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Grobe-Einsler M, Baljasnikowa V, Faikus A, Schaprian T, Kaut O. Cerebellar transcranial magnetic stimulation improves motor function in Parkinson's disease. Ann Clin Transl Neurol 2024. [PMID: 39238196 DOI: 10.1002/acn3.52183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/19/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE To determine whether an accelerated protocol of 48 Hz cerebellar repetitive transcranial magnetic stimulation results in improved motor function in individuals with Parkinson's disease. METHODS In this double-blind randomized sham-controlled study, 35 individuals with Parkinson's disease and stable medical treatment were randomized to either sham or verum transcranial magnetic stimulation. The stimulation was applied bilaterally and medial over the cerebellum and comprised a novel accelerated protocol encompassing two sessions per day on 5 consecutive days. Patients were assessed at baseline, on day 5 after the last stimulation and 1 month post intervention. Measurements included dynamic posturography, UPDRS III, 8-Meter walk test, and Timed Up and Go test. RESULTS The accelerated protocol was safe and feasible in an outpatient setting. Patients in the verum group showed significant improvement (p < 0.001) of motor symptoms as measured in the UPDRS III. Improvement was mainly carried by the domains rigor, bradykinesia, and gait and persisted after 1 month (p = 0.009), whereas tremor remained unchanged. INTERPRETATION The effect of a high-dose transcranial magnetic stimulation in patients with Parkinson's disease is encouraging and comparable to other studies using much longer stimulation protocols. This short-term intervention of 5 days facilitates the future application in an outpatient setting. Reduction in hospitalization rates directly benefits patients with motor impairment.
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Affiliation(s)
- Marcus Grobe-Einsler
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Aline Faikus
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Tamara Schaprian
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Oliver Kaut
- SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
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Mercado NM, Szarowicz C, Stancati JA, Sortwell CE, Boezwinkle SA, Collier TJ, Caulfield ME, Steece-Collier K. Advancing age and the rs6265 BDNF SNP are permissive to graft-induced dyskinesias in parkinsonian rats. NPJ Parkinsons Dis 2024; 10:163. [PMID: 39179609 PMCID: PMC11344059 DOI: 10.1038/s41531-024-00771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024] Open
Abstract
The rs6265 single nucleotide polymorphism (SNP) in the gene for brain-derived neurotrophic factor is a common variant that alters therapeutic outcomes for individuals with Parkinson's disease (PD). We previously investigated the effects of this SNP on the experimental therapeutic approach of neural grafting, demonstrating that young adult parkinsonian rats carrying the variant Met allele exhibited enhanced graft function compared to wild-type rats and also exclusively developed aberrant graft-induced dyskinesias (GID). Aging is the primary risk factor for PD and reduces graft efficacy. Here we investigated whether aging interacts with this SNP to further alter cell transplantation outcomes. We hypothesized that aging would reduce enhancement of graft function associated with this genetic variant and exacerbate GID in all grafted subjects. Unexpectedly, beneficial graft function was maintained in aged rs6265 subjects. However, aging was permissive to GID induction, regardless of genotype, with the greatest incidence and severity found in rs6265-expressing animals.
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Affiliation(s)
- Natosha M Mercado
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Carlye Szarowicz
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
| | - Jennifer A Stancati
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Caryl E Sortwell
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, 49503, USA
| | - Samuel A Boezwinkle
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Timothy J Collier
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, 49503, USA
| | - Margaret E Caulfield
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Kathy Steece-Collier
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA.
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, 49503, USA.
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Gandhi SE, Nodehi A, Lawton MA, Grosset KA, Marshall V, Ben-Shlomo Y, Grosset DG. Dopa Responsiveness in Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 38898616 DOI: 10.1002/mdc3.14139] [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: 01/30/2024] [Revised: 04/26/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dopaminergic responsiveness is a defining feature of Parkinson's disease (PD). However, there is limited information on how this evolves over time. OBJECTIVES To examine serial dopaminergic responses, if there are distinct patterns, and which factors predict these. METHODS We analyzed data from the Parkinson's Progression Markers Initiative on repeated dopaminergic challenge tests (≥24.5% defined as a definite response). Growth-mixture modeling evaluated for different response patterns and multinomial logistic regression tested for predictors of these clusters. RESULTS 1525 dopaminergic challenge tests were performed in 336 patients. At enrolment, mean age was 61.2 years (SD 9.6), 66.4% were male and disease duration was 0.5 years (SD 0.5). 1 to 2 years after diagnosis, 48.0% of tests showed a definite response, but this proportion increased with longer disease duration (51.1-74.3%). We identified 3 response groups: "Striking" (n = 29, 8.7%); "Excellent" (n = 110; 32.7%) and "Modest" (n = 197, 58.6%). Significant differences were as follows: striking responders commenced treatment earlier (P = 0.02), were less likely to be on dopamine agonist monotherapy (P = 0.01), and had better cognition (P < 0.01) and activities of daily living (P = 0.01). Excellent responders had higher challenge doses (P = 0.03) and were more likely to be on combination therapy (P < 0.01). CONCLUSION Three distinct patterns of the dopaminergic response were observed. As the proportion of PD cases with definite dopa responsiveness increased over time, the initial treatment response may be an unreliable diagnostic aid.
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Affiliation(s)
- Sacha E Gandhi
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Anahita Nodehi
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael A Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Katherine A Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Vicky Marshall
- Institute of Neurological Sciences, Glasgow, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Donald G Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Kassubek J, Jost WH, Schwarz J. Sublingual apomorphine in the treatment of Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02777-z. [PMID: 38743091 DOI: 10.1007/s00702-024-02777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Abstract
Advanced Parkinson´s disease (PD) is often complicated by fluctuations of disability depending on plasma levels of levodopa. For most patients OFF phases with worsening of tremor and immobility, but also pain, depression, autonomic symptoms are troublesome. While adjustments of levodopa administrations can relief such fluctuations for some time, "on demand" therapies become more and more important. These "on demand" therapies should provide fast and efficacious relief. During the past years, new options for on demand therapies in PD-associated OFF episodes have been developed, including new formulations of levodopa and apomorphine to provide fast and readily accessible on demand treatment. In this narrative review, the challenges of the treatment of PD-associated fluctuations and OFF states are addressed, with a special focus on sublingual apomorphine (SL-APO) including the results from recent clinical trials.
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Affiliation(s)
- Jan Kassubek
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 16, 77723, Wolfach, Germany.
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Kumar SB, Girish A, Sutar S, Premanand SA, Garg V, Yadav AK, Shukla R, Murthy TPK, Singh TR. A computational study on structural and functional consequences of nsSNPs in human dopa decarboxylase. J Biomol Struct Dyn 2024:1-15. [PMID: 38193892 DOI: 10.1080/07391102.2023.2301517] [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: 07/28/2023] [Accepted: 11/04/2023] [Indexed: 01/10/2024]
Abstract
The Dopa Decarboxylase (DDC) gene plays an important role in the synthesis of biogenic amines such as dopamine, serotonin, and histamine. Non-synonymous single nucleotide polymorphisms (nsSNPs) in the DDC gene have been linked with various neurodegenerative disorders. In this study, a comprehensive in silico analysis of nsSNPs in the DDC gene was conducted to assess their potential functional consequences and associations with disease outcomes. Using publicly available databases, a complete list of nsSNPs in the DDC gene was obtained. 29 computational tools and algorithms were used to characterise the effects of these nsSNPs on protein structure, function, and stability. In addition, the population-based association studies were performed to investigate possible associations between specific nsSNPs and arthritis. Our research identified four novel DDC gene nsSNPs that have a major impact on the structure and function of proteins. Through molecular dynamics simulations (MDS), we observed changes in the stability of the DDC protein induced by specific nsSNPs. Furthermore, population-based association studies have revealed potential associations between certain DDC nsSNPs and various neurological disorders, including Parkinson's disease and dementia. The in silico approach used in this study offers insightful information about the functional effects of nsSNPs in the DDC gene. These discoveries provide insight into the cellular processes that underlie cognitive disorders. Furthermore, the detection of disease-associated nsSNPs in the DDC gene may facilitate the development of tailored and targeted therapy approaches.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- S Birendra Kumar
- Department of Biotechnology, Ramaiah Institute of Technology, Bengaluru, India
| | - Aishwarya Girish
- Department of Biotechnology, Ramaiah Institute of Technology, Bengaluru, India
| | - Samruddhi Sutar
- Department of Biotechnology, Ramaiah Institute of Technology, Bengaluru, India
| | | | - Vrinda Garg
- Department of Biotechnology, Ramaiah Institute of Technology, Bengaluru, India
| | - Arvind Kumar Yadav
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Solan, India
| | - Rohit Shukla
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Solan, India
| | - T P Krishna Murthy
- Department of Biotechnology, Ramaiah Institute of Technology, Bengaluru, India
| | - Tiratha Raj Singh
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Solan, India
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Wu Y, Xu XJ, Sun X, Zhai H, Wang T, Cao XB, Xu Y. Integrated PET/MRI With 11C-CFT and 18F-FDG for levodopa response difference in Parkinson's disease. Behav Brain Res 2023; 454:114609. [PMID: 37532003 DOI: 10.1016/j.bbr.2023.114609] [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: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
AIM Parkinson's disease is one of the most common neurodegenerative diseases. Excellent levodopa responsiveness has been proposed as a characteristic supporting feature in substantiating the PD diagnosis. However, a small portion of clinically established PD patients shows poor levodopa response. This study aims to investigate brain function alterations of PD patients with poor levodopa responsiveness by PET/MRI. METHOD A total of 46 PD patients were recruited. They all completed 11C-CFT PET/MRI scans and the acute levodopa challenge test. Among these 46 PD patients, 42 participants further underwent 18F-FDG PET/MRI scans. Clinical variables regarding demographic data, disease features and cognition scales were also collected. Based on the improvement rate of UPDRS-III, PD patients were divided into non-responders (improvement rate < 33 %) and responders (improvement rate ≥ 33 %). Statistical parametric zapping was performed to analyze molecular imaging. Dopaminergic uptake and metabolism of 70 brain regions were converted to quantitative values and expressed as standard uptake value (SUV). SUV was further normalized by the cerebellum. The resulting SUV ratios and clinical variables were then compared by SPSS. RESULTS The difference between levodopa non-responders (n = 17) and responders (n = 29) in the UPDRS III baseline was statistically significant and the former had a lower UPDRS III baseline (19 (10, 32), p<0.05). In contrast, no statistical difference between these two groups was found in age, gender, disease duration, cognition, motor subtype and Hoehn-Yahr stage. Dopaminergic uptake differences between levodopa non-responders (n = 17) and responders (n = 29) were shown in the left inferior frontal cortex (1.00 ± 0.09 vs 1.07 ± 0.08, p < 0.05 and FDR < 0.2), the right posterior cingulum (1.10 ± 0.10 vs 1.20 ± 0.13, p < 0.05 and FDR < 0.2) and the right insula (1.21 ± 0.12 vs 1.30 ± 0.10, p < 0.05 and FDR < 0.2). The metabolic alterations between levodopa non-responders (n = 16) and responders (n = 26) were shown in the right supplementary motor area (1.30 (1.18, 1.39) vs 1.41 (1.31, 1.53), p < 0.05 and FDR < 0.2), right precuneus (1.37 ± 0.10 vs 1.47 ± 0.18, p < 0.05 and FDR < 0.2), right parietal cortex (1.14 ± 0.15 vs 1.27 ± 0.21, p < 0.05 and FDR < 0.2), right supramarginal gyrus (1.16 (1.12, 1.26) vs 1.25 (1.14, 1.46), p < 0.05 and FDR < 0.2), right postcentral gyrus (1.15 (1.08, 1.32) vs 1.24 (1.17, 1.39), p < 0.05 and FDR < 0.2), medulla (0.75 ± 0.07 vs 0.80 ± 0.07, p < 0.05 and FDR < 0.2), right rolandic operculum (1.25 (1.18, 1.32) vs 1.33 (1.25, 1.50), p < 0.05 and FDR < 0.2), right olfactory (0.95 (0.91, 1.01) vs 1.01 (0.95, 1.15), p < 0.05 and FDR < 0.2), the right insula (1.15 (1.06, 1.22) vs 1.21 (1.12, 1.35), p < 0.05 and FDR < 0.2) and the left cerebellum crus (0.96 (0.91, 1.01) vs 0.92 (0.86, 0.96), p < 0.05 and FDR < 0.2). CONCLUSIONS PD patients with poor response to levodopa showed less severe impairment of baseline motor symptoms, more severe dopaminergic deficits in the left inferior frontal, right posterior cingulate cortex and the right insula, and lower metabolism in the right supplementary motor area, right precuneus, right parietal cortex, right supramarginal gyrus, right postcentral gyrus, medulla, right rolandic operculum, right olfactory, the right insula and higher metabolism in the left cerebellum crus.
