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Benatar M, Macklin EA, Malaspina A, Rogers ML, Hornstein E, Lombardi V, Renfrey D, Shepheard S, Magen I, Cohen Y, Granit V, Statland JM, Heckmann JM, Rademakers R, McHutchison CA, Petrucelli L, McMillan CT, Wuu J. Prognostic Clinical and Biological Markers for Amyotrophic Lateral Sclerosis Disease Progression: Validation and Implications for Clinical Trial Design and Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.12.24311876. [PMID: 39185513 PMCID: PMC11343261 DOI: 10.1101/2024.08.12.24311876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background With increasing recognition of the value of incorporating prognostic markers into amyotrophic lateral sclerosis (ALS) trial design and analysis plans, there is a pressing need to understand which among the prevailing clinical and biochemical markers have real value, and how they can be optimally used. Methods A subset of patients with ALS recruited through the multi-center Phenotype-Genotype-Biomarker study (clinicaltrials.gov: NCT02327845 ) was identified as "trial-like" based on meeting common trial eligibility criteria. Clinical phenotyping was performed by evaluators trained in relevant assessments. Serum neurofilament light (NfL) and phosphorylated neurofilament heavy (pNfH), urinary p75 ECD , plasma microRNA-181, and an array of biochemical and clinical measures were evaluated for their prognostic value. Associations with functional progression were estimated by random-slopes mixed models of ALS functional rating scale-revised (ALSFRS-R) score. Associations with survival were estimated by log-rank test and Cox proportional hazards regression. Potential sample size savings from adjusting for given biomarkers in a hypothetical trial were estimated. Findings Baseline serum NfL is a powerful prognostic biomarker, predicting survival and ALSFRS-R rate of decline. Serum NfL <40pg/ml and >100pg/ml correspond to future ALSFRS-R slopes of ∼0.5 and 1.5 points/month, respectively. Serum NfL also adds value to the best available clinical predictors, encapsulated by the European Network to Cure ALS (ENCALS) predictor score. In models of functional decline, the addition of NfL yields ∼25% sample size saving above those achieved by inclusion of either clinical predictors or ENCALS score alone. The prognostic value of serum pNfH, urinary p75 ECD , and plasma miR-181ab is more limited. Interpretation Among the multitude of biomarkers considered, only blood NfL adds value to the ENCALS prediction model and should be incorporated into analysis plans for all ongoing and future ALS trials. Defined thresholds of NfL might also be used in trial design, for enrichment or stratified randomisation, to improve trial efficiency. Funding NIH (U01-NS107027, U54-NS092091). ALSA (16-TACL-242). Research in Context Evidence Before This Study: The phenotypic heterogeneity of ALS poses a challenge for clinical trials, making it more difficult to discern therapeutic effects of investigational agents amidst the noise of natural variability. Prognostic markers are important tools to help mitigate this issue. A host of clinical markers and putative biomarkers have been proposed to have prognostic value, but their relative utility, especially when considered jointly, and the practical implications of their use, have not been well defined.Added Value of This Study: Using a trial-like population from a natural history study, in which clinical trial-grade phenotypic data and multi-modal biomarker data were collected, we show that a subset of clinical factors, encapsulated by the ENCALS predictive model score, and serum neurofilament light chain (NfL) are the most powerful prognostic markers when considering either ALSFRS-R functional decline or permanent assisted ventilation (PAV)/tracheostomy-free survival. Importantly, serum NfL adds prognostic value even after adjusting for the ENCALS score, yielding an additional sample size saving of ∼27% in a hypothetical future clinical trial. While serum phosphorylated neurofilament heavy chain (pNfH), urinary p75 ECD , and plasma miR-181ab each holds some prognostic value, when considered together with the ENCALS score and serum NfL, only p75 ECD may yield additional but modest sample size saving. Implication of All Available Evidence: Blood NfL is a validated biomarker for multiple contexts-of-use. As a prognostic marker, it should be used together with clinical predictors, such as the ENCALS predictive model score, in all ongoing and future ALS clinical trials. The utility of urinary p75 ECD and plasma miR-181ab is less clear. Serum pNfH, as well as serum uric acid, albumin, creatinine, and C-reactive protein (CRP), provide no additional prognostic information.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A Macklin
- Departments of Neurology and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Andrea Malaspina
- UCL Queen Square Motor Neuron Disease Center, UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK
| | - Mary-Louise Rogers
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Eran Hornstein
- Department of Molecular Genetics and Molecular Neuroscience, Weizmann Institute of Science, Israel
| | - Vittoria Lombardi
- UCL Queen Square Motor Neuron Disease Center, UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK
| | - Danielle Renfrey
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephanie Shepheard
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Iddo Magen
- Department of Molecular Genetics and Molecular Neuroscience, Weizmann Institute of Science, Israel
| | - Yahel Cohen
- Department of Molecular Genetics and Molecular Neuroscience, Weizmann Institute of Science, Israel
| | - Volkan Granit
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS USA
| | - Jeannine M Heckmann
