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Liu K, An J, Zhang J, Zhao J, Sun P, He Z. Network pharmacology combined with experimental validation show that apigenin as the active ingredient of Campsis grandiflora flower against Parkinson's disease by inhibiting the PI3K/AKT/NF-κB pathway. PLoS One 2024; 19:e0311824. [PMID: 39383141 PMCID: PMC11463827 DOI: 10.1371/journal.pone.0311824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 09/25/2024] [Indexed: 10/11/2024] Open
Abstract
The exploration of novel natural products for Parkinson's disease (PD) is a focus of current research, as there are no definitive drugs to cure or stop the disease. Campsis grandiflora (Thunb.) K. Schum (Lingxiaohua) is a traditional Chinese medicine (TCM), and the exact active constituents and putative mechanisms for treating PD are unknown. Through data mining and network pharmacology, apigenin (APi) was identified as the main active ingredient of Lingxiaohua, and key targets (TNF, AKT1, INS, TP53, CASP3, JUN, BCL2, MMP9, FOS, and HIF1A) of Lingxiaohua for the treatment of PD were discovered. The primary routes implicated were identified as PI3K/AKT, Apoptosis, TNF, and NF-κB pathways. Subsequently, therapeutic potential of APi in PD and its underlying mechanism were experimentally evaluated. APi suppressed the release of mediators of inflammation and initiation of NF-κB pathways in MES23.5 cells induced by MPP+. APi suppressed caspase-3 activity and apoptosis and elevated p-AKT levels in MES23.5 cells. Pretreatment with LY294002, a PI3K inhibitor, resulted in APi treatment blocking the activation of NF-κB pathway and expression of inflammatory factors in MES23.5 cells by activating the PI3K/AKT pathway. In conclusion, APi protects dopaminergic neurons by controlling the PI3K/AKT/NF-κB pathway, giving novel insights into the pharmacological mechanism of Lingxiaohua in treating PD.
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Affiliation(s)
- Kai Liu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurosurgery, People’s Hospital of Rizhao, Jining Medical College, Rizhao, Shandong, China
| | - Jing An
- Department of Pathology, People’s Hospital of Rizhao, Jining Medical College, Rizhao, Shandong, China
| | - Jing Zhang
- Department of Pharmacy, Jining Medical College, Rizhao, Shandong, China
| | - Jihu Zhao
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Sun
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaohui He
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Neha, Mazahir I, Khan SA, Kaushik P, Parvez S. The Interplay of Mitochondrial Bioenergetics and Dopamine Agonists as an Effective Disease-Modifying Therapy for Parkinson's Disease. Mol Neurobiol 2024; 61:8086-8103. [PMID: 38468113 DOI: 10.1007/s12035-024-04078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
Parkinson's disease (PD) is a progressive neurological ailment with a slower rate of advancement that is more common in older adults. The biggest risk factor for PD is getting older, and those over 60 have an exponentially higher incidence of this condition. The failure of the mitochondrial electron chain, changes in the dynamics of the mitochondria, and abnormalities in calcium and ion homeostasis are all symptoms of Parkinson's disease (PD). Increased mitochondrial reactive oxygen species (mROS) and an energy deficit are linked to these alterations. Levodopa (L-DOPA) is a medication that is typically used to treat most PD patients, but because of its negative effects, additional medications have been created utilizing L-DOPA as the parent molecule. Ergot and non-ergot derivatives make up most PD medications. PD is successfully managed with the use of dopamine agonists (DA). To get around the motor issues produced by L-DOPA, these dopamine derivatives can directly excite DA receptors in the postsynaptic membrane. In the past 10 years, two non-ergoline DA with strong binding properties for the dopamine D2 receptor (D2R) and a preference for the dopamine D3 receptor (D3R) subtype, ropinirole, and pramipexole (PPx) have been developed for the treatment of PD. This review covers the most recent research on the efficacy and safety of non-ergot drugs like ropinirole and PPx as supplementary therapy to DOPA for the treatment of PD.
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Affiliation(s)
- Neha
- Department of Toxicology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Iqra Mazahir
- Department of Toxicology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Sara Akhtar Khan
- Department of Toxicology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Pooja Kaushik
- Department of Toxicology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, India.
| | - Suhel Parvez
- Department of Toxicology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, 110062, India.
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Jost WH. Dopamine agonists in the treatment of Parkinson's disease: the show must go on. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02825-8. [PMID: 39261330 DOI: 10.1007/s00702-024-02825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024]
Abstract
Dopamine agonists (DA) have proven very successful in the treatment of Parkinson's disease for a good many years now. In the 1990's they experienced a high level of acceptance particularly in the European countries because their efficacy was in fact established, their tolerability was improved on and, in addition, several preparations were available with longer effect durations. But the discovery of cardiac fibroses led to a substantial setback and even rejection of therapy using ergoline DA. In recent years, impulse control disturbances have been observed increasingly with the result that higher doses have been reduced and the previously popular use of non-ergoline DA was discontinued. In addition, newer data on levodopa were published which clearly relativized the occurrence of late complications under levodopa and led to a differentiated use. Thus the importance of their use has waned over the years. But we should rather avoid repeating the mistakes of the past. DA serve us well and reliably so. The pendulum apparently thrives of the extremes but in the case of DA we should keep from falling back into the other extreme: We can and in fact must further make use of the DA, but with a clear view of specific goals and in a differentiated way. DA constitute the second-most important substance class after levodopa. Their optimized application can only be recommended for the good of our patients.
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Affiliation(s)
- Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77723, Wolfach, Germany.
