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Fortanier E, Hostin MA, Michel C, Delmont E, Bellemare ME, Guye M, Bendahan D, Attarian S. One-Year Longitudinal Assessment of Patients With CMT1A Using Quantitative MRI. Neurology 2024; 102:e209277. [PMID: 38630962 DOI: 10.1212/wnl.0000000000209277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Intramuscular fat fraction (FF) assessed using quantitative MRI (qMRI) has emerged as one of the few responsive outcome measures in CMT1A suitable for future clinical trials. This study aimed to identify the relevance of multiple qMRI biomarkers for tracking longitudinal changes in CMT1A and to assess correlations between MRI metrics and clinical parameters. METHODS qMRI was performed in CMT1A patients at 2 time points, a year apart, and various metrics were extracted from 3-dimensional volumes of interest at thigh and leg levels. A semiautomated segmentation technique was used, enabling the analysis of central slices and a larger 3D muscle volume. Metrics included proton density (PD), magnetization transfer ratio (MTR), and intramuscular FF. The sciatic and tibial nerves were also assessed. Disease severity was gauged using Charcot Marie Tooth Neurologic Score (CMTNSv2), Charcot Marie Tooth Examination Score, Overall Neuropathy Limitation Scale scores, and Medical Research Council (MRC) muscle strength. RESULTS Twenty-four patients were included. FF significantly rose in the 3D volume at both thigh (+1.04% ± 2.19%, p = 0.041) and leg (+1.36% ± 1.87%, p = 0.045) levels. The 3D analyses unveiled a length-dependent gradient in FF, ranging from 22.61% ± 10.17% to 26.17% ± 10.79% at the leg level. There was noticeable variance in longitudinal changes between muscles: +3.17% ± 6.86% (p = 0.028) in the tibialis anterior compared with 0.37% ± 4.97% (p = 0.893) in the gastrocnemius medialis. MTR across the entire thigh volume showed a significant decline between the 2 time points -2.75 ± 6.58 (p = 0.049), whereas no significant differences were noted for the 3D muscle volume and PD. No longitudinal changes were observed in any nerve metric. Potent correlations were identified between FF and primary clinical measures: CMTNSv2 (ρ = 0.656; p = 0.001) and MRC in the lower limbs (ρ = -0.877; p < 0.001). DISCUSSION Our results further support that qMRI is a promising tool for following up longitudinal changes in CMT1A patients, FF being the paramount MRI metric for both thigh and leg regions. It is crucial to scrutinize the postimaging data extraction methods considering that annual changes are minimal (around +1.5%). Given the varied FF distribution, the existence of a length-dependent gradient, and the differential fatty involution across muscles, 3D volume analysis appeared more suitable than single slice analysis.
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Affiliation(s)
- Etienne Fortanier
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Marc Adrien Hostin
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Constance Michel
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Emilien Delmont
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Marc-Emmanuel Bellemare
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Maxime Guye
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - David Bendahan
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Shahram Attarian
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
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Zambon AA, Falzone YM, Bolino A, Previtali SC. Molecular mechanisms and therapeutic strategies for neuromuscular diseases. Cell Mol Life Sci 2024; 81:198. [PMID: 38678519 PMCID: PMC11056344 DOI: 10.1007/s00018-024-05229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 05/01/2024]
Abstract
Neuromuscular diseases encompass a heterogeneous array of disorders characterized by varying onset ages, clinical presentations, severity, and progression. While these conditions can stem from acquired or inherited causes, this review specifically focuses on disorders arising from genetic abnormalities, excluding metabolic conditions. The pathogenic defect may primarily affect the anterior horn cells, the axonal or myelin component of peripheral nerves, the neuromuscular junction, or skeletal and/or cardiac muscles. While inherited neuromuscular disorders have been historically deemed not treatable, the advent of gene-based and molecular therapies is reshaping the treatment landscape for this group of condition. With the caveat that many products still fail to translate the positive results obtained in pre-clinical models to humans, both the technological development (e.g., implementation of tissue-specific vectors) as well as advances on the knowledge of pathogenetic mechanisms form a collective foundation for potentially curative approaches to these debilitating conditions. This review delineates the current panorama of therapies targeting the most prevalent forms of inherited neuromuscular diseases, emphasizing approved treatments and those already undergoing human testing, offering insights into the state-of-the-art interventions.
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Affiliation(s)
- Alberto Andrea Zambon
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Institute for Experimental Neurology, Inspe, Milan, Italy
- Neurology Department, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Yuri Matteo Falzone
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Institute for Experimental Neurology, Inspe, Milan, Italy
- Neurology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Bolino
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Institute for Experimental Neurology, Inspe, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Carlo Previtali
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Institute for Experimental Neurology, Inspe, Milan, Italy.
- Neurology Department, San Raffaele Scientific Institute, Milan, Italy.
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Eichinger K, Sowden JE, Burns J, McDermott MP, Krischer J, Thornton J, Pareyson D, Scherer SS, Shy ME, Reilly MM, Herrmann DN. Accelerate Clinical Trials in Charcot-Marie-Tooth Disease (ACT-CMT): A Protocol to Address Clinical Trial Readiness in CMT1A. Front Neurol 2022; 13:930435. [PMID: 35832173 PMCID: PMC9271780 DOI: 10.3389/fneur.2022.930435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/27/2022] [Indexed: 12/30/2022] Open
Abstract
With therapeutic trials on the horizon for Charcot-Marie-Tooth type 1A (CMT1A), reliable, valid, and responsive clinical outcome assessments and biomarkers are essential. Accelerate Clinical Trials in CMT (ACT-CMT) is an international study designed to address important gaps in CMT1A clinical trial readiness including the lack of a validated, responsive functional outcome measure for adults, and a lack of validated biomarkers for multicenter application in clinical trials in CMT1A. The primary aims of ACT-CMT include validation of the Charcot-Marie-Tooth Functional Outcome Measure, magnetic resonance imaging of intramuscular fat accumulation as a lower limb motor biomarker, and in-vivo reflectance confocal microscopy of Meissner corpuscle sensory receptor density, a sensory biomarker. Initial studies have indicated that these measures are feasible, reliable and valid. A large prospective, multi-site study is necessary to fully validate and examine the responsiveness of these outcome measures in relation to existing outcomes for use in future clinical trials involving individuals with CMT1A. Two hundred 15 adults with CMT1A are being recruited to participate in this prospective, international, multi-center study. Serial assessments, up to 3 years, are performed and include the CMT-FOM, CMT Exam Score-Rasch, Overall Neuropathy Limitations Scale, CMT-Health Index, as well as nerve conduction studies, and magnetic resonance imaging and Meissner corpuscle biomarkers. Correlations using baseline data will be examined for validity. Longitudinal analyses will document the changes in function, intramuscular fat accumulation, Meissner corpuscle sensory receptor density. Lastly, we will use anchor-based and other statistical methods to determine the minimally clinically important change for these clinical outcome assessments and biomarkers in CMT1A. Reliable, and responsive clinical outcome assessments of function and disease progression biomarkers are urgently needed for application in early and late phase clinical trials in CMT1A. The ACT-CMT study protocol will address this need through the prospective, longitudinal, multicenter examination in unprecedented detail of novel and existing clinical outcome assessments and motor and sensory biomarkers, and enhance international clinical trial infrastructure, training and preparedness for future therapeutic trials in CMT and related neuropathies.
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Affiliation(s)
- Katy Eichinger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janet E. Sowden
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Joshua Burns
- Faculty of Medicine and Health and Children's Hospital at Westmead, The University of Sydney School of Health Sciences, Sydney, NSW, Australia
| | - Michael P. McDermott
- Department of Neurology, University of Rochester, Rochester, NY, United States
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Jeffrey Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - John Thornton
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Davide Pareyson
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Steven S. Scherer
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael E. Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Mary M. Reilly
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - David N. Herrmann
- Department of Neurology, University of Rochester, Rochester, NY, United States
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Kramarz C, Rossor AM. Neurological update: hereditary neuropathies. J Neurol 2022; 269:5187-5191. [PMID: 35596796 PMCID: PMC9363318 DOI: 10.1007/s00415-022-11164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
In this update, we review the recent discovery of autosomal recessive variants in sorbitol dehydrogenase as one of the commonest and potentially treatable causes of hereditary motor neuropathy and CMT2. We also report on recent therapeutic advances in hereditary neuropathy including the use of lipid nanoparticle sequestered antisense oligonucleotides in CMT1A and lipid nanoparticle delivered CRISPR-Cas9 gene editing in ATTR amyloidosis.