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Affiliation(s)
- Yi Wu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Jun Xu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xun Sun
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Zhai
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xue-Bing Cao
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yan Xu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Pahwa R, Pagan FL, Kremens DE, Saint-Hilaire M. Clinical Use of On-Demand Therapies for Patients with Parkinson's Disease and OFF Periods. Neurol Ther 2023; 12:1033-1049. [PMID: 37221354 PMCID: PMC10310675 DOI: 10.1007/s40120-023-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
On-demand therapies for Parkinson's disease (PD) provide rapid, reliable relief for patients experiencing OFF periods; however, practical guidelines on the use of these therapies are not generally available. This paper reviews the use of on-demand treatments. Motor fluctuations occur in nearly all patients with PD after long-term use of levodopa. As the goal of PD treatment is to provide good ON time, on-demand treatments that have a more rapid reliable onset than the slower-acting oral medications provide rapid relief for OFF periods. All current on-demand treatments bypass the gastrointestinal tract, providing dopaminergic therapy directly into the blood stream by subcutaneous injection, through the buccal mucosa, or by inhalation into the pulmonary circulation. On-demand treatments are fast acting (10- to 20-min onset), with maximum, reliable, and significant responses reached within 30 min after administration. Oral medications pass through the gastrointestinal tract and thus have slower absorption owing to gastroparesis and competition with food. On-demand therapies, by providing fast-acting relief, can have a positive impact on a patient's quality of life when patients are experiencing OFF periods.
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Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd, Mailstop 2012, Kansas City, KS, 66160, USA.
| | - Fernando L Pagan
- Department of Neurology, Georgetown University Hospital, Washington, DC, USA
| | - Daniel E Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University School of Medicine, Boston, MA, USA
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Tan AH, Gatto EM. Movement Disorder Rounds: Learning through observation, Building on collective experiences. Parkinsonism Relat Disord 2023; 110:105396. [PMID: 37045676 DOI: 10.1016/j.parkreldis.2023.105396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Fatima TSD, Fathima ST, Kandadai RM, Borgohain R, Sreenu B, Kutala VK. Association of Catechol-O-Methyltransferase Gene Polymorphisms and Haplotypes in the Levodopa-Induced Adverse Events in Subjects with Parkinson's Disease. Indian J Clin Biochem 2023; 38:262-274. [PMID: 37025429 PMCID: PMC10070583 DOI: 10.1007/s12291-022-01046-8] [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: 02/23/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
The presence of dyskinesia is the most common side effect of chronic administration of levodopa in Parkinson's disease (PD) subjects. Genetic polymorphisms in levodopa metabolizing gene, catechol-O-methyl transferase (COMT), is shown to influence the inter-individual variability in drug response and adverse events. In the present study, the association of COMT rs6269, rs4633, rs4818, and rs4680 polymorphisms and haplotypes on pharmacokinetics and adverse events with levodopa was investigated in 150 PD patients. The age of onset of PD was 58.00 ± 10 yrs. The most common side effect faced by 78% of the subjects was dyskinesia. The AUC of levodopa was found to be significantly higher in subjects with dyskinesia (1695 ± 113 ng/ml/hr, p < 0.0001) than those without dyskinesia (1550 ± 122 ng/ml/hr). We found that the frequency of subjects presenting dyskinesia was significantly higher in subjects carrying variant genotype of COMT rs6269, rs4633, and rs4680 than that with wild genotype and these subjects presented higher AUC of levodopa. In addition, in subjects with dyskinesia, the AUC of levodopa was found to be significantly higher with low COMT (ACCG) haplotype. The association of COMT rs6269, COMT rs4633, COMT rs4818, and COMT rs4680 variant genotypes with the risk of dyskinesia due to levodopa therapy showed an ROC AUC of 0.67 indicating the moderate prediction of dyskinesia (p = 0.0021) with these COMT variants. In conclusion, PD subjects carrying the variant genotypes of COMT strongly influence high levodopa-induced dyskinesia. Hence the genotyping of COMT before the levodopa therapy will be useful to reduce the adverse events associated with the chronic levodopa treatment.
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Affiliation(s)
- Tasneem SD Fatima
- Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Syed Tazeem Fathima
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Rupam Borgohain
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Boddupally Sreenu
- Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Vijay Kumar Kutala
- Department of Biochemistry, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
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Caulfield ME, Vander Werp MJ, Stancati JA, Collier TJ, Sortwell CE, Sandoval IM, Manfredsson FP, Steece-Collier K. Downregulation of striatal CaV1.3 inhibits the escalation of levodopa-induced dyskinesia in male and female parkinsonian rats of advanced age. Neurobiol Dis 2023; 181:106111. [PMID: 37001610 DOI: 10.1016/j.nbd.2023.106111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
In the past 25 years, the prevalence of Parkinson's disease (PD) has nearly doubled. Age remains the primary risk factor for PD and as the global aging population increases this trend is predicted to continue. Even when treated with levodopa, the gold standard dopamine (DA) replacement therapy, individuals with PD frequently develop therapeutic side effects. Levodopa-induced dyskinesia (LID), a common side effect of long-term levodopa use, represents a significant unmet clinical need in the treatment of PD. Previously, in young adult (3-month-old) male parkinsonian rats, we demonstrated that the silencing of CaV1.3 (Cacan1d) L-type voltage-gated calcium channels via striatal delivery of rAAV-CaV1.3-shRNA provides uniform protection against the induction of LID, and significant reduction of established severe LID. With the goal of more closely replicating a clinical demographic, the current study examined the effects of CaV1.3-targeted gene therapy on LID escalation in male and female parkinsonian rats of advanced age (18-month-old at study completion). We tested the hypothesis that silencing aberrant CaV1.3 channel activity in the parkinsonian striatum would prevent moderate to severe dyskinesia with levodopa dose escalation. To test this hypothesis, 15-month-old male and female F344 rats were rendered unilaterally parkinsonian and primed with low-dose (3-4 mg/kg) levodopa. Following the establishment of stable, mild dyskinesias, rats received an intrastriatal injection of either the Cacna1d-specific rAAV-CaV1.3-shRNA vector (CAV-shRNA), or the scramble control rAAV-SCR-shRNA vector (SCR-shRNA). Daily (M-Fr) low-dose levodopa was maintained for 4 weeks during the vector transduction and gene silencing window followed by escalation to 6 mg/kg, then to 12 mg/kg levodopa. SCR-shRNA-shRNA rats showed stable LID expression with low-dose levodopa and the predicted escalation of LID severity with increased levodopa doses. Conversely, complex behavioral responses were observed in aged rats receiving CAV-shRNA, with approximately half of the male and female subjects-therapeutic 'Responders'-demonstrating protection against LID escalation, while the remaining half-therapeutic 'Non-Responders'-showed LID escalation similar to SCR-shRNA rats. Post-mortem histological analyses revealed individual variability in the detection of Cacna1d regulation in the DA-depleted striatum of aged rats. However, taken together, male and female therapeutic 'Responder' rats receiving CAV-shRNA had significantly less striatal Cacna1d in their vector-injected striatum relative to contralateral striatum than those with SCR-shRNA. The current data suggest that mRNA-level silencing of striatal CaV1.3 channels maintains potency in a clinically relevant in vivo scenario by preventing dose-dependent dyskinesia escalation in rats of advanced age. As compared to the uniform response previously reported in young male rats, there was notable variability between individual aged rats, particularly females, in the current study. Future investigations are needed to derive the sex-specific and age-related mechanisms which underlie variable responses to gene therapy and to elucidate factors which determine the therapeutic efficacy of treatment for PD.
