for fragile X syndrome. APPLICATION OF CLINICAL GENETICS 2015; 8:75-93. [PMID: 25897255 PMCID: PMC4396424 DOI: 10.2147/tacg.s35673] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fragile X syndrome (FXS) is the most common single gene cause of intellectual disability and autism spectrum disorder. Caused by a silenced fragile X mental retardation 1 gene and the subsequent deficiency in fragile X mental retardation protein, patients with FXS experience a range of physical, behavioral, and intellectual debilitations. The FXS field, as a whole, has recently met with some challenges, as several targeted clinical trials with high expectations of success have failed to elucidate significant improvements in a variety of symptom domains. As new clinical trials in FXS are planned, there has been much discussion about the use of the commonly used clinical outcome measures, as well as study design considerations, patient stratification, and optimal age range for treatment. The evidence that modification of these drug targets and use of these failed compounds would prove to be efficacious in human clinical study were rooted in years of basic and translational research. There are questions arising as to the use of the mouse models for studying FXS treatment development. This issue is twofold: many of the symptom domains and molecular and biochemical changes assessed and indicative of efficacy in mouse model study are not easily amenable to clinical trials in people with FXS because of the intolerability of the testing paradigm or a lack of noninvasive techniques (prepulse inhibition, sensory hypersensitivity, startle reactivity, or electrophysiologic, biochemical, or structural changes in the brain); and capturing subtle yet meaningful changes in symptom domains such as sociability, anxiety, and hyperactivity in human FXS clinical trials is challenging with the currently used measures (typically parent/caregiver rating scales). Clinicians, researchers, and the pharmaceutical industry have all had to take a step back and critically evaluate the way we think about how to best optimize future investigations into pharmacologic FXS treatments. As new clinical trials are coming down the drug discovery pipeline, it is clear that the field is moving in a direction that values the development of molecular biomarkers, less subjective quantitative measures of symptom improvement, and rating scales developed specifically for use in FXS in conjunction with drug safety. While summarizing preclinical evidence, where applicable, and discussing challenges in FXS treatment development, this review details both completed clinical trials for the targeted and symptomatic treatment of FXS and introduces novel projects on the cusp of clinical trial investigation.
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Affiliation(s)
- Tori L Schaefer
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew H Davenport
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Scerif G, Baker K. Annual research review: Rare genotypes and childhood psychopathology--uncovering diverse developmental mechanisms of ADHD risk. J Child Psychol Psychiatry 2015; 56:251-73. [PMID: 25494546 DOI: 10.1111/jcpp.12374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Through the increased availability and sophistication of genetic testing, it is now possible to identify causal diagnoses in a growing proportion of children with neurodevelopmental disorders. In addition to developmental delay and intellectual disability, many genetic disorders are associated with high risks of psychopathology, which curtail the wellbeing of affected individuals and their families. Beyond the identification of significant clinical needs, understanding the diverse pathways from rare genetic mutations to cognitive dysfunction and emotional-behavioural disturbance has theoretical and practical utility. METHODS We overview (based on a strategic search of the literature) the state-of-the-art on causal mechanisms leading to one of the most common childhood behavioural diagnoses - attention deficit hyperactivity disorder (ADHD) - in the context of specific genetic disorders. We focus on new insights emerging from the mapping of causal pathways from identified genetic differences to neuronal biology, brain abnormalities, cognitive processing differences and ultimately behavioural symptoms of ADHD. FINDINGS First, ADHD research in the context of rare genotypes highlights the complexity of multilevel mechanisms contributing to psychopathology risk. Second, comparisons between genetic disorders associated with similar psychopathology risks can elucidate convergent or distinct mechanisms at each level of analysis, which may inform therapeutic interventions and prognosis. Third, genetic disorders provide an unparalleled opportunity to observe dynamic developmental interactions between neurocognitive risk and behavioural symptoms. Fourth, variation in expression of psychopathology risk within each genetic disorder points to putative moderating and protective factors within the genome and the environment. CONCLUSION A common imperative emerging within psychopathology research is the need to investigate mechanistically how developmental trajectories converge or diverge between and within genotype-defined groups. Crucially, as genetic predispositions modify interaction dynamics from the outset, longitudinal research is required to understand the multi-level developmental processes that mediate symptom evolution.
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Affiliation(s)
- Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Wang H, Pati S, Pozzo-Miller L, Doering LC. Targeted pharmacological treatment of autism spectrum disorders: fragile X and Rett syndromes. Front Cell Neurosci 2015; 9:55. [PMID: 25767435 PMCID: PMC4341567 DOI: 10.3389/fncel.2015.00055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/05/2015] [Indexed: 12/27/2022] Open
Abstract
Autism spectrum disorders (ASDs) are genetically and clinically heterogeneous and lack effective medications to treat their core symptoms. Studies of syndromic ASDs caused by single gene mutations have provided insights into the pathophysiology of autism. Fragile X and Rett syndromes belong to the syndromic ASDs in which preclinical studies have identified rational targets for drug therapies focused on correcting underlying neural dysfunction. These preclinical discoveries are increasingly translating into exciting human clinical trials. Since there are significant molecular and neurobiological overlaps among ASDs, targeted treatments developed for fragile X and Rett syndromes may be helpful for autism of different etiologies. Here, we review the targeted pharmacological treatment of fragile X and Rett syndromes and discuss related issues in both preclinical studies and clinical trials of potential therapies for the diseases.
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Affiliation(s)
- Hansen Wang
- Faculty of Medicine, University of Toronto, 1 King's College Circle Toronto, ON, Canada
| | - Sandipan Pati
- Department of Neurology, Epilepsy Division, The University of Alabama at Birmingham Birmingham, AL, USA
| | - Lucas Pozzo-Miller
- Department of Neurobiology, Civitan International Research Center, The University of Alabama at Birmingham Birmingham, AL, USA
| | - Laurie C Doering
- Faculty of Health Sciences, Department of Pathology and Molecular Medicine, McMaster University Hamilton, ON, Canada
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