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Tóth Š, Kulcsárová K, Maretta M, Kunová A, Mechírová E, Gdovinová Z, Feketeová E, Ribeiro Ventosa J, Baloghová J, Bekeová M, Christová P, Mrázová S, Muránska S, Zeidan D, Škorvánek M. α-synuclein antibody 5G4 identifies idiopathic REM-sleep behavior disorder in abdominal skin biopsies. Parkinsonism Relat Disord 2024; 120:105956. [PMID: 38217955 DOI: 10.1016/j.parkreldis.2023.105956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Idiopathic REM-sleep behavior disorder (iRBD) is considered the most specific prodromal marker of Parkinson's disease (PD). With the need to improve early detection of prodromal α-synucleinopathies, several methods to identify peripheral α-synuclein (α-syn) pathology have been exploited in manifest and prodromal PD with varying diagnostic accuracy. Recently, a disease specific 5G4 antibody has been evaluated in skin biopsies of manifest PD patients. The aim of our study was to analyze the 5G4 α-syn immunoreactivity in skin biopsies of deeply phenotyped subjects with iRBD and controls. METHODS The study cohort consisted of 28 patients with PD, 24 subjects with iRBD and 27 healthy controls, recruited from the CEGEMOD, PDBIOM and PARCAS cohorts. All subjects were deeply phenotyped and assessed for prodromal PD (pPD) probability based on MDS research criteria. Abdominal skin punch biopsies were processed and stained using a conformation specific 5G4 α-syn antibody as well as axonal markers SMI-31 and S100. RESULTS 5G4-positivity was identified in 23/28 PD patients, 20/24 iRBD subjects and 8/27 healthy controls. Compared to healthy controls, sensitivity and specificity reached 83.33 % and 70.37 % for iRBD; and 82.14 % and 70.37 % for PD, respectively. 5G4-positivity rate in our study was irrespective of the calculated pPD probability of iRBD subjects. CONCLUSIONS This work establishes the diagnostic yield of conformation specific 5G4 α-syn antibody testing in skin biopsies of subjects with pPD, specifically iRBD. The diagnostic accuracy for this method seems to be similar for both manifest and prodromal PD and is not dependent on the pPD probability ratios.
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Affiliation(s)
- Štefan Tóth
- Department of Histology and Embryology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic.
| | - Kristína Kulcsárová
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Košice, Slovak Republic; Department of Clinical Neurosciences, University Scientific Park MEDIPARK, P. J. Šafárik University, Kosice, Slovak Republic
| | - Milan Maretta
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Alexandra Kunová
- Department of Histology and Embryology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Eva Mechírová
- Department of Histology and Embryology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Zuzana Gdovinová
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Eva Feketeová
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Joaquim Ribeiro Ventosa
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Košice, Slovak Republic; Department of Clinical Neurosciences, University Scientific Park MEDIPARK, P. J. Šafárik University, Kosice, Slovak Republic
| | - Janette Baloghová
- Department of Dermatovenerology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Dermatovenerology, University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Martina Bekeová
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Petronela Christová
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Soňa Mrázová
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Soňa Muránska
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Dema Zeidan
- Department of Histology and Embryology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic
| | - Matej Škorvánek
- Department of Neurology, Medical Faculty of P. J. Šafárik University, Košice, Slovak Republic; Department of Neurology, University Hospital of L. Pasteur, Košice, Slovak Republic