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Fischer DL, Auinger P, Goudreau JL, Paumier KL, Cole-Strauss A, Kemp CJ, Lipton JW, Sortwell CE. BDNF rs10501087, rs1491850 and rs11030094 polymorphisms associated with delayed progression in early-stage Parkinson's disease. Front Neurol 2022; 13:1053591. [PMID: 36468063 PMCID: PMC9713476 DOI: 10.3389/fneur.2022.1053591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Parkinson's disease (PD) is heterogenous in its presentation, progression and response to therapies. Genetic polymorphisms may account for some of this variability. Several single nucleotide polymorphisms (SNPs) in the brain-derived neurotrophic factor gene BDNF have been associated with differing clinical outcomes from different dopaminergic replacement strategies, and one of these, the rs6265 SNP, has been associated with a milder clinical phenotype in the unmedicated, early-stage of PD. We examined if other BDNF SNPs with potential pharmacogenetic effects also are associated with different rates of disease progression. The Deprenyl And Tocopherol Antioxidative Therapy Of Parkinsonism (DATATOP) study was analyzed retrospectively. DNA samples (n = 217) were genotyped for the BDNF rs908867, rs11030094, rs10501087, rs1157659, and rs1491850 SNPs, and the primary endpoint was time to initiate symptomatic pharmacotherapy. Genotypes were compared using the Cox proportional hazard ratio (HR) with baseline age, sex, site, time since PD diagnosis and rs6265 genotype as covariates. The primary endpoint was associated with a delay with three SNPs: rs10501087 [HR (95% Confidence Interval) = 28.3 (3.6-223.1, p = 0.002) and 7.6 (1.9-29.8, p = 0.004) for T/T and T/C subjects, respectively, vs. C/C subjects], rs1491850 [HR = 3.3 (1.3-8.4, p = 0.04) and 2.8 (1.3-6.4, p = 0.03) for T/T and T/C subjects, respectively, vs. C/C subjects] and rs11030094 [HR = 2.5 (1.1-5.6, p = 0.03) and 2.0 (1.3-6.4, p = 0.03) for A/A and A/G subjects, respectively, vs. G/G subjects]. From the primary endpoint, specific rs10501087, rs1491850, and rs11030094 SNP genotypes are associated with a slower rate of PD progression in the unmedicated state. A prospective clinical trial examining many BDNF SNPs is warranted.
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Affiliation(s)
- D. Luke Fischer
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Peggy Auinger
- Department of Neurology, Center for Health and Technology, University of Rochester, Rochester, NY, United States
| | - John L. Goudreau
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, United States
| | - Katrina L. Paumier
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Allyson Cole-Strauss
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Christopher J. Kemp
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Jack W. Lipton
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, United States
| | - Caryl E. Sortwell
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, United States
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12
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Gaßner H, Trutt E, Seifferth S, Friedrich J, Zucker D, Salhani Z, Adler W, Winkler J, Jost WH. Treadmill training and physiotherapy similarly improve dual task gait performance: a randomized-controlled trial in Parkinson's disease. J Neural Transm (Vienna) 2022; 129:1189-1200. [PMID: 35697942 PMCID: PMC9463305 DOI: 10.1007/s00702-022-02514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022]
Abstract
Motor-cognitive dual tasks are used to investigate the interplay between gait and cognition. Dual task walking in patients with Parkinson's disease (PD) results in decreased gait speed and more importantly in an increased fall risk. There is evidence that physical training may improve gait during dual task challenge. Physiotherapy and treadmill walking are known to improve single task gait. The aim of this study was to investigate the impact of individualized physiotherapy or treadmill training on gait during dual task performance. 105 PD patients were randomly assigned to an intervention group (physiotherapy or treadmill). Both groups received 10 individual interventional sessions of 25 min each and additional group therapy sessions for 14 days. Primary outcome measure was the dual task gait speed. Secondary outcomes were additional gait parameters during dual task walking, UPDRS-III, BBS and walking capacity. All gait parameters were recorded using sensor-based gait analysis. Gait speed improved significantly by 4.2% (treadmill) and 8.3% (physiotherapy). Almost all secondary gait parameters, UPDRS-III, BBS, and walking capacity improved significantly and similarly in both groups. However, interaction effects were not observed. Both interventions significantly improved gait in patients with mild to moderate PD. However, treadmill walking did not show significant benefits compared to individualized physiotherapy. Our data suggest that both interventions improve dual task walking and therefore support safe and independent walking. This result may lead to more tailored therapeutic preferences.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
- Fraunhofer IIS, Fraunhofer Institute for Integrated Circuits IIS, Am Wolfsmantel 33, 91058, Erlangen, Germany.
| | | | - Sarah Seifferth
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Jana Friedrich
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | | | | | - Werner Adler
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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13
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Levodopa responsiveness in Parkinson's disease: harnessing real-life experience with machine-learning analysis. J Neural Transm (Vienna) 2022; 129:1289-1297. [PMID: 36030311 DOI: 10.1007/s00702-022-02540-2] [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: 05/16/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
Responsiveness to levodopa varies greatly among patients with Parkinson's disease (PD). The factors that affect it are ill defined. The aim of the study was to identify factors predictive of long-term response to levodopa. The medical records of 296 patients with PD (mean age of onset, 62.2 ± 9.7 years) were screened for demographics, previous treatments, and clinical phenotypes. All patients were assessed with the Unified PD Rating Scale (UPDRS)-III before and 3 months after levodopa initiation. Regression and machine-learning analyses were used to determine factors that are associated with levodopa responsiveness and might identify patients who will benefit from treatment. The UPDRS-III score improved by ≥ 30% (good response) in 128 patients (43%). On regression analysis, female gender, young age at onset, and early use of dopamine agonists predicted a good response. Time to initiation of levodopa treatment had no effect on responsiveness except in patients older than 72 years, who were less responsive. Machine-learning analysis validated these factors and added several others: symptoms of rigidity and bradykinesia, disease onset in the legs and on the left side, and fewer white vascular ischemic changes, comorbidities, and pre-non-motor symptoms. The main determinants of variations in levodopa responsiveness are gender, age, and clinical phenotype. Early use of dopamine agonists does not hamper levodopa responsiveness. In addition to validating the regression analysis results, machine-learning methods helped to determine the specific clinical phenotype of patients who may benefit from levodopa in terms of comorbidities and pre-motor and non-motor symptoms.
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14
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Szarowicz CA, Steece-Collier K, Caulfield ME. New Frontiers in Neurodegeneration and Regeneration Associated with Brain-Derived Neurotrophic Factor and the rs6265 Single Nucleotide Polymorphism. Int J Mol Sci 2022; 23:ijms23148011. [PMID: 35887357 PMCID: PMC9319713 DOI: 10.3390/ijms23148011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Brain-derived neurotrophic factor is an extensively studied neurotrophin implicated in the pathology of multiple neurodegenerative and psychiatric disorders including, but not limited to, Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, traumatic brain injury, major de-pressive disorder, and schizophrenia. Here we provide a brief summary of current knowledge on the role of BDNF and the common human single nucleotide polymorphism, rs6265, in driving the pathogenesis and rehabilitation in these disorders, as well as the status of BDNF-targeted therapies. A common trend has emerged correlating low BDNF levels, either detected within the central nervous system or peripherally, to disease states, suggesting that BDNF replacement therapies may hold clinical promise. In addition, we introduce evidence for a distinct role of the BDNF pro-peptide as a biologically active ligand and the need for continuing studies on its neurological function outside of that as a molecular chaperone. Finally, we highlight the latest research describing the role of rs6265 expression in mechanisms of neurodegeneration as well as paradoxical advances in the understanding of this genetic variant in neuroregeneration. All of this is discussed in the context of personalized medicine, acknowledging there is no “one size fits all” therapy for neurodegenerative or psychiatric disorders and that continued study of the multiple BDNF isoforms and genetic variants represents an avenue for discovery ripe with therapeutic potential.
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Affiliation(s)
- Carlye A. Szarowicz
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (C.A.S.); (K.S.-C.)
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 48824, USA
| | - Kathy Steece-Collier
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (C.A.S.); (K.S.-C.)
| | - Margaret E. Caulfield
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (C.A.S.); (K.S.-C.)
- Correspondence: ; Tel.: +1-616-234-0969; Fax: +1- 616-234-0991
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15
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Betrouni N, Moreau C, Rolland AS, Carrière N, Viard R, Lopes R, Kuchcinski G, Eusebio A, Thobois S, Hainque E, Hubsch C, Rascol O, Brefel C, Drapier S, Giordana C, Durif F, Maltête D, Guehl D, Hopes L, Rouaud T, Jarraya B, Benatru I, Tranchant C, Tir M, Chupin M, Bardinet E, Defebvre L, Corvol JC, Devos D. Can Dopamine Responsiveness Be Predicted in Parkinson's Disease Without an Acute Administration Test? JOURNAL OF PARKINSON'S DISEASE 2022; 12:2179-2190. [PMID: 35871363 DOI: 10.3233/jpd-223334] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dopamine responsiveness (dopa-sensitivity) is an important parameter in the management of patients with Parkinson's disease (PD). For quantification of this parameter, patients undergo a challenge test with acute Levodopa administration after drug withdrawal, which may lead to patient discomfort and use of significant resources. OBJECTIVE Our objective was to develop a predictive model combining clinical scores and imaging. METHODS 350 patients, recruited by 13 specialist French centers and considered for deep brain stimulation, underwent an acute L-dopa challenge (dopa-sensitivity > 30%), full assessment, and MRI investigations, including T1w and R2* images. Data were randomly divided into a learning base from 10 centers and data from the remaining centers for testing. A machine selection approach was applied to choose the optimal variables and these were then used in regression modeling. Complexity of the modelling was incremental, while the first model considered only clinical variables, the subsequent included imaging features. The performances were evaluated by comparing the estimated values and actual valuesResults:Whatever the model, the variables age, sex, disease duration, and motor scores were selected as contributors. The first model used them and the coefficients of determination (R2) was 0.60 for the testing set and 0.69 in the learning set (p < 0.001). The models that added imaging features enhanced the performances: with T1w (R2 = 0.65 and 0.76, p < 0.001) and with R2* (R2 = 0.60 and 0.72, p < 0.001). CONCLUSION These results suggest that modeling is potentially a simple way to estimate dopa-sensitivity, but requires confirmation in a larger population, including patients with dopa-sensitivity < 30.