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Affiliation(s)
- Caroline Kramarz
- Department of Neuromuscular Disease, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, WC1N 3BG, UK
| | - Alexander M Rossor
- Department of Neuromuscular Disease, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, WC1N 3BG, UK.
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Effects of 5 Years Aerobic Exercise on Cognition in Older Adults: The Generation 100 Study: A Randomized Controlled Trial. Sports Med 2021; 52:1689-1699. [PMID: 34878637 PMCID: PMC9213353 DOI: 10.1007/s40279-021-01608-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
Objective The objective of this study was to investigate whether a 5-year exercise intervention and change in peak oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$$V{\text{O}}_{{2{\text{peak}}}}$$\end{document}VO2peak) is associated with cognitive function in older adults. Methods Nine hundred and forty-five participants (48% women, mean age at study end 78.2 ± 2.02 years) from the Generation 100 Study were randomized 2:1:1 to a control group, moderate-intensity continuous training or high-intensity interval training twice weekly for 5 years. Peak oxygen uptake was measured using ergospirometry at baseline and after 5 years. Global cognition and mild cognitive impairment (MCI) were assessed with the Montreal Cognitive Assessment scale (MoCA) after 5 years. Results Compared to the control group, the combined moderate-intensity continuous training plus high-intensity interval training (ExComb) group did not have significantly different cognitive scores (beta value 0.26, 95% confidence interval [CI] − 0.17, 0.69) or odds of MCI (odds ratio 0.86, 95% CI 0.66, 1.13). Men in the ExComb group had 0.80 points higher MoCA (95% CI 0.21, 1.40) and 32% lower odds of MCI compared with male controls (95% CI 0.47, 0.99), with no such findings in women. In the total sample, each 1 metabolic equivalent of task increase in \documentclass[12pt]{minimal}
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\begin{document}$$V{\text{O}}_{{2{\text{peak}}}}$$\end{document}VO2peak corresponded to 0.46 points higher MoCA (95% CI 0.25, 0.67) and 27% lower odds of MCI (95% CI 0.63, 0.85). Compared to \documentclass[12pt]{minimal}
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\begin{document}$$V{\text{O}}_{{2{\text{peak}}}}$$\end{document}VO2peak stable, participants whose \documentclass[12pt]{minimal}
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\begin{document}$$V{\text{O}}_{{2{\text{peak}}}}$$\end{document}VO2peak increased did not have significantly different cognitive scores (beta value 0.24, CI − 0.68, 1.15) or odds of MCI (odds ratio 0.70, 95% CI 0.36, 1.34), whereas participants whose \documentclass[12pt]{minimal}
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\begin{document}$$V{\text{O}}_{{2{\text{peak}}}}$$\end{document}VO2peak decreased had 0.64 points lower MoCA (95% CI − 1.15, − 0.14) and 35% higher odds of MCI (95% CI 0.98, 1.87). Conclusions Overall, exercise was not significantly associated with cognition among older adults. However, maintaining or increasing \documentclass[12pt]{minimal}
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\begin{document}$$V{\text{O}}_{{2{\text{peak}}}}$$\end{document}VO2peak appeared to benefit cognition. Clinical Trial Registration ClinicalTrials.gov NCT01666340. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01608-5.
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Pisciotta C, Saveri P, Pareyson D. Challenges in Treating Charcot-Marie-Tooth Disease and Related Neuropathies: Current Management and Future Perspectives. Brain Sci 2021; 11:1447. [PMID: 34827446 PMCID: PMC8615778 DOI: 10.3390/brainsci11111447] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
There is still no effective drug treatment available for Charcot-Marie-Tooth neuropathies (CMT). Current management relies on rehabilitation therapy, surgery for skeletal deformities, and symptomatic treatment of pain; fatigue and cramps are frequent complaints that are difficult to treat. The challenge is to find disease-modifying therapies. Several approaches, including gene silencing, to counteract the PMP22 gene overexpression in the most frequent CMT1A type are under investigation. PXT3003 is the compound in the most advanced phase for CMT1A, as a second-phase III trial is ongoing. Gene therapy to substitute defective genes or insert novel ones and compounds acting on pathways important for different CMT types are being developed and tested in animal models. Modulation of the Neuregulin pathway determining myelin thickness is promising for both hypo-demyelinating and hypermyelinating neuropathies; intervention on Unfolded Protein Response seems effective for rescuing misfolded myelin proteins such as P0 in CMT1B. HDAC6 inhibitors improved axonal transport and ameliorated phenotypes in different CMT models. Other potential therapeutic strategies include targeting macrophages, lipid metabolism, and Nav1.8 sodium channel in demyelinating CMT and the P2X7 receptor, which regulates calcium influx into Schwann cells, in CMT1A. Further approaches are aimed at correcting metabolic abnormalities, including the accumulation of sorbitol caused by biallelic mutations in the sorbitol dehydrogenase (SORD) gene and of neurotoxic glycosphingolipids in HSN1.
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Affiliation(s)
| | | | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.P.); (P.S.)
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Attarian S, Young P, Brannagan TH, Adams D, Van Damme P, Thomas FP, Casanovas C, Kafaie J, Tard C, Walter MC, Péréon Y, Walk D, Stino A, de Visser M, Verhamme C, Amato A, Carter G, Magy L, Statland JM, Felice K. A double-blind, placebo-controlled, randomized trial of PXT3003 for the treatment of Charcot-Marie-Tooth type 1A. Orphanet J Rare Dis 2021; 16:433. [PMID: 34656144 PMCID: PMC8520617 DOI: 10.1186/s13023-021-02040-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Charcot-Marie-Tooth disease type 1A (CMT1A) is a rare, orphan, hereditary neuromuscular disorder with no cure and for which only symptomatic treatment is currently available. A previous phase 2 trial has shown preliminary evidence of efficacy for PXT3003 in treating CMT1A. This phase 3, international, randomized, double-blind, placebo-controlled study further investigated the efficacy and safety of high- or low-dose PXT3003 (baclofen/naltrexone/D-sorbitol [mg]: 6/0.70/210 or 3/0.35/105) in treating subjects with mild to moderate CMT1A. METHODS In this study, 323 subjects with mild-to-moderate CMT1A were randomly assigned in a 1:1:1 ratio to receive 5 mL of high- or low-dose PXT3003, or placebo, orally twice daily for up to 15 months. Efficacy was assessed using the change in Overall Neuropathy Limitations Scale total score from baseline to months 12 and 15 (primary endpoint). Secondary endpoints included the 10-m walk test and other assessments. The high-dose group was discontinued early due to unexpected crystal formation in the high-dose formulation, which resulted in an unanticipated high discontinuation rate, overall and especially in the high-dose group. The statistical analysis plan was adapted to account for the large amount of missing data before database lock, and a modified full analysis set was used in the main analyses. Two sensitivity analyses were performed to check the interpretation based on the use of the modified full analysis set. RESULTS High-dose PXT3003 demonstrated significant improvement in the Overall Neuropathy Limitations Scale total score vs placebo (mean difference: - 0.37 points; 97.5% CI [- 0.68 to - 0.06]; p = 0.008), and consistent treatment effects were shown in the sensitivity analyses. Both PXT3003 doses were safe and well-tolerated. CONCLUSION The high-dose group demonstrated a statistically significant improvement in the primary endpoint and a good safety profile. Overall, high-dose PXT3003 is a promising treatment option for patients with Charcot-Marie-Tooth disease type 1A.
