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Cristiani CM, Scaramuzzino L, Quattrone A, Parrotta EI, Cuda G, Quattrone A. Serum Oligomeric α-Synuclein and p-tau181 in Progressive Supranuclear Palsy and Parkinson's Disease. Int J Mol Sci 2024; 25:6882. [PMID: 38999992 PMCID: PMC11241320 DOI: 10.3390/ijms25136882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Clinical differentiation of progressive supranuclear palsy (PSP) from Parkinson's disease (PD) is challenging due to overlapping phenotypes and the late onset of specific atypical signs. Therefore, easily assessable diagnostic biomarkers are highly needed. Since PD is a synucleopathy while PSP is a tauopathy, here, we investigated the clinical usefulness of serum oligomeric-α-synuclein (o-α-synuclein) and 181Thr-phosphorylated tau (p-tau181), which are considered as the most important pathological protein forms in distinguishing between these two parkinsonisms. We assessed serum o-α-synuclein and p-tau181 by ELISA and SIMOA, respectively, in 27 PSP patients, 43 PD patients, and 39 healthy controls (HC). Moreover, we evaluated the correlation between serum biomarkers and biological and clinical features of these subjects. We did not find any difference in serum concentrations of p-tau181 and o-α-synuclein nor in the o-α-synuclein/p-tau181 ratio between groups. However, we observed that serum p-tau181 positively correlated with age in HC and PD, while serum o-α-synuclein correlated positively with disease severity in PD and negatively with age in PSP. Finally, the o-α-synuclein/p-tau181 ratio showed a negative correlation with age in PD.
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Affiliation(s)
- Costanza Maria Cristiani
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (C.M.C.)
| | - Luana Scaramuzzino
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (C.M.C.)
| | - Andrea Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (C.M.C.)
| | - Elvira Immacolata Parrotta
- Institute of Molecular Biology, Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy
| | - Giovanni Cuda
- Department of Clinical and Experimental Medicine, University “Magna Graecia”, 88100 Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (C.M.C.)
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2
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Kim KY, Shin KY, Chang KA. Potential Exosome Biomarkers for Parkinson's Disease Diagnosis: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:5307. [PMID: 38791346 PMCID: PMC11121363 DOI: 10.3390/ijms25105307] [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: 03/25/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease worldwide. Given its prevalence, reliable biomarkers for early diagnosis are required. Exosomal proteins within extracellular nanovesicles are promising candidates for diagnostic, screening, prognostic, and disease monitoring purposes in neurological diseases such as PD. This review aims to evaluate the potential of extracellular vesicle proteins or miRNAs as biomarkers for PD. A comprehensive literature search until January 2024 was conducted across multiple databases, including PubMed, EMBASE, Web of Science, and Cochrane Library, to identify relevant studies reporting exosome biomarkers in blood samples from PD patients. Out of 417 articles screened, 47 studies were selected for analysis. Among exosomal protein biomarkers, α-synuclein, tau, Amyloid β 1-42, and C-X-C motif chemokine ligand 12 (CXCL12) were identified as significant markers for PD. Concerning miRNA biomarkers, miRNA-24, miR-23b-3p, miR-195-3p, miR-29c, and mir-331-5p are promising across studies. α-synuclein exhibited increased levels in PD patients compared to control groups in twenty-one studies, while a decrease was observed in three studies. Our meta-analysis revealed a significant difference in total exosomal α-synuclein levels between PD patients and healthy controls (standardized mean difference [SMD] = 1.369, 95% confidence interval [CI] = 0.893 to 1.846, p < 0.001), although these results are limited by data availability. Furthermore, α-synuclein levels significantly differ between PD patients and healthy controls (SMD = 1.471, 95% CI = 0.941 to 2.002, p < 0.001). In conclusion, certain exosomal proteins and multiple miRNAs could serve as potential biomarkers for diagnosis, prognosis prediction, and assessment of disease progression in PD.
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Affiliation(s)
- Ka Young Kim
- Department of Nursing, College of Nursing, Gachon University, Incheon 21936, Republic of Korea;
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
| | - Ki Young Shin
- Bio-MAX Institute, Seoul National University, Seoul 08826, Republic of Korea
| | - Keun-A Chang
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
- Department of Pharmacology, College of Medicine, Gachon University, Incheon 21999, Republic of Korea
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3
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Peng KW, Klotz A, Guven A, Kapadnis U, Ravipaty S, Tolstikov V, Vemulapalli V, Rodrigues LO, Li H, Kellogg MD, Kausar F, Rees L, Sarangarajan R, Schüle B, Langston W, Narain P, Narain NR, Kiebish MA. Identification and validation of N-acetylputrescine in combination with non-canonical clinical features as a Parkinson's disease biomarker panel. Sci Rep 2024; 14:10036. [PMID: 38693432 PMCID: PMC11063140 DOI: 10.1038/s41598-024-60872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/29/2024] [Indexed: 05/03/2024] Open
Abstract
Parkinson's disease is a progressive neurodegenerative disorder in which loss of dopaminergic neurons in the substantia nigra results in a clinically heterogeneous group with variable motor and non-motor symptoms with a degree of misdiagnosis. Only 3-25% of sporadic Parkinson's patients present with genetic abnormalities that could represent a risk factor, thus environmental, metabolic, and other unknown causes contribute to the pathogenesis of Parkinson's disease, which highlights the critical need for biomarkers. In the present study, we prospectively collected and analyzed plasma samples from 194 Parkinson's disease patients and 197 age-matched non-diseased controls. N-acetyl putrescine (NAP) in combination with sense of smell (B-SIT), depression/anxiety (HADS), and acting out dreams (RBD1Q) clinical measurements demonstrated combined diagnostic utility. NAP was increased by 28% in Parkinsons disease patients and exhibited an AUC of 0.72 as well as an OR of 4.79. The clinical and NAP panel demonstrated an area under the curve, AUC = 0.9 and an OR of 20.4. The assessed diagnostic panel demonstrates combinatorial utility in diagnosing Parkinson's disease, allowing for an integrated interpretation of disease pathophysiology and highlighting the use of multi-tiered panels in neurological disease diagnosis.
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Affiliation(s)
- Kuan-Wei Peng
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | - Allison Klotz
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | - Arcan Guven
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | - Unnati Kapadnis
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | - Shobha Ravipaty
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | | | | | | | - Hongyan Li
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | - Mark D Kellogg
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
- Department of Laboratory Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Farah Kausar
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Linda Rees
- Neurocrine Biosciences, San Diego, CA, 92130, USA
| | | | - Birgitt Schüle
- Department of Pathology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - William Langston
- Department of Pathology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Paula Narain
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
| | - Niven R Narain
- BPGbio, 500 Old Connecticut Path, Framingham, MA, 01701, USA
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4
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Camacho M, Wilms M, Almgren H, Amador K, Camicioli R, Ismail Z, Monchi O, Forkert ND. Exploiting macro- and micro-structural brain changes for improved Parkinson's disease classification from MRI data. NPJ Parkinsons Dis 2024; 10:43. [PMID: 38409244 PMCID: PMC10897162 DOI: 10.1038/s41531-024-00647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease. Accurate PD diagnosis is crucial for effective treatment and prognosis but can be challenging, especially at early disease stages. This study aimed to develop and evaluate an explainable deep learning model for PD classification from multimodal neuroimaging data. The model was trained using one of the largest collections of T1-weighted and diffusion-tensor magnetic resonance imaging (MRI) datasets. A total of 1264 datasets from eight different studies were collected, including 611 PD patients and 653 healthy controls (HC). These datasets were pre-processed and non-linearly registered to the MNI PD25 atlas. Six imaging maps describing the macro- and micro-structural integrity of brain tissues complemented with age and sex parameters were used to train a convolutional neural network (CNN) to classify PD/HC subjects. Explainability of the model's decision-making was achieved using SmoothGrad saliency maps, highlighting important brain regions. The CNN was trained using a 75%/10%/15% train/validation/test split stratified by diagnosis, sex, age, and study, achieving a ROC-AUC of 0.89, accuracy of 80.8%, specificity of 82.4%, and sensitivity of 79.1% on the test set. Saliency maps revealed that diffusion tensor imaging data, especially fractional anisotropy, was more important for the classification than T1-weighted data, highlighting subcortical regions such as the brainstem, thalamus, amygdala, hippocampus, and cortical areas. The proposed model, trained on a large multimodal MRI database, can classify PD patients and HC subjects with high accuracy and clinically reasonable explanations, suggesting that micro-structural brain changes play an essential role in the disease course.
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Affiliation(s)
- Milton Camacho
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.
- Department of Radiology, University of Calgary, Calgary, AB, Canada.
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Hannes Almgren
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Kimberly Amador
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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5
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Holmes SE, Honhar P, Tinaz S, Naganawa M, Hilmer AT, Gallezot JD, Dias M, Yang Y, Toyonaga T, Esterlis I, Mecca A, Van Dyck C, Henry S, Ropchan J, Nabulsi N, Louis ED, Comley R, Finnema SJ, Carson RE, Matuskey D. Synaptic loss and its association with symptom severity in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:42. [PMID: 38402233 PMCID: PMC10894197 DOI: 10.1038/s41531-024-00655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/06/2024] [Indexed: 02/26/2024] Open
Abstract
Parkinson's disease (PD) is the fastest growing neurodegenerative disease, but at present there is no cure, nor any disease-modifying treatments. Synaptic biomarkers from in vivo imaging have shown promise in imaging loss of synapses in PD and other neurodegenerative disorders. Here, we provide new clinical insights from a cross-sectional, high-resolution positron emission tomography (PET) study of 30 PD individuals and 30 age- and sex-matched healthy controls (HC) with the radiotracer [11C]UCB-J, which binds to synaptic vesicle glycoprotein 2A (SV2A), and is therefore, a biomarker of synaptic density in the living brain. We also examined a measure of relative brain perfusion from the early part of the same PET scan. Our results provide evidence for synaptic density loss in the substantia nigra that had been previously reported, but also extend this to other early-Braak stage regions known to be affected in PD (brainstem, caudate, olfactory cortex). Importantly, we also found a direct association between synaptic density loss in the nigra and severity of symptoms in patients. A greater extent and wider distribution of synaptic density loss in PD patients with longer illness duration suggests that [11C]UCB-J PET can be used to measure synapse loss with disease progression. We also demonstrate lower brain perfusion in PD vs. HC groups, with a greater extent of abnormalities in those with longer duration of illness, suggesting that [11C]UCB-J PET can simultaneously provide information on changes in brain perfusion. These results implicate synaptic imaging as a useful PD biomarker for future disease-modifying interventions.
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Affiliation(s)
- Sophie E Holmes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Praveen Honhar
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale School of Engineering and Applied Sciences, Yale University, New Haven, CT, USA
| | - Sule Tinaz
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Mika Naganawa
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ansel T Hilmer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale School of Engineering and Applied Sciences, Yale University, New Haven, CT, USA
| | | | - Mark Dias
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Yanghong Yang
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Takuya Toyonaga
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Adam Mecca
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Shannan Henry
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jim Ropchan
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Nabeel Nabulsi
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, New Haven, CT, USA
| | | | | | - Richard E Carson
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale School of Engineering and Applied Sciences, Yale University, New Haven, CT, USA
| | - David Matuskey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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6
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Leung IHK, Strudwick MW. A systematic review of the challenges, emerging solutions and applications, and future directions of PET/MRI in Parkinson's disease. EJNMMI REPORTS 2024; 8:3. [PMID: 38748251 PMCID: PMC10962627 DOI: 10.1186/s41824-024-00194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 05/19/2024]
Abstract
PET/MRI is a hybrid imaging modality that boasts the simultaneous acquisition of high-resolution anatomical data and metabolic information. Having these exceptional capabilities, it is often implicated in clinical research for diagnosing and grading, as well as tracking disease progression and response to interventions. Despite this, its low level of clinical widespread use is questioned. This is especially the case with Parkinson's disease (PD), the fastest progressively disabling and neurodegenerative cause of death. To optimise the clinical applicability of PET/MRI for diagnosing, differentiating, and tracking PD progression, the emerging novel uses, and current challenges must be identified. This systematic review aimed to present the specific challenges of PET/MRI use in PD. Further, this review aimed to highlight the possible resolution of these challenges, the emerging applications and future direction of PET/MRI use in PD. EBSCOHost (indexing CINAHL Plus, PsycINFO) Ovid (Medline, EMBASE) PubMed, Web of Science, and Scopus from 2006 (the year of first integrated PET/MRI hybrid system) to 30 September 2022 were used to search for relevant primary articles. A total of 933 studies were retrieved and following the screening procedure, 18 peer-reviewed articles were included in this review. This present study is of great clinical relevance and significance, as it informs the reasoning behind hindered widespread clinical use of PET/MRI for PD. Despite this, the emerging applications of image reconstruction developed by PET/MRI research data to the use of fully automated systems show promising and desirable utility. Furthermore, many of the current challenges and limitations can be resolved by using much larger-sampled and longitudinal studies. Meanwhile, the development of new fast-binding tracers that have specific affinity to PD pathological processes is warranted.