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Haji S, Sako W, Murakami N, Osaki Y, Izumi Y. Factors associated with a placebo effect in Parkinson's disease in clinical trials: a meta-analysis. J Neurol 2024; 271:5825-5837. [PMID: 38955829 DOI: 10.1007/s00415-024-12529-4] [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: 04/18/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Outcomes of clinical trials of treatment in patients with Parkinson's disease (PD) may be influenced by placebo effects. The aim of this study was to determine the factors associated with placebo effects in Parkinson's disease (PD) for guidance with design of future clinical trials. METHODS Factors associated with placebo effects in PD were examined in a meta-analysis using a random effects model with pooling of placebo effects on the Unified Parkinson's Disease Rating Scale part III (UPDRS III) or Movement Disorder Society sponsored revision of UPDRS III (MDS-UPDRS III). The following prespecified variables were included in the analyses: with or without drug at baseline, with or without a placebo run-in phase, with or without motor fluctuation, published year, number of study sites, placebo administration period, age, sex, disease duration, and daily levodopa dose. Publication bias was assessed by visual inspection of funnel plots and adjusted using the trim-and-fill method. RESULTS Thirty-eight articles with a total of 4828 subjects satisfied the inclusion criteria. There was a significant placebo effect using UPDRS III or MDS-UPDRS III (SMD = - 0.25; 95% CI - 0.35 to - 0.14; p < 0.001, I2 = 92%). Subgroup and/or multivariate meta-regression analyses revealed that placebo effects were associated with advanced PD (p = 0.04), drug exposure at baseline (p < 0.001), placebo administration period (p < 0.001), and disease duration (p < 0.01). CONCLUSIONS The results of this study are important as guidance in design of future clinical trials in which the influence of placebo effects is minimized.
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Affiliation(s)
- Shotaro Haji
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Wataru Sako
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Nagahisa Murakami
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Neurology, Shinko Hospital, Kobe, Japan
| | - Yusuke Osaki
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Höllerhage M, Becktepe J, Classen J, Deuschl G, Ebersbach G, Hopfner F, Lingor P, Löhle M, Maaß S, Pötter-Nerger M, Odin P, Woitalla D, Trenkwalder C, Höglinger GU. Pharmacotherapy of motor symptoms in early and mid-stage Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12632-6. [PMID: 39207521 DOI: 10.1007/s00415-024-12632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE There are multiple pharmacological treatment options for motor symptoms of Parkinson's disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. METHODS The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson's Guideline Group, and publicly released in November 2023. RESULTS In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise "Parkinson medication", "Initial monotherapy", "Early combination therapy", "Fluctuations and dyskinesia", and "Parkinsonian tremor". Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. CONCLUSION The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations.
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Affiliation(s)
| | - Jos Becktepe
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | | | - Franziska Hopfner
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany
| | - Paul Lingor
- School of Medicine and Health, Department of Neurology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Matthias Löhle
- Department of Neurology, University of Rostock, 18051, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Sylvia Maaß
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Günter U Höglinger
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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Ramanzini LG, Frare JM, Camargo LFM, Silveira JOF, Jankovic J. Does Delaying Levodopa Prevent Motor Complications in Parkinson's Disease? A Meta-Analysis. Mov Disord Clin Pract 2024. [PMID: 39189097 DOI: 10.1002/mdc3.14198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 07/24/2024] [Accepted: 08/11/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND There has been a long debate whether delaying treatment with levodopa prevents motor complications in Parkinson's disease (PD). OBJECTIVES We performed a meta-analysis on randomized clinical trials (RCTs) that compared early- versus delayed-start treatment with levodopa in PD. METHODS A systematic review was conducted in PubMed, EMBASE, and Web of Science databases from inception to July 1, 2023. Only RCTs that compared early and delayed levodopa treatment in PD were included. Non-randomized comparisons from follow-up studies were included as well. Our primary outcomes were occurrence of overall motor complications, motor fluctuations, and dyskinesias. RESULTS Seven studies with a total of 1149 patients (636 in the early-start group and 513 in the delayed-start) were included in our analysis. There was no difference between groups regarding motor complications (OR 1.39; 95% CI: 0.68-1.72; P = 0.37) or dyskinesias (OR 1.52; 95% CI: 0.90-2.57; P = 0.11). Motor fluctuations occurred less frequently in the early-start group (OR 0.70; 95% CI: 0.52-0.95; P = 0.02). Nonetheless, on subgroup analysis of dopamine agonists, rate of dyskinesias was smaller in the delayed-start group (OR 1.82; 95% CI: 1.08-3.07; P = 0.03). CONCLUSIONS Delaying treatment with levodopa does not seem to prevent levodopa-related motor complications in PD. Adjunct treatment with dopamine agonists may reduce the need for higher doses of levodopa and thus reduce the risk for dyskinesias but this practice is often associated with a higher frequency of adverse effects related to dopamine agonists.
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Affiliation(s)
| | - Julia M Frare
- Department of Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Luís F M Camargo
- Medical School, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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Crispo JAG, Farhat N, Fortin Y, Perez-Lloret S, Sikora L, Morgan RL, Habash M, Gogna P, Kelly SE, Elliott J, Kohen DE, Bjerre LM, Mattison DR, Hessian RC, Willis AW, Krewski D. Non-Ergot Dopamine Agonists and the Risk of Heart Failure and Other Adverse Cardiovascular Reactions in Parkinson's Disease. Brain Sci 2024; 14:776. [PMID: 39199470 PMCID: PMC11352331 DOI: 10.3390/brainsci14080776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
Reports suggest possible risks of adverse cardiovascular reactions, including heart failure, associated with non-ergot dopamine agonist (DA) use in Parkinson's disease (PD). The objectives of our review were to evaluate the risk of heart failure and other adverse cardiovascular reactions in PD patients who received a non-ergot DA compared with other anti-PD pharmacological interventions, placebo, or no intervention. Studies were identified via searches of six bibliographic databases. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were eligible for study inclusion. Random-effect meta-analyses were performed to estimate adverse cardiovascular reaction risks. Quality of evidence was assessed using GRADE. In total, forty-four studies (thirty-six RCTs and eight NRS) satisfied our inclusion criteria. A single RCT found no significant difference in the risk of heart failure with ropinirole compared with bromocriptine (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.07 to 2.04; low certainty). Conversely, three case-control studies reported a risk of heart failure with non-ergot DA treatment. The quality of evidence for the risk of heart failure was judged as low or very low. Findings suggest that non-ergot DA use may be associated with adverse cardiovascular outcomes, including heart failure. Studies are needed to better understand cardiovascular risks associated with PD treatment.