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Affiliation(s)
- Nacim Betrouni
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
| | - Caroline Moreau
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- CHU Lille, Neurology and Movement Disorders Department, Reference Center for Parkinson's Disease, Lille, France; NS-Park French Network
| | - Anne-Sophie Rolland
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
| | - Nicolas Carrière
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- CHU Lille, Neurology and Movement Disorders Department, Reference Center for Parkinson's Disease, Lille, France; NS-Park French Network
- University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France; NS-Park French Network
| | - Romain Viard
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France; NS-Park French Network
| | - Renaud Lopes
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France; NS-Park French Network
| | - Gregory Kuchcinski
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- CHU Lille, Neuroradioloy Department, Lille, France
| | - Alexandre Eusebio
- Aix Marseille Universitë, AP-HM, Hôpital de La Timone, Service de Neurologie et Pathologie du Mouvement, UMR CNRS 7289, Institut de Neuroscience de La Timone, Marseille, France; NS-Park French Network
| | - Stephane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, Bron, France
| | - Elodie Hainque
- Dëpartement de Neurologie, Hôpital Pitië-Salpêtrière, AP-HP, Paris, France; NS-Park French Network
| | - Cecile Hubsch
- Fondation Ophtalmologique A de Rothschild, Unitë James Parkinson, Paris, France; NS-Park French Network
| | - Olivier Rascol
- University of Toulouse 3, University Hospital of Toulouse, INSERM, Departments of Neuroscience and Clinical Pharmacology, Clinical Investigation Center CIC 1436, Toulouse Parkinson Expert Center, NS-NeuroToul Center of Excellence for Neurodegenerative Disorders (COEN), Toulouse, France; NS-Park French Network
| | - Christine Brefel
- University of Toulouse 3, University Hospital of Toulouse, INSERM, Departments of Neuroscience and Clinical Pharmacology, Clinical Investigation Center CIC 1436, Toulouse Parkinson Expert Center, NS-NeuroToul Center of Excellence for Neurodegenerative Disorders (COEN), Toulouse, France; NS-Park French Network
| | - Sophie Drapier
- Service de Neurologie, CHU Pont Chaillou, 2 rue Henri le Guilloux, Rennes cedex, France; NS-Park French Network
| | - Caroline Giordana
- Universitë Clermont Auvergne, EA7280, Clermont-Ferrand University Hospital, Neurology Department, Clermont-Ferrand, France; NS-Park French Network
| | - Franck Durif
- Universitë Clermont Auvergne, EA7280, Clermont-Ferrand University Hospital, Neurology Department, Clermont-Ferrand, France; NS-Park French Network
| | - David Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France; NS-Park French Network
| | - Dominique Guehl
- Service d'Explorations Fonctionnelles du Système Nerveux, Institut des Maladies Neurodëgënëratives Cliniques, CHU de Bordeaux, Bordeaux, France; NS-Park French Network
| | - Lucie Hopes
- Neurology Department, Nancy University Hospital, Nancy, France; NS-Park French Network
| | - Tiphaine Rouaud
- Clinique Neurologique, Hôpital Guillaume et Renë Laennec, Boulevard Jacques Monod, Nantes Cedex, France; NS-Park French Network
| | - Bechir Jarraya
- Movement Disorders Unit, Foch Hospital, Universitë Paris-Saclay (UVSQ), INSERM U992, NeuroSpin, CEA Paris-Saclay, Suresnes, France; NS-Park French Network
| | - Isabelle Benatru
- Service de Neurologie, Centre Expert Parkinson, CIC-INSERM 1402, CHU Poitiers, Poitiers, France; NS-Park French Network
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Institut de Gënëtique et de Biologie Molëculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Universitë de Strasbourg, Illkirch, France; Fëdëration de Mëdecine Translationnelle de Strasbourg (FMTS), Universitë de Strasbourg, Strasbourg, France; NS-Park French Network
| | - Melissa Tir
- Department of Neurosurgery, Amiens University Hospital, Amiens, France; Medical Imaging Unit, Amiens University Hospital, Amiens, France; BioFlowImage Research Group, Jules Verne University of Picardie, Amiens, France; NS-Park French Network
| | - Marie Chupin
- CATI, Institut du Cerveau et de le Moelle Epinière, ICM, INSERM U1127, CNRS UMR7225, Sorbonne Universitë, Paris, France
| | - Eric Bardinet
- Institut du Cerveau et de le Moelle Epinière, ICM, INSERM U1127, CNRS UMR7225, Sorbonne Universitë, Paris, France
| | - Luc Defebvre
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- CHU Lille, Neurology and Movement Disorders Department, Reference Center for Parkinson's Disease, Lille, France; NS-Park French Network
| | - Jean-Christophe Corvol
- Dëpartement de Neurologie, Hôpital Pitië-Salpêtrière, AP-HP, Paris, France; NS-Park French Network
- Facultë de Mëdecine de Sorbonne Universitë, UMR S 1127, INSERM U 1127, and CNRS UMR 7225, and Institut du Cerveau et de la Moëlle Epinière, Paris, France; NS-Park French Network
| | - David Devos
- University Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, Lille, France
- CHU Lille, Neurology and Movement Disorders Department, Reference Center for Parkinson's Disease, Lille, France; NS-Park French Network
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16
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Sortwell CE, Hacker ML, Fischer DL, Konrad PE, Davis TL, Neimat JS, Wang L, Song Y, Mattingly ZR, Cole-Strauss A, Lipton JW, Charles PD. BDNF rs6265 Genotype Influences Outcomes of Pharmacotherapy and Subthalamic Nucleus Deep Brain Stimulation in Early-Stage Parkinson's Disease. Neuromodulation 2021; 25:846-853. [PMID: 34288271 PMCID: PMC8770717 DOI: 10.1111/ner.13504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The efficacy of pharmacotherapy and deep brain stimulation of the subthalamic nucleus in treating Parkinson's disease motor symptoms is highly variable and may be influenced by patient genotype. The relatively common (prevalence about one in three) and protein-altering rs6265 single nucleotide polymorphism (C > T) in the gene BDNF has been associated with different clinical outcomes with levodopa. OBJECTIVE We sought to replicate this reported association in early-stage Parkinson's disease subjects and to examine whether a difference in clinical outcomes was present with subthalamic nucleus deep brain stimulation. MATERIALS AND METHODS Fifteen deep brain stimulation and 13 medical therapy subjects were followed for 24 months as part of the Vanderbilt DBS in Early Stage PD clinical trial (NCT00282152, FDA IDE #G050016). Primary outcome measures were the Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Questionnaire-39. RESULTS Outcomes with drug therapy in subjects carrying the rs6265 T allele were significantly worse following 12 months of treatment compared to C/C subjects (UPDRS: +20 points, p = 0.019; PDQ-39: +16 points, p = 0.018). In contrast, rs6265 genotype had no effect on overall motor response to subthalamic nucleus deep brain stimulation at any time point; further, rs6265 C/C subjects treated with stimulation were associated with worse UPDRS part II scores at 24 months compared to medical therapy. CONCLUSIONS Genotyping for the rs6265 polymorphism may be useful for predicting long-term response to drug therapy and counseling Parkinson's disease patients regarding whether to consider earlier subthalamic nucleus deep brain stimulation. Validation in a larger cohort of early-stage Parkinson's disease subjects is warranted.
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Affiliation(s)
- Caryl E Sortwell
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Luke Fischer
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph S Neimat
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lily Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yanna Song
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zach R Mattingly
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Allyson Cole-Strauss
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Jack W Lipton
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.,Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - P David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Levodopa responsiveness in Parkinson's disease patients and white matter alterations in diffusion tensor imaging: a cross-sectional tract-based spatial statistics study. Neuroreport 2021; 32:636-642. [PMID: 33850092 DOI: 10.1097/wnr.0000000000001641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to investigate the relationship between levodopa responsiveness and white matter alterations in Parkinson's disease patients using diffusion tensor imaging (DTI). Twenty-six recruited Parkinson's disease patients were evaluated using the Mini-Mental State Examination, Hoehn and Yahr scale (H&Y) and Unified Parkinson's Disease Rating Scale (UPDRS). Each patient underwent a DTI scan and an acute levodopa challenge test. The improvement rate of UPDRS-III was calculated, Parkinson's disease patients were grouped into a responsive group (improvement rate ≥30%) and a nonresponsive group (improvement rate <30%). The differences in fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity between the two groups were measured using tract-based spatial statistics. There was no difference in demographic features or baseline evaluations between groups. The UPDRS-III score after the challenge was higher in the nonresponsive group than that in the responsive group. Compared to the responsive group, patients in the nonresponsive group exhibited decreased fractional anisotropy in the corpus callosum; cingulum; left corona radiata; left internal capsule; left middle frontal gyrus; left superior longitudinal fasciculus and right somatosensory cortex. Mean diffusivity and radial diffusivity were increased in wide-ranging areas in the nonresponsive group. No difference was observed in axial diffusivity. White matter alterations in the abovementioned areas may affect the function of the dopaminergic network and thus may be associated with the levodopa response in Parkinson's disease patients. Further studies are needed to analyze the specific mechanism and pathological changes underlying these effects.