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Affiliation(s)
- Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Marseille, France.
| | - Peter Young
- Department of Neurology, Medical Park Bad Feilnbach, Bad Feilnbach, Germany
| | - Thomas H Brannagan
- Columbia University Medical Center, The Neurological Institute, New York, USA
| | - David Adams
- French Reference Center for Rare Peripheral Neuropathies, Service de Neurologie Adulte, APHP, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, KU, Leuven, Belgium
- Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Florian P Thomas
- Department of Neurology, Hackensack University Medical Center, Hackensack, USA
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, USA
| | - Carlos Casanovas
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
- Neurometabolic Diseases Group, Bellvitge Research Institute (IDIBELL) and CIBERER, Barcelona, Spain
| | - Jafar Kafaie
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, USA
| | - Céline Tard
- U1171, Centre de référence des maladies neuromusculaires Nord Est Ile de France, Hôpital Salengro CHU de Lille, Lille, France
| | - Maggie C Walter
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires AOC, Filnemus, Euro-NMD, CHU Nantes, Hôtel-Dieu, Nantes, France
| | - David Walk
- Clinical Neuroscience Research Unit, University of Minnesota, Minneapolis, USA
| | - Amro Stino
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Anthony Amato
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Gregory Carter
- St. Luke's Rehabilitation Institute, Physical Medicine and Rehabilitation, Spokane, USA
| | | | | | - Kevin Felice
- Department of Neuromuscular Medicine, Hospital for Special Care, New Britain, USA
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Abstract
Demyelinating forms of Charcot-Marie-Tooth disease (CMT) are genetically and phenotypically heterogeneous and result from highly diverse biological mechanisms including gain of function (including dominant negative effects) and loss of function. While no definitive treatment is currently available, rapid advances in defining the pathomechanisms of demyelinating CMT have led to promising pre-clinical studies, as well as emerging clinical trials. Especially promising are the recently completed pre-clinical genetic therapy studies in PMP-22, GJB1, and SH3TC2-associated neuropathies, particularly given the success of similar approaches in humans with spinal muscular atrophy and transthyretin familial polyneuropathy. This article focuses on neuropathies related to mutations in PMP-22, MPZ, and GJB1, which together comprise the most common forms of demyelinating CMT, as well as on select rarer forms for which promising treatment targets have been identified. Clinical characteristics and pathomechanisms are reviewed in detail, with emphasis on therapeutically targetable biological pathways. Also discussed are the challenges facing the CMT research community in its efforts to advance the rapidly evolving biological insights to effective clinical trials. These considerations include the limitations of currently available animal models, the need for personalized medicine approaches/allele-specific interventions for select forms of demyelinating CMT, and the increasing demand for optimal clinical outcome assessments and objective biomarkers.
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Affiliation(s)
- Vera Fridman
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Mailstop B185, Room 5113C, Aurora, CO, 80045, USA.
| | - Mario A Saporta
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Gómez X, Sanon S, Zambrano K, Asquel S, Bassantes M, Morales JE, Otáñez G, Pomaquero C, Villarroel S, Zurita A, Calvache C, Celi K, Contreras T, Corrales D, Naciph MB, Peña J, Caicedo A. Key points for the development of antioxidant cocktails to prevent cellular stress and damage caused by reactive oxygen species (ROS) during manned space missions. NPJ Microgravity 2021; 7:35. [PMID: 34556658 PMCID: PMC8460669 DOI: 10.1038/s41526-021-00162-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/03/2021] [Indexed: 02/08/2023] Open
Abstract
Exposure to microgravity and ionizing radiation during spaceflight missions causes excessive reactive oxygen species (ROS) production that contributes to cellular stress and damage in astronauts. Average spaceflight mission time is expected to lengthen as humanity aims to visit other planets. However, longer missions or spaceflights will undoubtedly lead to an increment in microgravity, ionizing radiation and ROS production. Strategies to minimize ROS damage are necessary to maintain the health of astronauts, future space colonists, and tourists during and after spaceflight missions. An antioxidant cocktail formulated to prevent or mitigate ROS damage during space exploration could help maintain the health of space explorers. We propose key points to consider when developing an antioxidant cocktail. We discuss how ROS damages our body and organs, the genetic predisposition of astronauts to its damage, characteristics and evidence of the effectiveness of antioxidants to combat excess ROS, differences in drug metabolism when on Earth and in space that could modify antioxidant effects, and the characteristics and efficacy of common antioxidants. Based on this information we propose a workflow for assessing astronaut resistance to ROS damage, infight monitoring of ROS production, and an antioxidant cocktail. Developing an antioxidant cocktail represents a big challenge to translate current medical practices from an Earth setting to space. The key points presented in this review could promote the development of different antioxidant formulations to maintain space explorers' health in the future.
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Affiliation(s)
- Xavier Gómez
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
- Universidad San Francisco de Quito USFQ, Instituto de Investigaciones en Biomedicina iBioMed, Quito, Ecuador
- Mito-Act Research Consortium, Quito, Ecuador
| | - Serena Sanon
- Universidad San Francisco de Quito USFQ, Instituto de Investigaciones en Biomedicina iBioMed, Quito, Ecuador
- Cornell University, Ithaca, NY, USA
- Mito-Act Research Consortium, Quito, Ecuador
| | - Kevin Zambrano
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
- Universidad San Francisco de Quito USFQ, Instituto de Investigaciones en Biomedicina iBioMed, Quito, Ecuador
- Mito-Act Research Consortium, Quito, Ecuador
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Samira Asquel
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Mariuxi Bassantes
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Julián E Morales
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Gabriela Otáñez
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Core Pomaquero
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Sarah Villarroel
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Alejandro Zurita
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Carlos Calvache
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Kathlyn Celi
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Terry Contreras
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Dylan Corrales
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - María Belén Naciph
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - José Peña
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Andrés Caicedo
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador.
- Universidad San Francisco de Quito USFQ, Instituto de Investigaciones en Biomedicina iBioMed, Quito, Ecuador.
- Mito-Act Research Consortium, Quito, Ecuador.
- Sistemas Médicos SIME, Universidad San Francisco de Quito USFQ, Quito, Ecuador.
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10
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Poitras ME, Légaré F, Tremblay Vaillancourt V, Godbout I, Poirier A, Prévost K, Spence C, Chouinard MC, Zomahoun HTV, Khadhraoui L, Massougbodji J, Bujold M, Pluye P, Hudon C. High Users of Healthcare Services: Development and Alpha Testing of a Patient Decision Aid for Case Management. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:757-766. [PMID: 33083997 DOI: 10.1007/s40271-020-00465-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Some patients with complex healthcare needs become high users of healthcare services. Case management allows these patients and their interprofessional team to work together to evaluate their needs, priorities and available resources. High-user patients must make an informed decision when choosing whether to engage in case management and currently there is no tool to support them. OBJECTIVE The objective of this study was to develop and conduct a pilot alpha testing of a patient decision aid that supports high-user patients with complex needs and the teams who guide those patients in shared decision making when engaging in case management. METHODS We chose a user-centered design to co-develop a patient decision aid with stakeholders informed by the Ottawa Research Institute and International Patient Decision Aid Standards frameworks. Perceptions and preferences for the patient decision aid's content and format were assessed with patients and clinicians and were iteratively collected through interviews and focus groups. We developed a prototype and assessed its acceptability by using a think-aloud method and a questionnaire with three patient-partners, six clinicians and seven high-user patients with complex needs. RESULTS The three rounds of evaluation to assess the decision aid's acceptability highlighted comments related to simplicity, readability and visual aspect. A section presenting clinical vignettes including story telling was identified as the most helpful. CONCLUSIONS We created and evaluated a patient decision aid. Considering the positive comments, we believe that this aid has the potential to help high-user patients with complex care needs make better choices concerning case management.
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Affiliation(s)
- Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada. .,Département de la recherche, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada. .,Centre de Recherche Charles-LeMoyne-Saguenay-Lac-Saint-Jean Sur Les Innovations en Santé, Saguenay, QC, Canada.