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7
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Tran C, Shen K, Liu K, Ashok A, Ramirez-Zamora A, Chen J, Li Y, Fang R. Deep learning predicts prevalent and incident Parkinson's disease from UK Biobank fundus imaging. Sci Rep 2024; 14:3637. [PMID: 38351326 PMCID: PMC10864361 DOI: 10.1038/s41598-024-54251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/10/2024] [Indexed: 02/16/2024] Open
Abstract
Parkinson's disease is the world's fastest-growing neurological disorder. Research to elucidate the mechanisms of Parkinson's disease and automate diagnostics would greatly improve the treatment of patients with Parkinson's disease. Current diagnostic methods are expensive and have limited availability. Considering the insidious and preclinical onset and progression of the disease, a desirable screening should be diagnostically accurate even before the onset of symptoms to allow medical interventions. We highlight retinal fundus imaging, often termed a window to the brain, as a diagnostic screening modality for Parkinson's disease. We conducted a systematic evaluation of conventional machine learning and deep learning techniques to classify Parkinson's disease from UK Biobank fundus imaging. Our results suggest Parkinson's disease individuals can be differentiated from age and gender-matched healthy subjects with 68% accuracy. This accuracy is maintained when predicting either prevalent or incident Parkinson's disease. Explainability and trustworthiness are enhanced by visual attribution maps of localized biomarkers and quantified metrics of model robustness to data perturbations.
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Affiliation(s)
- Charlie Tran
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Kai Shen
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Kang Liu
- Department of Physics, University of Florida, Gainesville, FL, 32661, USA
| | - Akshay Ashok
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, 32611, USA
| | | | - Jinghua Chen
- Department of Ophthalmology, University of Florida, Gainesville, FL, 32661, USA
| | - Yulin Li
- Department of Biostatistics, University of Florida, Gainesville, FL, 32661, USA
| | - Ruogu Fang
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, 32611, USA.
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, 1275 Center Drive, PO Box 116131, Gainesville, FL, 32611-6131, USA.
- Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL, 32611, USA.
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8
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Beauchamp LC, Dore V, Villemagne VL, Xu S, Finkelstein D, Barnham KJ, Rowe C. Using 18F-AV-133 VMAT2 PET Imaging to Monitor Progressive Nigrostriatal Degeneration in Parkinson Disease. Neurology 2023; 101:e2314-e2324. [PMID: 37816639 PMCID: PMC10727223 DOI: 10.1212/wnl.0000000000207748] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are limited validated biomarkers in Parkinson disease (PD) which substantially hinders the ability to monitor disease progression and consequently measure the efficacy of disease-modifying treatments. Imaging biomarkers, such as vesicular monoamine transporter type 2 (VMAT2) PET, enable enhanced diagnostic accuracy and detect early neurodegenerative changes associated with prodromal PD. This study sought to assess whether 18F-AV-133 VMAT2 PET is sensitive enough to monitor and quantify disease progression over a 2-year window. METHODS 18F-AV-133 PET scans were performed on participants with PD and REM sleep behavior disorder (RBD) and neurologic controls (NC). All participants were scanned twice ∼26 months apart. Regional tracer retention was calculated with a primary visual cortex reference region and expressed as the standard uptake volume ratio. Regions of interest included caudate, anterior, and posterior putamen. At the time of scanning, participants underwent clinical evaluation including UPDRSMOTOR test, Sniffin' Sticks, and Hospital Anxiety and Depression Score. RESULTS Over the 26-month interval, a significant decline in PET signal was observed in all 3 regions in participants with PD (N = 26) compared with NC (N = 12), consistent with a decrease in VMAT2 level and ongoing neurodegeneration. Imaging trajectory calculations suggest that the neurodegeneration in PD occurs over ∼33 years [CI: 27.2-39.5], with ∼10.5 years [CI: 9.1-11.3] of degeneration in the posterior putamen before it becomes detectable on a VMAT2 PET scan, a further ∼6.5 years [CI: 1.6-12.7] until symptom onset, and a further ∼3 years [CI: 0.3-8.7] until clinical diagnosis. DISCUSSION Over a 2-year period, 18F-AV-133 VMAT2 PET was able to detect progression of nigrostriatal degeneration in participants with PD, and it represents a sensitive tool to identify individuals at risk of progression to PD, which are currently lacking using clinical readouts. Trajectory models propose that there is nigrostriatal degeneration occurring for 20 years before clinical diagnosis. These data demonstrate that VMAT2 PET provides a sensitive measure to monitor neurodegenerative progression of PD which has implications for PD diagnostics and subsequently clinical trial patient stratification and monitoring. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that VMAT2 PET can detect patients with Parkinson disease and quantify progression over a 2-year window.
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Affiliation(s)
- Leah C Beauchamp
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Vincent Dore
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Victor L Villemagne
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - SanSan Xu
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - David Finkelstein
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Kevin J Barnham
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia.
| | - Christopher Rowe
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
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9
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Koretsky MJ, Alvarado C, Makarious MB, Vitale D, Levine K, Bandres-Ciga S, Dadu A, Scholz SW, Sargent L, Faghri F, Iwaki H, Blauwendraat C, Singleton A, Nalls M, Leonard H. Genetic risk factor clustering within and across neurodegenerative diseases. Brain 2023; 146:4486-4494. [PMID: 37192343 PMCID: PMC10629980 DOI: 10.1093/brain/awad161] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
Overlapping symptoms and co-pathologies are common in closely related neurodegenerative diseases (NDDs). Investigating genetic risk variants across these NDDs can give further insight into disease manifestations. In this study we have leveraged genome-wide single nucleotide polymorphisms and genome-wide association study summary statistics to cluster patients based on their genetic status across identified risk variants for five NDDs (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, Lewy body dementia and frontotemporal dementia). The multi-disease and disease-specific clustering results presented here provide evidence that NDDs have more overlapping genetic aetiology than previously expected and how neurodegeneration should be viewed as a spectrum of symptomology. These clustering analyses also show potential subsets of patients with these diseases that are significantly depleted for any known common genetic risk factors suggesting environmental or other factors at work. Establishing that NDDs with overlapping pathologies share genetic risk loci, future research into how these variants might have different effects on downstream protein expression, pathology and NDD manifestation in general is important for refining and treating NDDs.
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Affiliation(s)
- Mathew J Koretsky
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Chelsea Alvarado
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
| | - Mary B Makarious
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- UCL Movement Disorders Centre, University College London, London, WC1E 6BT, UK
| | - Dan Vitale
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
| | - Kristin Levine
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
| | - Sara Bandres-Ciga
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
| | - Anant Dadu
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Lana Sargent
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
| | - Faraz Faghri
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
| | - Hirotaka Iwaki
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
| | - Cornelis Blauwendraat
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew Singleton
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mike Nalls
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
| | - Hampton Leonard
- Center for Alzheimer’s Disease and Related Dementias, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
- Data Tecnica International LLC, Washington, DC 20037, USA
- DZNE, Tuebingen 72076, Germany
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10
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Beach TG, Adler CH, Shill HA, Serrano GE, Zhang N. α-synuclein seed amplification in Parkinson's disease. Lancet Neurol 2023; 22:985. [PMID: 37863604 DOI: 10.1016/s1474-4422(23)00373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/22/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Thomas G Beach
- Banner Sun Health Research Institute, Sun City, AZ, USA.
| | | | - Holly A Shill
- Barrow Neurological Institute, Phoenix 85351, AZ, USA
| | | | - Nan Zhang
- Mayo Clinic Arizona, Phoenix, AZ, USA
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11
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Bräuer S, Rossi M, Sajapin J, Henle T, Gasser T, Parchi P, Brockmann K, Falkenburger BH. Kinetic parameters of alpha-synuclein seed amplification assay correlate with cognitive impairment in patients with Lewy body disorders. Acta Neuropathol Commun 2023; 11:162. [PMID: 37814347 PMCID: PMC10563218 DOI: 10.1186/s40478-023-01653-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023] Open
Abstract
The alpha-synuclein (aSyn) seed amplification assay (SAA) can identify aSyn aggregates as indicator for Lewy body pathology in biomaterials of living patients and help in diagnosing Parkinson´s disease and dementia syndromes. Our objective was to confirm that qualitative results of aSyn SAA are reproducible across laboratories and to determine whether quantitative findings correlate with patient clinical characteristics. Therefore cerebrospinal fluid samples were re-analysed by aSyn SAA in a second laboratory with four technical replicates for each sample. Kinetic parameters derived from each aggregation curve were summarized and correlated with patient characteristics. We found that qualitative findings were identical between the two laboratories for 54 of 55 patient samples. The number of positive replicates for each sample also showed good agreement between laboratories. Moreover, specific kinetic parameters of the SAA showed a strong correlation with clinical parameters, notably with cognitive performance evaluated by the Montreal Cognitive Assessment. We concluded that SAA findings are highly reproducible across laboratories following the same protocol. SAA reports not only the presence of Lewy pathology but is also associated with clinical characteristics. Thus, aSyn SAA can potentially be used for patient stratification and determining the target engagement of aSyn targeting treatments.
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Affiliation(s)
- Stefan Bräuer
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Marcello Rossi
- IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Johann Sajapin
- Department of Food Chemistry, TU Dresden, Dresden, Germany
| | - Thomas Henle
- Department of Food Chemistry, TU Dresden, Dresden, Germany
| | - Thomas Gasser
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Björn H Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany.
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12
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Barbero JA, Unadkat P, Choi YY, Eidelberg D. Functional Brain Networks to Evaluate Treatment Responses in Parkinson's Disease. Neurotherapeutics 2023; 20:1653-1668. [PMID: 37684533 PMCID: PMC10684458 DOI: 10.1007/s13311-023-01433-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] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Network analysis of functional brain scans acquired with [18F]-fluorodeoxyglucose positron emission tomography (FDG PET, to map cerebral glucose metabolism), or resting-state functional magnetic resonance imaging (rs-fMRI, to map blood oxygen level-dependent brain activity) has increasingly been used to identify and validate reproducible circuit abnormalities associated with neurodegenerative disorders such as Parkinson's disease (PD). In addition to serving as imaging markers of the underlying disease process, these networks can be used singly or in combination as an adjunct to clinical diagnosis and as a screening tool for therapeutics trials. Disease networks can also be used to measure rates of progression in natural history studies and to assess treatment responses in individual subjects. Recent imaging studies in PD subjects scanned before and after treatment have revealed therapeutic effects beyond the modulation of established disease networks. Rather, other mechanisms of action may be at play, such as the induction of novel functional brain networks directly by treatment. To date, specific treatment-induced networks have been described in association with novel interventions for PD such as subthalamic adeno-associated virus glutamic acid decarboxylase (AAV2-GAD) gene therapy, as well as sham surgery or oral placebo under blinded conditions. Indeed, changes in the expression of these networks with treatment have been found to correlate consistently with clinical outcome. In aggregate, these attributes suggest a role for functional brain networks as biomarkers in future clinical trials.