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18
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Martin WRW, Miles M, Zhong Q, Hartlein J, Racette BA, Norris SA, Ushe M, Maiti B, Criswell S, Davis AA, Kotzbauer PT, Cairns NJ, Perrin RJ, Perlmutter JS. Is Levodopa Response a Valid Indicator of Parkinson's Disease? Mov Disord 2021; 36:948-954. [PMID: 33253432 PMCID: PMC8046721 DOI: 10.1002/mds.28406] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The clinical diagnosis of Parkinson's disease (PD) requires the presence of parkinsonism and supportive criteria that include a clear and dramatic beneficial response to dopaminergic therapy. Our aim was to test the diagnostic criterion of dopaminergic response by evaluating its association with pathologically confirmed diagnoses in a large population of parkinsonian patients. METHODS We reviewed clinical data maintained in an electronic medical record from all patients with autopsy data who had been seen in the Movement Disorders Center at Washington University, St. Louis, between 1996 and 2018. All patients with parkinsonism who underwent postmortem neuropathologic examination were included in this analysis. RESULTS There were 257 unique parkinsonian patients with autopsy-based diagnoses who had received dopaminergic therapy. Marked or moderate response to dopaminergic therapy occurred in 91.2% (166/182) of those with autopsy-confirmed PD, 52.0% (13/25) of those with autopsy-confirmed multiple systems atrophy, 44.4% (8/18) of those with autopsy-confirmed progressive supranuclear palsy, and 1 (1/8) with autopsy-confirmed corticobasal degeneration. Other diagnoses were responsible for the remaining 24 individuals, 9 of whom had a moderate response to dopaminergic therapy. CONCLUSION A substantial response to dopaminergic therapy is frequent but not universal in PD. An absent response does not exclude PD. In other neurodegenerative disorders associated with parkinsonism, a prominent response may also be evident, but this occurs less frequently than in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- W R Wayne Martin
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Michael Miles
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Qiaonan Zhong
- Department of Medicine, Mayo Clinic, Rochester, Missouri, USA
| | - Johanna Hartlein
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brad A Racette
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | - Scott A Norris
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mwiza Ushe
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Baijayanta Maiti
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan Criswell
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Albert A Davis
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Paul T Kotzbauer
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nigel J Cairns
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Richard J Perrin
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Departments of Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
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The BDNF Val66Met polymorphism (rs6265) enhances dopamine neuron graft efficacy and side-effect liability in rs6265 knock-in rats. Neurobiol Dis 2020; 148:105175. [PMID: 33188920 PMCID: PMC7855552 DOI: 10.1016/j.nbd.2020.105175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Prevalent in approximately 20% of the worldwide human population, the
rs6265 (also called ‘Val66Met’) single nucleotide polymorphism
(SNP) in the gene for brain-derived neurotrophic factor (BDNF)
is a common genetic variant that can alter therapeutic responses in individuals
with Parkinson’s disease (PD). Possession of the variant Met allele
results in decreased activity-dependent release of BDNF. Given the resurgent
worldwide interest in neural transplantation for PD and the biological relevance
of BDNF, the current studies examined the effects of the rs6265 SNP on
therapeutic efficacy and side-effect development following primary dopamine (DA)
neuron transplantation. Considering the significant reduction in BDNF release
associated with rs6265, we hypothesized that rs6265-mediated dysfunctional BDNF
signaling contributes to the limited clinical benefit observed in a
subpopulation of PD patients despite robust survival of grafted DA neurons, and
further, that this mutation contributes to the development of aberrant
graft-induced dyskinesias (GID). To this end, we generated a CRISPR knock-in rat
model of the rs6265 BDNF SNP to examine for the first time the
influence of a common genetic polymorphism on graft survival, functional
efficacy, and side-effect liability, comparing these parameters between
wild-type (Val/Val) rats and those homozygous for the variant Met allele
(Met/Met). Counter to our hypothesis, the current research indicates that
Met/Met rats show enhanced graft-associated therapeutic efficacy and a
paradoxical enhancement of graft-derived neurite outgrowth compared to wild-type
rats. However, consistent with our hypothesis, we demonstrate that the rs6265
genotype in the host rat is strongly linked to development of GID, and that this
behavioral phenotype is significantly correlated with neurochemical signatures
of atypical glutamatergic neurotransmission by grafted DA neurons.
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Fischer DL, Auinger P, Goudreau JL, Cole-Strauss A, Kieburtz K, Elm JJ, Hacker ML, Charles PD, Lipton JW, Pickut BA, Sortwell CE. BDNF rs6265 Variant Alters Outcomes with Levodopa in Early-Stage Parkinson's Disease. Neurotherapeutics 2020; 17:1785-1795. [PMID: 33215284 PMCID: PMC7851242 DOI: 10.1007/s13311-020-00965-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Disease outcomes are heterogeneous in Parkinson's disease and may be predicted by gene variants. This study investigated if the BDNF rs6265 single nucleotide polymorphism (SNP) is associated with differential outcomes with specific pharmacotherapy treatment strategies in the "NIH Exploratory Trials in PD Long-term Study 1" (NET-PD LS-1, n = 540). DNA samples were genotyped for the rs6265 SNP and others (rs11030094, rs10501087, rs1491850, rs908867, and rs1157659). The primary measures were the Unified Parkinson's Disease Rating Scale (UPDRS) and its motor component (UPDRS-III). Groups were divided by genotype and treatment regimen (levodopa monotherapy vs levodopa with other medications vs no levodopa). T allele carriers were associated with worse UPDRS outcomes compared to C/C subjects when treated with levodopa monotherapy (+ 6 points, p = 0.02) and to T allele carriers treated with no levodopa treatment strategies (UPDRS: + 8 points, p = 0.01; UPDRS-III: + 6 points, p = 0.01). Similar effects of worse outcomes associated with levodopa monotherapy were observed in the BDNF rs11030094, rs10501087, and rs1491850 SNPs. This study suggests the levodopa monotherapy strategy is associated with worse disease outcomes in BDNF rs6265 T carriers. Pending prospective validation, BDNF variants may be precision medicine factors to consider for symptomatic treatment decisions for early-stage PD patients.
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Affiliation(s)
- D Luke Fischer
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
| | - Peggy Auinger
- Center for Health and Technology, Department of Neurology, University of Rochester, Rochester, NY, USA
| | - John L Goudreau
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Allyson Cole-Strauss
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
| | - Karl Kieburtz
- Center for Health and Technology, Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Jordan J Elm
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jack W Lipton
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Barbara A Pickut
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Caryl E Sortwell
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA.
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA.
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Genetic variations in catechol-O-methyltransferase gene are associated with levodopa response variability in Chinese patients with Parkinson's disease. Sci Rep 2020; 10:9521. [PMID: 32533012 PMCID: PMC7293305 DOI: 10.1038/s41598-020-65332-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/01/2020] [Indexed: 01/26/2023] Open
Abstract
Catechol-O-methyltransferase (COMT) is one of the main enzymes in dopamine metabolism and is reported to be associated with susceptibility to Parkinson’s disease (PD) and pharmacotherapy. However, researchers mostly focus on the most common polymorphism, rs4680. In this case-control study, we investigated the association of SNPs other than rs4680 with the levodopa (L-dopa) response and other clinical features in Chinese PD patients. Eleven single nucleotide polymorphisms (SNPs) in the COMT gene were genotyped, and clinical data were collected. Patients with the TT genotype of rs165728 or rs174699 had larger daily levodopa equivalent doses (LEDs) than the patients with CC and CT genotypes under the dominant model (p = 0.01421 for rs165728 and p = 0.02302 for rs174699). Under the dominant model, the patients with GG at rs4680 G > A had a lower occurrence of dyskinesia than those with AA and AG (p = 0.0196). Patients with CC at rs4633 had a lower occurrence of dyskinesia than those with TT and TC (p = 0.0429) under the dominant model. The frequencies of the rs174675 T and rs933271 C alleles were higher in PD patients than in the controls (p < 0.05). Our primary results showed the possible association of SNPs other than the most common functional rs4680 in COMT with interindividual variance in the L-dopa daily dose and susceptibility to dyskinesia in Chinese patients, although this was an exploratory study based on a small sample size. Larger and more randomized samples are necessary for further investigation.
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Kuusimäki T, Kurki S, Sipilä JOT, Salminen-Mankonen H, Carpén O, Kaasinen V. Sex-Dependent Improvement in Survival of Parkinson's Disease Patients. Mov Disord Clin Pract 2020; 7:516-520. [PMID: 32626796 DOI: 10.1002/mdc3.12954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/14/2020] [Accepted: 03/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background Advances in the treatment of Parkinson's disease (PD) and changes in general life expectancy may have improved survival in patients with PD. Objective The objective of this study was to investigate recent trends in PD mortality. Methods In total, 1521 patients with PD in local and national registries were followed for 11 years (2006-2016) from diagnosis until exit date or death, and the causes of death were recorded. Results The survival of men with PD improved during the follow-up period, but no change was observed in women (2-year postdiagnosis survival in men, 79.0%-86.3%, P = 0.03; 2-year postdiagnosis survival in women, 82.8%-87.5%, P = 0.42). Pneumonia was the most common immediate cause of death. Discussion The survival of men with PD has improved in Finland without a similar change in women. Because changes in treatment likely affect both sexes similarly, the results may reflect the decreasing sex gap in life expectancy. This phenomenon will likely increase the already high male-to-female prevalence ratio of PD.
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Affiliation(s)
- Tomi Kuusimäki
- Division of Clinical Neurosciences Turku University Hospital Turku Finland.,Department of Clinical Neurosciences University of Turku Turku Finland
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital Turku Finland
| | - Jussi O T Sipilä
- Division of Clinical Neurosciences Turku University Hospital Turku Finland.,Department of Clinical Neurosciences University of Turku Turku Finland.,Siun Sote, North Karelia Central Hospital, Department of Neurology Joensuu Finland
| | - Heli Salminen-Mankonen
- Turku Centre for Biotechnology University of Turku and Åbo Akademi University Turku Finland
| | - Olli Carpén
- Auria Biobank, University of Turku and Turku University Hospital Turku Finland.,Department of Pathology University of Turku and Turku University Hospital Turku Finland.,Department of Pathology and Research Program for Systems Oncology University of Helsinki and Helsinki University Hospital Laboratory, Helsinki University Hospital Helsinki Finland
| | - Valtteri Kaasinen
- Division of Clinical Neurosciences Turku University Hospital Turku Finland.,Department of Clinical Neurosciences University of Turku Turku Finland
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23
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Pitz V, Malek N, Tobias ES, Grosset KA, Gentleman S, Grosset DG. The Levodopa Response Varies in Pathologically Confirmed Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2020; 7:218-222. [PMID: 32071945 DOI: 10.1002/mdc3.12885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/11/2019] [Accepted: 12/02/2019] [Indexed: 01/18/2023] Open
Abstract
Background A good response to levodopa is a key feature of Parkinson's disease (PD), and a poor response suggests an alternative diagnosis, but the extent of variation in the levodopa response in definite PD is not well defined. Literature Review A systematic review of articles reporting pathologically confirmed PD and levodopa responsiveness from 1971 to 2018 was performed using the medical subheadings "postmortem," "Parkinson's disease," "levodopa," and "l-dopa" in PubMed, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) databases. Cases A total of 12 articles described 445 PD cases: 61.7% male, age at disease onset 64.0 years (SD 9.6), age at death 77.1 years (SD 7.2). Levodopa responsiveness was reported in 399 cases (89.7%) either as a graded or a binary response. In the 280 cases (70.2%) describing a graded response, it was excellent in 37.5%, good in 45.7%, moderate in 12.1%, and poor in 4.6%. In the 119 cases describing a binary response (29.8%), 73.1% were levodopa responsive, and 26.9% were nonresponsive. Comorbid brain pathology was present in 137 of 235 cases assessed, being cerebrovascular in 46.0% and Alzheimer's disease in 37.2% of these, but its contribution to levodopa responsiveness was unclear. Conclusions The levodopa motor response varies in definite PD. Explanations other than diagnostic inaccuracy should be explored.
