Early diagnosis of ALS: The search for signs of denervation in clinically normal muscles

Motionless volumetric structured light sheet microscopy

To meet the increasing need for low-cost, compact imaging technology with cellular resolution, we have developed a microLED-based structured light sheet microscope for three-dimensional ex vivo and in vivo imaging of biological tissue in multiple modalities. All the illumination structure is generated directly at the microLED panel-which serves as the source-so light sheet scanning and modulation is completely digital, yielding a system that is simpler and less prone to error than previously reported methods. Volumetric images with optical sectioning are thus achieved in an inexpensive, compact form factor without any moving parts. We demonstrate the unique properties and general applicability of our technique by ex vivo imaging of porcine and murine tissue from the gastrointestinal tract, kidney, and brain.

Petri net transition times as training features for multiclass models to support the detection of neurodegenerative diseases

This paper proposes the transition times of Petri net models of human gait as training features for multiclass random forests (RFs) and classification trees (CTs). These models are designed to support screening for neurodegenerative diseases. The proposed Petri net describes gait in terms of nine cyclic phases and the timing of the nine events that mark the transition between phases. Since the transition times between strides vary, each is represented as a random variable characterized by its mean and standard deviation. These transition times are calculated using the PhysioNet database of vertical ground reaction forces (VGRFs) generated by feet-ground contact. This database comprises the VGRFs of four groups: amyotrophic lateral sclerosis, the control group, Huntington's disease, and Parkinson disease. The RF produced an overall classification accuracy of 91%, and the specificities and sensitivities for each class were between 80% and 100%. However, despite this high performance, the RF-generated models demonstrated lack of interpretability prompted the training of a CT using identical features. The obtained tree comprised only four features and required a maximum of three comparisons. However, this simplification dramatically reduced the overall accuracy from 90.6% to 62.3%. The proposed set features were compared with those included in PhysioNet database of VGRFs. In terms of both the RF and CT, more accurate models were established using our features than those of the PhysioNet.

A novel method based on matching pursuit decomposition of gait signals for Parkinson's disease, Amyotrophic lateral sclerosis and Huntington's disease detection

BACKGROUND AND OBJECTIVE

An accurate detection of neurodegenerative diseases (NDDs) definitely improves the life of patients and has attracted growing attention.

METHODS

In this paper, a general automatic method for detection of Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD) has been proposed based on the localized time-frequency information of gait signals. The new main part of the detection method is to obtain a small set of sparse coefficients for the local representation of gait signals with appropriate time and frequency resolution. For this purpose, a hybrid feature set based on sparse matching pursuit decomposition and two sets of nonlinear and linear features has been developed. Then, principal components of the proposed feature have been analyzed using a sparse coding classifier. Results The proposed approach has achieved high average accuracy rates of 93%, 94%, and 97% for PD, ALS, and HD detection, respectively.

CONCLUSIONS

The obtained results have indicated that combination of time and frequency information of the gait signals through adaptive localized window length in MP makes it more efficient in comparison with the existing time, frequency or other time-frequency gait parameters. The great potential of nonlinear sparse features for PD and HD detection and linear ones for ALS detection has also been shown.

Neuromuscular junction-on-a-chip: ALS disease modeling and read-out development in microfluidic devices

Amyotrophic lateral sclerosis (ALS) is a fatal and progressive neurodegenerative disease affecting upper and lower motor neurons with no cure available. Clinical and animal studies reveal that the neuromuscular junction (NMJ), a synaptic connection between motor neurons and skeletal muscle fibers, is highly vulnerable in ALS and suggest that NMJ defects may occur at the early stages of the disease. However, mechanistic insight into how NMJ dysfunction relates to the onset and progression of ALS is incomplete, which hampers therapy development. This is, in part, caused by a lack of robust in vitro models. The ability to combine microfluidic and induced pluripotent stem cell (iPSC) technologies has opened up new avenues for studying molecular and cellular ALS phenotypes in vitro. Microfluidic devices offer several advantages over traditional culture approaches when modeling the NMJ, such as the spatial separation of different cell types and increased control over the cellular microenvironment. Moreover, they are compatible with 3D cell culture, which enhances NMJ functionality and maturity. Here, we review how microfluidic technology is currently being employed to develop more reliable in vitro NMJ models. To validate and phenotype such models, various morphological and functional read-outs have been developed. We describe and discuss the relevance of these read-outs and specifically illustrate how these read-outs have enhanced our understanding of NMJ pathology in ALS. Finally, we share our view on potential future directions and challenges.

