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Sekiya H, Koga S, Murakami A, Kawazoe M, Kim M, Martin NB, Uitti RJ, Cheshire WP, Wszolek ZK, Dickson DW. Validation Study of the MDS Criteria for the Diagnosis of Multiple System Atrophy in the Mayo Clinic Brain Bank. Neurology 2023; 101:e2460-e2471. [PMID: 37816641 PMCID: PMC10791062 DOI: 10.1212/wnl.0000000000207905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The second consensus criteria in 2008 have been used in diagnosing multiple system atrophy (MSA). The International Parkinson and Movement Disorder Society (MDS) proposed new diagnostic criteria for MSA in 2022. This study aimed to compare the diagnostic accuracy between these 2 criteria and validate the clinical utility of the newly proposed criteria for MSA. METHODS We conducted a retrospective autopsy cohort study of consecutive patients with a clinical or pathologic diagnosis of MSA from the Mayo Clinic brain bank between 1998 and 2021. We studied 352 patients (250 pathologically diagnosed MSA and 102 non-MSA); MDS criteria and the second consensus criteria were applied. The sensitivity, specificity, and area under the curve (AUC) of receiver operating characteristic curves were compared between these criteria. Comparison was conducted between clinical subtypes and among clinically challenging cases (those with different clinical diagnoses or those with suspected but undiagnosed MSA before death). We also used machine learning algorithm, eXtreme Gradient Boosting, to identify clinical features contributing diagnostic performance. RESULTS The sensitivity and specificity of clinically established and probable MSA by the MDS criteria were 16% and 99% and 64% and 74%, respectively. The sensitivity and specificity of probable MSA and possible MSA by the second consensus criteria were 72% and 52% and 93% and 21%, respectively. The AUC of MDS clinically probable MSA was the highest (0.69). The diagnostic performance did not differ between clinical subtypes. In clinically challenging cases, MDS clinically established MSA maintained high specificity and MDS clinically probable MSA demonstrated the highest AUC (0.62). MRI findings contributed to high specificity. In addition, combining core clinical features with 2 or more from any of the 13 supporting features and the absence of exclusion criteria also yielded high specificity. Among supporting features, rapid progression was most important for predicting MSA pathology. DISCUSSION The MDS criteria showed high specificity with clinically established MSA and moderate sensitivity and specificity with clinically probable MSA. The observation that high specificity could be achieved with clinical features alone suggests that MSA diagnosis with high specificity is possible even in areas where MRI is not readily available.
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Affiliation(s)
- Hiroaki Sekiya
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Shunsuke Koga
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Aya Murakami
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Miki Kawazoe
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Minji Kim
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Nicholas B Martin
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Ryan J Uitti
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - William P Cheshire
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Zbigniew K Wszolek
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Department of Neuroscience (H.S., S.K., A.M., M. Kawazoe, N.B.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Division of Neurology (H.S.), Kobe University Graduate School of Medicine; Department of Neurology (A.M.), Kansai Medical University Hirakata, Japan; Departments of Artificial Intelligence and Informatics Research (M. Kim) and Neurology (R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL
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Stankovic I, Fanciulli A, Sidoroff V, Wenning GK. A Review on the Clinical Diagnosis of Multiple System Atrophy. CEREBELLUM (LONDON, ENGLAND) 2023; 22:825-839. [PMID: 35986227 PMCID: PMC10485100 DOI: 10.1007/s12311-022-01453-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
Multiple system atrophy (MSA) is a rare, adult-onset, progressive neurodegenerative disorder with major diagnostic challenges. Aiming for a better diagnostic accuracy particularly at early disease stages, novel Movement Disorder Society criteria for the diagnosis of MSA (MDS MSA criteria) have been recently developed. They introduce a neuropathologically established MSA category and three levels of clinical diagnostic certainty including clinically established MSA, clinically probable MSA, and the research category of possible prodromal MSA. The diagnosis of clinically established and clinically probable MSA is based on the presence of cardiovascular or urological autonomic failure, parkinsonism (poorly L-Dopa-responsive for the diagnosis of clinically established MSA), and cerebellar syndrome. These core clinical features need to be associated with supportive motor and non-motor features (MSA red flags) and absence of any exclusion criteria. Characteristic brain MRI markers are required for a diagnosis of clinically established MSA. A research category of possible prodromal MSA is devised to capture patients manifesting with autonomic failure or REM sleep behavior disorder and only mild motor signs at the earliest disease stage. There is a number of promising laboratory markers for MSA that may help increase the overall clinical diagnostic accuracy. In this review, we will discuss the core and supportive clinical features for a diagnosis of MSA in light of the new MDS MSA criteria, which laboratory tools may assist in the clinical diagnosis and which major differential diagnostic challenges should be borne in mind.
