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Massey L, Gilroy J, Kowal E, Doolan D, Clough A. Aboriginal families living with MJD in remote Australia: questions of access and equity. Int J Equity Health 2024; 23:187. [PMID: 39294722 PMCID: PMC11409620 DOI: 10.1186/s12939-024-02228-x] [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: 05/02/2023] [Accepted: 07/09/2024] [Indexed: 09/21/2024] Open
Abstract
Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups.Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice.Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care.
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Affiliation(s)
- Libby Massey
- Division of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia.
- MJD Foundation, Alyangula, NT, Australia.
| | - John Gilroy
- The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Emma Kowal
- Alfred Deakin Institute, Deakin University, Melbourne, Australia
| | - Denise Doolan
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Alan Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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2
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Lima M, Raposo M, Ferreira A, Melo ARV, Pavão S, Medeiros F, Teves L, Gonzalez C, Lemos J, Pires P, Lopes P, Valverde D, Gonzalez J, Kay T, Vasconcelos J. The Homogeneous Azorean Machado-Joseph Disease Cohort: Characterization and Contributions to Advances in Research. Biomedicines 2023; 11:biomedicines11020247. [PMID: 36830784 PMCID: PMC9953730 DOI: 10.3390/biomedicines11020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Machado-Joseph disease (MJD)/spinocerebellar ataxia type 3 (SCA3) is the most common autosomal dominant ataxia worldwide. MJD is characterized by late-onset progressive cerebellar ataxia associated with variable clinical findings, including pyramidal signs and a dystonic-rigid extrapyramidal syndrome. In the Portuguese archipelago of the Azores, the worldwide population cluster for this disorder (prevalence of 39 in 100,000 inhabitants), a cohort of MJD mutation carriers belonging to extensively studied pedigrees has been followed since the late 1990s. Studies of the homogeneous Azorean MJD cohort have been contributing crucial information to the natural history of this disease as well as allowing the identification of novel molecular biomarkers. Moreover, as interventional studies for this globally rare and yet untreatable disease are emerging, this cohort should be even more important for the recruitment of trial participants. In this paper, we profile the Azorean cohort of MJD carriers, constituted at baseline by 20 pre-ataxic carriers and 52 patients, which currently integrates the European spinocerebellar ataxia type 3/Machado-Joseph disease Initiative (ESMI), a large European longitudinal MJD cohort. Moreover, we summarize the main studies based on this cohort and highlight the contributions made to advances in MJD research. Knowledge of the profile of the Azorean MJD cohort is not only important in the context of emergent interventional trials but is also pertinent for the implementation of adequate interventional measures, constituting relevant information for Lay Associations and providing data to guide healthcare decision makers.
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Affiliation(s)
- Manuela Lima
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Correspondence:
| | - Mafalda Raposo
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Ana Ferreira
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Ana Rosa Vieira Melo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Sara Pavão
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
| | - Filipa Medeiros
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
| | - Luís Teves
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, 4200-135 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Carlos Gonzalez
- Serviço de Psicologia Clínica, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - João Lemos
- Unidade de Psicologia Clínica, Hospital do Santo Espírito da Ilha Terceira, 9700-049 Angra do Heroísmo, Portugal
| | - Paula Pires
- Serviço de Neurologia, Hospital do Santo Espírito da Ilha Terceira, 9700-049 Angra do Heroísmo, Portugal
| | - Pedro Lopes
- Serviço de Neurologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - David Valverde
- Serviço de Patologia Clínica, Unidade de Saúde da Ilha das Flores, 9500-370 Santa Cruz das Flores, Portugal
| | - José Gonzalez
- Augenarztpraxis Petrescu Wuppertal, Department of Ophthalmology, 42389 Wuppertal, Germany
| | - Teresa Kay
- Serviço de Genética Médica, Hospital D. Estefânia, 1169-045 Lisboa, Portugal
| | - João Vasconcelos
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Hospital Internacional dos Açores (HIA), 9560-421 Ponta Delgada, Portugal
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3
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Correia JS, Duarte-Silva S, Salgado AJ, Maciel P. Cell-based therapeutic strategies for treatment of spinocerebellar ataxias: an update. Neural Regen Res 2022; 18:1203-1212. [PMID: 36453395 PMCID: PMC9838137 DOI: 10.4103/1673-5374.355981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Spinocerebellar ataxias are heritable neurodegenerative diseases caused by a cytosine-adenine-guanine expansion, which encodes a long glutamine tract (polyglutamine) in the respective wild-type protein causing misfolding and protein aggregation. Clinical features of polyglutamine spinocerebellar ataxias include neuronal aggregation, mitochondrial dysfunction, decreased proteasomal activity, and autophagy impairment. Mutant polyglutamine protein aggregates accumulate within neurons and cause neural dysfunction and death in specific regions of the central nervous system. Spinocerebellar ataxias are mostly characterized by progressive ataxia, speech and swallowing problems, loss of coordination and gait deficits. Over the past decade, efforts have been made to ameliorate disease symptoms in patients, yet no cure is available. Previous studies have been proposing the use of stem cells as promising tools for central nervous system tissue regeneration. So far, pre-clinical trials have shown improvement in various models of neurodegenerative diseases following stem cell transplantation, including animal models of spinocerebellar ataxia types 1, 2, and 3. However, contrasting results can be found in the literature, depending on the animal model, cell type, and route of administration used. Nonetheless, clinical trials using cellular implants into degenerated brain regions have already been applied, with the expectation that these cells would be able to differentiate into the specific neuronal subtypes and re-populate these regions, reconstructing the affected neural network. Meanwhile, the question of how feasible it is to continue such treatments remains unanswered, with long-lasting effects being still unknown. To establish the value of these advanced therapeutic tools, it is important to predict the actions of the transplanted cells as well as to understand which cell type can induce the best outcomes for each disease. Further studies are needed to determine the best route of administration, without neglecting the possible risks of repetitive transplantation that these approaches so far appear to demand. Despite the challenges ahead of us, cell-transplantation therapies are reported to have transient but beneficial outcomes in spinocerebellar ataxias, which encourages efforts towards their improvement in the future.
