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Harding IH, Nur Karim MI, Selvadurai LP, Corben LA, Delatycki MB, Monti S, Saccà F, Georgiou-Karistianis N, Cocozza S, Egan GF. Localized Changes in Dentate Nucleus Shape and Magnetic Susceptibility in Friedreich Ataxia. Mov Disord 2024; 39:1109-1118. [PMID: 38644761 DOI: 10.1002/mds.29816] [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: 11/13/2023] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND The dentate nuclei of the cerebellum are key sites of neuropathology in Friedreich ataxia (FRDA). Reduced dentate nucleus volume and increased mean magnetic susceptibility, a proxy of iron concentration, have been reported by magnetic resonance imaging studies in people with FRDA. Here, we investigate whether these changes are regionally heterogeneous. METHODS Quantitative susceptibility mapping data were acquired from 49 people with FRDA and 46 healthy controls. The dentate nuclei were manually segmented and analyzed using three dimensional vertex-based shape modeling and voxel-based assessments to identify regional changes in morphometry and susceptibility, respectively. RESULTS Individuals with FRDA, relative to healthy controls, showed significant bilateral surface contraction most strongly at the rostral and caudal boundaries of the dentate nuclei. The magnitude of this surface contraction correlated with disease duration, and to a lesser extent, ataxia severity. Significantly greater susceptibility was also evident in the FRDA cohort relative to controls, but was instead localized to bilateral dorsomedial areas, and also correlated with disease duration and ataxia severity. CONCLUSIONS Changes in the structure of the dentate nuclei in FRDA are not spatially uniform. Atrophy is greatest in areas with high gray matter density, whereas increases in susceptibility-reflecting iron concentration, demyelination, and/or gliosis-predominate in the medial white matter. These findings converge with established histological reports and indicate that regional measures of dentate nucleus substructure are more sensitive measures of disease expression than full-structure averages. Biomarker development and therapeutic strategies that directly target the dentate nuclei, such as gene therapies, may be optimized by targeting these areas of maximal pathology. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Muhammad Ikhsan Nur Karim
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Louisa P Selvadurai
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Pediatrics, University of Melbourne, Parkville, Australia
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Serena Monti
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Francesco Saccà
- Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
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Cocozza S, Bosticardo S, Battocchio M, Corben L, Delatycki M, Egan G, Georgiou‐Karistianis N, Monti S, Palma G, Pane C, Saccà F, Schiavi S, Selvadurai L, Tranfa M, Daducci A, Brunetti A, Harding IH. Gradient of microstructural damage along the dentato-thalamo-cortical tract in Friedreich ataxia. Ann Clin Transl Neurol 2024; 11:1691-1702. [PMID: 38952134 PMCID: PMC11251475 DOI: 10.1002/acn3.52048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE The dentato-thalamo-cortical tract (DTT) is the main cerebellar efferent pathway. Degeneration of the DTT is a core feature of Friedreich ataxia (FRDA). However, it remains unclear whether DTT disruption is spatially specific, with some segments being more impacted than others. This study aimed to investigate microstructural integrity along the DTT in FRDA using a profilometry diffusion MRI (dMRI) approach. METHODS MRI data from 45 individuals with FRDA (mean age: 33.2 ± 13.2, Male/Female: 26/19) and 37 healthy controls (mean age: 36.5 ± 12.7, Male/Female:18/19) were included in this cross-sectional multicenter study. A profilometry analysis was performed on dMRI data by first using tractography to define the DTT as the white matter pathway connecting the dentate nucleus to the contralateral motor cortex. The tract was then divided into 100 segments, and dMRI metrics of microstructural integrity (fractional anisotropy, mean diffusivity and radial diffusivity) at each segment were compared between groups. The process was replicated on the arcuate fasciculus for comparison. RESULTS Across all diffusion metrics, the region of the DTT connecting the dentate nucleus and thalamus was more impacted in FRDA than downstream cerebral sections from the thalamus to the cortex. The arcuate fasciculus was minimally impacted. INTERPRETATION Our study further expands the current knowledge about brain involvement in FRDA, showing that microstructural abnormalities within the DTT are weighted to early segments of the tract (i.e., the superior cerebellar peduncle). These findings are consistent with the hypothesis of DTT undergoing anterograde degeneration arising from the dentate nuclei and progressing to the primary motor cortex.
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Affiliation(s)
- Sirio Cocozza
- Department of Advanced Biomedical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Sara Bosticardo
- Department of Computer Science, Diffusion Imaging and Connectivity Estimation (DICE) LabUniversity of VeronaVeronaItaly
| | - Matteo Battocchio
- Department of Computer Science, Diffusion Imaging and Connectivity Estimation (DICE) LabUniversity of VeronaVeronaItaly
| | - Louise Corben
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PediatricsUniversity of MelbourneParkvilleVictoriaAustralia
- School of Psychological Sciences, The Turner Institute for Brain and Mental HealthMonash UniversityClaytonVictoriaAustralia
| | - Martin Delatycki
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PediatricsUniversity of MelbourneParkvilleVictoriaAustralia
- School of Psychological Sciences, The Turner Institute for Brain and Mental HealthMonash UniversityClaytonVictoriaAustralia
| | - Gary Egan
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityClaytonVictoriaAustralia
- Monash Biomedical ImagingMonash UniversityClaytonVictoriaAustralia
| | - Nellie Georgiou‐Karistianis
- School of Psychological Sciences, The Turner Institute for Brain and Mental HealthMonash UniversityClaytonVictoriaAustralia
| | - Serena Monti
- Institute of Biostructures and BioimagingNational Research CouncilNapoliItaly
| | - Giuseppe Palma
- Institute of NanotechnologyNational Research CouncilLecceItaly
| | - Chiara Pane
- Department of Neurosciences Reproductive and Odontostomatological SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Francesco Saccà
- Department of Neurosciences Reproductive and Odontostomatological SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Simona Schiavi
- Department of Computer Science, Diffusion Imaging and Connectivity Estimation (DICE) LabUniversity of VeronaVeronaItaly
- ASG Superconductors SpAGenoaItaly
| | - Louisa Selvadurai
- School of Psychological Sciences, The Turner Institute for Brain and Mental HealthMonash UniversityClaytonVictoriaAustralia
| | - Mario Tranfa
- Department of Advanced Biomedical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Alessandro Daducci
- Department of Computer Science, Diffusion Imaging and Connectivity Estimation (DICE) LabUniversity of VeronaVeronaItaly
| | - Arturo Brunetti
- Department of Advanced Biomedical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Ian H. Harding