Epidemiology and diagnostic process of amyotrophic lateral sclerosis as distinct from myelopathy: 5-year cohort study of whole-population in South Korea

OBJECTIVE

To investigate the incidence, prevalence, and demographic factors of all amyotrophic lateral sclerosis (ALS) patients diagnosed in South Korea from 2011 to 2015, and to analyze cases misdiagnosed as myelopathy.

METHODS

The whole population registered under the Korean National Health Insurance Service (KNHIS) was applied. All 4551 patients who were registered as having ALS code from 2011 to 2015 were included. For all ALS patients, the incidence, prevalence, and demographic factors were assessed. Trends of diagnosis for myelopathy, and surgery prior to confirmation of ALS diagnosis were identified.

RESULTS

When the whole 48,135,715 KNHIS population enrolled in 2015, the incidence of ALS in 2015 was estimated to be 1.68 per 100,000 person-years, and the prevalence was 6.49 per 100,000 persons. Life expectancy of ALS can be calculated as 3.9 years after the diagnosis, and the mean age of diagnosis was 59.5 ± 13.1. A total of 1902 patients diagnosed with myelopathy before a diagnosis of ALS accounted for 0.13% of all myelopathy patients, and 41.8% of all ALS patients. It took an average of 471.7 d to confirm a diagnosis of ALS after the myelopathy diagnosis. Among the patients finally diagnosed with ALS, more patients underwent surgery for myelopathy (n = 263, 13.8%) than among patients who were diagnosed with myelopathy alone, and underwent surgery (n = 141,148, 9.8%).

CONCLUSIONS

This whole-population nationwide demographic study confirmed the data from previous studies. Clinicians should consider the possibility of ALS when making a myelopathy diagnosis, especially if the symptoms are sufficiently severe to require surgery.

MicroRNA Dysregulation in Aging and Pathologies of the Skeletal Muscle

Skeletal muscle is one of the biggest organs of the body with important mechanistic and metabolic functions. Muscle homeostasis is controlled by environmental, genetic, and epigenetic factors. Indeed, MiRNAs, small noncoding RNAs robust regulators of gene expression, have and have been shown to regulate muscle homeostasis on several levels: through controlling myogenesis, muscle growth (hypertrophy) and atrophy, as well as interactions of muscle with other tissues. Given the large number of MiRNA target genes and the important role of MiRNAs in most physiological processes and various diseases, MiRNAs may have an enormous potential as therapeutic targets against numerous disorders, including pathologies of muscle. The purpose of this review is to present the current knowledge of the role of MiRNAs in skeletal muscle homeostasis and pathologies and the potential of MiRNAs as therapeutics for skeletal muscle wasting, with particular focus on the age- and disease-related loss of muscle mass and function.

Early phase interference between low-intensity running and power training in moderately trained females

PURPOSE

The aim of the study was to investigate the effects of low-intensity running performed immediately after lower-body power-training sessions on power development.

METHODS

Twenty young females participated in 6 weeks, 3/week, of either lower body power training (PT) or lower body power training followed by 30 min of low-intensity running (PET) eliciting 60-70 % of maximal heart rate. The following were measured before and after the training period: counter-movement jump, isometric leg press force and rate of force development (RFD), half squat 1-RM, vastus lateralis fiber type composition and cross sectional area, resting intramuscular fiber conduction velocity (MFCV), and heart rate during the modified Bruce treadmill test.