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.,Population Health and Practice-Changing Research, CHU de Québec, Université Laval, Québec, QC, Canada
| | - Vanessa Tremblay Vaillancourt
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada.,Département de la recherche, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada.,Centre de Recherche Charles-LeMoyne-Saguenay-Lac-Saint-Jean Sur Les Innovations en Santé, Saguenay, QC, Canada
| | - Isabelle Godbout
- Québec SPOR Support Unit, Université du Québec à Montréal, Montréal, QC, Canada
| | | | - Karina Prévost
- Département de la recherche, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada
| | - Claude Spence
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada
| | | | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada.,Centre de Recherche sur ses Soins et les Services de Première Ligne, Université Laval, Québec, QC, Canada
| | | | | | - Mathieu Bujold
- Family Medicine Department, McGill University, Montréal, QC, Canada
| | - Pierre Pluye
- Family Medicine Department, McGill University, Montréal, QC, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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11
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Rominger C, Fink A, Weber B, Papousek I, Schwerdtfeger AR. Everyday bodily movement is associated with creativity independently from active positive affect: a Bayesian mediation analysis approach. Sci Rep 2020; 10:11985. [PMID: 32686709 PMCID: PMC7371881 DOI: 10.1038/s41598-020-68632-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/23/2020] [Indexed: 12/21/2022] Open
Abstract
Previous (predominantly) laboratory studies reported positive relations of physical activity (or everyday bodily movement) with executive functioning, some even showed effects on creative thinking. Furthermore, positive-activated affect was found to be positively associated with everyday bodily movements and creativity. The mechanisms, however, underlying these relationships are poorly understood. The aim of this study was twofold: Firstly, we investigated whether everyday bodily movement was associated with creative performance. Secondly, we examined if positive-activated affect may mediate the association between bodily movement and creative performance. In a sample of 79 participants everyday bodily movement was recorded during five consecutive days using accelerometers. Creativity in the figural and verbal domain was assessed with performance tests, along with self-reported positive-activated affect as a trait. Findings revealed that creativity, positive-activated affect, and everyday bodily movement were associated with each other. However, positive-activated affect did not mediate the association between everyday bodily movement and creative performance. The pattern of findings argues for shared variance between bodily movement and creativity (fluency and originality) that is largely independent from variations in positive-activated affect.
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Affiliation(s)
- Christian Rominger
- Department of Psychology, Health Psychology Unit, University of Graz, Univ.-Platz 2, 8010, Graz, Austria.
| | - Andreas Fink
- Department of Psychology, Health Psychology Unit, University of Graz, Univ.-Platz 2, 8010, Graz, Austria
| | - Bernhard Weber
- Department of Psychology, Health Psychology Unit, University of Graz, Univ.-Platz 2, 8010, Graz, Austria
| | - Ilona Papousek
- Department of Psychology, Health Psychology Unit, University of Graz, Univ.-Platz 2, 8010, Graz, Austria
| | - Andreas R Schwerdtfeger
- Department of Psychology, Health Psychology Unit, University of Graz, Univ.-Platz 2, 8010, Graz, Austria
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12
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Sunnetci Silistre E, Erbas O. The Ameliorative Effects of Ascorbic Acid on Critical Illness Polyneuropathy in Rodent Sepsis Model. J Pediatr Intensive Care 2020; 9:265-270. [PMID: 33133742 DOI: 10.1055/s-0040-1710587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022] Open
Abstract
Although the exact pathophysiology of critical illness polyneuropathy (CIP) is still unknown, there are several hypotheses, some of which are increased inflammation and oxidative stress. We used rodent sepsis model in which we induced sepsis through cecal ligation followed by cecal puncture. We then administered ascorbic acid (AA) and evaluated outcomes. The levels of malondialdehyde (MDA), tumor necrosis factor α (TNF-α), interleukins (IL)-6 in the plasma, and heat shock protein-70 (HSP-70) levels in the sciatic nerve were measured, and also electromyography analyses were performed. While plasma MDA, TNF-α, and IL-6 levels were decreased significantly with AA treatment, sciatic nerve levels of HSP-70 were significantly elevated in the AA group. A significant increase in compound muscle action potential (CMAP) amplitude and a significant decrease in CMAP latency were detected in the AA group. We observed healing effects of AA on a rat model of CIP and these effects seem to be related to its anti-inflammatory and antioxidant properties.
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Affiliation(s)
| | - Oytun Erbas
- Department of Physiology, Bilim University Medical Faculty, Istanbul, Turkey
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13
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Rossor AM, Shy ME, Reilly MM. Are we prepared for clinical trials in Charcot-Marie-Tooth disease? Brain Res 2020; 1729:146625. [PMID: 31899213 PMCID: PMC8418667 DOI: 10.1016/j.brainres.2019.146625] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/11/2019] [Accepted: 12/24/2019] [Indexed: 12/21/2022]
Abstract
There has been considerable progress in developing treatments for Charcot-Marie-Tooth disease with a number of therapies either completing or nearing clinical trials. In the case of CMT1A, the commonest subtype of CMT, there have been more than five randomised, double blind placebo-controlled trials. Although these trials were negative for the primary outcome measure, considerable lessons have been learnt leading to the collection of large prospective natural history data sets with which to inform future trial design as well as the development of new and sensitive outcome measures. In this review we summarise the difficulties of conducting clinical trials in a slowly progressive disease such as CMT1A and the requirement for sensitive, reproducible and clinically relevant outcome measures. We summarise the current array of CMT specific outcome measures subdivided into clinical outcome measures, functional outcome measures, patient reported outcome measures, biomarkers of disease burden and treatment specific biomarkers of target engagement. Although there is now an array of CMT specific outcome measures, which collectively incorporate clinically relevant, sensitive and reproducible outputs, a single outcome measure incorporating all three qualities remains elusive.
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Affiliation(s)
- A M Rossor
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, United Kingdom.
| | - M E Shy
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - M M Reilly
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, United Kingdom
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14
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Hartmannsberger B, Doppler K, Stauber J, Schlotter-Weigel B, Young P, Sereda MW, Sommer C. Intraepidermal nerve fibre density as biomarker in Charcot-Marie-Tooth disease type 1A. Brain Commun 2020; 2:fcaa012. [PMID: 32954280 PMCID: PMC7425304 DOI: 10.1093/braincomms/fcaa012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 01/03/2023] Open
Abstract
Charcot-Marie-Tooth disease type 1A, caused by a duplication of the gene peripheral myelin protein 22 kDa, is the most frequent subtype of hereditary peripheral neuropathy with an estimated prevalence of 1:5000. Patients suffer from sensory deficits, muscle weakness and foot deformities. There is no treatment approved for this disease. Outcome measures in clinical trials were based mainly on clinical features but did not evaluate the actual nerve damage. In our case-control study, we aimed to provide objective and reproducible outcome measures for future clinical trials. We collected skin samples from 48 patients with Charcot-Marie-Tooth type 1A, 7 patients with chronic inflammatory demyelinating polyneuropathy, 16 patients with small fibre neuropathy and 45 healthy controls. To analyse skin innervation, 40-µm cryosections of glabrous skin taken from the lateral index finger were double-labelled by immunofluorescence. The disease severity of patients with Charcot-Marie-Tooth type 1A was assessed by the Charcot-Marie-Tooth neuropathy version 2 score, which ranged from 3 (mild) to 27 (severe) and correlated with age (P < 0.01, R = 0.4). Intraepidermal nerve fibre density was reduced in patients with Charcot-Marie-Tooth type 1A compared with the healthy control group (P < 0.01) and negatively correlated with disease severity (P < 0.05, R = -0.293). Meissner corpuscle (MC) density correlated negatively with age in patients with Charcot-Marie-Tooth type 1A (P < 0.01, R = -0.45) but not in healthy controls (P = 0.07, R = 0.28). The density of Merkel cells was reduced in patients with Charcot-Marie-Tooth type 1A compared with healthy controls (P < 0.05). Furthermore, in patients with Charcot-Marie-Tooth type 1A, the fraction of denervated Merkel cells was highly increased and correlated with age (P < 0.05, R = 0.37). Analysis of nodes of Ranvier revealed shortened paranodes and a reduced fraction of long nodes in patients compared with healthy controls (both P < 0.001). Langerhans cell density was increased in chronic inflammatory demyelinating polyneuropathy, but not different in Charcot-Marie-Tooth type 1A compared with healthy controls. Our data suggest that intraepidermal nerve fibre density might be used as an outcome measure in Charcot-Marie-Tooth type 1A disease, as it correlates with disease severity. The densities of Meissner corpuscles and Merkel cells might be an additional tool for the evaluation of the disease progression. Analysis of follow-up biopsies will clarify the effects of Charcot-Marie-Tooth type 1A disease progression on cutaneous innervation.