- Monash Biomedical ImagingMonash UniversityClaytonVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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Fernandez L, Corben LA, Bilal H, Delatycki MB, Egan GF, Harding IH. Free-Water Imaging in Friedreich Ataxia Using Multi-Compartment Models. Mov Disord 2024; 39:370-379. [PMID: 37927246 DOI: 10.1002/mds.29648] [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: 07/28/2023] [Revised: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The neurological phenotype of Friedreich ataxia (FRDA) is characterized by neurodegeneration and neuroinflammation in the cerebellum and brainstem. Novel neuroimaging approaches quantifying brain free-water using diffusion magnetic resonance imaging (dMRI) are potentially more sensitive to these processes than standard imaging markers. OBJECTIVES To quantify the extent of free-water and microstructural change in FRDA-relevant brain regions using neurite orientation dispersion and density imaging (NODDI), and bitensor diffusion tensor imaging (btDTI). METHOD Multi-shell dMRI was acquired from 14 individuals with FRDA and 14 controls. Free-water measures from NODDI (FISO) and btDTI (FW) were compared between groups in the cerebellar cortex, dentate nuclei, cerebellar peduncles, and brainstem. The relative sensitivity of the free-water measures to group differences was compared to microstructural measures of NODDI intracellular volume, free-water corrected fractional anisotropy, and conventional uncorrected fractional anisotropy. RESULTS In individuals with FRDA, FW was elevated in the cerebellar cortex, peduncles (excluding middle), dentate, and brainstem (P < 0.005). FISO was elevated primarily in the cerebellar lobules (P < 0.001). On average, FW effect sizes were larger than all other markers (mean ηρ 2 = 0.43), although microstructural measures also had very large effects in the superior and inferior cerebellar peduncles and brainstem (ηρ 2 > 0.37). Across all regions and metrics, effect sizes were largest in the superior cerebellar peduncles (ηρ 2 > 0.46). CONCLUSIONS Multi-compartment diffusion measures of free-water and neurite integrity distinguish FRDA from controls with large effects. Free-water magnitude in the brainstem and cerebellum provided the greatest distinction between groups. This study supports further applications of multi-compartment diffusion modeling, and investigations of free-water as a measure of disease expression and progression in FRDA. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lara Fernandez
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Hiba Bilal
- Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Service, Melbourne, Victoria, Australia
| | - Gary F Egan
- Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
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Álvarez-Cuesta JA, Mora-Batista C, Reyes-Carreto R, Carrillo-Rodes FJ, Fitz SJT, González-Zaldivar Y, Vargas-De-León C. On the Cut-Off Value of the Anteroposterior Diameter of the Midbrain Atrophy in Spinocerebellar Ataxia Type 2 Patients. Brain Sci 2024; 14:53. [PMID: 38248268 PMCID: PMC10813098 DOI: 10.3390/brainsci14010053] [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: 11/22/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Spinocerebellar ataxias (SCA) is a term that refers to a group of hereditary ataxias, which are neurological diseases characterized by degeneration of the cells that constitute the cerebellum. Studies suggest that magnetic resonance imaging (MRI) supports diagnoses of ataxias, and linear measurements of the aneteroposterior diameter of the midbrain (ADM) have been investigated using MRI. These measurements correspond to studies in spinocerebellar ataxia type 2 (SCA2) patients and in healthy subjects. Our goal was to obtain the cut-off value for ADM atrophy in SCA2 patients. (2) Methods: This study evaluated 99 participants (66 SCA2 patients and 33 healthy controls). The sample was divided into estimations (80%) and validation (20%) samples. Using the estimation sample, we fitted a logistic model using the ADM and obtained the cut-off value through the inverse of regression. (3) Results: The optimal cut-off value of ADM was found to be 18.21 mm. The area under the curve (AUC) of the atrophy risk score was 0.957 (95% CI: 0.895-0.991). Using this cut-off on the validation sample, we found a sensitivity of 100.00% (95% CI: 76.84%-100.00%) and a specificity of 85.71% (95% CI: 42.13%-99.64%). (4) Conclusions: We obtained a cut-off value that has an excellent discriminatory capacity to identify SCA2 patients.
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Affiliation(s)
- José Alberto Álvarez-Cuesta
- Centro de Investigación y Rehabilitación de las Ataxias Hereditarias, VPWP+RM5, Holguín 80100, Cuba; (J.A.Á.-C.); (F.J.C.-R.); (Y.G.-Z.)
| | - Camilo Mora-Batista
- Facultad de Matemáticas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39087, Mexico;
| | - Ramón Reyes-Carreto
- Facultad de Matemáticas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39087, Mexico;
| | - Frank Jesus Carrillo-Rodes
- Centro de Investigación y Rehabilitación de las Ataxias Hereditarias, VPWP+RM5, Holguín 80100, Cuba; (J.A.Á.-C.); (F.J.C.-R.); (Y.G.-Z.)
| | | | - Yanetza González-Zaldivar
- Centro de Investigación y Rehabilitación de las Ataxias Hereditarias, VPWP+RM5, Holguín 80100, Cuba; (J.A.Á.-C.); (F.J.C.-R.); (Y.G.-Z.)
| | - Cruz Vargas-De-León
- División de Investigación, Hospital Juárez de México, Ciudad de México 07760, Mexico
- Laboratorio de Modelación Bioestadística para la Salud, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico
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Destrebecq V, Rovai A, Trotta N, Comet C, Naeije G. Proprioceptive and tactile processing in individuals with Friedreich ataxia: an fMRI study. Front Neurol 2023; 14:1224345. [PMID: 37808498 PMCID: PMC10556689 DOI: 10.3389/fneur.2023.1224345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Friedreich ataxia (FA) neuropathology affects dorsal root ganglia, posterior columns in the spinal cord, the spinocerebellar tracts, and cerebellar dentate nuclei. The impact of the somatosensory system on ataxic symptoms remains debated. This study aims to better evaluate the contribution of somatosensory processing to ataxia clinical severity by simultaneously investigating passive movement and tactile pneumatic stimulation in individuals with FA. Methods Twenty patients with FA and 20 healthy participants were included. All subjects underwent two 6 min block-design functional magnetic resonance imaging (fMRI) paradigms consisting of twelve 30 s alternating blocks (10 brain volumes per block, 120 brain volumes per paradigm) of a tactile oddball paradigm and a passive movement paradigm. Spearman rank correlation tests were used for correlations between BOLD levels and ataxia severity. Results The passive movement paradigm led to the lower activation of primary (cSI) and secondary somatosensory cortices (cSII) in FA compared with healthy subjects (respectively 1.1 ± 0.78 vs. 0.61 ± 1.02, p = 0.04, and 0.69 ± 0.5 vs. 0.3 ± 0.41, p = 0.005). In the tactile paradigm, there was no significant difference between cSI and cSII activation levels in healthy controls and FA (respectively 0.88 ± 0.73 vs. 1.14 ± 0.99, p = 0.33, and 0.54 ± 0.37 vs. 0.55 ± 0.54, p = 0.93). Correlation analysis showed a significant correlation between cSI activation levels in the tactile paradigm and the clinical severity (R = 0.481, p = 0.032). Interpretation Our study captured the difference between tactile and proprioceptive impairments in FA using somatosensory fMRI paradigms. The lack of correlation between the proprioceptive paradigm and ataxia clinical parameters supports a low contribution of afferent ataxia to FA clinical severity.
