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Considine CM, Rossetti MA, Anderson K, Del Bene VA, Anderson SA, Celka AS, Edmondson MC, Sheese ALN, Piccolino A, Teixeira AL, Stout JC. Huntington study group's neuropsychology working group position on best practice recommendations for the clinical neuropsychological evaluation of patients with Huntington disease. Clin Neuropsychol 2024; 38:984-1006. [PMID: 37849335 DOI: 10.1080/13854046.2023.2267789] [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: 03/10/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
Objective: Neuropsychological evaluation is critical to detection and management of cognitive and neuropsychiatric changes associated with Huntington disease (HD). Accurate assessment of non-motor complications of HD is critical given the prominent impact on functional disability, frequently commensurate with or exceeding that of motor symptoms. The increasing emphasis on developing disease-modifying therapies targeting cognitive decline in HD requires consensus on clinical neuropsychological assessment methods. The Neuropsychology Working Group (NPWG) of the Huntington Study Group (HSG) sought to provide evidence and consensus-based, practical guidelines for the evaluation of cognitive and neuropsychiatric symptoms associated with HD. Method: The NPWG recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to inform best practices in assessing, diagnosing, and treating the non-motor symptoms in HD. A review was circulated among the NPWG, and in an iterative process informed by reviewed literature, best practices in neuropsychological evaluation of patients with HD were identified. Results: A brief review of the available literature and rational for a clinical consensus battery is offered. Conclusion: Clinical neuropsychologists are uniquely positioned to both detect and characterize the non-motor symptoms in HD, and further, provide neurologists and allied health professions with clinically meaningful information that impacts functional outcomes and quality of life. The NPWG provides guidance on best practices to clinical neuropsychologists in this statement. A companion paper operationalizing clinical application of previous research-based non-motor diagnostic criteria for HD is forthcoming, which also advises on non-motor symptom screening methods for the non-neuropsychologist working with HD.
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Affiliation(s)
- Ciaran M Considine
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - M Agustina Rossetti
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kendra Anderson
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Sharlet A Anderson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea S Celka
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | | | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Adam Piccolino
- Psychology, Piccolino Psychological Services, Burnsville, MN, USA
| | - Antonio L Teixeira
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, and School of Psychological Science, Monash University, Melbourne, Australia
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Hasnain N, Arif TB, Shafaut R, Zakaria F, Fatima SZ, Haque IU. Association between sex and Huntington's disease: an updated review on symptomatology and prognosis of neurodegenerative disorders. Wien Med Wochenschr 2024; 174:87-94. [PMID: 35723821 DOI: 10.1007/s10354-022-00941-2] [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: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Huntington's disease is a rare autosomal dominant disorder presenting with chorea, rigidity, hypo-/akinesia, cognitive decline, and psychiatric disturbances. Numerous risk factors have been defined in the onset of this disease. However, the number of CAG repeats in the genes are the most crucial factor rendering patients susceptible to the disease. Studies have shown significant differences in onset and disease presentation among the sexes, which prompts analysis of the impact of different sexes on disease etiology and progression. This article therefore discusses the evidence-based role of sex in aspects of symptomatology, pathogenesis, biomarkers, progression, and prognosis of Huntington's disease, with a secondary review of sex-linked differences in Alzheimer's and Parkinson's disease.
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Affiliation(s)
- Nimra Hasnain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
- Department of Medicine, Dr. Ruth K. M. Pfao Civil Hospital, Karachi, Pakistan
| | - Taha Bin Arif
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
- Department of Medicine, Dr. Ruth K. M. Pfao Civil Hospital, Karachi, Pakistan.
| | - Roha Shafaut
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Zakaria
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ibtehaj Ul Haque
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
- Department of Medicine, Dr. Ruth K. M. Pfao Civil Hospital, Karachi, Pakistan
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Mead EA, Wang Y, Patel S, Thekkumthala AP, Kepich R, Benn-Hirsch E, Lee V, Basaly A, Bergeson S, Siegelmann HT, Pietrzykowski AZ. miR-9 utilizes precursor pathways in adaptation to alcohol in mouse striatal neurons. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:11323. [PMID: 38116240 PMCID: PMC10730111 DOI: 10.3389/adar.2023.11323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
microRNA-9 (miR-9) is one of the most abundant microRNAs in the mammalian brain, essential for its development and normal function. In neurons, it regulates the expression of several key molecules, ranging from ion channels to enzymes, to transcription factors broadly affecting the expression of many genes. The neuronal effects of alcohol, one of the most abused drugs in the world, seem to be at least partially dependent on regulating the expression of miR-9. We previously observed that molecular mechanisms of the development of alcohol tolerance are miR-9 dependent. Since a critical feature of alcohol action is temporal exposure to the drug, we decided to better understand the time dependence of alcohol regulation of miR-9 biogenesis and expression. We measured the effect of intoxicating concentration of alcohol (20 mM ethanol) on the expression of all major elements of miR-9 biogenesis: three pri-precursors (pri-mir-9-1, pri-mir-9-2, pri-mir-9-3), three pre-precursors (pre-mir-9-1, pre-mir-9-2, pre-mir-9-3), and two mature microRNAs: miR-9-5p and miR-9-3p, using digital PCR and RT-qPCR, and murine primary medium spiny neurons (MSN) cultures. We subjected the neurons to alcohol based on an exposure/withdrawal matrix of different exposure times (from 15 min to 24 h) followed by different withdrawal times (from 0 h to 24 h). We observed that a short exposure increased mature miR-9-5p expression, which was followed by a gradual decrease and subsequent increase of the expression, returning to pre-exposure levels within 24 h. Temporal changes of miR-9-3p expression were complementing miR-9-5p changes. Interestingly, an extended, continuous presence of the drug caused a similar pattern. These results suggest the presence of the adaptive mechanisms of miR-9 expression in the presence and absence of alcohol. Measurement of miR-9 pre- and pri-precursors showed further that the primary effect of alcohol on miR-9 is through the mir-9-2 precursor pathway with a smaller contribution of mir-9-1 and mir-9-3 precursors. Our results provide new insight into the adaptive mechanisms of neurons to alcohol exposure. It would be of interest to determine next which microRNA-based mechanisms are involved in a transition from the acute, intoxicating effects of alcohol to the chronic, addictive effects of the drug.