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Affiliation(s)
- Joana Sofia Correia
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s – PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Sara Duarte-Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s – PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - António José Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s – PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Patrícia Maciel
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s – PT Government Associate Laboratory, Braga, Guimarães, Portugal,Correspondence to: Patrícia Maciel, .
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Oliveira JBL, Martinez ARM, França MC. Pharmacotherapy for the management of the symptoms of Machado-Joseph Disease. Expert Opin Pharmacother 2022; 23:1687-1694. [PMID: 36254604 DOI: 10.1080/14656566.2022.2135432] [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: 11/04/2022]
Abstract
INTRODUCTION Machado-Joseph disease or spinocerebellar ataxia type 3 (SCA3/MJD) is the leading cause of autosomal dominant ataxia worldwide. This is a slowly progressive, but very disabling disorder. Ataxia is the main clinical feature, but additional motor and non-motor manifestations may be found. Many of these manifestations are amenable to pharmacological treatments, which may impact the quality of life of affected subjects. AREAS COVERED Authors review available literature on both disease-modifying and symptomatic pharmacological therapies for SCA3/MJD. Discussion is stratified into motor (ataxic and non-ataxic syndromes) and non-motor manifestations. Ongoing clinical trials and future perspectives are also discussed in the manuscript. EXPERT OPINION Symptomatic treatment is the mainstay of clinical care and should be tailored for each patient with SCA3/MJD. Management of ataxia is still a challenging task, but relief (at least partial) of dystonia, pain/cramps, fatigue, and sleep disorders is an achievable goal for many patients. Even though there are no disease-modifying treatments so far, recent advances in understanding the biology of disease and international collaborations of clinical researchers are now paving the way for a new era where more clinical trials will be available for this devastating disorder.
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Affiliation(s)
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Inagaki T, Hashizume A, Hijikata Y, Yamada S, Ito D, Kishimoto Y, Torii R, Sato H, Hirakawa A, Katsuno M. Development of a functional composite for the evaluation of spinal and bulbar muscular atrophy. Sci Rep 2022; 12:17443. [PMID: 36261455 PMCID: PMC9581920 DOI: 10.1038/s41598-022-22322-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/12/2022] [Indexed: 01/12/2023] Open
Abstract
This study aimed to develop a functional measurement that combines quantitative motor evaluation index of various body regions in patients with spinal and bulbar muscular atrophy (SBMA). We assessed subjects with SBMA and healthy controls with quantitative muscle strength measurements and functional scales. We selected tongue pressure, grip power, % peak expiratory flow (%PEF), timed walking test, and % forced vital capacity (%FVC) as components. By combining these values with Z-score, we created a functional composite (SBMA functional composite: SBMAFC). We also calculated the standardized response mean to compare the sensitivity of SBMAFC with that of existing measurements. A total of 97 genetically confirmed patients with SBMA and 36 age- and sex-matched healthy controls were enrolled. In the longitudinal analysis, the standardized response mean of SBMAFC was larger than that of existing rating scales. Receiver operating characteristic (ROC) analysis demonstrated that the SBMAFC is capable of distinguishing between subjects with early-stage SBMA and healthy controls. SBMAFC is more sensitive to disease progression than existing functional rating scales and is a potential outcome measure in clinical trials of SBMA.
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Affiliation(s)
- Tomonori Inagaki
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Atsushi Hashizume
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan ,grid.27476.300000 0001 0943 978XDepartment of Clinical Research Education, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yasuhiro Hijikata
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Shinichiro Yamada
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Daisuke Ito
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yoshiyuki Kishimoto
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Ryota Torii
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Hiroyuki Sato
- grid.265073.50000 0001 1014 9130Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Akihiro Hirakawa
- grid.265073.50000 0001 1014 9130Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Masahisa Katsuno
- grid.27476.300000 0001 0943 978XDepartment of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan ,grid.27476.300000 0001 0943 978XDepartment of Clinical Research Education, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
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6
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Arciniegas Ruiz SM, Eldar-Finkelman H. Glycogen Synthase Kinase-3 Inhibitors: Preclinical and Clinical Focus on CNS-A Decade Onward. Front Mol Neurosci 2022; 14:792364. [PMID: 35126052 PMCID: PMC8813766 DOI: 10.3389/fnmol.2021.792364] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/07/2021] [Indexed: 12/11/2022] Open
Abstract
The protein kinase, GSK-3, participates in diverse biological processes and is now recognized a promising drug discovery target in treating multiple pathological conditions. Over the last decade, a range of newly developed GSK-3 inhibitors of diverse chemotypes and inhibition modes has been developed. Even more conspicuous is the dramatic increase in the indications that were tested from mood and behavior disorders, autism and cognitive disabilities, to neurodegeneration, brain injury and pain. Indeed, clinical and pre-clinical studies were largely expanded uncovering new mechanisms and novel insights into the contribution of GSK-3 to neurodegeneration and central nerve system (CNS)-related disorders. In this review we summarize new developments in the field and describe the use of GSK-3 inhibitors in the variety of CNS disorders. This remarkable volume of information being generated undoubtedly reflects the great interest, as well as the intense hope, in developing potent and safe GSK-3 inhibitors in clinical practice.
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Rodríguez-Labrada R, Martins AC, Magaña JJ, Vazquez-Mojena Y, Medrano-Montero J, Fernandez-Ruíz J, Cisneros B, Teive H, McFarland KN, Saraiva-Pereira ML, Cerecedo-Zapata CM, Gomez CM, Ashizawa T, Velázquez-Pérez L, Jardim LB. Founder Effects of Spinocerebellar Ataxias in the American Continents and the Caribbean. THE CEREBELLUM 2021; 19:446-458. [PMID: 32086717 DOI: 10.1007/s12311-020-01109-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spinocerebellar ataxias (SCAs) comprise a heterogeneous group of autosomal dominant disorders. The relative frequency of the different SCA subtypes varies broadly among different geographical and ethnic groups as result of genetic drifts. This review aims to provide an update regarding SCA founders in the American continents and the Caribbean as well as to discuss characteristics of these populations. Clusters of SCAs were detected in Eastern regions of Cuba for SCA2, in South Brazil for SCA3/MJD, and in Southeast regions of Mexico for SCA7. Prevalence rates were obtained and reached 154 (municipality of Báguano, Cuba), 166 (General Câmara, Brazil), and 423 (Tlaltetela, Mexico) patients/100,000 for SCA2, SCA3/MJD, and SCA7, respectively. In contrast, the scattered families with spinocerebellar ataxia type 10 (SCA10) reported all over North and South Americas have been associated to a common Native American ancestry that may have risen in East Asia and migrated to Americas 10,000 to 20,000 years ago. The comprehensive review showed that for each of these SCAs corresponded at least the development of one study group with a large production of scientific evidence often generalizable to all carriers of these conditions. Clusters of SCA populations in the American continents and the Caribbean provide unusual opportunity to gain insights into clinical and genetic characteristics of these disorders. Furthermore, the presence of large populations of patients living close to study centers can favor the development of meaningful clinical trials, which will impact on therapies and on quality of life of SCA carriers worldwide.