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Affiliation(s)
- Virginie Destrebecq
- Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles (LNT), UNI – ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Antonin Rovai
- Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles (LNT), UNI – ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicola Trotta
- Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles (LNT), UNI – ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Camille Comet
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Gilles Naeije
- Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles (LNT), UNI – ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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Naeije G, Rovai A, Destrebecq V, Trotta N, De Tiège X. Anodal Cerebellar Transcranial Direct Current Stimulation Reduces Motor and Cognitive Symptoms in Friedreich's Ataxia: A Randomized, Sham-Controlled Trial. Mov Disord 2023; 38:1443-1450. [PMID: 37310043 DOI: 10.1002/mds.29453] [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: 02/17/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Friedreich Ataxia is the most common recessive ataxia with only one therapeutic drug approved solely in the United States. OBJECTIVE The aim of this work was to investigate whether anodal cerebellar transcranial direct current stimulation (ctDCS) reduces ataxic and cognitive symptoms in individuals with Friedreich's ataxia (FRDA) and to assess the effects of ctDCS on the activity of the secondary somatosensory (SII) cortex. METHODS We performed a single-blind, randomized, sham-controlled, crossover trial with anodal ctDCS (5 days/week for 1 week, 20 min/day, density current: 0.057 mA/cm2 ) in 24 patients with FRDA. Each patient underwent a clinical evaluation (Scale for the Assessment and Rating of Ataxia, composite cerebellar functional severity score, cerebellar cognitive affective syndrome scale) before and after anodal and sham ctDCS. Activity of the SII cortex contralateral to a tactile oddball stimulation of the right index finger was evaluated with brain functional magnetic resonance imaging at baseline and after anodal/sham ctDCS. RESULTS Anodal ctDCS led to a significant improvement in the Scale for the Assessment and Rating of Ataxia (-6.5%) and in the cerebellar cognitive affective syndrome scale (+11%) compared with sham ctDCS. It also led to a significant reduction in functional magnetic resonance imaging signal at the SII cortex contralateral to tactile stimulation (-26%) compared with sham ctDCS. CONCLUSIONS One week of treatment with anodal ctDCS reduces motor and cognitive symptoms in individuals with FRDA, likely by restoring the neocortical inhibition normally exerted by cerebellar structures. This study provides class I evidence that ctDCS stimulation is effective and safe in FRDA. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gilles Naeije
- Université libre de Bruxelles, UNI-ULB Neuroscience Institute, Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium
| | - Antonin Rovai
- Université libre de Bruxelles, UNI-ULB Neuroscience Institute, Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Department of Translational Neuroimaging, Brussels, Belgium
| | - Virginie Destrebecq
- Université libre de Bruxelles, UNI-ULB Neuroscience Institute, Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium
| | - Nicola Trotta
- Université libre de Bruxelles, UNI-ULB Neuroscience Institute, Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles, Brussels, Belgium
| | - Xavier De Tiège
- Université libre de Bruxelles, UNI-ULB Neuroscience Institute, Laboratoire de Neuroanatomie et de Neuroimagerie translationnelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Department of Translational Neuroimaging, Brussels, Belgium
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Adanyeguh IM, Joers JM, Deelchand DK, Hutter DH, Eberly LE, Guo B, Iltis I, Bushara KO, Henry PG, Lenglet C. Brain MRI detects early-stage alterations and disease progression in Friedreich ataxia. Brain Commun 2023; 5:fcad196. [PMID: 37483529 PMCID: PMC10360047 DOI: 10.1093/braincomms/fcad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
Friedreich ataxia is a progressive neurodegenerative disorder characterized by cerebellar and spinal atrophy. However, studies to elucidate the longitudinal progression of the pathology in the brain are somewhat inconsistent and limited, especially for early-stage Friedreich ataxia. Using a multimodal neuroimaging protocol, combined with advanced analysis methods, we sought to identify macrostructural and microstructural alterations in the brain of patients with early-stage Friedreich ataxia to better understand its distribution patterns and progression. We enrolled 28 patients with Friedreich ataxia and 20 age- and gender-matched controls. Longitudinal clinical and imaging data were collected in the patients at baseline, 12, 24 and 36 months. Macrostructural differences were observed in patients with Friedreich ataxia, compared to controls, including lower volume of the cerebellar white matter (but not cerebellar grey matter), superior cerebellar peduncle, thalamus and brainstem structures, and higher volume of the fourth ventricle. Diffusion tensor imaging and fixel-based analysis metrics also showed microstructural differences in several brain regions, especially in the cerebellum and corticospinal tract. Over time, many of these macrostructural and microstructural alterations progressed, especially cerebellar grey and white matter volumes, and microstructure of the superior cerebellar peduncle, posterior limb of the internal capsule and superior corona radiata. In addition, linear regressions showed significant associations between many of those imaging metrics and clinical scales. This study provides evidence of early-stage macrostructural and microstructural alterations and of progression over time in the brain in Friedreich ataxia. Moreover, it allows to non-invasively map such brain alterations over a longer period (3 years) than any previous study, and identifies several brain regions with significant involvement in the disease progression besides the cerebellum. We show that fixel-based analysis of diffusion MRI data is particularly sensitive to longitudinal change in the cerebellar peduncles, as well as motor and sensory white matter tracts. In combination with other morphometric measures, they may therefore provide sensitive imaging biomarkers of disease progression for clinical trials.