- Division of Neurology, Department of Medicine, University of Cape Town, South Africa
| | - Rosa Rademakers
- VIB Center for Molecular Neurology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Caroline A McHutchison
- School of Philosophy, Psychology, and Language Sciences, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
| | | | - Corey T McMillan
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joanne Wuu
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Bai J, Zhang X, Wang H, Yu W, He Z, Wang J, Feng F, Li M, Wang H, Yang F, Huang X. Gender-specific association of uric acid and survival in sporadic amyotrophic lateral sclerosis patients. Brain Res 2023:148445. [PMID: 37290609 DOI: 10.1016/j.brainres.2023.148445] [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: 10/29/2022] [Revised: 05/19/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the relationship between serum uric acid (UA) and survival in sporadic amyotrophic lateral sclerosis(sALS) patients. METHOD A total of 801 sporadic amyotrophic lateral sclerosis(sALS) patients fulfilled the revised El Escorial criteria were enrolled and followed up in the study. Baseline clinical data and laboratory variables including gender, age, age of onset, site of onset, disease duration, body mass index (BMI), uric acid (UA), creatinine (Cr), and creatine kinase (CK) were collected during enrollment. Multivariate Cox regression models were used to evaluate the survival-related factors after adjustment for confounders. RESULTS The serum UA level was significantly lower in female patients than that in male patients (243.5 vs 314.9μmol/L, p<0.001). Gender, BMI, Cr, CK were significantly associated with the level of uric acid according to the linear regression analysis. In the multivariate Cox regression analysis, higher serum UA level (>268.0μmol/L) was an independent protective factor for prolonged survival among female patients (HR=0.69, P=0.042) after adjustment for confounders. CONCLUSION The present study provided further support that higher UA was a protective factor for survival in sALS patients, especially in female.
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Affiliation(s)
- Jiongming Bai
- College of Medicine, Nankai University, Tianjin, China; Medical School of Chinese PLA, Beijing, China
| | - Xiaolan Zhang
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haoran Wang
- College of Medicine, Nankai University, Tianjin, China; Medical School of Chinese PLA, Beijing, China
| | - Wenxiu Yu
- Medical School of Chinese PLA, Beijing, China; Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhengqing He
- Medical School of Chinese PLA, Beijing, China; Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiao Wang
- Medical School of Chinese PLA, Beijing, China; Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Feng Feng
- Medical School of Chinese PLA, Beijing, China; Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Mao Li
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongfen Wang
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Yang
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xusheng Huang
- College of Medicine, Nankai University, Tianjin, China; Medical School of Chinese PLA, Beijing, China; Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Kutlubaev MA, Areprintseva DK, Pervushina EV. [The influence of uric acid on the course of amyotrophic lateral sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:177-180. [PMID: 37315259 DOI: 10.17116/jnevro2023123051177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Uric acid has antioxidant and neuroprotective properties. A number of studies show that high levels of uric acid may have a positive influence on the course of amyotrophic lateral sclerosis (ALS), especially in males. The frequency of ALS is lower in patients with gout than in the general population. We present a case of a patient with gout and slowly progressive ALS. More research is needed on the potential role of uric acid in ALS and other neurodegenerative disorders.
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Biomolecular Modifications Linked to Oxidative Stress in Amyotrophic Lateral Sclerosis: Determining Promising Biomarkers Related to Oxidative Stress. Processes (Basel) 2021. [DOI: 10.3390/pr9091667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Reduction–oxidation reactions are essential to cellular homeostasis. Oxidative stress transcends physiological antioxidative system damage to biomolecules, including nucleic acids and proteins, and modifies their structures. Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron disease. The cells present in the central nervous system, including motor neurons, are vulnerable to oxidative stress. Neurodegeneration has been demonstrated to be caused by oxidative biomolecular modifications. Oxidative stress has been suggested to be involved in the pathogenesis of ALS. Recent progress in research on the underlying mechanisms of oxidative stress in ALS has led to the development of disease-modifying therapies, including edaravone. However, the clinical effects of edaravone remain limited, and ALS is a heretofore incurable disease. The reason for the lack of reliable biomarkers and the precise underlying mechanisms between oxidative stress and ALS remain unclear. As extracellular proteins and RNAs present in body fluids and represent intracellular pathological neurodegenerative processes, extracellular proteins and/or RNAs are predicted to promise diagnosis, prediction of disease course, and therapeutic biomarkers for ALS. Therefore, we aimed to elucidate the underlying mechanisms between oxidative stress and ALS, and promising biomarkers indicating the mechanism to determine whether therapy targeting oxidative stress can be fundamental for ALS.
