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Jaroszynska N, Salzinger A, Tsarouchas TM, Becker CG, Becker T, Lyons DA, MacDonald RB, Keatinge M. C9ORF72 Deficiency Results in Neurodegeneration in the Zebrafish Retina. J Neurosci 2024; 44:e2128232024. [PMID: 38658168 PMCID: PMC11209673 DOI: 10.1523/jneurosci.2128-23.2024] [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: 11/13/2023] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
Hexanucleotide repeat expansions within the gene C9ORF72 are the most common cause of the neurodegenerative diseases amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). This disease-causing expansion leads to a reduction in C9ORF72 expression levels in patients, suggesting loss of C9ORF72 function could contribute to disease. To further understand the consequences of C9ORF72 deficiency in vivo, we generated a c9orf72 mutant zebrafish line. Analysis of the adult female spinal cords revealed no appreciable neurodegenerative pathology such as loss of motor neurons or increased levels of neuroinflammation. However, detailed examination of adult female c9orf72-/- retinas showed prominent neurodegenerative features, including a decrease in retinal thickness, gliosis, and an overall reduction in neurons of all subtypes. Analysis of rod and cone cells within the photoreceptor layer showed a disturbance in their outer segment structure and rhodopsin mislocalization from rod outer segments to their cell bodies and synaptic terminals. Thus, C9ORF72 may play a previously unappreciated role in retinal homeostasis and suggests C9ORF72 deficiency can induce tissue specific neuronal loss.
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Affiliation(s)
- Natalia Jaroszynska
- Institute of Ophthalmology, University College London, London EC1Y 0AD, United Kingdom
| | - Andrea Salzinger
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
- UK Dementia Research Institute at University of Edinburgh, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
| | - Themistoklis M Tsarouchas
- Department of Psychiatry and Behavioural Sciences, Stanford University School of Medicine, Palo Alto, California 94305
| | - Catherina G Becker
- Center for Regenerative Therapies Dresden (CRTD), Dresden 01307, Germany
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh BioQuarter, Edinburgh EH16 4SB, United Kingdom
| | - Thomas Becker
- Center for Regenerative Therapies Dresden (CRTD), Dresden 01307, Germany
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh BioQuarter, Edinburgh EH16 4SB, United Kingdom
| | - David A Lyons
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh BioQuarter, Edinburgh EH16 4SB, United Kingdom
| | - Ryan B MacDonald
- Institute of Ophthalmology, University College London, London EC1Y 0AD, United Kingdom
| | - Marcus Keatinge
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
- UK Dementia Research Institute at University of Edinburgh, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
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Patterson EJ, Bounds AD, Wagner SK, Kadri-Langford R, Taylor R, Daly D. Oculomics: A Crusade Against the Four Horsemen of Chronic Disease. Ophthalmol Ther 2024; 13:1427-1451. [PMID: 38630354 PMCID: PMC11109082 DOI: 10.1007/s40123-024-00942-x] [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: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024] Open
Abstract
Chronic, non-communicable diseases present a major barrier to living a long and healthy life. In many cases, early diagnosis can facilitate prevention, monitoring, and treatment efforts, improving patient outcomes. There is therefore a critical need to make screening techniques as accessible, unintimidating, and cost-effective as possible. The association between ocular biomarkers and systemic health and disease (oculomics) presents an attractive opportunity for detection of systemic diseases, as ophthalmic techniques are often relatively low-cost, fast, and non-invasive. In this review, we highlight the key associations between structural biomarkers in the eye and the four globally leading causes of morbidity and mortality: cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease. We observe that neurodegenerative disease is a particularly promising target for oculomics, with biomarkers detected in multiple ocular structures. Cardiovascular disease biomarkers are present in the choroid, retinal vasculature, and retinal nerve fiber layer, and metabolic disease biomarkers are present in the eyelid, tear fluid, lens, and retinal vasculature. In contrast, only the tear fluid emerged as a promising ocular target for the detection of cancer. The retina is a rich source of oculomics data, the analysis of which has been enhanced by artificial intelligence-based tools. Although not all biomarkers are disease-specific, limiting their current diagnostic utility, future oculomics research will likely benefit from combining data from various structures to improve specificity, as well as active design, development, and optimization of instruments that target specific disease signatures, thus facilitating differential diagnoses.
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Affiliation(s)
| | | | - Siegfried K Wagner
- Moorfields Eye Hospital NHS Trust, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | | | - Robin Taylor
- Occuity, The Blade, Abbey Square, Reading, Berkshire, RG1 3BE, UK
| | - Dan Daly
- Occuity, The Blade, Abbey Square, Reading, Berkshire, RG1 3BE, UK
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Hopf S, Tüscher O, Schuster AK. [Retinal OCT biomarkers and neurodegenerative diseases of the central nervous system beyond Alzheimer's disease]. DIE OPHTHALMOLOGIE 2024; 121:93-104. [PMID: 38263475 DOI: 10.1007/s00347-023-01974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Optical coherence tomography (OCT) biomarkers are increasingly used by neurologists, psychiatrists, and ophthalmologists for the diagnosis, prognosis, and follow-up of neurodegenerative diseases. Long-term data on OCT biomarkers of selected primary and secondary neurodegenerative diseases of the central nervous system (CNS), such as multiple sclerosis (MS) or Parkinson's disease, are already available in part. In addition, there are rare neurodegenerative diseases with early disease onset that may show OCT abnormalities. METHODS A literature review on the association of OCT biomarkers with neurodegenerative diseases of the CNS beyond Alzheimer's disease is presented. Parkinson's disease, MS, Friedreich's ataxia, Huntington's disease, spinocerebellar ataxia, and lysosomal storage diseases are addressed. RESULTS Relevant OCT biomarkers of neurodegenerative diseases are the macular ganglion cell inner plexiform layer (GCIPL) and the peripapillary retinal nerve fiber layer (pRNFL) thickness. Different sectors may be affected depending on the disease entity in addition to global pRFNL reduction. OCT‑angiography (OCT-A) is also increasingly used as a biomarker in neurodegenerative diseases. CONCLUSION Optical coherence tomography biomarkers are used in an interdisciplinary context. Retinal pathologies should be excluded by an ophthalmologist. While OCT biomarkers are increasingly used clinically in MS, the benefit in other neurodegenerative diseases, especially the rare ones, is less well documented. Further longitudinal studies are required.
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Affiliation(s)
- Susanne Hopf
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - Oliver Tüscher
- Zentrum für seltene Erkrankungen des Nervensystems (ZSEN) Mainz und Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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Gao J, Leinonen H, Wang EJ, Ding M, Perry G, Palczewski K, Wang X. Sex-Specific Early Retinal Dysfunction in Mutant TDP-43 Transgenic Mice. J Alzheimers Dis 2024; 97:927-937. [PMID: 38143367 PMCID: PMC11174142 DOI: 10.3233/jad-231102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Increasing evidence has highlighted retinal impairments in neurodegenerative diseases. Dominant mutations in TAR DNA-binding protein 43 (TDP-43) cause amyotrophic lateral sclerosis (ALS), and the accumulation of TDP-43 in the cytoplasm is a pathological hallmark of ALS, frontotemporal dementia (FTD), and many other neurodegenerative diseases. OBJECTIVE While homozygous transgenic mice expressing the disease-causing human TDP-43 M337V mutant (TDP-43M337V mice) experience premature death, hemizygous TDP-43M337V mice do not suffer sudden death, but they exhibit age-dependent motor-coordinative and cognitive deficits. This study aims to leverage the hemizygous TDP-43M337V mice as a valuable ALS/FTD disease model for the assessment also of retinal changes during the disease progression. METHODS We evaluated the retinal function of young TDP-43M337V mice by full field electroretinogram (ERG) recordings. RESULTS At 3-4 months of age, well before the onset of brain dysfunction at 8 months, the ERG responses were notably impaired in the retinas of young female TDP-43M337V mice in contrast to their male counterparts and age-matched non-transgenic mice. Mitochondria have been implicated as critical targets of TDP-43. Further investigation revealed that significant changes in the key regulators of mitochondrial dynamics and bioenergetics were only observed in the retinas of young female TDP-43M337V mice, while these alterations were not present in the brains of either gender. CONCLUSIONS Together our findings suggest a sex-specific vulnerability within the retina in the early disease stage, and highlight the importance of retinal changes and mitochondrial markers as potential early diagnostic indicators for ALS, FTD, and other TDP-43 related neurodegenerative conditions.
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Affiliation(s)
- Ju Gao
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA
| | - Henri Leinonen
- School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland
| | - Evan J Wang
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Mao Ding
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA
| | - George Perry
- College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA
| | - Krzysztof Palczewski
- Department of Ophthalmology, Gavin Herbert Eye Institute, UCI, Irvine, CA, USA
- Department of Physiology and Biophysics, Chemistry and Molecular biology and Biochemsitry, UCI, Irvine, CA, USA
| | - Xinglong Wang
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
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Suh A, Ong J, Kamran SA, Waisberg E, Paladugu P, Zaman N, Sarker P, Tavakkoli A, Lee AG. Retina Oculomics in Neurodegenerative Disease. Ann Biomed Eng 2023; 51:2708-2721. [PMID: 37855949 DOI: 10.1007/s10439-023-03365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023]
Abstract
Ophthalmic biomarkers have long played a critical role in diagnosing and managing ocular diseases. Oculomics has emerged as a field that utilizes ocular imaging biomarkers to provide insights into systemic diseases. Advances in diagnostic and imaging technologies including electroretinography, optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy, fluorescence lifetime imaging ophthalmoscopy, and OCT angiography have revolutionized the ability to understand systemic diseases and even detect them earlier than clinical manifestations for earlier intervention. With the advent of increasingly large ophthalmic imaging datasets, machine learning models can be integrated into these ocular imaging biomarkers to provide further insights and prognostic predictions of neurodegenerative disease. In this manuscript, we review the use of ophthalmic imaging to provide insights into neurodegenerative diseases including Alzheimer Disease, Parkinson Disease, Amyotrophic Lateral Sclerosis, and Huntington Disease. We discuss recent advances in ophthalmic technology including eye-tracking technology and integration of artificial intelligence techniques to further provide insights into these neurodegenerative diseases. Ultimately, oculomics opens the opportunity to detect and monitor systemic diseases at a higher acuity. Thus, earlier detection of systemic diseases may allow for timely intervention for improving the quality of life in patients with neurodegenerative disease.
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Affiliation(s)
- Alex Suh
- Tulane University School of Medicine, New Orleans, LA, USA.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St #450, Houston, TX, 77030, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Ingwersen J, Masanneck L, Pawlitzki M, Samadzadeh S, Weise M, Aktas O, Meuth SG, Albrecht P. Real-world evidence of ocrelizumab-treated relapsing multiple sclerosis cohort shows changes in progression independent of relapse activity mirroring phase 3 trials. Sci Rep 2023; 13:15003. [PMID: 37696848 PMCID: PMC10495413 DOI: 10.1038/s41598-023-40940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
Ocrelizumab is a B cell-depleting drug widely used in relapsing-remitting multiple sclerosis (RRMS) and primary-progressive MS. In RRMS, it is becoming increasingly apparent that accumulation of disability not only manifests as relapse-associated worsening (RAW) but also as progression independent of relapse activity (PIRA) throughout the disease course. This study's objective was to investigate the role of PIRA in RRMS patients treated with ocrelizumab. We performed a single-center, retrospective, cross-sectional study of clinical data acquired at a German tertiary multiple sclerosis referral center from 2018 to 2022. All patients with RRMS treated with ocrelizumab for at least six months and complete datasets were analyzed. Confirmed disability accumulation (CDA) was defined as a ≥ 12-week confirmed increase from the previous expanded disability status scale (EDSS) score of ≥ 1.0 if the previous EDSS was ≤ 5.5 or a ≥ 0.5-point increase if the previous EDSS was > 5.5. PIRA was defined as CDA without relapse since the last EDSS measurement and at least for the preceding 12 weeks. RAW was defined as CDA in an interval of EDSS measurements with ≥ 1 relapses. Cox proportional hazard models were used to analyze the probability of developing PIRA depending on various factors, including disease duration, previous disease-modifying treatments (DMTs), and optical coherence tomography-assessed retinal degeneration parameters. 97 patients were included in the analysis. Mean follow-up time was 29 months (range 6 to 51 months). 23.5% developed CDA under ocrelizumab therapy (n = 23). Of those, the majority developed PIRA (87.0% of CDA, n = 20) rather than RAW (13.0% of CDA, n = 3). An exploratory investigation using Cox proportional hazards ratios revealed two possible factors associated with an increased probability of developing PIRA: a shorter disease duration prior to ocrelizumab (p = 0.02) and a lower number of previous DMTs prior to ocrelizumab (p = 0.04). Our data show that in ocrelizumab-treated RRMS patients, the main driver of disability accumulation is PIRA rather than RAW. Furthermore, these real-world data show remarkable consistency with data from phase 3 randomized controlled trials of ocrelizumab in RRMS, which may increase confidence in translating results from tightly controlled RCTs into the real-world clinical setting.