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Affiliation(s)
- Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Victoria Sidoroff
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Park DG, Kim JY, Kim MS, Kim MH, An YS, Chang J, Yoon JH. Neurofilament light chain and cardiac MIBG uptake as predictors for phenoconversion in isolated REM sleep behavior disorder. J Neurol 2023; 270:4393-4402. [PMID: 37233802 DOI: 10.1007/s00415-023-11785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Isolated rapid-eye-movement (REM) sleep behavior disorder (iRBD) is considered as a prodromal stage of either multiple system atrophy (MSA) or Lewy body disease (LBD; Parkinson's disease and dementia with Lewy bodies). However, current knowledge is limited in predicting and differentiating the type of future phenoconversion in iRBD patients. We investigated the role of plasma neurofilament light chain (NfL) and cardiac metaiodobenzylguanidine (MIBG) uptake as predictors for phenoconversion. METHODS Forty patients with iRBD were enrolled between April 2018 and October 2019 and prospectively followed every 3 months to determine phenoconversion to either MSA or LBD. Plasma NfL levels were measured at enrollment. Cardiac MIBG uptake and striatal dopamine transporter uptake were assessed at baseline. RESULTS Patients were followed for a median of 2.92 years. Four patients converted to MSA and 7 to LBD. Plasma NfL level at baseline was significantly higher in future MSA-converters (median 23.2 pg/mL) when compared with the rest of the samples (median 14.1 pg/mL, p = 0.003). NfL level above 21.3 pg/mL predicted phenoconversion to MSA with the sensitivity of 100% and specificity of 94.3%. Baseline MIBG heart-to-mediastinum ratio of LBD-converters (median 1.10) was significantly lower when compared with the rest (median 2.00, p < 0.001). Heart-to-mediastinum ratio below 1.545 predicted phenoconversion to LBD with the sensitivity of 100% and specificity of 92.9%. CONCLUSIONS Plasma NfL and cardiac MIBG uptake may be useful biomarkers in predicting phenoconversion of iRBD. Elevated plasma NfL levels may suggest imminent phenoconversion to MSA, whereas low cardiac MIBG uptake suggests phenoconversion to LBD.
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Affiliation(s)
- Don Gueu Park
- Department of Neurology, Ajou University School of Medicine, 164, Worldcup-Ro, Songjae Hall, Suwon-Si, Gyeonggi-Do, 16499, South Korea
| | - Ju Yeong Kim
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon-Si, Republic of Korea
| | - Min Seung Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Mi Hee Kim
- Department of Neurology, Ajou University School of Medicine, 164, Worldcup-Ro, Songjae Hall, Suwon-Si, Gyeonggi-Do, 16499, South Korea
| | - Young-Sil An
- Department of Nuclear Medicine, Ajou University School of Medicine, Suwon-Si, Republic of Korea
| | - Jaerak Chang
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon-Si, Republic of Korea.
- Department of Brain Science, Ajou University School of Medicine, 164, Worldcup-Ro, Songjae Hall, Suwon-Si, Gyeonggi-Do, 16499, South Korea.
| | - Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, 164, Worldcup-Ro, Songjae Hall, Suwon-Si, Gyeonggi-Do, 16499, South Korea.
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Cheshire WP, Koga S, Tipton PW, Sekiya H, Ross OA, Uitti RJ, Josephs KA, Dickson DW. Cancer in pathologically confirmed multiple system atrophy. Clin Auton Res 2023; 33:451-458. [PMID: 37178348 PMCID: PMC10529111 DOI: 10.1007/s10286-023-00946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The aim of this study was to assess whether cancer occurs with increased frequency in multiple system atrophy (MSA). The pathological hallmark of MSA is glial cytoplasmic inclusions containing aggregated α-synuclein, and the related protein γ-synuclein correlates with invasive cancer. We investigated whether these two disorders are associated clinically. METHODS Medical records of 320 patients with pathologically confirmed MSA seen between 1998 and 2022 were reviewed. After excluding those with insufficient medical histories, the remaining 269 and an equal number of controls matched for age and sex were queried for personal and family histories of cancer recorded on standardized questionnaires and in clinical histories. Additionally, age-adjusted rates of breast cancer were compared with US population incidence data. RESULTS Of 269 cases in each group, 37 with MSA versus 45 of controls had a personal history of cancer. Reported cases of cancer in parents were 97 versus 104 and in siblings 31 versus 44 for MSA and controls, respectively. Of 134 female cases in each group, 14 MSA versus 10 controls had a personal history of breast cancer. The age-adjusted rate of breast cancer in MSA was 0.83%, as compared with 0.67% in controls and 2.0% in the US population. All comparisons were nonsignificant. CONCLUSION The evidence from this retrospective cohort found no significant clinical association of MSA with breast cancer or other cancers. These results do not exclude the possibility that knowledge about synuclein pathology at the molecular level in cancer may lead to future discoveries and potential therapeutic targets for MSA.
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Affiliation(s)
- William P Cheshire
- Division of Autonomic Disorders, Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA.