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Affiliation(s)
- János A Barbero
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
| | - Prashin Unadkat
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, 11030, USA
| | - Yoon Young Choi
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.
- Molecular Medicine and Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.
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13
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Verbeek MM, Bloem BR. An emerging biomarker for dopaminergic cell loss. NATURE AGING 2023; 3:1180-1182. [PMID: 37735241 DOI: 10.1038/s43587-023-00501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Marcel M Verbeek
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Taha HB. Rethinking the reliability and accuracy of biomarkers in CNS-originating EVs for Parkinson's disease and multiple system atrophy. Front Neurol 2023; 14:1192115. [PMID: 37731853 PMCID: PMC10507694 DOI: 10.3389/fneur.2023.1192115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Hash Brown Taha
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
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15
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Beach TG, Adler CH, Shill HA, Zhang N, Driver-Dunckley ED, Mehta SH, Serrano GE. Accuracy of the Early Diagnosis of Parkinson's Disease. Mov Disord 2023; 38:1573-1574. [PMID: 37565398 PMCID: PMC10662959 DOI: 10.1002/mds.29556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Charles H. Adler
- Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic in Scottsdale, Arizona
| | - Holly A. Shill
- Department of Neurology at Barrow Neurological Institute, the Department of Neurology at the University of Arizona College of Medicine, and the Department of Neurology at Creighton University School of Medicine, Phoenix, Arizona
| | - Nan Zhang
- Department of Health Science Research, Section of Biostatistics, Mayo Clinic in Scottsdale, Arizona
| | - Erika D. Driver-Dunckley
- Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic in Scottsdale, Arizona
| | - Shyamal H. Mehta
- Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic in Scottsdale, Arizona
| | - Geidy E. Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
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16
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Mollenhauer B. Status of Current Biofluid Biomarkers in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:S18-S20. [PMID: 37637982 PMCID: PMC10448129 DOI: 10.1002/mdc3.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Brit Mollenhauer
- Department of NeurologyUniversity Medical Center GöttingenGöttingenGermany
- Paracelsus‐Elena‐KlinikKasselGermany
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17
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Dutta S, Hornung S, Taha HB, Bitan G. Biomarkers for parkinsonian disorders in CNS-originating EVs: promise and challenges. Acta Neuropathol 2023; 145:515-540. [PMID: 37012443 PMCID: PMC10071251 DOI: 10.1007/s00401-023-02557-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
Extracellular vesicles (EVs), including exosomes, microvesicles, and oncosomes, are nano-sized particles enclosed by a lipid bilayer. EVs are released by virtually all eukaryotic cells and have been shown to contribute to intercellular communication by transporting proteins, lipids, and nucleic acids. In the context of neurodegenerative diseases, EVs may carry toxic, misfolded forms of amyloidogenic proteins and facilitate their spread to recipient cells in the central nervous system (CNS). CNS-originating EVs can cross the blood-brain barrier into the bloodstream and may be found in other body fluids, including saliva, tears, and urine. EVs originating in the CNS represent an attractive source of biomarkers for neurodegenerative diseases, because they contain cell- and cell state-specific biological materials. In recent years, multiple papers have reported the use of this strategy for identification and quantitation of biomarkers for neurodegenerative diseases, including Parkinson's disease and atypical parkinsonian disorders. However, certain technical issues have yet to be standardized, such as the best surface markers for isolation of cell type-specific EVs and validating the cellular origin of the EVs. Here, we review recent research using CNS-originating EVs for biomarker studies, primarily in parkinsonian disorders, highlight technical challenges, and propose strategies for overcoming them.
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Affiliation(s)
- Suman Dutta
- International Institute of Innovation and Technology, New Town, Kolkata, India
| | - Simon Hornung
- Division of Peptide Biochemistry, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Hash Brown Taha
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 635 Charles E. Young Drive South/Gordon 451, Los Angeles, CA, 90095, USA
| | - Gal Bitan
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 635 Charles E. Young Drive South/Gordon 451, Los Angeles, CA, 90095, USA.
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA.
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA, USA.
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18
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Tan AH, Gatto EM. Movement Disorder Rounds: Learning through observation, Building on collective experiences. Parkinsonism Relat Disord 2023; 110:105396. [PMID: 37045676 DOI: 10.1016/j.parkreldis.2023.105396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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19
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Virameteekul S, Revesz T, Jaunmuktane Z, Warner TT, De Pablo-Fernández E. Clinical Diagnostic Accuracy of Parkinson's Disease: Where Do We Stand? Mov Disord 2023; 38:558-566. [PMID: 36602274 DOI: 10.1002/mds.29317] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinical diagnostic accuracy of Parkinson's disease (PD) remains suboptimal. Changes in disease concept may have improved clinical diagnostic accuracy in the past decade. However, current clinical diagnostic criteria have not been validated against neuropathological confirmation. OBJECTIVES This study aims to provide up-to-date clinical diagnostic accuracy data and validate current clinical diagnostic criteria for PD against neuropathology. METHODS A retrospective review of medical records of consecutive patients with parkinsonism from the Queen Square Brain Bank was performed between 2009 and 2019. Clinical diagnosis was documented at early (within 5 years of motor symptom onset) and final stages and categorized by movement disorder experts or regular clinicians. Movement Disorder Society Parkinson's disease (MDS-PD) diagnostic criteria were retrospectively applied. Diagnostic accuracy parameters (sensitivity, specificity, positive/negative predictive value, and accuracy) were calculated using neuropathological diagnosis as the gold standard. RESULTS A total of 267 patients (141 PD and 126 non-PD parkinsonism) were included. Clinical diagnostic accuracy was 97.2% for experts, 92.5% for the MDS clinically probable PD criteria, and 90.3% for clinicians. Similar figures were obtained when applied at an early stage (91.5%, 89.5%, and 84.2% diagnostic accuracy, respectively). MDS clinically established early PD criteria demonstrated very high specificity (98.4%) at early stages. CONCLUSIONS Our results showed an important improvement in PD clinical diagnostic accuracy in clinical practice over the past decade, more marked at early stages of the disease. MDS-PD diagnostic criteria is a valid tool in clinical practice and research for the identification of PD patients showing excellent sensitivity and specificity, although movement disorder experts' diagnosis remains the gold standard PD diagnosis during life. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sasivimol Virameteekul
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tamas Revesz
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Eduardo De Pablo-Fernández
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
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20
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Concha-Marambio L, Weber S, Farris CM, Dakna M, Lang E, Wicke T, Ma Y, Starke M, Ebentheuer J, Sixel-Döring F, Muntean ML, Schade S, Trenkwalder C, Soto C, Mollenhauer B. Accurate Detection of α-Synuclein Seeds in Cerebrospinal Fluid from Isolated Rapid Eye Movement Sleep Behavior Disorder and Patients with Parkinson's Disease in the DeNovo Parkinson (DeNoPa) Cohort. Mov Disord 2023; 38:567-578. [PMID: 36781413 PMCID: PMC10153075 DOI: 10.1002/mds.29329] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/06/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Misfolded α-synuclein (αSyn) aggregates (αSyn-seeds) in cerebrospinal fluid (CSF) are biomarkers for synucleinopathies such as Parkinson's disease (PD). αSyn-seeds have been detected in prodromal cases with isolated rapid eye movement sleep behavior disorder (iRBD). OBJECTIVES The objective of this study was to determine the accuracy of the αSyn-seed amplification assay (αS-SAA) in a comprehensively characterized cohort with a high proportion of PD and iRBD CSF samples collected at baseline. METHODS We used a high-throughput αS-SAA to analyze 233 blinded CSF samples from 206 participants of the DeNovo Parkinson Cohort (DeNoPa) (113 de novo PD, 64 healthy controls, 29 iRBD confirmed by video polysomnography). Results were compared with the final diagnosis, which was determined after up to 10 years of longitudinal clinical evaluations, including dopamine-transporter-single-photon emission computed tomography (DAT-SPECT) at baseline, CSF proteins, Movement Disorder Society-Unified Parkinson's Disease Rating Scale, and various cognitive and nonmotor scales. RESULTS αS-SAA detected αSyn-seeds in baseline PD-CSF with 98% accuracy. αSyn-seeds were detected in 93% of the iRBD cases. αS-SAA results showed higher agreement with the final than the initial diagnosis, as 14 patients were rediagnosed as non-αSyn aggregation disorder. For synucleinopathies, αS-SAA showed higher concordance with the final diagnosis than DAT-SPECT. Statistically significant correlations were found between assay parameters and disease progression. CONCLUSIONS Our results confirm αS-SAA accuracy at the first clinical evaluation when a definite diagnosis is most consequential. αS-SAA conditions reported here are highly sensitive, enabling the detection of αSyn-seeds in CSF from iRBD just months after the first symptoms, suggesting that αSyn-seeds are present in the very early prodromal phase of synucleinopathies. Therefore, αSyn-seeds are clear risk markers for synuclein-related disorders, but not for time of phenoconversion. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Sandrina Weber
- Department of Neurology, University Medical Centre Goettingen, Robert-Koch Str. 40, 37073 Goettingen, Germany
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
| | - Carly M. Farris
- R&D Unit, Amprion Inc., 11095 Flintkote Av., San Diego, California, 92121, USA
| | - Mohammed Dakna
- Department of Neurology, University Medical Centre Goettingen, Robert-Koch Str. 40, 37073 Goettingen, Germany
| | - Elisabeth Lang
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
| | - Tamara Wicke
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
| | - Yihua Ma
- R&D Unit, Amprion Inc., 11095 Flintkote Av., San Diego, California, 92121, USA
| | - Maritta Starke
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
| | - Jens Ebentheuer
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
| | - Friederike Sixel-Döring
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
- Department of Neurology, Philipps University Marburg, Baldingerstraße 35043 Marburg, Germany
| | | | - Sebastian Schade
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
- Department of Neurosurgery, University Medical Centre Goettingen, Robert-Koch Str. 40, 37073 Goettingen, Germany
| | - Claudio Soto
- R&D Unit, Amprion Inc., 11095 Flintkote Av., San Diego, California, 92121, USA
- Mitchell Center for Alzheimer’s Disease and Related Brain Disorders, University of Texas McGovern Medical School, Houston, TX, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Centre Goettingen, Robert-Koch Str. 40, 37073 Goettingen, Germany
- Paracelsus-Elena-Klinik, Klinikstrasse 16, 34119 Kassel, Germany
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21
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Schmitz M, Candelise N, Canaslan S, Altmeppen HC, Matschke J, Glatzel M, Younas N, Zafar S, Hermann P, Zerr I. α-Synuclein conformers reveal link to clinical heterogeneity of α-synucleinopathies. Transl Neurodegener 2023; 12:12. [PMID: 36915212 PMCID: PMC10012698 DOI: 10.1186/s40035-023-00342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
α-Synucleinopathies, such as Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy, are a class of neurodegenerative diseases exhibiting intracellular inclusions of misfolded α-synuclein (αSyn), referred to as Lewy bodies or oligodendroglial cytoplasmic inclusions (Papp-Lantos bodies). Even though the specific cellular distribution of aggregated αSyn differs in PD and DLB patients, both groups show a significant pathological overlap, raising the discussion of whether PD and DLB are the same or different diseases. Besides clinical investigation, we will focus in addition on methodologies, such as protein seeding assays (real-time quaking-induced conversion), to discriminate between different types of α-synucleinopathies. This approach relies on the seeding conversion properties of misfolded αSyn, supporting the hypothesis that different conformers of misfolded αSyn may occur in different types of α-synucleinopathies. Understanding the pathological processes influencing the disease progression and phenotype, provoked by different αSyn conformers, will be important for a personalized medical treatment in future.