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Affiliation(s)
- Edward Andrew Mead
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Yongping Wang
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Sunali Patel
- Thermo Fisher Scientific Inc., Austin, TX, United States
| | - Austin P. Thekkumthala
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Rebecca Kepich
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Elizabeth Benn-Hirsch
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Victoria Lee
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Azra Basaly
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Susan Bergeson
- Department of Cell Biology and Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Hava T. Siegelmann
- Department of Machine Learning, Mohamed bin Zayed University of Artificial Intelligence, Abu Dhabi, United Arab Emirates
- Biologically Inspired Neural & Dynamical Systems Laboratory, The Manning College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Andrzej Zbigniew Pietrzykowski
- Laboratory of Adaptation, Reward and Addiction, Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Mendizabal A, Diaz JM, Bustamante AV, Bordelon Y. Health Services in Huntington Disease: A Systematic Literature Review. Neurol Clin Pract 2023; 13:e200108. [PMID: 36865636 PMCID: PMC9973320 DOI: 10.1212/cpj.0000000000200108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
Purpose of Review Clinical trials for Huntington disease (HD) have primarily focused on managing chorea and, more recently, the development of disease-modifying therapies (DMTs). Nonetheless, understanding health services among patients with HD is essential for assessing new therapeutics, development of quality metrics, and overall quality of life of patients and families with HD. Health services assess health care utilization patterns, outcomes, and health care-associated costs, which can help shape the development of therapeutics and aid in policies that affect patients with a specific condition. In this systematic literature review, we analyze data of published studies looking at causes of hospitalization, outcomes, and health care costs in HD. Recent Findings The search yielded 8 articles published in the English language and comprising data from the United States, Australia, New Zealand, and Israel. The most common cause of hospitalization among patients with HD was dysphagia or dysphagia-related complications (e.g., aspiration pneumonia or malnutrition), followed by psychiatric or behavioral symptoms. Patients with HD had more prolonged hospitalizations than non-HD patients, and it was most prominent among those with advanced disease. Patients with HD were more likely to be discharged to a facility. A small percentage received inpatient palliative care consultation, and behavioral symptoms were a primary cause of discharge to another facility. Interventions such as gastrostomy tube placement had associated morbidity, and it was common among patients with HD with a diagnosis of dementia. Palliative care consultation and specialized nursing care were associated with more routine discharges and fewer hospitalizations. In terms of cost, patients with HD with private and public insurances had the highest expenditure with more advanced disease, and expenses were associated with hospitalization and medication costs. Summary In addition to DMTs, HD clinical trial development should also consider the leading causes of hospitalization, morbidity, and mortality in patients with HD, including dysphagia and psychiatric disease. No research study, to our knowledge, has systematically reviewed health services research studies in HD. Evidence from health services research is needed to evaluate the efficacy of pharmacologic and supportive therapies. This type of research is also critical in understanding health care costs associated with the disease and to better advocate and shape policies that can benefit this patient population.
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Affiliation(s)
- Adys Mendizabal
- Department of Neurology (AM, JMD, YB), David Geffen School of Medicine, University of California Los Angeles (UCLA); Institute of Society and Genetics (AM), College of Life Sciences, University of California Los Angeles (UCLA); and Department of Health Policy and Management (AVB), Fielding School of Public Health, University of California Los Angeles (UCLA)
| | - Jennifer M Diaz
- Department of Neurology (AM, JMD, YB), David Geffen School of Medicine, University of California Los Angeles (UCLA); Institute of Society and Genetics (AM), College of Life Sciences, University of California Los Angeles (UCLA); and Department of Health Policy and Management (AVB), Fielding School of Public Health, University of California Los Angeles (UCLA)
| | - Arturo V Bustamante
- Department of Neurology (AM, JMD, YB), David Geffen School of Medicine, University of California Los Angeles (UCLA); Institute of Society and Genetics (AM), College of Life Sciences, University of California Los Angeles (UCLA); and Department of Health Policy and Management (AVB), Fielding School of Public Health, University of California Los Angeles (UCLA)
| | - Yvette Bordelon
- Department of Neurology (AM, JMD, YB), David Geffen School of Medicine, University of California Los Angeles (UCLA); Institute of Society and Genetics (AM), College of Life Sciences, University of California Los Angeles (UCLA); and Department of Health Policy and Management (AVB), Fielding School of Public Health, University of California Los Angeles (UCLA)
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5
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Jeyakumar N, Hilmer SN, Teixeira-Pinto A, Loy CT. Frailty and Associated Environmental Factors Only Have Small Effects on Age of Onset in Huntington's Disease. J Huntingtons Dis 2023; 12:355-361. [PMID: 38007671 DOI: 10.3233/jhd-230572] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND Over one third of age of onset variation in Huntington's disease is unexplained by CAG repeat length. In Alzheimer's disease, frailty partly modulates the relationship between neuropathology and dementia. OBJECTIVE We investigated whether a multi-domain frailty index, reflecting non-genetic factors in Huntington's disease, similarly modulates the relationship between CAG repeat length and age of onset. METHODS We created a frailty index assessing comorbidities, substance abuse, polypharmacy, and education. We applied multiple linear regression models to 2,741 subjects with manifest Huntington's disease from the Enroll-HD cohort study, including 729 subjects with late-onset (post-60 years) disease, using frailty index or constituent item scores and CAG repeat length as independent variables. We used actual and "residual" ages of onset (difference between actual and CAG-based predicted onset) as dependent variables, the latter offsetting the increased time available to accumulate comorbidities in older subjects. RESULTS Higher frailty index scores were associated with significantly lower residual ages of onset in the late-onset subgroup (p = 0.03), though the effect was small (R2 = 0.27 with frailty as a predictor vs. 0.26 without). Number of comorbidities was also associated with significantly lower residual ages of onset in the late-onset subgroup (p = 0.04). Drug abuse and smoking were associated with significantly earlier ages of onset in the whole cohort (p < 0.01, p = 0.02) and late-onset subgroup (p < 0.01, p = 0.03). CONCLUSIONS The impact of non-genetic factors on age of onset, assessed using a frailty index or separately, in Huntington's disease is limited.