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Affiliation(s)
- James A. G. Crispo
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Human Sciences Division, NOSM University, Sudbury, ON P3E 2C6, Canada
| | - Nawal Farhat
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Yannick Fortin
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Santiago Perez-Lloret
- Observatorio de Salud, Pontificia Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires C1107AAZ, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires C1121ABG, Argentina
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Mara Habash
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Shannon E. Kelly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Dafna E. Kohen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Lise M. Bjerre
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Institut du Savoir Montfort, Ottawa, ON K1K 0T2, Canada
| | - Donald R. Mattison
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
| | - Renée C. Hessian
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Allison W. Willis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurological Outcomes Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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Huenchuguala S, Segura-Aguilar J. Targets to Search for New Pharmacological Treatment in Idiopathic Parkinson's Disease According to the Single-Neuron Degeneration Model. Biomolecules 2024; 14:673. [PMID: 38927076 PMCID: PMC11201619 DOI: 10.3390/biom14060673] [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: 03/15/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
One of the biggest problems in the treatment of idiopathic Parkinson's disease is the lack of new drugs that slow its progression. L-Dopa remains the star drug in the treatment of this disease, although it induces severe side effects. The failure of clinical studies with new drugs depends on the use of preclinical models based on neurotoxins that do not represent what happens in the disease since they induce rapid and expansive neurodegeneration. We have recently proposed a single-neuron degeneration model for idiopathic Parkinson's disease that requires years to accumulate enough lost neurons for the onset of motor symptoms. This single-neuron degeneration model is based on the excessive formation of aminochrome during neuromelanin synthesis that surpass the neuroprotective action of the enzymes DT-diaphorase and glutathione transferase M2-2, which prevent the neurotoxic effects of aminochrome. Although the neurotoxic effects of aminochrome do not have an expansive effect, a stereotaxic injection of this endogenous neurotoxin cannot be used to generate a preclinical model in an animal. Therefore, the aim of this review is to evaluate the strategies for pharmacologically increasing the expression of DT diaphorase and GSTM2-2 and molecules that induce the expression of vesicular monoamine transporter 2, such as pramipexole.
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Affiliation(s)
- Sandro Huenchuguala
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Santiago 8370003, Chile;
| | - Juan Segura-Aguilar
- Molecular & Clinical Pharmacology, ICBM, Faculty of Medicine, University of Chile, Santiago 8330111, Chile
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9
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Li X, Dong ZY, Dong M, Chen L. Early dopaminergic replacement treatment initiation benefits motor symptoms in patients with Parkinson's disease. Front Hum Neurosci 2024; 18:1325324. [PMID: 38807633 PMCID: PMC11131585 DOI: 10.3389/fnhum.2024.1325324] [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: 10/21/2023] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
Background Parkinson's disease (PD) generally progresses slowly, but it is controversial whether delaying treatment accelerates the progression. Objective Determine the correlation between the time of dopaminergic replacement treatment initiation and the severity of clinical symptoms in PD, including motor and non-motor symptoms. Methods PD patients were divided between 155 people who were diagnosed de novo and 165 PD patients receiving dopamine replacement therapy. Basic patient characteristics included gender, age, age at onset, disease duration, and the time of dopaminergic replacement treatment initiation. We used MDS-UPDRS scores to evaluate the severity of motor symptoms and we also used the scale to assess the severity of non-motor symptoms such as cognition, mood, sleep, and quality of life. Results The mean time between symptom onset and the initiation of drug treatment was 31.0 (22.5) months. After adjusting for age, sex, age at onset, and disease duration, we found that the MDS-Unified Parkinson's Disease Rating Scale (UPDRS)-III score increased faster in the de novo group with a similar disease duration (F = 8.7, p = 0.0034) than the treatment group. The cumulative incidence of progression to H-Y score 3 in de novo PD group over disease duration was 39.7% in 50months and 92.2% in 100 months, while in treated group such cumulative incidence was 15.5% in 50 months, 51.4% in 100 months and 81.5% in 150 months. The cumulative incidence of patients in the de novo PD group was higher than that in the treated group (p = 0.001), suggesting that untreated patients were more likely to progress to the advanced stages. Symptoms onset, the time between symptom onset and treatment initiation, age, sex, and disease duration explained 28.95% of the total variation in the MDS-UPDRS-III score for motor symptoms. In drug-naïve patients, the time between symptom onset and treatment initiation explained 20.1% of the total variation in the MDS-UPDRS-III score for motor symptoms (t = 6.15, p < 0.001). Conclusions These data in our study showed that early dopaminergic replacement treatment have played a positive role in PD patients, while dopaminergic replacement delayed treatment might be detrimental to motor symptoms and non-motor state of PD patient. Recognizing early stage symptoms of PD and early diagnosis are of great significance to treatment.
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Affiliation(s)
- Xin Li
- Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhao-ying Dong
- Department of Neurology, Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Meng Dong
- Tianjin Medical University, Tianjin, China
| | - Lei Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Diseases and Neurodegenerative Disease, Tianjin, China
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10
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Davidson B, Milosevic L, Kondrataviciute L, Kalia LV, Kalia SK. Neuroscience fundamentals relevant to neuromodulation: Neurobiology of deep brain stimulation in Parkinson's disease. Neurotherapeutics 2024; 21:e00348. [PMID: 38579455 PMCID: PMC11000190 DOI: 10.1016/j.neurot.2024.e00348] [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: 11/15/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Deep Brain Stimulation (DBS) has become a pivotal therapeutic approach for Parkinson's Disease (PD) and various neuropsychiatric conditions, impacting over 200,000 patients. Despite its widespread application, the intricate mechanisms behind DBS remain a subject of ongoing investigation. This article provides an overview of the current knowledge surrounding the local, circuit, and neurobiochemical effects of DBS, focusing on the subthalamic nucleus (STN) as a key target in PD management. The local effects of DBS, once thought to mimic a reversible lesion, now reveal a more nuanced interplay with myelinated axons, neurotransmitter release, and the surrounding microenvironment. Circuit effects illuminate the modulation of oscillatory activities within the basal ganglia and emphasize communication between the STN and the primary motor cortex. Neurobiochemical effects, encompassing changes in dopamine levels and epigenetic modifications, add further complexity to the DBS landscape. Finally, within the context of understanding the mechanisms of DBS in PD, the article highlights the controversial question of whether DBS exerts disease-modifying effects in PD. While preclinical evidence suggests neuroprotective potential, clinical trials such as EARLYSTIM face challenges in assessing long-term disease modification due to enrollment timing and methodology limitations. The discussion underscores the need for robust biomarkers and large-scale prospective trials to conclusively determine DBS's potential as a disease-modifying therapy in PD.