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Kuzkina A, Panzer C, Seger A, Schmitt D, Rößle J, Schreglmann SR, Knacke H, Salabasidou E, Kohl A, Sittig E, Barbe M, Berg D, Volkmann J, Sommer C, Oertel WH, Schaeffer E, Sommerauer M, Janzen A, Doppler K. Dermal Real-Time Quaking-Induced Conversion Is a Sensitive Marker to Confirm Isolated Rapid Eye Movement Sleep Behavior Disorder as an Early α-Synucleinopathy. Mov Disord 2023; 38:1077-1082. [PMID: 36750755 DOI: 10.1002/mds.29340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Skin biopsy is a potential tool for the premortem confirmation of an α-synucleinopathy. OBJECTIVE The aim was to assess the aggregation assay real-time quaking-induced conversion (RT-QuIC) of skin biopsy lysates to confirm isolated rapid eye movement sleep behavior disorder (iRBD) as an α-synucleinopathy. METHODS Skin biopsies of patients with iRBD, Parkinson's disease (PD), and controls were analyzed using RT-QuIC and immunohistochemical detection of phospho-α-synuclein. RESULTS α-Synuclein aggregation was detected in 97.4% of iRBD patients (78.4% of iRBD biopsies), 87.2% of PD patients (70% of PD biopsies), and 13% of controls (7.9% of control biopsies), with a higher seeding activity in iRBD compared to PD. RT-QuIC was more sensitive but less specific than immunohistochemistry. CONCLUSIONS Dermal RT-QuIC is a sensitive method to detect α-synuclein aggregation in iRBD, and high seeding activity may indicate a strong involvement of dermal nerve fibers in these patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anastasia Kuzkina
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Celine Panzer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Aline Seger
- Department of Neurology, University Hospital Cologne, University of Cologne, Köln, Germany
| | - Daniela Schmitt
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jonas Rößle
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Henrike Knacke
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elena Salabasidou
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Antonia Kohl
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Elisabeth Sittig
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Michael Barbe
- Department of Neurology, University Hospital Cologne, University of Cologne, Köln, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang H Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
- Helmholtz Center for Health and Environment, Institute for Neurogenomics, München-Neuherberg, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Cologne, University of Cologne, Köln, Germany
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Annette Janzen
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
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Kuzkina A, Rößle J, Seger A, Panzer C, Kohl A, Maltese V, Musacchio T, Blaschke SJ, Tamgüney G, Kaulitz S, Rak K, Scherzad A, Zimmermann PH, Klussmann JP, Hackenberg S, Volkmann J, Sommer C, Sommerauer M, Doppler K. Combining skin and olfactory α-synuclein seed amplification assays (SAA)-towards biomarker-driven phenotyping in synucleinopathies. NPJ Parkinsons Dis 2023; 9:79. [PMID: 37248217 DOI: 10.1038/s41531-023-00519-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Seed amplification assays (SAA) are becoming commonly used in synucleinopathies to detect α-synuclein aggregates. Studies in Parkinson's disease (PD) and isolated REM-sleep behavior disorder (iRBD) have shown a considerably lower sensitivity in the olfactory epithelium than in CSF or skin. To get an insight into α-synuclein (α-syn) distribution within the nervous system and reasons for low sensitivity, we compared SAA assessment of nasal brushings and skin biopsies in PD (n = 27) and iRBD patients (n = 18) and unaffected controls (n = 30). α-syn misfolding was overall found less commonly in the olfactory epithelium than in the skin, which could be partially explained by the nasal brushing matrix exerting an inhibitory effect on aggregation. Importantly, the α-syn distribution was not uniform: there was a higher deposition of misfolded α-syn across all sampled tissues in the iRBD cohort compared to PD (supporting the notion of RBD as a marker of a more malignant subtype of synucleinopathy) and in a subgroup of PD patients, misfolded α-syn was detectable only in the olfactory epithelium, suggestive of the recently proposed brain-first PD subtype. Assaying α-syn of diverse origins, such as olfactory (part of the central nervous system) and skin (peripheral nervous system), could increase diagnostic accuracy and allow better stratification of patients.