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Affiliation(s)
- J Ingwersen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - L Masanneck
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - M Pawlitzki
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S Samadzadeh
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
| | - M Weise
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - O Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - P Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Maria Hilf Clinics, Moenchengladbach, Germany.
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Miscioscia A, Puthenparampil M, Blasi L, Rinaldi F, Perini P, Sorarù G, Gallo P. Neurodegeneration in the retina of motoneuron diseases: a longitudinal study in amyotrophic lateral sclerosis and Kennedy's disease. J Neurol 2023; 270:4478-4486. [PMID: 37289322 PMCID: PMC10421755 DOI: 10.1007/s00415-023-11802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND To what extent retinal atrophy in neurodegenerative diseases reflects the severity and/or the chronicity of brain pathology or is a local independent phenomenon remains to be clarified. Moreover, whether retinal atrophy has a clinical (diagnostic and prognostic) value in these diseases remains unclear. OBJECTIVE To add light on the pathological significance and clinical value of retinal atrophy in patients with amyotrophic lateral sclerosis (ALS) and Kennedy's disease (KD). METHODS Thirty-five ALS, thirty-seven KD, and forty-nine age-matched healthy controls (HC) were included in a one-year longitudinal study. Spectrum-domain optical coherence tomography (OCT) was performed at study entry (T0) and after 12 months (T1). Disease duration and functional rating scale (FRS) for ALS and KD patients were correlated to retinal thicknesses. RESULTS Compared to HC, peripapillary retinal nerve fiber layer (pRNFL) thickness was significantly thinner in both ALS (p = 0.034) and KD (p = 0.003). pRNFL was thinner in KD compared to ALS, but the difference was not significant. In KD, pRNFL atrophy significantly correlated with both disease severity (r = 0.296, p = 0.035) and disease duration (r = - 0.308, p = 0.013) while no significant correlation was found in ALS (disease severity: r = 0.147, p = 0.238; disease duration: r = - 0.093, p = 0.459). During the follow-up, pRNFL thickness remained stable in KD while significantly decreased in ALS (p = 0.043). CONCLUSIONS Our study provides evidence of retinal atrophy in both ALS and KD and suggests that retinal thinning is a primary local phenomenon in motoneuron diseases. The clinical value of pRNFL atrophy in KD is worthy of further investigation.
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Affiliation(s)
- Alessandro Miscioscia
- Department of Neurosciences, DNS, School of Medicine, University of Padua, Padua, Italy.
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Neurology Clinic, University Hospital of Padua, Via Giustiniani, 5, 35128, Padua, Italy.
| | - Marco Puthenparampil
- Department of Neurosciences, DNS, School of Medicine, University of Padua, Padua, Italy
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Neurology Clinic, University Hospital of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Lorenzo Blasi
- Department of Neurosciences, DNS, School of Medicine, University of Padua, Padua, Italy
- Neuromuscular Center, Neurology Clinic, University Hospital of Padua, Padua, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Neurology Clinic, University Hospital of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Neurology Clinic, University Hospital of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Gianni Sorarù
- Department of Neurosciences, DNS, School of Medicine, University of Padua, Padua, Italy
- Neuromuscular Center, Neurology Clinic, University Hospital of Padua, Padua, Italy
| | - Paolo Gallo
- Department of Neurosciences, DNS, School of Medicine, University of Padua, Padua, Italy
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Neurology Clinic, University Hospital of Padua, Via Giustiniani, 5, 35128, Padua, Italy
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Vautier A, Lebreton AL, Codron P, Awada Z, Gohier P, Cassereau J. Retinal vessels as a window on amyotrophic lateral sclerosis pathophysiology: A systematic review. Rev Neurol (Paris) 2023; 179:548-562. [PMID: 36842953 DOI: 10.1016/j.neurol.2022.11.010] [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: 07/30/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 02/28/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare fatal motor neuron disease. Although many potential mechanisms have been proposed, the pathophysiology of the disease remains unknown. Currently available treatments can only delay the progression of the disease and prolong life expectancy by a few months. There is still no definitive cure for ALS, and the development of new treatments is limited by a lack of understanding of the underlying biological processes that trigger and promote neurodegeneration. Several scientific results suggest a neurovascular impairment in ALS providing perspectives for the development of new biomarkers and treatments. In this article, we performed a systematic review using PRISMA guidelines including PubMed, EmBase, GoogleScholar, and Web of Science Core Collection to analyze the scientific literature published between 2000 and 2021 discussing the neurocardiovascular involvement and ophthalmologic abnormalities in ALS. In total, 122 articles were included to establish this systematic review. Indeed, microvascular pathology seems to be involved in ALS, affecting all the neurovascular unit components. Retinal changes have also been recently highlighted without significant alteration of the visual pathways. Despite the peripheral location of the retina, it is considered as an extension of the central nervous system (CNS) as it displays similarities to the brain, the inner blood-retinal barrier, and the blood-brain barrier. This suggests that the eye could be considered as a 'window' into the brain in many CNS disorders. Thus, studying ocular manifestations of brain pathologies seems very promising in understanding neurodegenerative disorders, mainly ALS. Optical coherence tomography angiography (OCT-A) could therefore be a powerful approach for exploration of retinal microvascularization allowing to obtain new diagnostic and prognostic biomarkers of ALS.
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Affiliation(s)
- A Vautier
- Department of Ophthalmology, University Hospital, Angers, France.
| | - A L Lebreton
- Department of Ophthalmology, University Hospital, Angers, France
| | - P Codron
- Amyotrophic Lateral Sclerosis (ALS) Center, Department of Neurology, University Hospital, Angers, France; Department of Neurobiology and Neuropathology, University Hospital, Angers, France; University of Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France
| | - Z Awada
- Department of neuroscience, LHH-SIUH, New York, USA
| | - P Gohier
- Department of Ophthalmology, University Hospital, Angers, France
| | - J Cassereau
- Amyotrophic Lateral Sclerosis (ALS) Center, Department of Neurology, University Hospital, Angers, France; University of Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France.
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Pediconi N, Gigante Y, Cama S, Pitea M, Mautone L, Ruocco G, Ghirga S, Di Angelantonio S. Retinal fingerprints of ALS in patients: Ganglion cell apoptosis and TDP-43/p62 misplacement. Front Aging Neurosci 2023; 15:1110520. [PMID: 37009460 PMCID: PMC10061015 DOI: 10.3389/fnagi.2023.1110520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by the progressive loss of motor neuron function. Although ophthalmic deficits are not considered a classic symptom of ALS, recent studies suggest that changes in retinal cells, similar to those in the spinal cord motor neurons, have been observed in postmortem human tissues and animal models.MethodsIn this study, we examined by immunofluorescence analysis the retinal cell layers of sporadic ALS patients in post-mortem retinal slices. We evaluated the presence of cytoplasmic TDP-43 and SQSTM1/p62 aggregates, activation of the apoptotic pathway, and microglia and astrocytes reactivity.ResultsWe found in the retinal ganglion cell layer of ALS patients the increase of mislocalized TDP-43, SQSTM1/p62 aggregates, activation of cleaved caspase-3, and microglia density, suggesting that retinal changes can be used as an additional diagnostic tool for ALS.DiscussionThe retina is considered part of the central nervous system, and neurodegenerative changes in the brain may be accompanied by structural and possibly functional changes in the neuroretina and ocular vasculature. Therefore, using in vivo retinal biomarkers as an additional diagnostic tool for ALS may provide an opportunity to longitudinally monitor individuals and therapies over time in a noninvasive and cost-effective manner.
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Affiliation(s)
- Natalia Pediconi
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
| | - Ylenia Gigante
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
- D-Tails s.r.l., Rome, Italy
| | - Silvia Cama
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Martina Pitea
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
- D-Tails s.r.l., Rome, Italy
| | - Lorenza Mautone
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ruocco
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
- Department of Physics, Sapienza University of Rome, Rome, Italy
| | - Silvia Ghirga
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
- Silvia Ghirga,
| | - Silvia Di Angelantonio
- Center for Life Nano- and Neuro-Science of Istituto Italiano di Tecnologia (IIT), Rome, Italy
- D-Tails s.r.l., Rome, Italy
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
- *Correspondence: Silvia Di Angelantonio,
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Wong BM, Hudson C, Snook E, Tayyari F, Jung H, Binns MA, Samet S, Cheng RW, Balian C, Mandelcorn ED, Margolin E, Finger E, Black SE, Tang-Wai DF, Zinman L, Tan B, Lou W, Masellis M, Abrahao A, Frank A, Beaton D, Sunderland KM, Arnott SR, Tartaglia MC, Hatch WV. Retinal nerve fiber layer in frontotemporal lobar degeneration and amyotrophic lateral sclerosis. Front Neurosci 2022; 16:964715. [PMID: 36278002 PMCID: PMC9583385 DOI: 10.3389/fnins.2022.964715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Tauopathy and transactive response DNA binding protein 43 (TDP-43) proteinopathy are associated with neurodegenerative diseases. These proteinopathies are difficult to detect in vivo. This study examined if spectral-domain optical coherence tomography (SD-OCT) can differentiate in vivo the difference in peripapillary retinal nerve fibre layer (pRNFL) thickness and macular retinal thickness between participants with presumed tauopathy (progressive supranuclear palsy) and those with presumed TDP-43 proteinopathy (amyotrophic lateral sclerosis and semantic variant primary progressive aphasia). Study design Prospective, multi-centre, observational study. Materials and methods pRNFL and macular SD-OCT images were acquired in both eyes of each participant using Heidelberg Spectralis SD-OCT. Global and pRNFL thickness in 6 sectors were analyzed, as well as macular thickness in a central 1 mm diameter zone and 4 surrounding sectors. Linear mixed model methods adjusting for baseline differences between groups were used to compare the two groups with respect to pRNFL and macular thickness. Results A significant difference was found in mean pRNFL thickness between groups, with the TDP-43 group (n = 28 eyes) having a significantly thinner pRNFL in the temporal sector than the tauopathy group (n = 9 eyes; mean difference = 15.46 μm, SE = 6.98, p = 0.046), which was not significant after adjusting for multiple comparisons. No other significant differences were found between groups for pRNFL or macular thickness. Conclusion The finding that the temporal pRNFL in the TDP-43 group was on average 15.46 μm thinner could potentially have clinical significance. Future work with larger sample sizes, longitudinal studies, and at the level of retinal sublayers will help to determine the utility of SD-OCT to differentiate between these two proteinopathies.
