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Gentile F, Maranzano A, Verde F, Bettoni V, Colombo E, Doretti A, Olivero M, Scheveger F, Colombrita C, Bulgarelli I, Spinelli EG, Torresani E, Messina S, Maderna L, Agosta F, Morelli C, Filippi M, Silani V, Ticozzi N. The value of routine blood work-up in clinical stratification and prognosis of patients with amyotrophic lateral sclerosis. J Neurol 2024; 271:794-803. [PMID: 37801095 PMCID: PMC10827966 DOI: 10.1007/s00415-023-12015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is an unmet need in amyotrophic lateral sclerosis (ALS) to provide specific biomarkers for the disease. Due to their easy availability, we aimed to investigate whether routine blood parameters provide useful clues for phenotypic classification and disease prognosis. METHODS We analyzed a large inpatient cohort of 836 ALS patients who underwent deep phenotyping with evaluation of the clinical and neurophysiological burden of upper (UMN) and lower (LMN) motor neuron signs. Disability and progression rate were measured through the revised ALS Functional Rating Scale (ALSFRS-R) and its changes during time. Cox regression analysis was performed to assess survival associations. RESULTS Creatinine significantly correlated with LMN damage (r = 0.38), active (r = 0.18) and chronic (r = 0.24) denervation and baseline ALSFRS-R (r = 0.33). Creatine kinase (CK), alanine (ALT) and aspartate (AST) transaminases correlated with active (r = 0.35, r = 0.27, r = 0.24) and chronic (r = 0.37, r = 0.20, r = 0.19) denervation, while albumin and C-reactive protein significantly correlated with LMN score (r = 0.20 and r = 0.17). Disease progression rate showed correlations with chloride (r = -0.19) and potassium levels (r = -0.16). After adjustment for known prognostic factors, total protein [HR 0.70 (95% CI 0.57-0.86)], creatinine [HR 0.86 (95% CI 0.81-0.92)], chloride [HR 0.95 (95% CI 0.92-0.99)], lactate dehydrogenase [HR 0.99 (95% CI 0.99-0.99)], and AST [HR 1.02 (95% CI 1.01-1.02)] were independently associated with survival. CONCLUSIONS Creatinine is a reliable biomarker for ALS, associated with clinical features, disability and survival. Markers of nutrition/inflammation may offer additional prognostic information and partially correlate with clinical features. AST and chloride could further assist in predicting progression rate and survival.
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Affiliation(s)
- Francesco Gentile
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federico Verde
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Veronica Bettoni
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Colombo
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Alberto Doretti
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Marco Olivero
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | | | - Claudia Colombrita
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ilaria Bulgarelli
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Erminio Torresani
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Messina
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Luca Maderna
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federica Agosta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudia Morelli
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy.
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy.
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Donini L, Tanel R, Zuccarino R, Basso M. Protein biomarkers for the diagnosis and prognosis of Amyotrophic Lateral Sclerosis. Neurosci Res 2023; 197:31-41. [PMID: 37689321 DOI: 10.1016/j.neures.2023.09.002] [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: 07/01/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is the most common motor neuron disease, still incurable. The disease is highly heterogenous both genetically and phenotypically. Therefore, developing efficacious treatments is challenging in many aspects because it is difficult to predict the rate of disease progression and stratify the patients to minimize statistical variability in clinical studies. Moreover, there is a lack of sensitive measures of therapeutic effect to assess whether a pharmacological intervention ameliorates the disease. There is also urgency of markers that reflect a molecular mechanism dysregulated by ALS pathology and can be rescued when a treatment relieves the condition. Here, we summarize and discuss biomarkers tested in multicentered studies and across different laboratories like neurofilaments, the most used marker in ALS clinical studies, neuroinflammatory-related proteins, p75ECD, p-Tau/t-Tau, and UCHL1. We also explore the applicability of muscle proteins and extracellular vesicles as potential biomarkers.
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Affiliation(s)
- Luisa Donini
- Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Italy.
| | - Raffaella Tanel
- Clinical Center NeMO, APSS Ospedale Riabilitativo Villa Rosa, Pergine 38057, TN, Italy.
| | - Riccardo Zuccarino
- Clinical Center NeMO, APSS Ospedale Riabilitativo Villa Rosa, Pergine 38057, TN, Italy
| | - Manuela Basso
- Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Italy.