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Affiliation(s)
- Matthias Schmitz
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany.
| | - Niccolò Candelise
- National Center for Drug Research and Evaluation, Institute Superiore di Sanità, Rome, Italy
| | - Sezgi Canaslan
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Hermann C Altmeppen
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Neelam Younas
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Saima Zafar
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Peter Hermann
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Inga Zerr
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
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22
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Vaneyck J, Yousif TA, Segers-Nolten I, Blum C, Claessens MMAE. Quantitative Seed Amplification Assay: A Proof-of-Principle Study. J Phys Chem B 2023; 127:1735-1743. [PMID: 36795058 PMCID: PMC9986870 DOI: 10.1021/acs.jpcb.2c08326] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Amyloid fibrils of the protein α-synuclein (αS) have recently been identified as a biomarker for Parkinson's disease (PD). To detect the presence of these amyloid fibrils, seed amplification assays (SAAs) have been developed. SAAs allow for the detection of αS amyloid fibrils in biomatrices such as cerebral spinal fluid and are promising for PD diagnosis by providing a dichotomous (yes/no) response. The additional quantification of the number of αS amyloid fibrils may enable clinicians to evaluate and follow the disease progression and severity. Developing quantitative SAAs has been shown to be challenging. Here, we report on a proof-of-principle study on the quantification of αS fibrils in fibril-spiked model solutions of increasing compositional complexity including blood serum. We show that parameters derived from standard SAAs can be used for fibril quantification in these solutions. However, interactions between the monomeric αS reactant that is used for amplification and biomatrix components such as human serum albumin have to be taken into account. We demonstrate that quantification of fibrils is possible even down to the single fibril level in a model sample consisting of fibril-spiked diluted blood serum.
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Affiliation(s)
- Jonathan Vaneyck
- Nanobiophysics (NBP), Faculty of Science and Technology, MESA + Institute for Nanotechnology and Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, Overijssel, The Netherlands
| | - Therese A Yousif
- Nanobiophysics (NBP), Faculty of Science and Technology, MESA + Institute for Nanotechnology and Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, Overijssel, The Netherlands
| | - Ine Segers-Nolten
- Nanobiophysics (NBP), Faculty of Science and Technology, MESA + Institute for Nanotechnology and Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, Overijssel, The Netherlands
| | - Christian Blum
- Nanobiophysics (NBP), Faculty of Science and Technology, MESA + Institute for Nanotechnology and Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, Overijssel, The Netherlands
| | - Mireille M A E Claessens
- Nanobiophysics (NBP), Faculty of Science and Technology, MESA + Institute for Nanotechnology and Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, Overijssel, The Netherlands
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23
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Chen Y, Hou L, Li W, Wang Q, Zhou W, Yang H. Referral criteria to palliative care for patients with Parkinson's disease: a systematic review. Curr Med Res Opin 2023; 39:267-279. [PMID: 36369847 DOI: 10.1080/03007995.2022.2146405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This systematic review aimed to identify the referral criteria for palliative care in patients with Parkinson's disease. METHODS We conducted an electronic search for publications on referral criteria for palliative care in patients with Parkinson's disease in six electronic databases. The articles were thoroughly reviewed by two independent reviewers for inclusion using a predefined data extraction list. The referral criteria were thematically classified using a coding methodology. RESULTS This systematic review included 36 publications. We identified 14 referral criteria themes. The most common referral indicators were functional decline (n = 11 [31%]), needs assessment tools (n = 11 [31%]), physical or emotional symptoms (n = 10[28%]), need for palliative care (n = 10 [28%]), decision support (n = 9 [25%]), advanced Parkinson's disease (n = 7[19%]), and diagnosis of Parkinson's disease (n = 7 [19%]). However, there was a lack of consensus on symptom assessment tools. In addition, there were no agreed cut-offs or defined time for palliative care referral for patients with Parkinson's disease. CONCLUSIONS The 14 themes identified in this systematic review were categorized into disease- and needs-based criteria. These themes show the wide range of referral timing and procedures. Further studies should be conducted to reveal standardized referral criteria.
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Affiliation(s)
- Yiping Chen
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Liyuan Hou
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wei Li
- International Medical Department, Peking Union Medical College Hospital, Beijing, China
| | - Qiaohong Wang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Nursing, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Neuroscience Institute, Singapore
| | - Hui Yang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
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24
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Perovnik M, Rus T, Schindlbeck KA, Eidelberg D. Functional brain networks in the evaluation of patients with neurodegenerative disorders. Nat Rev Neurol 2023; 19:73-90. [PMID: 36539533 DOI: 10.1038/s41582-022-00753-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Network analytical tools are increasingly being applied to brain imaging maps of resting metabolic activity (PET) or blood oxygenation-dependent signals (functional MRI) to characterize the abnormal neural circuitry that underlies brain diseases. This approach is particularly valuable for the study of neurodegenerative disorders, which are characterized by stereotyped spread of pathology along discrete neural pathways. Identification and validation of disease-specific brain networks facilitate the quantitative assessment of pathway changes over time and during the course of treatment. Network abnormalities can often be identified before symptom onset and can be used to track disease progression even in the preclinical period. Likewise, network activity can be modulated by treatment and might therefore be used as a marker of efficacy in clinical trials. Finally, early differential diagnosis can be achieved by simultaneously measuring the activity levels of multiple disease networks in an individual patient's scans. Although these techniques were originally developed for PET, over the past several years analogous methods have been introduced for functional MRI, a more accessible non-invasive imaging modality. This advance is expected to broaden the application of network tools to large and diverse patient populations.
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Affiliation(s)
- Matej Perovnik
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaž Rus
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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25
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Panyakaew P, Duangjino K, Kerddonfag A, Ploensin T, Piromsopa K, Kongkamol C, Bhidayasiri R. Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson's Disease: A Time-Series Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:975-988. [PMID: 37574743 PMCID: PMC10578277 DOI: 10.3233/jpd-230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Impaired dexterity is an early motor symptom in Parkinson's disease (PD) that significantly impacts the daily activity of patients; however, what constitutes complex dexterous movements remains controversial. OBJECTIVE To explore the characteristics of finger dexterity in mild-to-moderate stage PD. METHODS We quantitatively assessed finger dexterity in 48 mild-to-moderate stage PD patients and 49 age-matched controls using a simple alternating two-finger typing test for 15 seconds. Time-series analyses of various kinematic parameters with machine learning were compared between sides and groups. RESULTS Both the more and less affected hands of patients with PD had significantly lower typing frequency and slower typing velocity than the non-dominant and the dominant hands of controls (p = 0.019, p = 0.016, p < 0.001, p < 0.001). The slope of the typing velocity decreased with time, indicating a sequence effect in the PD group. A typing duration of 6 seconds was determined sufficient to discriminate PD patients from controls. Typing error, repetition, and repetition rate were significantly higher in the more affected hands of patients with PD than in the non-dominant hand of controls (p < 0.001, p = 0.03, p < 0.001). The error rate was constant, whereas the repetition rate was steep during the initiation of typing. A predictive model of the more affected hand demonstrated an accuracy of 70% in differentiating PD patients from controls. CONCLUSION Our study demonstrated complex components of impaired finger dexterity in mild-to-moderate stage PD, namely bradykinesia with sequence effects, error, and repetition at the initiation of movement, suggesting that multiple neural networks may be involved in dexterity deficits in PD.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Kotchakorn Duangjino
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Apiwoot Kerddonfag
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Teerit Ploensin
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Krerk Piromsopa
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
- Research Group on Applied Computer Engineering Technology for Medicine and Healthcare, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Chanon Kongkamol
- Department of Family and Prevention Medicine, Faculty of Medicine, Prince of Songkla University, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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26
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Oligomeric α-synuclein and tau aggregates in NDEVs differentiate Parkinson's disease from atypical parkinsonisms. Neurobiol Dis 2023; 176:105947. [PMID: 36481435 DOI: 10.1016/j.nbd.2022.105947] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The early differential diagnosis of Parkinson's disease (PD) and atypical Parkinsonian syndromes (APS), including corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP), is challenging because of an overlap of clinical features and the lack of reliable biomarkers. Neural-derived extracellular vesicles (NDEVs) isolated from blood provide a window into the brain's biochemistry and may assist in distinguishing between PD and APS. We verified in a case-control study whether oligomeric α-Synuclein and Tau aggregates isolated from NDEVs could allow the differential diagnosis of these conditions. Blood sampling and clinical data, including disease duration, motor severity, global cognition, and levodopa equivalent daily dose (LEDD), were collected from patients with a diagnosis of either PD (n = 70), PSP (n = 21), or CBD (n = 19). NDEVs were isolated from serum by immunocapture using an antibody against the neuronal surface marker L1CAM; oligomeric α-Synuclein and aggregated Tau were measured by ELISA. NDEVs analyses showed that oligomeric α-Synuclein is significantly augmented in PD compared to APS, whereas Tau aggregates are significantly increased in APS compared to PD (p < 0.0001). ROC analyses showed that these two biomarkers have a "good" power of classification (p < 0.0001 for both proteins), with high sensitivity and specificity, with NDEVs concentration of Tau aggregates and oligomeric α-Synuclein being respectively the best biomarker for PD/PSP and PD/CBD diagnostic differentiation. Logistic and multiple regression analysis confirmed that NDEVs-derived oligomeric α-Synuclein and Tau aggregates differentiate PD from CBD and PSP (p < 0.001). Notably, a positive correlation between NDEVs oligomeric α-Synuclein and disease severity (disease duration, p = 0.023; Modified H&Y, p = 0.015; UPDRS motor scores, p = 0.004) was found in PD patients and, in these same patients, NDEVs Tau aggregates concentration inversely correlated with global cognitive scores (p = 0.043). A minimally invasive blood test measuring the concentration of α-synuclein and Tau aggregates in NDEVs can represent a promising tool to distinguish with high sensitivity and specificity PD from CBD or PSP patients. Optimization and validation of these data will be needed to confirm the diagnostic value of these biomarkers in distinguishing synucleinopathies from taupathies.
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27
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Thaler A, Alcalay RN. Diagnosis and Medical Management of Parkinson Disease. Continuum (Minneap Minn) 2022; 28:1281-1300. [DOI: 10.1212/con.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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28
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Diamond JM, Lopes MB, Elias WJ, Jansen LA. Gamma-Aminobutyric Acid A Receptor Subunit Expression and Cellular Localization in the Human Parkinsonian Globus Pallidus. World Neurosurg 2022; 165:e159-e168. [PMID: 35659589 DOI: 10.1016/j.wneu.2022.05.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The gamma-aminobutyric acid A (GABAA) receptor is an important mediator of cellular signaling in the globus pallidus and might be implicated in the pathophysiology of Parkinson disease (PD). The goal of the present study was to characterize GABAA receptor subunit expression in the normal and parkinsonian human globus pallidus. METHODS Postmortem brain specimens were obtained from 8 patients with pathological evidence of PD at autopsy and from 4 control patients without such evidence. These tissues were exposed to primary antibodies directed against the α1 and α3 subunits of the GABAA receptor and were visualized and quantified using fluorescence microscopy. RESULTS No differences were found in the pallidal neuronal density in the control versus PD tissues. Projection neurons strongly expressed the α1, α3, and β2 GABAA receptor subunits. After normalizing the immunofluorescence intensities in the globus pallidus to those in the adjacent structures, no significant differences were found in GABAA receptor subunit expression in the globus pallidus between the PD specimens and the control specimens. CONCLUSIONS Compensatory changes in GABAA receptor α1 and α3 subunit expression in response to PD-related signaling abnormalities in the globus pallidus did not occur in our PD cohort.