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Affiliation(s)
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Julia Stauber
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany
| | - Beate Schlotter-Weigel
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany
| | - Peter Young
- Medical Park Bad Feilnbach Reithofpark, Department of Neurology, 83075 Bad Feilnbach, Germany
| | - Michael W Sereda
- Department of Clinical Neurophysiology, University Medical Center Göttingen (UMG), 37075 Göttingen, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
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15
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Araki T. Regulatory Mechanism of Peripheral Nerve Myelination by Glutamate-Induced Signaling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1190:23-31. [PMID: 31760635 DOI: 10.1007/978-981-32-9636-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Regulation of differentiation and proliferation of Schwann cells is an essential part of the regulation of peripheral nerve development, degeneration, and regeneration. ZNRF1, a ubiquitin ligase, is expressed in undifferentiated/repair Schwann cells, directs glutamine synthetase to proteasomal degradation, and thereby increase glutamate levels in Schwann cell environment. Glutamate elicits subcellular signaling in Schwann cells via mGluR2 to modulate Neuregulin-1/ErbB2/3 signaling and thereby promote undifferentiated phenotype of Schwann cell.
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Affiliation(s)
- Toshiyuki Araki
- Department of Peripheral Nervous System Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
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16
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Pantera H, Shy ME, Svaren J. Regulating PMP22 expression as a dosage sensitive neuropathy gene. Brain Res 2019; 1726:146491. [PMID: 31586623 DOI: 10.1016/j.brainres.2019.146491] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022]
Abstract
Structural variation in the human genome has emerged as a major cause of disease as genomic data have accumulated. One of the most common structural variants associated with human disease causes the heritable neuropathy known as Charcot-Marie-Tooth (CMT) disease type 1A. This 1.4 Mb duplication causes nearly half of the CMT cases that are genetically diagnosed. The PMP22 gene is highly induced in Schwann cells during development, although its precise role in myelin formation and homeostasis is still under active investigation. The PMP22 gene can be considered as a nucleoprotein complex with enzymatic activity to produce the PMP22 transcript, and the complex is allosterically regulated by transcription factors that respond to intracellular signals and epigenomic modifications. The control of PMP22 transcript levels has been one of the major therapeutic targets of therapy development, and this review summarizes those approaches as well as efforts to characterize the regulation of the PMP22 gene.
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Affiliation(s)
- Harrison Pantera
- Molecular and Cellular Pharmacology Training Program, University of Wisconsin, Madison, WI, USA
| | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - John Svaren
- Waisman Center and Department of Comparative Biosciences, University of Wisconsin, Madison, WI, USA.
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17
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Chelban V, Wilson MP, Warman Chardon J, Vandrovcova J, Zanetti MN, Zamba‐Papanicolaou E, Efthymiou S, Pope S, Conte MR, Abis G, Liu Y, Tribollet E, Haridy NA, Botía JA, Ryten M, Nicolaou P, Minaidou A, Christodoulou K, Kernohan KD, Eaton A, Osmond M, Ito Y, Bourque P, Jepson JEC, Bello O, Bremner F, Cordivari C, Reilly MM, Foiani M, Heslegrave A, Zetterberg H, Heales SJR, Wood NW, Rothman JE, Boycott KM, Mills PB, Clayton PT, Houlden H. PDXK mutations cause polyneuropathy responsive to pyridoxal 5'-phosphate supplementation. Ann Neurol 2019; 86:225-240. [PMID: 31187503 PMCID: PMC6772106 DOI: 10.1002/ana.25524] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify disease-causing variants in autosomal recessive axonal polyneuropathy with optic atrophy and provide targeted replacement therapy. METHODS We performed genome-wide sequencing, homozygosity mapping, and segregation analysis for novel disease-causing gene discovery. We used circular dichroism to show secondary structure changes and isothermal titration calorimetry to investigate the impact of variants on adenosine triphosphate (ATP) binding. Pathogenicity was further supported by enzymatic assays and mass spectroscopy on recombinant protein, patient-derived fibroblasts, plasma, and erythrocytes. Response to supplementation was measured with clinical validated rating scales, electrophysiology, and biochemical quantification. RESULTS We identified biallelic mutations in PDXK in 5 individuals from 2 unrelated families with primary axonal polyneuropathy and optic atrophy. The natural history of this disorder suggests that untreated, affected individuals become wheelchair-bound and blind. We identified conformational rearrangement in the mutant enzyme around the ATP-binding pocket. Low PDXK ATP binding resulted in decreased erythrocyte PDXK activity and low pyridoxal 5'-phosphate (PLP) concentrations. We rescued the clinical and biochemical profile with PLP supplementation in 1 family, improvement in power, pain, and fatigue contributing to patients regaining their ability to walk independently during the first year of PLP normalization. INTERPRETATION We show that mutations in PDXK cause autosomal recessive axonal peripheral polyneuropathy leading to disease via reduced PDXK enzymatic activity and low PLP. We show that the biochemical profile can be rescued with PLP supplementation associated with clinical improvement. As B6 is a cofactor in diverse essential biological pathways, our findings may have direct implications for neuropathies of unknown etiology characterized by reduced PLP levels. ANN NEUROL 2019;86:225-240.
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Affiliation(s)
- Viorica Chelban
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Neurology and NeurosurgeryInstitute of Emergency MedicineChisinauMoldova
| | - Matthew P. Wilson
- Genetics and Genomic MedicineUniversity College London Great Ormond Street Institute of Child HealthLondonUnited Kingdom
| | - Jodi Warman Chardon
- Department of Medicine (Neurology)University of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
| | - Jana Vandrovcova
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - M. Natalia Zanetti
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Eleni Zamba‐Papanicolaou
- Cyprus Institute of Neurology and GeneticsNicosiaCyprus
- Cyprus School of Molecular MedicineNicosiaCyprus
| | - Stephanie Efthymiou
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Simon Pope
- Neurometabolic Unit, National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Maria R. Conte
- Randall Centre of Cell and Molecular Biophysics, School of Basic and Medical BiosciencesKing's College LondonLondonUnited Kingdom
| | - Giancarlo Abis
- Randall Centre of Cell and Molecular Biophysics, School of Basic and Medical BiosciencesKing's College LondonLondonUnited Kingdom
| | - Yo‐Tsen Liu
- Department of NeurologyNeurological Institute, Taipei Veterans General HospitalTaipeiTaiwan
- National Yang‐Ming University School of MedicineTaipeiTaiwan
- Institute of Brain Science, National Yang‐Ming UniversityTaipeiTaiwan
| | - Eloise Tribollet
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Nourelhoda A. Haridy
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Neurology and PsychiatryAssiut University Hospital, Faculty of MedicineAsyutEgypt
| | - Juan A. Botía
- Reta Lila Weston Research LaboratoriesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Information and Communications EngineeringUniversity of MurciaMurciaSpain
| | - Mina Ryten
- Reta Lila Weston Research LaboratoriesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Medical & Molecular GeneticsKing's College London, Guy's HospitalLondonUnited Kingdom
| | - Paschalis Nicolaou
- Cyprus Institute of Neurology and GeneticsNicosiaCyprus
- Cyprus School of Molecular MedicineNicosiaCyprus
| | - Anna Minaidou
- Cyprus Institute of Neurology and GeneticsNicosiaCyprus
- Cyprus School of Molecular MedicineNicosiaCyprus
| | - Kyproula Christodoulou
- Cyprus Institute of Neurology and GeneticsNicosiaCyprus
- Cyprus School of Molecular MedicineNicosiaCyprus
| | - Kristin D. Kernohan
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
- Newborn Screening Ontario, Children's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Alison Eaton
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
| | - Matthew Osmond
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
| | - Yoko Ito
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
| | - Pierre Bourque
- Department of Medicine (Neurology)University of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - James E. C. Jepson
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Oscar Bello
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Fion Bremner
- Neuro‐ophthalmology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Carla Cordivari
- Clinical Neurophysiology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Mary M. Reilly
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Martha Foiani