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Philip W Tipton
- Division of Movement Disorders, Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan J Uitti
- Division of Movement Disorders, Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Keith A Josephs
- Division of Movement Disorders, Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Abstract
Multiple system atrophy (MSA) is a rare neurodegenerative disease that is characterized by neuronal loss and gliosis in multiple areas of the central nervous system including striatonigral, olivopontocerebellar and central autonomic structures. Oligodendroglial cytoplasmic inclusions containing misfolded and aggregated α-synuclein are the histopathological hallmark of MSA. A firm clinical diagnosis requires the presence of autonomic dysfunction in combination with parkinsonism that responds poorly to levodopa and/or cerebellar ataxia. Clinical diagnostic accuracy is suboptimal in early disease because of phenotypic overlaps with Parkinson disease or other types of degenerative parkinsonism as well as with other cerebellar disorders. The symptomatic management of MSA requires a complex multimodal approach to compensate for autonomic failure, alleviate parkinsonism and cerebellar ataxia and associated disabilities. None of the available treatments significantly slows the aggressive course of MSA. Despite several failed trials in the past, a robust pipeline of putative disease-modifying agents, along with progress towards early diagnosis and the development of sensitive diagnostic and progression biomarkers for MSA, offer new hope for patients.
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Kuo MC, Lu YC, Tai CH, Soong BW, Hu FC, Chen ML, Lin CH, Wu RM. COQ2 and SNCA polymorphisms interact with environmental factors to modulate the risk of multiple system atrophy and subtype disposition. Eur J Neurol 2022; 29:2956-2966. [PMID: 35748722 DOI: 10.1111/ene.15475] [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: 01/10/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple system atrophy (MSA) has no definitive genetic or environmental (G-E) risk factors, and the integrated effect of these factors on MSA etiology remains unknown. OBJECTIVE To investigate the integrated effect of G-E factors associated with MSA and its subtypes, MSA-P and MSA-C. METHODS A consecutive case-control study was conducted in two medical centers, and the interactions between genotypes of five previously reported susceptible single nucleotide polymorphisms (SNPs; SNCA_rs3857059, SNCA_rs11931074, COQ2_rs148156462, EDN1_rs16872704, MAPT_rs9303521) and graded exposure (never, ever, current) of four environmental factors (smoking, alcohol, drinking well water, pesticide exposure) were analyzed by a stepwise logistic regression model. RESULTS A total of 207 MSA patients and 136 healthy controls (HCs) were enrolled. In addition to SNP COQ2_rs148156462 (TT), MSA risk was correlated with G-E interactions, including COQ2_rs148156462 (Tc) × pesticide non-exposure, COQ2_rs148156462 (TT) × current smokers, SNCA_rs11931074 (tt) × alcohol non-users, and SNCA_rs11931074 (GG) × well water non-drinkers (all p < 0.01), with an area under the receiver operating characteristic curve (AUC) of 0.804 (95% confidence interval (CI): 0.671-0.847). Modulated risk of MSA-C, with MSA-P as a control, correlated with COQ2_rs148156462 (TT) × alcohol non-drinkers, SNCA_rs11931074 (GG) × well-water ever-drinkers, SNCA_rs11931074 (Gt) × well-water never-drinkers, and SNCA_rs3857059 (gg) × pesticide non-exposure (all p < 0.05), with an AUC of 0.749 (95% CI: 0.683-0.815). CONCLUSIONS Certain COQ2 and SNCA SNPs interact with common environmental factors to modulate MSA etiology and subtype disposition. The mechanisms underlying the observed correlation between G-E interactions and MSA etiopathogenesis warrant further investigation.
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Affiliation(s)
- Ming-Che Kuo
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Che Lu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Ph.D. Program in Translational Medicine, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bing-Wen Soong
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Chang Hu
- Graduate Institute of Clinical Medicine and School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Ling Chen
- College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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Tseng FS, Deng X, Ong YL, Li HH, Tan EK. Multiple System Atrophy (MSA) and smoking: a meta-analysis and mechanistic insights. Aging (Albany NY) 2020; 12:21959-21970. [PMID: 33161394 PMCID: PMC7695394 DOI: 10.18632/aging.104021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The association between cigarette smoking and multiple system atrophy (MSA) has been debated. We conducted a systematic review and a meta-analysis to investigate this link. RESULTS We identified 161 articles from database searching and bibliographic review. Five case-control studies satisfied the inclusion and exclusion criteria, and 435 and 352 healthy controls and MSA patients were examined. The prevalence of MSA amongst ever smokers was lower compared to never smokers (aOR=0.57; 95% CI, 0.29-1.14), although this result did not reach statistical significance. This was also observed for current and former smokers, with a stronger association for current smokers (aOR=0.63 vs aOR=0.96). CONCLUSIONS There is a suggestion that smoking protects against MSA. Prospective studies in larger patient cohorts are required to further evaluate the cause-effect relationship and functional studies in cellular and animal models will provide mechanistic insights on their potential etiologic links. METHODS PubMed and Cochrane Library were searched from inception to July 7, 2019 to identify case-control studies that analyzed smoking as an environmental risk or protective factor for MSA. Two authors independently extracted data and performed risk-of-bias and quality assessment. The random-effects model was assumed to account for between-study variance when pooling the crude and adjusted odds ratios.