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3
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Gao J, Dharmadasa T, Malaspina A, Shaw PJ, Talbot K, Turner MR, Thompson AG. Creatine kinase and prognosis in amyotrophic lateral sclerosis: a literature review and multi-centre cohort analysis. J Neurol 2022; 269:5395-5404. [PMID: 35614165 PMCID: PMC9467954 DOI: 10.1007/s00415-022-11195-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a prognostically heterogeneous neurodegenerative disease. Blood creatine kinase (CK) level has been inconsistently reported as a prognostic biomarker and raised levels in some ALS patients have been presumed to reflect muscle wasting, which is also variable. METHODS MEDLINE was systematically searched for papers related to CK in ALS and the relevant studies were reviewed. Using data from 222 ALS patients in a multi-centre, prospective, longitudinal cohort, survival analyses using Kaplan-Meier and Cox proportional hazards models were undertaken in relation to CK and other prognostic factors. RESULTS Twenty-five studies investigating CK in ALS were identified, of which 10 specifically studied the link between CK and survival. Five studies observed no association, four found that higher CK levels were associated with longer survival and one, the opposite. In our cohort (n = 222), 39% of patients had a CK level above the laboratory reference range. Levels were higher in males compared to females (p < 0.001), in patients with limb versus bulbar onset of symptoms (p < 0.001) and in patients with higher lower motor neuron burden (p < 0.001). There was no significant trend in longitudinal CK values. Although a higher standardised log (CK) at first visit was associated with longer survival in univariate analysis (hazard ratio 0.75, p = 0.003), there was no significant association after adjusting for other prognostic covariates. CONCLUSION While raised CK levels in ALS do reflect lower motor neuron denervation to a large extent, they are not independently associated with survival when measured in the symptomatic phase of the disease.
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Affiliation(s)
- Jiali Gao
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, West Wing level 3 / level 6, Oxford, OX3 9DU, UK
| | - Thanuja Dharmadasa
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, West Wing level 3 / level 6, Oxford, OX3 9DU, UK
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, West Wing level 3 / level 6, Oxford, OX3 9DU, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, West Wing level 3 / level 6, Oxford, OX3 9DU, UK.
| | - Alexander G Thompson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, West Wing level 3 / level 6, Oxford, OX3 9DU, UK.
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Hertel N, Kuzma-Kozakiewicz M, Gromicho M, Grosskreutz J, de Carvalho M, Uysal H, Dengler R, Petri S, Körner S. Analysis of routine blood parameters in patients with amyotrophic lateral sclerosis and evaluation of a possible correlation with disease progression—a multicenter study. Front Neurol 2022; 13:940375. [PMID: 35968316 PMCID: PMC9364810 DOI: 10.3389/fneur.2022.940375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Amyotrophic lateral sclerosis (ALS) pathogenesis is still unclear, its course is considerably variable, and prognosis is hard to determine. Despite much research, there is still a lack of easily accessible markers predicting prognosis. We investigated routine blood parameters in ALS patients regarding correlations with disease severity, progression rate, and survival. Additionally, we analyzed disease and patients' characteristics relating to baseline blood parameter levels. Methods We analyzed creatine kinase (CK), albumin (ALB), creatinine (CREA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG) levels around time of diagnosis in 1,084 ALS patients. We carried out linear regression analyses including disease and patients' characteristics with each blood parameter to detect correlations with them. Linear regression models were performed for ALSFRS-R at study entry, its retrospectively defined rate of decay and prospectively collected progression rate. Different survival analysis methods were used to examine associations between blood parameters and survival. Results We found higher CK (p-value 0.001), ALB (p-value <0.001), CREA (p-value <0.001), and HDL levels (p-value 0.044) at time of diagnosis being associated with better functional status according to ALSFRS-R scores at study entry. Additionally, higher CREA levels were associated with lower risk of death (p-value 0.003). Conclusions Our results indicate potential of CK, ALB, CREA, and HDL as disease severity or progression markers, and may also provide clues to ALS pathogenesis. However, these values are highly dependent on other variables, and further careful, longitudinal analyses will be necessary to prove the relevance of our findings.