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Affiliation(s)
- Isaac M Adanyeguh
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - James M Joers
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Dinesh K Deelchand
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Diane H Hutter
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bin Guo
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Isabelle Iltis
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Khalaf O Bushara
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Pierre-Gilles Henry
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Christophe Lenglet
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Tax CM, Genc S, MacIver CL, Nilsson M, Wardle M, Szczepankiewicz F, Jones DK, Peall KJ. Ultra-strong diffusion-weighted MRI reveals cerebellar grey matter abnormalities in movement disorders. Neuroimage Clin 2023; 38:103419. [PMID: 37192563 PMCID: PMC10199248 DOI: 10.1016/j.nicl.2023.103419] [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: 12/06/2022] [Revised: 02/28/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Abstract
Structural brain MRI has proven invaluable in understanding movement disorder pathophysiology. However, most work has focused on grey/white matter volumetric (macrostructural) and white matter microstructural effects, limiting understanding of frequently implicated grey matter microstructural differences. Using ultra-strong spherical tensor encoding diffusion-weighted MRI, a persistent MRI signal was seen in healthy cerebellar grey matter even at high diffusion-weightings (b ≥ 10,000 s/mm2). Quantifying the proportion of this signal (denoted fs), previously ascertained to originate from inside small spherical spaces, provides a potential proxy for cell body density. In this work, this approach was applied for the first time to a clinical cohort, including patients with diagnosed movement disorders in which the cerebellum has been implicated in symptom pathophysiology. Five control participants (control group 1, median age 24.5 years (20-39 years), imaged at two timepoints, demonstrated consistency in measurement of all three measures - MD (Mean Diffusivity) fs, and Ds (dot diffusivity)- with intraclass correlation coefficients (ICC) of 0.98, 0.86 and 0.76, respectively. Comparison with an older control group (control group 2 (n = 5), median age 51 years (43-58 years)) found no significant differences, neither with morphometric nor microstructural (MD (p = 0.36), fs (p = 0.17) and Ds (p = 0.22)) measures. The movement disorder cohort (Parkinson's Disease, n = 5, dystonia, n = 5. Spinocerebellar Ataxia 6, n = 5) when compared to the age-matched control cohort (Control Group 2) identified significantly lower MD (p < 0.0001 and p < 0.0001) and higher fs values (p < 0.0001 and p < 0.0001) in SCA6 and dystonia cohorts respectively. Lobar division of the cerebellum found these same differences in the superior and inferior posterior lobes, while no differences were seen in either the anterior lobes or with Ds measurements. In contrast to more conventional measures from diffusion tensor imaging, this framework provides enhanced specificity to differences in restricted spherical spaces in grey matter (including small cells) by eliminating signals from cerebrospinal fluid and axons. In the context of human and animal histopathology studies, these findings potentially implicate the cerebellar Purkinje and granule cells as contributors to the observed signal differences, with both cell types having been implicated in several neurological disorders through both postmortem and animal model studies. This novel microstructural imaging approach shows promise for improving movement disorder diagnosis, prognosis, and treatment.
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Affiliation(s)
- Chantal M.W. Tax
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, UK
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sila Genc
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Claire L MacIver
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Markus Nilsson
- Diagnostic Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mark Wardle
- Cardiff and Vale University Health Board, University Hospital of Wales Cardiff, Heath Park, Cardiff, UK
| | - Filip Szczepankiewicz
- Diagnostic Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
- Medical Radiation Physics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Derek K. Jones
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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9
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Kerestes R, Cummins H, Georgiou-Karistianis N, Selvadurai LP, Corben LA, Delatycki MB, Egan GF, Harding IH. Reduced cerebello-cerebral functional connectivity correlates with disease severity and impaired white matter integrity in Friedreich ataxia. J Neurol 2023; 270:2360-2369. [PMID: 36859626 PMCID: PMC10130106 DOI: 10.1007/s00415-023-11637-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
Friedreich ataxia (FRDA) is a rare, inherited neurodegenerative disease characterised in most cases by progressive and debilitating motor dysfunction. Degeneration of cerebellar white matter pathways have been previously reported, alongside indications of cerebello-cerebral functional alterations. In this work, we examine resting-state functional connectivity changes within cerebello-cerebral circuits, and their associations with disease severity (Scale for the Assessment and Rating of Ataxia [SARA]), psychomotor function (speeded and paced finger tapping), and white matter integrity (diffusion tensor imaging) in 35 adults with FRDA and 45 age and sex-matched controls. Voxel-wise seed-based functional connectivity was assessed for three cerebellar cortical regions (anterior lobe, lobules I-V; superior posterior lobe, lobules VI-VIIB; inferior posterior lobe, lobules VIIIA-IX) and two dentate nucleus seeds (dorsal and ventral). Compared to controls, people with FRDA showed significantly reduced connectivity between the anterior cerebellum and bilateral pre/postcentral gyri, and between the superior posterior cerebellum and left dorsolateral PFC. Greater disease severity correlated with lower connectivity in these circuits. Lower anterior cerebellum-motor cortex functional connectivity also correlated with slower speeded finger tapping and less fractional anisotropy in the superior cerebellar peduncles, internal capsule, and precentral white matter in the FRDA cohort. There were no significant between-group differences in inferior posterior cerebellar or dentate nucleus connectivity. This study indicates that altered cerebello-cerebral functional connectivity is associated with functional status and white matter damage in cerebellar efferent pathways in people with FRDA, particularly in motor circuits.
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Affiliation(s)
- Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Hannah Cummins
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Louisa P Selvadurai
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Gary F Egan
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia. .,Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia.
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10
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Weil EL, Nakawah MO, Masdeu JC. Advances in the neuroimaging of motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:359-381. [PMID: 37562878 DOI: 10.1016/b978-0-323-98818-6.00039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Neuroimaging is a valuable adjunct to the history and examination in the evaluation of motor system disorders. Conventional imaging with computed tomography or magnetic resonance imaging depicts important anatomic information and helps to identify imaging patterns which may support diagnosis of a specific motor disorder. Advanced imaging techniques can provide further detail regarding volume, functional, or metabolic changes occurring in nervous system pathology. This chapter is an overview of the advances in neuroimaging with particular emphasis on both standard and less well-known advanced imaging techniques and findings, such as diffusion tensor imaging or volumetric studies, and their application to specific motor disorders. In addition, it provides reference to emerging imaging biomarkers in motor system disorders such as Parkinson disease, amyotrophic lateral sclerosis, and Huntington disease, and briefly reviews the neuroimaging findings in different causes of myelopathy and peripheral nerve disorders.
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Affiliation(s)
- Erika L Weil
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States.
| | - Mohammad Obadah Nakawah
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Joseph C Masdeu
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States
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11
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Bizzoca A, Jirillo E, Flace P, Gennarini G. Overall Role of Contactins Expression in Neurodevelopmental Events and Contribution to Neurological Disorders. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-128217. [PMID: 36515028 DOI: 10.2174/1871527322666221212160048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neurodegenerative disorders may depend upon a misregulation of the pathways which sustain neurodevelopmental control. In this context, this review article focuses on Friedreich ataxia (FA), a neurodegenerative disorder resulting from mutations within the gene encoding the Frataxin protein, which is involved in the control of mitochondrial function and oxidative metabolism. OBJECTIVE The specific aim of the present study concerns the FA molecular and cellular substrates, for which available transgenic mice models are proposed, including mutants undergoing misexpression of adhesive/morphoregulatory proteins, in particular belonging to the Contactin subset of the immunoglobulin supergene family. METHODS In both mutant and control mice, neurogenesis was explored by morphological/morphometric analysis through the expression of cell type-specific markers, including -tubulin, the Contactin-1 axonal adhesive glycoprotein, as well as the Glial Fibrillary Acidic Protein (GFAP). RESULTS Specific consequences were found to arise from the chosen misexpression approach, consisting of a neuronal developmental delay associated with glial upregulation. Protective effects against the arising phenotype resulted from antioxidants (essentially epigallocatechin gallate (EGCG)) administration, which was demonstrated through the profiles of neuronal (-tubulin and Contactin 1) as well as glial (GFAP) markers, in turn indicating the concomitant activation of neurodegeneration and neuro repair processes. The latter also implied activation of the Notch-1 signaling. CONCLUSION Overall, this study supports the significance of changes in morphoregulatory proteins expression in the FA pathogenesis and of antioxidant administration in counteracting it, which, in turn, allows to devise potential therapeutic approaches.