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Affiliation(s)
| | - Sarah N Hilmer
- The Kolling Institute, The University of Sydney, Sydney, Australia
| | | | - Clement T Loy
- Macquarie Medical School, Macquarie University, Sydney, Australia
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6
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Methamphetamine induced neurotoxic diseases, molecular mechanism, and current treatment strategies. Biomed Pharmacother 2022; 154:113591. [PMID: 36007276 DOI: 10.1016/j.biopha.2022.113591] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Methamphetamine (MA) is a extremely addictive psychostimulant drug with a significant abuse potential. Long-term MA exposure can induce neurotoxic effects through oxidative stress, mitochondrial functional impairment, endoplasmic reticulum stress, the activation of astrocytes and microglial cells, axonal transport barriers, autophagy, and apoptosis. However, the molecular and cellular mechanisms underlying MA-induced neurotoxicity remain unclear. MA abuse increases the chances of developing neurotoxic conditions such as Parkinson's disease (PD), Alzheimer's disease (AD) and other neurotoxic diseases. MA increases the risk of PD by increasing the expression of alpha-synuclein (ASYN). Furthermore, MA abuse is linked to high chances of developing AD and subsequent neurodegeneration due to biological variations in the brain region or genetic and epigenetic variations. To date, there is no Food and Drug Administration (FDA)-approved therapy for MA-induced neurotoxicity, although many studies are being conducted to develop effective therapeutic strategies. Most current studies are now focused on developing therapies to diminish the neurotoxic effects of MA, based on the underlying mechanism of neurotoxicity. This review article highlights current research on several therapeutic techniques targeting multiple pathways to reduce the neurotoxic effects of MA in the brain, as well as the putative mechanism of MA-induced neurotoxicity.
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7
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Di Tella S, Lo Monaco MRI, Petracca M, Zinzi P, Solito M, Piano C, Calabresi P, Silveri MC, Bentivoglio AR. Beyond the CAG triplet number: exploring potential predictors of delayed age of onset in Huntington's disease. J Neurol 2022; 269:6634-6640. [PMID: 35915275 DOI: 10.1007/s00415-022-11297-3] [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: 06/02/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Huntington's disease (HD) is a genetic neurodegenerative disease characterized by cognitive, motor, and psychiatric dysfunction. It is caused by an expansion of the trinucleotide repeat sequence cytosine-adenine-guanine (CAG) in the Huntingtin gene on chromosome 4. Onset typically occurs in the fourth or fifth decade, ranging from childhood to late adulthood. The CAG triplet number is generally inversely proportional to the age of onset (AOO), but the repeat number only accounts for ∼70% of the variability in AOO. Several studies demonstrated the impact of genetic modifiers on age of disease onset. In addition to genetics, we also explored the demographic, anamnestic, and socio-environmental factors that can affect AOO, to help us understand the non-genetic variability of age of onset in HD. METHODS We analyzed the retrospective data of the ENROLL-HD global registry study, particularly focusing on the continuum of ages, to include sociodemographic, genetic, and anamnestic psychobehavioral variables in a multivariate regression model aimed at identifying the potential predictors of age of motor onset (n = 5053). We ran the same regression model in the sample of subjects who had the same number of triplets (41 CAG, n = 593) and in the sample whose family history was absent/unknown (n = 630). RESULTS Patients with delayed onset more frequently have unknown/missing family history, are married or widowed, live in larger urbanized contexts and have a lower educational level. Individuals with earlier onset more frequently develop psychobehavioral symptoms. CONCLUSIONS In the past, the HD gene was considered the epitome of genetic determinism. Our results are consistent with recent evidence that other factors might modulate its impact. These findings allow characterizing the determinants of AOO beyond the CAG expansions and provide valuable information for stratifying patients for future clinical trial designs.
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Affiliation(s)
- Sonia Di Tella
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Maria RIta Lo Monaco
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy. .,Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Martina Petracca
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Paola Zinzi
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Marcella Solito
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Carla Piano
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Maria Caterina Silveri
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy.,Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Anna Rita Bentivoglio
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCSS, Largo A Gemelli, 8, 00168, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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Smoking, alcohol consumption, and age at onset of Huntington's disease: a Mendelian randomization study. Parkinsonism Relat Disord 2022; 97:34-38. [PMID: 35299068 DOI: 10.1016/j.parkreldis.2022.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Smoking and alcohol consumption have been associated with earlier age at onset (AAO) of Huntington's disease (HD) in observational studies. We conducted this Mendelian randomization (MR) study to evaluate whether these associations are causal. METHODS We selected genetic instruments for lifetime smoking (n = 462,690) and alcohol consumption (n = 941,280) based on two large genome-wide association studies (GWAS). The summary-level data for residual AAO of HD were derived from a GWAS meta-analysis carried out by the Genetic Modifiers of Huntington's disease Consortium (n = 9,064 HD patients). We conducted univariable and multivariable MR analyses to evaluate the independent impact of smoking and alcohol consumption on AAO of HD. RESULTS Genetically predicted lifetime smoking was causally related to an earlier AAO of HD in the univariable MR analyses (β = -2.16 years per standard deviation (SD) increase in lifetime smoking index, 95% confidence interval (CI) = -3.70 to -0.63, P = 0.006). This association persisted significant in the multivariable MR analyses after adjusting for alcohol consumption (β = -2.04 years per SD increase in lifetime smoking index, 95% CI = -3.85 to -0.22, P = 0.028). However, no significant association was found between alcohol consumption and AAO of HD. CONCLUSIONS This study suggests that genetically predicted smoking is causally related to an earlier AAO of HD.