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Affiliation(s)
- Nora Hertel
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | | | - Marta Gromicho
- Institute of Physiology-Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Mamede de Carvalho
- Institute of Physiology-Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Hilmi Uysal
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hanover, Germany
- Center for Systems Neuroscience (ZSN), Hanover, Germany
| | - Sonja Körner
- Department of Neurology, Hannover Medical School, Hanover, Germany
- *Correspondence: Sonja Körner
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5
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Shen D, Yang X, Wang Y, He D, Sun X, Cai Z, Li J, Liu M, Cui L. The Gold Coast criteria increases the diagnostic sensitivity for amyotrophic lateral sclerosis in a Chinese population. Transl Neurodegener 2021; 10:28. [PMID: 34372918 PMCID: PMC8351337 DOI: 10.1186/s40035-021-00253-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess and compare the diagnostic utility of a new diagnostic criteria for amyotrophic lateral sclerosis (ALS), abbreviated as the 'Gold Coast Criteria', with the revised El Escorial (rEEC) and Awaji criteria. METHODS Clinical and electrophysiological data of 1185 patients from January 2014 to December 2019 in the Peking Union Medical College Hospital ALS database were reviewed. The sensitivity of the Gold Coast criteria was compared to that of the possible rEEC and Awaji criteria (defined by the proportion of patients categorized as definite, probable, or possible ALS). RESULTS A final diagnosis of ALS was recorded in 1162 patients. The sensitivity of the Gold Coast criteria (96.6%, 95% confidence interval [CI] = 95.3%-97.5%) was greater than that of the rEEC (85.1%, 95%CI = 82.9%-87.1%) and Awaji (85.3%, 95%CI = 83.2%-87.3%). In addition, the sensitivity of the novel criteria maintained robust across subgroups, and the advantage was more prominent in limb-onset ALS patients and those who completed electromyographic tests. In those who did not achieve any of the rEEC diagnostic categories, the sensitivity of Gold Coast criteria was 84.4%. CONCLUSIONS The current study demonstrated that the Gold Coast criteria exhibited greater diagnostic sensitivity than the rEEC and Awaji criteria in a Chinese ALS population. The application of the Gold Coast criteria should be considered in clinical practice and future therapeutic trials.
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Affiliation(s)
- Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xunzhe Yang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yanying Wang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Di He
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xiaohan Sun
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhengyi Cai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jinyue Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China.
- Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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6
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Guo QF, Hu W, Xu LQ, Luo H, Wang N, Zhang QJ. Decreased serum creatinine levels predict short survival in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2021; 8:448-455. [PMID: 33449454 PMCID: PMC7886033 DOI: 10.1002/acn3.51299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the associations between serum creatinine and creatine kinase (CK) levels with survival in male and female ALS patients. Methods A prospective cohort study was carried out including 346 ALS patients with repeated serum creatinine and CK measurements. Kaplan Meier analysis and multivariable Cox regression were used to perform survival analysis. Results There were 218 male and 128 female patients, and the males had significantly higher baseline serum creatinine and CK levels than females. After multivariable Cox regression analysis, lower baseline serum creatinine levels were associated with a short survival in both male (≤61 μmol/L, HR: 1.629; 95%CI: 1.168–2.273) and female ALS patients (≤52 μmol/L, HR: 1.677; 95%CI: 1.042–2.699), whereas, the serum CK levels were not correlated with survival. Besides, creatinine levels were positively associated with ALSFRS‐R scores, and inversely with the decline rate of ALSFRS‐R per month. During follow‐up, serum creatinine levels tended to be decreased along with the disease progression, and the higher decline rate of creatinine per month (>1.5) showed significantly shorter survival, compared to the lower group (≤1.5) (30.0 months vs. 65.0 months, Chi square = 28.25, P < 0.0001). Interpretation Serum creatinine could be a reliable and easily accessible prognostic chemical marker for ALS, and decreased baseline creatinine levels could predict a poor prognosis and a short survival in both male and female ALS patients.