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Chen L, Xu L, Tang L, Xia K, Tian D, Zhang G, Wang Y, Yu Z, Ma J, Zhang Y, Wang F, Sun C, Zhang G, Fu J, Jiao L, Yilihamu M, Wang S, Zhan S, Fan D. Trends in the clinical features of amyotrophic lateral sclerosis: A 14-year Chinese cohort study. Eur J Neurol 2021; 28:2893-2900. [PMID: 34048130 DOI: 10.1111/ene.14943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to determine the transitional patterns in the clinical characteristics, treatments and comorbidities in amyotrophic lateral sclerosis (ALS) patients over the past 14 years using data from a large clinical cohort in mainland China. METHODS Sporadic ALS patients who visited the Peking University Third Hospital from January 2005 to December 2018 were included in this study. The 14 years were divided into three periods, and changes in the baseline characteristics of the participants were analyzed at 5-year intervals. RESULTS In total, 3410 patients with sporadic ALS were recruited: 2181 were men and 1229 were women. The proportion of patients with bulbar-onset ALS increased from 13.0% in 2005-2009 to 19.5% in 2015-2018 (p < 0.001). The mean (standard deviation) age at onset increased from 49.5 (11.4) years in 2005-2009 to 53.0 (11.0) years in 2015-2018 (p < 0.001). ALS patients with diabetes or hypertension showed a delay in ALS onset, and the delay was even more apparent when the patients had both comorbidities. The proportion of riluzole users in 2015-2018 was approximately 2.5-fold of that in 2005-2009 (p < 0.001). CONCLUSIONS In the context of a lack of clinical data on ALS in mainland China, this study evaluated a large cohort of patients diagnosed over a 14-year period. The age at onset and percentage of patients who used riluzole both increased over the study period. Additionally, it was found that patients with comorbidities such as diabetes and hypertension had a delayed age of ALS onset.
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Affiliation(s)
- Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Kailin Xia
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Danyang Tian
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Gan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yajun Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Zhou Yu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Jingyue Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Fan Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Can Sun
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Gaoqi Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Lin Jiao
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Mubalake Yilihamu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
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Xu LQ, Hu W, Guo QF, Xu GR, Wang N, Zhang QJ. Serum Uric Acid Levels Predict Mortality Risk in Male Amyotrophic Lateral Sclerosis Patients. Front Neurol 2021; 12:602663. [PMID: 33776880 PMCID: PMC7991582 DOI: 10.3389/fneur.2021.602663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the associations between serum uric acid levels with survival in male and female ALS patients. Methods: A longitudinal cohort study was carried out including 313 sporadic and 16 familial ALS patients with repeated serum uric acid measurements. Multivariate Cox regression models were used to evaluate the survival-related factors. Results: There were 207 male and 122 female, and the mean age of onset was 55.7 ± 11.2 years old. The male patients had significantly higher baseline uric acid levels than that in female patients (342.4 ± 91.4 vs. 279.3 ± 71.4 μmol/L; p < 0.0001). The uric acid levels were inversely associated with the decline rate of ALSFRS-R per month (ΔALSFRS-R). After multivariate Cox regression analysis, a survival advantage was found in male, but not female, with higher serum uric acid levels. In males, a shorter diagnostic delay (≤10 m), lower BMI at baseline (≤18.70 kg/m2), faster disease progression (ΔALSFRS-R > 0.63), and lower baseline uric acid levels (≤292 μmol/L, HR: 1.936; 95% CI: 1.334-2.810) were associated with a shorter survival. During follow-up, the serum uric acid levels were not significantly altered over time. Conclusion: There is an inverse correlation between baseline serum uric acid levels and risk of death, prominently in male ALS patients.
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Affiliation(s)
- Liu-Qing Xu
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei Hu
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qi-Fu Guo
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guo-Rong Xu
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Wang
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Qi-Jie Zhang
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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7
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Haji S, Sako W, Murakami N, Osaki Y, Furukawa T, Izumi Y, Kaji R. The value of serum uric acid as a prognostic biomarker in amyotrophic lateral sclerosis: Evidence from a meta-analysis. Clin Neurol Neurosurg 2021; 203:106566. [PMID: 33706058 DOI: 10.1016/j.clineuro.2021.106566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the value of uric acid (UA) as a prognostic biomarker for amyotrophic lateral sclerosis (ALS) using a meta-analysis of hazard ratio-based studies. METHODS We included data from Tokushima University (47 patients with ALS) and three previous studies (1835 patients with ALS) with a hazard ratio (HR) identified by a systematic computational search. A total of four studies and 1882 patients were enrolled in the pooled analysis. We pooled HRs of death or tracheostomy, which were estimated by a Cox proportional hazard model, using a random-effects model. Heterogeneity was assessed by Q statistic, and a p value < 0.1 was considered significant heterogeneity. Furthermore, sensitivity analysis was performed to assess the effect of each single study and the robustness of the summary effect. We evaluated publication bias by visual assessment of the funnel plot and Egger's test, and adjusted the bias using a trim-and-fill method. RESULTS This meta-analysis revealed that UA could be a prognostic factor for ALS (all, HR = 0.87, p < 0.001; men, HR = 0.83, p < 0.001; women, HR = 0.76, p < 0.001). The included studies were homogeneous (all, p = 0.43; men, p = 0.9; women, p = 0.49). Sensitivity analysis confirmed the robustness of these summary effects. Publication bias was detected, which was adjusted for by a trim-and-fill method. The adjusted results showed significant summary effects (all, HR = 0.88, p = 0.002; men, HR = 0.83, p < 0.001; women, HR = 0.77, p < 0.001). CONCLUSION The present meta-analysis suggests that the serum UA level could be a prognostic biomarker in patients with ALS. Sensitivity analyses and the trim-and-fill method supported the robustness of these results.