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Affiliation(s)
- Joshua M Diamond
- Department of Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - M Beatriz Lopes
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - W Jeff Elias
- Department of Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
| | - Laura A Jansen
- Department of Neurology, University of Virginia Medical Center, Charlottesville, Virginia, USA
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29
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Crotty GF, Keavney JL, Alcalay RN, Marek K, Marshall GA, Rosas HD, Schwarzschild MA. Planning for Prevention of Parkinson Disease: Now Is the Time. Neurology 2022; 99:1-9. [PMID: 36219787 PMCID: PMC10519135 DOI: 10.1212/wnl.0000000000200789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Parkinson disease (PD) is a chronic progressive neurodegenerative disease with increasing worldwide prevalence. Despite many trials of neuroprotective therapies in manifest PD, no disease-modifying therapy has been established. Over the past several decades, a series of breakthroughs have identified discrete populations at substantially increased risk of developing PD. Based on this knowledge, now is the time to design and implement PD prevention trials. This endeavor builds on experience gained from early prevention trials in Alzheimer disease and Huntington disease. This article first reviews prevention trial precedents in these other neurodegenerative diseases before focusing on the critical design elements for PD prevention trials, including whom to enroll for these trials, what therapeutics to test, and how to measure outcomes in prevention trials. Our perspective reflects progress and remaining challenges that motivated a 2021 conference, "Planning for Prevention of Parkinson: A Trial Design Symposium and Workshop."
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Affiliation(s)
- Grace F Crotty
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Jessi L Keavney
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Roy N Alcalay
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kenneth Marek
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gad A Marshall
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - H Diana Rosas
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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30
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Survey of Machine Learning Techniques in the Analysis of EEG Signals for Parkinson’s Disease: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146967] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Parkinson’s disease (PD) affects 7–10 million people worldwide. Its diagnosis is clinical and can be supported by image-based tests, which are expensive and not always accessible. Electroencephalograms (EEG) are non-invasive, widely accessible, low-cost tests. However, the signals obtained are difficult to analyze visually, so advanced techniques, such as Machine Learning (ML), need to be used. In this article, we review those studies that consider ML techniques to study the EEG of patients with PD. Methods: The review process was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which are used to provide quality standards for the objective evaluation of various studies. All publications before February 2022 were included, and their main characteristics and results were evaluated and documented through three key points associated with the development of ML techniques: dataset quality, data preprocessing, and model evaluation. Results: 59 studies were included. The predominating models were Support Vector Machine (SVM) and Artificial Neural Networks (ANNs). In total, 31 articles diagnosed PD with a mean accuracy of 97.35 ± 3.46%. There was no standard cleaning protocol for EEG and a great heterogeneity in EEG characteristics was shown, although spectral features predominated by 88.37%. Conclusions: Neither the cleaning protocol nor the number of EEG channels influenced the classification results. A baseline value was provided for the PD diagnostic problem, although recent studies focus on the identification of cognitive impairment.
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31
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Hall S, Orrù CD, Serrano GE, Galasko D, Hughson AG, Groveman BR, Adler CH, Beach TG, Caughey B, Hansson O. Performance of αSynuclein RT-QuIC in relation to neuropathological staging of Lewy body disease. Acta Neuropathol Commun 2022; 10:90. [PMID: 35733234 PMCID: PMC9219141 DOI: 10.1186/s40478-022-01388-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022] Open
Abstract
Currently, there is a need for diagnostic markers in Lewy body disorders (LBD). α-synuclein (αSyn) RT-QuIC has emerged as a promising assay to detect misfolded αSyn in clinically or neuropathologically established patients with various synucleinopathies. In this study, αSyn RT-QuIC was used to analyze lumbar CSF in a clinical cohort from the Swedish BioFINDER study and postmortem ventricular CSF in a neuropathological cohort from the Arizona Study of Aging and Neurodegenerative Disorders/Brain and Body Donation Program (AZSAND/BBDP). The BioFINDER cohort included 64 PD/PDD, 15 MSA, 15 PSP, 47 controls and two controls who later converted to PD/DLB. The neuropathological cohort included 101 cases with different brain disorders, including LBD and controls. In the BioFINDER cohort αSyn RT-QuIC identified LBD (i.e. PD, PDD and converters) vs. controls with a sensitivity of 95% and a specificity of 83%. The two controls that converted to LBD were αSyn RT-QuIC positive. Within the AZSAND/BBDP cohort, αSyn RT-QuIC identified neuropathologically verified "standard LBD" (i.e. PD, PD with AD and DLB; n = 25) vs. no LB pathology (n = 53) with high sensitivity (100%) and specificity (94%). Only 57% were αSyn RT-QuIC positive in the subgroup with "non-standard" LBD (i.e., AD with Lewy Bodies not meeting criteria for DLB or PD, and incidental LBD, n = 23). Furthermore, αSyn RT-QuIC reliably identified cases with LB pathology in the cortex (97% sensitivity) vs. cases with no LBs or LBs present only in the olfactory bulb (93% specificity). However, the sensitivity was low, only 50%, for cases with LB pathology restricted to the brainstem or amygdala, not affecting the allocortex or neocortex. In conclusion, αSyn RT-QuIC of CSF samples is highly sensitive and specific for identifying cases with clinicopathologically-defined Lewy body disorders and shows a lower sensitivity for non-standard LBD or asymptomatic LBD or in cases with modest LB pathology not affecting the cortex.
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Affiliation(s)
- Sara Hall
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, 20502, Malmö, Sweden.
| | - Christina D Orrù
- LPVD, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, MT, USA
| | - Geidy E Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Andrew G Hughson
- LPVD, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, MT, USA
| | | | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Byron Caughey
- LPVD, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, MT, USA
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, 20502, Malmö, Sweden.
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van Rumund A, Esselink RAJ, Berrevoets-Aerts MB, Otto M, Bloem BR, Verbeek MM. Factors associated with mortality in early stages of parkinsonism. NPJ Parkinsons Dis 2022; 8:67. [PMID: 35655067 PMCID: PMC9163117 DOI: 10.1038/s41531-022-00329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/27/2022] [Indexed: 11/09/2022] Open
Abstract
Prognosis of patients with parkinsonism varies greatly between the various parkinsonian syndromes. However, it is often difficult to distinguish the different forms, particularly in early stages. We examined predictors of mortality and functional outcome in patients with recent-onset parkinsonism with an initially uncertain diagnosis (n = 156). Patients were recruited between 2003 and 2006, comprehensively investigated, and followed prospectively (up to 15 years, mean 7 years). A final clinical diagnosis was established after follow-up. Independent predictors of mortality were investigated with multivariable Cox regression and combined into a simple prediction model. Model performance to predict 5- and 10-year mortality and functional outcome after 3 years was evaluated and externally validated in a second cohort of 62 patients with parkinsonism with an initially uncertain diagnosis. Ninety-one patients died (58%). Orthostatic hypotension, impaired cognition, abnormal tandem gait, and elevated neurofilament light chain concentration in serum or CSF were associated with mortality. A simple model that combined these factors showed excellent performance for prediction of functional outcome after 3 years and mortality after 5 and 10 years (c-statistic ~0.90 for all models). Model performance was confirmed after external validation: prediction of functional outcome after 3 years (c-statistic 0.89, 95% CI 0.80–0.98) and mortality after 5 years (c-statistic 0.91, 95% CI 0.84–0.99) were comparable to the results in the discovery cohort. These findings help clinicians to estimate a patient’s prognosis, irrespective of the specific diagnosis.
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Affiliation(s)
- Anouke van Rumund
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. .,Radboudumc Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
| | - Rianne A J Esselink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | | | - Markus Otto
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Schalkamp AK, Rahman N, Monzón-Sandoval J, Sandor C. Deep phenotyping for precision medicine in Parkinson's disease. Dis Model Mech 2022; 15:dmm049376. [PMID: 35647913 PMCID: PMC9178512 DOI: 10.1242/dmm.049376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A major challenge in medical genomics is to understand why individuals with the same disorder have different clinical symptoms and why those who carry the same mutation may be affected by different disorders. In every complex disorder, identifying the contribution of different genetic and non-genetic risk factors is a key obstacle to understanding disease mechanisms. Genetic studies rely on precise phenotypes and are unable to uncover the genetic contributions to a disorder when phenotypes are imprecise. To address this challenge, deeply phenotyped cohorts have been developed for which detailed, fine-grained data have been collected. These cohorts help us to investigate the underlying biological pathways and risk factors to identify treatment targets, and thus to advance precision medicine. The neurodegenerative disorder Parkinson's disease has a diverse phenotypical presentation and modest heritability, and its underlying disease mechanisms are still being debated. As such, considerable efforts have been made to develop deeply phenotyped cohorts for this disorder. Here, we focus on Parkinson's disease and explore how deep phenotyping can help address the challenges raised by genetic and phenotypic heterogeneity. We also discuss recent methods for data collection and computation, as well as methodological challenges that have to be overcome.
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Affiliation(s)
| | | | | | - Cynthia Sandor
- UK Dementia Research Institute at Cardiff University,Division of Psychological Medicine and Clinical Neuroscience, Haydn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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34
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Gibbons CH, Freeman R, Bellaire B, Adler CH, Moore D, Levine T. Synuclein-One study: skin biopsy detection of phosphorylated α-synuclein for diagnosis of synucleinopathies. Biomark Med 2022; 16:499-509. [PMID: 35272481 PMCID: PMC9169016 DOI: 10.2217/bmm-2021-0646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
Finding an easily accessible and reliable tool to diagnose the diseases collectively defined as 'synucleinopathies' is an urgent, unmet priority. The synucleinopathies include Parkinson's disease, multiple system atrophy, pure autonomic failure and dementia with Lewy bodies. There are millions of people who have a diagnosis of a synucleinopathy, with more diagnosed every year. With accessibility, ease of implementation, consistently high sensitivity (>80%) and specificity approaching 100%, skin biopsy has great potential as the clinical test of choice for the diagnosis of synucleinopathies. The large, multi-center Synuclein-One study will determine the sensitivity, specificity, accuracy and precision of α-synuclein detection within punch skin biopsies in patients with clinically established synucleinopathies using standardized, robust methods suitable for large-scale analysis. Clinical Trial Registration: NCT04700722 (ClinicalTrials.gov).
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Affiliation(s)
- Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | | | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Dan Moore
- Calico Computing, Livermore, CA 94550, USA
| | - Todd Levine
- Department of Neurology, Honorhealth, Phoenix, AZ 85251, USA
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Giannoccaro MP, Avoni P, Rizzo G, Incensi A, Infante R, Donadio V, Liguori R. Presence of Skin α-Synuclein Deposits Discriminates Parkinson's Disease from Progressive Supranuclear Palsy and Corticobasal Syndrome. JOURNAL OF PARKINSON'S DISEASE 2022; 12:585-591. [PMID: 34864689 PMCID: PMC8925116 DOI: 10.3233/jpd-212904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies reported skin phosphorylated α-synuclein (p-syn) deposits in Parkinson's disease (PD) patients but not in patients with parkinsonism due to tauopathies, although data on the latter are limited. OBJECTIVE We aimed to assess the presence of skin p-syn deposits in patients with clinical diagnosis of parkinsonism usually due to tauopathy and PD. METHODS We consecutively recruited 26 patients, 18 fulfilling clinical diagnostic criteria of progressive supranuclear palsy (PSP) and 8 of corticobasal syndrome (CBS), 26 patients with PD, and 26 healthy controls (HC). All subjects underwent skin biopsy to study p-syn deposits in skin nerves by immunofluorescence. RESULTS Skin p-syn deposits were present in only two of the PSP/CBS patients and none of the HC. Conversely, all PD patients showed p-syn deposition (p < 0.001, Chi-square). The two p-syn positive patients were diagnosed with PSP and CBS, respectively. Although clinical and MRI findings supported these diagnoses, both patients had some atypical features more typical of synucleinopathies. CONCLUSION The detection of skin p-syn deposits may help in the differential diagnosis of parkinsonism. Indeed, in this study, all PD patients and only two out of 26 with a clinical diagnosis of PSP/CBS had skin p-syn deposits. Furthermore, these two patients showed clinical features that could suggest an atypical synucleinopathy presentation or a mixed pathology.