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Affiliation(s)
| | - Ana Carolina Martins
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
| | - Jonathan J Magaña
- Department of Genetics, Laboratory of Genomic Medicine, National Rehabilitation Institute (INR-LGII), 14389, Mexico City, Mexico
| | - Yaimeé Vazquez-Mojena
- Centre for the Research and Rehabilitation of Hereditary Ataxias, 80100, Holguín, Cuba
| | | | - Juan Fernandez-Ruíz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, 04510, Mexico City, Mexico
| | - Bulmaro Cisneros
- Department of Genetics and Molecular Biology, Center of Research and Advanced Studies (CINVESTAV-IPN), 07360, Mexico City, Mexico
| | - Helio Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas Federal University of Paraná, Curitiba, PR, 80240-440, Brazil
| | | | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-903, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-903, Brazil
| | - César M Cerecedo-Zapata
- Department of Genetics, Laboratory of Genomic Medicine, National Rehabilitation Institute (INR-LGII), 14389, Mexico City, Mexico
- Rehabilitation and Social Inclusion Center of Veracruz (CRIS-DIF), Xalapa, 91070, Veracruz, Mexico
| | | | - Tetsuo Ashizawa
- Program of Neuroscience, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, 80100, Holguín, Cuba.
- Cuban Academy of Sciences, 10100, La Havana, Cuba.
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-903, Brazil
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-903, Brazil
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Perez-Lloret S, van de Warrenburg B, Rossi M, Rodríguez-Blázquez C, Zesiewicz T, Saute JAM, Durr A, Nishizawa M, Martinez-Martin P, Stebbins GT, Schrag A, Skorvanek M. Assessment of Ataxia Rating Scales and Cerebellar Functional Tests: Critique and Recommendations. Mov Disord 2020; 36:283-297. [PMID: 33022077 DOI: 10.1002/mds.28313] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We assessed the clinimetric properties of ataxia rating scales and functional tests, and made recommendations regarding their use. METHODS A systematic literature search was conducted to identify the instruments used to rate ataxia symptoms. The identified rating scales and functional ability tests were reviewed and ranked by the panel as "recommended," "suggested," or "listed" for the assessment of patients with discrete cerebellar disorders, using previously established criteria. RESULTS We reviewed 14 instruments (9 rating scales and 5 functional tests). "Recommended" rating scales for the assessment of symptoms severity were: for Friedreich's ataxia, the Friedreich's Ataxia Rating Scale, the International Cooperative Ataxia Rating Scale (ICARS), and the Scale for the Assessment and Rating of Ataxia (SARA); for spinocerebellar ataxias, ICARS and SARA; for ataxia telangiectasia: ICARS and SARA; for brain tumors, SARA; for congenital disorder of glycosylation-phosphomannomutase-2 deficiency, ICARS; for cerebellar symptoms in multiple sclerosis, ICARS; for cerebellar symptoms in multiple system atrophy: Unified Multiple System Atrophy Rating Scale and ICARS; and for fragile X-associated tremor ataxia syndrome, ICARS. "Recommended" functional tests were: for Friedreich's ataxia, Ataxia Functional Composite Score and Composite Cerebellar Functional Severity Score; and for spinocerebellar ataxias, Ataxia Functional Composite Score, Composite Cerebellar Functional Severity Score, and SCA Functional Index. CONCLUSIONS We identified some "recommended" scales and functional tests for the assessment of patients with major hereditary ataxias and other cerebellar disorders. The main limitations of these instruments include the limited assessment of patients in the more severe end of the spectrum and children. Further research in these populations is warranted. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Santiago Perez-Lloret
- National Research Council (CAECIHS-UAI, CONICET), Buenos Aires, Argentina.,Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, Argentina.,Department of Physiology, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Bart van de Warrenburg
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Malco Rossi
- Movement Disorders Section, Raul Carrea Institute for Neurological Research, Buenos Aires, Argentina
| | | | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Jonas A M Saute
- Medical Genetics Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Neurology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | | | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, United Kingdom
| | - Matej Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic
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9
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Da Silva JD, Teixeira-Castro A, Maciel P. From Pathogenesis to Novel Therapeutics for Spinocerebellar Ataxia Type 3: Evading Potholes on the Way to Translation. Neurotherapeutics 2019; 16:1009-1031. [PMID: 31691128 PMCID: PMC6985322 DOI: 10.1007/s13311-019-00798-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD), is a neurodegenerative disorder caused by a polyglutamine expansion in the ATXN3 gene. In spite of the identification of a clear monogenic cause 25 years ago, the pathological process still puzzles researchers, impairing prospects for an effective therapy. Here, we propose the disruption of protein homeostasis as the hub of SCA3 pathogenesis, being the molecular mechanisms and cellular pathways that are deregulated in SCA3 downstream consequences of the misfolding and aggregation of ATXN3. Moreover, we attempt to provide a realistic perspective on how the translational/clinical research in SCA3 should evolve. This was based on molecular findings, clinical and epidemiological characteristics, studies of proposed treatments in other conditions, and how that information is essential for their (re-)application in SCA3. This review thus aims i) to critically evaluate the current state of research on SCA3, from fundamental to translational and clinical perspectives; ii) to bring up the current key questions that remain unanswered in this disorder; and iii) to provide a frame on how those answers should be pursued.