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Affiliation(s)
- Fan-Shuen Tseng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Xiao Deng
- Department of Neurology, National Neuroscience Institute, Singapore 169856, Singapore
| | - Yi-Lin Ong
- Department of Neurology, National Neuroscience Institute, Singapore 169856, Singapore
| | - Hui-Hua Li
- Department of Clinical Research, Singapore General Hospital, Singapore 169856, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore 169856, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
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Takeshige-Amano H, Saiki S, Fujimaki M, Ueno SI, Li Y, Hatano T, Ishikawa KI, Oji Y, Mori A, Okuzumi A, Tsunemi T, Daida K, Ishiguro Y, Imamichi Y, Nanmo H, Nojiri S, Funayama M, Hattori N. Shared Metabolic Profile of Caffeine in Parkinsonian Disorders. Mov Disord 2020; 35:1438-1447. [PMID: 32357260 PMCID: PMC7496239 DOI: 10.1002/mds.28068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 01/05/2023] Open
Abstract
Objective The objective of this study was to determine comprehensive metabolic changes of caffeine in the serum of patients with parkinsonian disorders including Parkinson's disease (PD), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA) and to compare this with healthy control serum. Methods Serum levels of caffeine and its 11 downstream metabolites from independent double cohorts consisting of PD (n = 111, 160), PSP (n = 30, 19), MSA (n = 23, 17), and healthy controls (n = 43, 31) were examined by liquid chromatography–mass spectrometry. The association of each metabolite with clinical parameters and medication was investigated. Mutations in caffeine‐associated genes were investigated by direct sequencing. Results A total of 9 metabolites detected in more than 50% of participants in both cohorts were decreased in 3 parkinsonian disorders compared with healthy controls without any significant association with age at sampling, sex, or disease severity (Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale motor section) in PD, and levodopa dose or levodopa equivalent dose in PSP and MSA. Of the 9 detected metabolites, 8 in PD, 5 in PSP, and 3 in MSA were significantly decreased in both cohorts even after normalizing to daily caffeine consumption. No significant genetic variations in CYP1A2 or CYP2E1 were detected when compared with controls. Conclusion Serum caffeine metabolic profiles in 3 parkinsonian diseases show a high level of overlap, indicative of a common potential mechanism such as caffeine malabsorption from the small intestine, hypermetabolism, increased clearance of caffeine, and/or reduced caffeine consumption. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Shinji Saiki
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Motoki Fujimaki
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Ueno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuanzhe Li
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kei-Ichi Ishikawa
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yutaka Oji
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Mori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ayami Okuzumi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kensuke Daida
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuta Ishiguro
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoko Imamichi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisayoshi Nanmo
- Mathematical Science Unit, Graduate School of Engineering Science, Yokohama National University, Kanagawa, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Manabu Funayama
- Research Institute of Diseases of Old Age, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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Heras-Garvin A, Stefanova N. MSA: From basic mechanisms to experimental therapeutics. Parkinsonism Relat Disord 2020; 73:94-104. [PMID: 32005598 DOI: 10.1016/j.parkreldis.2020.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 01/16/2023]
Abstract
Multiple system atrophy (MSA) is a rare and fatal neurodegenerative disorder characterized by rapidly progressive autonomic and motor dysfunction. Pathologically, MSA is mainly characterized by the abnormal accumulation of misfolded α-synuclein in the cytoplasm of oligodendrocytes, which plays a major role in the pathogenesis of the disease. Striatonigral degeneration and olivopontecerebellar atrophy underlie the motor syndrome, while degeneration of autonomic centers defines the autonomic failure in MSA. At present, there is no treatment that can halt or reverse its progression. However, over the last decade several studies in preclinical models and patients have helped to better understand the pathophysiological events underlying MSA. The etiology of this fatal disorder remains unclear and may be multifactorial, caused by a combination of factors which may serve as targets for novel therapeutic approaches. In this review, we summarize the current knowledge about the etiopathogenesis and neuropathology of MSA, its different preclinical models, and the main disease modifying therapies that have been used so far or that are planned for future clinical trials.
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Affiliation(s)
- Antonio Heras-Garvin
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Austria.
| | - Nadia Stefanova
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Austria.
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Jackson L, Coon EA, Ahlskog JE, Bower JH, Sandroni P, Benarroch EE, Mandrekar JN, Low PA, Singer W. Earlier age of onset in multiple system atrophy with smoking and heavy alcohol use. Parkinsonism Relat Disord 2019; 66:212-215. [PMID: 31327626 DOI: 10.1016/j.parkreldis.2019.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/25/2019] [Accepted: 07/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether smoking or alcohol use impacts the age of onset and disease duration in multiple system atrophy (MSA). METHODS All patients diagnosed with MSA at Mayo Clinic, Rochester between 1998 and 2012 completed standardized questionnaires surveying smoking and alcohol use at the time of presentation. RESULTS Of 551 patients with smoking and alcohol use data, 281 were past or present smokers with age of onset of 60.76 years compared to 62.97 years in controls (p = 0.0144). Age of onset in the 87 heavy alcohol users was 56.87 years compared to 62.97 years in controls (p = 0.0133). There was no difference in disease duration for smokers (p = 0.2758) or heavy alcohol users (p = 0.4820) compared to controls. CONCLUSION Our findings show that smoking history and/or heavy alcohol use is associated with younger age of onset in MSA but do not influence survival.