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Affiliation(s)
- Shotaro Haji
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Wataru Sako
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Nagahisa Murakami
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yusuke Osaki
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takahiro Furukawa
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; Department of Neurology, Shinko Hospital, Kobe, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryuji Kaji
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; Department of Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan
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8
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Aberrations in Oxidative Stress Markers in Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:1712323. [PMID: 31281567 PMCID: PMC6590548 DOI: 10.1155/2019/1712323] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022]
Abstract
Oxidative stress has been reported to be involved in the onset and development of amyotrophic lateral sclerosis (ALS). Data from clinical studies have highlighted increased peripheral blood oxidative stress markers in patients with ALS, but results are inconsistent. Therefore, we quantitatively pooled data on levels of blood oxidative stress markers in ALS patients from the literature using a meta-analytic technique. A systematic search was performed on PubMed and Web of Science, and we included studies analyzing blood oxidative stress marker levels in patients with ALS and normal controls. We included 41 studies with 4,588 ALS patients and 6,344 control subjects, and 15 oxidative stress marker levels were subjected to random-effects meta-analysis. The results demonstrated that malondialdehyde (Hedges' g, 1.168; 95% CI, 0.812 to 1.523; P < 0.001), 8-hydroxyguanosine (Hedges' g, 2.194; 95% CI, 0.554 to 3.835; P = 0.009), and Advanced Oxidation Protein Product (Hedges' g, 0.555; 95% CI, 0.317 to 0.792; P < 0.001) levels were significantly increased in patients with ALS when compared with control subjects. Uric acid (Hedges' g, -0.798; 95% CI, -1.117 to -0.479; P < 0.001) and glutathione (Hedges' g, -1.636; 95% CI, -3.020 to -0.252; P = 0.02) levels were significantly reduced in ALS patients. In contrast, blood Cu, superoxide dismutase, glutathione peroxidase, ceruloplasmin, triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein, coenzyme-Q10, and transferrin levels were not significantly different between cases and controls. Taken together, our results showed significantly increased blood levels of 8-hydroxyguanosine, malondialdehyde, and Advanced Oxidation Protein Product and decreased glutathione and uric acid levels in the peripheral blood of ALS patients. This meta-analysis helps to clarify the oxidative stress marker profile in ALS patients, supporting the hypothesis that oxidative stress is a central component underpinning ALS pathogenesis.
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Verber NS, Shepheard SR, Sassani M, McDonough HE, Moore SA, Alix JJP, Wilkinson ID, Jenkins TM, Shaw PJ. Biomarkers in Motor Neuron Disease: A State of the Art Review. Front Neurol 2019; 10:291. [PMID: 31001186 PMCID: PMC6456669 DOI: 10.3389/fneur.2019.00291] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data.
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Affiliation(s)
- Nick S Verber
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Stephanie R Shepheard
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Harry E McDonough
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Sophie A Moore
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - James J P Alix
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Iain D Wilkinson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Tom M Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
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Chen X, Wei QQ, Chen Y, Cao B, Ou R, Hou Y, Yuan X, Zhang L, Liu H, Shang H. Clinical disease stage related changes of serological factors in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:53-60. [PMID: 30784318 DOI: 10.1080/21678421.2018.1550516] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Little is known whether disease clinical stage would influence the serological values in Amyotrophic lateral sclerosis (ALS). We aimed to explore the association between the levels of serological factors with clinical progression determined by the King's College staging system. METHODS ALS Patients were registered from May 2008 to December 2016. The differences of serological values between patients and healthy controls, and the correlation of these serological values with disease stage were examined. RESULTS A total of 571 patients and 571 age-/gender-/BMI-matched healthy controls were included. The levels of creatinine, uric acid (UA), albumin, total protein, total cholesterol, and high-density lipoprotein (HDL) were significantly lower, and the low-density lipoprotein/HDL ratio was higher in ALS patients than those in healthy controls. The levels of UA, albumin, and total protein were significantly reversely correlated with diseases stages. The longitudinal observation of 81 ALS patients also showed that the levels of UA, creatinine, albumin, total protein, and HDL were significantly decreased in the second hematological examinations. CONCLUSIONS In the present study, ALS patients and control subjects were evenly matched with regard to sex, age, and BMI value, this finding could be considered as a metabolite signature in ALS. The changes of metabolite-based serological factors with progression of disease stage might be related to the pathophysiology of disease, and might have clinical utility in clinical practice.