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Affiliation(s)
- Bryan M. Wong
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Christopher Hudson
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Emily Snook
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Faryan Tayyari
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Malcolm A. Binns
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Saba Samet
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Carmen Balian
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Sandra E. Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - David F. Tang-Wai
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network Memory Clinic, Toronto, ON, Canada
| | - Lorne Zinman
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mario Masellis
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Agessandro Abrahao
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andrew Frank
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Derek Beaton
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | | | - Stephen R. Arnott
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network Memory Clinic, Toronto, ON, Canada
| | - Wendy V. Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
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11
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Correlation between Retinal Vascularization and Disease Aggressiveness in Amyotrophic Lateral Sclerosis. Biomedicines 2022; 10:biomedicines10102390. [PMID: 36289652 PMCID: PMC9598742 DOI: 10.3390/biomedicines10102390] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Abnormalities in retinal vascularization and neural density have been found in many neurodegenerative diseases; however, conflicting results are described in Amyotrophic Lateral Sclerosis (ALS). The aim of the present study was, therefore, to systematically analyze retinal layers and vascularization by means of spectral-domain (SD-OCT) and optical coherence tomography angiography (OCT-A) in ALS patients. We enrolled 48 ALS patients and 45 healthy controls. ALS patients were divided into three groups: slow progressors (n = 10), intermediate progressors (n = 24) and fast progressors (n = 14), according to the disease progression rate. For SD-OCT, we evaluated the Subfoveal choroidal thickness (SFCT), ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL). Regarding the OCT-A, we assessed the vessel density (VD) in superficial and deep capillary plexuses, radial peripapillary capillary plexus, choriocapillary and the foveal avascular zone (FAZ) area. SD-OCT exam did not show any significant differences in GCC and RNFL thickness between patients and controls and among the three ALS groups. The SFCT was statistically greater in patients compared with controls (357.95 ± 55.15 µm vs. 301.3 ± 55.80 µm, p < 0.001); interestingly, the SFCT was thicker in patients with slow and intermediate disease progression than in those with fast disease progression (394.45 ± 53.73 µm vs. 393.09 ± 42.17 µm vs. 267.71 ± 56.24 µm, p < 0.001). OCT-A did not reveal any significant results. Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-r) and disease duration did not correlate with any of the OCT parameters, except for SFCT with ALSFRS-r (r = 0.753, p = 0.024). This study demonstrated the possible association between choroidal thickness and disease activity in ALS. OCT could be a useful biomarker in the management of the disease.
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12
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Cunha LP, Pires LA, Cruzeiro MM, Almeida ALM, Martins LC, Martins PN, Shigaeff N, Vale TC. Optical coherence tomography in neurodegenerative disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:180-191. [PMID: 35352756 PMCID: PMC9648920 DOI: 10.1590/0004-282x-anp-2021-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/21/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not widely available. Therefore, it is highly desirable to search for noninvasive, easily accessible, low-cost clinical biomarkers suitable for large-scale population screening, in order to focus on making diagnoses at the earliest stages of the disease. In this scenario, imaging studies focusing on the structures of the retina have increasingly been used for evaluating neurodegenerative diseases. The retina shares embryological, histological, biochemical, microvascular and neurotransmitter similarities with the cerebral cortex, thus making it a uniquely promising biomarker for neurodegenerative diseases. Optical coherence tomography is a modern noninvasive imaging technique that provides high-resolution two-dimensional cross-sectional images and quantitative reproducible three-dimensional volumetric measurements of the optic nerve head and retina. This technology is widely used in ophthalmology practice for diagnosing and following up several eye diseases, such as glaucoma, diabetic retinopathy and age-related macular degeneration. Its clinical impact on neurodegenerative diseases has raised enormous interest over recent years, as several clinical studies have demonstrated that these diseases give rise to reduced thickness of the inner retinal nerve fiber layer, mainly composed of retinal ganglion cells and their axons. In this review, we aimed to address the clinical utility of optical coherence tomography for diagnosing and evaluating different neurodegenerative diseases, to show the potential of this noninvasive and easily accessible method.
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Affiliation(s)
- Leonardo Provetti Cunha
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Divisão de Oftalmologia, Juiz de Fora MG, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Oftalmologia, São Paulo SP, Brazil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
| | - Leopoldo Antônio Pires
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
| | - Marcelo Maroco Cruzeiro
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
| | - Ana Laura Maciel Almeida
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
| | - Luiza Cunha Martins
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora MG, Brazil
| | - Pedro Nascimento Martins
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora MG, Brazil
| | - Nadia Shigaeff
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Instituto de Ciências Humanas, Departamento de Psicologia, Juiz de Fora MG, Brazil
| | - Thiago Cardoso Vale
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
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13
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Zhang Y, Liu X, Fu J, Zhang Y, Yang X, Zhang S, Fan D. Selective and Inverse U-Shaped Curve Alteration of the Retinal Nerve in Amyotrophic Lateral Sclerosis: A Potential Mirror of the Disease. Front Aging Neurosci 2022; 13:783431. [PMID: 35069179 PMCID: PMC8770270 DOI: 10.3389/fnagi.2021.783431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Alterations in the visual pathway involving the retina have been reported in amyotrophic lateral sclerosis (ALS) but they lack consistency and subgroup analysis. We aimed to assess the retinal nerve fiber layer (RNFL) and retinal ganglion cells (RGCs) alterations in different stages of ALS patients and their association with ALS progression parameters. Methods: The study population consisted of 70 clinically diagnosed ALS patients and 55 age, sex matched controls. All of them underwent ophthalmic assessments and optical coherence tomography imaging. Four quadrants of the peripapillary RNFL and ganglion cell/inner plexiform complex (GCIP) were observed and automatically measured. Early-stage distal motor neuron axon dysfunction in ALS was detected by compound muscle action potential (CMAP) of the distal limbs within 12 months. The ALS disease parameters included the ALSFRS-R score and the disease progression rate (ΔFS). Results: Generally compared with controls, the nasal (p = 0.016) quadrant of the RNFL was thicker in ALS patients. When controlling for age and ΔFS, the RNFL(r = 0.37, p = 0.034) and GCIP(r = 0.40, p = 0.021) were significantly thickened as disease progressed within 12 months, while the RNFL declined with time after one year (r = −0.41, p = 0.037). ALS patients was subclassified into thickened RNFL (T-RNFL, >95th percentile of normal), impaired RNFL (I-RNFL, <5th percentile of normal) and normal RNFL. There were significant differences in the GCIP among the three groups (p < 0.001). In the T-RNFL group (n = 18), the RNFL was negatively correlated with the abductor pollicis brevis-CMAP amplitude within 12 months (r = −0.56, p = 0.01). Patients within 12 months in this group progressed faster than others (p = 0.039). In the normal RNFL group (n = 22), 13 patients were diagnosed beyond 12 months, whose ΔFS was remarkably lower (p = 0.007). In I-RNFL group (n = 30), the early stage patients (<12 months) had significant higher ΔFS (p = 0.006). One patient was with SOD1 pathogenic variant (p.A5V). Conclusion: Alterations of retinal nerve were not consistent in ALS patients with diverse phenotypes and progression rates. Generally speaking, the RNFL thickened during the first year and then gradually declined, which is related to but preceding the thickness change of the RGCs. Patients with a significant RNFL thinning in the early stage may have a faster progression rate. The inverse U-shaped curve transformation might be in accordance with early-stage motor neuron axonopathy.
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Affiliation(s)
- Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yuanjin Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xue Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- *Correspondence: Dongsheng Fan
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14
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Ami D, Duse A, Mereghetti P, Cozza F, Ambrosio F, Ponzini E, Grandori R, Lunetta C, Tavazzi S, Pezzoli F, Natalello A. Tear-Based Vibrational Spectroscopy Applied to Amyotrophic Lateral Sclerosis. Anal Chem 2021; 93:16995-17002. [PMID: 34905686 PMCID: PMC8717331 DOI: 10.1021/acs.analchem.1c02546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
![]()
Biofluid analysis
by optical spectroscopy techniques is attracting
considerable interest due to its potential to revolutionize diagnostics
and precision medicine, particularly for neurodegenerative diseases.
However, the lack of effective biomarkers combined with the unaccomplished
identification of convenient biofluids has drastically hampered optical
advancements in clinical diagnosis and monitoring of neurodegenerative
disorders. Here, we show that vibrational spectroscopy applied to
human tears opens a new route, offering a non-invasive, label-free
identification of a devastating disease such as amyotrophic lateral
sclerosis (ALS). Our proposed approach has been validated using two
widespread techniques, namely, Fourier transform infrared (FTIR) and
Raman microspectroscopies. In conjunction with multivariate analysis,
this vibrational approach made it possible to discriminate between
tears from ALS patients and healthy controls (HCs) with high specificity
(∼97% and ∼100% for FTIR and Raman spectroscopy, respectively)
and sensitivity (∼88% and ∼100% for FTIR and Raman spectroscopy,
respectively). Additionally, the investigation of tears allowed us
to disclose ALS spectroscopic markers related to protein and lipid
alterations, as well as to a reduction of the phenylalanine level,
in comparison with HCs. Our findings show that vibrational spectroscopy
is a new potential ALS diagnostic approach and indicate that tears
are a reliable and non-invasive source of ALS biomarkers.
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Affiliation(s)
- Diletta Ami
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Piazza della Scienza 2, 20126 Milano, Italy
| | - Alessandro Duse
- Department of Materials Science, University of Milano-Bicocca, Via R. Cozzi 55, 20125 Milano, Italy.,COMiB Research Centre in Optics and Optometry, Via R. Cozzi 55, 20125 Milano, Italy
| | | | - Federica Cozza
- COMiB Research Centre in Optics and Optometry, Via R. Cozzi 55, 20125 Milano, Italy.,NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Francesca Ambrosio
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Piazza della Scienza 2, 20126 Milano, Italy
| | - Erika Ponzini
- Department of Materials Science, University of Milano-Bicocca, Via R. Cozzi 55, 20125 Milano, Italy.,COMiB Research Centre in Optics and Optometry, Via R. Cozzi 55, 20125 Milano, Italy
| | - Rita Grandori
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Piazza della Scienza 2, 20126 Milano, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.,NEMO Lab, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Silvia Tavazzi
- Department of Materials Science, University of Milano-Bicocca, Via R. Cozzi 55, 20125 Milano, Italy.,COMiB Research Centre in Optics and Optometry, Via R. Cozzi 55, 20125 Milano, Italy
| | - Fabio Pezzoli
- Department of Materials Science, University of Milano-Bicocca, Via R. Cozzi 55, 20125 Milano, Italy
| | - Antonino Natalello
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Piazza della Scienza 2, 20126 Milano, Italy
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15
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Ingwersen J, Graf J, Kluge J, Weise M, Dietrich M, Lee JI, Harmel J, Hartung HP, Ruck T, Meuth SG, Albrecht P, Aktas O, Ringelstein M. CNS Involvement in Chronic Inflammatory Demyelinating Polyneuropathy: Subtle Retinal Changes in Optical Coherence Tomography. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 9:9/1/e1099. [PMID: 34667130 PMCID: PMC8529418 DOI: 10.1212/nxi.0000000000001099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
Background and Objectives Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease primarily affecting the peripheral nervous system. However, several noncontrolled studies have suggested concomitant inflammatory CNS demyelination similar to multiple sclerosis. The aim of this study was to investigate an involvement of the visual pathway in patients with CIDP. Methods In this prospective cross-sectional study, we used high-resolution spectral-domain optical coherence tomography to compare the thickness of the peripapillary retinal nerve fiber layer and the deeper macular retinal layers as well as the total macular volume (TMV) in 22 patients with CIDP and 22 age-matched and sex-matched healthy control (HC) individuals. Retinal layers were semiautomatically segmented by the provided software and were correlated with clinical measures and nerve conduction studies. Results In patients with CIDP compared with healthy age-matched and sex-matched controls, we found slight but significant volume reductions of the ganglion cell/inner plexiform layer complex (CIDP 1.86 vs HC 1.95 mm3, p = 0.015), the retinal pigment epithelium (CIDP 0.38 vs HC 0.40 mm3, p = 0.02), and the TMV (CIDP 8.48 vs HC 8.75 mm3, p = 0.018). The ganglion cell layer volume and motor nerve conduction velocity were positively associated (B = 0.002, p = 0.02). Discussion Our data reveal subtle retinal neurodegeneration in patients with CIDP, providing evidence for visual pathway involvement, detectable by OCT. The results need corroboration in independent, larger cohorts.
