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Orrù CD, Ma TC, Hughson AG, Groveman BR, Srivastava A, Galasko D, Angers R, Downey P, Crawford K, Hutten SJ, Kang UJ, Caughey B. A rapid α-synuclein seed assay of Parkinson's disease CSF panel shows high diagnostic accuracy. Ann Clin Transl Neurol 2021; 8:374-384. [PMID: 33373501 PMCID: PMC7886040 DOI: 10.1002/acn3.51280] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Assays that specifically measure α-synuclein seeding activity in biological fluids could revolutionize the diagnosis of Parkinson's disease. Recent improvements in α-synuclein real-time quaking-induced conversion assays of cerebrospinal fluid have dramatically reduced reaction times from 5-13 days down to 1-2 days. OBJECTIVE To test our improved assay against a panel of cerebrospinal fluid specimens from patients with Parkinson's disease and healthy controls from the MJ Fox Foundation/NINDS BioFIND collection. METHODS Specimens collected from healthy controls and patients with clinically typical moderate-to-advanced Parkinson's disease were tested without prior knowledge of disease status. Correlative analyses between assay parameters and clinical measures were performed by an independent investigator. RESULTS BioFIND samples gave positive signals in 105/108 (97%) Parkinson's disease cases versus 11/85 (13%) healthy controls. Receiver operating characteristic analyses of diagnosis of cases versus healthy controls gave areas under the curve of 95%. Beyond binary positive/negative determinations, only weak correlations were observed between various assay response parameters and Parkinson's disease clinical measures or other cerebrospinal fluid analytes. Of note, REM sleep behavioral disorder questionnaire scores correlated with the reaction times needed to reach 50% maximum fluorescence. Maximum fluorescence was inversely correlated with Unified Parkinson's Disease Rating Scale motor scores, which was driven by the patients without REM sleep behavioral disorder. CONCLUSIONS Our improved α-synuclein seed amplification assay dramatically reduces the time needed to diagnose Parkinson's disease while maintaining the high-performance standards associated with previous α-synuclein seed assays, supporting the clinical utility of this assay for Parkinson's disease diagnosis.
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Affiliation(s)
- Christina D. Orrù
- Laboratory of Persistent Viral DiseasesRocky Mountain LaboratoriesNational Institute of Allergy and Infectious DiseasesNIHHamiltonMontana
| | - Thong C. Ma
- Department of NeurologyNew York University Grossman School of MedicineNew YorkNew York
| | - Andrew G. Hughson
- Laboratory of Persistent Viral DiseasesRocky Mountain LaboratoriesNational Institute of Allergy and Infectious DiseasesNIHHamiltonMontana
| | - Bradley R. Groveman
- Laboratory of Persistent Viral DiseasesRocky Mountain LaboratoriesNational Institute of Allergy and Infectious DiseasesNIHHamiltonMontana
| | - Ankit Srivastava
- Laboratory of Persistent Viral DiseasesRocky Mountain LaboratoriesNational Institute of Allergy and Infectious DiseasesNIHHamiltonMontana
| | - Douglas Galasko
- Department of NeurosciencesUniversity of California‐San DiegoLa JollaCalifornia
| | | | | | - Karen Crawford
- Laboratory of Neuro ImagingMark and Mary Stevens Neuroimaging and Informatics InstituteKeck School of Medicine of USCUniversity of Southern CaliforniaLos AngelesCalifornia
| | | | - Un Jung Kang
- Department of NeurologyNew York University Grossman School of MedicineNew YorkNew York
| | - Byron Caughey
- Laboratory of Persistent Viral DiseasesRocky Mountain LaboratoriesNational Institute of Allergy and Infectious DiseasesNIHHamiltonMontana
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2
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Beach TG, Serrano GE, Kremer T, Canamero M, Dziadek S, Sade H, Derkinderen P, Corbillé AG, Letournel F, Munoz DG, White CL, Schneider J, Crary JF, Sue LI, Adler CH, Glass MJ, Intorcia AJ, Walker JE, Foroud T, Coffey CS, Ecklund D, Riss H, Goßmann J, König F, Kopil CM, Arnedo V, Riley L, Linder C, Dave KD, Jennings D, Seibyl J, Mollenhauer B, Chahine L. Immunohistochemical Method and Histopathology Judging for the Systemic Synuclein Sampling Study (S4). J Neuropathol Exp Neurol 2019; 77:793-802. [PMID: 30107604 DOI: 10.1093/jnen/nly056] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Immunohistochemical (IHC) α-synuclein (Asyn) pathology in peripheral biopsies may be a biomarker of Parkinson disease (PD). The multi-center Systemic Synuclein Sampling Study (S4) is evaluating IHC Asyn pathology within skin, colon and submandibular gland biopsies from 60 PD and 20 control subjects. Asyn pathology is being evaluated by a blinded panel of specially trained neuropathologists. Preliminary work assessed 2 candidate immunoperoxidase methods using a set of PD and control autopsy-derived sections from formalin-fixed, paraffin-embedded blocks of the 3 tissues. Both methods had 100% specificity; one, utilizing the 5C12 monoclonal antibody, was more sensitive in skin (67% vs 33%), and was chosen for further use in S4. Four trainee neuropathologists were trained to perform S4 histopathology readings; in subsequent testing, their scoring was compared to that of the trainer neuropathologist on both glass slides and digital images. Specificity and sensitivity were both close to 100% with all readers in all tissue types on both glass slides and digital images except for skin, where sensitivity averaged 75% with digital images and 83.5% with glass slides. Semiquantitative (0-3) density score agreement between trainees and trainer averaged 67% for glass slides and 62% for digital images.