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Affiliation(s)
- Maria Pia Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Patologia Neuromuscolare e Neuroimmunologia, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Patrizia Avoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Alex Incensi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Patologia Neuromuscolare e Neuroimmunologia, Bologna, Italy
| | - Rossella Infante
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Patologia Neuromuscolare e Neuroimmunologia, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Patologia Neuromuscolare e Neuroimmunologia, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
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Matsubara T, Kameyama M, Tanaka N, Sengoku R, Orita M, Furuta K, Iwata A, Arai T, Maruyama H, Saito Y, Murayama S. Autopsy Validation of the Diagnostic Accuracy of 123I-Metaiodobenzylguanidine Myocardial Scintigraphy for Lewy Body Disease. Neurology 2022; 98:e1648-e1659. [PMID: 35256483 PMCID: PMC9052572 DOI: 10.1212/wnl.0000000000200110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES 123I-meta-iodobenzyl-guanidine (123I-MIBG) myocardial scintigraphy is employed as a diagnostic imaging test to differentiate Lewy body diseases (LBDs), including Parkinson's disease and dementia with Lewy bodies, from other similar diseases. However, its diagnostic accuracy lacks validation compared with that of the gold standard. We aimed to validate the diagnostic accuracy of 123I-MIBG myocardial scintigraphy for LBD against autopsy, the gold standard. METHODS This retrospective, cross-sectional study included consecutive autopsy patients from the Brain Bank for Aging Research who had undergone 123I-MIBG myocardial scintigraphy. We compared the 123I-MIBG myocardial scintigraphy findings with autopsy findings. Furthermore, the proportion of residual tyrosine hydroxylase (TH)-immunoreactive sympathetic fibers in the anterior wall of the left ventricle was investigated to assess the condition of the cardiac sympathetic nerves assumed to cause reduced 123I-MIBG uptake in LBDs. RESULTS We analyzed the data of 56 patients (30 with pathologically confirmed LBDs and 26 without LBD pathology). Compared with the neuropathological diagnosis, the early heart-to-mediastinum (H/M) ratio had a sensitivity and specificity of 70.0% (95% confidence interval [CI]: 50.6-85.3%) and 96.2% (95% CI: 80.4-99.9%), respectively. The delayed H/M ratio had a sensitivity and specificity of 80.0% (95% CI: 61.4-92.3%) and 92.3% (95% CI: 74.9-99.1%), respectively. The washout rate had a sensitivity and specificity of 80.0% (95% CI: 61.4-92.3%) and 84.6% (95% CI: 65.1-95.6%), respectively. The proportion of residual TH-immunoreactive cardiac sympathetic fibers strongly correlated with the amount of cardiac 123I-MIBG uptake when assessed with early and delayed H/M ratio values (correlation coefficient: 0.75 and 0.81, respectively; p < 0.001). DISCUSSION This clinicopathological validation study revealed that 123I-MIBG myocardial scintigraphy could robustly differentiate LBDs from similar diseases. Abnormal 123I-MIBG myocardial scintigraphy findings strongly support the presence of LBD and cardiac sympathetic denervation. However, LBD pathology should not necessarily be excluded by normal myocardial scintigraphy results, especially when other biomarkers suggest the presence of comorbid Alzheimer's disease pathology. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that 123I-MIBG myocardial scintigraphy accurately identifies patients with LBD.
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Affiliation(s)
- Tomoyasu Matsubara
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masashi Kameyama
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Noriko Tanaka
- Health Data Science Research Section, Healthy Aging Innovation Center (HAIC), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Renpei Sengoku
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Makoto Orita
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Ko Furuta
- Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Shigeo Murayama
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,The Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, Osaka, Japan
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O’Day C, Finkelstein DI, Diwakarla S, McQuade RM. A Critical Analysis of Intestinal Enteric Neuron Loss and Constipation in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1841-1861. [PMID: 35848035 PMCID: PMC9535602 DOI: 10.3233/jpd-223262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/06/2023]
Abstract
Constipation afflicts many patients with Parkinson's disease (PD) and significantly impacts on patient quality of life. PD-related constipation is caused by intestinal dysfunction, but the etiology of this dysfunction in patients is unknown. One possible cause is neuron loss within the enteric nervous system (ENS) of the intestine. This review aims to 1) Critically evaluate the evidence for and against intestinal enteric neuron loss in PD patients, 2) Justify why PD-related constipation must be objectively measured, 3) Explore the potential link between loss of enteric neurons in the intestine and constipation in PD, 4) Provide potential explanations for disparities in the literature, and 5) Outline data and study design considerations to improve future research. Before the connection between intestinal enteric neuron loss and PD-related constipation can be confidently described, future research must use sufficiently large samples representative of the patient population (majority diagnosed with idiopathic PD for at least 5 years), implement a consistent neuronal quantification method and study design, including standardized patient recruitment criteria, objectively quantify intestinal dysfunctions, publish with a high degree of data transparency and account for potential PD heterogeneity. Further investigation into other potential influencers of PD-related constipation is also required, including changes in the function, connectivity, mitochondria and/or α-synuclein proteins of enteric neurons and their extrinsic innervation. The connection between enteric neuron loss and other PD-related gastrointestinal (GI) issues, including gastroparesis and dysphagia, as well as changes in nutrient absorption and the microbiome, should be explored in future research.
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Affiliation(s)
- Chelsea O’Day
- Gut-Axis Injury & Repair Laboratory, Department of Medicine - Western Centre for Health Research and Education (WCHRE), The University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Western Centre for Health Research and Education (WCHRE) Level 3 and 4, Sunshine Hospital, St Albans, VIC, Australia
| | - David Isaac Finkelstein
- Parkinson’s Disease Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Shanti Diwakarla
- Gut-Axis Injury & Repair Laboratory, Department of Medicine - Western Centre for Health Research and Education (WCHRE), The University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Western Centre for Health Research and Education (WCHRE) Level 3 and 4, Sunshine Hospital, St Albans, VIC, Australia
| | - Rachel Mai McQuade
- Gut-Axis Injury & Repair Laboratory, Department of Medicine - Western Centre for Health Research and Education (WCHRE), The University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Western Centre for Health Research and Education (WCHRE) Level 3 and 4, Sunshine Hospital, St Albans, VIC, Australia
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Adler CH, Beach TG, Zhang N, Shill HA, Driver-Dunckley E, Mehta SH, Atri A, Caviness JN, Serrano G, Shprecher DR, Sue LI, Belden CM. Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: An Updated Clinicopathologic Study. Neurol Clin Pract 2021; 11:e414-e421. [PMID: 34484939 DOI: 10.1212/cpj.0000000000001016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/01/2020] [Indexed: 11/15/2022]
Abstract
Objective To update data for diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Methods Data from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) were used to determine the predictive value of a clinical PD diagnosis. Two clinical diagnostic confidence levels were used, possible PD (PossPD, never treated or not responsive) and probable PD (ProbPD, 2/3 cardinal clinical signs and responsive to dopaminergic medications). Neuropathologic diagnosis was the gold standard. Results Based on the first visit to AZSAND, 15/54 (27.8%) PossPD participants and 138/163 (84.7%) ProbPD participants had confirmed PD. PD was confirmed in 24/34 (70.6%) ProbPD with <5 years and 114/128 (89.1%) with ≥5 years disease duration. Using the consensus final clinical diagnosis following death, 161/187 (86.1%) ProbPD had neuropathologically confirmed PD. Diagnostic accuracy for ProbPD improved if included motor fluctuations, dyskinesias, and hyposmia, and hyposmia for PossPD. Conclusions This updated study confirmed lower clinical diagnostic accuracy for elderly, untreated or poorly responsive PossPD participants and for ProbPD with <5 years of disease duration, even when medication responsive. Caution continues to be needed when interpreting clinical studies of PD, especially studies of early disease, that do not have autopsy confirmation. Classification of Evidence This study provides Class II evidence that a clinical diagnosis of ProbPD at the first visit identifies participants who will have pathologically confirmed PD with a sensitivity of 82.6% and a specificity of 86.0%.
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Affiliation(s)
- Charles H Adler
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas G Beach
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nan Zhang
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Holly A Shill
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Erika Driver-Dunckley
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Shyamal H Mehta
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alireza Atri
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - John N Caviness
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Geidy Serrano
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David R Shprecher
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lucia I Sue
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Christine M Belden
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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α-Synuclein in blood exosomes immunoprecipitated using neuronal and oligodendroglial markers distinguishes Parkinson's disease from multiple system atrophy. Acta Neuropathol 2021; 142:495-511. [PMID: 33991233 PMCID: PMC8357708 DOI: 10.1007/s00401-021-02324-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022]
Abstract
The diagnosis of Parkinson’s disease (PD) and atypical parkinsonian syndromes is difficult due to the lack of reliable, easily accessible biomarkers. Multiple system atrophy (MSA) is a synucleinopathy whose symptoms often overlap with PD. Exosomes isolated from blood by immunoprecipitation using CNS markers provide a window into the brain’s biochemistry and may assist in distinguishing between PD and MSA. Thus, we asked whether α-synuclein (α-syn) in such exosomes could distinguish among healthy individuals, patients with PD, and patients with MSA. We isolated exosomes from the serum or plasma of these three groups by immunoprecipitation using neuronal and oligodendroglial markers in two independent cohorts and measured α-syn in these exosomes using an electrochemiluminescence ELISA. In both cohorts, α-syn concentrations were significantly lower in the control group and significantly higher in the MSA group compared to the PD group. The ratio between α-syn concentrations in putative oligodendroglial exosomes compared to putative neuronal exosomes was a particularly sensitive biomarker for distinguishing between PD and MSA. Combining this ratio with the α-syn concentration itself and the total exosome concentration, a multinomial logistic model trained on the discovery cohort separated PD from MSA with an AUC = 0.902, corresponding to 89.8% sensitivity and 86.0% specificity when applied to the independent validation cohort. The data demonstrate that a minimally invasive blood test measuring α-syn in blood exosomes immunoprecipitated using CNS markers can distinguish between patients with PD and patients with MSA with high sensitivity and specificity. Future optimization and validation of the data by other groups would allow this strategy to become a viable diagnostic test for synucleinopathies.
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GaborPDNet: Gabor Transformation and Deep Neural Network for Parkinson’s Disease Detection Using EEG Signals. ELECTRONICS 2021. [DOI: 10.3390/electronics10141740] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Parkinson’s disease (PD) is globally the most common neurodegenerative movement disorder. It is characterized by a loss of dopaminergic neurons in the substantia nigra of the brain. However, current methods to diagnose PD on the basis of clinical features of Parkinsonism may lead to misdiagnoses. Hence, noninvasive methods such as electroencephalographic (EEG) recordings of PD patients can be an alternative biomarker. In this study, a deep-learning model is proposed for automated PD diagnosis. EEG recordings of 16 healthy controls and 15 PD patients were used for analysis. Using Gabor transform, EEG recordings were converted into spectrograms, which were used to train the proposed two-dimensional convolutional neural network (2D-CNN) model. As a result, the proposed model achieved high classification accuracy of 99.46% (±0.73) for 3-class classification (healthy controls, and PD patients with and without medication) using tenfold cross-validation. This indicates the potential of proposed model to simultaneously automatically detect PD patients and their medication status. The proposed model is ready to be validated with a larger database before implementation as a computer-aided diagnostic (CAD) tool for clinical-decision support.