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Affiliation(s)
- Jens Ingwersen
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Jonas Graf
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Julia Kluge
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Margit Weise
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Michael Dietrich
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - John-Ih Lee
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Jens Harmel
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Hans-Peter Hartung
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Tobias Ruck
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Sven G Meuth
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Philipp Albrecht
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Orhan Aktas
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Marius Ringelstein
- From the Department of Neurology (J.A., J.G., J.K., M.W., M.D., J.-I.L., J.H., H.-P.H., T.R., S.G.M., P.A., O.A., M.R.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Department of Neurology (H.-P.H., M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; and Department of Neurology (H.-P.H.), Palacky University in Olomouc, Olomouc, Czech Republic.
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Chiò A, Canosa A, Calvo A, Moglia C, Cicolin A, Mora G. Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis. Expert Rev Neurother 2021; 21:1419-1440. [PMID: 34554894 DOI: 10.1080/14737175.2021.1984883] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The burden of non-motor symptoms is a major determinant of quality of life and outcome in amyotrophic lateral sclerosis (ALS) and has profound negative effect also on caregivers. AREAS COVERED Non-motor symptoms in ALS include cognitive impairment, neurobehavioral symptoms, depression and anxiety, suicidal ideation, pain, disordered sleep, fatigue, weight loss and reduced appetite, and autonomic dysfunctions. This review summarizes the measures used for the assessment of non-motor symptoms and their properties and recaps the frequency and progression of these symptoms along the course of ALS. EXPERT OPINION Non-motor symptoms in ALS represent a major component of the disease and span over several domains. These symptoms require a high level of medical attention and should be checked at each visit using ad hoc questionnaires and proactively treated. Several instruments assessing non-motor symptoms have been used in ALS. Specific screening questionnaires for non-motor symptoms can be used for monitoring patients during telehealth visits and for remote surveillance through sensors and apps installed on smartphones. Novel trials for non-motor symptoms treatment specifically designed for ALS are necessary to increase and refine the therapeutic armamentarium. Finally, scales assessing the most frequent and burdensome non-motor symptoms should be included in clinical trials.
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Affiliation(s)
- Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Alessandro Cicolin
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Sleep Medicine Center, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Gabriele Mora
- Neurorehabilitation Department, Ics Maugeri Irccs, Institute of Milan, Milan, Italy
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17
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Soldatov VO, Kukharsky MS, Soldatova MO, Puchenkova OA, Nikitina Y, Lysikova EA, Kartashkina NL, Deykin AV, Pokrovskiy MV. Retinal abnormalities in transgenic mice overexpressing aberrant human FUS[1-359] gene. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Retinal damage is an optional sign in a number of neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). The aim of this work was to assess the structural and functional state of the retina in a murine model of ALS caused by overexpression of the aberrant FUS protein [1-359]. The retinal examination was carried out on 12 transgenic and 13 wild-type mice of 2.5–3 months of age. The study revealed not statistically significant higher level of ophthalmoscopic violations in FUS[1-359] mice. Moreover, gene expression assay confirmed an increased expression of the inflammatory genes Vegfa, Il1b, Il6, Icam1, Tnfa. However, despite the detected structural and functional abnormalities, western blot analysis and quantitative PCR did not detect the expression of the protein and mRNA products of the FUS transgene in the retina of FUS[1-359] mice.
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Affiliation(s)
- VO Soldatov
- Belgorod State National Research University, Belgorod, Russia
| | - MS Kukharsky
- Institute of Physiologically Active Substances, Moscow, Russia
| | | | - OA Puchenkova
- Belgorod State National Research University, Belgorod, Russia
| | - YuA Nikitina
- Institute of Physiologically Active Substances, Moscow, Russia
| | - EA Lysikova
- Institute of Physiologically Active Substances, Moscow, Russia
| | - NL Kartashkina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - AV Deykin
- Belgorod State National Research University, Belgorod, Russia
| | - MV Pokrovskiy
- Belgorod State National Research University, Belgorod, Russia
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18
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Petzold A, Albrecht P, Balcer L, Bekkers E, Brandt AU, Calabresi PA, Deborah OG, Graves JS, Green A, Keane PA, Nij Bijvank JA, Sander JW, Paul F, Saidha S, Villoslada P, Wagner SK, Yeh EA. Artificial intelligence extension of the OSCAR-IB criteria. Ann Clin Transl Neurol 2021; 8:1528-1542. [PMID: 34008926 PMCID: PMC8283174 DOI: 10.1002/acn3.51320] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI)-based diagnostic algorithms have achieved ambitious aims through automated image pattern recognition. For neurological disorders, this includes neurodegeneration and inflammation. Scalable imaging technology for big data in neurology is optical coherence tomography (OCT). We highlight that OCT changes observed in the retina, as a window to the brain, are small, requiring rigorous quality control pipelines. There are existing tools for this purpose. Firstly, there are human-led validated consensus quality control criteria (OSCAR-IB) for OCT. Secondly, these criteria are embedded into OCT reporting guidelines (APOSTEL). The use of the described annotation of failed OCT scans advances machine learning. This is illustrated through the present review of the advantages and disadvantages of AI-based applications to OCT data. The neurological conditions reviewed here for the use of big data include Alzheimer disease, stroke, multiple sclerosis (MS), Parkinson disease, and epilepsy. It is noted that while big data is relevant for AI, ownership is complex. For this reason, we also reached out to involve representatives from patient organizations and the public domain in addition to clinical and research centers. The evidence reviewed can be grouped in a five-point expansion of the OSCAR-IB criteria to embrace AI (OSCAR-AI). The review concludes by specific recommendations on how this can be achieved practically and in compliance with existing guidelines.
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Affiliation(s)
- Axel Petzold
- Moorfields Eye HospitalCity Road, The National Hospital for Neurology and NeurosurgeryQueen SquareUCL Queen Square Institute of NeurologyLondonUK
- Neuro‐ophthalmology Expert CenterAmsterdam UMCThe Netherlands
| | - Philipp Albrecht
- Department of NeurologyMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Laura Balcer
- Departments of NeurologyPopulation Health and OphthalmologyNYU Grossman School of MedicineNew YorkUSA
| | | | | | - Peter A. Calabresi
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | | | - Ari Green
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Pearse A Keane
- Moorfields Eye HospitalCity Road, The National Hospital for Neurology and NeurosurgeryQueen SquareUCL Queen Square Institute of NeurologyLondonUK
| | | | - Josemir W. Sander
- NIHR UCL Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Friedemann Paul
- Experimental and Clinical Research CenterMax Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of HealthGermany
| | - Shiv Saidha
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Pablo Villoslada
- Institut d’Investigacion Biomediques August Pi Sunyer (DIBAPS) and Hospital ClinicUniversity of BarcelonaBarcelonaSpain
| | - Siegfried K Wagner
- Moorfields Eye HospitalCity Road, The National Hospital for Neurology and NeurosurgeryQueen SquareUCL Queen Square Institute of NeurologyLondonUK
| | - E. Ann Yeh
- Division of NeurologyDepartment of PediatricsHospital for Sick ChildrenDivision of Neurosciences and Mental Health SickKids Research InstituteUniversity of TorontoCanada
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19
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Soldatov VO, Kukharsky MS, Belykh AE, Sobolev AM, Deykin AV. Retinal Damage in Amyotrophic Lateral Sclerosis: Underlying Mechanisms. Eye Brain 2021; 13:131-146. [PMID: 34012311 PMCID: PMC8128130 DOI: 10.2147/eb.s299423] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/04/2021] [Indexed: 01/04/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease resulting in a gradual loss of motor neuron function. Although ophthalmic complaints are not presently considered a classic symptom of ALS, retinal changes such as thinning, axonal degeneration and inclusion bodies have been found in many patients. Retinal abnormalities observed in postmortem human tissues and animal models are similar to spinal cord changes in ALS. These findings are not dramatically unexpected because retina shares an ontogenetic relationship with the brain, and many genes are associated both with neurodegeneration and retinal diseases. Experimental studies have demonstrated that ALS affects many “vulnerable points” of the retina. Aggregate deposition, impaired nuclear protein import, endoplasmic reticulum stress, glutamate excitotoxicity, vascular regression, and mitochondrial dysfunction are factors suspected as being the main cause of motor neuron damage in ALS. Herein, we show that all of these pathways can affect retinal cells in the same way as motor neurons. Furthermore, we suppose that understanding the patterns of neuro-ophthalmic interaction in ALS can help in the diagnosis and treatment of this disease.
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Affiliation(s)
- Vladislav O Soldatov
- Core Facility Centre, Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia.,Department of Pharmacology and Clinical Pharmacology, Belgorod State National Research University, Belgorod, Russia
| | - Michail S Kukharsky
- Department of General and Cell Biology, Faculty of Medical Biology, Pirogov Russian National Research Medical University, Moscow, Russia.,Laboratory of Genetic Modelling of Neurodegenerative Processes, Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Andrey E Belykh
- Department of Pathophysiology, Kursk State Medical University, Kursk, Russia
| | - Andrey M Sobolev
- Laboratory of Genetic Modelling of Neurodegenerative Processes, Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Alexey V Deykin
- Department of Pharmacology and Clinical Pharmacology, Belgorod State National Research University, Belgorod, Russia.,Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
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20
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Sharma K, Amin Mohammed Amin M, Gupta N, Zinman L, Zhou X, Irving H, Yücel Y. Retinal Spheroids and Axon Pathology Identified in Amyotrophic Lateral Sclerosis. Invest Ophthalmol Vis Sci 2021; 61:30. [PMID: 33226405 PMCID: PMC7691787 DOI: 10.1167/iovs.61.13.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine whether patients with amyotrophic lateral sclerosis (ALS) show retinal axon pathology. Methods Postmortem eyes from 10 patients with ALS were sectioned and compared with 10 age-matched controls. Retinal sections were evaluated with periodic acid Schiff and phosphorylated (P-NF) and nonphosphorylated (NP-NF) forms of neurofilament with SMI 31 and 32 antibodies. Spheroids identified in the retinal nerve fiber layer were counted and their overall density was calculated in central, peripheral, and peripapillary regions. P-NF intensity was quantified. Morphometric features of ALS cases were compared with age-matched controls using the exact Wilcoxon matched-pairs signed-rank test. Results Distinct periodic acid Schiff–positive round profiles were identified in the retinal nerve fiber layer of patients with ALS and were most commonly observed in the peripapillary and peripheral retina. The density of periodic acid Schiff–positive spheroids was significantly greater in patients with ALS compared with controls (P = 0.027), with increased density in the peripapillary region (P = 0.047). Spheroids positive for P-NF and NP-NF were detected. P-NF–positive spheroid density was significantly increased in patients with ALS (P = 0.004), while the density of NP-NF spheroids did not differ significantly between ALS and control groups (P > 0.05). P-NF immunoreactivity in the retinal nerve fiber layer was significantly greater in patients with ALS than in controls (P = 0.002). Conclusions Retinal spheroids and axon pathology discovered in patients with ALS, similar to hallmark findings in spinal cord motor neurons, point to disrupted axon transport as a shared pathogenesis. Retinal manifestations detected in ALS suggest a novel biomarker detectable by noninvasive retinal imaging to help to diagnose and monitor ALS disease.
