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Escudero-Cabarcas J, Pineda-Alhucema W, Martinez-Banfi M, Acosta-López JE, Cervantes-Henriquez ML, Mejía-Segura E, Jiménez-Figueroa G, Sánchez-Barros C, Puentes-Rozo PJ, Noguera-Machacón LM, Ahmad M, de la Hoz M, Vélez JI, Arcos-Burgos M, Pineda DA, Sánchez M. Theory of Mind in Huntington's Disease: A Systematic Review of 20 Years of Research. J Huntingtons Dis 2024; 13:15-31. [PMID: 38517797 DOI: 10.3233/jhd-230594] [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: 03/24/2024]
Abstract
Background People with Huntington's disease (HD) exhibit neurocognitive alterations throughout the disease, including deficits in social cognitive processes such as Theory of Mind (ToM). Objective The aim is to identify methodologies and ToM instruments employed in HD, alongside relevant findings, within the scientific literature of the past two decades. Methods We conducted a comprehensive search for relevant papers in the SCOPUS, PubMed, APA-PsyArticles, Web of Science, Redalyc, and SciELO databases. In the selection process, we specifically focused on studies that included individuals with a confirmed genetic status of HD and investigated ToM functioning in patients with and without motor symptoms. The systematic review followed the PRISMA protocol. Results A total of 27 papers were selected for this systematic review, covering the period from 2003 to 2023. The findings consistently indicate that ToM is globally affected in patients with manifest motor symptoms. In individuals without motor symptoms, impairments are focused on the affective dimensions of ToM. Conclusions Based on our analysis, affective ToM could be considered a potential biomarker for HD. Therefore, it is recommended that ToM assessment be included as part of neuropsychological evaluation protocols in clinical settings. Suchinclusion could aid in the identification of early stages of the disease and provide new opportunities for treatment, particularly with emerging drugs like antisense oligomers. The Prospero registration number for this review is CRD42020209769.
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Affiliation(s)
- Johana Escudero-Cabarcas
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Wilmar Pineda-Alhucema
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Martha Martinez-Banfi
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Johan E Acosta-López
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Martha L Cervantes-Henriquez
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Elsy Mejía-Segura
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Giomar Jiménez-Figueroa
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Cristian Sánchez-Barros
- Hospital Juaneda Miramar Departamento de Neurofisiología Clínica Palma de Mallorca, Islas Baleares, España
| | - Pedro J Puentes-Rozo
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
- Grupo de Neurociencias del Caribe, Universidad del Atlántico, Barranquilla, Colombia
| | | | - Mostapha Ahmad
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud Barranquilla, Colombia
| | - Moisés de la Hoz
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud Barranquilla, Colombia
| | | | - Mauricio Arcos-Burgos
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - David A Pineda
- Grupo de investigación Neuropsicología y Conducta, Universidad de San Buenaventura, Medellín, Colombia
| | - Manuel Sánchez
- Centro de Inv. e Innovación en Ciencias Sociales, Facultad de ciencias jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla, Colombia
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Tabrizi SJ, Estevez-Fraga C, van Roon-Mom WMC, Flower MD, Scahill RI, Wild EJ, Muñoz-Sanjuan I, Sampaio C, Rosser AE, Leavitt BR. Potential disease-modifying therapies for Huntington's disease: lessons learned and future opportunities. Lancet Neurol 2022; 21:645-658. [PMID: 35716694 PMCID: PMC7613206 DOI: 10.1016/s1474-4422(22)00121-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 01/03/2023]
Abstract
Huntington's disease is the most frequent autosomal dominant neurodegenerative disorder; however, no disease-modifying interventions are available for patients with this disease. The molecular pathogenesis of Huntington's disease is complex, with toxicity that arises from full-length expanded huntingtin and N-terminal fragments of huntingtin, which are both prone to misfolding due to proteolysis; aberrant intron-1 splicing of the HTT gene; and somatic expansion of the CAG repeat in the HTT gene. Potential interventions for Huntington's disease include therapies targeting huntingtin DNA and RNA, clearance of huntingtin protein, DNA repair pathways, and other treatment strategies targeting inflammation and cell replacement. The early termination of trials of the antisense oligonucleotide tominersen suggest that it is time to reflect on lessons learned, where the field stands now, and the challenges and opportunities for the future.