RESULTS

Counter-movement jump height and peak power increased after PT (10.7 ± 6.2 and 12.9 ± 18.7 %, p < 0.05) but not after PET (3.4 ± 7.6 and 5.11 ± 10.94 %, p > 0.05). Maximum isometric force, RFD, and half squat 1-RM increased similarly in both groups. Muscle fiber type composition was not altered in either group. Muscle fiber cross sectional area increased only after PT (17.5 ± 17.4, 14.5 ± 10.4, 20.36 ± 11.3 %, in type I, IIA, and IIX fibers, respectively, p < 0.05). Likewise, mean MFCV increased with PT only (before: 4.53 ± 0.38 m s(-1), after: 5.09 ± 0.39 m s(-1), p = 0.027). Submaximal heart rate during the Bruce treadmill test remained unchanged after PT but decreased after PET.

CONCLUSION

These results suggest that low-intensity running performed after lower-body power training impairs the exercise-induced adaptation in stretch-shortening cycle jumping performance (vertical jump height, peak power), during the first 6 weeks of training, which may be partially linked to inhibited muscle fiber hypertrophy and muscle fiber conduction velocity.

Prediction of prognosis of ALS: Importance of active denervation findings of the cervical-upper limb area and trunk area

Amyotrophic lateral sclerosis (ALS) is a motor neuron disease characterized by serious muscle atrophy and weakness. The purpose of this study was to find prognostic factors in patients with mild ALS using application forms for the Specified Disease Treatment Research Program in Japan. We classified ALS as mild, moderate and severe. The subjects consisted of 363 patients with mild ALS who underwent needle electromyography at registration and were followed for more than one year. Time to progression to severe ALS and time to deterioration of activities of daily living such as speech dysfunction, upper limb dysfunction, and walking disability were used as outcomes. Cox proportional hazards model analysis was performed to identify prognostic factors. Of the patients with initially mild ALS, 38.3% (139/363) had progressed severe ALS at the last follow-up. In multivariate analysis of time to progression to severe ALS, bulbar onset (hazard ratio [95% confidence interval]: 1.68 [1.13-2.49], p = 0.010), tongue atrophy (1.69 [1.14-2.51], p = 0.009), dyspnea (1.57 [1.02-2.41], p = 0.042) and active denervation findings (ADFs) of the cervical-upper limb area (1.81 [1.25-2.63], p = 0.002) emerged as prognostic factors. Furthermore ADFs in the trunk area were prognostic factors for upper limb dysfunction and walking disability (1.72 [1.05-2.81], p = 0.031, and 1.97 [1.09-3.59], p = 0.026). In conclusion ADFs of the cervical-upper limb area and trunk area were prognostic factors in ALS patients.

ALS as a distal axonopathy: molecular mechanisms affecting neuromuscular junction stability in the presymptomatic stages of the disease

Amyotrophic Lateral Sclerosis (ALS) is being redefined as a distal axonopathy, in that many molecular changes influencing motor neuron degeneration occur at the neuromuscular junction (NMJ) at very early stages of the disease prior to symptom onset. A huge variety of genetic and environmental causes have been associated with ALS, and interestingly, although the cause of the disease can differ, both sporadic and familial forms of ALS show a remarkable similarity in terms of disease progression and clinical manifestation. The NMJ is a highly specialized synapse, allowing for controlled signaling between muscle and nerve necessary for skeletal muscle function. In this review we will evaluate the clinical, animal experimental and cellular/molecular evidence that supports the idea of ALS as a distal axonopathy. We will discuss the early molecular mechanisms that occur at the NMJ, which alter the functional abilities of the NMJ. Specifically, we focus on the role of axon guidance molecules on the stability of the cytoskeleton and how these molecules may directly influence the cells of the NMJ in a way that may initiate or facilitate the dismantling of the neuromuscular synapse in the presymptomatic stages of ALS.