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Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Canada.
| | - Luka Milosevic
- KITE, Toronto, Canada; CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Laura Kondrataviciute
- CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Lorraine V Kalia
- CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Canada; KITE, Toronto, Canada; CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada
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11
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Soileau LG, Talbot NC, Storey NR, Spillers NJ, D'antoni JV, Carr PC, Galardo CM, Shilpadevi P, Ahmadzadeh S, Shekoohi S, Kaye AD. Impulse control disorders in Parkinson's disease patients treated with pramipexole and ropinirole: a systematic review and meta-analysis. Neurol Sci 2024; 45:1399-1408. [PMID: 38079019 DOI: 10.1007/s10072-023-07254-1] [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: 10/18/2023] [Accepted: 12/02/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND This analysis is the first systematic review and meta-analysis assessing occurrences of ICD in PD patients treated with oral DAs: ropinirole (ROP) and pramipexole (PRX). This study compares the two oral DAs to a transdermal patch, rotigotine (RTG). METHODS We performed an extensive systematic search for eligible studies from PubMed, Embase, Cochrane Library, and Google Scholar. The data was analyzed by various software, including EndNote, Rayyan, PRISM, and RevMan. Two studies incorporating 658 patients collectively were assessed. RESULTS This meta-analysis shows a significant correlation between the usage of PRX (25.3%) or ROP (21.8%) and the development of ICD in PD patients. Compared to the transdermal patch, RTG, PRX was found to have a significant relative risk (P < 0.0001) of 3.46 (95% CI 2.07-5.76), and ROP was found to have a significant relative risk (P < 0.0001) of 2.98 (95% CI 1.77-5.02). The data collected shows RTG is approximately three times less likely to cause ICDs than oral PRX and ROP. CONCLUSION The present investigation provides insight into ICD occurrences with PRX, ROP, and RTG to allow physicians to make more informed decisions on risk versus reward when deciding how to treat a PD patient with these drugs. However, related to various disclosed limitations, our conclusion cannot provide definitive practice protocols.
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Affiliation(s)
- Lenise G Soileau
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Nicholas R Storey
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Noah J Spillers
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - James V D'antoni
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Peter C Carr
- School of Medicine, Louisiana State University Health Science Center New Orleans, 433 Bolivar St, New Orleans, LA, 70112, USA
| | - Connor M Galardo
- University of Southern Mississippi, 118 College Drive, Hattiesburg, MS, 39406, USA
| | - Patil Shilpadevi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
- Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA
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12
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Terada T, Bunai T, Hashizume T, Matsudaira T, Yokokura M, Takashima H, Konishi T, Obi T, Ouchi Y. Neuroinflammation following anti-parkinsonian drugs in early Parkinson's disease: a longitudinal PET study. Sci Rep 2024; 14:4708. [PMID: 38409373 PMCID: PMC10897150 DOI: 10.1038/s41598-024-55233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
The progression of neuroinflammation after anti-parkinsonian therapy on the Parkinson's disease (PD) brain and in vivo evidence of the therapy purporting neuroprotection remain unclear. To elucidate this, we examined changes in microglial activation, nigrostriatal degeneration, and clinical symptoms longitudinally after dopamine replacement therapy in early, optimally-controlled PD patients with and without zonisamide treatment using positron emission tomography (PET). We enrolled sixteen PD patients (Hoehn and Yahr stage 1-2), and age-matched normal subjects. PD patients were randomly divided into two groups: one (zonisamide+) that did and one (zonisamide-) that did not undergo zonisamide therapy. Annual changes in neuroinflammation ([11C]DPA713 PET), dopamine transporter availability ([11C]CFT PET) and clinical severity were examined. Voxelwise differentiations in the binding of [11C]DPA713 (BPND) and [11C]CFT (SUVR) were compared with normal data and between the zonisamide+ and zonisamide- PD groups. The cerebral [11C]DPA713 BPND increased with time predominantly over the parieto-occipital region in PD patients. Comparison of the zonisamide+ group with the zonisamide- group showed lower levels in the cerebral [11C]DPA713 BPND in the zonisamide+ group. While the striatal [11C]CFT SUVR decreased longitudinally, the [11C]CFT SUVR in the nucleus accumbens showed a higher binding in the zonisamide+ group. A significant annual increase in attention score were found in the zonisamide+ group. The current results indicate neuroinflammation proceeds to the whole brain even after anti-parkinsonian therapy, but zonisamide coadministration might have the potential to ameliorate proinflammatory responses, exerting a neuroprotective effect in more damaged nigrostriatal regions with enhanced attention in PD.
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Affiliation(s)
- Tatsuhiro Terada
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Tomoyasu Bunai
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takanori Hashizume
- Laboratory of Drug Metabolism and Pharmacokinetics, Faculty of Pharmacy, Osaka Ohtani University, Tondabayashi, Japan
| | - Takashi Matsudaira
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Masamichi Yokokura
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotsugu Takashima
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Takashi Konishi
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Tomokazu Obi
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
- Hamamatsu Medical Imaging Center, Hamamatsu Medical Photonics Foundation, Hamamatsu, Japan.
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13
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Wolff AW, Bidner H, Remane Y, Zimmer J, Aarsland D, Rascol O, Wyse RK, Hapfelmeier A, Lingor P. Protocol for a randomized, placebo-controlled, double-blind phase IIa study of the safety, tolerability, and symptomatic efficacy of the ROCK-inhibitor Fasudil in patients with Parkinson's disease (ROCK-PD). Front Aging Neurosci 2024; 16:1308577. [PMID: 38419648 PMCID: PMC10899319 DOI: 10.3389/fnagi.2024.1308577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Background The Rho-kinase (ROCK) inhibitor Fasudil has shown symptomatic and disease-modifying effects in Parkinson's disease (PD) models in vitro and in vivo. In Japan, Fasudil has been approved for the treatment of subarachnoid haemorrhage since 1995 and shows a favourable safety profile. Objectives/design To investigate the safety, tolerability, and symptomatic efficacy of ROCK-inhibitor Fasudil in comparison to placebo in a randomized, national, multicenter, double-blind phase IIa study in patients with PD. Methods/analysis We plan to include 75 patients with at least 'probable' PD (MDS criteria), Hoehn and Yahr stages 1-3, and age 30-80 years in 13 German study sites. Patients must be non-fluctuating and their response to PD medication must have been stable for 6 weeks. Patients will be randomly allocated to treatment with the oral investigational medicinal product (IMP) containing either Fasudil in two dosages, or placebo, for a total of 22 days. As primary analysis, non-inferiority of low/high dose of Fasudil on the combined endpoint consisting of occurrence of intolerance and/or treatment-related serious adverse events (SAEs) over 22 days will be assessed in a sequential order, starting with the lower dose. Secondary endpoints will include tolerability alone over 22 days and occurrence of treatment-related SAEs (SARs) over 22 and 50 days and will be compared on group level. Additional secondary endpoints include efficacy on motor and non-motor symptoms, measured on established scales, and will be assessed at several timepoints. Biomaterial will be collected to determine pharmacokinetics of Fasudil and its active metabolite, and to evaluate biomarkers of neurodegeneration. Ethics/registration/discussion After positive evaluation by the competent authority and the ethics committee, patient recruitment started in the 3rd quarter of 2023. ROCK-PD is registered with Eudra-CT (2021-003879-34) and clinicaltrials.gov (NCT05931575). Results of this trial can pave way for conducting extended-duration studies assessing both symptomatic efficacy and disease-modifying properties of Fasudil.