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Affiliation(s)
- Antonella Bizzoca
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
| | - Paolo Flace
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
| | - Gianfranco Gennarini
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
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12
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Georgiou-Karistianis N, Corben LA, Reetz K, Adanyeguh IM, Corti M, Deelchand DK, Delatycki MB, Dogan I, Evans R, Farmer J, França MC, Gaetz W, Harding IH, Harris KS, Hersch S, Joules R, Joers JJ, Krishnan ML, Lax M, Lock EF, Lynch D, Mareci T, Muthuhetti Gamage S, Pandolfo M, Papoutsi M, Rezende TJR, Roberts TPL, Rosenberg JT, Romanzetti S, Schulz JB, Schilling T, Schwarz AJ, Subramony S, Yao B, Zicha S, Lenglet C, Henry PG. A natural history study to track brain and spinal cord changes in individuals with Friedreich's ataxia: TRACK-FA study protocol. PLoS One 2022; 17:e0269649. [PMID: 36410013 PMCID: PMC9678384 DOI: 10.1371/journal.pone.0269649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Drug development for neurodegenerative diseases such as Friedreich's ataxia (FRDA) is limited by a lack of validated, sensitive biomarkers of pharmacodynamic response in affected tissue and disease progression. Studies employing neuroimaging measures to track FRDA have thus far been limited by their small sample sizes and limited follow up. TRACK-FA, a longitudinal, multi-site, and multi-modal neuroimaging natural history study, aims to address these shortcomings by enabling better understanding of underlying pathology and identifying sensitive, clinical trial ready, neuroimaging biomarkers for FRDA. METHODS 200 individuals with FRDA and 104 control participants will be recruited across seven international study sites. Inclusion criteria for participants with genetically confirmed FRDA involves, age of disease onset ≤ 25 years, Friedreich's Ataxia Rating Scale (FARS) functional staging score of ≤ 5, and a total modified FARS (mFARS) score of ≤ 65 upon enrolment. The control cohort is matched to the FRDA cohort for age, sex, handedness, and years of education. Participants will be evaluated at three study visits over two years. Each visit comprises of a harmonized multimodal Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) scan of the brain and spinal cord; clinical, cognitive, mood and speech assessments and collection of a blood sample. Primary outcome measures, informed by previous neuroimaging studies, include measures of: spinal cord and brain morphometry, spinal cord and brain microstructure (measured using diffusion MRI), brain iron accumulation (using Quantitative Susceptibility Mapping) and spinal cord biochemistry (using MRS). Secondary and exploratory outcome measures include clinical, cognitive assessments and blood biomarkers. DISCUSSION Prioritising immediate areas of need, TRACK-FA aims to deliver a set of sensitive, clinical trial-ready neuroimaging biomarkers to accelerate drug discovery efforts and better understand disease trajectory. Once validated, these potential pharmacodynamic biomarkers can be used to measure the efficacy of new therapeutics in forestalling disease progression. CLINICAL TRIAL REGISTRATION ClinicalTrails.gov Identifier: NCT04349514.
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Affiliation(s)
- Nellie Georgiou-Karistianis
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Louise A. Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Isaac M. Adanyeguh
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Manuela Corti
- Powell Gene Therapy Centre, University of Florida, Gainesville, Florida, United States of America
| | - Dinesh K. Deelchand
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Martin B. Delatycki
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Rebecca Evans
- Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, United States of America
| | - Jennifer Farmer
- Friedreich’s Ataxia Research Alliance (FARA), Downingtown, Pennsylvania, United States of America
| | - Marcondes C. França
- Department of Neurology, University of Campinas, Campinas, Sao Paulo, Brazil
| | - William Gaetz
- Department of Radiology, Lurie Family Foundations MEG Imaging Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Ian H. Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Karen S. Harris
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Steven Hersch
- Neurology Business Group, Eisai Inc., Nutley, New Jersey, United States of America
| | | | - James J. Joers
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michelle L. Krishnan
- Translational Medicine, Novartis Institutes for Biomedical Research, Cambridge, MA, United States of America
| | | | - Eric F. Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - David Lynch
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Thomas Mareci
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, United States of America
| | - Sahan Muthuhetti Gamage
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Massimo Pandolfo
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | | | | | - Timothy P. L. Roberts
- Department of Radiology, Lurie Family Foundations MEG Imaging Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Jens T. Rosenberg
- McKnight Brain Institute, Department of Neurology, University of Florida, Gainesville, Florida, United States of America
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Jörg B. Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Traci Schilling
- PTC Therapeutics, Inc, South Plainfield, New Jersey, United States of America
| | - Adam J. Schwarz
- Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, United States of America
| | - Sub Subramony
- McKnight Brain Institute, Department of Neurology, University of Florida, Gainesville, Florida, United States of America
| | - Bert Yao
- PTC Therapeutics, Inc, South Plainfield, New Jersey, United States of America
| | - Stephen Zicha
- Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, United States of America
| | - Christophe Lenglet
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Pierre-Gilles Henry
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States of America
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13
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Recessive cerebellar and afferent ataxias - clinical challenges and future directions. Nat Rev Neurol 2022; 18:257-272. [PMID: 35332317 DOI: 10.1038/s41582-022-00634-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 02/07/2023]
Abstract
Cerebellar and afferent ataxias present with a characteristic gait disorder that reflects cerebellar motor dysfunction and sensory loss. These disorders are a diagnostic challenge for clinicians because of the large number of acquired and inherited diseases that cause cerebellar and sensory neuron damage. Among such conditions that are recessively inherited, Friedreich ataxia and RFC1-associated cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) include the characteristic clinical, neuropathological and imaging features of ganglionopathies, a distinctive non-length-dependent type of sensory involvement. In this Review, we discuss the typical and atypical phenotypes of Friedreich ataxia and CANVAS, along with the features of other recessive ataxias that present with a ganglionopathy or polyneuropathy, with an emphasis on recently described clinical features, natural history and genotype-phenotype correlations. We review the main developments in understanding the complex pathology that affects the sensory neurons and cerebellum, which seem to be most vulnerable to disorders that affect mitochondrial function and DNA repair mechanisms. Finally, we discuss disease-modifying therapeutic advances in Friedreich ataxia, highlighting the most promising candidate molecules and lessons learned from previous clinical trials.