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Affiliation(s)
- Xueping Chen
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Qian-Qian Wei
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Yongping Chen
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Bei Cao
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - RuWei Ou
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Yanbing Hou
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Xiaoqin Yuan
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Lingyu Zhang
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Hui Liu
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Huifang Shang
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
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11
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Takei K, Tsuda K, Takahashi F, Hirai M, Palumbo J. An assessment of treatment guidelines, clinical practices, demographics, and progression of disease among patients with amyotrophic lateral sclerosis in Japan, the United States, and Europe. Amyotroph Lateral Scler Frontotemporal Degener 2018; 18:88-97. [PMID: 28872912 DOI: 10.1080/21678421.2017.1361445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is an increasing clinical research focus on neuroprotective agents in amyotrophic lateral sclerosis (ALS). However, it is unclear how generalisable clinical study trial results are between different countries and regions. OBJECTIVE To assess similarities and differences in clinical practice and treatment guidelines for ALS, and also to compare the demographics and rate of progression of disease in patients with ALS enrolled in clinical trials in Japan, the US, and Europe. METHODS We performed a review of clinical studies published since 2000 to compare the demographics and characteristics of patients with ALS. Progression of ALS disease was assessed in patients receiving placebo. The changes per month in ALSFRS-R score were calculated and compared between the studies. RESULTS Overall, diagnostic criteria, recognition of ALS symptoms, comorbidities, use of riluzole, and nutritional, and respiratory support were similar. Regarding demographics and characteristics, there were no clear differences in the incidence of sporadic ALS (range 91-98%), bulbar onset (range 11-41%), and median time from onset to diagnosis (range 9-14 months) among the populations despite the difference in race between regions. However, use of tracheostomy-based invasive respiratory support was higher in Japan (29-38%) than in the US (4%) and Europe (1-31%). Rate of progression of disease was similar between the US and Europe study populations (range -0.89 to -1.60 points/month), and the Japanese study populations (range -1.03 to -1.21 points/month). CONCLUSION There is evidence to support the generalisability of data from the Japanese ALS trial experience to the US and Europe populations in early to mid-stage of ALS.
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Affiliation(s)
- Koji Takei
- a Mitsubishi Tanabe Pharma Development America Inc. , Jersey City , NJ , USA and
| | - Kikumi Tsuda
- a Mitsubishi Tanabe Pharma Development America Inc. , Jersey City , NJ , USA and
| | | | - Manabu Hirai
- b Mitsubishi Tanabe Pharma Corporation , Tokyo , Japan
| | - Joseph Palumbo
- a Mitsubishi Tanabe Pharma Development America Inc. , Jersey City , NJ , USA and.,b Mitsubishi Tanabe Pharma Corporation , Tokyo , Japan
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12
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Zhang F, Zhang Q, Ke Y, Hao J, Lu L, Lu N, Chen X. Serum uric acid levels in patients with amyotrophic lateral sclerosis: a meta-analysis. Sci Rep 2018; 8:1100. [PMID: 29348425 PMCID: PMC5773600 DOI: 10.1038/s41598-018-19609-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/04/2018] [Indexed: 12/12/2022] Open
Abstract
The pathogenic mechanism of ALS remains unclear. However, increasing evidence has indicated that uric acid (UA) may play a protective role in the pathogenesis of ALS. The aim of this study was to evaluate the association between serum UA levels and ALS. A comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library was conducted up to 31st August, 2017, using keywords. A random-effects model or fixed-effects model was used to calculate the pooled estimate according to the inter-group heterogeneity. Finally, we indentified 8 case-control and 3 cohort studies. The results indicated that patients with ALS had significant decreased levels of serum UA compared to healthy controls (standardized mean difference (SMD) = -0.72, 95% CI [-0.98,-0.46], P < 0.001). Increased serum UA levels were associated with lower all-cause mortality risk among ALS patients (risk ratio (RR) = 0.70, 95% CI [0.57, 0.87], P = 0.001). To summarize, there is an inverse association between serum UA levels and risk of death among ALS patients. Randomized controlled trials with high quality are required to elucidate the role of UA on ALS.
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Affiliation(s)
- Fan Zhang
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Qin Zhang
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yaqiong Ke
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Jianbo Hao
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Ling Lu
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Nannan Lu
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Xiling Chen
- Department of Geriatrics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China.
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13
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O'Reilly ÉJ, Bjornevik K, Schwarzschild MA, McCullough ML, Kolonel LN, Le Marchand L, Manson JE, Ascherio A. Pre-diagnostic plasma urate and the risk of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:194-200. [PMID: 29277115 DOI: 10.1080/21678421.2017.1418005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To prospectively examine for the first time the association between plasma urate levels measured in healthy participants and future amyotrophic lateral sclerosis (ALS) risk. METHODS A pooled case-control study nested in five US prospective cohorts comprising 319,617 participants who provided blood, of which 275 had ALS during follow-up. Pre-diagnostic plasma urate was determined for all participants using a clinical colorimetric enzyme assay. Gender-specific multivariable-adjusted rate ratios (RR) of ALS incidence or death estimated by conditional logistic regression and pooled using inverse-variance weighting. RESULTS In age- and matching factor-adjusted analyses, a 1 mg/dL increase in urate concentration was associated with RR = 0.88 (95% CI: [0.78, 0.997] p = 0.044). After adjustment for BMI, a strong predictor of ALS and urate levels, and other potential covariates, the RR = 0.89 (95% CI: [0.78, 1.02]; p = 0.08 for 1mg/dL increase in urate). CONCLUSION Elevation of plasma urate was modestly inversely associated with the risk of ALS and warrants further study for a potential role in this disease.