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Affiliation(s)
- Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Thomas Kremer
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Marta Canamero
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Sebastian Dziadek
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Hadassah Sade
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Pascal Derkinderen
- Department of Neurology, CHU Nantes, Inserm, U1235, Nantes University, Nantes F-44035, France.,CHU Angers, Neurobiology and Neuropathology Laboratory, Angers F-49033, France
| | - Anne-Gaëlle Corbillé
- Department of Neurology, CHU Nantes, Inserm, U1235, Nantes University, Nantes F-44035, France.,CHU Angers, Neurobiology and Neuropathology Laboratory, Angers F-49033, France
| | - Franck Letournel
- Department of Neurology, CHU Nantes, Inserm, U1235, Nantes University, Nantes F-44035, France.,CHU Angers, Neurobiology and Neuropathology Laboratory, Angers F-49033, France
| | - David G Munoz
- Laboratory Medicine and Keenan Research Centre for Biomedical Research of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - John F Crary
- Department of Pathology, Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lucia I Sue
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Charles H Adler
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Michael J Glass
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Anthony J Intorcia
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Jessica E Walker
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Tatiana Foroud
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Dixie Ecklund
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Holly Riss
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | | | - Fatima König
- Targos Molecular Pathology GmbH, Kassel, Germany
| | - Catherine M Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Carly Linder
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kuldip D Dave
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center Goettingen, Goettingen, Germany
| | - Lana Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
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3
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Kang UJ, Boehme AK, Fairfoul G, Shahnawaz M, Ma TC, Hutten SJ, Green A, Soto C. Comparative study of cerebrospinal fluid α-synuclein seeding aggregation assays for diagnosis of Parkinson's disease. Mov Disord 2019; 34:536-544. [PMID: 30840785 PMCID: PMC6519150 DOI: 10.1002/mds.27646] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND PD diagnosis is based primarily on clinical criteria and can be inaccurate. Biological markers, such as α-synuclein aggregation, that reflect ongoing pathogenic processes may increase diagnosis accuracy and allow disease progression monitoring. Though α-synuclein aggregation assays have been published, reproducibility, standardization, and validation are key challenges for their development as clinical biomarkers. OBJECTIVE To cross-validate two α-synuclein seeding aggregation assays developed to detect pathogenic oligomeric α-synuclein species in CSF using samples from the same PD patients and healthy controls from the BioFIND cohort. METHODS CSF samples were tested by two independent laboratories in a blinded fashion. BioFIND features standardized biospecimen collection of clinically typical moderate PD patients and nondisease controls. α-synuclein aggregation was measured by protein misfolding cyclic amplification (Soto lab) and real-time quaking-induced conversion (Green lab). Results were analyzed by an independent statistician. RESULTS Measuring 105 PD and 79 healthy control CSF samples, these assays showed 92% concordance. The areas under the curve from receiver operating characteristic curve analysis for the diagnosis of PD versus healthy controls were 0.93 for protein misfolding cyclic amplification, 0.89 for real-time quaking-induced conversion, and 0.95 when considering only concordant assay results. Clinical characteristics of false-positive and -negative subjects were not different from true-negative and -positive subjects, respectively. CONCLUSIONS These α-synuclein seeding aggregation assays are reliable and reproducible for PD diagnosis. Assay parameters did not correlate with clinical parameters, including disease severity or duration. This assay is highly accurate for PD diagnosis and may impact clinical practice and clinical trials. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Un Jung Kang
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
| | - Amelia K. Boehme
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
| | - Graham Fairfoul
- The National CJD Research & Surveillance Unit, Western General HospitalUniversity of EdinburghEdinburghUnited Kingdom
| | - Mohammad Shahnawaz
- Mitchell Center for Alzheimer's Disease and Related Brain DisordersUniversity of Texas‐Houston Medical SchoolHoustonTexas
| | - Thong Chi Ma
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