Characterization of early pathogenesis in the SOD1(G93A) mouse model of ALS: part II, results and discussion

Pathological events are well characterized in amyotrophic lateral sclerosis (ALS) mouse models, but review of the literature fails to identify a specific initiating event that precipitates disease pathology. There is now growing consensus in the field that axon and synapses are first cellular sites of degeneration, but controversy exists over whether axon and synapse loss is initiated autonomously at those sites or by pathology in the cell body, in nonneuronal cells or even in nonmotoneurons (MNs). Previous studies have identified pathological events in the mutant superoxide dismutase 1 (SOD1) models involving spinal cord, peripheral axons, neuromuscular junctions (NMJs), or muscle; however, few studies have systematically examined pathogenesis at multiple sites in the same study. We have performed ultrastructural examination of both central and peripheral components of the neuromuscular system in the SOD1(G93A) mouse model of ALS. Twenty percent of MNs undergo degeneration by P60, but NMJ innervation in fast fatigable muscles is reduced by 40% by P30. Gait alterations and muscle weakness were also found at P30. There was no change in axonal transport prior to initial NMJ denervation. Mitochondrial morphological changes are observed at P7 and become more prominent with disease progression. At P30 there was a significant decrease in excitatory axo-dendritic and axo-somatic synapses with an increase in C-type axo-somatic synapses. Our study examined early pathology in both peripheral and central neuromuscular system. The muscle denervation is associated with functional motor deficits and begins during the first postnatal month in SOD1(G93A) mice. Physiological dysfunction and pathology in the mitochondria of synapses and MN soma and dendrites occur, and disease onset in these animals begins more than 2 months earlier than originally thought. This information may be valuable for designing preclinical trials that are more likely to impact disease onset and progression.

Expression of human FUS protein in Drosophila leads to progressive neurodegeneration

Mutations in the Fused in sarcoma/Translated in liposarcoma gene (FUS/TLS, FUS) have been identified among patients with amyotrophic lateral sclerosis (ALS). FUS protein aggregation is a major pathological hallmark of FUS proteinopathy, a group of neurodegenerative diseases characterized by FUS-immunoreactive inclusion bodies. We prepared transgenic Drosophila expressing either the wild type (Wt) or ALS-mutant human FUS protein (hFUS) using the UAS-Gal4 system. When expressing Wt, R524S or P525L mutant FUS in photoreceptors, mushroom bodies (MBs) or motor neurons (MNs), transgenic flies show age-dependent progressive neural damages, including axonal loss in MB neurons, morphological changes and functional impairment in MNs. The transgenic flies expressing the hFUS gene recapitulate key features of FUS proteinopathy, representing the first stable animal model for this group of devastating diseases.

Diagnostic problems and delay of diagnosis in amyotrophic lateral sclerosis

OBJECTIVE

Initial symptoms of amyotrophic lateral sclerosis (ALS) mimic several neurological syndromes that may decelerate a correct diagnosis. The aim of our study was to investigate if diagnostic and therapeutic parameters have influence on the time of diagnosis.

METHODS

We retrospectively reviewed the medical records of 100 consecutive ALS patients focusing on clinical and diagnostic data, the timing of diagnosis and treatments attributed to the onset of symptoms of ALS.

RESULTS

Among 100 consecutive patients with ALS, 12% underwent surgery due to symptoms retrospectively attributable to ALS. The comparison of duration from first symptoms to correct diagnosis showed a significant difference between operated and non-operated patients. 35% of all ALS patients had bulbar onset symptoms. The mean time from first symptoms to diagnosis was 9 months in this group. In patients without bulbar onset it was 16.4 months which also represents a significant difference. In 44% of patients other diagnoses were considered and medically treated previous to correct diagnosis, but there was no significant delay of diagnosis.

CONCLUSION

Our study confirms that diagnosis of ALS is still a common clinical problem and shows the need of sensitive and specific diagnostic tests.