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Affiliation(s)
- Vanessa Pitz
- Institute of Neuroscience and Psychology University of Glasgow Glasgow United Kingdom
| | - Naveed Malek
- Department of Neurology Ipswich Hospital NHS Trust Ipswich United Kingdom
| | - Edward S Tobias
- School of Medicine, Dentistry and Nursing University of Glasgow Glasgow United Kingdom.,Department of Clinical Genetics Queen Elizabeth University Hospital Glasgow United Kingdom
| | - Katherine A Grosset
- Institute of Neuroscience and Psychology University of Glasgow Glasgow United Kingdom.,Department of Neurology Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow United Kingdom
| | - Steve Gentleman
- Department of Medicine Imperial College London London United Kingdom
| | - Donald G Grosset
- Institute of Neuroscience and Psychology University of Glasgow Glasgow United Kingdom.,Department of Neurology Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow United Kingdom
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24
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L-dopa responsiveness in early Parkinson's disease is associated with the rate of motor progression. Parkinsonism Relat Disord 2019; 65:55-61. [DOI: 10.1016/j.parkreldis.2019.05.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/26/2022]
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25
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Fischer DL, Auinger P, Goudreau JL, Paumier KL, Cole-Strauss A, Kemp CJ, Lipton JW, Sortwell CE. Bdnf variant is associated with milder motor symptom severity in early-stage Parkinson's disease. Parkinsonism Relat Disord 2018; 53:70-75. [DOI: 10.1016/j.parkreldis.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 10/16/2022]
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27
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Isaacson SH, Fisher S, Gupta F, Hermanowicz N, Kremens DE, Lew MF, Marek K, Pahwa R, Russell DS, Seibyl J. Clinical utility of DaTscan™ imaging in the evaluation of patients with parkinsonism: a US perspective. Expert Rev Neurother 2016; 17:219-225. [DOI: 10.1080/14737175.2017.1256205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, FL, USA
| | - Stanley Fisher
- Saint Luke’s Marion Bloch Neuroscience Institute, Kansas City, MO, USA
| | - Fiona Gupta
- Hackensack University Medical Center, Movement Disorders Center, Hackensack, NJ, USA
| | - Neal Hermanowicz
- Irvine Health Movement Disorders Program, University of California, Irvine, CA, USA
| | - Daniel E. Kremens
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mark F. Lew
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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28
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Wimalasena NK, Le VQ, Wimalasena K, Schreiber SL, Karmacharya R. Gene Expression-Based Screen for Parkinson's Disease Identifies GW8510 as a Neuroprotective Agent. ACS Chem Neurosci 2016; 7:857-63. [PMID: 27270122 DOI: 10.1021/acschemneuro.6b00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We carried out a gene expression-based in silico screen in order to identify small molecules with gene-expression profiles that are anticorrelated with a gene-expression profile for Parkinson's disease (PD). We identified the cyclin-dependent kinase 2/5 (CDK2/5) inhibitor GW8510 as our most significant hit and characterized its effects in rodent MN9D cells and in human neuronal cells derived from induced pluripotent stem cells. GW8510 demonstrated neuroprotective ability in MN9D cells in the presence of 1-methyl-4-phenylpyridium (MPP(+)), a widely used neurotoxin model for Parkinson's disease. In order to delineate the nature and extent of GW8510's neuroprotective properties, we studied GW8510 in human neuronal cells in the context of various mechanisms of cellular stress. We found that GW8510 was protective against small-molecule mitochondrial and endoplasmic reticulum stressors. Our findings illustrate an approach to using small-molecule gene expression libraries to identify compounds with therapeutic potential in human diseases.
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Affiliation(s)
- Nivanthika K. Wimalasena
- Center for the Science of Therapeutics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, United States
- Center
for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental
Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Program in Neuroscience, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Viet Q. Le
- Department of Science and Mathematics,
National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York 14623, United States
| | - Kandatege Wimalasena
- Department of Chemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Stuart L. Schreiber
- Center for the Science of Therapeutics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, United States
- Howard Hughes Medical Institute, Department of Chemistry and Chemical
Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Rakesh Karmacharya
- Center for the Science of Therapeutics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, United States
- Center
for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental
Genetics Unit, Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Schizophrenia and Bipolar Disorder Program, Harvard Medical School and McLean Hospital, Belmont, Massachusetts 02478, United States
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29
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Cortical and motor responses to acute forced exercise in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:56-62. [PMID: 26857399 DOI: 10.1016/j.parkreldis.2016.01.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/23/2015] [Accepted: 01/12/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Studies in animal models of Parkinson's disease (PD) have suggested that the rate of exercise performance is important in treatment efficacy and neuroprotection. In humans with PD, lower-extremity forced-exercise (FE) produced global improvements in motor symptoms based on clinical ratings and biomechanical measures of upper extremity function. METHODS fMRI was used to compare the underlying changes in brain activity in PD patients following the administration of anti-parkinsonian medication and following a session of FE. RESULTS Nine individuals with PD completed fMRI scans under each condition: off anti-PD medication, on anti-PD medication, and off medication + FE. Unified Parkinson's Disease Rating Motor Scale scores improved by 50% in the FE condition compared to the off-medication condition. The pattern of fMRI activation after FE was similar to that seen with anti-PD medication. Direct comparison of the fMRI activation patterns showed high correlation between FE and anti-PD medication. CONCLUSION These findings suggest that medication and FE likely utilize the same pathways to produce symptomatic relief in individuals with PD.
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30
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Moreau C, Meguig S, Corvol JC, Labreuche J, Vasseur F, Duhamel A, Delval A, Bardyn T, Devedjian JC, Rouaix N, Petyt G, Brefel-Courbon C, Ory-Magne F, Guehl D, Eusebio A, Fraix V, Saulnier PJ, Lagha-Boukbiza O, Durif F, Faighel M, Giordana C, Drapier S, Maltête D, Tranchant C, Houeto JL, Debû B, Azulay JP, Tison F, Destée A, Vidailhet M, Rascol O, Dujardin K, Defebvre L, Bordet R, Sablonnière B, Devos D. Polymorphism of the dopamine transporter type 1 gene modifies the treatment response in Parkinson's disease. Brain 2015; 138:1271-83. [PMID: 25805645 DOI: 10.1093/brain/awv063] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/17/2015] [Indexed: 11/14/2022] Open
Abstract
After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guidelines on setting the optimal dose for a given patient. The dopamine transporter type 1, now known as solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3) is the most powerful determinant of dopamine neurotransmission and might therefore influence the treatment response. We recently demonstrated that methylphenidate (a dopamine transporter inhibitor) is effective in patients with Parkinson's disease with motor and gait disorders. The objective of the present study was to determine whether genetic variants of the dopamine transporter type 1-encoding gene (SLC6A3) are associated with differences in the response to treatment of motor symptoms and gait disorders with l-DOPA and methylphenidate (with respect to the demographic, the disease and the treatment parameters and the other genes involved in the dopaminergic neurotransmission). This analysis was part of a multicentre, parallel-group, double-blind, placebo-controlled, randomized clinical trial of methylphenidate in Parkinson's disease (Protocol ID:2008-005801-20; ClinicalTrials.gov:NCT00914095). We scored the motor Unified Parkinson's Disease Rating Scale and the Stand-Walk-Sit Test before and after a standardized acute l-DOPA challenge before randomization and then after 3 months of methylphenidate treatment. Patients were screened for variants of genes involved in dopamine metabolism: rs28363170 and rs3836790 polymorphisms in the SLC6A3 gene, rs921451 and rs3837091 in the DDC gene (encoding the aromatic L-amino acid decarboxylase involved in the synthesis of dopamine from l-DOPA), rs1799836 in the MAOB gene (coding for monoamine oxidase B) and rs4680 in the COMT gene (coding for catechol-O-methyltransferase). Investigators and patients were blinded to the genotyping data throughout the study. Eighty-one subjects were genotyped and 61 were analysed for their acute motor response to l-DOPA. The SLC6A3 variants were significantly associated with greater efficacy of l-DOPA for motor symptoms. The SLC6A3 variants were also associated with greater efficacy of methylphenidate for motor symptoms and gait disorders in the ON l-DOPA condition. The difference between motor Unified Parkinson's Disease Rating Scale scores for patients with different SLC6A3 genotypes was statistically significant in a multivariate analysis that took account of other disease-related, treatment-related and pharmacogenetic parameters. Our preliminary results suggest that variants of SLC6A3 are genetic modifiers of the treatment response to l-DOPA and methylphenidate in Parkinson's disease. Further studies are required to assess the possible value of these genotypes for (i) guiding l-DOPA dose adaptations over the long term; and (ii) establishing the risk/benefit balance associated with methylphenidate treatment for gait disorders.