| | | | - Alison Green
- The National CJD Research & Surveillance Unit, Western General HospitalUniversity of EdinburghEdinburghUnited Kingdom
| | - Claudio Soto
- Mitchell Center for Alzheimer's Disease and Related Brain DisordersUniversity of Texas‐Houston Medical SchoolHoustonTexas
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4
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Xu SS, Alexander PK, Lie Y, Dore V, Bozinovski S, Mulligan RS, Young K, Villemagne VL, Rowe CC. Diagnostic accuracy of imaging brain vesicular monoamine transporter type 2 (VMAT2) in clinically uncertain parkinsonian syndrome (CUPS): a 3-year follow-up study in community patients. BMJ Open 2018; 8:e025533. [PMID: 30446576 PMCID: PMC6252699 DOI: 10.1136/bmjopen-2018-025533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To further validate the diagnostic utility of 18F-AV-133 vesicular monoamine transporter type 2 (VMAT2) positron emission tomography (PET) in patients with clinically uncertain parkinsonian syndromes (CUPS) by comparison to clinical diagnosis at 3 years follow-up. DESIGN, SETTING AND PARTICIPANTS In a previous study, we reported that 18F-AV-133 PET in community patients with CUPS changed diagnosis and management and increased diagnostic confidence. The current diagnosis of this cohort was obtained from the patient and treating specialist and compared with the diagnosis suggested 3 years earlier by the 18F-AV-133 PET. A second 18F-AV-133 PET was available in those with a discordant or inconclusive final diagnosis. STUDY OUTCOME MEASURES The primary end point was the proportion of patients who had a follow-up clinical diagnosis, which was concordant with their initial 18F-AV-133 PET scan. Secondary end points were the proportion of patients who had the same diagnosis at follow-up as that reached after the initial scan and the stability of diagnostic changes made after the first scan. RESULTS 81 of the 85 patients previously recruited to the CUPS study had follow-up of which 79 had a clinical diagnosis and 2 remained CUPS. The diagnosis was in agreement with the initial 18F-AV-133 PET scan result in 74 cases. Five patients had a discordant diagnosis; one patient with rubral tremor had a severely abnormal scan that had worsened when rescanned; four cases with normal initial and repeat scans had a clinical diagnosis of Parkinson's disease. Two patients with suspected genetic disorders remained classified as CUPS and both had normal scans. In the 24 CUPS cohort patients where 18F-AV-133 PET initially changed diagnosis, this change was supported by follow-up diagnosis in all but the one rubral tremor case. CONCLUSION 18F-AV-133 PET is a useful tool in improving diagnostic accuracy in CUPS providing results and diagnostic changes that remain robust after 3 years follow-up.
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Affiliation(s)
- San San Xu
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Paschal K Alexander
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Yenni Lie
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Vincent Dore
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Health & Biosecurity Flagship, The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Svetlana Bozinovski
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Rachel S Mulligan
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Kenneth Young
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Victor L Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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5
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Beach TG, Adler CH. Importance of low diagnostic Accuracy for early Parkinson's disease. Mov Disord 2018; 33:1551-1554. [PMID: 30288780 PMCID: PMC6544441 DOI: 10.1002/mds.27485] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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6
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Ferrer P. Author response: Teaching NeuroImages: A rare case of giant perivascular spaces in the midbrain manifesting as atypical parkinsonism. Neurology 2018; 91:192. [DOI: 10.1212/wnl.0000000000005850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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7
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Langston JW, Wiley JC, Tagliati M. Optimizing Parkinson's disease diagnosis: the role of a dual nuclear imaging algorithm. NPJ PARKINSONS DISEASE 2018; 4:5. [PMID: 29507872 PMCID: PMC5824845 DOI: 10.1038/s41531-018-0041-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/08/2018] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
Abstract
The diagnosis of Parkinson's disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine 123I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining 123I-ioflupane SPECT and the noradrenergic receptor ligand 123I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral 123I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.