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Affiliation(s)
- Lauren Jackson
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Jay N Mandrekar
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Abstract
Multiple system atrophy (MSA) is an orphan, fatal, adult-onset neurodegenerative disorder of uncertain etiology that is clinically characterized by various combinations of parkinsonism, cerebellar, autonomic, and motor dysfunction. MSA is an α-synucleinopathy with specific glioneuronal degeneration involving striatonigral, olivopontocerebellar, and autonomic nervous systems but also other parts of the central and peripheral nervous systems. The major clinical variants correlate with the morphologic phenotypes of striatonigral degeneration (MSA-P) and olivopontocerebellar atrophy (MSA-C). While our knowledge of the molecular pathogenesis of this devastating disease is still incomplete, updated consensus criteria and combined fluid and imaging biomarkers have increased its diagnostic accuracy. The neuropathologic hallmark of this unique proteinopathy is the deposition of aberrant α-synuclein in both glia (mainly oligodendroglia) and neurons forming glial and neuronal cytoplasmic inclusions that cause cell dysfunction and demise. In addition, there is widespread demyelination, the pathogenesis of which is not fully understood. The pathogenesis of MSA is characterized by propagation of misfolded α-synuclein from neurons to oligodendroglia and cell-to-cell spreading in a "prion-like" manner, oxidative stress, proteasomal and mitochondrial dysfunction, dysregulation of myelin lipids, decreased neurotrophic factors, neuroinflammation, and energy failure. The combination of these mechanisms finally results in a system-specific pattern of neurodegeneration and a multisystem involvement that are specific for MSA. Despite several pharmacological approaches in MSA models, addressing these pathogenic mechanisms, no effective neuroprotective nor disease-modifying therapeutic strategies are currently available. Multidisciplinary research to elucidate the genetic and molecular background of the deleterious cycle of noxious processes, to develop reliable biomarkers and targets for effective treatment of this hitherto incurable disorder is urgently needed.
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Lee HJ, Lee KE, Yi TI, Kim HY. Feedback Facility-Assisted Balance Training in a Patient With Multiple System Atrophy: A Case Presentation. PM R 2017; 10:555-559. [PMID: 28943458 DOI: 10.1016/j.pmrj.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
Multiple system atrophy is a rare neurodegenerative disease with a poor prognosis. Furthermore, there are no pharmacological or notable rehabilitation strategies available to prevent the worsening of the disease. This case presentation assessed the outcome of feedback facility-assisted balance training in combination with physical therapy in a 61-year-old man. The patient participated in 30 training sessions over 6 weeks for 30 minutes each that involved balance training. His static and dynamic balance abilities were improved on the Berg Balance Scale, Trunk Impairment Scale, Functional Independence Measure, and Functional Reach. Although this patient's gait speed and muscle strength did not show improvement after training, feedback facility-assisted balance training might be a potential strategy to help reduce the rate of symptom deterioration in patients with multiple system atrophy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
| | - Ko Eun Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
| | - Tae Im Yi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
| | - Hyun Young Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.,Department of Rehabilitation Medicine, Seoul Chuk Hospital, 8, Dongsomun-ro 47 gil, Seongbuk-gu, Seoul, 02729, Korea
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13
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Abstract
Multiple system atrophy (MSA) is a devastating and fatal neurodegenerative disorder. The clinical presentation of this disease is highly variable, with parkinsonism, cerebellar ataxia and autonomic failure being the most common - and often debilitating - symptoms. These symptoms progress rapidly, and patients die from MSA-related complications after 9 years of symptom duration on average. Unfortunately, the course of the disease cannot be improved by drug or surgical treatment. In addition, symptomatic treatment options are currently limited, and therapeutic benefits are often only transient. Thus, further interventional studies of candidate disease-modifying and symptomatic therapies are essential to improve patient care. In the past 15 years, the understanding of MSA-specific requirements in trial methodology has improved, resulting in a substantial increase in high-quality interventional studies. In this Review, we discuss MSA risk factors, clinical presentation and neuropathology, and we provide a hypothesis on key pathophysiological events, a summary of recent randomized controlled trials, and an overview of ongoing international collaborations.
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Oxidative Stress and Environmental Exposures are Associated with Multiple System Atrophy in Chinese Patients. Can J Neurol Sci 2017; 43:703-9. [PMID: 27670212 DOI: 10.1017/cjn.2016.261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Oxidative stress is involved in the pathogenesis of multiple system atrophy (MSA). The aim of this study is to examine oxidant biomarkers including homocysteine (Hcys), bilirubin, uric acid, lipids, and potential environmental risk factors and to ascertain whether these data correlate with MSA in a Chinese population. METHODS In this study, serum levels of Hcys, bilirubin, uric acid, and lipids were studied in 55 MSA patients and 76 healthy controls (HCs). Education, anti-parkinsonian agent usage, smoking, drinking, farming, and living area of the subjects also were analyzed. The Unified MSA Rating Scale (UMSARS), Hoehn & Yahr stage, International Cooperative Ataxia Rating Scale, and Mini-Mental State Examination were used to assess the disease severity, the parkinsonism, ataxia, and the cognitive ability of MSA, respectively. RESULTS The levels of Hcys were higher (p<0.001) and those of total bilirubin (p=0.007), indirect bilirubin (p=0.011), and total cholesterol (p=0.046) were lower in MSA patients than in healthy controls, whereas uric acid levels did not differ significantly between MSA and healthy controls. Moreover, Hcys levels in MSA patients had positive correlations with illness duration (r s =0.422, p=0.001) and UMSARS-I (r s =0.555, p<0.001), respectively. High-density lipoprotein cholesterol levels were negatively correlated with UMSARS-I (r s =-0.325, p=0.015). Farming was more frequent in MSA patients (1-20 years: odds ratio, 6.36; p20 years: odds ratio, 10.26; p=0.001), whereas current smoking was less frequent (odds ratio, 0.13, p=0.002). CONCLUSIONS Elevated Hcys and decreased high-density lipoprotein cholesterol may be associated with the disease severity of MSA. Environmental exposures such as farming and smoking may contribute to the occurrence but not the progression of MSA.