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Affiliation(s)
- Caroline Moreau
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Sayah Meguig
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | - Jean-Christophe Corvol
- 4 Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, Département des Maladies du Système Nerveux, Paris, France
| | - Julien Labreuche
- 5 Department of Biostatistics, Lille University, CHU Lille, Lille, France
| | - Francis Vasseur
- 5 Department of Biostatistics, Lille University, CHU Lille, Lille, France
| | - Alain Duhamel
- 5 Department of Biostatistics, Lille University, CHU Lille, Lille, France
| | - Arnaud Delval
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Thomas Bardyn
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | | | - Nathalie Rouaix
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | - Gregory Petyt
- 6 Department of Nuclear Medicine, Lille University, CHU Lille, Lille, France
| | - Christine Brefel-Courbon
- 7 Departments of Clinical Pharmacology and Neurosciences, CIC9302, University Hospital and Paul Sabatier University, Toulouse, France
| | - Fabienne Ory-Magne
- 7 Departments of Clinical Pharmacology and Neurosciences, CIC9302, University Hospital and Paul Sabatier University, Toulouse, France
| | - Dominique Guehl
- 8 Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR CNRS 5293 and CHU de Bordeaux, Bordeaux, France
| | - Alexandre Eusebio
- 9 Department of Neurology and Movement Disorders - APHM Timone University Hospital and Institut de Neurosciences de la Timone, AMU-CNRS UMR 7289, Marseille, France
| | - Valérie Fraix
- 10 Department of Psychiatry and Neurology, CHU Grenoble, Grenoble, France
| | - Pierre-Jean Saulnier
- 11 Department of Movement Disorders and Neurology, Centre d'Investigation Clinique, INSERM CIC 0802, INSERM U1084, Laboratoire de Neurosciences Expérimentales et Cliniques, CHU de Poitiers, Poitiers, France
| | - Ouhaid Lagha-Boukbiza
- 12 Department of Movement Disorders and Neurology, CHU Strasbourg, Strasbourg, France
| | - Frank Durif
- 13 Department of Movement Disorders and Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mirela Faighel
- 14 Department of Movement Disorders and Neurology, INSERM, CIC04, CHU Nantes, Nantes, France
| | - Caroline Giordana
- 15 Department of Movement Disorders and Neurology, CHU Nice, Nice, France
| | - Sophie Drapier
- 16 Department of Neurology, EA- 425 Université Rennes 1 et CHU Pontchaillou, CHU Rennes, Rennes, France
| | - David Maltête
- 17 Department of Neurology and INSERM CIC-CRB 0204, Rouen University Hospital, CHU Rouen Rouen, France
| | - Christine Tranchant
- 12 Department of Movement Disorders and Neurology, CHU Strasbourg, Strasbourg, France
| | - Jean-Luc Houeto
- 11 Department of Movement Disorders and Neurology, Centre d'Investigation Clinique, INSERM CIC 0802, INSERM U1084, Laboratoire de Neurosciences Expérimentales et Cliniques, CHU de Poitiers, Poitiers, France
| | - Bettina Debû
- 10 Department of Psychiatry and Neurology, CHU Grenoble, Grenoble, France
| | - Jean-Philippe Azulay
- 9 Department of Neurology and Movement Disorders - APHM Timone University Hospital and Institut de Neurosciences de la Timone, AMU-CNRS UMR 7289, Marseille, France
| | - François Tison
- 8 Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR CNRS 5293 and CHU de Bordeaux, Bordeaux, France
| | - Alain Destée
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 18 INSERM U837/6 Lille JPARC, France
| | - Marie Vidailhet
- 6 Department of Nuclear Medicine, Lille University, CHU Lille, Lille, France
| | - Olivier Rascol
- 7 Departments of Clinical Pharmacology and Neurosciences, CIC9302, University Hospital and Paul Sabatier University, Toulouse, France 19 INSERM NS-PARK National Network, France
| | - Kathy Dujardin
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Luc Defebvre
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Régis Bordet
- 2 INSERM U1171, Lille University, Lille, France 18 INSERM U837/6 Lille JPARC, France
| | - Bernard Sablonnière
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | - David Devos
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France 20 Department of Medical Pharmacology, Lille University, CHU Lille, Lille, France
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Abstract
PURPOSE OF REVIEW This review summarizes currently available treatment options and treatment strategies, investigational treatments, and the importance of exercise for early Parkinson's disease. RECENT FINDINGS The available treatment options for early Parkinson's disease have changed little in the past decade and include carbidopa/levodopa, dopamine agonists, and monoamine oxidase type B (MAO-B) inhibitors. However, we discuss changes in treatment strategies, including dosing and the use of combination therapy used in an attempt to reduce or delay the appearance of motor complications and other adverse events. We will also review several investigational treatments that have shown promise for the treatment of early Parkinson's disease, including a new extended release formulation of carbidopa/levodopa (IPX066), safinamide which inhibits MAO-B, dopamine uptake and glutamate and pardoprunox which is a 5HT-1A agonist and a partial dopamine agonist. Finally, we discuss recent studies focusing on exercise as an important component in the management of early Parkinson's disease. SUMMARY Advances in the management of early Parkinson's disease include evolving treatment strategies, new investigational treatments, and earlier implementation of various forms of exercise.
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Pearson-Fuhrhop KM, Dunn EC, Mortero S, Devan WJ, Falcone GJ, Lee P, Holmes AJ, Hollinshead MO, Roffman JL, Smoller JW, Rosand J, Cramer SC. Dopamine genetic risk score predicts depressive symptoms in healthy adults and adults with depression. PLoS One 2014; 9:e93772. [PMID: 24834916 PMCID: PMC4023941 DOI: 10.1371/journal.pone.0093772] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/08/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Depression is a common source of human disability for which etiologic insights remain limited. Although abnormalities of monoamine neurotransmission, including dopamine, are theorized to contribute to the pathophysiology of depression, evidence linking dopamine-related genes to depression has been mixed. The current study sought to address this knowledge-gap by examining whether the combined effect of dopamine polymorphisms was associated with depressive symptomatology in both healthy individuals and individuals with depression. METHODS Data were drawn from three independent samples: (1) a discovery sample of healthy adult participants (n = 273); (2) a replication sample of adults with depression (n = 1,267); and (3) a replication sample of healthy adult participants (n = 382). A genetic risk score was created by combining functional polymorphisms from five genes involved in synaptic dopamine availability (COMT and DAT) and dopamine receptor binding (DRD1, DRD2, DRD3). RESULTS In the discovery sample, the genetic risk score was associated with depressive symptomatology (β = -0.80, p = 0.003), with lower dopamine genetic risk scores (indicating lower dopaminergic neurotransmission) predicting higher levels of depression. This result was replicated with a similar genetic risk score based on imputed genetic data from adults with depression (β = -0.51, p = 0.04). Results were of similar magnitude and in the expected direction in a cohort of healthy adult participants (β = -0.86, p = 0.15). CONCLUSIONS Sequence variation in multiple genes regulating dopamine neurotransmission may influence depressive symptoms, in a manner that appears to be additive. Further studies are required to confirm the role of genetic variation in dopamine metabolism and depression.
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Affiliation(s)
- Kristin M. Pearson-Fuhrhop
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, California, United States of America
| | - Erin C. Dunn
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Sarah Mortero
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, California, United States of America
| | - William J. Devan
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Guido J. Falcone
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Phil Lee
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Avram J. Holmes
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Yale University, New Haven, Connecticut, United States of America
| | - Marisa O. Hollinshead
- Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, United States of America
| | - Joshua L. Roffman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jordan W. Smoller
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Steven C. Cramer
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, California, United States of America
- Department of Neurology, University of California Irvine, Irvine, California, United States of America
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Pahwa R, Lyons KE, Hauser RA, Fahn S, Jankovic J, Pourcher E, Hsu A, O'Connell M, Kell S, Gupta S. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Parkinsonism Relat Disord 2014; 20:142-8. [DOI: 10.1016/j.parkreldis.2013.08.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/15/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Akhtar RS, Stern MB. New concepts in the early and preclinical detection of Parkinson’s disease: therapeutic implications. Expert Rev Neurother 2014; 12:1429-38. [DOI: 10.1586/ern.12.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bajaj N, Hauser RA, Grachev ID. Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry 2013; 84:1288-95. [PMID: 23486993 PMCID: PMC3812862 DOI: 10.1136/jnnp-2012-304436] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diagnosis of movement disorders including Parkinson's disease (PD) and essential tremor is determined through clinical assessment. The difficulty with diagnosis of early PD has been highlighted in several recent clinical trials. Studies have suggested relatively high clinical diagnostic error rates for PD and essential tremor. This review was undertaken to clarify the utility of DaT-SPECT imaging with ((123)I)ioflupane (DaTSCAN or DaTscan or ((123)I)FP-CIT) in assisting practitioners in their clinical decision making by visualising the dopamine transporter in parkinsonian cases. In some patients with suspected parkinsonian syndromes, SPECT imaging with ((123)I)ioflupane is useful to assist in the diagnosis and to help guide prognosis and treatment decisions, including avoiding medications that are unlikely to provide benefit. Clinicians ordering ((123)I)ioflupane SPECT should be aware of its limitations and pitfalls and should order scans when there is diagnostic uncertainty or when the scan will be helpful in clinical decision making.
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Affiliation(s)
- Nin Bajaj
- Department of Clinical Neurology, National Parkinson's Foundation International Centre of Excellence, Nottingham University Hospitals NHS Trust and University of Nottingham, , Nottingham, UK
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Zuo L, Motherwell MS. The impact of reactive oxygen species and genetic mitochondrial mutations in Parkinson's disease. Gene 2013; 532:18-23. [PMID: 23954870 DOI: 10.1016/j.gene.2013.07.085] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/23/2013] [Indexed: 12/27/2022]
Abstract
The exact pathogenesis of Parkinson's disease (PD) is still unknown and proper mechanisms that correspond to the disease remain unidentified. It is understood that PD is age-related; as age increases, the chance of onset responds accordingly. Although there are no current means of curing PD, the understanding of reactive oxygen species (ROS) provides significant insight to possible treatments. Complex I deficiencies of the respiratory chain account for the majority of unfavorable neural apoptosis generation in PD. Dopaminergic neurons are severely damaged as a result of the deficiency. Symptoms such as inhibited cognitive ability and loss of smooth motor function are the results of such impairment. The genetic mutations of Parkinson's related proteins such as PINK1 and LRRK2 contribute to mitochondrial dysfunction which precedes ROS formation. Various pathways are inhibited by these mutations, and inevitably causing neural cell damage. Antioxidants are known to negate the damaging effects of free radical overexpression. This paper expands on the specific impact of mitochondrial genetic change and production of free radicals as well as its correlation to the neurodegeneration in Parkinson's disease.