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Affiliation(s)
- Qi-Fu Guo
- 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
| | - Liu-Qing Xu
- Department of Neurology, Fujian Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hao Luo
- 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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Cheng Y, Chen Y, Shang H. Aberrations of biochemical indicators in amyotrophic lateral sclerosis: a systematic review and meta-analysis. Transl Neurodegener 2021; 10:3. [PMID: 33419478 PMCID: PMC7792103 DOI: 10.1186/s40035-020-00228-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Accumulating evidence has suggested that the pathological changes in amyotrophic lateral sclerosis (ALS) are not only confined to the central nervous system but also occur in the peripheral circulating system. Here, we performed a meta-analysis based on the PubMed, EMBASE, EBSCO, and CNKI databases, to find out biochemical indicators associated with energy metabolism, iron homeostasis, and muscle injury that are altered in ALS patients and their correlations with ALS phenotypes. Forty-six studies covering 17 biochemical indicators, representing 5454 ALS patients and 7986 control subjects, were included in this meta-analysis. Four indicators, including fasting blood glucose level (weighted mean difference [WMD] = 0.13, 95% CI [0.06–0.21], p = 0.001), serum ferritin level (WMD = 63.42, 95% CI [48.12–78.73], p < 0.001), transferrin saturation coefficient level (WMD = 2.79, 95% CI [1.52–4.05], p < 0.001), and creatine kinase level (WMD = 80.29, 95% CI [32.90–127.67], p < 0.001), were significantly higher in the ALS patients, whereas the total iron-binding capacity (WMD = − 2.42, 95% CI [− 3.93, − 0.90], p = 0.002) was significantly lower in ALS patients than in the control subjects. In contrast, the other 12 candidates did not show significant differences between ALS patients and controls. Moreover, pooled hazard ratios (HR) showed significantly reduced survival (HR = 1.38, 95% CI [1.02–1.88], p = 0.039) of ALS patients with elevated serum ferritin levels. These findings suggest that abnormalities in energy metabolism and disruption of iron homeostasis are involved in the pathogenesis of ALS. In addition, the serum ferritin level is negatively associated with the overall survival of ALS patients.
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Affiliation(s)
- Yangfan Cheng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,National Clinical Research Center for Geriatric, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongping Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,National Clinical Research Center for Geriatric, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, China. .,National Clinical Research Center for Geriatric, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, 610041, China.
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8
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Chen XP, Wei QQ, Ou RW, Hou YB, Zhang LY, Yuan XQ, Yao YQ, Jia DS, Zhang Q, Li WX, Shang HF. Creatine kinase in the diagnosis and prognostic prediction of amyotrophic lateral sclerosis: a retrospective case-control study. Neural Regen Res 2021; 16:591-595. [PMID: 32985493 PMCID: PMC7996010 DOI: 10.4103/1673-5374.293159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Creatine kinase is a muscle enzyme that has been reported at various levels in different studies involving patients with amyotrophic lateral sclerosis. In the present retrospective case-control study, we included 582 patients with amyotrophic lateral sclerosis and 582 age- and sex-matched healthy controls. All amyotrophic lateral sclerosis participants received treatment in the Department of Neurology, West China Hospital, China, between May 2008 and December 2018. Serum creatine kinase levels in patients with amyotrophic lateral sclerosis were significantly higher than those in healthy controls. Subgroup analysis revealed that serum creatine kinase levels in men were higher than those in women in both amyotrophic lateral sclerosis patients and healthy controls. Compared with patients with bulbar-onset amyotrophic lateral sclerosis, patients with limb-onset amyotrophic lateral sclerosis had higher creatine kinase levels. Spearman's correlation analysis revealed that serum creatine kinase levels were not correlated with body mass index, Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score, or progression rate. After adjusting for prognostic covariates, higher log creatine kinase values were correlated with higher overall survival in the amyotrophic lateral sclerosis patients. We also investigated the longitudinal changes in serum creatine kinase levels in 81 amyotrophic lateral sclerosis patients; serum creatine kinase levels were decreased at the second blood test, which was sampled at least 6 months after the first blood test. Together, our results suggest that serum creatine kinase levels can be used as an independent factor for predicting the prognosis of amyotrophic lateral sclerosis patients. This study received ethical approval from the Ethics Committee of West China Hospital, China (approval No. 2015(236)) on December 23, 2015.
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Affiliation(s)
- Xue-Ping Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qian-Qian Wei
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Ru-Wei Ou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yan-Bing Hou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Ling-Yu Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Xiao-Qin Yuan
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yun-Qian Yao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - De-Sheng Jia
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qian Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wei-Xue Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Ceccanti M, Pozzilli V, Cambieri C, Libonati L, Onesti E, Frasca V, Fiorini I, Petrucci A, Garibaldi M, Palma E, Bendotti C, Fabbrizio P, Trolese MC, Nardo G, Inghilleri M. Creatine Kinase and Progression Rate in Amyotrophic Lateral Sclerosis. Cells 2020; 9:cells9051174. [PMID: 32397320 PMCID: PMC7291088 DOI: 10.3390/cells9051174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no recognized clinical prognostic factor. Creatinine kinase (CK) increase in these patients is already described with conflicting results on prognosis and survival. In 126 ALS patients who were fast or slow disease progressors, CK levels were assayed for 16 months every 4 months in an observational case-control cohort study with prospective data collection conducted in Italy. CK was also measured at baseline in 88 CIDP patients with secondary axonal damage and in two mouse strains (129SvHSD and C57-BL) carrying the same SOD1G93A transgene expression but showing a fast (129Sv-SOD1G93A) and slow (C57-SOD1G93A) ALS progression rate. Higher CK was found in ALS slow progressors compared to fast progressors in T1, T2, T3, and T4, with a correlation with Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores. Higher CK was found in spinal compared to bulbar-onset patients. Transgenic and non-transgenic C57BL mice showed higher CK levels compared to 129SvHSD strain. At baseline mean CK was higher in ALS compared to CIDP. CK can predict the disease progression, with slow progressors associated with higher levels and fast progressors to lower levels, in both ALS patients and mice. CK is higher in ALS patients compared to patients with CIDP with secondary axonal damage; the higher levels of CK in slow progressors patients, but also in C57BL transgenic and non-transgenic mice designs CK as a predisposing factor for disease rate progression.