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Affiliation(s)
- Jorge Diogo Da Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Andreia Teixeira-Castro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Maciel
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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10
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Abstract
The spinocerebellar ataxias (SCAs) comprise more than 40 autosomal dominant neurodegenerative disorders that present principally with progressive ataxia. Within the past few years, studies of pathogenic mechanisms in the SCAs have led to the development of promising therapeutic strategies, especially for SCAs caused by polyglutamine-coding CAG repeats. Nucleotide-based gene-silencing approaches that target the first steps in the pathogenic cascade are one promising approach not only for polyglutamine SCAs but also for the many other SCAs caused by toxic mutant proteins or RNA. For these and other emerging therapeutic strategies, well-coordinated preparation is needed for fruitful clinical trials. To accomplish this goal, investigators from the United States and Europe are now collaborating to share data from their respective SCA cohorts. Increased knowledge of the natural history of SCAs, including of the premanifest and early symptomatic stages of disease, will improve the prospects for success in clinical trials of disease-modifying drugs. In addition, investigators are seeking validated clinical outcome measures that demonstrate responsiveness to changes in SCA populations. Findings suggest that MRI and magnetic resonance spectroscopy biomarkers will provide objective biological readouts of disease activity and progression, but more work is needed to establish disease-specific biomarkers that track target engagement in therapeutic trials. Together, these efforts suggest that the development of successful therapies for one or more SCAs is not far away.
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11
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Yang ZH, Shi CH, Zhou LN, Li YS, Yang J, Liu YT, Mao CY, Luo HY, Xu GW, Xu YM. Metabolic Profiling Reveals Biochemical Pathways and Potential Biomarkers of Spinocerebellar Ataxia 3. Front Mol Neurosci 2019; 12:159. [PMID: 31316347 PMCID: PMC6611058 DOI: 10.3389/fnmol.2019.00159] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
Spinocerebellar ataxia 3, also known as Machado-Joseph disease (SCA3/MJD), is a rare autosomal-dominant neurodegenerative disease caused by an abnormal expansion of CAG repeats in the ATXN3 gene. In the present study, we performed a global metabolomic analysis to identify pathogenic biochemical pathways and novel biomarkers implicated in SCA3 patients. Metabolic profiling of serum samples from 13 preclinical SCA3 patients, 13 symptomatic SCA3 patients, and 15 healthy controls were mapped using ultra-high-performance liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry techniques. The symptomatic SCA3 patients showed a metabolic profile significantly distinct from those of the preclinical SCA3 patients and healthy controls. The principal differential metabolites were involved in the amino acid (AA) metabolism and fatty acid metabolism pathways. In addition, four candidate serum biomarkers, FFA 16:1 (palmitoleic acid), FFA 18:3 (linolenic acid), L-Proline and L-Tryptophan, were selected to discriminate between symptomatic SCA3 patients and healthy controls by receiver operator curve analysis with an area under the curve of 0.979. Our study demonstrates that symptomatic SCA3 patients present distinct metabolic profiles with perturbed AA metabolism and fatty acid metabolism, and FFA 16:1, FFA 18:3, L-Proline and L-Tryptophan are identified as potential disease biomarkers.
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Affiliation(s)
- Zhi-Hua Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Chang-He Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Li-Na Zhou
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Yu-Sheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yu-Tao Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Cheng-Yuan Mao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Hai-Yang Luo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Guo-Wang Xu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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12
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Furtado GV, Oliveira CMD, Bolzan G, Saute JAM, Saraiva-Pereira ML, Jardim LB. State biomarkers for Machado Joseph disease: Validation, feasibility and responsiveness to change. Genet Mol Biol 2019; 42:238-251. [PMID: 31188927 PMCID: PMC6687346 DOI: 10.1590/1678-4685-gmb-2018-0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/04/2018] [Indexed: 12/18/2022] Open
Abstract
Machado-Joseph disease (SCA3/MJD) is the most common spinocerebellar ataxia worldwide, and particularly so in Southern Brazil. Due to an expanded polyglutamine at ataxin-3, SCA3/MJD presents a relentless course with no current disease modifying treatment. Clinical scales used to measure SCA3/MJD progression present moderate effect sizes, a major drawback for their use as main outcomes in clinical trials, given the rarity and slow progression of the disease. This limitation might be overcome by finding good surrogate markers. We present here a review of studies on peripheral and neurophysiological markers in SCA3/MJD that can be candidates for state biomarkers. Data on markers already studied were summarized, giving emphasis on validation against clinical scale, and responsiveness to change. While some biological fluid compounds and neurophysiological parameters showed poor responsiveness, others seemed to be good candidates. Some potential candidates that are waiting for responsiveness studies were serum levels of neuron specific enolase, vestibulo-ocular reflex and video-oculography. Candidates evaluated by RNA and microRNA expression levels need further studies to improve their measurements. Data on peripheral levels of Beclin-1 and DNAJB1 are promising but still incipient. We conclude that several potential candidates should follow onto validating studies for surrogate state biomarkers of SCA3/MJD.
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Affiliation(s)
- Gabriel Vasata Furtado
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Camila Maria de Oliveira
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriela Bolzan
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Jonas Alex Morales Saute
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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13
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Giugliani R, Bender F, Couto R, Bochernitsan A, Brusius-Facchin AC, Burin M, Amorim T, Acosta AX, Purificação A, Leistner-Segal S, Saraiva-Pereira ML, Jardim LB, Matte U, Riegel M, Cardoso-Dos-Santos AC, Rodrigues G, Oliveira MZD, Tagliani-Ribeiro A, Heck S, Dresch V, Schuler-Faccini L, Kubaski F. Population medical genetics: translating science to the community. Genet Mol Biol 2019; 42:312-320. [PMID: 30985854 PMCID: PMC6687347 DOI: 10.1590/1678-4685-gmb-2018-0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/11/2018] [Indexed: 12/02/2022] Open
Abstract
Rare genetic disorders are currently in the spotlight due to the elevated number
of different conditions and significant total number of affected patients. The
study of these disorders is extremely helpful for the elucidation of
physiological processes related with complex disorders. Isolated populations are
instrumental for the study of genetic disorders, considering their homogeneity
and high proportion of affected patients in a small geographic area. These
favorable conditions lead to the creation of a new discipline, known as
“population medical genetics”, which integrates medical genetics, population
genetics, epidemiological genetics and community genetics. In order to develop
practical activities in this new discipline, the National Institute of
Population Medical Genetics (INaGeMP) was created in 2008 in Brazil. INaGeMP has
developed several tools and funded numerous research activities. In this review,
we highlight three successful projects developed in the first 10 years of
INaGeMP activities (2008-2018): a newborn screening pilot study for MPS VI in
Northeast Brazil, the study of Machado-Joseph disease in Brazilian families with
Azorian ancestry, and the high twinning rate in a small town in southern Brazil.