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Affiliation(s)
- Kieran Sharma
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Amin Mohammed Amin
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physics, Faculty of Science, Ryerson University, Toronto, Ontario, Canada
| | - Neeru Gupta
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Glaucoma & Nerve Protection Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Xun Zhou
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hyacinth Irving
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Yeni Yücel
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physics, Faculty of Science, Ryerson University, Toronto, Ontario, Canada.,Ophthalmic Pathology Laboratory, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, Science and Technology (iBEST), St. Michael's Hospital, Ryerson University, Toronto, Ontario, Canada.,Department of Mechanical Engineering, Faculty of Engineering and Architectural Science, Ryerson University, Toronto, Ontario, Canada
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21
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Rojas P, Ramírez AI, Cadena M, Fernández-Albarral JA, Salobrar-García E, López-Cuenca I, Santos-García I, de Lago E, Urcelay-Segura JL, Ramírez JM, de Hoz R, Salazar JJ. Retinal Ganglion Cell Loss and Microglial Activation in a SOD1G93A Mouse Model of Amyotrophic Lateral Sclerosis. Int J Mol Sci 2021; 22:ijms22041663. [PMID: 33562231 PMCID: PMC7915199 DOI: 10.3390/ijms22041663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/26/2022] Open
Abstract
The neurodegenerative disease amyotrophic lateral sclerosis (ALS) affects the spinal cord, brain stem, and cerebral cortex. In this pathology, both neurons and glial cells are affected. However, few studies have analyzed retinal microglia in ALS models. In this study, we quantified the signs of microglial activation and the number of retinal ganglion cells (RGCs) in an SOD1G93A transgenic mouse model at 120 days (advanced stage of the disease) in retinal whole-mounts. For SOD1G93A animals (compared to the wild-type), we found, in microglial cells, (i) a significant increase in the area occupied by each microglial cell in the total area of the retina; (ii) a significant increase in the arbor area in the outer plexiform layer (OPL) inferior sector; (iii) the presence of cells with retracted processes; (iv) areas of cell groupings in some sectors; (v) no significant increase in the number of microglial cells; (vi) the expression of IFN-γ and IL-1β; and (vii) the non-expression of IL-10 and arginase-I. For the RGCs, we found a decrease in their number. In conclusion, in the SOD1G93A model (at 120 days), retinal microglial activation occurred, taking a pro-inflammatory phenotype M1, which affected the OPL and inner retinal layers and could be related to RGC loss.
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Affiliation(s)
- Pilar Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
- Instituto Oftálmico de Madrid, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.C.); (J.L.U.-S.)
| | - Ana I. Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
- OFTARED-ISCIII, IIORC, Universidad Complutense de Madrid, 28011 Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, 28037 Madrid, Spain
| | - Manuel Cadena
- Instituto Oftálmico de Madrid, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.C.); (J.L.U.-S.)
| | - José A. Fernández-Albarral
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
| | - Elena Salobrar-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
- OFTARED-ISCIII, IIORC, Universidad Complutense de Madrid, 28011 Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, 28037 Madrid, Spain
| | - Inés López-Cuenca
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
| | - Irene Santos-García
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, 28011 Madrid, Spain; (I.S.-G.); (E.d.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28040 Madrid, Spain
| | - Eva de Lago
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, 28011 Madrid, Spain; (I.S.-G.); (E.d.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28040 Madrid, Spain
| | - José L. Urcelay-Segura
- Instituto Oftálmico de Madrid, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.C.); (J.L.U.-S.)
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - José M. Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
- OFTARED-ISCIII, IIORC, Universidad Complutense de Madrid, 28011 Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
- OFTARED-ISCIII, IIORC, Universidad Complutense de Madrid, 28011 Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, 28037 Madrid, Spain
- Correspondence: (R.d.H.); (J.J.S.)
| | - Juan J. Salazar
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.R.); (A.I.R.); (J.A.F.-A.); (E.S.-G.); (I.L.-C.); (J.M.R.)
- OFTARED-ISCIII, IIORC, Universidad Complutense de Madrid, 28011 Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, 28037 Madrid, Spain
- Correspondence: (R.d.H.); (J.J.S.)
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Cozza F, Lizio A, Greco LC, Bona S, Donvito G, Carraro E, Tavazzi S, Ticozzi N, Poletti B, Sansone VA, Lunetta C. Ocular Involvement Occurs Frequently at All Stages of Amyotrophic Lateral Sclerosis: Preliminary Experience in a Large Italian Cohort. J Clin Neurol 2021; 17:96-105. [PMID: 33480204 PMCID: PMC7840315 DOI: 10.3988/jcn.2021.17.1.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose The study aimed to obtain optometric findings of amyotrophic lateral sclerosis (ALS) patients in different stages of the disease, and to determine the relation between ocular data and ALS-related features; that is, functional and cognitive impairment and staging. Methods The optometric protocol included tests of the ocular motility [broad-H test and Northeastern State University College of Optometry (NSUCO) test], near point of convergence (NPC), error refraction, best-corrected visual acuity, and binocular visual alignment, and an ocular symptoms questionnaire. The functional measures included the Amyotrophic Lateral Sclerosis Functional Rating Scale–revised (ALSFRS-r) and Milano-Torino staging (MiToS), and cognitive impairment was assessed using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Demographic and clinical features were also collected, including whether the patients used an eye-tracking communication device (ETCD). Results Two-hundred consecutive ALS patients (median age of 64 years, 118 males and 82 females) in different stages of disease were recruited. Nearly 70% of patients reported at least one ocular symptom, and the use of an ETCD was found to be significantly related to the presence of most symptoms. Moreover, the severely symptomatic group was characterized by significantly lower ALSFRS-r total and subscale scores, and higher MiToS. Abnormal NPC values were significantly related to lower ALSFRS-r total and bulbar-subscale scores. Patients with acceptable NSUCO test values exhibited significantly higher ECAS scores. Conclusions The presence of ocular alteration in patients in different stages of ALS supports the idea that this is a multisystem disorder and emphasizes the importance of optometric evaluations in multidisciplinary assessments to address ocular impairment early in the disease process.
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Affiliation(s)
- Federica Cozza
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy.,Materials Science Department & COMiB Research Center, University of Milano Bicocca, Milan, Italy.
| | - Andrea Lizio
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | | | - Stefania Bona
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Giordana Donvito
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Elena Carraro
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Silvia Tavazzi
- Materials Science Department & COMiB Research Center, University of Milano Bicocca, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Valeria Ada Sansone
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy.,Neurorehabilitation Unit, Department of Biomedical Sciences of Health, University of Milan, Milan, Italy
| | - Christian Lunetta
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
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23
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Lee JI, Gemerzki L, Weise M, Boerker L, Graf J, Jansen L, Guthoff R, Aktas O, Gliem M, Jander S, Hartung HP, Albrecht P. Retinal layers and visual conductivity changes in a case series of microangiopathic ischemic stroke patients. BMC Neurol 2020; 20:333. [PMID: 32883246 PMCID: PMC7469096 DOI: 10.1186/s12883-020-01894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background It is unknown whether microangiopathic ischemic strokes outside the visual pathway go along with subclinical changes of the retinal structure or the visual system. The objectives of this prospective non-interventional case series were to investigate if spectral-domain optical coherence tomography (SD-OCT) or multifocal visual evoked potentials (mfVEPs) can detect structural retinal changes or functional impairment of the visual system in patients with microangiopathic ischemic stroke. Methods We used SD-OCT to cross-sectionally analyze the retinal morphology of 15 patients with microangiopathic ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification not affecting the visual pathway. We employed semi-automated segmentation of macular volume scans to analyze the thickness of the macular retinal layers and peripapillary ring scans to investigate the retinal morphology in comparison to a control group without stroke. Visual function was assessed by the mfVEP technique in 13 microangiopathic ischemic stroke patients. Results First peak latency of mfVEPs was significantly delayed in the microangiopathic ischemic stroke group compared to the control patients. Neither the retinal layers nor the mfVEPs’ amplitude differed between the microangiopathic ischemic stroke patients and the control group. Conclusions In conclusion, microangiopathic ischemic stroke patients presented a delayed first peak latency in mfVEPs as a sign of subclinical functional impairment of the visual pathway. However, our case series suggests no influence on retinal structure resulting from microangiopathic ischemic stroke outside the visual system. Larger and longitudinal studies are needed to confirm these mfVEP findings.
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24
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Rojas P, Ramírez AI, Fernández-Albarral JA, López-Cuenca I, Salobrar-García E, Cadena M, Elvira-Hurtado L, Salazar JJ, de Hoz R, Ramírez JM. Amyotrophic Lateral Sclerosis: A Neurodegenerative Motor Neuron Disease With Ocular Involvement. Front Neurosci 2020; 14:566858. [PMID: 33071739 PMCID: PMC7544921 DOI: 10.3389/fnins.2020.566858] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes degeneration of the lower and upper motor neurons and is the most prevalent motor neuron disease. This disease is characterized by muscle weakness, stiffness, and hyperreflexia. Patients survive for a short period from the onset of the disease. Most cases are sporadic, with only 10% of the cases being genetic. Many genes are now known to be involved in familial ALS cases, including some of the sporadic cases. It has also been observed that, in addition to genetic factors, there are numerous molecular mechanisms involved in these pathologies, such as excitotoxicity, mitochondrial disorders, alterations in axonal transport, oxidative stress, accumulation of misfolded proteins, and neuroinflammation. This pathology affects the motor neurons, the spinal cord, the cerebellum, and the brain, but recently, it has been shown that it also affects the visual system. This impact occurs not only at the level of the oculomotor system but also at the retinal level, which is why the retina is being proposed as a possible biomarker of this pathology. The current review discusses the main aspects mentioned above related to ALS, such as the main genes involved, the most important molecular mechanisms that affect this pathology, its ocular involvement, and the possible usefulness of the retina as a biomarker.
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Affiliation(s)
- Pilar Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Instituto Oftálmico de Madrid, Madrid, Spain
| | - Ana I Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - José A Fernández-Albarral
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Inés López-Cuenca
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Salobrar-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Cadena
- Hospital General Universitario Gregorio Marañón, Instituto Oftálmico de Madrid, Madrid, Spain
| | - Lorena Elvira-Hurtado
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan J Salazar
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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25
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Yap TE, Balendra SI, Almonte MT, Cordeiro MF. Retinal correlates of neurological disorders. Ther Adv Chronic Dis 2019; 10:2040622319882205. [PMID: 31832125 PMCID: PMC6887800 DOI: 10.1177/2040622319882205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Considering the retina as an extension of the brain provides a platform from which to study diseases of the nervous system. Taking advantage of the clear optical media of the eye and ever-increasing resolution of modern imaging techniques, retinal morphology can now be visualized at a cellular level in vivo. This has provided a multitude of possible biomarkers and investigative surrogates that may be used to identify, monitor and study diseases until now limited to the brain. In many neurodegenerative conditions, early diagnosis is often very challenging due to the lack of tests with high sensitivity and specificity, but, once made, opens the door to patients accessing the correct treatment that can potentially improve functional outcomes. Using retinal biomarkers in vivo as an additional diagnostic tool may help overcome the need for invasive tests and histological specimens, and offers the opportunity to longitudinally monitor individuals over time. This review aims to summarise retinal biomarkers associated with a range of neurological conditions including Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and prion diseases from a clinical perspective. By comparing their similarities and differences according to primary pathological processes, we hope to show how retinal correlates can aid clinical decisions, and accelerate the study of this rapidly developing area of research.
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Affiliation(s)
- Timothy E. Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - Shiama I. Balendra
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Melanie T. Almonte
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - M. Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, 11–43 Bath Street, London, EC1V 9EL UK
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26
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Cerveró A, Casado A, Riancho J. Retinal changes in amyotrophic lateral sclerosis: looking at the disease through a new window. J Neurol 2019; 268:2083-2089. [PMID: 31792674 DOI: 10.1007/s00415-019-09654-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most frequent degenerative disease affecting motor neurons (MN). ALS has been traditionally considered as a pure motor system disease; however, there are currently sufficient evidences supporting the involvement of other non-motor systems. Recently, the development and the implementation of the optical coherence tomography (OCT) have provided new data regarding the ocular involvement in the disease. In this sense, alterations in retinal nerve fiber layer thickness (RNFL), other retinal layers thicknesses such as outer nuclear layer (ONL) and inner nuclear layer (INL) and changes in the retinal blood vessels have been described in ALS patients. Interestingly, the study of ocular alterations in ALS appears not only as new biomarker tool, but also as a new opportunity to deep into the pathogenesis of the disease. In this article we will review and standardize published studies regarding OCT and ALS, emphasizing both their strengths and weaknesses.