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OZAWA T, ONODERA O. Multiple system atrophy: clinicopathological characteristics in Japanese patients. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:251-258. [PMID: 28496050 PMCID: PMC5489432 DOI: 10.2183/pjab.93.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/30/2017] [Indexed: 05/31/2023]
Abstract
Multiple system atrophy (MSA) is an adult-onset neurodegenerative disorder that has both clinical and pathological variants. Clinical examples include MSA with predominant cerebellar ataxia (MSA-C) and MSA with predominant parkinsonism (MSA-P), whereas olivopontocerebellar atrophy and striatonigral degeneration represent pathological variants. We performed systematic reviews of studies that addressed the relative frequencies of clinical or pathological variants of MSA in various populations to determine the clinicopathological characteristics in Japanese MSA. The results revealed that the majority of Japanese patients have MSA-C, while the majority of patients in Europe and North America have MSA-P. A comparative study of MSA pathology showed that the olivopontocerebellar-predominant pathology was more frequent in Japanese MSA than in British MSA. Demonstrated differences in pathological subtype thus appear consistent with differences in the clinical subtype of MSA demonstrated between Japan and European populations. We concluded that olivopontocerebellar-predominant pathology and MSA-C may represent clinicopathological characteristics in Japanese MSA. Factors determining predominant involvement of olivopontocerebellar regions in MSA should therefore be explored.
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Affiliation(s)
- Tetsutaro OZAWA
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Osamu ONODERA
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
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Hara D, Maki F, Tanaka S, Sasaki R, Hasegawa Y. MRI-based cerebellar volume measurements correlate with the International Cooperative Ataxia Rating Scale score in patients with spinocerebellar degeneration or multiple system atrophy. CEREBELLUM & ATAXIAS 2016; 3:14. [PMID: 27536377 PMCID: PMC4987966 DOI: 10.1186/s40673-016-0052-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Progression of clinical symptoms and cerebellar atrophy may vary among subtypes of spinocerebellar degeneration and multiple system atrophy. The aim of this cross-sectional study was to demonstrate the relationship between the International Cooperative Ataxia Rating Scale (ICARS) score and cerebellar volume derived from magnetic resonance imaging (MRI) in a broad spectrum of Japanese patients with cerebellar ataxia. METHODS A total of 86 patients with cerebellar ataxia (18 with cortical cerebellar atrophy, 34 with spinocerebellar ataxia, and 34 with multiple system atrophy) and 30 healthy subjects were studied. MRI-based cerebellar volume measurements were performed in all subjects using T1-weighted images acquired with a 1.5-T MRI scanner. The cerebellar volume/cranial anteroposterior (AP) diameter was used for statistical analysis. RESULTS Stepwise multiple regression analyses demonstrated that cerebellar volume/cranial AP diameter and midbrain AP/cranial AP diameter were significantly associated with the total score and domain I sub-score of ICARS. We found no interactions between these two anatomical factors in the ICARS total and domain I sub-scores. The main effects of these two predictors were statistically significant both in total and domain I sub-scores (p = 0.001 and 0.022, respectively). CONCLUSIONS Cerebellar volume and midbrain AP diameter normalized to the cranial AP diameter were significantly correlated with the ICARS total and domain I sub-scores. Further longitudinal studies are warranted to explore the role of these MRI biomarkers for predicting disease progression.