The results of these projects in terms of scientific output and contributions to
the affected communities highlight the success and importance of INaGeMP.
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Affiliation(s)
- Roberto Giugliani
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernanda Bender
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rowena Couto
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bochernitsan
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ana Carolina Brusius-Facchin
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maira Burin
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tatiana Amorim
- APAE, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Angelina Xavier Acosta
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Fundação Oswaldo Cruz (FIOCRUZ), Salvador, BA, Brazil.,Department of Pediatrics, Universidade Federal da Bahia, Salvador, BA, Brazi
| | | | - Sandra Leistner-Segal
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Luiza Saraiva-Pereira
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Biochemistry, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Genetics Identification Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Celular and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Genetics Identification Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ursula Matte
- Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariluce Riegel
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Augusto César Cardoso-Dos-Santos
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Graziella Rodrigues
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Marcelo Zagonel de Oliveira
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Alice Tagliani-Ribeiro
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Selia Heck
- Prefeitura Municipal de Cândido Godói, Candido Godói, RS, Brazil
| | - Vanusa Dresch
- Prefeitura Municipal de Cândido Godói, Candido Godói, RS, Brazil
| | - Lavínia Schuler-Faccini
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Francyne Kubaski
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
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14
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Saute JAM, Jardim LB. Riluzole in patients with hereditary cerebellar ataxia. Lancet Neurol 2018; 15:788-789. [PMID: 27302350 DOI: 10.1016/s1474-4422(16)00128-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre 90.035-903, Brazil; Department of Internal Medicine and Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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15
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Zesiewicz TA, Wilmot G, Kuo SH, Perlman S, Greenstein PE, Ying SH, Ashizawa T, Subramony SH, Schmahmann JD, Figueroa KP, Mizusawa H, Schöls L, Shaw JD, Dubinsky RM, Armstrong MJ, Gronseth GS, Sullivan KL. Comprehensive systematic review summary: Treatment of cerebellar motor dysfunction and ataxia: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2018; 90:464-471. [PMID: 29440566 DOI: 10.1212/wnl.0000000000005055] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 12/04/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To systematically review evidence regarding ataxia treatment. METHODS A comprehensive systematic review was performed according to American Academy of Neurology methodology. CONCLUSIONS For patients with episodic ataxia type 2, 4-aminopyridine 15 mg/d probably reduces ataxia attack frequency over 3 months (1 Class I study). For patients with ataxia of mixed etiology, riluzole probably improves ataxia signs at 8 weeks (1 Class I study). For patients with Friedreich ataxia or spinocerebellar ataxia (SCA), riluzole probably improves ataxia signs at 12 months (1 Class I study). For patients with SCA type 3, valproic acid 1,200 mg/d possibly improves ataxia at 12 weeks. For patients with spinocerebellar degeneration, thyrotropin-releasing hormone possibly improves some ataxia signs over 10 to 14 days (1 Class II study). For patients with SCA type 3 who are ambulatory, lithium probably does not improve signs of ataxia over 48 weeks (1 Class I study). For patients with Friedreich ataxia, deferiprone possibly worsens ataxia signs over 6 months (1 Class II study). Data are insufficient to support or refute the use of numerous agents. For nonpharmacologic options, in patients with degenerative ataxias, 4-week inpatient rehabilitation probably improves ataxia and function (1 Class I study); transcranial magnetic stimulation possibly improves cerebellar motor signs at 21 days (1 Class II study). For patients with multiple sclerosis-associated ataxia, the addition of pressure splints possibly has no additional benefit compared with neuromuscular rehabilitation alone (1 Class II study). Data are insufficient to support or refute use of stochastic whole-body vibration therapy (1 Class III study).
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Affiliation(s)
- Theresa A Zesiewicz
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - George Wilmot
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Sheng-Han Kuo
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Susan Perlman
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Patricia E Greenstein
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Sarah H Ying
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Tetsuo Ashizawa
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - S H Subramony
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Jeremy D Schmahmann
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - K P Figueroa
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Hidehiro Mizusawa
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Ludger Schöls
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Jessica D Shaw
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Richard M Dubinsky
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Melissa J Armstrong
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Gary S Gronseth
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
| | - Kelly L Sullivan
- From the Department of Neurology (T.A.Z., J.D. Shaw), University of South Florida, Tampa; Department of Neurology (G.W.), Emory University, Atlanta, GA; Department of Neurology (S.-H.K.), Columbia University, New York, NY; Department of Neurology (S.P.), University of California, Los Angeles; Department of Neurology (P.E.G.), Beth Israel Deaconess Medical Center, Boston, MA; Shire (S.H.Y.), Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (T.A.), Houston Methodist Research Institute, TX; Department of Neurology (S.H.S., M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (J.D. Schmahmann), Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA; Department of Neurology (K.P.F.), University of Utah, Salt Lake City; National Center of Neurology and Psychiatry (H.M.), Tokyo, Japan; Department of Neurology and Hertie-Institute for Clinical Brain Research (L.S.), Tübingen, Germany; Department of Neurology (R.M.D., G.S.D.), University of Kansas Medical Center, Kansas City; and Jiann-Ping Hsu College of Public Health (K.L.S.), Georgia Southern University, Statesboro
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16
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Lima M, Raposo M. Towards the Identification of Molecular Biomarkers of Spinocerebellar Ataxia Type 3 (SCA3)/Machado-Joseph Disease (MJD). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1049:309-319. [PMID: 29427111 DOI: 10.1007/978-3-319-71779-1_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Whereas spinocerebellar ataxia type 3 (SCA3)/Machado-Joseph disease (MJD) remains an untreatable disorder, disease-modifying compounds have begun being tested in the context of clinical trials; their success is dependent on the sensitivity of the methods used to measure subtle therapeutic benefits. Thus, efforts are being made to propose a battery of potential outcome measures, including molecular biomarkers (MBs), which remain to be identified; MBs are particularly pertinent if SCA3 trials are expected to enroll preataxic subjects. Recently, promising candidate MBs of SCA3 have emerged from gene expression studies. In this chapter we provide a synthesis of the cross-sectional and pilot longitudinal studies of blood-based transcriptional biomarkers conducted so far. Other alterations with potential to track the progression of SCA3, such as those involving mitochondrial DNA (mtDNA) are also referred. It is expected that a set of molecular biomarkers can be identified; these will be used in complementarity with clinical and imaging markers to fully track SCA3, from its preataxic phase to the disease stage.