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Affiliation(s)
- Andrea Cerveró
- Department of Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alfonso Casado
- Department of Ophthalmology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Javier Riancho
- Service of Neurology, Hospital Sierrallana-IDIVAL, Barrio Ganzo, s/n, 39300, Torrelavega, Cantabria, Spain. .,CIBERNED, Madrid, Spain.
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27
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Rojas P, de Hoz R, Ramírez AI, Ferreras A, Salobrar-Garcia E, Muñoz-Blanco JL, Urcelay-Segura JL, Salazar JJ, Ramírez JM. Changes in Retinal OCT and Their Correlations with Neurological Disability in Early ALS Patients, a Follow-Up Study. Brain Sci 2019; 9:brainsci9120337. [PMID: 31771268 PMCID: PMC6955774 DOI: 10.3390/brainsci9120337] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To compare early visual changes in amyotrophic lateral sclerosis (ALS) patients with healthy controls in a baseline exploration, to follow-up the patients after 6 months, and to correlate these visual changes with neurological disability. METHODS All patients underwent a comprehensive neurological and ophthalmological examination. A linear mixed analysis and Bonferroni p-value correction were performed, testing four comparisons as follows: Control baseline vs. control follow-up, control baseline vs. ALS baseline, control follow-up vs. ALS follow-up, and ALS baseline vs. ALS follow-up. RESULTS The mean time from the diagnosis was 10.80 ± 5.5 months. The analysis of the optical coherence tomography (OCT) showed: (1) In ALS baseline vs. control baseline, a macular significantly increased thickness of the inner macular ring temporal and inferior areas; (2) in ALS follow-up vs. ALS baseline, a significant macular thinning in the inner and outer macular ring inferior areas; (3) in ALS follow-up vs. ALS baseline, a significant peripapillary retinal nerve fiber layer (pRNFL) thinning in the superior and inferior quadrants; and (4) ALS patients showed a moderate correlation between some OCT pRNFL parameters and Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) score. CONCLUSION The OCT showed retinal changes in patients with motoneuron disease and could serve as a complementary tool for studying ALS.
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Affiliation(s)
- Pilar Rojas
- General University Hospital Gregorio Marañón, Ophthalmic Institute of Madrid, 28007 Madrid, Spain; (P.R.); (J.L.U.-S.)
- Ramón Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, 28040 Madrid, Spain; (R.d.H.); (A.I.R.); (E.S.-G.)
| | - Rosa de Hoz
- Ramón Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, 28040 Madrid, Spain; (R.d.H.); (A.I.R.); (E.S.-G.)
- Department of Immunology, Ophthalmology and Otorhinolaryngology, School of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Ana I. Ramírez
- Ramón Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, 28040 Madrid, Spain; (R.d.H.); (A.I.R.); (E.S.-G.)
- Department of Immunology, Ophthalmology and Otorhinolaryngology, School of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Antonio Ferreras
- Miguel Servet University Hospital, Aragonese Institute of Health Sciences, 50009 Zaragoza, Spain;
| | - Elena Salobrar-Garcia
- Ramón Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, 28040 Madrid, Spain; (R.d.H.); (A.I.R.); (E.S.-G.)
- Department of Immunology, Ophthalmology and Otorhinolaryngology, School of Medicine, Complutense University, 28040 Madrid, Spain
| | - José L. Muñoz-Blanco
- Department of Neurology, ALS-Neuromuscular Unit, Gregorio Marañón Health Research Institute, 28007 Madrid, Spain;
| | - José L. Urcelay-Segura
- General University Hospital Gregorio Marañón, Ophthalmic Institute of Madrid, 28007 Madrid, Spain; (P.R.); (J.L.U.-S.)
- Department of Immunology, Ophthalmology and Otorhinolaryngology, School of Medicine, Complutense University, 28040 Madrid, Spain
| | - Juan J. Salazar
- Ramón Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, 28040 Madrid, Spain; (R.d.H.); (A.I.R.); (E.S.-G.)
- Department of Immunology, Ophthalmology and Otorhinolaryngology, School of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
- Correspondence: (J.J.S.); (J.M.R.)
| | - José M. Ramírez
- Ramón Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, 28040 Madrid, Spain; (R.d.H.); (A.I.R.); (E.S.-G.)
- Department of Immunology, Ophthalmology and Otorhinolaryngology, School of Medicine, Complutense University, 28040 Madrid, Spain
- Correspondence: (J.J.S.); (J.M.R.)
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Lambe J, Saidha S, Bermel RA. Optical coherence tomography and multiple sclerosis: Update on clinical application and role in clinical trials. Mult Scler 2019; 26:624-639. [PMID: 32412377 DOI: 10.1177/1352458519872751] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Optical coherence tomography (OCT) has emerged as a fast, non-invasive, inexpensive, high-resolution imaging technique in multiple sclerosis (MS). Retinal layer quantification by OCT facilitates a 'window' into not only local retinal pathology but also global neurodegenerative processes, recognised to be the principal substrates of disability accumulation in MS. While OCT measures in MS have been demonstrated to reflect visual function, inflammatory activity outside of the visual pathways, disability measures including the prediction of disability progression, whole brain atrophy, and the differential neuroprotective effects of disease-modifying therapies, debate continues regarding the clinical utility of OCT in everyday practice. This review presents an overview of the evidence supporting OCT, with particular focus on its application in the MS clinic. We will also discuss the role of OCT in MS clinical trials to develop novel neuroprotective and potential remyelinating therapies.
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Affiliation(s)
- Jeffrey Lambe
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio, USA
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29
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Cho KI, Yoon D, Yu M, Peachey NS, Ferreira PA. Microglial activation in an amyotrophic lateral sclerosis-like model caused by Ranbp2 loss and nucleocytoplasmic transport impairment in retinal ganglion neurons. Cell Mol Life Sci 2019; 76:3407-3432. [PMID: 30944974 PMCID: PMC6698218 DOI: 10.1007/s00018-019-03078-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/21/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022]
Abstract
Nucleocytoplasmic transport is dysregulated in sporadic and familial amyotrophic lateral sclerosis (ALS) and retinal ganglion neurons (RGNs) are purportedly involved in ALS. The Ran-binding protein 2 (Ranbp2) controls rate-limiting steps of nucleocytoplasmic transport. Mice with Ranbp2 loss in Thy1+-motoneurons develop cardinal ALS-like motor traits, but the impairments in RGNs and the degree of dysfunctional consonance between RGNs and motoneurons caused by Ranbp2 loss are unknown. This will help to understand the role of nucleocytoplasmic transport in the differential vulnerability of neuronal cell types to ALS and to uncover non-motor endophenotypes with pathognomonic signs of ALS. Here, we ascertain Ranbp2's function and endophenotypes in RGNs of an ALS-like mouse model lacking Ranbp2 in motoneurons and RGNs. Thy1+-RGNs lacking Ranbp2 shared with motoneurons the dysregulation of nucleocytoplasmic transport. RGN abnormalities were comprised morphologically by soma hypertrophy and optic nerve axonopathy and physiologically by a delay of the visual pathway's evoked potentials. Whole-transcriptome analysis showed restricted transcriptional changes in optic nerves that were distinct from those found in sciatic nerves. Specifically, the level and nucleocytoplasmic partition of the anti-apoptotic and novel substrate of Ranbp2, Pttg1/securin, were dysregulated. Further, acetyl-CoA carboxylase 1, which modulates de novo synthesis of fatty acids and T-cell immunity, showed the highest up-regulation (35-fold). This effect was reflected by the activation of ramified CD11b+ and CD45+-microglia, increase of F4\80+-microglia and a shift from pseudopodial/lamellipodial to amoeboidal F4\80+-microglia intermingled between RGNs of naive mice. Further, there was the intracellular sequestration in RGNs of metalloproteinase-28, which regulates macrophage recruitment and polarization in inflammation. Hence, Ranbp2 genetic insults in RGNs and motoneurons trigger distinct paracrine signaling likely by the dysregulation of nucleocytoplasmic transport of neuronal-type selective substrates. Immune-modulators underpinning RGN-to-microglial signaling are regulated by Ranbp2, and this neuronal-glial system manifests endophenotypes that are likely useful in the prognosis and diagnosis of motoneuron diseases, such as ALS.
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Affiliation(s)
- Kyoung-In Cho
- Department of Ophthalmology, Duke University Medical Center, DUEC 3802, 2351 Erwin Road, Durham, NC, 27710, USA
| | - Dosuk Yoon
- Department of Ophthalmology, Duke University Medical Center, DUEC 3802, 2351 Erwin Road, Durham, NC, 27710, USA
| | - Minzhong Yu
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Neal S Peachey
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106, USA
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Paulo A Ferreira
- Department of Ophthalmology, Duke University Medical Center, DUEC 3802, 2351 Erwin Road, Durham, NC, 27710, USA.
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30
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Rohani M, Meysamie A, Zamani B, Sowlat MM, Akhoundi FH. Reduced retinal nerve fiber layer (RNFL) thickness in ALS patients: a window to disease progression. J Neurol 2018; 265:1557-1562. [PMID: 29713825 DOI: 10.1007/s00415-018-8863-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/03/2018] [Accepted: 04/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess RNFL thickness in ALS patients and compare it to healthy controls, and to detect possible correlations between RNFL thickness in ALS patients and disease severity and duration. METHODS Study population consisted of ALS patients and age- and sex-matched controls. We used the revised ALS functional rating scale (ALSFRS-R) as a measure of disease severity. RNFL thickness in the four quadrants were measured with a spectral domain OCT (Topcon 3D, 2015). RESULTS We evaluated 20 ALS patients (40 eyes) and 25 healthy matched controls. Average RNFL thickness in ALS patients was significantly reduced compared to controls (102.57 ± 13.46 compared to 97.11 ± 10.76, p 0.04). There was a significant positive correlation between the functional abilities of the patients based on the ALSFRS-R and average RNFL thickness and also RNFL thickness in most quadrants. A linear regression analysis proved that this correlation was independent of age. In ALS patients, RNFL thickness in the nasal quadrant of the left eyes was significantly reduced compared to the corresponding quadrant in the right eyes even after adjustment for multiplicity (85.80 ± 23.20 compared to 96.80 ± 16.96, p = 0.008). CONCLUSION RNFL thickness in ALS patients is reduced compared to healthy controls. OCT probably could serve as a marker of neurodegeneration and progression of the disease in ALS patients. RNFL thickness is different among the right and left eyes of ALS patients pointing to the fact that asymmetric CNS involvement in ALS is not confined to the motor system.
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Affiliation(s)
- Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran.,Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Alipasha Meysamie
- Department of Community and Preventive Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Zamani
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fahimeh Haji Akhoundi
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Vali-e-Asr Sq., Beh-Afarin Blvd, Tehran, 1417613151, Iran.