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Affiliation(s)
- Daisuke Hara
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Futaba Maki
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Shigeaki Tanaka
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Rie Sasaki
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yasuhiro Hasegawa
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
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Jellinger KA, Wenning GK. Multiple system atrophy: pathogenic mechanisms and biomarkers. J Neural Transm (Vienna) 2016; 123:555-72. [PMID: 27098666 DOI: 10.1007/s00702-016-1545-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/31/2016] [Indexed: 12/13/2022]
Abstract
Multiple system atrophy (MSA) is a unique proteinopathy that differs from other α-synucleinopathies since the pathological process resulting from accumulation of aberrant α-synuclein (αSyn) involves the oligodendroglia rather than neurons, although both pathologies affect multiple parts of the brain, spinal cord, autonomic and peripheral nervous system. Both the etiology and pathogenesis of MSA are unknown, although animal models have provided insight into the basic molecular changes of this disorder. Accumulation of aberrant αSyn in oligodendroglial cells and preceded by relocation of p25α protein from myelin to oligodendroglia results in the formation of insoluble glial cytoplasmic inclusions that cause cell dysfunction and demise. These changes are associated with proteasomal, mitochondrial and lipid transport dysfunction, oxidative stress, reduced trophic transport, neuroinflammation and other noxious factors. Their complex interaction induces dysfunction of the oligodendroglial-myelin-axon-neuron complex, resulting in the system-specific pattern of neurodegeneration characterizing MSA as a synucleinopathy with oligodendroglio-neuronopathy. Propagation of modified toxic αSyn species from neurons to oligodendroglia by "prion-like" transfer and its spreading associated with neuronal pathways result in a multi-system involvement. No reliable biomarkers are currently available for the clinical diagnosis and prognosis of MSA. Multidisciplinary research to elucidate the genetic and molecular background of the deleterious cycle of noxious processes, to develop reliable diagnostic biomarkers and to deliver targets for effective treatment of this hitherto incurable disorder is urgently needed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
| | - Gregor K Wenning
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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18
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Cao B, Guo X, Chen K, Song W, Huang R, Wei Q, Zhao B, Shang HF. Serum creatinine is associated with the prevalence but not disease progression of multiple system atrophy in Chinese population. Neurol Res 2016; 38:255-60. [PMID: 26351825 DOI: 10.1179/1743132815y.0000000095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Bei Cao
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - XiaoYan Guo
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Ke Chen
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Wei Song
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Rui Huang
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - QianQian Wei
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Bi Zhao
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Hui-Fang Shang
- a Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
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Bleasel JM, Halliday GM, Kim WS. Animal modeling an oligodendrogliopathy--multiple system atrophy. Acta Neuropathol Commun 2016; 4:12. [PMID: 26860328 PMCID: PMC4748629 DOI: 10.1186/s40478-016-0279-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/23/2016] [Indexed: 12/21/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare, yet rapidly-progressive neurodegenerative disease that presents clinically with autonomic failure in combination with parkinsonism or cerebellar ataxia. The definitive neuropathology differentiating MSA from Lewy body diseases is the presence of α-synuclein aggregates in oligodendrocytes (called glial cytoplasmic inclusion or GCI) rather than the fibrillar aggregates in neurons (called Lewy bodies). This makes the pathological pathway(s) in MSA unique in that oligodendrocytes are involved rather than predominantly neurons, as is most other neurodegenerative disorders. MSA is therefore regarded as an oligodendrogliopathy. The etiology of MSA is unknown. No definitive risk factors have been identified, although α-synuclein and other genes have been variably linked to MSA risk. Utilization of postmortem brain tissues has greatly advanced our understanding of GCI pathology and the subsequent neurodegeneration. However, extrapolating the early pathogenesis of MSA from such resource has been difficult and limiting. In recent years, cell and animal models developed for MSA have been instrumental in delineating unique MSA pathological pathways, as well as aiding in clinical phenotyping. The purpose of this review is to bring together and discuss various animal models that have been developed for MSA and how they have advanced our understanding of MSA pathogenesis, particularly the dynamics of α-synuclein aggregation. This review will also discuss how animal models have been used to explore potential therapeutic avenues for MSA, and future directions of MSA modeling.
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Sunwoo MK, Yun HJ, Song SK, Ham JH, Hong JY, Lee JE, Lee HS, Sohn YH, Lee JM, Lee PH. Mesenchymal stem cells can modulate longitudinal changes in cortical thickness and its related cognitive decline in patients with multiple system atrophy. Front Aging Neurosci 2014; 6:118. [PMID: 24982631 PMCID: PMC4056280 DOI: 10.3389/fnagi.2014.00118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/26/2014] [Indexed: 12/20/2022] Open
Abstract
Multiple system atrophy (MSA) is an adult-onset, sporadic neurodegenerative disease. Because the prognosis of MSA is fatal, neuroprotective or regenerative strategies may be invaluable in MSA treatment. Previously, we obtained clinical and imaging evidence that mesenchymal stem cell (MSC) treatment could have a neuroprotective role in MSA patients. In the present study, we evaluated the effects of MSC therapy on longitudinal changes in subcortical deep gray matter volumes and cortical thickness and their association with cognitive performance. Clinical and imaging data were obtained from our previous randomized trial of autologous MSC in MSA patients. During 1-year follow-up, we assessed longitudinal differences in automatic segmentation-based subcortical deep gray matter volumes and vertex-wise cortical thickness between placebo (n = 15) and MSC groups (n = 11). Next, we performed correlation analysis between the changes in cortical thickness and changes in the Korean version of the Montreal Cognitive Assessment (MoCA) scores and cognitive performance of each cognitive subdomain using a multiple, comparison correction. There were no significant differences in age at baseline, age at disease onset, gender ratio, disease duration, clinical severity, MoCA score, or education level between the groups. The automated subcortical volumetric analysis revealed that the changes in subcortical deep gray matter volumes of the caudate, putamen, and thalamus did not differ significantly between the groups. The areas of cortical thinning over time in the placebo group were more extensive, including the frontal, temporal, and parietal areas, whereas these areas in the MSC group were less extensive. Correlation analysis indicated that declines in MoCA scores and phonemic fluency during the follow-up period were significantly correlated with cortical thinning of the frontal and posterior temporal areas and anterior temporal areas in MSA patients, respectively. In contrast, no significant correlations were observed in the MSC group. These results suggest that MSC treatment in patients with MSA may modulate cortical thinning over time and related cognitive performance, inferring a future therapeutic candidate for cognitive disorders.