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Affiliation(s)
- Manuela Lima
- Departamento de Biologia, Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal. .,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal. .,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal.
| | - Mafalda Raposo
- Departamento de Biologia, Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
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17
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Saute JAM, Jardim LB. Planning Future Clinical Trials for Machado-Joseph Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1049:321-348. [PMID: 29427112 DOI: 10.1007/978-3-319-71779-1_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is an autosomal dominant multiple neurological systems degenerative disorder caused by a CAG repeat expansion at ATXN3 gene. Only a few treatments were evaluated in randomized clinical trials (RCT) in SCA3/MJD patients, with a lack of evidence for both disease-modifying and symptomatic therapies. The present chapter discuss in detail major methodological issues for planning future RCT for SCA3/MJD. There are several potential therapies for SCA3/MJD with encouraging preclinical results. Route of treatment, dosage titration and potential therapy biomarkers might differ among candidate drugs; however, the core study design and protocol will be mostly the same. RCT against placebo group is the best study design to test a disease-modifying therapy; the same cannot be stated for some symptomatic treatments. Main outcomes for future RCT are clinical scales: the Scale for the Assessment and Rating of ataxia (SARA) is currently the instrument of choice to prove efficacy of disease-modifying or symptomatic treatments against ataxia, the most important disease feature. Ataxia quantitative scales or its composite scores can be used as primary outcomes to provide preliminary evidence of efficacy in phase 2 RCT, due to a greater sensitivity to change. Details regarding eligibility criteria, randomization, sample size estimation, duration and type of analysis for both disease modifying and symptomatic treatment trials, were also discussed. Finally, a section anticipates the methodological issues for testing novel drugs when an effective treatment is already available. We conclude emphasizing four points, the first being the need of RCT for a number of different aims in the care of SCA3/MJD. Due to large sample sizes needed to warrant power, RCT for disease-modifying therapies should be multicenter enterprises. There is an urge need for surrogate markers validated for several drug classes. Finally, engagement of at risk or presymptomatic individuals in future trials will enable major advances on treatment research for SCA3/MJD.
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Affiliation(s)
- Jonas Alex Morales Saute
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, HCPA, Porto Alegre, RS, Brazil
- Programa de Pós-Gradução em Medicina, Ciências Médicas Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Departamento de Medicina Interna, UFRGS, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, HCPA, Porto Alegre, RS, Brazil.
- Programa de Pós-Gradução em Medicina, Ciências Médicas Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Departamento de Medicina Interna, UFRGS, Porto Alegre, RS, Brazil.
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Rio de Janeiro, Brazil.
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Abstract
Machado-Joseph disease (MJD) also known as Spinocerebellar ataxia type 3, is a hereditary neurodegenerative disease associated with severe clinical manifestations and premature death. Although rare, it is the most common autosomal dominant spinocerebellar ataxia worldwide and has a distinct geographic distribution, reaching peak prevalence in certain regions of Brazil, Portugal and China. Due to its clinical heterogeneity, it was initially described as several different entities and as had many designations over the last decades. An accurate diagnosis become possible in 1994, after the identification of the MJD1 gene. Among its wide clinical spectrum, progressive cerebellar ataxia is normally present. Other symptoms include pyramidal syndrome, peripheral neuropathy, oculomotor abnormalities, extrapyramidal signs and sleep disorders. On the basis of the presence/absence of important extra-pyramidal signs, and the presence/absence of peripheral signs, five clinical types have been defined. Neuroimaging studies like MRI, DTI and MRS, can be useful as they can characterize structural and functional differences in specific subgroups of patients with MJD. There is no effective treatment for MJD. Symptomatic therapies are used to relieve some of the clinical symptoms and physiotherapy is also helpful in improving quality of live. Several clinical trials have been carried out using different molecules like sulfamethoxazole-trimethoprim, varenicline and lithium carbonate, but the results of these trials were negative or showed little benefit. Future studies sufficiently powered and adequately designed are warranted.
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Wang Z. Experimental and Clinical Strategies for Treating Spinocerebellar Ataxia Type 3. Neuroscience 2017; 371:138-154. [PMID: 29229556 DOI: 10.1016/j.neuroscience.2017.11.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 01/02/2023]
Abstract
Spinocerebellar ataxia type 3 (SCA3), or Machado-Joseph disease (MJD), is an autosomal dominant neurodegenerative disorder caused by the expansion of a polyglutamine (polyQ) tract in the ataxin-3 protein. To date, there is no effective therapy available to prevent progression of this disease. However, clinical strategies for alleviating various symptoms are imperative to promote a better quality of life for SCA3/MJD patients. Furthermore, experimental therapeutic strategies, including gene silencing or mutant protein clearance, mutant polyQ protein modification, stabilizing the native protein conformation, rescue of cellular dysfunction and neuromodulation to slow the progression of SCA3/MJD, have been developed. In this study, based on the current knowledge, I detail the clinical and experimental therapeutic strategies for treating SCA3/MJD, paying particular attention to drug discovery.
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Affiliation(s)
- Zijian Wang
- Genetic Engineering Laboratory, College of Biological and Environmental Engineering, Xi'an University, Xi'an, Shaanxi 710065, China.