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Affiliation(s)
- Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Valeria Pozzilli
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Chiara Cambieri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Laura Libonati
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Emanuela Onesti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Vittorio Frasca
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Ilenia Fiorini
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Antonio Petrucci
- Centre for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Matteo Garibaldi
- Neuromuscular Disease Centre, Department of Neurology, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Laboratory Affiliated to Istituto Pasteur Italia, Sapienza University of Rome, 00185 Rome, Italy;
| | - Caterina Bendotti
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Paola Fabbrizio
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Maria Chiara Trolese
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Giovanni Nardo
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
- Correspondence: ; Tel.: +39-0-6499-14122
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10
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Prior DE, Stommel E, Lawson VH, Kandel J, Robbins NM. Distribution of serum creatine kinase levels in amyotrophic lateral sclerosis. Muscle Nerve 2019; 61:E16-E18. [PMID: 31811651 DOI: 10.1002/mus.26776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Devin E Prior
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Lebanon, New Hampshire
| | - Elijah Stommel
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Lebanon, New Hampshire
| | - Victoria H Lawson
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Lebanon, New Hampshire
| | - Jason Kandel
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Lebanon, New Hampshire
| | - Nathaniel M Robbins
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Lebanon, New Hampshire
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11
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Ito D, Hashizume A, Hijikata Y, Yamada S, Iguchi Y, Iida M, Kishimoto Y, Moriyoshi H, Hirakawa A, Katsuno M. Elevated serum creatine kinase in the early stage of sporadic amyotrophic lateral sclerosis. J Neurol 2019; 266:2952-2961. [PMID: 31456060 DOI: 10.1007/s00415-019-09507-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the changes of muscle-related biomarkers at the early stage of amyotrophic lateral sclerosis, and to confirm these findings in an experimental animal model. METHODS Thirty-nine subjects with sporadic amyotrophic lateral sclerosis and 20 healthy controls were enrolled and longitudinally evaluated. We evaluated serum creatine kinase and creatinine levels and appendicular lean soft-tissue mass using dual X-ray absorptiometry. The levels of biomarkers at early ALS stages were estimated using linear mixed models with unstructured correlation and random intercepts. We also analyzed the longitudinal changes of serum creatine kinase and creatinine, together with the mRNA levels of acetylcholine receptor subunit γ (Chrng) and muscle-associated receptor tyrosine kinase, markers of denervation, in the gastrocnemius muscle of superoxide dismutase 1 (SOD1)G93A transgenic mice, an animal model of amyotrophic lateral sclerosis. RESULTS The estimated levels of creatine kinase were higher in subjects with amyotrophic lateral sclerosis at the early stage than in healthy controls, although the estimated appendicular lean soft-tissue mass and creatinine levels were equivalent between both groups, suggesting that the elevation of creatine kinase precedes both muscular atrophy and subjective motor symptoms in sporadic amyotrophic lateral sclerosis. In SOD1G93A mice, the serum levels of creatine kinase were elevated at 9 weeks of age (peri-onset) when Chrng started to be up-regulated, and were then down-regulated at 15 weeks of age, consistent with the clinical data from patients with sporadic amyotrophic lateral sclerosis. INTERPRETATION Creatine kinase elevation precedes muscular atrophy and reflects muscle denervation at the early stage.
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Affiliation(s)
- Daisuke Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinichiro Yamada
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yohei Iguchi
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Madoka Iida
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoshiyuki Kishimoto
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideyuki Moriyoshi
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi, 466-8550, Japan.
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