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Affiliation(s)
- Mun Kyung Sunwoo
- Department of Neurology, Bundang Jesaeng General Hospital Seongnam, Korea
| | - Hyuk Jin Yun
- Department of Biomedical Engineering, Hanyang University Seoul, South Korea
| | - Sook K Song
- Department of Neurology, Jeju University College of Medicine Jeju, Korea
| | - Ji Hyun Ham
- Department of Neurology, Yonsei University College of Medicine Seoul, Korea
| | - Jin Yong Hong
- Department of Neurology, Wonju College of Medicine, Yonsei University Wonju, Korea
| | - Ji E Lee
- Department of Neurology, Yonsei University College of Medicine Seoul, Korea
| | - Hye S Lee
- Department of Biostatistics, Yonsei University College of Medicine Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine Seoul, Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine Seoul, Korea ; Severance Biomedical Science Institute, Yonsei University College of Medicine Seoul Korea
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Bleasel JM, Wong JH, Halliday GM, Kim WS. Lipid dysfunction and pathogenesis of multiple system atrophy. Acta Neuropathol Commun 2014; 2:15. [PMID: 24502382 PMCID: PMC3922275 DOI: 10.1186/2051-5960-2-15] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 12/24/2022] Open
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by the accumulation of α-synuclein protein in the cytoplasm of oligodendrocytes, the myelin-producing support cells of the central nervous system (CNS). The brain is the most lipid-rich organ in the body and disordered metabolism of various lipid constituents is increasingly recognized as an important factor in the pathogenesis of several neurodegenerative diseases. α-Synuclein is a 17 kDa protein with a close association to lipid membranes and biosynthetic processes in the CNS, yet its precise function is a matter of speculation, particularly in oligodendrocytes. α-Synuclein aggregation in neurons is a well-characterized feature of Parkinson’s disease and dementia with Lewy bodies. Epidemiological evidence and in vitro studies of α-synuclein molecular dynamics suggest that disordered lipid homeostasis may play a role in the pathogenesis of α-synuclein aggregation. However, MSA is distinct from other α-synucleinopathies in a number of respects, not least the disparate cellular focus of α-synuclein pathology. The recent identification of causal mutations and polymorphisms in COQ2, a gene encoding a biosynthetic enzyme for the production of the lipid-soluble electron carrier coenzyme Q10 (ubiquinone), puts membrane transporters as central to MSA pathogenesis, although how such transporters are involved in the early myelin degeneration observed in MSA remains unclear. The purpose of this review is to bring together available evidence to explore the potential role of membrane transporters and lipid dyshomeostasis in the pathogenesis of α-synuclein aggregation in MSA. We hypothesize that dysregulation of the specialized lipid metabolism involved in myelin synthesis and maintenance by oligodendrocytes underlies the unique neuropathology of MSA.
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Cao B, Guo X, Chen K, Song W, Huang R, Wei QQ, Zhao B, Shang HF. Serum lipid levels are associated with the prevalence but not with the disease progression of multiple system atrophy in a Chinese population. Neurol Res 2013; 36:150-6. [DOI: 10.1179/1743132813y.0000000277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Cao B, Guo X, Chen K, Song W, Huang R, Wei QQ, Zhao B, Shang HF. Uric acid is associated with the prevalence but not disease progression of multiple system atrophy in Chinese population. J Neurol 2013; 260:2511-5. [PMID: 23801150 DOI: 10.1007/s00415-013-7006-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 02/05/2023]
Abstract
Oxidative stress is involved in the pathogenesis of multiple system atrophy (MSA). Uric acid has an antioxidative effect. Our aim is to clarify the correlations between serum uric acid and MSA in Chinese population. A total of 234 patients with probable MSA and 240 age- and gender- matched healthy controls were included in the study. The serum uric acid levels of all the patients and controls were evaluated. The Unified MSA Rating Scale (UMSARS) was used to assess the severity and the mean rate of annualized changes of UMSARS to assess the progression of MSA. The mean age of MSA patients was 58.90 ± 9.00 years and the mean disease duration was 2.60 ± 1.75 years. The serum uric acid levels of MSA patients were significantly lower than that of controls in males (p = 0.0001). The occurrence of MSA was increased in the lowest uric acid quartiles compared with the highest uric acid quartiles (p = 0.005). In a gender-specific analysis, increased occurrence was found in the lowest quartiles and second quartiles compared with the highest quartiles in males (p = 0.001 and p = 0.0001 respectively), but not in females. No correlation was found between the mean rate of annualized changes and serum levels of uric acid, as well as other independent factors, such as age, BMI, gender, subtype (C-type or P-type) and disease duration at the initial visit in 107 followed-up patients. MSA patients have lower levels of serum uric acid than controls. High levels of serum uric acid may be associated with a lower prevalence of MSA in the Chinese population, especially in males. However, serum uric acid does not deteriorate or ameliorate the progression of MSA.
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Affiliation(s)
- Bei Cao
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, 610041, Sichuan, China
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