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14
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Vavla M, Arrigoni F, Peruzzo D, Montanaro D, Frijia F, Pizzighello S, De Luca A, Della Libera E, Tessarotto F, Guerra P, Harding IH, Martinuzzi A. Functional MRI Studies in Friedreich's Ataxia: A Systematic Review. Front Neurol 2022; 12:802496. [PMID: 35360279 PMCID: PMC8960250 DOI: 10.3389/fneur.2021.802496] [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] [Received: 10/26/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Friedreich's ataxia (FRDA) is an inherited neurodegenerative movement disorder with early onset, widespread cerebral and cerebellar pathology, and no cure still available. Functional MRI (fMRI) studies, although currently limited in number, have provided a better understanding of brain changes in people with FRDA. This systematic review aimed to provide a critical overview of the findings and methodologies of all fMRI studies conducted in genetically confirmed FRDA so far, and to offer recommendations for future study designs. About 12 cross-sectional and longitudinal fMRI studies, included 198 FRDA children and young adult patients and, 205 healthy controls (HCs), according to the inclusion criteria. Details regarding GAA triplet expansion and demographic and clinical severity measures were widely reported. fMRI designs included motor and cognitive task paradigms, and resting-state studies, with widespread changes in functionally activated areas and extensive variability in study methodologies. These studies highlight a mixed picture of both hypoactivation and hyperactivation in different cerebral and cerebellar brain regions depending on fMRI design and cohort characteristics. Functional changes often correlate with clinical variables. In aggregate, the findings provide support for cerebro-cerebellar loop damage and the compensatory mechanism hypothesis. Current literature indicates that fMRI is a valuable tool for gaining in vivo insights into FRDA pathology, but addressing that its limitations would be a key to improving the design, interpretation, and generalizability of studies in the future.
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Affiliation(s)
- Marinela Vavla
- Department of Neurorehabilitation, Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Italy
- *Correspondence: Marinela Vavla ;
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Denis Peruzzo
- Neuroimaging Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Domenico Montanaro
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
- U.O.S.D. Servizio Autonomo di Risonanza Magnetica, Dipartimento Clinico di Neuroscienze dell'Età Evolutiva - IRCCS Fondazione Stella Maris - Pisa, Italy
| | - Francesca Frijia
- U.O.C. Bioingegneria e Ing. Clinica, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Silvia Pizzighello
- Department of Neurorehabilitation, Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Italy
| | - Alberto De Luca
- Department of Neurology, UMC Utrecht Brain Center, UMC Utrecht, Utrecht, Netherlands
| | | | - Federica Tessarotto
- Department of Neurorehabilitation, Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Italy
| | - Paola Guerra
- Department of Neurorehabilitation, Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Italy
| | - Ian H. Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrea Martinuzzi
- Department of Neurorehabilitation, Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Italy
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15
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Harding IH, Ward PGD. Brain susceptibility imaging provides valuable in vivo insights into cerebellar diseases, but biological interpretations remain elusive. Brain Commun 2022; 4:fcac007. [PMID: 35178517 PMCID: PMC8846579 DOI: 10.1093/braincomms/fcac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/09/2021] [Accepted: 02/03/2022] [Indexed: 11/14/2022] Open
Abstract
This scientific commentary relates to: 'Quantitative susceptibility mapping reveals alterations of dentate nuclei in common types of degenerative cerebellar ataxias' by Deistung et al. (https://doi.org/10.1093/braincomms/fcab306).
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Affiliation(s)
- Ian H. Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Phillip G. D. Ward
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Melbourne, Australia
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16
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Harding IH, Lynch DR, Koeppen AH, Pandolfo M. Central Nervous System Therapeutic Targets in Friedreich Ataxia. Hum Gene Ther 2021; 31:1226-1236. [PMID: 33238751 PMCID: PMC7757690 DOI: 10.1089/hum.2020.264] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Friedreich ataxia (FRDA) is an autosomal recessive inherited multisystem disease, characterized by marked differences in the vulnerability of neuronal systems. In general, the proprioceptive system appears to be affected early, while later in the disease, the dentate nucleus of the cerebellum and, to some degree, the corticospinal tracts degenerate. In the current era of expanding therapeutic discovery in FRDA, including progress toward novel gene therapies, a deeper and more specific consideration of potential treatment targets in the nervous system is necessary. In this work, we have re-examined the neuropathology of FRDA, recognizing new issues superimposed on classical findings, and dissected the peripheral nervous system (PNS) and central nervous system (CNS) aspects of the disease and the affected cell types. Understanding the temporal course of neuropathological changes is needed to identify areas of modifiable disease progression and the CNS and PNS locations that can be targeted at different time points. As most major targets of long-term therapy are in the CNS, this review uses multiple tools for evaluation of the importance of specific CNS locations as targets. In addition to clinical observations, the conceptualizations in this study include physiological, pathological, and imaging approaches, and animal models. We believe that this review, through analysis of a more complete set of data derived from multiple techniques, provides a comprehensive summary of therapeutic targets in FRDA.
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Affiliation(s)
- Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - David R Lynch
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Arnulf H Koeppen
- Research, Neurology, and Pathology Services, Veterans Affairs Medical Center and Departments of Neurology and Pathology, Albany Medical College, Albany, New York, USA
| | - Massimo Pandolfo
- Laboratory of Experimental Neurology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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17
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Harding IH, Chopra S, Arrigoni F, Boesch S, Brunetti A, Cocozza S, Corben LA, Deistung A, Delatycki M, Diciotti S, Dogan I, Evangelisti S, França MC, Göricke SL, Georgiou-Karistianis N, Gramegna LL, Henry PG, Hernandez-Castillo CR, Hutter D, Jahanshad N, Joers JM, Lenglet C, Lodi R, Manners DN, Martinez ARM, Martinuzzi A, Marzi C, Mascalchi M, Nachbauer W, Pane C, Peruzzo D, Pisharady PK, Pontillo G, Reetz K, Rezende TJR, Romanzetti S, Saccà F, Scherfler C, Schulz JB, Stefani A, Testa C, Thomopoulos SI, Timmann D, Tirelli S, Tonon C, Vavla M, Egan GF, Thompson PM. Brain Structure and Degeneration Staging in Friedreich Ataxia: Magnetic Resonance Imaging Volumetrics from the ENIGMA-Ataxia Working Group. Ann Neurol 2021; 90:570-583. [PMID: 34435700 PMCID: PMC9292360 DOI: 10.1002/ana.26200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 01/24/2023]
Abstract
Objective Friedreich ataxia (FRDA) is an inherited neurological disease defined by progressive movement incoordination. We undertook a comprehensive characterization of the spatial profile and progressive evolution of structural brain abnormalities in people with FRDA. Methods A coordinated international analysis of regional brain volume using magnetic resonance imaging data charted the whole‐brain profile, interindividual variability, and temporal staging of structural brain differences in 248 individuals with FRDA and 262 healthy controls. Results The brainstem, dentate nucleus region, and superior and inferior cerebellar peduncles showed the greatest reductions in volume relative to controls (Cohen d = 1.5–2.6). Cerebellar gray matter alterations were most pronounced in lobules I–VI (d = 0.8), whereas cerebral differences occurred most prominently in precentral gyri (d = 0.6) and corticospinal tracts (d = 1.4). Earlier onset age predicted less volume in the motor cerebellum (rmax = 0.35) and peduncles (rmax = 0.36). Disease duration and severity correlated with volume deficits in the dentate nucleus region, brainstem, and superior/inferior cerebellar peduncles (rmax = −0.49); subgrouping showed these to be robust and early features of FRDA, and strong candidates for further biomarker validation. Cerebral white matter abnormalities, particularly in corticospinal pathways, emerge as intermediate disease features. Cerebellar and cerebral gray matter loss, principally targeting motor and sensory systems, preferentially manifests later in the disease course. Interpretation FRDA is defined by an evolving spatial profile of neuroanatomical changes beyond primary pathology in the cerebellum and spinal cord, in line with its progressive clinical course. The design, interpretation, and generalization of research studies and clinical trials must consider neuroanatomical staging and associated interindividual variability in brain measures. ANN NEUROL 2021;90:570–583