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9
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Sathe S, Ware J, Levey J, Neacy E, Blumenstein R, Noble S, Mühlbäck A, Rosser A, Landwehrmeyer GB, Sampaio C. Enroll-HD: An Integrated Clinical Research Platform and Worldwide Observational Study for Huntington's Disease. Front Neurol 2021; 12:667420. [PMID: 34484094 PMCID: PMC8416308 DOI: 10.3389/fneur.2021.667420] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Established in July 2012, Enroll-HD is both an integrated clinical research platform and a worldwide observational study designed to meet the clinical research requirements necessary to develop therapeutics for Huntington's disease (HD). The platform offers participants a low-burden entry into HD research, providing a large, well-characterized, research-engaged cohort with associated clinical data and biosamples that facilitates recruitment into interventional trials and other research studies. Additional studies that use Enroll-HD data and/or biosamples are built into the platform to further research on biomarkers and outcome measures. Enroll-HD is now operating worldwide in 21 countries at 159 clinical sites across four continents—Europe, North America, Latin America, and Australasia—and has recruited almost 25,000 participants, generating a large, rich clinical database with associated biosamples to expedite HD research; any researcher at a verifiable research organization can access the clinical datasets and biosamples from Enroll-HD and nested studies. Important operational features of Enroll-HD include a strong emphasis on standardization, data quality, and protecting participant identity, a single worldwide study protocol, a flexible EDC system capable of integrating multiple studies, a comprehensive monitoring infrastructure, an online portal to train and certify site personnel, and standardized study documents including informed consent forms and contractual agreements.
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Affiliation(s)
- Swati Sathe
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Jen Ware
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | - Eileen Neacy
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | | | - Simon Noble
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | | | - Anne Rosser
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Brain Research and Intracranial Neurotherapeutics Unit, Cardiff University, Cardiff, United Kingdom
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10
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Gibson JS, Isaacs DA, Claassen DO, Stovall JG. Lifetime neuropsychiatric symptoms in Huntington's disease: Implications for psychiatric nursing. Arch Psychiatr Nurs 2021; 35:284-289. [PMID: 33966794 DOI: 10.1016/j.apnu.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Abstract
Neuropsychiatric manifestations of Huntington's disease (HD) can present years before motor symptoms. Nurses with specialized training provide superior care for HD patients, but HD exposure in nursing education is limited. Here we aimed to describe the historical neuropsychiatric burden in 50 HD patients and discuss implications for psychiatric nurses. Fifty patients with HD were assessed by a board-certified psychiatrist and completed surveys about symptoms, social history, medication use, and quality of life outcomes. Descriptive statistics were used to summarize patient characteristics, and correlation analyses assessed the relationships between neuropsychiatric symptoms and quality of life outcomes. Most patients (72%) reported a history of neuropsychiatric symptoms prior to their HD diagnosis. Prodromal anger/irritability was most common (52%), though few patients received treatment for this. Anxiety was the most common current symptom (78%), yet 40% of patients had never been prescribed an SSRI. Anxiety was associated with poorer patient-reported quality of life outcomes (p < .01). HD patients in this sample experienced frequent, early-onset neuropsychiatric symptoms. In coming years, psychiatric nurses in community settings will be more likely to encounter gene-positive HD patients before they develop motor symptoms. Psychiatric nurses can address identified gaps through enhanced screening and encouraging early intervention in those at risk.
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Affiliation(s)
- Jessie S Gibson
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue, A-0118 MCN, Nashville, TN 37232, USA.
| | - David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue, A-0118 MCN, Nashville, TN 37232, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue, A-0118 MCN, Nashville, TN 37232, USA
| | - Jeffrey G Stovall
- Department of Psychiatry, Vanderbilt University Medical Center, 1601 23rd Avenue South, Suite 3068, Nashville, TN 37212, USA
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11
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Gibson JS, Claassen DO. State-of-the-art pharmacological approaches to reduce chorea in Huntington's disease. Expert Opin Pharmacother 2021; 22:1015-1024. [PMID: 33550875 PMCID: PMC8222076 DOI: 10.1080/14656566.2021.1876666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023]
Abstract
Introduction Chorea is a common motor manifestation of Huntington's disease (HD). Two vesicular monoamine transporter type 2 (VMAT-2) inhibitors have been approved by the FDA for treatment of HD chorea, and a third is currently being assessed in a phase 3 trial. Antipsychotic therapies are used off-label for treatment of chorea and can treat comorbid psychiatric symptoms. There is considerable clinical equipoise regarding the safe and effective treatment of chorea and comorbid symptoms in HD.Areas covered: The authors review existing medications used to treat HD chorea in the United States of America (USA). Implications for common comorbid symptoms (e.g. psychiatric, metabolic) are also discussed. Available therapies vary widely in cost, dosing frequency, and off -target effects, both beneficial or negative.Expert opinion: Treatment considerations for chorea should account for patient comorbidities. The authors recommend prospective, observational clinical effectiveness studies which can evaluate the long-term comparative effectiveness and safety of VMAT-2 inhibitors and antipsychotics in HD. Data regarding safety of dual therapy is another critical need. This is especially timely given the changing landscape of HD therapies which may increase cost burden and possibly extend both asymptomatic and symptomatic years for HD patients.
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Affiliation(s)
| | - Daniel O. Claassen
- Department of Neurology, Division of Behavioral and Cognitive Neurology, Vanderbilt University Medical Center
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Griffin BA, Booth MS, Busse M, Wild EJ, Setodji C, Warner JH, Sampaio C, Mohan A. Estimating the causal effects of modifiable, non-genetic factors on Huntington disease progression using propensity score weighting. Parkinsonism Relat Disord 2021; 83:56-62. [PMID: 33476879 PMCID: PMC7949328 DOI: 10.1016/j.parkreldis.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Despite being genetically inherited, it is unclear how non-genetic factors (e.g., substance use, employment) might contribute to the progression and severity of Huntington's disease (HD). METHODS We used propensity score (PS) weighting in a large (n = 2914) longitudinal dataset (Enroll-HD) to examine the impact of education, employment status, and use of tobacco, alcohol, and recreational and therapeutic drugs on HD progression. Each factor was investigated in isolation while controlling for 19 other factors to ensure that groups were balanced at baseline on potential confounders using PS weights. Outcomes were compared several years later using doubly robust models. RESULTS Our results highlighted cases where modifiable (non-genetic) factors - namely light and moderate alcohol use and employment - would have been associated with HD progression in models that did not use PS weights to control for baseline imbalances. These associations did not hold once we applied PS weights to balance baseline groups. We also found potential evidence of a protective effect of substance use (primarily marijuana use), and that those who needed antidepressant treatment were likely to progress faster than non-users. CONCLUSIONS Our study is the first to examine the effect of non-genetic factors on HD using a novel application of PS weighting. We show that previously-reported associated factors - including light and moderate alcohol use - are reduced and no longer significantly linked to HD progression after PS weighting. This indicates the potential value of PS weighting in examining non-genetic factors contributing to HD as well as in addressing the known biases that occur with observational data.