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Affiliation(s)
- Éilis J O'Reilly
- a School of Public Health , College of Medicine, University College Cork , Cork , Ireland.,b Department of Nutrition , Harvard TH Chan School of Public Health , Boston , MA , USA
| | - Kjetil Bjornevik
- c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway.,d The Norwegian Multiple Sclerosis Competence Center, Department of Neurology , Haukeland University Hospital , Bergen , Norway
| | | | | | - Laurence N Kolonel
- g Epidemiology Program , University of Hawaii Cancer Center , Honolulu , HI , USA
| | - Loic Le Marchand
- g Epidemiology Program , University of Hawaii Cancer Center , Honolulu , HI , USA
| | - Joann E Manson
- h Department of Medicine Brigham and Women's Hospital , Harvard Medical School , Boston , MA , USA.,i Department of Epidemiology , Harvard TH Chan School of Public Health , Boston , MA , USA , and
| | - Alberto Ascherio
- b Department of Nutrition , Harvard TH Chan School of Public Health , Boston , MA , USA.,i Department of Epidemiology , Harvard TH Chan School of Public Health , Boston , MA , USA , and.,j Channing Division of Network Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , MA , USA
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14
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Paganoni S, Nicholson K, Chan J, Shui A, Schoenfeld D, Sherman A, Berry J, Cudkowicz M, Atassi N. Urate levels predict survival in amyotrophic lateral sclerosis: Analysis of the expanded Pooled Resource Open-Access ALS clinical trials database. Muscle Nerve 2017; 57:430-434. [PMID: 28857199 DOI: 10.1002/mus.25950] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Urate has been identified as a predictor of amyotrophic lateral sclerosis (ALS) survival in some but not all studies. Here we leverage the recent expansion of the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database to study the association between urate levels and ALS survival. METHODS Pooled data of 1,736 ALS participants from the PRO-ACT database were analyzed. Cox proportional hazards regression models were used to evaluate associations between urate levels at trial entry and survival. RESULTS After adjustment for potential confounders (i.e., creatinine and body mass index), there was an 11% reduction in risk of reaching a survival endpoint during the study with each 1-mg/dL increase in uric acid levels (adjusted hazard ratio 0.89, 95% confidence interval 0.82-0.97, P < 0.01). DISCUSSION Our pooled analysis provides further support for urate as a prognostic factor for survival in ALS and confirms the utility of the PRO-ACT database as a powerful resource for ALS epidemiological research. Muscle Nerve 57: 430-434, 2018.
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Affiliation(s)
- Sabrina Paganoni
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 600 Boston, Massachusetts, 02114.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts
| | - Katharine Nicholson
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 600 Boston, Massachusetts, 02114
| | - James Chan
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Amy Shui
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - David Schoenfeld
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Alexander Sherman
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 600 Boston, Massachusetts, 02114
| | - James Berry
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 600 Boston, Massachusetts, 02114
| | - Merit Cudkowicz
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 600 Boston, Massachusetts, 02114
| | - Nazem Atassi
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Suite 600 Boston, Massachusetts, 02114
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15
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Muñoz-Rugeles L, Galano A, Alvarez-Idaboy JR. The role of acid–base equilibria in formal hydrogen transfer reactions: tryptophan radical repair by uric acid as a paradigmatic case. Phys Chem Chem Phys 2017; 19:15296-15309. [DOI: 10.1039/c7cp01557g] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The sequential proton gain electron transfer and proton electron sequential transfer mechanisms play the most important roles in tryptophan repair by uric acid.
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Affiliation(s)
- Leonardo Muñoz-Rugeles
- Facultad de Química
- Departamento de Física y Química Teórica
- Universidad Nacional Autónoma de México
- México
- Mexico
| | - Annia Galano
- Departamento de Química
- Universidad Autónoma Metropolitana-Iztapalapa
- México
- Mexico
| | - Juan Raúl Alvarez-Idaboy
- Facultad de Química
- Departamento de Física y Química Teórica
- Universidad Nacional Autónoma de México
- México
- Mexico
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16
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Paganoni S, Schwarzschild MA. Urate as a Marker of Risk and Progression of Neurodegenerative Disease. Neurotherapeutics 2017; 14:148-153. [PMID: 27995438 PMCID: PMC5233635 DOI: 10.1007/s13311-016-0497-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Urate is a naturally occurring antioxidant whose levels are associated with reduced risk of developing Parkinson's disease (PD) and Alzheimer's disease. Urate levels are also associated with favorable progression in PD, amyotrophic lateral sclerosis, Huntington's disease, and multisystem atrophy. These epidemiological data are consistent with laboratory studies showing that urate exhibits neuroprotective effects by virtue of its antioxidant properties in several preclinical models. This body of evidence supports the hypothesis that urate may represent a shared pathophysiologic mechanism across neurodegenerative diseases. Most importantly, beyond its role as a molecular predictor of disease risk and progression, urate may constitute a novel therapeutic target. Indeed, clinical trials of urate elevation in PD and amyotrophic lateral sclerosis are testing the impact of raising peripheral urate levels on disease outcomes. These studies will contribute to unraveling the neuroprotective potential of urate in human pathology. In parallel, preclinical experiments are deepening our understanding of the molecular pathways that underpin urate's activities. Altogether, these efforts will bring about new insights into the translational potential of urate, its determinants, and its targets and their relevance to neurodegeneration.
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Affiliation(s)
- Sabrina Paganoni
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA.