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Affiliation(s)
- Li Zuo
- Molecular Physiology and Biophysics Laboratory, Department of Biological Sciences, Oakland University, Rochester, MI 48309, USA; Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, Biophysics Graduate Program, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Elm JJ. Design innovations and baseline findings in a long-term Parkinson's trial: the National Institute of Neurological Disorders and Stroke Exploratory Trials in Parkinson's Disease Long-Term Study-1. Mov Disord 2013; 27:1513-21. [PMID: 23079770 DOI: 10.1002/mds.25175] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Based on the preclinical data and the results of a phase II futility study, creatine was selected for an efficacy trial in Parkinson's disease (PD). We present the design rationale and a description of the study cohort at baseline. A randomized, multicenter, double-blind, parallel-group, placebo-controlled phase III study of creatine (10 g daily) in participants with early, treated PD, the Long-term Study-1 (LS-1), is being conducted by the National Institute of Neurological Disorders and Stroke Exploratory Trials in Parkinson's Disease network. The study utilizes a global statistical test (GST) encompassing five clinical rating scales to provide a multidimensional assessment of disease progression. A total of 1,741 PD participants from 45 sites in the United States and Canada were randomized 1:1 to either 10 g of creatine/day or matching placebo. Participants are being evaluated for a minimum of 5 years. The LS-1 baseline cohort includes participants treated with dopaminergic therapy and generally mild PD. LS-1 represents the largest cohort of patients with early treated PD ever enrolled in a clinical trial. The GST approach should provide high power to test the hypothesis that daily administration of creatine (10 g/day) is more effective than placebo in slowing clinical decline in PD between baseline and the 5-year follow-up visit against the background of dopaminergic therapy and best PD care.
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Affiliation(s)
- Jordan J Elm
- Division of Biostatistics and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Suite 303, PO Box 250835, Charleston, SC 29425, USA.
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Genetic variation in the human brain dopamine system influences motor learning and its modulation by L-Dopa. PLoS One 2013; 8:e61197. [PMID: 23613810 PMCID: PMC3629211 DOI: 10.1371/journal.pone.0061197] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 03/07/2013] [Indexed: 11/19/2022] Open
Abstract
Dopamine is important to learning and plasticity. Dopaminergic drugs are the focus of many therapies targeting the motor system, where high inter-individual differences in response are common. The current study examined the hypothesis that genetic variation in the dopamine system is associated with significant differences in motor learning, brain plasticity, and the effects of the dopamine precursor L-Dopa. Skilled motor learning and motor cortex plasticity were assessed using a randomized, double-blind, placebo-controlled, crossover design in 50 healthy adults during two study weeks, one with placebo and one with L-Dopa. The influence of five polymorphisms with established effects on dopamine neurotransmission was summed using a gene score, with higher scores corresponding to higher dopaminergic neurotransmission. Secondary hypotheses examined each polymorphism individually. While training on placebo, higher gene scores were associated with greater motor learning (p = .03). The effect of L-Dopa on learning varied with the gene score (gene score*drug interaction, p = .008): participants with lower gene scores, and thus lower endogenous dopaminergic neurotransmission, showed the largest learning improvement with L-Dopa relative to placebo (p<.0001), while L-Dopa had a detrimental effect in participants with higher gene scores (p = .01). Motor cortex plasticity, assessed via transcranial magnetic stimulation (TMS), also showed a gene score*drug interaction (p = .02). Individually, DRD2/ANKK1 genotype was significantly associated with motor learning (p = .02) and its modulation by L-Dopa (p<.0001), but not with any TMS measures. However, none of the individual polymorphisms explained the full constellation of findings associated with the gene score. These results suggest that genetic variation in the dopamine system influences learning and its modulation by L-Dopa. A polygene score explains differences in L-Dopa effects on learning and plasticity most robustly, thus identifying distinct biological phenotypes with respect to L-Dopa effects on learning and plasticity. These findings may have clinical applications in post-stroke rehabilitation or the treatment of Parkinson's disease.
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Zhuang X, Mazzoni P, Kang UJ. The role of neuroplasticity in dopaminergic therapy for Parkinson disease. Nat Rev Neurol 2013; 9:248-56. [PMID: 23588357 DOI: 10.1038/nrneurol.2013.57] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dopamine replacement is a mainstay of therapeutic strategies for Parkinson disease (PD). The motor response to therapy involves an immediate improvement in motor function, known as the short-duration response (SDR), followed by a long-duration response (LDR) that develops more slowly, over weeks. Here, we review evidence in patients and animal models suggesting that dopamine-dependent corticostriatal plasticity, and retention of such plasticity in the absence of dopamine, are the mechanisms underlying the LDR. Conversely, experience-dependent aberrant plasticity that develops slowly under reduced dopamine levels could contribute substantially to PD motor symptoms before initiation of dopamine replacement therapy. We place these findings in the context of the role of dopamine in basal ganglia function and corticostriatal plasticity, and provide a new framework suggesting that therapies that enhance the LDR could be more effective than those targeting the SDR. We further propose that changes in neuroplasticity constitute a form of disease modification that is distinct from prevention of degeneration, and could be responsible for some of the unexplained disease-modifying effects of certain therapies. Understanding such plasticity could provide novel therapeutic approaches that combine rehabilitation and pharmacotherapy for treatment of neurological and psychiatric disorders involving basal ganglia dysfunction.
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Affiliation(s)
- Xiaoxi Zhuang
- Department of Neurobiology, University of Chicago Medicine and Biological Sciences, 947 South 58th Street, MC 0926, Chicago, IL 60637, USA
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Abstract
Parkinson's disease (PD) is the most common cause of parkinsonism, yet the diagnosis and management can be a challenge. The United Kingdom Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria and dopamine transporter/single-photon emission computed tomography (DaT-SPECT) are diagnostic aids that can improve diagnostic accuracy. Even though PD is a progressive disease, for years, physicians and patients have delayed treatment until functional disability occurs. However, studies of monoamine oxidase-type B (MAO-B) inhibitors, dopamine agonists, and levodopa, all of which can be used as initial therapy, have demonstrated that PD patients receiving treatment do better than those who do not receive treatment, and some studies have shown that those receiving treatment earlier do better long term. Therefore, the management strategy for PD has moved toward earlier initiation of treatment. Although treatment for each patient should be individualized and based on their specific symptoms, severity, and lifestyle, in general MAO-B inhibitors may be used initially to treat mild symptoms, adding a dopamine agonist in younger patients or levodopa in older patients, as symptoms become more severe.
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Affiliation(s)
- Kelly E Lyons
- Parkinson's Disease and Movement Disorder Center, Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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Löhle M, Reichmann H. Controversies in neurology: why monoamine oxidase B inhibitors could be a good choice for the initial treatment of Parkinson's disease. BMC Neurol 2011; 11:112. [PMID: 21939547 PMCID: PMC3192665 DOI: 10.1186/1471-2377-11-112] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 09/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early initiation of pharmacotherapy in Parkinson's disease (PD) is nowadays widely advocated by experts since the delay of treatment has shown to be associated with a significant deterioration of health related quality of life in affected patients. Due to marked advances in PD treatment during the last decades, physicians are nowadays fortunately equipped with a variety of substances that can effectively ameliorate emerging motor symptoms of the disease, among them levodopa, dopamine agonists and monoamine oxidase type B (MAO-B) inhibitors. Despite numerous drug intervention trials in early PD, there is however still ongoing controversy among neurologists which substance to use for the initial treatment of the disease. DISCUSSION In multiple studies, MAO-B inhibitors, such as selegiline and rasagiline, have shown to provide mild symptomatic effects, delay the need for levodopa, and to reduce the incidence of motor fluctuations. Although their symptomatic efficacy is inferior compared to dopamine agonists and levodopa, MAO-B inhibitors undoubtedly have fewer side effects and are easy to administer. In contrary to their competitors, MAO-B inhibitors may furthermore offer a chance for disease modification, which so far remains a major unmet need in the management of PD and eventually makes them ideal candidates for the early treatment of the disease. SUMMARY MAO-B inhibitors may constitute a preferable therapeutic option for early PD, mainly due to their favourable safety profile and their putative neuroprotective capabilities. Since the symptomatic effects of MAO-B inhibitors are comparatively mild, dopamine agonists and levodopa should however be considered for initial treatment in those PD patients, in whom robust and immediate symptomatic relief needs to be prioritized.
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Affiliation(s)
- Matthias Löhle
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
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Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology 2011; 77:851-7. [PMID: 21832214 DOI: 10.1212/wnl.0b013e31822c9123] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes. METHODS This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty. RESULTS More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79). CONCLUSIONS Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.
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Affiliation(s)
- A W Willis
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Single photon emission computed tomography striatal asymmetry index may predict dopaminergic responsiveness in Parkinson disease. Clin Neuropharmacol 2011; 34:71-3. [PMID: 21406999 DOI: 10.1097/wnf.0b013e318211f945] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Parkinson disease (PD) is a neurodegenerative disorder, characterized by the excellent response to l-dopa and by asymmetry of neurological signs. The aim of the present study is to investigate a possible relationship between responsiveness to l-dopa in patients with PD and asymmetry detected by single photon emission computed tomography (SPECT) with [I]FP-CIT (DaTSCAN). METHODS We performed a retrospective study in 20 patients with PD never previously exposed to l-dopa, who had undergone (1) a short-term l-dopa test with l-dopa/carbidopa 250/25 mg to quantify dopaminergic responsiveness, and (2) a SPECT with DaTSCAN to assess the degree of nigrostriatal neuronal degeneration. We estimated the magnitude and the duration of the response to l-dopa test as well as the striatal asymmetry index (SAI) detected by SPECT with DaTSCAN. RESULTS At l-dopa short-term test, most patients showed at least a mild response to the drug, and only 3 patients presented no response. Overall, the Unified Parkinson's Disease Rating Scale-Motor Examination section score at baseline was 24.9 ± 8.2, and that at peak was 21.2 ± 8 with a magnitude of the response scoring 16 ± 13.9%; the duration was 254 ± 91.2 minutes. The caudate and putamen uptakes of DaTSCAN were lower contralaterally to the most affected side. A significant positive correlation between the SAI and the magnitude of the response to l-dopa was found (r = 0.64, P = 0.002). Linear regression model provided an increase of 0.76 units of magnitude of l-dopa response every SAI unit. CONCLUSIONS Asymmetry resulted positively related to the magnitude of the response to l-dopa short-term test and may be usefully used to predict dopaminergic responsiveness in patients with PD.
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Evans JR, Barker RA. Defining meaningful outcome measures in trials of disease-modifying therapies in Parkinson's disease. Expert Opin Pharmacother 2011; 12:1249-58. [PMID: 21345151 DOI: 10.1517/14656566.2011.548807] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hauser RA. New considerations in the medical management of early Parkinson's disease: Impact of recent clinical trials on treatment strategy. Parkinsonism Relat Disord 2009; 15 Suppl 3:S17-21. [DOI: 10.1016/s1353-8020(09)70772-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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