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Affiliation(s)
- Andreas W Wolff
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Helen Bidner
- Münchner Studienzentrum (MSZ), School of Medicine, Technical University of Munich, Munich, Germany
| | - Yvonne Remane
- Department of Clinical Pharmacy and Drug Safety Center, Leipzig University, Leipzig, Germany
| | - Janine Zimmer
- Department of Clinical Pharmacy and Drug Safety Center, Leipzig University, Leipzig, Germany
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Olivier Rascol
- Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, University of Toulouse 3, University Hospital of Toulouse, INSERM, Toulouse, France
| | | | - Alexander Hapfelmeier
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
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14
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Seppänen P, Forsberg MM, Tiihonen M, Laitinen H, Beal S, Dorman DC. A Systematic Review and Meta-Analysis of the Efficacy and Safety of Rasagiline or Pramipexole in the Treatment of Early Parkinson's Disease. PARKINSON'S DISEASE 2024; 2024:8448584. [PMID: 38264500 PMCID: PMC10805557 DOI: 10.1155/2024/8448584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/29/2023] [Accepted: 11/29/2023] [Indexed: 01/25/2024]
Abstract
Background Rasagiline or pramipexole monotherapy has been suggested for the management of early Parkinson's disease (PD). The aim of this research was to systematically review the clinical efficacy and safety of rasagiline or pramipexole in early PD (defined as disease duration ≤5 years and Hoehn and Yahr stage of ≤3). Methods Randomized controlled trials (RCTs) of rasagiline or pramipexole for early PD published up to September 2021 were retrieved. Outcomes of interest included changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II and III and the incidence of adverse events. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated, and heterogeneity was measured with the I2 test. Results Nine rasagiline and eleven pramipexole RCTs were included. One post hoc analysis of one rasagiline study was included. Five studies for each drug were included in meta-analyses of the UPDRS scores. The rasagiline meta-analysis focused on patients receiving 1 mg/day. Rasagiline and pramipexole significantly improved UPDRS Part II and III scores when compared to placebo. Significant heterogeneity among the studies was present (I2 > 70%). Neither rasagiline nor pramipexole increased the relative risk for any adverse events, serious adverse events, or adverse events leading to withdrawal when compared with placebo. Conclusion Applying a Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to summarize the evidence, we found moderate confidence in the body of evidence for the efficacy of rasagiline or pramipexole in early PD, suggesting further well-designed, multicenter comparative RCTs remain needed.
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Affiliation(s)
- Pauli Seppänen
- University of Eastern Finland, Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Markus M. Forsberg
- University of Eastern Finland, Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Miia Tiihonen
- University of Eastern Finland, Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | | | - Selena Beal
- North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA
| | - David C. Dorman
- North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA
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15
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Dong W, Qiu C, Lu Y, Luo B, Jiang X, Chang L, Yan J, Sun J, Liu W, Zhang L, Zhang W. Effect of deep brain stimulation compared with drug therapy alone on the progression of Parkinson's disease. Front Neurosci 2024; 17:1330752. [PMID: 38260017 PMCID: PMC10800581 DOI: 10.3389/fnins.2023.1330752] [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: 10/31/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background Parkinson's disease (PD) symptoms deteriorate with disease progression. Although deep brain stimulation (DBS) can effectively improve the motor signs of PD patients, it is not yet known whether DBS surgery, which is an invasive treatment modality, may change the progression of PD. Objective The aim of this work was to compare the effect of DBS with that of drug treatment on the progression of PD. Methods A total of 77 patients with PD with the Hoehn and Yahr scale (HY) stage of 2.5 or 3 were included, and were divided into 34 in the drug therapy alone group (Drug-G) and 43 in the DBS therapy group (DBS-G). All patients were subjected to a follow-up of 2 years, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Montreal Cognitive Assessment (MOCA), the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD) scores. In addition, the quality of life of patients and the burden on their family were assessed by the 39-item PD questionnaire (PDQ-39) scores, daily levodopa equivalent dose (LED), patient's annual treatment-related costs, and the Zarit Caregiver Burden Scale (ZCBS) score. The changes in relevant scale scores between the two groups were compared at each follow-up stage. Results The UPDRS-III score of the patients in the "off" state increased from year to year in both groups, and the degree of increase of this score was greater in the DBS-G than in the Drug-G group. The MOCA score in both groups began to decline in the 2nd year of follow-up, and the decline was greater in the Drug-G than in the DBS-G group. DBS treatment did not affect patients' psychiatric disorders. The PDQ39, LED, costs, and ZCBS were negatively correlated with the follow-up time in patients in the DBS-G group, and positively correlated with the follow-up time in patients in the Drug-G. Conclusion PD is progressive regardless of treatment. The findings from this follow-up study suggest that the disease progression of patients in DBS-G may be slightly faster compared to the drug-G, but the advantages of DBS are also evident. Indeed, DBS better improves patient's motor signs and quality of life and reduces the family burden. In addition, DBS has less impact on patients in terms of cognitive and mental effects.