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Affiliation(s)
- Beth Ann Griffin
- RAND Center for Causal Inference, RAND Corporation, 1200, South Hayes Street, Arlington, VA, USA.
| | | | - Monica Busse
- Centre for Trials Research, Cardiff University, Neuadd Merionydd, Heath Park, CF14 4XN, Cardiff, UK
| | - Edward J Wild
- Huntington's Disease Centre, UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Claude Setodji
- RAND Center for Causal Inference, RAND Corporation, 4570, Fifth Ave #600, Pittsburgh, PA, USA
| | - John H Warner
- CHDI Management/CHDI Foundation, 155 Village Boulevard, Suite 200, Princeton, NJ, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, 155 Village Boulevard, Suite 200, Princeton, NJ, USA
| | - Amrita Mohan
- CHDI Management/CHDI Foundation, 155 Village Boulevard, Suite 200, Princeton, NJ, USA
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Schultz JL, Harshman LA, Langbehn DR, Nopoulos PC. Hypertension Is Associated With an Earlier Age of Onset of Huntington's Disease. Mov Disord 2020; 35:1558-1564. [PMID: 32339315 PMCID: PMC9853516 DOI: 10.1002/mds.28062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Hypertension (HTN) is associated with worsening clinical outcomes in neurodegenerative diseases. The relationship between HTN and the age of diagnosis (ADx) of Huntington's disease (HD) is not clear, however. This study sought to determine if the presence of HTN in adult patients with premanifest HD was associated with an earlier ADx compared with normotensive patients with HD. METHODS Premanifest participants from Enroll-HD were included if they had a cytosine-adenine-guanine greater than or equal to 36, baseline diagnostic confidence level less than 4, baseline total functional capacity score greater than 11, and baseline motor score less than 21. There were 3020 premanifest participants with HD, and 293 reported a diagnosis of HTN. HTN was transformed into a time-dependent variable, and a Cox proportional hazard survival model determine if the presence of HTN affected the time to motor conversion. Baseline cytosine-adenine-guanine-age product score, cytosine-adenine-guanine repeat length, baseline age, sex, baseline body mass index, smoking history, and region were included as covariates. RESULTS Participants with HTN had an increased annualized hazard of motor conversion compared to normotensive participants with HD (hazard ratio, 1.29; 95% confidence interval, 1.02-1.64; P = 0.034). CONCLUSIONS A previous study reported a protective effect of HTN in HD, but did not account for the fact that the prevalence of HTN increases with age. By controlling for this confounder, we more accurately outline the association between the ADx of HD to demonstrate that a diagnosis of HTN may be associated with an earlier ADx of HD. These results represent an association, however, and further investigation is warranted. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jordan L. Schultz
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 52242,Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA 52242,University of Iowa College of Pharmacy, Division of Pharmacy Practice and Sciences, 100 Newton Road, Iowa City, IA 52242
| | - Lyndsay A. Harshman
- Stead Family Department of Pediatrics at the University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242
| | - Douglas R. Langbehn
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 52242
| | - Peg C. Nopoulos
- Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 52242,Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA 52242,Stead Family Department of Pediatrics at the University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242
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Parast L, Griffin BA. Quantifying the bias due to observed individual confounders in causal treatment effect estimates. Stat Med 2020; 39:2447-2476. [PMID: 32388870 DOI: 10.1002/sim.8549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/10/2022]
Abstract
It is often of interest to use observational data to estimate the causal effect of a target exposure or treatment on an outcome. When estimating the treatment effect, it is essential to appropriately adjust for selection bias due to observed confounders using, for example, propensity score weighting. Selection bias due to confounders occurs when individuals who are treated are substantially different from those who are untreated with respect to covariates that are also associated with the outcome. A comparison of the unadjusted, naive treatment effect estimate with the propensity score adjusted treatment effect estimate provides an estimate of the selection bias due to these observed confounders. In this article, we propose methods to identify the observed covariate that explains the largest proportion of the estimated selection bias. Identification of the most influential observed covariate or covariates is important in resource-sensitive settings where the number of covariates obtained from individuals needs to be minimized due to cost and/or patient burden and in settings where this covariate can provide actionable information to healthcare agencies, providers, and stakeholders. We propose straightforward parametric and nonparametric procedures to examine the role of observed covariates and quantify the proportion of the observed selection bias explained by each covariate. We demonstrate good finite sample performance of our proposed estimates using a simulation study and use our procedures to identify the most influential covariates that explain the observed selection bias in estimating the causal effect of alcohol use on progression of Huntington's disease, a rare neurological disease.
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Affiliation(s)
- Layla Parast
- Statistics Group, RAND Corporation, Santa Monica, California, USA
| | - Beth Ann Griffin
- Statistics Group, RAND Corporation, Santa Monica, California, USA
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Kumar A, Kumar V, Singh K, Kumar S, Kim YS, Lee YM, Kim JJ. Therapeutic Advances for Huntington's Disease. Brain Sci 2020; 10:brainsci10010043. [PMID: 31940909 PMCID: PMC7016861 DOI: 10.3390/brainsci10010043] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 02/07/2023] Open
Abstract
Huntington’s disease (HD) is a progressive neurological disease that is inherited in an autosomal fashion. The cause of disease pathology is an expansion of cytosine-adenine-guanine (CAG) repeats within the huntingtin gene (HTT) on chromosome 4 (4p16.3), which codes the huntingtin protein (mHTT). The common symptoms of HD include motor and cognitive impairment of psychiatric functions. Patients exhibit a representative phenotype of involuntary movement (chorea) of limbs, impaired cognition, and severe psychiatric disturbances (mood swings, depression, and personality changes). A variety of symptomatic treatments (which target glutamate and dopamine pathways, caspases, inhibition of aggregation, mitochondrial dysfunction, transcriptional dysregulation, and fetal neural transplants, etc.) are available and some are in the pipeline. Advancement in novel therapeutic approaches include targeting the mutant huntingtin (mHTT) protein and the HTT gene. New gene editing techniques will reduce the CAG repeats. More appropriate and readily tractable treatment goals, coupled with advances in analytical tools will help to assess the clinical outcomes of HD treatments. This will not only improve the quality of life and life span of HD patients, but it will also provide a beneficial role in other inherited and neurological disorders. In this review, we aim to discuss current therapeutic research approaches and their possible uses for HD.