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20
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de Assis AM, Saute JAM, Longoni A, Haas CB, Torrez VR, Brochier AW, Souza GN, Furtado GV, Gheno TC, Russo A, Monte TL, Castilhos RM, Schumacher-Schuh A, D'Avila R, Donis KC, de Mello Rieder CR, Souza DO, Camey S, Leotti VB, Jardim LB, Portela LV. Peripheral Oxidative Stress Biomarkers in Spinocerebellar Ataxia Type 3/Machado-Joseph Disease. Front Neurol 2017; 8:485. [PMID: 28979235 PMCID: PMC5611390 DOI: 10.3389/fneur.2017.00485] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/31/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is a polyglutamine disorder with no current disease-modifying treatment. Conformational changes in mutant ataxin-3 trigger different pathogenic cascades, including reactive oxygen species (ROS) generation; however, the clinical relevance of oxidative stress elements as peripheral biomarkers of SCA3/MJD remains unknown. We aimed to evaluate ROS production and antioxidant defense capacity in symptomatic and presymptomatic SCA3/MJD individuals and correlate these markers with clinical and molecular data with the goal of assessing their properties as disease biomarkers. METHODS Molecularly confirmed SCA3/MJD carriers and controls were included in an exploratory case-control study. Serum ROS, measured by 2',7'-dichlorofluorescein diacetate (DCFH-DA) as well as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) antioxidant enzyme activities, levels were assessed. RESULTS Fifty-eight early/moderate stage symptomatic SCA3/MJD, 12 presymptomatic SCA3/MJD, and 47 control individuals were assessed. The DCFH-DA levels in the symptomatic group were 152.82 nmol/mg of protein [95% confidence interval (CI), 82.57-223.08, p < 0.001] higher than in the control and 243.80 nmol/mg of protein (95% CI, 130.64-356.96, p < 0.001) higher than in the presymptomatic group. The SOD activity in the symptomatic group was 3 U/mg of protein (95% CI, 0.015-6.00, p = 0.048) lower than in the presymptomatic group. The GSH-Px activity in the symptomatic group was 13.96 U/mg of protein (95% CI, 5.90-22.03, p < 0.001) lower than in the control group and 20.52 U/mg of protein (95% CI, 6.79-34.24, p < 0.001) lower than in the presymptomatic group and was inversely correlated with the neurological examination score for spinocerebellar ataxias (R = -0.309, p = 0.049). CONCLUSION Early/moderate stage SCA3/MJD patients presented a decreased antioxidant capacity and increased ROS generation. GSH-Px activity was the most promising oxidative stress disease biomarker in SCA3/MJD. Further longitudinal studies are necessary to identify both the roles of redox parameters in SCA3/MJD pathophysiology and as surrogate outcomes for clinical trials.
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Affiliation(s)
- Adriano M de Assis
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Saúde e Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas (UCPel), Pelotas, Brazil
| | - Jonas Alex Morales Saute
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Longoni
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Clarissa Branco Haas
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vitor Rocco Torrez
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Andressa Wigner Brochier
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gabriele Nunes Souza
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gabriel Vasata Furtado
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tailise Conte Gheno
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Russo
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Thais Lampert Monte
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Raphael Machado Castilhos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Artur Schumacher-Schuh
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rui D'Avila
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Karina Carvalho Donis
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Carlos Roberto de Mello Rieder
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Neurologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Diogo Onofre Souza
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Suzi Camey
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luis Valmor Portela
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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21
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Braga Neto P, Pedroso JL, Kuo SH, Marcondes Junior CF, Teive HAG, Barsottini OGP. Current concepts in the treatment of hereditary ataxias. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:244-52. [PMID: 27050855 DOI: 10.1590/0004-282x20160038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 02/19/2023]
Abstract
Hereditary ataxias (HA) represents an extensive group of clinically and genetically heterogeneous neurodegenerative diseases, characterized by progressive ataxia combined with extra-cerebellar and multi-systemic involvements, including peripheral neuropathy, pyramidal signs, movement disorders, seizures, and cognitive dysfunction. There is no effective treatment for HA, and management remains supportive and symptomatic. In this review, we will focus on the symptomatic treatment of the main autosomal recessive ataxias, autosomal dominant ataxias, X-linked cerebellar ataxias and mitochondrial ataxias. We describe management for different clinical symptoms, mechanism-based approaches, rehabilitation therapy, disease modifying therapy, future clinical trials and perspectives, genetic counseling and preimplantation genetic diagnosis.
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Affiliation(s)
- Pedro Braga Neto
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
| | - José Luiz Pedroso
- Departmento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, United States
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22
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Lopes-Ramos CM, Pereira TC, Dogini DB, Gilioli R, Lopes-Cendes I. Lithium carbonate and coenzyme Q10 reduce cell death in a cell model of Machado-Joseph disease. ACTA ACUST UNITED AC 2016; 49:e5805. [PMID: 27878228 PMCID: PMC5188859 DOI: 10.1590/1414-431x20165805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023]
Abstract
Machado-Joseph disease (MJD) or spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant neurodegenerative disorder caused by expansion of the polyglutamine domain of the ataxin-3 (ATX3) protein. MJD/SCA3 is the most frequent autosomal dominant ataxia in many countries. The mechanism underlying MJD/SCA3 is thought to be mainly related to protein misfolding and aggregation leading to neuronal dysfunction followed by cell death. Currently, there are no effective treatments for patients with MJD/SCA3. Here, we report on the potential use of lithium carbonate and coenzyme Q10 to reduce cell death caused by the expanded ATX3 in cell culture. Cell viability and apoptosis were evaluated by MTT assay and by flow cytometry after staining with annexin V-FITC/propidium iodide. Treatment with lithium carbonate and coenzyme Q10 led to a significant increase in viability of cells expressing expanded ATX3 (Q84). In addition, we found that the increase in cell viability resulted from a significant reduction in the proportion of apoptotic cells. Furthermore, there was a significant change in the expanded ATX3 monomer/aggregate ratio after lithium carbonate and coenzyme Q10 treatment, with an increase in the monomer fraction and decrease in aggregates. The safety and tolerance of both drugs are well established; thus, our results indicate that lithium carbonate and coenzyme Q10 are good candidates for further in vivo therapeutic trials.