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Affiliation(s)
- Wenwen Dong
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Qiu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Lu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Bei Luo
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Jiang
- Department of Geriatric Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Chang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiuqi Yan
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Sun
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatric Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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16
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Mahlknecht P, Poewe W. Pharmacotherapy for Disease Modification in Early Parkinson's Disease: How Early Should We Be? JOURNAL OF PARKINSON'S DISEASE 2024; 14:S407-S421. [PMID: 38427503 DOI: 10.3233/jpd-230354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Slowing or halting progression continues to be a major unmet medical need in Parkinson's disease (PD). Numerous trials over the past decades have tested a broad range of interventions without ultimate success. There are many potential reasons for this failure and much debate has focused on the need to test 'disease-modifying' candidate drugs in the earliest stages of disease. While generally accepted as a rational approach, it is also associated with significant challenges around the selection of trial populations as well as trial outcomes and durations. From a health care perspective, intervening even earlier and before at-risk subjects have gone on to develop overt clinical disease is at the heart of preventive medicine. Recent attempts to develop a framework for a biological definition of PD are aiming to enable 'preclinical' and subtype-specific diagnostic approaches. The present review addresses past efforts towards disease-modification, including drug targets and reasons for failure, as well as novel targets that are currently being explored in disease-modification trials in early established PD. The new biological definitions of PD may offer new opportunities to intervene even earlier. We critically discuss the potential and challenges around planning 'disease-prevention' trials in subjects with biologically defined 'preclinical' or prodromal PD.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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17
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Arshad U, Rahman F, Hanan N, Chen C. Longitudinal Meta-Analysis of Historical Parkinson's Disease Trials to Inform Future Trial Design. Mov Disord 2023; 38:1716-1727. [PMID: 37400277 DOI: 10.1002/mds.29514] [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: 01/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The outcome of clinical trials in neurodegeneration can be highly uncertain due to the presence of a strong placebo effect. OBJECTIVES To develop a longitudinal model that can enhance the success of future Parkinson's disease trials by quantifying trial-to-trial variations in placebo and active treatment response. METHODS A longitudinal model-based meta-analysis was conducted on the total score of Unified Parkinson's Disease Rating Scale (UPDRS) Parts 1, 2, and 3. The analysis included aggregate data from 66 arms (observational [4], placebo [28], or investigational-drug-treated [34]) from 4 observational studies and 17 interventional trials. Inter-study variabilities in key parameters were estimated. Residual variability was weighted by the size of study arms. RESULTS The baseline total UPDRS was estimated to average at 24.5 points. Disease score was estimated to worsen by 3.90 points/year for the duration of the treatments; whilst notably, arms with a lower baseline progressed faster. The model captured the transient nature of the placebo response and sustained symptomatic drug effect. Both placebo and drug effects peaked within 2 months; although, 1 year was needed to observe the full treatment difference. Across these studies, the progression rate varied by 59.4%, the half-life for offset of placebo response varied by 79.4%, and the amplitude for drug effect varied by 105.3%. CONCLUSION The longitudinal model-based meta-analysis describes UPDRS progression rate, captures the dynamics of the placebo response, quantifies the effect size of the available therapies, and sets the expectation of uncertainty for future trials. The findings provide informative priors to enhance the rigor and success of future trials of promising agents, including potential disease modifiers. © 2023 GSK. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Usman Arshad
- Clinical Pharmacology Modeling and Simulation, GSK, Upper Providence, Pennsylvania, USA
| | - Fatima Rahman
- Clinical Pharmacology Modeling and Simulation, GSK, Upper Providence, Pennsylvania, USA
| | - Nathan Hanan
- Clinical Pharmacology Modeling and Simulation, GSK, Upper Providence, Pennsylvania, USA
| | - Chao Chen
- Clinical Pharmacology Modeling and Simulation, GSK, Upper Providence, Pennsylvania, USA
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18
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Woitalla D, Buhmann C, Hilker-Roggendorf R, Höglinger G, Koschel J, Müller T, Weise D. Role of dopamine agonists in Parkinson's disease therapy. J Neural Transm (Vienna) 2023; 130:863-873. [PMID: 37165120 DOI: 10.1007/s00702-023-02647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
Dopamine agonists are an important component of Parkinson's therapy. When weighing up the various therapy options, therapy with levodopa has recently been increasingly preferred due to its stronger efficacy and the ostensibly lower rate of side effects. The advantage of the lower incidence of motor complications during therapy with dopamine agonists was neglected. The occurrence of side effects can be explained by the different receptor affinity to the individual dopaminergic and non-dopaminergic receptors of the individual dopamine agonists. However, the different affinity to individual receptors also explains the different effect on individual Parkinson symptoms and can, therefore, contribute to a targeted use of the different dopamine agonists. Since comparative studies on the differential effect of dopamine agonists have only been conducted for individual substances, empirical knowledge of the differential effect is of great importance. Therefore, the guidelines for the treatment of Parkinson's disease do not consider the differential effect of the dopamine agonists. The historical consideration of dopamine agonists within Parkinson's therapy deserves special attention to be able to classify the current discussion about the significance of dopamine agonists.
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Affiliation(s)
- D Woitalla
- Department of Neurology, Katholische Kliniken Der Ruhrhalbinsel, Essen, Germany.
| | - C Buhmann
- Department of Neurology, Universitätsklinikum Hamburg, Hamburg, Germany
| | | | - G Höglinger
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - J Koschel
- Department of Neurology Parkinson-Klinik Ortenau, Wolfach, Germany
| | - T Müller
- Department of Neurology, Alexianer St. Joseph Krankenhaus, Berlin, Germany
| | - D Weise
- Department of Neurology, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany
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19
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Ong WY, Leow DMK, Herr DR, Yeo CJJ. What Do Randomized Controlled Trials Inform Us About Potential Disease-Modifying Strategies for Parkinson's Disease? Neuromolecular Med 2023; 25:1-13. [PMID: 35776238 DOI: 10.1007/s12017-022-08718-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/05/2022] [Indexed: 01/09/2023]
Abstract
Research advances have shed new insight into cellular pathways contributing to PD pathogenesis and offer increasingly compelling therapeutic targets. In this review, we made a broad survey of the published literature that report possible disease-modifying effects on PD. While there are many studies that demonstrate benefits for various therapies for PD in animal and human studies, we confined our search to human "randomised controlled trials" and with the key words "neuroprotection" or "disease-modifying". It is hoped that through studying the results of these trials, we might clarify possible mechanisms that underlie idiopathic PD. This contrasts with studying the effect of pathophysiology of familial PD, which could be carried out by gene knockouts and animal models. Randomised controlled trials indicate promising effects of MAO-B inhibitors, dopamine agonists, NMDA receptor antagonists, metabotropic glutamate receptor antagonists, therapies related to improving glucose utilization and energy production, therapies related to reduction of excitotoxicity and oxidative stress, statin use, therapies related to iron chelation, therapies related to the use of phytochemicals, and therapies related to physical exercise and brain reward pathway on slowing PD progression. Cumulatively, these approaches fall into two categories: direct enhancement of dopaminergic signalling, and reduction of neurodegeneration. Overlaps between the two categories result in challenges in distinguishing between symptomatic versus disease-modifying effects with current clinical trial designs. Nevertheless, a broad-based approach allows us to consider all possible therapeutic avenues which may be neuroprotective. While the traditional standard of care focuses on symptomatic management with dopaminergic drugs, more recent approaches suggest ways to preserve dopaminergic neurons by attenuating excitotoxicity and oxidative stress.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore.