- Clinical Neurophysiology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Department of Neurodegenerative DiseaseUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Amanda Heslegrave
- Department of Neurodegenerative DiseaseUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- UK Dementia Research Institute at University College LondonLondonUnited Kingdom
| | - Henrik Zetterberg
- Department of Neurodegenerative DiseaseUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- UK Dementia Research Institute at University College LondonLondonUnited Kingdom
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, Sahlgrenska Academy at University of GothenburgMölndalSweden
| | - Simon J. R. Heales
- Neurometabolic Unit, National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Nicholas W. Wood
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Neurogenetics LaboratoryNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - James E. Rothman
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Department of Cell BiologyYale School of MedicineNew HavenCT
| | - Kym M. Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
| | - Philippa B. Mills
- Genetics and Genomic MedicineUniversity College London Great Ormond Street Institute of Child HealthLondonUnited Kingdom
| | - Peter T. Clayton
- Genetics and Genomic MedicineUniversity College London Great Ormond Street Institute of Child HealthLondonUnited Kingdom
| | - Henry Houlden
- Department of Neuromuscular DiseasesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
- Neurogenetics LaboratoryNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
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18
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Barbullushi K, Abati E, Rizzo F, Bresolin N, Comi GP, Corti S. Disease Modeling and Therapeutic Strategies in CMT2A: State of the Art. Mol Neurobiol 2019; 56:6460-6471. [DOI: 10.1007/s12035-019-1533-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
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Prada V, Schizzi S, Poggi I, Mori L, Gemelli C, Hamedani M, Accogli S, Maggi G, Grandis M, Mancardi GL, Schenone A. Hand Rehabilitation Treatment for Charcot-Marie-Tooth Disease: An Open Label Pilot Study. JOURNAL OF NEUROLOGY & NEUROPHYSIOLOGY 2018; 9:465. [PMID: 30305981 PMCID: PMC6175056 DOI: 10.4172/2155-9562.1000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Charcot-Marie-Tooth neuropathy affects mainly and early the lower limbs, but hands deformities are a relevant problem, which involves the quality of life of the patients. Unfortunately, there are few studies about the evaluation of the upper limbs and very rare works about the rehabilitation. A treatment study at the moment is missing and it is important to search rehabilitation exercises to improve the dexterity and the quality of life of the patients. METHODS We recruited 9 patients with clinical and genetic diagnosis of CMT and we proposed a rehabilitation protocol which includes muscle recruitment, stretching and proprioceptive exercises for the hand with the duration of 4 weeks (two sessions for week). We evaluated the patients before and one week after the treatment with Thumb Opposition Test, Sollerman Hand Function Scale, dynamometry (tripod pinch and hand grip). RESULTS The rehabilitation protocol has been well tolerated and there were not dropouts. We did not observe any worsening in every scale we used. Every parameter tested showed an improvement especially in the right/dominant hand. CONCLUSION This study demonstrates that this three phases treatment is well tolerated by patients, it is not detrimental for the hands status and perfectly reproducible by professionals. Moreover, this could be the basis for future randomized single blind projects.
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Affiliation(s)
- Valeria Prada
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
| | - S Schizzi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
| | - I Poggi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
| | - L Mori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
- Ospedale Policlinico San Martino IRCCS, Dipartimento di Neurologia, Genova, Italy
| | - C Gemelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
| | - M Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
| | - S Accogli
- Ospedale Policlinico San Martino IRCCS, Dipartimento di Neurologia, Genova, Italy
| | - G Maggi
- Ospedale Policlinico San Martino IRCCS, Dipartimento di Neurologia, Genova, Italy
| | - M Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
- Ospedale Policlinico San Martino IRCCS, Dipartimento di Neurologia, Genova, Italy
| | - GL Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
- Ospedale Policlinico San Martino IRCCS, Dipartimento di Neurologia, Genova, Italy
| | - A Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Italy
- Ospedale Policlinico San Martino IRCCS, Dipartimento di Neurologia, Genova, Italy
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20
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Muhammad AKMG, Kim K, Epifantseva I, Aghamaleky-Sarvestany A, Simpkinson ME, Carmona S, Landeros J, Bell S, Svaren J, Baloh RH. Cell transplantation strategies for acquired and inherited disorders of peripheral myelin. Ann Clin Transl Neurol 2018; 5:186-200. [PMID: 29468179 PMCID: PMC5817839 DOI: 10.1002/acn3.517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 01/26/2023] Open
Abstract
Objective To investigate transplantation of rat Schwann cells or human iPSC-derived neural crest cells and derivatives into models of acquired and inherited peripheral myelin damage. Methods Primary cultured rat Schwann cells labeled with a fluorescent protein for monitoring at various times after transplantation. Human-induced pluripotent stem cells (iPSCs) were differentiated into neural crest stem cells, and subsequently toward a Schwann cell lineage via two different protocols. Cell types were characterized using flow cytometry, immunocytochemistry, and transcriptomics. Rat Schwann cells and human iPSC derivatives were transplanted into (1) nude rats pretreated with lysolecithin to induce demyelination or (2) a transgenic rat model of dysmyelination due to PMP22 overexpression. Results Rat Schwann cells transplanted into sciatic nerves with either toxic demyelination or genetic dysmyelination engrafted successfully, and migrated longitudinally for relatively long distances, with more limited axial migration. Transplanted Schwann cells engaged existing axons and displaced dysfunctional Schwann cells to form normal-appearing myelin. Human iPSC-derived neural crest stem cells and their derivatives shared similar engraftment and migration characteristics to rat Schwann cells after transplantation, but did not further differentiate into Schwann cells or form myelin. Interpretation These results indicate that cultured Schwann cells surgically delivered to peripheral nerve can engraft and form myelin in either acquired or inherited myelin injury, as proof of concept for pursuing cell therapy for diseases of peripheral nerve. However, lack of reliable technology for generating human iPSC-derived Schwann cells for transplantation therapy remains a barrier in the field.
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Affiliation(s)
- A K M G Muhammad
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Kevin Kim
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Irina Epifantseva
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Arwin Aghamaleky-Sarvestany
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Megan E Simpkinson
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Sharon Carmona
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Jesse Landeros
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - Shaughn Bell
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
| | - John Svaren
- Waisman Center and Department of Comparative Biosciences University of Wisconsin-Madison Madison Wisconsin 53706
| | - Robert H Baloh
- Board of Governors Regenerative Medicine Institute Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048.,Department of Neurology Cedars-Sinai Medical Center 8700 Beverly Boulevard Los Angeles California 90048
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21
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Abstract
PURPOSE OF REVIEW Charcot-Marie-Tooth disease (CMT) is one of the commonest inherited neuromuscular diseases with a population prevalence of 1 in 2500. This review will cover recent advances in the genetics and pathomechanisms of CMT and how these are leading to the development of rational therapies. RECENT FINDINGS Pathomechanistic and therapeutic target advances in CMT include the identification of the ErbB receptor signalling pathway as a therapeutic target in CMT1A and pharmacological modification of the unfolded protein response in CMT1B. In CMT2D, due to mutations in glycyl-tRNA synthetase, vascular endothelial growth factor-mediated stimulation of the Nrp1 receptor has been identified as a therapeutic target. Preclinical advances have been accompanied by the publication of large natural history cohorts and the identification of a sensitive biomarker of disease (muscle MRI) that is able to detect disease progression in CMT1A over 1 year. SUMMARY Advances in next-generation sequencing technology, cell biology and animal models of CMT are paving the way for rational treatments. The combination of robust natural history data and the identification of sensitive biomarkers mean that we are now entering an exciting therapeutic era in the field of the genetic neuropathies.