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Beach TG, Adler CH, Sue LI, Shill HA, Driver-Dunckley E, Mehta SH, Intorcia AJ, Glass MJ, Walker JE, Arce R, Nelson CM, Serrano GE. Vagus Nerve and Stomach Synucleinopathy in Parkinson's Disease, Incidental Lewy Body Disease, and Normal Elderly Subjects: Evidence Against the "Body-First" Hypothesis. JOURNAL OF PARKINSONS DISEASE 2021; 11:1833-1843. [PMID: 34151862 PMCID: PMC10082635 DOI: 10.3233/jpd-212733] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Braak and others have proposed that Lewy-type α-synucleinopathy in Parkinson's disease (PD) may arise from an exogenous pathogen that passes across the gastric mucosa and then is retrogradely transported up the vagus nerve to the medulla. OBJECTIVE We tested this hypothesis by immunohistochemically staining, with a method specific for p-serine 129 α-synuclein (pSyn), stomach and vagus nerve tissue from an autopsy series of 111 normal elderly subjects, 33 with incidental Lewy body disease (ILBD) and 53 with PD. METHODS Vagus nerve samples were taken adjacent to the carotid artery in the neck. Stomach samples were taken from the gastric body, midway along the greater curvature. Formalin-fixed paraffin-embedded sections were immunohistochemically stained for pSyn, shown to be highly specific and sensitive for α-synuclein pathology. RESULTS Median disease duration for the PD group was 13 years. In the vagus nerve none of the 111 normal subjects had pSyn in the vagus, while 12/26 ILBD (46%) and 32/36 PD (89%) subjects were pSyn-positive. In the stomach none of the 102 normal subjects had pSyn while 5/30 (17%) ILBD and 42/52 (81%) of PD subjects were pSyn-positive. CONCLUSION As there was no pSyn in the vagus nerve or stomach of subjects without brain pSyn, these results support initiation of pSyn in the brain. The presence of pSyn in the vagus nerve and stomach of a subset of ILBD cases indicates that synucleinopathy within the peripheral nervous system may occur, within a subset of individuals, at preclinical stages of Lewy body disease.
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Affiliation(s)
| | - Charles H Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, AZ, USA
| | | | | | - Shyamal H Mehta
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | | | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ, USA
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Abstract
Parkinson's disease is a recognisable clinical syndrome with a range of causes and clinical presentations. Parkinson's disease represents a fast-growing neurodegenerative condition; the rising prevalence worldwide resembles the many characteristics typically observed during a pandemic, except for an infectious cause. In most populations, 3-5% of Parkinson's disease is explained by genetic causes linked to known Parkinson's disease genes, thus representing monogenic Parkinson's disease, whereas 90 genetic risk variants collectively explain 16-36% of the heritable risk of non-monogenic Parkinson's disease. Additional causal associations include having a relative with Parkinson's disease or tremor, constipation, and being a non-smoker, each at least doubling the risk of Parkinson's disease. The diagnosis is clinically based; ancillary testing is reserved for people with an atypical presentation. Current criteria define Parkinson's disease as the presence of bradykinesia combined with either rest tremor, rigidity, or both. However, the clinical presentation is multifaceted and includes many non-motor symptoms. Prognostic counselling is guided by awareness of disease subtypes. Clinically manifest Parkinson's disease is preceded by a potentially long prodromal period. Presently, establishment of prodromal symptoms has no clinical implications other than symptom suppression, although recognition of prodromal parkinsonism will probably have consequences when disease-modifying treatments become available. Treatment goals vary from person to person, emphasising the need for personalised management. There is no reason to postpone symptomatic treatment in people developing disability due to Parkinson's disease. Levodopa is the most common medication used as first-line therapy. Optimal management should start at diagnosis and requires a multidisciplinary team approach, including a growing repertoire of non-pharmacological interventions. At present, no therapy can slow down or arrest the progression of Parkinson's disease, but informed by new insights in genetic causes and mechanisms of neuronal death, several promising strategies are being tested for disease-modifying potential. With the perspective of people with Parkinson's disease as a so-called red thread throughout this Seminar, we will show how personalised management of Parkinson's disease can be optimised.
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Affiliation(s)
- Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands.
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
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Martin WRW, Miles M, Zhong Q, Hartlein J, Racette BA, Norris SA, Ushe M, Maiti B, Criswell S, Davis AA, Kotzbauer PT, Cairns NJ, Perrin RJ, Perlmutter JS. Is Levodopa Response a Valid Indicator of Parkinson's Disease? Mov Disord 2021; 36:948-954. [PMID: 33253432 PMCID: PMC8046721 DOI: 10.1002/mds.28406] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The clinical diagnosis of Parkinson's disease (PD) requires the presence of parkinsonism and supportive criteria that include a clear and dramatic beneficial response to dopaminergic therapy. Our aim was to test the diagnostic criterion of dopaminergic response by evaluating its association with pathologically confirmed diagnoses in a large population of parkinsonian patients. METHODS We reviewed clinical data maintained in an electronic medical record from all patients with autopsy data who had been seen in the Movement Disorders Center at Washington University, St. Louis, between 1996 and 2018. All patients with parkinsonism who underwent postmortem neuropathologic examination were included in this analysis. RESULTS There were 257 unique parkinsonian patients with autopsy-based diagnoses who had received dopaminergic therapy. Marked or moderate response to dopaminergic therapy occurred in 91.2% (166/182) of those with autopsy-confirmed PD, 52.0% (13/25) of those with autopsy-confirmed multiple systems atrophy, 44.4% (8/18) of those with autopsy-confirmed progressive supranuclear palsy, and 1 (1/8) with autopsy-confirmed corticobasal degeneration. Other diagnoses were responsible for the remaining 24 individuals, 9 of whom had a moderate response to dopaminergic therapy. CONCLUSION A substantial response to dopaminergic therapy is frequent but not universal in PD. An absent response does not exclude PD. In other neurodegenerative disorders associated with parkinsonism, a prominent response may also be evident, but this occurs less frequently than in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- W R Wayne Martin
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Michael Miles
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Qiaonan Zhong
- Department of Medicine, Mayo Clinic, Rochester, Missouri, USA
| | - Johanna Hartlein
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brad A Racette
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | - Scott A Norris
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mwiza Ushe
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Baijayanta Maiti
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan Criswell
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Albert A Davis
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Paul T Kotzbauer
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nigel J Cairns
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Richard J Perrin
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Departments of Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
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Al-Qassabi A, Tsao TS, Racolta A, Kremer T, Cañamero M, Belousov A, Santana MA, Beck RC, Zhang H, Meridew J, Pugh J, Lian F, Robida MD, Ritter M, Czech C, Beach TG, Pestic-Dragovich L, Taylor KI, Zago W, Tang L, Dziadek S, Postuma RB. Immunohistochemical Detection of Synuclein Pathology in Skin in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinsonism. Mov Disord 2021; 36:895-904. [PMID: 33232556 PMCID: PMC10123546 DOI: 10.1002/mds.28399] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Recent studies reported abnormal alpha-synuclein deposition in biopsy-accessible sites of the peripheral nervous system in Parkinson's disease (PD). This has considerable implications for clinical diagnosis. Moreover, if deposition occurs early, it may enable tissue diagnosis of prodromal PD. OBJECTIVE The aim of this study was to develop and test an automated bright-field immunohistochemical assay of cutaneous pathological alpha-synuclein deposition in patients with idiopathic rapid eye movement sleep behavior disorder, PD, and atypical parkinsonism and in control subjects. METHODS For assay development, postmortem skin biopsies were taken from 28 patients with autopsy-confirmed Lewy body disease and 23 control subjects. Biopsies were stained for pathological alpha-synuclein in automated stainers using a novel dual-immunohistochemical assay for serine 129-phosphorylated alpha-synuclein and pan-neuronal marker protein gene product 9.5. After validation, single 3-mm punch skin biopsies were taken from the cervical 8 paravertebral area from 79 subjects (28 idiopathic rapid eye movement sleep behavior disorder, 20 PD, 10 atypical parkinsonism, and 21 control subjects). Raters blinded to clinical diagnosis assessed the biopsies. RESULTS The immunohistochemistry assay differentiated alpha-synuclein pathology from nonpathological-appearing alpha-synuclein using combined phosphatase and protease treatments. Among autopsy samples, 26 of 28 Lewy body samples and none of the 23 controls were positive. Among living subjects, punch biopsies were positive in 23 (82%) subjects with idiopathic rapid eye movement sleep behavior disorder, 14 (70%) subjects with PD, 2 (20%) subjects with atypical parkinsonism, and none (0%) of the control subjects. After a 3-year follow-up, eight idiopathic rapid eye movement sleep behavior disorder subjects phenoconverted to defined neurodegenerative syndromes, in accordance with baseline biopsy results. CONCLUSION Even with a single 3-mm punch biopsy, there is considerable promise for using pathological alpha-synuclein deposition in skin to diagnose both clinical and prodromal PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ahmed Al-Qassabi
- Department of Neurology, McGill University–Montreal General Hospital, Montreal, Quebec, Canada
- Sultan Qaboos University Hospital, Muscat
| | | | | | - Thomas Kremer
- Roche Pharmaceutical Research and Early Development, Roche Innovation Centre Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Marta Cañamero
- Roche Pharmaceutical Research and Early Development, Penzberg, Germany
| | - Anton Belousov
- Roche Pharmaceutical Research and Early Development, Roche Innovation Centre Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | | | | | - Judith Pugh
- Roche Tissue Diagnostics, Tucson, Arizona, USA
| | - Fangru Lian
- Roche Tissue Diagnostics, Tucson, Arizona, USA
| | | | - Mirko Ritter
- Roche Centralised and Point of Care Solutions, Penzberg, Germany
| | - Christian Czech
- Roche Pharmaceutical Research and Early Development, Roche Innovation Centre Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Kirsten I. Taylor
- Roche Pharmaceutical Research and Early Development, Roche Innovation Centre Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Wagner Zago
- Prothena Biosciences Inc., South San Francisco, California, USA
| | - Lei Tang
- Roche Tissue Diagnostics, Tucson, Arizona, USA
| | - Sebastian Dziadek
- Roche Pharmaceutical Research and Early Development, Roche Innovation Centre Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Ronald B. Postuma
- Department of Neurology, McGill University–Montreal General Hospital, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- CARSM, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada
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Chittoor-Vinod VG, Nichols RJ, Schüle B. Genetic and Environmental Factors Influence the Pleomorphy of LRRK2 Parkinsonism. Int J Mol Sci 2021; 22:1045. [PMID: 33494262 PMCID: PMC7864502 DOI: 10.3390/ijms22031045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 12/25/2022] Open
Abstract
Missense mutations in the LRRK2 gene were first identified as a pathogenic cause of Parkinson's disease (PD) in 2004. Soon thereafter, a founder mutation in LRRK2, p.G2019S (rs34637584), was described, and it is now estimated that there are approximately 100,000 people worldwide carrying this risk variant. While the clinical presentation of LRRK2 parkinsonism has been largely indistinguishable from sporadic PD, disease penetrance and age at onset can be quite variable. In addition, its neuropathological features span a wide range from nigrostriatal loss with Lewy body pathology, lack thereof, or atypical neuropathology, including a large proportion of cases with concomitant Alzheimer's pathology, hailing LRRK2 parkinsonism as the "Rosetta stone" of parkinsonian disorders, which provides clues to an understanding of the different neuropathological trajectories. These differences may result from interactions between the LRRK2 mutant protein and other proteins or environmental factors that modify LRRK2 function and, thereby, influence pathobiology. This review explores how potential genetic and biochemical modifiers of LRRK2 function may contribute to the onset and clinical presentation of LRRK2 parkinsonism. We review which genetic modifiers of LRRK2 influence clinical symptoms, age at onset, and penetrance, what LRRK2 mutations are associated with pleomorphic LRRK2 neuropathology, and which environmental modifiers can augment LRRK2 mutant pathophysiology. Understanding how LRRK2 function is influenced and modulated by other interactors and environmental factors-either increasing toxicity or providing resilience-will inform targeted therapeutic development in the years to come. This will allow the development of disease-modifying therapies for PD- and LRRK2-related neurodegeneration.