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Affiliation(s)
- Sarah J Tabrizi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Carlos Estevez-Fraga
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Michael D Flower
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rachael I Scahill
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Edward J Wild
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Cristina Sampaio
- CHDI Management, CHDI Foundation Los Angeles, CA, USA; Laboratory of Clinical Pharmacology, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Anne E Rosser
- BRAIN unit, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Blair R Leavitt
- Centre for Huntington's disease, University of British Columbia, Vancouver, BC, Canada
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Delva A, Michiels L, Koole M, Van Laere K, Vandenberghe W. Synaptic Damage and Its Clinical Correlates in People With Early Huntington Disease: A PET Study. Neurology 2021; 98:e83-e94. [PMID: 34663644 DOI: 10.1212/wnl.0000000000012969] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Synaptic damage has been proposed to play a major role in the pathophysiology of Huntington's disease (HD), but in vivo evidence in humans is lacking. We performed a PET imaging study to assess synaptic damage and its clinical correlates in early HD in vivo. METHODS: In this cross-sectional study, premanifest and early manifest (Shoulson-Fahn stage 1 and 2) HD mutation carriers and age- and gender-matched healthy controls underwent clinical assessment of motor and non-motor manifestations and time-of-flight PET with 11C-UCB-J, a radioligand targeting the ubiquitous presynaptic terminal marker SV2A. We also performed 18F-FDG PET in all subjects, as regional cerebral glucose consumption is thought to largely reflect synaptic activity. Volumes of interest were delineated based on individual 3D T1 MRI. Standardized uptake value ratio (SUVR)-1 images were calculated for 11C-UCB-J with the centrum semiovale as reference region. 18F-FDG PET activity was normalized to the pons. All PET data were corrected for partial volume effects. Volume of interest- and voxel-based analyses were performed. Correlations between clinical scores and 11C-UCB-J PET data were calculated. RESULTS 18 HD mutation carriers (51.4 ± 11.6 years; 6 female; 7 premanifest, 11 early manifest) and 15 healthy controls (52.3 ± 3.5 years; 4 female) were included. In the HD group, significant loss of SV2A binding was found in putamen, caudate, pallidum, cerebellum, parietal, temporal and frontal cortex, whereas reduced 18F-FDG uptake was restricted to caudate and putamen. In the premanifest subgroup, 11C-UCB-J and 18F-FDG PET showed significant reductions in putamen and caudate only. In the total HD group, SV2A loss in the putamen correlated with motor impairment. DISCUSSION Our data reveal loss of presynaptic terminal integrity in early HD, which begins in the striatum in the premanifest phase, spreads extensively to extrastriatal regions in the early manifest phase, and correlates with motor impairment. 11C-UCB-J PET is more sensitive than 18F-FDG PET for detection of extrastriatal changes in early HD. CLASSIFICATION OF EVIDENCE This study provides class III evidence that 11C-UCB-J PET accurately identifies HD from normal controls.
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Affiliation(s)
- Aline Delva
- Department of Neurosciences, KU Leuven, Belgium; .,Department of Neurology, University Hospitals Leuven, Belgium
| | - Laura Michiels
- Department of Neurosciences, KU Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Belgium.,VIB, Center for Brain & Disease Research, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Belgium.,Division of Nuclear Medicine, University Hospitals Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurosciences, KU Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Belgium
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Bachoud-Lévi AC, Massart R, Rosser A. Cell therapy in Huntington's disease: Taking stock of past studies to move the field forward. Stem Cells 2021; 39:144-155. [PMID: 33176057 PMCID: PMC10234449 DOI: 10.1002/stem.3300] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 06/02/2023]
Abstract
Huntington's disease (HD) is a rare inherited neurodegenerative disease that manifests mostly in adulthood with progressive cognitive, behavioral, and motor dysfunction. Neuronal loss occurs predominantly in the striatum but also extends to other brain regions, notably the cortex. Most patients die around 20 years after motor onset, although there is variability in the rate of progression and some phenotypic heterogeneity. The most advanced experimental therapies currently are huntingtin-lowering strategies, some of which are in stage 3 clinical trials. However, even if these approaches are successful, it is unlikely that they will be applicable to all patients or will completely halt continued loss of neural cells in all cases. On the other hand, cellular therapies have the potential to restore atrophied tissues and may therefore provide an important complementary therapeutic avenue. Pilot studies of fetal cell grafts in the 2000s reported the most dramatic clinical improvements yet achieved for this disease, but subsequent studies have so far failed to identify methodology to reliably reproduce these results. Moving forward, a major challenge will be to generate suitable donor cells from (nonfetal) cell sources, but in parallel there are a host of procedural and trial design issues that will be important for improving reliability of transplants and so urgently need attention. Here, we consider findings that have emerged from clinical transplant studies in HD to date, in particular new findings emerging from the recent multicenter intracerebral transplant HD study, and consider how these data may be used to inform future cell therapy trials.
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Affiliation(s)
- Anne-Catherine Bachoud-Lévi
- Assistance Publique-Hôpitaux de Paris, National Reference Center for Huntington's Disease, Neurology Department, Henri Mondor-Albert Chenevier Hospital, Créteil, France
- Département d'Etudes Cognitives, École Normale Supérieure, PSL University, Paris, France
- Inserm U955, Institut Mondor de Recherche Biomédicale, Equipe E01 NeuroPsychologie Interventionnelle, Créteil, France
- NeurATRIS, Créteil, France
- Université Paris-Est Créteil, Faculté de Médecine, Créteil, France
| | - Renaud Massart
- Assistance Publique-Hôpitaux de Paris, National Reference Center for Huntington's Disease, Neurology Department, Henri Mondor-Albert Chenevier Hospital, Créteil, France
- Département d'Etudes Cognitives, École Normale Supérieure, PSL University, Paris, France
- Inserm U955, Institut Mondor de Recherche Biomédicale, Equipe E01 NeuroPsychologie Interventionnelle, Créteil, France
- NeurATRIS, Créteil, France
| | - Anne Rosser
- Centre for Trials Research, Cardiff University, Cardiff, UK
- Cardiff University Brain Repair Group, Life Sciences Building, School of Biosciences, Cardiff, UK
- Neuroscience and Mental Health Research Institute and Division of Psychological Medicine and Clinical Neurosciences, Hadyn Ellis Building, Cardiff, UK
- Brain Repair And Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Cardiff, UK
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