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Affiliation(s)
- Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Louise A Corben
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.,Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, Department for Radiation Medicine, University Hospital Halle (Saale), Halle (Saale), Germany.,Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi,", University of Bologna, Bologna, Italy
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Stefania Evangelisti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcondes C França
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Laura L Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Pierre-Gilles Henry
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Carlos R Hernandez-Castillo
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.,CONACYT-Institute of Neuroethology, University of Veracruz, Xalapa, Mexico
| | - Diane Hutter
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - James M Joers
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Christophe Lenglet
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - David N Manners
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Andrea Martinuzzi
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Center, Conegliano, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi,", University of Bologna, Bologna, Italy
| | - Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,", University of Florence, Florence, Italy.,Clinical Epidemiology Unit, ISPRO, Oncological Network, Prevention and Research Institute, Florence, Italy
| | | | - Chiara Pane
- NSRO Department, University of Naples Federico II, Naples, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Pramod K Pisharady
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Thiago J R Rezende
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Francesco Saccà
- NSRO Department, University of Naples Federico II, Naples, Italy
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Stefania Tirelli
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Marinela Vavla
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Center, Conegliano, Italy
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
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18
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Mitochondrial and metabolic dysfunction in Friedreich ataxia: update on pathophysiological relevance and clinical interventions. Neuronal Signal 2021; 5:NS20200093. [PMID: 34046211 PMCID: PMC8132591 DOI: 10.1042/ns20200093] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Friedreich ataxia (FRDA) is a recessive disorder resulting from relative deficiency of the mitochondrial protein frataxin. Frataxin functions in the process of iron–sulfur (Fe–S) cluster synthesis. In this review, we update some of the processes downstream of frataxin deficiency that may mediate the pathophysiology. Based on cellular models, in vivo models and observations of patients, ferroptosis may play a major role in the pathogenesis of FRDA along with depletion of antioxidant reserves and abnormalities of mitochondrial biogenesis. Ongoing clinical trials with ferroptosis inhibitors and nuclear factor erythroid 2-related factor 2 (Nrf2) activators are now targeting each of the processes. In addition, better understanding of the mitochondrial events in FRDA may allow the development of improved imaging methodology for assessing the disorder. Though not technologically feasible at present, metabolic imaging approaches may provide a direct methodology to understand the mitochondrial changes occurring in FRDA and provide a methodology to monitor upcoming trials of frataxin restoration.
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19
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Öz G, Harding IH, Krahe J, Reetz K. MR imaging and spectroscopy in degenerative ataxias: toward multimodal, multisite, multistage monitoring of neurodegeneration. Curr Opin Neurol 2021; 33:451-461. [PMID: 32657886 DOI: 10.1097/wco.0000000000000834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Degenerative ataxias are rare and currently untreatable movement disorders, primarily characterized by neurodegeneration in the cerebellum and brainstem. We highlight MRI studies with the most potential for utility in pending ataxia trials and underscore advances in disease characterization and diagnostics in the field. RECENT FINDINGS With availability of advanced MRI acquisition methods and specialized software dedicated to the analysis of MRI of the cerebellum, patterns of cerebellar atrophy in different degenerative ataxias are increasingly well defined. The field further embraced rigorous multimodal investigations to study network-level microstructural and functional brain changes and their neurochemical correlates. MRI and magnetic resonance spectroscopy were shown to be more sensitive to disease progression than clinical scales and to detect abnormalities in premanifest mutation carriers. SUMMARY Magnetic resonance techniques are increasingly well placed for characterizing the expression and progression of degenerative ataxias. The most impactful work has arguably come through multi-institutional studies that monitor relatively large cohorts, multimodal investigations that assess the sensitivity of different measures and their interrelationships, and novel imaging approaches that are targeted to known pathophysiology (e.g., iron and spinal imaging in Friedreich ataxia). These multimodal, multi-institutional studies are paving the way to clinical trial readiness and enhanced understanding of disease in degenerative ataxias.
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Affiliation(s)
- Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School.,Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Janna Krahe
- Department of Neurology.,JARA Brain Institute Molecular Neuroscience and Neuroimaging, Research Centre Ju[Combining Diaeresis]lich, RWTH Aachen University, Aachen, Germany
| | - Kathrin Reetz
- Department of Neurology.,JARA Brain Institute Molecular Neuroscience and Neuroimaging, Research Centre Ju[Combining Diaeresis]lich, RWTH Aachen University, Aachen, Germany
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20
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Selvadurai LP, Georgiou-Karistianis N, Shishegar R, Sheridan C, Egan GF, Delatycki MB, Harding IH, Corben LA. Longitudinal structural brain changes in Friedreich ataxia depend on disease severity: the IMAGE-FRDA study. J Neurol 2021; 268:4178-4189. [PMID: 33860369 DOI: 10.1007/s00415-021-10512-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Friedreich ataxia is an inherited neurodegenerative disease, with cerebral and cerebellar pathology evident. Despite an increased understanding of its neuropathology, disease progression in this disease remains poorly understood. This study aimed to characterise longitudinal change in brain structure using a multi-modal approach across cerebral and cerebellar grey and white matter. METHODS T1-weighted, diffusion-tensor, and magnetisation transfer magnetic resonance images were obtained from 28 individuals with Friedreich ataxia and 29 age- and gender-matched controls at two time-points, 2 years apart. Region-of-interest and exploratory between-group comparisons assessed changes in brain macrostructure (cerebellar lobule volume, cerebral cortical thickness/gyrification, brain white matter volume) and microstructure (white matter fractional anisotropy, mean/axial/radial diffusivity, magnetisation transfer ratio). Rates of change were correlated against change in neurological severity, Time 1 severity, and onset age. RESULTS Individuals with Friedreich ataxia had a greater rate of white matter volume loss than controls in the superior cerebellar peduncles and right peri-thalamic/posterior cerebral regions, and greater reduction in left primary motor cortex gyrification. Greater cerebellar/brainstem white matter volume loss and right dorsal premotor gyrification loss was observed amongst individuals with less severe neurological symptoms at Time 1. Conversely, cerebral atrophy and changes in axial diffusivity were observed in individuals with more severe Time 1 symptoms. Progression in radial diffusivity was more pronounced amongst individuals with earlier disease onset. Greater right ventral premotor gyrification loss correlated with greater neurological progression. CONCLUSION Heterogeneity in Friedreich ataxia progression is observed at the neurobiological level, with evidence of earlier cerebellar and later cerebral degeneration.