| | - Damien Meng-Kiat Leow
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Deron R Herr
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Crystal Jing-Jing Yeo
- Institute of Molecular and Cell Biology, A*Star, Singapore, 138673, Singapore
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
- LKC School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- National Neuroscience Institute, Singapore, 308433, Singapore
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20
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Duque KR, Vizcarra JA, Hill EJ, Espay AJ. Disease-modifying vs symptomatic treatments: Splitting over lumping. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:187-209. [PMID: 36803811 DOI: 10.1016/b978-0-323-85555-6.00020-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Clinical trials of putative disease-modifying therapies in neurodegeneration have obeyed the century-old principle of convergence, or lumping, whereby any feature of a clinicopathologic disease entity is considered relevant to most of those affected. While this convergent approach has resulted in important successes in trials of symptomatic therapies, largely aimed at correcting common neurotransmitter deficiencies (e.g., cholinergic deficiency in Alzheimer's disease or dopaminergic deficiency in Parkinson's disease), it has been consistently futile in trials of neuroprotective or disease-modifying interventions. As individuals affected by the same neurodegenerative disorder do not share the same biological drivers, splitting such disease into small molecular/biological subtypes, to match people to therapies most likely to benefit them, is vital in the pursuit of disease modification. We here discuss three paths toward the splitting needed for future successes in precision medicine: (1) encourage the development of aging cohorts agnostic to phenotype in order to enact a biology-to-phenotype direction of biomarker development and validate divergence biomarkers (present in some, absent in most); (2) demand bioassay-based recruitment of subjects into disease-modifying trials of putative neuroprotective interventions in order to match the right therapies to the right recipients; and (3) evaluate promising epidemiologic leads of presumed pathogenetic potential using Mendelian randomization studies before designing the corresponding clinical trials. The reconfiguration of disease-modifying efforts for patients with neurodegenerative disorders will require a paradigm shift from lumping to splitting and from proteinopathy to proteinopenia.
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Affiliation(s)
- Kevin R Duque
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Joaquin A Vizcarra
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Emily J Hill
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
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21
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Jing XZ, Yang HJ, Taximaimaiti R, Wang XP. Advances in the Therapeutic Use of Non-Ergot Dopamine Agonists in the Treatment of Motor and Non-Motor Symptoms of Parkinson's Disease. Curr Neuropharmacol 2023; 21:1224-1240. [PMID: 36111769 PMCID: PMC10286583 DOI: 10.2174/1570159x20666220915091022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Dopamine (DA) agonists, as an excellent dopamine replacement therapy for patients with early and advanced Parkinson's disease (PD), play a vital role in controlling motor and several nonmotor symptoms. Besides, the application of DA agonists may delay levodopa therapy and the associated risk of motor complications. Indeed, each DA agonist has unique pharmacokinetic and pharmacodynamic characteristics and therefore has different therapeutic efficacy and safety profile. The comorbidities, significant non-motor manifestations, concomitant medications, and clinical features of PD individuals should guide the selection of a specific DA agonist to provide a more patient-tailored treatment option. Thorough knowledge of DA agonists helps clinicians better balance clinical efficacy and side effects. Therefore, this review refers to recent English-written articles on DA agonist therapy for PD patients and summarizes the latest findings on non-ergot DA agonists as well as the advantages and disadvantages of each compound to help clinicians in the selection of a specific DA agonist. In addition, novel D1/D5 partial agonists and new formulations of DA agonists are also discussed.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hui-Jia Yang
- Center for Clinical Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian 116021, China
| | - Reyisha Taximaimaiti
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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22
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Zeissler ML, McFarthing K, Raphael KG, Rafaloff G, Windle R, Carroll CB. An International Multi-Stakeholder Delphi Survey Study on the Design of Disease Modifying Parkinson's Disease Trials. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1343-1356. [PMID: 38007672 PMCID: PMC10741330 DOI: 10.3233/jpd-230109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Design of disease modification (DM) trials for Parkinson's disease (PD) is challenging. Successful delivery requires a shared understanding of priorities and practicalities. OBJECTIVE To seek stakeholder consensus on phase 3 trials' overall goals and structure, inclusion criteria, outcome measures, and trial delivery and understand where perspectives differ. METHODS An international expert panel comprising people with Parkinson's (PwP), care partners (CP), clinical scientists, representatives from industry, funders and regulators participated in a survey-based Delphi study. Survey items were informed by a scoping review of DM trials and PwP input. Respondents scored item agreement over 3 rounds. Scores and reasoning were summarized by participant group each round until consensus, defined as≥70% of at least 3 participant groups falling within the same 3-point region of a 9-point Likert scale. RESULTS 92/121 individuals from 13 countries (46/69 PwP, 13/18 CP, 20/20 clinical scientists, representatives from 8/8 companies, 4/5 funders, and 1/1 regulator) completed the study. Consensus was reached on 14/31 survey items: 5/8 overall goals and structure, 1/8 Eligibility criteria, 7/13 outcome measures, and 1/2 trial delivery items. Extent of stakeholder endorsement for 428 reasons for scores was collated across items. CONCLUSIONS This is the first systematic multi-stakeholder consultation generating a unique repository of perspectives on pivotal aspects of DM trial design including those of PwP and CP. The panel endorsed outcomes that holistically measure PD and the importance of inclusive trials with hybrid delivery models. Areas of disagreement will inform mitigating strategies of researchers to ensure successful delivery of future trials.