- VA Boston Healthcare System, Boston, MA, USA.
| | - Michael A Schwarzschild
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- MassGeneral Institute for Neurodegenerative Disease (MIND), Boston, MA, USA
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17
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O'Reilly ÉIJ, Liu D, Johns DR, Cudkowicz ME, Paganoni S, Schwarzschild MA, Leitner M, Ascherio A. Serum urate at trial entry and ALS progression in EMPOWER. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:120-125. [PMID: 27677562 DOI: 10.1080/21678421.2016.1214733] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Our objective was to determine whether serum urate predicts ALS progression. A study population comprised adult participants of EMPOWER (n = 942), a phase III clinical trial to evaluate the efficacy of dexpramipexole to treat ALS. Urate was measured in blood samples collected during enrollment as part of the routine block chemistry. We measured outcomes by combined assessment of function and survival rank (CAFs), and time to death, by 12 months. Results showed that in females there was not a significant relation between urate and outcomes. In males, outcomes improved with increasing urate (comparing highest to lowest urate quartile: CAFS was 53 points better with p for trend = 0.04; and hazard ratio for death was 0.60 with p for trend = 0.07), but with adjustment for body mass index (BMI) at baseline, a predictor of both urate levels and prognosis, associations were attenuated and no longer statistically significant. Overall, participants with urate levels equal to or above the median (5.1 mg/dl) appeared to have a survival advantage compared to those below (hazard ratio adjusted for BMI: 0.67; 95% confidence interval 0.47-0.95). In conclusion, these findings suggest that while the association between urate at baseline and ALS progression is partially explained by BMI, there may be an independent beneficial effect of urate.
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Affiliation(s)
- ÉIlis J O'Reilly
- a Department of Nutrition, Harvard TH Chan School of Public Health, Boston. Channing Division of Network Medicine , Harvard Medical School and Brigham and Women's Hospital , Boston , Massachusetts
| | - Dawei Liu
- b ALS Neuroscience Discovery and Development , Biogen , Cambridge , Massachusetts
| | - Donald R Johns
- b ALS Neuroscience Discovery and Development , Biogen , Cambridge , Massachusetts
| | - Merit E Cudkowicz
- c Department of Neurology , Massachusetts General Hospital, MassGeneral Institute for Neurodegenerative Disease , Boston , Massachusetts
| | - Sabrina Paganoni
- c Department of Neurology , Massachusetts General Hospital, MassGeneral Institute for Neurodegenerative Disease , Boston , Massachusetts.,d Department of Physical Medicine and Rehabilitation , Harvard Medical School, Spaulding Rehabilitation Hospital , Boston, Massachusetts; VA Healthcare System , Boston , Massachusetts , and
| | - Michael A Schwarzschild
- c Department of Neurology , Massachusetts General Hospital, MassGeneral Institute for Neurodegenerative Disease , Boston , Massachusetts
| | - Melanie Leitner
- b ALS Neuroscience Discovery and Development , Biogen , Cambridge , Massachusetts
| | - Alberto Ascherio
- e Department of Epidemiology and Nutrition , Harvard TH Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital , Boston , Massachusetts , USA
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18
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19
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Blasco H, Vourc'h P, Pradat PF, Gordon PH, Andres CR, Corcia P. Further development of biomarkers in amyotrophic lateral sclerosis. Expert Rev Mol Diagn 2016; 16:853-68. [PMID: 27275785 DOI: 10.1080/14737159.2016.1199277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is an idiopathic neurodegenerative disease usually fatal in less than three years. Even if standard guidelines are available to diagnose ALS, the mean diagnosis delay is more than one year. In this context, biomarker discovery is a priority. Research has to focus on new diagnostic tools, based on combined explorations. AREAS COVERED In this review, we specifically focus on biology and imaging markers. We detail the innovative field of 'omics' approach and imaging and explain their limits to be useful in routine practice. We describe the most relevant biomarkers and suggest some perspectives for biomarker research. Expert commentary: The successive failures of clinical trials in ALS underline the need for new strategy based on innovative tools to stratify patients and to evaluate their responses to treatment. Biomarker data may be useful to improve the designs of clinical trials. Biomarkers are also needed to better investigate disease pathophysiology, to identify new therapeutic targets, and to improve the performance of clinical assessments for diagnosis and prognosis in the clinical setting. A consensus on the best management of neuroimaging and 'omics' methods is necessary and a systematic independent validation of findings may add robustness to future studies.