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Affiliation(s)
- Louisa P Selvadurai
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Clayton, VIC, 3800, Australia.
| | - Rosita Shishegar
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Clayton, VIC, 3800, Australia.,The Australian E-Health Research Centre, CSIRO, Melbourne, Australia
| | - Cathlin Sheridan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Gary F Egan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Clayton, VIC, 3800, Australia.,Monash Biomedical Imaging, Monash University, Clayton, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Victorian Clinical Genetics Services, Parkville, Australia
| | - Ian H Harding
- Monash Biomedical Imaging, Monash University, Clayton, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Louise A Corben
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Clayton, VIC, 3800, Australia.,Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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21
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Abstract
OBJECTIVE Friedreich's ataxia (FRDA) is the most common hereditary ataxia. It is a neurodegenerative disorder, characterized by progressive ataxia. FRDA is also associated with cognitive impairments. To date, the evolution of cognitive functioning is unknown. Our aim was to investigate the changes in the cognitive functioning of FRDA patients over an average eight-year timeframe. In addition, we aimed to study the relationship between cognitive changes and clinical variables. METHODS Twenty-nine FRDA patients who had been part of the sample of a previous study participated in the present study. The mean average time between the two assessments was 8.24 years. The participants completed an extensive battery of neuropsychological tests chosen to examine cognitive functioning in various cognitive domains: processing speed, attention, working memory, executive functions, verbal and visual memory, visuoperceptive and visuospatial skills, visuoconstructive functions and language. RESULTS At follow-up, cerebellar symptoms had worsened, and patients presented greater disability. Differences between baseline and follow-up were observed in motor and cognitive reaction times, several trials of the Stroop test, semantic fluency, and block designs. No other cognitive changes were observed. Deterioration in simple cognitive reactions times and block designs performance correlated with the progression of cerebellar symptoms. CONCLUSIONS Our study has demonstrated for the first time that patients with FRDA experience a significant decline over time in several cognitive domains. Specifically, after an eight-year period, FRDA patients worsened in processing speed, fluency, and visuoconstructive skills. This progression is unlikely to be due to greater motor or speech impairment.
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22
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Straub S, Mangesius S, Emmerich J, Indelicato E, Nachbauer W, Degenhardt KS, Ladd ME, Boesch S, Gizewski ER. Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R 2 and R 1 relaxometry. J Neurosci Res 2020; 98:2219-2231. [PMID: 32731306 PMCID: PMC7590084 DOI: 10.1002/jnr.24701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/12/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023]
Abstract
Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age 37 ± 14 years; four female) and 10 age- and sex-matched controls were included. Acquisition of magnetic resonance imaging (MRI) data for quantitative susceptibility mapping, R1 , R2 relaxometry and diffusion imaging was performed at 7 Tesla. Results of volume of interest (VOI)-based analyses of the quantitative data were compared with a voxel-based morphometry (VBM) evaluation. Differences between patients and controls were assessed using the analysis of covariance (ANCOVA; p < 0.01) with age and sex as covariates, effect size of group differences, and correlations with disease characteristics with Spearman correlation coefficient. For the VBM analysis, a statistical threshold of 0.001 for uncorrected and 0.05 for corrected p-values was used. Statistically significant differences between FRDA patients and controls were found in five out of twelve investigated structures, and statistically significant correlations with disease characteristics were revealed. Moreover, VBM revealed significant white matter atrophy within regions of the brainstem, and the cerebellum. These regions overlapped partially with brain regions for which significant differences between healthy controls and patients were found in the VOI-based quantitative MRI evaluation. It was shown that two independent analyses provided overlapping results. Moreover, positive results on correlations with disease characteristics were found, indicating that these quantitative MRI parameters could provide more detailed information and assist the search for effective treatments.
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Affiliation(s)
- Sina Straub
- Division of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Julian Emmerich
- Division of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | | | - Wolfgang Nachbauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Katja S Degenhardt
- Division of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany.,Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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23
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Selvadurai LP, Corben LA, Delatycki MB, Storey E, Egan GF, Georgiou‐Karistianis N, Harding IH. Multiple mechanisms underpin cerebral and cerebellar white matter deficits in Friedreich ataxia: The IMAGE-FRDA study. Hum Brain Mapp 2020; 41:1920-1933. [PMID: 31904895 PMCID: PMC7267947 DOI: 10.1002/hbm.24921] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 01/16/2023] Open
Abstract
Friedreich ataxia is a progressive neurodegenerative disorder with reported abnormalities in cerebellar, brainstem, and cerebral white matter. White matter structure can be measured using in vivo neuroimaging indices sensitive to different white matter features. For the first time, we examined the relative sensitivity and relationship between multiple white matter indices in Friedreich ataxia to more richly characterize disease expression and infer possible mechanisms underlying the observed white matter abnormalities. Diffusion-tensor, magnetization transfer, and T1-weighted structural images were acquired from 31 individuals with Friedreich ataxia and 36 controls. Six white matter indices were extracted: fractional anisotropy, diffusivity (mean, axial, radial), magnetization transfer ratio (microstructure), and volume (macrostructure). For each index, whole-brain voxel-wise between-group comparisons and correlations with disease severity, onset age, and gene triplet-repeat length were undertaken. Correlations between pairs of indices were assessed in the Friedreich ataxia cohort. Spatial similarities in the voxel-level pattern of between-group differences across the indices were also assessed. Microstructural abnormalities were maximal in cerebellar and brainstem regions, but evident throughout the brain, while macroscopic abnormalities were restricted to the brainstem. Poorer microstructure and reduced macrostructural volume correlated with greater disease severity and earlier onset, particularly in peri-dentate nuclei and brainstem regions. Microstructural and macrostructural abnormalities were largely independent. Reduced fractional anisotropy was most strongly associated with axial diffusivity in cerebral tracts, and magnetization transfer in cerebellar tracts. Multiple mechanisms likely underpin white matter abnormalities in Friedreich ataxia, with differential impacts in cerebellar and cerebral pathways.
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Affiliation(s)
- Louisa P. Selvadurai
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Louise A. Corben
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia
| | - Martin B. Delatycki
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia
- Victorian Clinical Genetics ServicesParkvilleVictoriaAustralia
| | - Elsdon Storey
- Department of MedicineMonash UniversityPrahranVictoriaAustralia
| | - Gary F. Egan
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
- Monash Biomedical ImagingMonash UniversityClaytonVictoriaAustralia
| | - Nellie Georgiou‐Karistianis
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Ian H. Harding
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
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