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31
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Lambe J, Murphy OC, Saidha S. Can Optical Coherence Tomography Be Used to Guide Treatment Decisions in Adult or Pediatric Multiple Sclerosis? Curr Treat Options Neurol 2018; 20:9. [DOI: 10.1007/s11940-018-0493-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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32
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Abdelhak A, Hübers A, Böhm K, Ludolph AC, Kassubek J, Pinkhardt EH. In vivo assessment of retinal vessel pathology in amyotrophic lateral sclerosis. J Neurol 2018; 265:949-953. [PMID: 29464376 DOI: 10.1007/s00415-018-8787-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Changes in skin and muscle small blood vessels (SBVs) and microvascular structures of the brain have been reported in patients with amyotrophic lateral sclerosis (ALS). A direct assessment of brain SBVs in vivo is currently not feasible. Retinal vessels are considered a "mirror" of brain SBVs. In this study, we used optic coherence tomography (OCT)-based measurements to detect changes in retinal blood vessels of ALS patients compared to those of healthy controls. METHODS We analysed Spectralis-OCT images of 34 ALS patients and 20 HCs. The inner wall thickness (IWT), outer wall thickness (OWT), and lumen diameter (LD) of retinal vessels were assessed using intensity-based measurements. In addition, the different retinal layers were analysed using automated segmentation software. The correlations between the various retinal layers and clinical parameters [e.g., disease duration and revised ALS functional rating scale (ALS-FRS-R)] were examined. RESULTS The OWT of retinal vessels was higher in ALS patients than in HCs (p = 0.04). There were no differences in the IWT, LD. ALS patients showed a thinning of the outer nuclear layer (ONL) compared to HCs (median 1.63 vs. 1.77, p = 0.002). The whole retinal thickness negatively correlated with the ALS-FRS scale (r = 0.3, p = 0.03). CONCLUSION Our study reports retinal vessel pathology in ALS patients. These changes may be related to those observed in SBVs in skin and muscle biopsies. Furthermore, we report a thinning of the ONL in ALS, revealing a possible affection of rods and cones function in ALS.
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Affiliation(s)
- A Abdelhak
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - A Hübers
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - K Böhm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - A C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - J Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - E H Pinkhardt
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Liu Z, Wang H, Fan D, Wang W. Comparison of optical coherence tomography findings and visual field changes in patients with primary open-angle glaucoma and amyotrophic lateral sclerosis. J Clin Neurosci 2018; 48:233-237. [DOI: 10.1016/j.jocn.2017.10.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022]
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Mukherjee N, McBurney-Lin S, Kuo A, Bedlack R, Tseng H. Retinal thinning in amyotrophic lateral sclerosis patients without ophthalmic disease. PLoS One 2017; 12:e0185242. [PMID: 28945811 PMCID: PMC5612691 DOI: 10.1371/journal.pone.0185242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 09/09/2017] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a fatal, rapidly progressive neurodegenerative disease that primarily affects motor neurons. Recently, three causative genes have been implicated in both ALS and glaucoma. However, it is still uncertain whether patients with ALS have neurodegeneration in their retinas. If so, retinal thickness measurements might be a useful biomarker for ALS progression. Previous work in this area has been inconclusive, as it has not taken into account the effect of ophthalmic diseases on retinal thinning. OBJECTIVE To determine whether there are differences in retinal neurons in ALS patients utilizing spectral-domain optical coherence tomography (SD-OCT). We tested the hypothesis that ALS patients exhibit retinal neurodegeneration that is not associated with ophthalmic diseases. DESIGN, SETTINGS AND PARTICIPANTS Observational, comparative, cross-sectional study performed on patients recruited from the Duke University Medical Center ALS clinic. Patients underwent a comprehensive ophthalmologic examination to rule out ocular pathology. 21 patients met inclusion criteria. Two eyes with ocular pathology were excluded, leading to a total of 40 eyes of 21 patients included in the study. Retinal neurodegeneration was assessed by retinal nerve fiber layer (RNFL) thickness measurement using SD-OCT (Spectralis; Heidelberg Engineering). MAIN OUTCOMES AND MEASURES ALS disease severity, determined through the ALS Functional Rating Scale (ALSFRS-R); mean and six sector RNFL thickness values compared to age-adjusted values in the normative database provided by Heidelberg Engineering; RNFL thickness correlation with ALSFRS-R, ALSFRS-R progression rate, forced vital capacity (FVC), and visual acuity. RESULTS ALSFRS-R mean score was 30+/-10. Mean RNFL thickness in ALS patients was 88.95 +/- 10.8 microns, significantly thinner than values in the normative database (95.81 +/- 0.8). These RNFL thickness values did not demonstrate correlation to ALSFRS-R score, ALSFRS-R progression rate, FVC, intraocular pressure, or visual acuity. CONCLUSIONS Using SD-OCT, our study shows that ALS patients without ocular pathology exhibit thinned retinal layers. Future studies are warranted to clarify the clinical relationship between retinal thinning and motor neuron loss in ALS.
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Affiliation(s)
- Nisha Mukherjee
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Shan McBurney-Lin
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anthony Kuo
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Richard Bedlack
- Duke ALS Clinic, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Henry Tseng
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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Ringer C, Weihe E, Schütz B. SOD1G93A Mutant Mice Develop a Neuroinflammation-Independent Dendropathy in Excitatory Neuronal Subsets of the Olfactory Bulb and Retina. J Neuropathol Exp Neurol 2017; 76:769-778. [PMID: 28859334 DOI: 10.1093/jnen/nlx057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nonmotor neuron-related pathology is a feature of amyotrophic lateral sclerosis (ALS), both in patients and in animal models. There is emerging evidence that sensory systems (olfaction and vision) are affected in humans. Here, we asked whether such sensory neuropathology is recapitulated in the superoxide dismutase 1 (SOD1G93A) mouse model of ALS. Neuronal vacuolization in olfaction and vision pathways was assessed in tissue sections from presymptomatic and symptomatic disease stages, and compared to wild type. In both, the olfactory bulb and retina, vacuolization started around postnatal day 60, and vacuole sizes increased until disease end-stage. Notably, vacuolization was largely restricted to the external plexiform layer of the olfactory bulb and to the inner plexiform layer of the retina. In both layers, hSOD1-immunoreactive vacuoles localized to dendrites of excitatory neurons. Downstream olfaction and vision pathway fiber tracts and relay stations did not display obvious vacuolization. Finally, on a morphological level, there was no evidence for an activation of astrocytes and microglia in the 2 affected areas. Thus, we identified a new pathology hallmark in SOD1G93A ALS mice: a glutamatergic sensory neuron dendropathy restricted to olfactory bulb mitral cells and retinal ganglionic cells.
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Affiliation(s)
- Cornelia Ringer
- Department of Molecular Neurosciences, Institute of Anatomy and Cell Biology, Philipps-University, Marburg, Germany
| | - Eberhard Weihe
- Department of Molecular Neurosciences, Institute of Anatomy and Cell Biology, Philipps-University, Marburg, Germany
| | - Burkhard Schütz
- Department of Molecular Neurosciences, Institute of Anatomy and Cell Biology, Philipps-University, Marburg, Germany
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High and Low Contrast Visual Acuity Are Not Affected in Amyotrophic Lateral Sclerosis. PLoS One 2016; 11:e0168714. [PMID: 28033389 PMCID: PMC5199071 DOI: 10.1371/journal.pone.0168714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/04/2016] [Indexed: 11/25/2022] Open
Abstract
The afferent visual system may be affected by neuro-degeneration in amyotrophic lateral sclerosis (ALS) based on observations of visual function impairment and retinal inclusions on histopathology in ALS patients. To test the hypothesis that visual acuity is impaired in ALS, we compared three measures of visual acuity in ALS patients (n = 25) attending a multidisciplinary ALS clinic and age matched control subjects (n = 25). Bilateral monocular and binocular visual acuities were assessed using high contrast (black letters on white background) and low contrast (2.5%, 1.25% grey letters on white background) visual acuity charts under controlled lighting conditions following refraction. Binocular summation was calculated as the difference between binocular and best monocular acuity scores. There were no associations between binocular or monocular high contrast visual acuity or low contrast visual acuity and amyotrophic lateral sclerosis diagnosis (generalized estimating equation models accounting for age). Binocular summation was similar in both amyotrophic lateral sclerosis and control subjects. There was a small magnitude association between increased duration of ALS symptoms and reduced 1.25% low contrast visual acuity. This study does not confirm prior observations of impaired visual acuity in patients with amyotrophic lateral sclerosis and does not support this particular measure of visual function for use in broad scale assessment of visual pathway involvement in ALS patients.
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Gordon-Lipkin E, Calabresi PA. Optical coherence tomography: A quantitative tool to measure neurodegeneration and facilitate testing of novel treatments for tissue protection in multiple sclerosis. J Neuroimmunol 2016; 304:93-96. [PMID: 28038893 DOI: 10.1016/j.jneuroim.2016.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/11/2016] [Indexed: 01/04/2023]
Abstract
Optical coherence tomography (OCT) is a relatively new imaging technology that has been introduced as a powerful biomarker in neurological disease, including multiple sclerosis. In this review, OCT as an imaging technique, its reproducibility and validation in multiple sclerosis, application to other neurodegenerative diseases and future technological directions are discussed.
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Affiliation(s)
- Eliza Gordon-Lipkin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Dietrich M, Cruz-Herranz A, Yiu H, Aktas O, Brandt AU, Hartung HP, Green A, Albrecht P. Whole-body positional manipulators for ocular imaging of anaesthetised mice and rats: a do-it-yourself guide. BMJ Open Ophthalmol 2016; 1:e000008. [PMID: 29354694 PMCID: PMC5759402 DOI: 10.1136/bmjophth-2016-000008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background In vivo retinal imaging of rodents has gained a growing interest in ophthalmology and neurology. The bedding of the animals with the possibility to perform adjustments in order to obtain an ideal camera-to-eye angle is challenging. Methods We provide a guide for a cost-effective, do-it-yourself rodent holder for ocular imaging techniques. The set-up was tested and refined in over 2000 optical coherence tomography measurements of mice and rats. Results The recommended material is very affordable, readily available and easily assembled. The holder can be adapted to both mice and rats. A custom-made mouthpiece is provided for the use of inhalant anaesthesia. The holder is highly functional and assures that the rodent’s eye is the centre of rotation for adjustments in both the axial and the transverse planes with a major time benefit over unrestrained positioning of the rodents. Conclusion We believe this guide is very useful for eye researchers focusing on in vivo retinal imaging in rodents as it significantly reduces examination times for ocular imaging.
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Affiliation(s)
- Michael Dietrich
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Andrés Cruz-Herranz
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States
| | - Hao Yiu
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States
| | - Orhan Aktas
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ari Green
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States
| | - Philipp Albrecht
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Cameron JR, Tatham AJ. A window to beyond the orbit: the value of optical coherence tomography in non-ocular disease. Acta Ophthalmol 2016; 94:533-9. [PMID: 26803923 DOI: 10.1111/aos.12978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/29/2015] [Indexed: 12/12/2022]
Abstract
Optical coherence tomography (OCT) imaging of the eye has become an essential tool for the ophthalmologist, aiding diagnosis and assisting with treatment decisions, in many ocular diseases. However, there is an evolving role for OCT in informing on non-ocular diseases, which ophthalmologists should be aware of. The purpose of this review was to examine recent evidence for the role of ocular OCT imaging to evaluate disease beyond the orbit and to discuss possible opportunities and challenges arising from this, from the perspective of the ophthalmologist.
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Affiliation(s)
- James R. Cameron
- Anne Rowling Regenerative Neurology Clinic; University of Edinburgh; Edinburgh UK
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Macular sub-layer thinning and association with pulmonary function tests in Amyotrophic Lateral Sclerosis. Sci Rep 2016; 6:29187. [PMID: 27383525 PMCID: PMC4935870 DOI: 10.1038/srep29187] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/16/2016] [Indexed: 01/24/2023] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a complex neurodegenerative disorder that may have anterior visual pathway involvement. In this study, we compare the macular structure of patients with ALS to healthy controls, and examine correlations between macular sub-layer thickness measurements and pulmonary function tests and disease duration. ALS patients underwent optical coherence tomography (OCT) imaging to obtain macular cube scans of the right eye. Macular cube OCT data from age-matched healthy subjects were provided by the OCT reading center. Semi-automated retinal segmentation software was used to quantify macular sub-layers. Pulmonary function tests and time since symptom onset were collected retrospectively from the electronic medical records of ALS patients. Macular retinal nerve fiber layer was significantly thinner in ALS patients compared to healthy controls (P < 0.05). Total macular and other sub-layer thicknesses were not reduced in the ALS cohort. Macular retinal nerve fiber layer thickness positively correlated with forced vital capacity % predicted and forced expiratory volume in 1 second % predicted (P < 0.05). In conclusion, analysis of OCT measurements supports the involvement of the anterior visual pathway in ALS. Subtle structural thinning in the macular retinal nerve fiber layer correlates with pulmonary function tests.