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Affiliation(s)
- C M Lopes-Ramos
- Departamento de Genética Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - T C Pereira
- Departamento de Biologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D B Dogini
- Departamento de Genética Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R Gilioli
- Centro Multidisciplinar para Investigação Biológica, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - I Lopes-Cendes
- Departamento de Genética Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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23
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Klaes A, Reckziegel E, Franca MC, Rezende TJR, Vedolin LM, Jardim LB, Saute JA. MR Imaging in Spinocerebellar Ataxias: A Systematic Review. AJNR Am J Neuroradiol 2016; 37:1405-12. [PMID: 27173364 PMCID: PMC7960281 DOI: 10.3174/ajnr.a4760] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Polyglutamine expansion spinocerebellar ataxias are autosomal dominant slowly progressive neurodegenerative diseases with no current treatment. MR imaging is the best-studied surrogate biomarker candidate for polyglutamine expansion spinocerebellar ataxias, though with conflicting results. We aimed to review quantitative central nervous system MR imaging technique findings in patients with polyglutamine expansion spinocerebellar ataxias and correlations with well-established clinical and molecular disease markers. MATERIALS AND METHODS We searched MEDLINE, LILACS, and Cochrane data bases of clinical trials between January 1995 and January 2016, for quantitative MR imaging volumetric approaches, MR spectroscopy, diffusion tensor imaging, or other quantitative techniques, comparing patients with polyglutamine expansion spinocerebellar ataxias (SCAs) with controls. Pertinent details for each study regarding participants, imaging methods, and results were extracted. RESULTS After reviewing the 706 results, 18 studies were suitable for inclusion: 2 studies in SCA1, 1 in SCA2, 15 in SCA3, 1 in SCA7, 1 in SCA1 and SCA6 presymptomatic carriers, and none in SCA17 and dentatorubropallidoluysian atrophy. Cerebellar hemispheres and vermis, whole brain stem, midbrain, pons, medulla oblongata, cervical spine, striatum, and thalamus presented significant atrophy in SCA3. The caudate, putamen and whole brain stem presented similar sensitivity to change compared with ataxia scales after 2 years of follow-up in a single prospective study in SCA3. MR spectroscopy and DTI showed abnormalities only in cross-sectional studies in SCA3. Results from single studies in other polyglutamine expansion spinocerebellar ataxias should be replicated in different cohorts. CONCLUSIONS Additional cross-sectional and prospective volumetric analysis, MR spectroscopy, and DTI studies are necessary in polyglutamine expansion spinocerebellar ataxias. The properties of preclinical disease biomarkers (presymptomatic) of MR imaging should be targeted in future studies.
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Affiliation(s)
- A Klaes
- From the Departments of Radiology (A.K., L.M.V.)
| | - E Reckziegel
- Medical Genetics Services (E.R., L.B.J., J.A.M.S.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - M C Franca
- Departments of Neurology (M.C.F., T.J.R.R.)
| | - T J R Rezende
- Departments of Neurology (M.C.F., T.J.R.R.) Cosmic Rays and Chronology (T.J.R.R.), Universidade Estadual de Campinas, Campinas, Brazil
| | - L M Vedolin
- From the Departments of Radiology (A.K., L.M.V.) Department of Internal Medicine (L.M.V., L.B.J.)
| | - L B Jardim
- Medical Genetics Services (E.R., L.B.J., J.A.M.S.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Internal Medicine (L.M.V., L.B.J.) Postgraduate Program in Medicine: Medical Sciences (L.B.J.), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J A Saute
- Medical Genetics Services (E.R., L.B.J., J.A.M.S.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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24
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Donis KC, Saute JAM, Krum-Santos AC, Furtado GV, Mattos EP, Saraiva-Pereira ML, Torman VL, Jardim LB. Spinocerebellar ataxia type 3/Machado-Joseph disease starting before adolescence. Neurogenetics 2016; 17:107-13. [PMID: 26780339 DOI: 10.1007/s10048-016-0473-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/03/2016] [Indexed: 01/19/2023]
Abstract
Onset of Machado-Joseph disease (SCA3/MJD) before adolescence has been rarely reported. This study aims to describe a cohort of SCA3/MJD with onset before 12 years of age, comparing their disease progression with the progression observed in patients with usual disease onset. We identified all cases from our cohort whose onset was before adolescence. After consent, patients were examined with clinical scales Scale for the Assessment and Rating of Ataxia (SARA) and Neurological Examination Score for Spinocerebellar Ataxia (NESSCA). Gender, age, age at onset, disease duration, CAG expanded repeats, transmitting parent, and anticipation of cases with infantile and adult onset were studied. Progression of NESSCA and SARA scores was estimated through a mixed model, and was compared with a historical group with onset after adolescence. Between 2000 and 2014, 461 symptomatic individuals from our region were diagnosed as SCA3/MJD. Onset of eight cases (2.2%), all heterozygotes, was before adolescence: seven were females (p = 0.054). CAG expanded repeats--75 ± 3 versus 84 ± 4--and anticipations--7 ± 9.7 versus 14.4 ± 7.2 years--were different between early childhood and adult onset groups (p < 0.03). The median survival of early childhood onset group was 23 years of age. The annual progression of SARA--2.3 and 0.6 points/year (p = 0.001)--and NESSCA--2.04 and 0.88 points/year (p = 0.043)--was faster in childhood than in adult onset group. Onset of SCA3/MJD before adolescence was related to larger expanded CAG repeats in heterozygosis; females seemed to be at higher risk. Disease progression was faster than in SCA3/MJD starting after 12 years.
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Affiliation(s)
- Karina Carvalho Donis
- Programa de Pós-Graduação na Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 90.035-903, Porto Alegre, Brazil
| | - Jonas Alex Morales Saute
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 90.035-903, Porto Alegre, Brazil
| | | | - Gabriel Vasata Furtado
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Preusser Mattos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 90.035-903, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.,Instituto de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil
| | - Vanessa Leotti Torman
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação na Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil. .,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 90.035-903, Porto Alegre, Brazil. .,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil. .,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil. .,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. .,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil. .,Instituto de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil.
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