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Affiliation(s)
- H Blasco
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P Vourc'h
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P F Pradat
- c Département des Maladies du Système Nerveux, Assistance Publique-Hôpitaux de Paris , Hôpital de la Salpêtrière , Paris , France.,d Sorbonne Universités, UPMC Université Paris 06, CNRS, INSERM , Laboratoire d'Imagerie Biomédicale , Paris , France
| | - P H Gordon
- e Neurology Unit, Northern Navajo Medical Center , Shiprock , NM , USA
| | - C R Andres
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P Corcia
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France.,f Centre SLA , Service de Neurologie et Neurophysiologie Clinique, CHRU de Tours , Tours , France
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20
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Benatar M, Boylan K, Jeromin A, Rutkove SB, Berry J, Atassi N, Bruijn L. ALS biomarkers for therapy development: State of the field and future directions. Muscle Nerve 2015; 53:169-82. [PMID: 26574709 DOI: 10.1002/mus.24979] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
Biomarkers have become the focus of intense research in the field of amyotrophic lateral sclerosis (ALS), with the hope that they might aid therapy development efforts. Notwithstanding the discovery of many candidate biomarkers, none have yet emerged as validated tools for drug development. In this review we present a nuanced view of biomarkers based on the perspective of the Food and Drug Administration; highlight the distinction between discovery and validation; describe existing and emerging resources; review leading biological fluid-based, electrophysiological, and neuroimaging candidates relevant to therapy development efforts; discuss lessons learned from biomarker initiatives in related neurodegenerative diseases; and outline specific steps that we, as a field, might take to hasten the development and validation of biomarkers that will prove useful in enhancing efforts to develop effective treatments for ALS patients. Most important among these is the proposal to establish a federated ALS Biomarker Consortium in which all interested and willing stakeholders may participate with equal opportunity to contribute to the broader mission of biomarker development and validation.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami, Miami, Florida, USA, 33136
| | - Kevin Boylan
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | | | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - James Berry
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nazem Atassi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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21
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Oh SI, Baek S, Park JS, Piao L, Oh KW, Kim SH. Prognostic Role of Serum Levels of Uric Acid in Amyotrophic Lateral Sclerosis. J Clin Neurol 2015; 11:376-82. [PMID: 26424237 PMCID: PMC4596112 DOI: 10.3988/jcn.2015.11.4.376] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/25/2015] [Accepted: 05/28/2015] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose It has been suggested that oxidative stress is one of the pathomechanisms underlying amyotrophic lateral sclerosis (ALS), and thus antioxidants such as uric acid (UA) that could reduce oxidative stress might be beneficial in the prevention or treatment of this disease. The objective of this study was to prospectively investigate serum UA levels in Korean ALS patients and to relate them to disease progression. Methods ALS patients and healthy controls who were individually well-matched for sex, age, and body mass index (BMI) underwent blood testing for serum UA levels, and analyzed whether UA levels were correlated with the disease status of the patients, as defined by the ALS Functional Rating Scale-Revised (ALSFRS-R). Results The study included 136 ALS patients and 136 matched controls. The UA level was lower in the ALS patients (4.50±1.17 mg/dL, mean±SD) than in the controls (5.51±1.22 mg/dL; p<0.001). Among the ALS patients, the level of UA acid was inversely correlated with the rate of disease progression (decrease in ALSFRS-R score). Kaplan-Meier analysis revealed that a better survival rate was more strongly correlated with top-tertile levels of serum UA than with bottom-tertile levels (log-rank test: p=0.035). Conclusions ALS patients had lower serum UA levels than did healthy individuals. UA levels in ALS were negatively correlated with the rate of disease progression and positively associated with survival, suggesting that UA levels contribute to the progression of ALS. UA levels could be considered a biomarker of disease progression in the early phase in ALS patients.
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Affiliation(s)
- Seong Il Oh
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Soojeong Baek
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Seok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Liying Piao
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea.,Department of Neurology, College of Medicine, Yanbian University Hospital, Yanji, China
| | - Ki Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea.
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Wei Q, Chen X, Zheng Z, Huang R, Guo X, Cao B, Zhao B, Shang HF. Frontal lobe function and behavioral changes in amyotrophic lateral sclerosis: a study from Southwest China. J Neurol 2014; 261:2393-400. [PMID: 25249295 DOI: 10.1007/s00415-014-7508-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 02/05/2023]
Abstract
Despite growing interest, the frequency and characteristics of frontal lobe functional and behavioral deficits in Chinese people with amyotrophic lateral sclerosis (ALS), as well as their impact on the survival of ALS patients, remain unknown. The Chinese version of the frontal assessment battery (FAB) and frontal behavioral inventory (FBI) were used to evaluate 126 sporadic ALS patients and 50 healthy controls. The prevalence of frontal lobe dysfunction was 32.5%. The most notable impairment domain of the FAB was lexical fluency (30.7%). The binary logistic regression model revealed that an onset age older than 45 years (OR 5.976, P = 0.002) and a lower educational level (OR 0.858, P = 0.002) were potential determinants of an abnormal FAB. Based on the FBI score, 46.0% of patients showed varied degrees of frontal behavioral changes. The most common impaired neurobehavioral domains were irritability (25.4%), logopenia (20.6%) and apathy (19.0%). The binary logistic regression model revealed that the ALS Functional Rating Scale-Revised scale score (OR 0.127, P = 0.001) was a potential determinant of an abnormal FBI. Frontal functional impairment and the severity of frontal behavioral changes were not associated with the survival status or the progression of ALS by the cox proportional hazard model and multivariate regression analyses, respectively. Frontal lobe dysfunction and frontal behavioral changes are common in Chinese ALS patients. Frontal lobe dysfunction may be related to the onset age and educational level. The severity of frontal behavioral changes may be associated with the ALSFRS-R. However, the frontal functional impairment and the frontal behavioral changes do not worsen the progression or survival of ALS.
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Affiliation(s)
- QianQian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
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