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Affiliation(s)
| | - Jesse C Wiley
- 2Department of Comparative Medicine, University of Washington, 1959 NE Pacific Ave Seattle, Seattle, WA USA
| | - Michele Tagliati
- Department of Neurology, Cedar-Sinai Medical Center, 127 S San Vicente Blvd, AHSP 6600, Los Angeles, CA 90272 USA
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8
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Lee JM, Derkinderen P, Kordower JH, Freeman R, Munoz DG, Kremer T, Zago W, Hutten SJ, Adler CH, Serrano GE, Beach TG. The Search for a Peripheral Biopsy Indicator of α-Synuclein Pathology for Parkinson Disease. J Neuropathol Exp Neurol 2017; 76:2-15. [DOI: 10.1093/jnen/nlw103] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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9
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NEUROIMÁGENES EN ENFERMEDAD DE PARKINSON: ROL DE LA RESONANCIA MAGNÉTICA, EL SPECT Y EL PET. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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10
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Abstract
PURPOSE OF REVIEW This review focuses on important new findings in the field of tremor and illustrates the consequences for the current definition and classification of tremor. RECENT FINDINGS Since 1998 when the consensus criteria for tremor were proposed, new variants of tremors and new diagnostic methods were discovered that have changed particularly the concepts of essential tremor and dystonic tremor. Accumulating evidence exists that essential tremor is not a single entity rather different conditions that share the common symptom action tremor without other major abnormalities. Tremor is a common feature in patients with adult-onset focal dystonia and may involve several different body parts and forms of tremor. Recent advances, in particular, in the field of genetics, suggest that dystonic tremor may even be present without overt dystonia. Monosymptomatic asymmetric rest and postural tremor has been further delineated, and apart from tremor-dominant Parkinson's disease, there are several rare conditions including rest and action tremor with normal dopamine transporter imaging (scans without evidence of dopaminergic deficit) and essential tremor with tremor at rest. SUMMARY Increasing knowledge in the last decades changed the view on tremors and highlights several caveats in the current tremor classification. Given the ambiguous assignment between tremor phenomenology and tremor etiology, a more cautious definition of tremors on the basis of clinical assessment data is needed.
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Erro R, Schneider SA, Stamelou M, Quinn NP, Bhatia KP. What do patients with scans without evidence of dopaminergic deficit (SWEDD) have? New evidence and continuing controversies. J Neurol Neurosurg Psychiatry 2016; 87:319-23. [PMID: 25991401 DOI: 10.1136/jnnp-2014-310256] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 05/04/2015] [Indexed: 11/03/2022]
Abstract
The term SWEDD (scans without evidence for dopaminergic deficit) refers to the absence, rather than the presence, of an imaging abnormality in patients clinically presumed to have Parkinson's disease (PD). However, such a term has since been widely used in the medical literature, even as a diagnostic label. While many authors have suggested that different disorders of PD lookalikes may account for a proportion of SWEDD cases, others have claimed that some of them may have a benign subtype of PD. Thus, there has been ensuing controversy and confusion and the use of this term continues without clarity of what it represents. We have systematically reviewed all the studies involving patients with SWEDD with the aim of shedding light on what these patients actually have. It becomes clear from this systematic review that while most 'SWEDD' cases are due to a clinical misdiagnosis of PD, there exists a small proportion of patients with SWEDD who may have PD on the basis of a positive levodopa response, clinical progression, imaging and/or genetic evidence. The latter challenge the seemingly incontrovertible relationship between dopaminergic tracer binding and the diagnosis of nigrostriatal parkinsonism, particularly PD. Patients with SWEDD are unlikely to reflect a single clinical entity and we suggest that the term SWEDD should be abandoned.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
| | - Susanne A Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK Department of Neurology, University Kiel, Kiel, Germany
| | - Maria Stamelou
- Second Department of Neurology, University of Athens, Greece; Movement Disorders Department, Hygeia Hospital, Athens, Greece Department of Neurology, Philipps University Marburg, Germany
| | - Niall P Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
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12