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22
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Cornett KMD, Menezes MP, Shy RR, Moroni I, Pagliano E, Pareyson D, Estilow T, Yum SW, Bhandari T, Muntoni F, Laura M, Reilly MM, Finkel RS, Eichinger KJ, Herrmann DN, Bray P, Halaki M, Shy ME, Burns J. Natural history of Charcot-Marie-Tooth disease during childhood. Ann Neurol 2017; 82:353-359. [PMID: 28796392 DOI: 10.1002/ana.25009] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the rate of disease progression in a longitudinal natural history study of children with Charcot-Marie-Tooth (CMT) disease. METHODS Two hundred six (103 female) participants aged 3 to 20 years enrolled in the Inherited Neuropathies Consortium were assessed at baseline and 2 years. Demographic, anthropometric, and diagnostic information were collected. Disease progression was assessed with the CMT Pediatric Scale (CMTPedS), a reliable Rasch-built linearly weighted disability scale evaluating fine and gross motor function, strength, sensation, and balance. RESULTS On average, CMTPedS Total scores progressed at a rate of 2.4 ± 4.9 over 2 years (14% change from baseline; p < 0.001). There was no difference between males and females (mean difference, 0.5; 95% confidence interval [CI], -0.9 to 1.9; p = 0.49). The most responsive CMTPedS items were dorsiflexion strength (z-score change, -0.3; 95% CI, -0.6 to -0.05; p = 0.02), balance (z-score change, -1.0; 95% CI, -1.9 to -0.09; p = 0.03), and long jump (z-score change, -0.4; 95% CI, -0.7 to -0.02; p = 0.04). Of the most common genetic subtypes, 111 participants with CMT1A/PMP22 duplication progressed by 1.8 ± 4.2 (12% change from baseline; p < 0.001), 9 participants with CMT1B/MPZ mutation progressed by 2.2 ± 5.1 (11% change), 6 participants with CMT2A/MFN2 mutation progressed by 6.2 ± 7.9 (23% change), and 7 participants with CMT4C/SH3TC2 mutations progressed by 3.0 ± 4.5 (12% change). Participants with CMT2A progressed faster than CMT1A (mean difference, -4.4; 95% CI, -8.1 to -0.8; p = 0.02). Children with CMT1A progressed consistently through early childhood (3-10 years) and adolescence (11-20 years; mean difference, 1.1; 95% CI, -0.6 to 2.7; p = 0.19), whereas CMT2A appeared to progress faster during early childhood than adolescence (mean difference, 10.0; 95% CI, -2.2 to 22.2; p = 0.08). INTERPRETATION Using the CMTPedS as an outcome measure of disease severity, children with CMT progress at a significant rate over 2 years. Understanding the rate at which children with CMT deteriorate is essential for adequately powering trials of disease-modifying interventions. Ann Neurol 2017;82:353-359.
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Affiliation(s)
- Kayla M D Cornett
- The University of Sydney, Sydney Children's Hospitals Network (Randwick and Westmead, Sydney, New South Wales, Australia
| | - Manoj P Menezes
- The University of Sydney, Sydney Children's Hospitals Network (Randwick and Westmead, Sydney, New South Wales, Australia.,Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary R Shy
- Carver College of Medicine, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Isabella Moroni
- IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | | | - Davide Pareyson
- IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Timothy Estilow
- Neuromuscular Program, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sabrina W Yum
- Division of Neurology, The Children's Hospital of Philadelphia, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Trupti Bhandari
- UCL Institute of Child Health & Great Ormond Street Hospital, London, United Kingdom
| | - Francesco Muntoni
- UCL Institute of Child Health & Great Ormond Street Hospital, London, United Kingdom
| | - Matilde Laura
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Richard S Finkel
- Neuromuscular Program, Division of Neurology, Nemours Children's Hospital, Orlando, FL
| | | | | | - Paula Bray
- The University of Sydney, Sydney Children's Hospitals Network (Randwick and Westmead, Sydney, New South Wales, Australia
| | - Mark Halaki
- Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael E Shy
- Carver College of Medicine, Department of Neurology, University of Iowa, Iowa City, IA
| | - Joshua Burns
- The University of Sydney, Sydney Children's Hospitals Network (Randwick and Westmead, Sydney, New South Wales, Australia.,Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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23
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Lencioni T, Piscosquito G, Rabuffetti M, Bovi G, Di Sipio E, Diverio M, Moroni I, Padua L, Pagliano E, Schenone A, Pareyson D, Ferrarin M. Responsiveness of gait analysis parameters in a cohort of 71 CMT subjects. Neuromuscul Disord 2017; 27:1029-1037. [PMID: 28844614 DOI: 10.1016/j.nmd.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/20/2017] [Accepted: 07/06/2017] [Indexed: 12/27/2022]
Abstract
Detection of worsening in the slowly progressive Charcot-Marie-Tooth disease (CMT) is difficult. As previous clinical scales showed low responsiveness, novel outcome measures are under study, including innovative approaches such as quantitative muscle MRI and instrumented movement analysis. Since gait analysis proved able to reliably quantify CMT locomotor deficits, we aimed to explore whether it can be a sensitive-to-change outcome measure in CMT studies. Clinical and biomechanical evaluations were performed in 71 CMT subjects at baseline and after a mean (±sd) of 28.9 ± 9.5 months. Locomotor tasks included natural walking, ascending and descending steps. Instrumented analysis of such tasks provided indexes related to muscle strength (kinetic parameters) and joint movement (kinematic parameters). Parameter responsiveness was expressed as Standardized Response Mean (SRM). Considering the whole CMT group, several parameters showed moderate responsiveness; subgrouping subjects according to disease severity allowed reaching high responsiveness (SRM >0.80). CMT Examination Score showed moderate responsiveness (SRM 0.53) in the minimally affected group; kinematic parameters were more responsive in this group, whereas kinetic parameters in the most severely affected one. Biomechanical parameters can represent suitable outcome measures for CMT by showing moderate-to-high responsiveness. These data suggest that appropriate selection of patient population and outcome measures is crucial for clinical trials' design.
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Affiliation(s)
- Tiziana Lencioni
- Biomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | - Giuseppe Piscosquito
- Functional Neuromotor Rehabilitation, IRCCS "ICS Maugeri", Scientific Institute of Telese Terme (BN), Italy
| | - Marco Rabuffetti
- Biomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | - Gabriele Bovi
- Biomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | - Enrica Di Sipio
- Department of Neurorehabilitation, IRCCS Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | - Manuela Diverio
- Polo Riabilitativo del Levante Ligure, Foundation Don Gnocchi Onlus, La Spezia, Italy
| | - Isabella Moroni
- Department of Child Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Luca Padua
- Department of Neurorehabilitation, IRCCS Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | - Emanuela Pagliano
- Department of Child Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Davide Pareyson
- Unit of Rare Neurological Disease of Adulthood, Department of Neurosciences, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy.
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Don Carlo Gnocchi Foundation Onlus, Milan, Italy
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24
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McBean GJ, López MG, Wallner FK. Redox-based therapeutics in neurodegenerative disease. Br J Pharmacol 2017; 174:1750-1770. [PMID: 27477685 PMCID: PMC5446580 DOI: 10.1111/bph.13551] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 06/02/2016] [Accepted: 07/01/2016] [Indexed: 12/13/2022] Open
Abstract
This review describes recent developments in the search for effective therapeutic agents that target redox homeostasis in neurodegenerative disease. The disruption to thiol redox homeostasis in Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis and multiple sclerosis is discussed, together with the experimental strategies that are aimed at preventing, or at least minimizing, oxidative damage in these diseases. Particular attention is given to the potential of increasing antioxidant capacity by targeting the Nrf2 pathway, the development of inhibitors of NADPH oxidases that are likely candidates for clinical use, together with strategies to reduce nitrosative stress and mitochondrial dysfunction. We describe the shortcomings of compounds that hinder their progression to the clinic and evaluate likely avenues for future research. LINKED ARTICLES This article is part of a themed section on Redox Biology and Oxidative Stress in Health and Disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.12/issuetoc.