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Affiliation(s)
- A Kuzkina
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - J Rößle
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Seger
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Panzer
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Kohl
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - V Maltese
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - T Musacchio
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - S J Blaschke
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - G Tamgüney
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany
- Institute of Biological Information Processing (Structural Biochemistry: IBI-7), Forschungszentrum Jülich, 52428, Jülich, Germany
| | - S Kaulitz
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - K Rak
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Scherzad
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - P H Zimmermann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Strasse 62, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University Hospital Cologne, Robert-Koch-Strasse 21, 50931, Cologne, Germany
| | - J P Klussmann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Strasse 62, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University Hospital Cologne, Robert-Koch-Strasse 21, 50931, Cologne, Germany
| | - S Hackenberg
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- RWTH Aachen University, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aachen, Germany
| | - J Volkmann
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - C Sommer
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - M Sommerauer
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - K Doppler
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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7
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Iranzo A, Mammana A, Muñoz-Lopetegi A, Dellavalle S, Mayà G, Rossi M, Serradell M, Baiardi S, Arqueros A, Quadalti C, Perissinotti A, Ruggeri E, Cano JS, Gaig C, Parchi P. Misfolded α-Synuclein Assessment in the Skin and CSF by RT-QuIC in Isolated REM Sleep Behavior Disorder. Neurology 2023; 100:e1944-e1954. [PMID: 36931726 PMCID: PMC10159765 DOI: 10.1212/wnl.0000000000207147] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/19/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Real-time quaking-induced conversion (RT-QuIC) assay detects misfolded α-synuclein (AS) in the skin and CSF of patients with the synucleinopathies Parkinson disease and dementia with Lewy bodies. Isolated REM sleep behavior disorder (IRBD) constitutes the prodromal stage of these synucleinopathies. We aimed to compare the ability of RT-QuIC to identify AS in the skin and CSF of patients with IRBD. METHODS This was a cross-sectional study where consecutive patients with polysomnographic-confirmed IRBD and age-matched controls without RBD underwent skin biopsy and lumbar puncture the same day. Three-millimeter skin punch biopsies were obtained bilaterally in the cervical region from dorsal C7 and C8 dermatomes and in distal legs. RT-QuIC assessed AS in these 6 skin sites and the CSF. RESULTS We recruited 91 patients with IRBD and 41 controls. In the skin, sensitivity to detect AS was 76.9% (95% CI 66.9-85.1), specificity 97.6% (95% CI 87.1-99.9) positive predictive value 98.6% (95% CI 91.0-99.8), negative predictive value 65.6% (95% CI 56.6-73.6), and accuracy 83.3% (95% CI 75.9-89.3). In the CSF, the sensitivity was 75.0% (95% CI 64.6-83.6), the specificity was 97.5% (95% CI 86.8-99.9), the positive predictive value was 98.5% (95% CI 90.5-99.8), the negative predictive value was 63.9% (95% CI 55.2-71.9), and the accuracy was 82.0% (95% CI 74.3-88.3). Results in the skin and CSF samples showed 99.2% agreement. Compared with negative patients, RT-QuIC AS-positive patients had a higher likelihood ratio of prodromal Parkinson disease (p < 0.001) and showed more frequently hyposmia (p < 0.001), dopamine transporter imaging single-photon emission CT deficit (p = 0.002), and orthostatic hypotension (p = 0.014). No severe or moderate adverse effects were reported. There was no difference between the percentage of participants reporting mild adverse events secondary to skin biopsy or lumbar puncture (9.1% vs 17.2%; p = 0.053). One hundred and ten (83%) and 104 (80%) participants, respectively, stated they would accept to undergo skin biopsy and lumbar puncture again for research purposes. DISCUSSION Our study in IRBD shows that (1) RT-QuIC detects AS in the skin and CSF with similar high sensitivity, specificity, and agreement, (2) AS RT-QuIC positivity is associated with supportive features and biomarkers of synucleinopathy, and (3) skin punch biopsy and lumbar puncture have comparable mild adverse effects, tolerance, and acceptance. RT-QuIC in the skin or CSF might represent a patient selection strategy for future neuroprotective trials targeting AS in IRBD. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that RT-QuIC-detected AS in the skin and CSF distinguishes patients with IRBD from controls.
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Affiliation(s)
- Alex Iranzo
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain.
| | - Angela Mammana
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Amaia Muñoz-Lopetegi
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Sofia Dellavalle
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Gerard Mayà
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Marcello Rossi
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Monica Serradell
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Simone Baiardi
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Aurora Arqueros
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Corinne Quadalti
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Andres Perissinotti
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Edoardo Ruggeri
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Joan Santamaria Cano
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Carles Gaig
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain
| | - Piero Parchi
- From the Neurology Service (A.I., A.M.-L., G.M., M.S., A.A., J.S.C., C.G.), Sleep Centre, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII; IRCCS (A.M., S.D., M.R., S.B., C.Q., E.R., P.P.), Istituto delle Scienze Neurologiche di Bologna (ISNB); Department of Biomedical and Neuromotor Sciences (A.M., S.B., P.P.), University of Bologna; and Nuclear Medicine Service (A.P.), Hospital Clínic Barcelona, Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Spain.
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