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Affiliation(s)
- Ashok Kumar
- Department of Genetics, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014, UP, India;
| | - Vijay Kumar
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
- Correspondence: (V.K.); (J.-J.K.)
| | - Kritanjali Singh
- Central Research Station, Subharti Medical College, Swami Vivekanand Subharti University, Meerut 250002, India;
| | - Sukesh Kumar
- PG Department of Botany, Nalanda College, Bihar Sharif, Magadh University, Bihar 824234, India;
| | - You-Sam Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
| | - Yun-Mi Lee
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
| | - Jong-Joo Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea; (Y.-S.K.); (Y.-M.L.)
- Correspondence: (V.K.); (J.-J.K.)
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Schultz JL, Nopoulos PC, Killoran A, Kamholz JA. Statin use and delayed onset of Huntington's disease. Mov Disord 2018; 34:281-285. [PMID: 30576007 DOI: 10.1002/mds.27591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/31/2018] [Accepted: 11/15/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is evidence to suggest that 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) may be beneficial in Huntington's disease (HD). OBJECTIVE This study aimed to determine if statin use was associated with delayed motor diagnosis in participants with premotor HD. METHODS Among premotor HD participants from the Enroll-HD database, statin users were propensity score matched with statin nonusers based on cytosine-adenine-guanine-age product score, cytosine-adenine-guanine repeat length, baseline age, sex, and region. A Cox regression survival analysis compared the annualized hazard ratio (HR) of receiving a motor diagnosis between the 2 groups. RESULTS The annualized HR of progressing to an HD motor diagnosis was lower in the statin users (n = 89) when compared with the statin nonusers (n = 89; HR = 0.27 [95% CI 0.18-0.50], P < .0001). CONCLUSIONS In patients with premotor HD, statin use was associated with a delayed motor diagnosis of HD. Further studies are warranted to investigate if statins would be an effective disease-modifying therapy for HD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jordan L Schultz
- Department of Psychiatry, Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA.,Department of Pharmaceutical Care, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Pharmacy Practice and Science, The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Peg C Nopoulos
- Department of Psychiatry, Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA.,Department of Neurology, Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA.,Stead Family Department of Pediatrics at the University of Iowa, Iowa City, Iowa, USA
| | - Annie Killoran
- Department of Neurology, Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA.,The Veteran's Affair Medical Center of Iowa City, Iowa City, Iowa, USA
| | - John A Kamholz
- Department of Psychiatry, Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA.,Department of Neurology, Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
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Schultz JL, Kamholz JA, Moser DJ, Feely SME, Paulsen JS, Nopoulos PC. Substance abuse may hasten motor onset of Huntington disease: Evaluating the Enroll-HD database. Neurology 2017; 88:909-915. [PMID: 28148631 DOI: 10.1212/wnl.0000000000003661] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/05/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between substances of abuse and age at motor onset (AMO) in patients with Huntington disease (HD) in a large and diverse patient population. METHODS This was a retrospective, observational study of the Enroll-HD database. Participants were determined to belong to 1 of 3 substance abuse groups: (1) tobacco abusers, (2) alcohol abusers, and (3) drug abusers. A group of participants who had never abused substances served as a control group. The average AMO of patients in the substance abuse groups was compared to the control group. The number of CAG repeats was used as a covariate in all analyses. RESULTS The average difference in AMOs of participants in the tobacco (n = 566), alcohol (n = 374), and drug abuse groups (n = 217) compared to the control group (n = 692) were 2.3 (F1, 1,258 = 33.8, p < 0.0001), 1.0 (F1, 1,066 = 4.2, p = 0.04), and 3.3 (F1, 909 = 29.7, p < 0.0001) years earlier, respectively. In all substance abuse groups, the AMO was lowered to a greater degree in female participants than it was in male participants. CONCLUSIONS Substances of abuse have a strong effect on the AMO in patients with HD. These effects seem to be amplified in women with HD compared to men. These results may provide a safe intervention capable of adding disease-free years to patients with HD.
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Affiliation(s)
- Jordan L Schultz
- From the Departments of Pharmaceutical Care (J.L.S.), Neurology (J.L.S., J.A.K., S.M.E.F., J.S.P., P.C.N.), Psychiatry (J.A.K., D.J.M., J.S.P., P.C.N.), and Pediatrics (P.C.N.), The University of Iowa Hospitals and Clinics, Iowa City.