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Affiliation(s)
- G J McBean
- School of Biomolecular and Biomedical Science, Conway InstituteUniversity College DublinDublinIreland
| | - M G López
- Instituto Teófilo Hernando for Drug Discovery, Department of Pharmacology, School of MedicineUniversidad Autónoma de MadridMadridSpain
| | - F K Wallner
- Redoxis ABSweden and University of SkövdeSkövdeSweden
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25
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Benoy V, Vanden Berghe P, Jarpe M, Van Damme P, Robberecht W, Van Den Bosch L. Development of Improved HDAC6 Inhibitors as Pharmacological Therapy for Axonal Charcot-Marie-Tooth Disease. Neurotherapeutics 2017; 14:417-428. [PMID: 27957719 PMCID: PMC5398982 DOI: 10.1007/s13311-016-0501-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy, with an estimated prevalence of 1 in 2500. The degeneration of motor and sensory nerve axons leads to motor and sensory symptoms that progress over time and have an important impact on the daily life of these patients. Currently, there is no curative treatment available. Recently, we identified histone deacetylase 6 (HDAC6), which deacetylates α-tubulin, as a potential therapeutic target in axonal CMT (CMT2). Pharmacological inhibition of the deacetylating function of HDAC6 reversed the motor and sensory deficits in a mouse model for mutant "small heat shock protein B1" (HSPB1)-induced CMT2 at the behavioral and electrophysiological level. In order to translate this potential therapeutic strategy into a clinical application, small drug-like molecules that are potent and selective HDAC6 inhibitors are essential. To screen for these, we developed a method that consisted of 3 distinct phases and that was based on the pathological findings in the mutant HSPB1-induced CMT2 mouse model. Three different inhibitors (ACY-738, ACY-775, and ACY-1215) were tested and demonstrated to be both potent and selective HDAC6 inhibitors. Moreover, these inhibitors increased the innervation of the neuromuscular junctions in the gastrocnemius muscle and improved the motor and sensory nerve conduction, confirming that HDAC6 inhibition is a potential therapeutic strategy in CMT2. Furthermore, ACY-1215 is an interesting lead molecule as it is currently tested in clinical trials for cancer. Taken together, these results may speed up the translation of pharmacological inhibition of HDAC6 into a therapy against CMT2.
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Affiliation(s)
- Veronick Benoy
- KU Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven, B-3000, Leuven, Belgium
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, B-3000, Leuven, Belgium
| | - Pieter Vanden Berghe
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, B-3000 Leuven, Belgium
| | | | - Philip Van Damme
- KU Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven, B-3000, Leuven, Belgium
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, B-3000, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Wim Robberecht
- KU Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven, B-3000, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Ludo Van Den Bosch
- KU Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven, B-3000, Leuven, Belgium.
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, B-3000, Leuven, Belgium.
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26
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Wang W, Guedj M, Bertrand V, Foucquier J, Jouve E, Commenges D, Proust-Lima C, Murphy NP, Blin O, Magy L, Cohen D, Attarian S. A Rasch Analysis of the Charcot-Marie-Tooth Neuropathy Score (CMTNS) in a Cohort of Charcot-Marie-Tooth Type 1A Patients. PLoS One 2017; 12:e0169878. [PMID: 28095456 PMCID: PMC5240958 DOI: 10.1371/journal.pone.0169878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/24/2016] [Indexed: 11/30/2022] Open
Abstract
The Charcot-Marie-Tooth Neuropathy Score (CMTNS) was developed as a main efficacy endpoint for application in clinical trials of Charcot-Marie-Tooth disease type 1A (CMT1A). However, the sensitivity of the CMTNS for measuring disease severity and progression in CMT1A patients has been questioned. Here, we applied a Rasch analysis in a French cohort of patients to evaluate the psychometrical properties of the CMTNS. Overall, our analysis supports the validity of the CMTNS for application to CMT1A patients though with some limitations such as certain items of the CMTNS being more suitable for moderate to severe forms of the disease, and some items being disordered. We suggest that additional items and/or categories be considered to better assess mild-to-moderate patients.
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Affiliation(s)
- Wenjia Wang
- Inserm U1219, Université de Bordeaux, Bordeaux, Aquitaine, France
- Pharnext, Issy-Les-Moulineaux, France
- * E-mail:
| | | | | | | | - Elisabeth Jouve
- CIC-CPCET, Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Aix Marseille Université, Marseille, France
| | - Daniel Commenges
- Inserm U1219, Université de Bordeaux, Bordeaux, Aquitaine, France
| | | | | | - Olivier Blin
- CIC-CPCET, Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Aix Marseille Université, Marseille, France
| | - Laurent Magy
- Centre de Référence Neuropathies Périphérique Rares, CHU de Limoges - Hôpital Dupuytren, Limoges, France
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27
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Dimitrova EN, Božinovikj I, Ristovska S, Pejcikj AH, Kolevska A, Hasani M. The Role of Rehabilitation in the Management of Patients with Charcot-Marie-Tooth Disease: Report of Two Cases. Open Access Maced J Med Sci 2016; 4:443-448. [PMID: 27703571 PMCID: PMC5042631 DOI: 10.3889/oamjms.2016.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Charcot-Marie-Tooth (CMT) disease is a hereditary disease with signs of chronic non-progressive motor-sensory neuropathy which is characterised by symmetric muscle atrophy and weakness of the distal portion of lower extremities. AIM: The aim is to present two cases with peroneal muscular atrophy, applied rehabilitation procedures and rehabilitation outcome. MATERIAL AND METHODS: Patient DR, aged 51, and patient KH, aged 78. Both patients had weakness and pronounced atrophy of the distal portion of lower extremities, numbness down the legs, contractures in the ankles and walking difficulties. Evaluation of patients included a clinical examination, Barthel Index, Time Up and Go test, measurement of the ankle range of motion, and a manual muscle test. On admission, the Barthel Index score was 60 in the first case, and 80 in the second. The rehabilitation program included exercise therapy with for lower extremity, occupational therapy, stationary bicycle riding, galvanic current, water exercises, and ankle-foot orthoses for both legs. RESULTS: The therapy applied had no significant changes in the clinical neurological status of the patients, but yet it provided some improvement in ankle contractures, better mobility, and a more stable gait. CONCLUSION: The application of rehabilitation procedures in patients with Charcot-Marie-Tooth disease can improve their functional status and walking stability.
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Affiliation(s)
- Erieta Nikolikj Dimitrova
- Institute of Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ivana Božinovikj
- Institute of Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Simona Ristovska
- Institute of Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandra Hadzieva Pejcikj
- Institute of Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandra Kolevska
- Institute of Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Mirjeta Hasani
- Institute of Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Zhou Y, Notterpek L. Promoting peripheral myelin repair. Exp Neurol 2016; 283:573-80. [PMID: 27079997 DOI: 10.1016/j.expneurol.2016.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/30/2016] [Accepted: 04/06/2016] [Indexed: 01/08/2023]
Abstract
Compared to the central nervous system (CNS), peripheral nerves have a remarkable ability to regenerate and remyelinate. This regenerative capacity to a large extent is dependent on and supported by Schwann cells, the myelin-forming glial cells of the peripheral nervous system (PNS). In a variety of paradigms, Schwann cells are critical in the removal of the degenerated tissue, which is followed by remyelination of newly-regenerated axons. This unique plasticity of Schwann cells has been the target of myelin repair strategies in acute injuries and chronic diseases, such as hereditary demyelinating neuropathies. In one approach, the endogenous regenerative capacity of Schwann cells is enhanced through interventions such as exercise, electrical stimulation or pharmacological means. Alternatively, Schwann cells derived from healthy nerves, or engineered from different tissue sources have been transplanted into the PNS to support remyelination. These transplant approaches can then be further enhanced by exercise and/or electrical stimulation, as well as by the inclusion of biomaterial engineered to support glial cell viability and neurite extension. Advances in our basic understanding of peripheral nerve biology, as well as biomaterial engineering, will further improve the functional repair of myelinated peripheral nerves.
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Affiliation(s)
- Ye Zhou
- Departments of Neuroscience and Neurology, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States
| | - Lucia Notterpek
- Departments of Neuroscience and Neurology, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States.
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