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Affiliation(s)
| | - R. Jeremy Nichols
- Department Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Birgitt Schüle
- Department Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA;
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Beach TG, Russell A, Sue LI, Intorcia AJ, Glass MJ, Walker JE, Arce R, Nelson CM, Hidalgo T, Chiarolanza G, Mariner M, Scroggins A, Pullen J, Souders L, Sivananthan K, Carter N, Saxon-LaBelle M, Hoffman B, Garcia A, Callan M, Fornwalt BE, Carew J, Filon J, Cutler B, Papa J, Curry JR, Oliver J, Shprecher D, Atri A, Belden C, Shill HA, Driver-Dunckley E, Mehta SH, Adler CH, Haarer CF, Ruhlen T, Torres M, Nguyen S, Schmitt D, Fietz M, Lue LF, Walker DG, Mizgerd JP, Serrano GE. Increased Risk of Autopsy-Proven Pneumonia with Sex, Season and Neurodegenerative Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.07.21249410. [PMID: 33442709 PMCID: PMC7805471 DOI: 10.1101/2021.01.07.21249410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There has been a markedly renewed interest in factors associated with pneumonia, a leading cause of death worldwide, due to its frequent concurrence with pandemics of influenza and Covid-19 disease. Reported predisposing factors to both bacterial pneumonia and pandemic viral lower respiratory infections are wintertime occurrence, older age, obesity, pre-existing cardiopulmonary conditions and diabetes. Also implicated are age-related neurodegenerative diseases that cause parkinsonism and dementia. We investigated the prevalence of autopsy-proven pneumonia in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), a longitudinal clinicopathological study, between the years 2006 and 2019 and before the beginning of the Covid-19 pandemic. Of 691 subjects dying at advanced ages (mean 83.4), pneumonia was diagnosed postmortem in 343 (49.6%). There were 185 subjects without dementia or parkinsonism while clinicopathological diagnoses for the other subjects included 319 with Alzheimer's disease dementia, 127 with idiopathic Parkinson's disease, 72 with dementia with Lewy bodies, 49 with progressive supranuclear palsy and 78 with vascular dementia. Subjects with one or more of these neurodegenerative diseases all had higher pneumonia rates, ranging between 50 and 61%, as compared to those without dementia or parkinsonism (40%). In multivariable logistic regression models, male sex and a non-summer death both had independent contributions (ORs of 1.67 and 1.53) towards the presence of pneumonia at autopsy while the absence of parkinsonism or dementia was a significant negative predictor of pneumonia (OR 0.54). Male sex, dementia and parkinsonism may also be risk factors for Covid-19 pneumonia. The apolipoprotein E4 allele, as well as obesity, chronic obstructive pulmonary disease, diabetes, hypertension, congestive heart failure, cardiomegaly and cigarette smoking history, were not significantly associated with pneumonia, in contradistinction to what has been reported for Covid-19 disease.
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Affiliation(s)
| | | | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | - Richard Arce
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Tony Hidalgo
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | - Joel Pullen
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | - Niana Carter
- Banner Sun Health Research Institute, Sun City, AZ
| | | | | | | | | | | | | | | | - Brett Cutler
- Banner Sun Health Research Institute, Sun City, AZ
| | - Jaclyn Papa
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Javon Oliver
- Banner Sun Health Research Institute, Sun City, AZ
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, AZ
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Shyamal H. Mehta
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Charles H. Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | | | | | | | | | | | | | - Lih-Fen Lue
- Banner Sun Health Research Institute, Sun City, AZ
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Beach TG, Malek-Ahmadi M. Alzheimer's Disease Neuropathological Comorbidities are Common in the Younger-Old. J Alzheimers Dis 2021; 79:389-400. [PMID: 33285640 PMCID: PMC8034496 DOI: 10.3233/jad-201213] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinicopathological studies have demonstrated that Alzheimer's disease dementia (ADD) is often accompanied by clinically undetectable comorbid neurodegenerative and cerebrovascular disease that alter the rate of cognitive decline. Aside from causing increased variability in clinical response, it is possible that the major ADD comorbidities may not respond to ADD-specific molecular therapeutics. OBJECTIVE As most reports have focused on comorbidity in the oldest-old, its extent in younger age groups that are more likely to be involved in clinical trials is largely unknown; our objective is to provide this information. METHODS We conducted a survey of neuropathological comorbidities in sporadic ADD using data from the US National Alzheimer's Coordinating Center. Subject data was restricted to those with dementia and meeting National Institute on Aging-Alzheimer's Association intermediate or high AD Neuropathological Change levels, excluding those with known autosomal dominant AD-related mutations. RESULTS Highly prevalent ADD comorbidities are not restricted to the oldest-old but are common even in early-onset ADD. The percentage of cases with ADD as the sole major neuropathological diagnosis is highest in the under-60 group, where "pure" ADD cases are still in the minority at 44%. After this AD as a sole major pathology in ADD declines to roughly 20%in the 70s and beyond. Lewy body disease is the most common comorbidity at younger ages but actually is less common at later ages, while for most others, their prevalence increases with age. CONCLUSION Alzheimer's disease neuropathological comorbidities are highly prevalent even in the younger-old.
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Manne S, Kondru N, Jin H, Serrano GE, Anantharam V, Kanthasamy A, Adler CH, Beach TG, Kanthasamy AG. Blinded RT-QuIC Analysis of α-Synuclein Biomarker in Skin Tissue From Parkinson's Disease Patients. Mov Disord 2020; 35:2230-2239. [PMID: 32960470 DOI: 10.1002/mds.28242] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND An unmet clinical need in Parkinson's disease (PD) is to identify biomarkers for diagnosis, preferably in peripherally accessible tissues such as skin. Immunohistochemical studies have detected pathological α-synuclein (αSyn) in skin biopsies from PD patients albeit sensitivity needs to be improved. OBJECTIVE Our study provides the ultrasensitive detection of pathological αSyn present in the skin of PD patients, and thus, pathological αSyn in skin could be a potential biomarker for PD. METHODS The real-time quaking-induced conversion assay was used to detect pathological αSyn present in human skin tissues. Further, we optimized this ultra-sensitive and specific assay for both frozen and formalin-fixed paraffin-embedded sections of skin tissues. We determined the seeding kinetics of the αSyn present in the skin from autopsied subjects consisting of frozen skin tissues from 25 PD and 25 controls and formalin-fixed paraffin-embedded skin sections from 12 PD and 12 controls. RESULTS In a blinded study of skin tissues from autopsied subjects, we correctly identified 24/25 PD and 24/25 controls using frozen skin tissues (96% sensitivity and 96% specificity) compared to 9/12 PD and 10/12 controls using formalin-fixed paraffin-embedded skin sections (75% sensitivity and 83% specificity). CONCLUSIONS Our blinded study results clearly demonstrate the feasibility of using skin tissues for clinical diagnosis of PD by detecting pathological αSyn. Moreover, this peripheral biomarker discovery study may have broader translational value in detecting misfolded proteins in skin samples as a longitudinal progression marker. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sireesha Manne
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA.,Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Naveen Kondru
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA.,Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Huajun Jin
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Geidy E Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Vellareddy Anantharam
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Arthi Kanthasamy
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Charles H Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Anumantha G Kanthasamy
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
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Chahine LM, Beach TG, Brumm MC, Adler CH, Coffey CS, Mosovsky S, Caspell-Garcia C, Serrano GE, Munoz DG, White CL, Crary JF, Jennings D, Taylor P, Foroud T, Arnedo V, Kopil CM, Riley L, Dave KD, Mollenhauer B. In vivo distribution of α-synuclein in multiple tissues and biofluids in Parkinson disease. Neurology 2020; 95:e1267-e1284. [PMID: 32747521 PMCID: PMC7538226 DOI: 10.1212/wnl.0000000000010404] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective The Systemic Synuclein Sampling Study (S4) measured α-synuclein in multiple tissues and biofluids within the same patients with Parkinson disease (PD) vs healthy controls (HCs). Methods S4 was a 6-site cross-sectional observational study of participants with early, moderate, or advanced PD and HCs. Motor and nonmotor measures and dopamine transporter SPECT were obtained. Biopsies of skin, colon, submandibular gland (SMG), CSF, saliva, and blood were collected. Tissue biopsy sections were stained with 5C12 monoclonal antibody against pathologic α-synuclein; digital images were interpreted by neuropathologists blinded to diagnosis. Biofluid total α-synuclein was quantified using ELISA. Results The final cohort included 59 patients with PD and 21 HCs. CSF α-synuclein was lower in patients with PD vs HCs; sensitivity/specificity of CSF α-synuclein for PD diagnosis was 87.0%/63.2%, respectively. Sensitivity of α-synuclein immunoreactivity for PD diagnosis was 56.1% for SMG and 24.1% for skin; specificity was 92.9% and 100%, respectively. There were no significant relationships between different measures of α-synuclein within participants. Conclusions S4 confirms lower total α-synuclein levels in CSF in patients with PD compared to HCs, but specificity is low. In contrast, α-synuclein immunoreactivity in skin and SMG is specific for PD but sensitivity is low. Relationships within participants across different tissues and biofluids could not be demonstrated. Measures of pathologic forms of α-synuclein with higher accuracy are critically needed. Classification of evidence This study provides Class III evidence that total CSF α-synuclein does not accurately distinguish patients with PD from HCs, and that monoclonal antibody staining for SMG and skin total α-synuclein is specific but not sensitive for PD diagnosis.
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Affiliation(s)
- Lana M Chahine
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany.
| | - Thomas G Beach
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Michael C Brumm
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Charles H Adler
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Christopher S Coffey
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Sherri Mosovsky
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Chelsea Caspell-Garcia
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Geidy E Serrano
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - David G Munoz
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Charles L White
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - John F Crary
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Danna Jennings
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Peggy Taylor
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Tatiana Foroud
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Vanessa Arnedo
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Catherine M Kopil
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Lindsey Riley
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Kuldip D Dave
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Brit Mollenhauer
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
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Archer DB, Mitchell T, Burciu RG, Yang J, Nigro S, Quattrone A, Quattrone A, Jeromin A, McFarland NR, Okun MS, Vaillancourt DE. Magnetic Resonance Imaging and Neurofilament Light in the Differentiation of Parkinsonism. Mov Disord 2020; 35:1388-1395. [PMID: 32357259 PMCID: PMC8316785 DOI: 10.1002/mds.28060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Accurate diagnosis is particularly challenging in Parkinson's disease (PD), multiple system atrophy (MSAp), and progressive supranuclear palsy (PSP). We compare the utility of 3 promising biomarkers to differentiate disease state and explain disease severity in parkinsonism: the Automated Imaging Differentiation in Parkinsonism (AID-P), the Magnetic Resonance Parkinsonism Index (MRPI), and plasma-based neurofilament light chain protein (NfL). METHODS For each biomarker, the area under the curve (AUC) of receiver operating characteristic curves were quantified for PD versus MSAp/PSP and MSAp versus PSP and statistically compared. Unique combinations of variables were also assessed. Furthermore, each measures association with disease severity was determined using stepwise multiple regression. RESULTS For PD versus MSAp/PSP, AID-P (AUC, 0.900) measures had higher AUC compared with NfL (AUC, 0.747) and MRPI (AUC, 0.669), P < 0.05. For MSAp versus PSP, AID-P (AUC, 0.889), and MRPI (AUC, 0.824) measures were greater than NfL (AUC, 0.537), P < 0.05. We then combined measures to determine if any unique combination provided enhanced accuracy and found that no combination performed better than the AID-P alone in differentiating parkinsonisms. Furthermore, we found that the AID-P demonstrated the highest association with the MDS-UPDRS (Radj2 -AID-P, 26.58%; NfL,15.12%; MRPI, 12.90%). CONCLUSIONS Compared with MRPI and NfL, AID-P provides the best overall differentiation of PD versus MSAp/PSP. Both AID-P and MRPI are effective in differentiating MSAp versus PSP. Furthermore, combining biomarkers did not improve classification of disease state compared with using AID-P alone. The findings demonstrate in the current sample that the AID-P and MRPI are robust biomarkers for PD, MSAp, and PSP. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Derek B. Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Trina Mitchell
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Jing Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Salvatore Nigro
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Nikolaus R. McFarland
- Fixel Institute for Neurological Disease, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
| | - Michael S. Okun
- Fixel Institute for Neurological Disease, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
- Department of Neurosurgery, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
| | - David E. Vaillancourt
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
- Fixel Institute for Neurological Disease, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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