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Cruz-Herranz A, Balk LJ, Oberwahrenbrock T, Saidha S, Martinez-Lapiscina EH, Lagreze WA, Schuman JS, Villoslada P, Calabresi P, Balcer L, Petzold A, Green AJ, Paul F, Brandt AU, Albrecht P. The APOSTEL recommendations for reporting quantitative optical coherence tomography studies. Neurology 2016; 86:2303-9. [PMID: 27225223 PMCID: PMC4909557 DOI: 10.1212/wnl.0000000000002774] [Citation(s) in RCA: 300] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/14/2016] [Indexed: 01/01/2023] Open
Abstract
Objective: To develop consensus recommendations for reporting of quantitative optical coherence tomography (OCT) study results. Methods: A panel of experienced OCT researchers (including 11 neurologists, 2 ophthalmologists, and 2 neuroscientists) discussed requirements for performing and reporting quantitative analyses of retinal morphology and developed a list of initial recommendations based on experience and previous studies. The list of recommendations was subsequently revised during several meetings of the coordinating group. Results: We provide a 9-point checklist encompassing aspects deemed relevant when reporting quantitative OCT studies. The areas covered are study protocol, acquisition device, acquisition settings, scanning protocol, funduscopic imaging, postacquisition data selection, postacquisition data analysis, recommended nomenclature, and statistical analysis. Conclusions: The Advised Protocol for OCT Study Terminology and Elements recommendations include core items to standardize and improve quality of reporting in quantitative OCT studies. The recommendations will make reporting of quantitative OCT studies more consistent and in line with existing standards for reporting research in other biomedical areas. The recommendations originated from expert consensus and thus represent Class IV evidence. They will need to be regularly adjusted according to new insights and practices.
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Affiliation(s)
- Andrés Cruz-Herranz
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Lisanne J Balk
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Timm Oberwahrenbrock
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Shiv Saidha
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Elena H Martinez-Lapiscina
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Wolf A Lagreze
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Joel S Schuman
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Pablo Villoslada
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Peter Calabresi
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Laura Balcer
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Axel Petzold
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Ari J Green
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Friedemann Paul
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Alexander U Brandt
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Philipp Albrecht
- From the Multiple Sclerosis Center (A.C.-H., P.V., A.J.G.), Department of Neurology, University of California San Francisco; Departments of Neurology and Ophthalmology (L.J.B., A.P.), VU University Medical Centre, Amsterdam, the Netherlands; Charité-Universitätsmedizin Berlin (T.O., F.P., A.U.B.), NeuroCure Clinical Research Center; Department of Neurology (T.O., F.P., A.U.B.), Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany; Department of Neurology (S.S., P.C.), Johns Hopkins University, Baltimore, MD; Center of Neuroimmunology and Department of Neurology (E.H.M.-L., P.V.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Spain; Eye Center (W.A.L.), University Medical Center, Freiburg, Germany; Departments of Ophthalmology (J.S.S.) and Neurology (L.B.), New York University School of Medicine, New York; Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery (A.P.), London, UK; and Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Germany.
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Neuroretinal alterations in the early stages of diabetic retinopathy in patients with type 2 diabetes mellitus. Eye (Lond) 2016; 30:673-9. [PMID: 26869156 DOI: 10.1038/eye.2016.13] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/20/2015] [Indexed: 01/05/2023] Open
Abstract
PurposeTo study neuroretinal alterations in patients affected by type 2 diabetes with no diabetic retinopathy (DR) or mild nonproliferative diabetic retinopathy (NPDR) and without any sign of diabetic macular edema.Patients and methodsIn total, 150 type 2 diabetic patients with no (131 eyes) or mild NPDR (19 eyes) and 50 healthy controls were enrolled in our study. All underwent a complete ophthalmologic examination, including Spectral-Domain optical coherence tomography (SD-OCT). Ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) thickness values were calculated after automated segmentation of SD-OCT scans.ResultsMean best-corrected visual acuity was 0.0±0.0 LogMAR in all the groups. Mean GC-IPL thickness was 80.6±8.1 μm in diabetic patients and 85.3±9.9 μm in healthy controls, respectively (P=0.001). Moreover, evaluating the two different diabetic groups, GC-IPL thickness was 80.7±8.1 μm and 79.7±8.8 μm in no-DR and mild-NPDR group (P=0.001 and P=0.022 compared with healthy controls, respectively). Average RNFL thickness was 86.1±10.1 μm in diabetes patients and 91.2±7.3 μm in controls, respectively (P=0.003). RNFL thickness was 86.4±10.2 μm in no-DR group and 84.1±9.4 μm in mild-NPDR group (P=0.007 and P=0.017 compared with healthy controls, respectively).ConclusionWe demonstrated a significantly reduced GC-IPL and RNFL thickness values in both no-DR and mild-NPDR groups compared with healthy controls. These data confirmed neuroretinal alterations are early in diabetes, preceding microvascular damages.
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Hübers A, Müller HP, Dreyhaupt J, Böhm K, Lauda F, Tumani H, Kassubek J, Ludolph AC, Pinkhardt EH. Retinal involvement in amyotrophic lateral sclerosis: a study with optical coherence tomography and diffusion tensor imaging. J Neural Transm (Vienna) 2015; 123:281-7. [PMID: 26582428 DOI: 10.1007/s00702-015-1483-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/06/2015] [Indexed: 11/25/2022]
Abstract
Although motor neuron degeneration is the predominant feature in ALS, recent data point to a more widespread pathology also comprising non-motor symptoms. Retinal thinning has been reported in a variety of neurodegenerative conditions. Yet, studies of retinal involvement in ALS are sparse and results are heterogeneous. We studied retinal alterations in ALS using a systematic approach combining Optical Coherence Tomography (OCT), Diffusion Tensor Imaging (DTI) and clinical phenotyping. We hypothesized that selective changes of specific retinal layers may be a reflection of overall neurodegeneration as measured by DTI. Spectral domain OCT images were analyzed to calculate the average thickness of retinal layers in 71 ALS patients and 20 controls. In 30 patients, the region of interest (ROI) based fractional anisotrophy (FA) was measured in the corticospinal tract (CST), as this region is preferentially affected by motor neuron degeneration. Clinical data were collected for correlation analysis. Patients showed a significant thinning of the inner nuclear layer (INL; p = 0.04) and the retinal nerve fibre layer (RNFL; p = 0.004) compared to controls. We saw significant correlations between retinal thickness and FA values of the CST in patients (p = 0.005). No significant correlation between clinical parameters and retinal involvement was observed. Our study provides evidence for a retinal involvement in ALS. Interestingly, ALS patients show a reduction in FA of the CST, which is correlated to retinal thinning. We conclude that retinal involvement is in fact associated to overall neurodegeneration and may be regarded as a potential technical biomarker in ALS.
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Affiliation(s)
- Annemarie Hübers
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hans Peter Müller
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstraße 13, 89075, Ulm, Germany
| | - Kathrin Böhm
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Florian Lauda
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Elmar H Pinkhardt
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Ringelstein M, Albrecht P, Kleffner I, Bühn B, Harmel J, Müller AK, Finis D, Guthoff R, Bergholz R, Duning T, Krämer M, Paul F, Brandt A, Oberwahrenbrock T, Mikolajczak J, Wildemann B, Jarius S, Hartung HP, Aktas O, Dörr J. Retinal pathology in Susac syndrome detected by spectral-domain optical coherence tomography. Neurology 2015. [DOI: 10.1212/wnl.0000000000001852] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Albrecht P, Blasberg C, Lukas S, Ringelstein M, Müller AK, Harmel J, Kadas EM, Finis D, Guthoff R, Aktas O, Hartung HP, Paul F, Brandt AU, Berlit P, Methner A, Kraemer M. Retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography. Neurology 2015; 85:521-7. [DOI: 10.1212/wnl.0000000000001832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022] Open
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Pasqualotto E, Matuz T, Federici S, Ruf CA, Bartl M, Olivetti Belardinelli M, Birbaumer N, Halder S. Usability and Workload of Access Technology for People With Severe Motor Impairment. Neurorehabil Neural Repair 2015; 29:950-7. [PMID: 25753951 DOI: 10.1177/1545968315575611] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Eye trackers are widely used among people with amyotrophic lateral sclerosis, and their benefits to quality of life have been previously shown. On the contrary, Brain-computer interfaces (BCIs) are still quite a novel technology, which also serves as an access technology for people with severe motor impairment. Objective. To compare a visual P300-based BCI and an eye tracker in terms of information transfer rate (ITR), usability, and cognitive workload in users with motor impairments. Methods. Each participant performed 3 spelling tasks, over 4 total sessions, using an Internet browser, which was controlled by a spelling interface that was suitable for use with either the BCI or the eye tracker. At the end of each session, participants evaluated usability and cognitive workload of the system. Results. ITR and System Usability Scale (SUS) score were higher for the eye tracker (Wilcoxon signed-rank test: ITR T = 9, P = .016; SUS T = 12.50, P = .035). Cognitive workload was higher for the BCI ( T = 4; P = .003). Conclusions. Although BCIs could be potentially useful for people with severe physical disabilities, we showed that the usability of BCIs based on the visual P300 remains inferior to eye tracking. We suggest that future research on visual BCIs should use eye tracking–based control as a comparison to evaluate performance or focus on nonvisual paradigms for persons who have lost gaze control.
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Affiliation(s)
| | | | - Stefano Federici
- University of Perugia, Perugia, Italy
- Sapienza Università di Roma, Rome, Italy
| | | | | | | | - Niels Birbaumer
- Eberhard Karls Universität, Tübingen, Germany
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Venezia Lido, Italy
| | - Sebastian Halder
- Universität Würzburg, Würzburg, Germany
- National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
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Volpe NJ, Simonett J, Fawzi AA, Siddique T. Ophthalmic Manifestations of Amyotrophic Lateral Sclerosis (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2015; 113:T12. [PMID: 26877563 PMCID: PMC4731009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine if clinical and histopathologic findings were present in the eyes of patients with amyotrophic lateral sclerosis (ALS) and explore correlations to an animal model of ALS. METHODS Two patients with ALS were studied histopathologically as well as the retinas of ALS/dementia transgenic mice with dysfunctional ubiquilin2, UBQLN2(P497H). Clinical study 1, an observational, cross-sectional study, was performed using optical coherence tomography (OCT) to obtain and compare mean total macular thickness and average and quadrant specific peripapillary retinal nerve fiber layer (pRNFL) scans from 16 patients with ALS to controls. Correlation analysis was performed to evaluate the association with disease duration. Clinical study 2 consisted of measuring visual acuity, color vision, contrast sensitivity, and quality of life in 12 patients. RESULTS Histopathologic studies demonstrated intraretinal inclusions in one patient and loss of ganglion cell axons in another. Mouse eyes had intraretinal inclusions in the inner plexiform layers. Total macular volume was thinner in patients compared to controls (P<.05), and 37.5% of patients with ALS had an average pRNFL below the 1st percentile. Total macular and pRNFL thickness correlated inversely with disease duration. CONCLUSIONS Histopathologic analysis of ALS eyes and mice with the UBQLN2(P497H) mutation, as well as OCT measurements, supports involvement of the anterior visual pathway. We identified pathologies, including intraretinal deposits and axonal loss. pRNFL and total macular thinning found on OCT correlated with disease duration. A pattern of vision loss specific for ALS was not identified. This study confirms ocular involvement in patients and transgenic animals with ALS/dementia.
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Affiliation(s)
- Nicholas J Volpe
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joseph Simonett
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Teepu Siddique
- Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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