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Algarni MA, Stoessl AJ. The role of biomarkers and imaging in Parkinson’s disease. Expert Rev Neurother 2016; 16:187-203. [DOI: 10.1586/14737175.2016.1135056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Adler CH, Dugger BN, Hentz JG, Hinni ML, Lott DG, Driver-Dunckley E, Mehta S, Serrano G, Sue LI, Duffy A, Intorcia A, Filon J, Pullen J, Walker DG, Beach TG. Peripheral Synucleinopathy in Early Parkinson's Disease: Submandibular Gland Needle Biopsy Findings. Mov Disord 2016; 31:250-6. [PMID: 26799362 DOI: 10.1002/mds.26476] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/16/2015] [Accepted: 10/25/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Finding a peripheral tissue biopsy site to diagnose early PD would be of value for clinical care, biomarker validation, and as research enrollment criteria. Whereas autopsy and advanced PD studies suggest that the submandibular gland is an important biopsy site, there are no studies in early PD. The aim of this study was to determine whether needle biopsy of the submandibular gland reveals Lewy type alpha-synucleinopathy in early PD. METHODS Twenty-five early PD (duration < 5 years) and 10 controls underwent transcutaneous needle core biopsies of the submandibular gland. Tissue was stained for phosphorylated alpha-synuclein, reviewed blind to clinical diagnosis, and only nerve element staining was considered positive. RESULTS Mean (standard deviation) age was 69.5 (8.3) for the PD group, 64.8 (8.0) years for controls, and disease duration 2.6 (1.1) years. Six PD and 1 control subject had inadequate glandular tissue. Positive staining was found in 14 of 19 (74%) PD and 2 of 9 (22%) control subjects. PD-positive and -negative cases did not differ clinically. Adverse events (mainly swelling and bruising) were common (77% of cases), but were minor and transient. CONCLUSIONS Submandibular gland needle biopsies identified phosphorylated alpha-synuclein staining in 74% of early PD subjects. False positives may be true false positives or may represent prodromal PD. If confirmed in larger studies with eventual autopsy confirmation, the potential value of submandibular gland biopsies for early PD may be to aid in clinical trial inclusion/exclusion and eventually serve as a gold standard for biomarker studies short of autopsy confirmation.
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Affiliation(s)
- Charles H Adler
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph G Hentz
- Department of Biostatistics, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - David G Lott
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - Erika Driver-Dunckley
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shyamal Mehta
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Geidy Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Amy Duffy
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Jessica Filon
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Joel Pullen
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Douglas G Walker
- Banner Sun Health Research Institute, Sun City, Arizona, USA.,Arizona State University, Tempe, Arizona, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
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14
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Beach TG, Adler CH, Serrano G, Sue LI, Walker D, Dugger BN, Shill HA, Driver-Dunckley E, Caviness JN, Intorcia A, Filon J, Scott S, Garcia A, Hoffman B, Belden CM, Davis KJ, Sabbagh MN. Prevalence of Submandibular Gland Synucleinopathy in Parkinson's Disease, Dementia with Lewy Bodies and other Lewy Body Disorders. JOURNAL OF PARKINSON'S DISEASE 2016; 6:153-63. [PMID: 26756744 PMCID: PMC5498170 DOI: 10.3233/jpd-150680] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical misdiagnosis, particularly at early disease stages, is a roadblock to finding new therapies for Lewy body disorders. Biopsy of a peripheral site might provide improved diagnostic accuracy. Previously, we reported, from both autopsy and needle biopsy, a high prevalence of submandibular gland synucleinopathy in Parkinson's disease (PD). Here, we report on an extension of these studies to subjects with dementia with Lewy bodies (DLB) and other Lewy body disorders in 228 autopsied subjects from the Arizona Study of Aging and Neurodegenerative Disorders. OBJECTIVE To provide an estimate of the prevalence of histological synucleinopathy in the submandibular glands of subjects with PD and other Lewy body disorders. METHODS Submandibular gland sections from autopsied subjects were stained with an immunohistochemical method for α-synuclein phosphorylated at serine 129. Included were 146 cases with CNS Lewy-type synucleinopathy (LTS), composed of 46 PD, 28 DLB, 14 incidental Lewy body disease (ILBD), 33 Alzheimer's disease with Lewy bodies (ADLB) and 2 with progressive supranuclear palsy and Lewy bodies (PSPLB). Control subjects included 79 normal elderly, 15 AD, 12 PSP, 2 conticobasal degeneration (CBD) and 2 multiple system atrophy (MSA). RESULTS Submandibular gland LTS was found in 42/47 (89%) of the PD subjects, 20/28 (71%) DLB, 4/33 (12%) ADLB and 1/9 (11%) ILBD subjects but none of the 110 control subjects. CONCLUSIONS These results provide support for further clinical trials of in vivo submandibular gland diagnostic biopsy for PD and DLB. An accurate peripheral biopsy diagnosis would assist subject selection for clinical trials and could also be used to verify other biomarkers.
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Affiliation(s)
| | | | | | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | - D.G. Walker
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | | | | | | | - Sarah Scott
- Banner Sun Health Research Institute, Sun City, AZ
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Bannon D, Landau AM, Doudet DJ. How Relevant Are Imaging Findings in Animal Models of Movement Disorders to Human Disease? Curr Neurol Neurosci Rep 2015; 15:53. [DOI: 10.1007/s11910-015-0571-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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