| | - John A Kamholz
- From the Departments of Pharmaceutical Care (J.L.S.), Neurology (J.L.S., J.A.K., S.M.E.F., J.S.P., P.C.N.), Psychiatry (J.A.K., D.J.M., J.S.P., P.C.N.), and Pediatrics (P.C.N.), The University of Iowa Hospitals and Clinics, Iowa City
| | - David J Moser
- From the Departments of Pharmaceutical Care (J.L.S.), Neurology (J.L.S., J.A.K., S.M.E.F., J.S.P., P.C.N.), Psychiatry (J.A.K., D.J.M., J.S.P., P.C.N.), and Pediatrics (P.C.N.), The University of Iowa Hospitals and Clinics, Iowa City
| | - Shawna M E Feely
- From the Departments of Pharmaceutical Care (J.L.S.), Neurology (J.L.S., J.A.K., S.M.E.F., J.S.P., P.C.N.), Psychiatry (J.A.K., D.J.M., J.S.P., P.C.N.), and Pediatrics (P.C.N.), The University of Iowa Hospitals and Clinics, Iowa City
| | - Jane S Paulsen
- From the Departments of Pharmaceutical Care (J.L.S.), Neurology (J.L.S., J.A.K., S.M.E.F., J.S.P., P.C.N.), Psychiatry (J.A.K., D.J.M., J.S.P., P.C.N.), and Pediatrics (P.C.N.), The University of Iowa Hospitals and Clinics, Iowa City
| | - Peg C Nopoulos
- From the Departments of Pharmaceutical Care (J.L.S.), Neurology (J.L.S., J.A.K., S.M.E.F., J.S.P., P.C.N.), Psychiatry (J.A.K., D.J.M., J.S.P., P.C.N.), and Pediatrics (P.C.N.), The University of Iowa Hospitals and Clinics, Iowa City
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Pagan F, Torres-Yaghi Y, Altshuler M. The diagnosis and natural history of Huntington disease. HUNTINGTON DISEASE 2017; 144:63-67. [DOI: 10.1016/b978-0-12-801893-4.00005-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Thomas EA. DNA methylation in Huntington's disease: Implications for transgenerational effects. Neurosci Lett 2016; 625:34-9. [PMID: 26522374 PMCID: PMC4864163 DOI: 10.1016/j.neulet.2015.10.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/08/2015] [Accepted: 10/23/2015] [Indexed: 12/29/2022]
Abstract
Huntington's disease (HD) is a devastating, neurodegenerative disorder caused by a CAG repeat mutation in the HTT gene. A growing body of evidence suggests that epigenetic modifications play a key role in HD pathogenesis. Expression of the disease protein, huntingtin, leads to extensive transcriptional dysregulation due to disruption of histone-modifying complexes and altered interactions with chromatin-related factors. Such epigenetic mechanisms also readily respond to environmental factors, which are now thought to influence the risk, onset and progression of neurodegenerative disorders, including HD. DNA methylation is an epigenetic modification that has been studied intensively, however, its role in HD is just emerging. In this review, DNA methylation differences associated with HD will be summarized, as well as the role of environmental factors to alter DNA methylation in a manner that could alter disease phenotypes. Further, transgenerational epigenetic inheritance will be discussed in the context of relevant environmental factors and their potential links to HD. The study of epigenetic states in HD presents an opportunity to gain new insights into risk factors and pathogenic mechanisms associated with HD, as well as to inform about treatment options.
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Affiliation(s)
- Elizabeth A Thomas
- Department of Molecular and Cellular Neuroscience, The Scripps Research Institute, La Jolla, CA, United States.
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Wallace M, Downing N, Lourens S, Mills J, Kim JI, Long J, Paulsen J. Is There an Association of Physical Activity with Brain Volume, Behavior, and Day-to-day Functioning? A Cross Sectional Design in Prodromal and Early Huntington Disease. PLOS CURRENTS 2016; 8. [PMID: 27818843 PMCID: PMC4866530 DOI: 10.1371/currents.hd.cba6ea74972cf8412a73ce52eb018c1e] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Huntington disease (HD) is a genetic neurodegenerative disease leading to progressive motor, cognitive, and behavioral decline. Subtle changes in these domains are detectable up to 15 years before a definitive motor diagnosis is made. This period, called prodromal HD, provides an opportunity to examine lifestyle behaviors that may impact disease progression. THEORETICAL FRAMEWORK Physical activity relates to decreased rates of brain atrophy and improved cognitive and day-to-day functioning in Alzheimer disease and healthy aging populations. Previous research has yielded mixed results regarding the impact of physical activity on disease progression in HD and paid little attention to the prodromal phase. METHODS We conducted analyses of associations among current physical activity level, current and retrospective rate of change for hippocampus and striatum volume, and cognitive, motor, and day-to-day functioning variables. Participants were 48 gene-expanded cases with prodromal and early-diagnosed HD and 27 nongene-expanded control participants. Participants wore Fitbit Ultra activity monitors for three days and completed the self-reported International Physical Activity Questionnaire (IPAQ). Hippocampal and striatal white matter volumes were measured using magnetic resonance imaging. Cognitive tests included the Stroop Color and Word Test, and the Symbol Digit Modalities Test (SDMT). Motor function was assessed using the Unified Huntington's Disease Rating Scale total motor score (TMS). Day-to-day functioning was measured using the World Health Organization Disability Assessment Schedule (WHODAS) version 2.0. RESULTS Higher Fitbit activity scores were significantly related to better scores on the SDMT and WHODAS in case participants but not in controls. Fitbit activity scores tracked better with TMS scores in the group as a whole, though the association did not reach statistical significance in the case participants. Higher Fitbit activity scores related to less day-to-day functioning decline in retrospective slope analyses. Fitbit activity scores did not differ significantly between cases and controls. CONCLUSIONS This is the first known study examining the associations between activity level and imaging, motor, cognitive, and day-to-day functioning outcomes in prodromal and early HD. Preliminary results suggest physical activity positively correlates with improved cognitive and day-to-day functioning and possibly motor function in individuals in the prodromal and early phase of the condition.
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Affiliation(s)
- McKenzie Wallace
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Iowa City, Iowa, USA
| | - Nancy Downing
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Spencer Lourens
- School of Medicine, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - James Mills
- Department on Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Ji-In Kim
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jeffrey Long
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jane Paulsen
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Progress in Huntington’s disease: the search for markers of disease onset and progression. J Neurol 2015; 262:1990-5. [DOI: 10.1007/s00415-015-7700-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW This review highlights the recent advances in Huntington's disease, with a particular focus on development of disease biomarkers for use in therapeutic trials in the premotor phase of the disease, as well as the growing literature regarding pathophysiological mechanisms and their relevance to potential therapeutic targets. RECENT FINDINGS There have been continued advances in the development of disease biomarkers, and promising neuroprotection trials are beginning to emerge in the premotor stage of Huntington's disease. Deeper understanding of the pathophysiological mechanisms is being translated into potential therapeutic strategies. SUMMARY The premotor stage of Huntington's disease provides an ideal time to trial disease-modifying therapy, but reliable biomarkers are required for monitoring disease progression, and this remains an area of intense research. Our understanding of the underlying pathophysiological mechanisms continues to expand, and a number of promising therapeutic strategies are emerging, including strategies to silence mutant huntingtin expression.
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Genetics of Huntington Disease (HD), HD-Like Disorders, and Other Choreiform Disorders. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Spielman LJ, Little JP, Klegeris A. Inflammation and insulin/IGF-1 resistance as the possible link between obesity and neurodegeneration. J Neuroimmunol 2014; 273:8-21. [PMID: 24969117 DOI: 10.1016/j.jneuroim.2014.06.004] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/17/2022]
Abstract
Obesity is a growing epidemic that contributes to several brain disorders including Alzheimer's, Parkinson's, and Huntington's diseases. Obesity could promote these diseases through several different mechanisms. Here we review evidence supporting the involvement of two recently recognized factors linking obesity with neurodegeneration: the induction of pro-inflammatory cytokines and onset of insulin and insulin-like growth factor 1 (IGF-1) resistance. Excess peripheral pro-inflammatory mediators, some of which can cross the blood brain barrier, may trigger neuroinflammation, which subsequently exacerbates neurodegeneration. Insulin and IGF-1 resistance leads to weakening of neuroprotective signaling by these molecules and can contribute to onset of neurodegenerative diseases.
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Affiliation(s)
- Lindsay J Spielman
- Department of Biology, University of British Columbia Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7 Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7 Canada
| | - Andis Klegeris
- Department of Biology, University of British Columbia Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7 Canada.
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Bettencourt C, Raposo M, Kazachkova N, Santos C, Kay T, Vasconcelos J, Maciel P, Donis KC, Saraiva-Pereira ML, Jardim LB, Sequeiros J, Bruges-Armas J, Lima M. Sequence analysis of 5' regulatory regions of the Machado-Joseph disease gene (ATXN3). THE CEREBELLUM 2013; 11:1045-50. [PMID: 22422287 DOI: 10.1007/s12311-012-0373-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Machado-Joseph disease (MJD) is a late-onset autosomal dominant neurodegenerative disorder, which is caused by a coding (CAG)(n) expansion in the ATXN3 gene (14q32.1). The number of CAG repeats in the expanded alleles accounts only for 50 to 75 % of onset variance, the remaining variation being dependent on other factors. Differential allelic expression of ATXN3 could contribute to the explanation of different ages at onset in patients displaying similar CAG repeat sizes. Variation in 5' regulatory regions of the ATXN3 gene may have the potential to influence expression levels and, ultimately, modulate the MJD phenotype. The main goal of this work was to analyze the extent of sequence variation upstream of the ATXN3 start codon. A fragment containing the core promoter and the 5' untranslated region (UTR) was sequenced and analyzed in 186 patients and 59 controls (490 chromosomes). In the core promoter, no polymorphisms were observed. In the 5' UTR, only one SNP (rs3814834) was found, but no improvements on the explanation of onset variance were observed, when adding its allelic state in a linear model. Accordingly, in silico analysis predicted that this SNP lays in a nonconserved position for CMYB binding. Therefore, no functional effect could be predicted for this variant.
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Affiliation(s)
- Conceição Bettencourt
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal.
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Ji J, Sundquist K, Sundquist J. Cancer incidence in patients with polyglutamine diseases: a population-based study in Sweden. Lancet Oncol 2012; 13:642-8. [PMID: 22503213 DOI: 10.1016/s1470-2045(12)70132-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Polyglutamine (polyQ) diseases are characterised by the expansion of CAG triplet repeats in specific genes. The accumulated encoded proteins affect the transcription of numerous transcription factors. We investigated whether polyQ diseases reduce the risk of cancer development. METHODS Data on patients with the polyQ diseases Huntington's disease (HD), spinobulbar muscular atrophy (SBMA), and hereditary ataxia (HA) in Sweden were linked to the Swedish Cancer Registry. We calculated standardised incidence ratios for cancers at specific sites or of specific types and the risks were compared with those in the general population. We also analysed risks in the unaffected parents of patients. FINDINGS In the period January, 1969, to December, 2008, we identified 1510 patients with HD, 471 with SBMA, and 3425 with HA. Cancer was diagnosed in 91 (6·0%) HD patients, 34 (7·2%) SBMA patients, and 421 (12·3%) HA patients. The standardised incidence ratios were 0·47 (95% CI 0·38-0·58), 0·65 (0·45-0·91), and 0·77 (0·70-0·85), respectively. Before diagnosis of polyQ disease, the risk of cancer was even lower. Cancer incidence and risk in the unaffected parents of patients with polyQ diseases were similar to those in the general population. INTERPRETATION The consistently decreased incidence of cancer in patients with polyQ diseases suggests that a common mechanism protects against the development of cancer. This feature could be related to the polyQ-tract expansion seen in these diseases. Further studies are warranted to investigate the underlying mechanisms linking cancer and polyQ diseases. FUNDING Swedish Cancer Society, Swedish Council for Working Life and Social Research.
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Affiliation(s)
- Jianguang Ji
- Centre for Primary Health Care Research, Lund University and Region Skåne, Lund, Sweden.
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Deshmukh RS, Chaudhary RK, Roy I. Effect of pesticides on the aggregation of mutant huntingtin protein. Mol Neurobiol 2012; 45:405-14. [PMID: 22415443 DOI: 10.1007/s12035-012-8252-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/28/2012] [Indexed: 01/08/2023]
Abstract
The classical reports on neurodegeneration concentrate on studying disruption of signalling cascades. Although it is now well recognized that misfolding and aggregation of specific proteins are associated with a majority of these diseases, their role in aggravating the symptoms is not so well understood. Huntington's disease (HD) is a neurodegenerative disorder that results from damage to complex II of mitochondria. In this work, we have studied the effect of mitochondrial complex I inhibitors, viz. 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and rotenone, and complex II inhibitor, viz. 3-nitropropionic acid, on the aggregation of mutant huntingtin (mthtt) protein, whose misfolding and aggregation results in cellular abnormalities characteristic of HD. All three inhibitors were found to accelerate the aggregation of mthtt in vitro, although the amounts of aggregates formed were different in all cases. Thus, apart from their effect on mitochondrial viability, these neurotoxins are capable of interfering with the protein aggregation process and thus, hastening the onset of the disease.
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Affiliation(s)
- Ruhi S Deshmukh
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Punjab, 160 062, India
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