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Affiliation(s)
| | | | - Karen G. Raphael
- College of Dentistry, New York University, New York, NY, USA
- Parkinson’s Research Advocate, USA
| | | | | | - Camille B. Carroll
- Faculty of Health, University of Plymouth, Plymouth, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
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23
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Targeting G Protein-Coupled Receptors in the Treatment of Parkinson's Disease. J Mol Biol 2022:167927. [PMID: 36563742 DOI: 10.1016/j.jmb.2022.167927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease characterized in part by the deterioration of dopaminergic neurons which leads to motor impairment. Although there is no cure for PD, the motor symptoms can be treated using dopamine replacement therapies including the dopamine precursor L-DOPA, which has been in use since the 1960s. However, neurodegeneration in PD is not limited to dopaminergic neurons, and many patients experience non-motor symptoms including cognitive impairment or neuropsychiatric disturbances, for which there are limited treatment options. Moreover, there are currently no treatments able to alter the progression of neurodegeneration. There are many therapeutic strategies being investigated for PD, including alternatives to L-DOPA for the treatment of motor impairment, symptomatic treatments for non-motor symptoms, and neuroprotective or disease-modifying agents. G protein-coupled receptors (GPCRs), which include the dopamine receptors, are highly druggable cell surface proteins which can regulate numerous intracellular signaling pathways and thereby modulate the function of neuronal circuits affected by PD. This review will describe the treatment strategies being investigated for PD that target GPCRs and their downstream signaling mechanisms. First, we discuss new developments in dopaminergic agents for alleviating PD motor impairment, the role of dopamine receptors in L-DOPA induced dyskinesia, as well as agents targeting non-dopamine GPCRs which could augment or replace traditional dopaminergic treatments. We then discuss GPCRs as prospective treatments for neuropsychiatric and cognitive symptoms in PD. Finally, we discuss the evidence pertaining to ghrelin receptors, β-adrenergic receptors, angiotensin receptors and glucagon-like peptide 1 receptors, which have been proposed as disease modifying targets with potential neuroprotective effects in PD.
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24
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Singh A, Malhotra D, Singh K, Chadha R, Bedi PMS. Thiazole derivatives in medicinal chemistry: Recent advancements in synthetic strategies, structure activity relationship and pharmacological outcomes. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Naoi M, Maruyama W, Shamoto-Nagai M. Neuroprotective Function of Rasagiline and Selegiline, Inhibitors of Type B Monoamine Oxidase, and Role of Monoamine Oxidases in Synucleinopathies. Int J Mol Sci 2022; 23:ijms231911059. [PMID: 36232361 PMCID: PMC9570229 DOI: 10.3390/ijms231911059] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022] Open
Abstract
Synucleinopathies are a group of neurodegenerative disorders caused by the accumulation of toxic species of α-synuclein. The common clinical features are chronic progressive decline of motor, cognitive, behavioral, and autonomic functions. They include Parkinson’s disease, dementia with Lewy body, and multiple system atrophy. Their etiology has not been clarified and multiple pathogenic factors include oxidative stress, mitochondrial dysfunction, impaired protein degradation systems, and neuroinflammation. Current available therapy cannot prevent progressive neurodegeneration and “disease-modifying or neuroprotective” therapy has been proposed. This paper presents the molecular mechanisms of neuroprotection by the inhibitors of type B monoamine oxidase, rasagiline and selegiline. They prevent mitochondrial apoptosis, induce anti-apoptotic Bcl-2 protein family, and pro-survival brain- and glial cell line-derived neurotrophic factors. They also prevent toxic oligomerization and aggregation of α-synuclein. Monoamine oxidase is involved in neurodegeneration and neuroprotection, independently of the catalytic activity. Type A monoamine oxidases mediates rasagiline-activated signaling pathways to induce neuroprotective genes in neuronal cells. Multi-targeting propargylamine derivatives have been developed for therapy in various neurodegenerative diseases. Preclinical studies have presented neuroprotection of rasagiline and selegiline, but beneficial effects have been scarcely presented. Strategy to improve clinical trials is discussed to achieve disease-modification in synucleinopathies.
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Affiliation(s)
- Makoto Naoi
- Correspondence: ; Tel.: +81-05-6173-1111 (ext. 3494); Fax: +81-561-731-142
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26
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Nimmons D, Bhanu C, Orlu M, Schrag A, Walters K. Orthostatic Hypotension and Antiparkinsonian Drugs: A Systematic Review and Meta-analysis. J Geriatr Psychiatry Neurol 2022; 35:639-654. [PMID: 34964392 PMCID: PMC9386765 DOI: 10.1177/08919887211060017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) is multifactorial in Parkinson's disease (PD). Antiparkinsonian medication can contribute to OH, leading to increased risk of falls, weakness and fatigue. METHODS We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of antiparkinsonian drugs associated with OH as an adverse effect, compared to placebo. We searched EMBASE, MEDLINE and Web of Science databases until November 2020. Analysis used fixed-effects models and the GRADE tool to rate quality of evidence. Meta-analysis was performed if 3 or more studies of a drug group were available. RESULTS Twenty-one RCTs including 3783 patients were included comparing 6 PD drug groups to placebo (MAO-B inhibitors, dopamine agonists, levodopa, COMT inhibitors, levodopa and adenosine receptor antagonists). OH was recorded as an adverse event or measurement of vital signs, without further specification on how this was defined or operationalised. Meta-analysis was performed for MAO-B inhibitors and dopamine agonists, as there were 3 or more studies for these drug groups. In this analysis, compared with placebo, neither MAO-B inhibitors or dopamine agonists were associated with increased risk of OH, (OR 2.28 [95% CI:0.81-6.46]), (OR 1.39 [95% CI:0.97-1.98]). CONCLUSIONS Most studies did not specifically report OH, or reporting of OH was limited, including how and when it was measured. Furthermore, studies specifically reporting OH included participants that were younger than typical PD populations without multimorbidity. Future trials should address this, for example,, by including individuals over the age of 75, to improve estimations of how antiparkinsonian medications affect risk of OH.
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Affiliation(s)
- Danielle Nimmons
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK,Danielle Nimmons, Research Department of Primary Care and Population Health, UCL, Rowland Hill Street, London NW3 2PF, UK.
| | - Cini Bhanu
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | | | - Anette Schrag
- Department of Neurology, Institute of Neurology, UCL, UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
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27
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Li T, Zou S, Zhang Z, Liu M, Liang Z. Efficacy of pramipexole on quality of life in patients with Parkinson's disease: a systematic review and meta-analysis. BMC Neurol 2022; 22:320. [PMID: 36008796 PMCID: PMC9404654 DOI: 10.1186/s12883-022-02830-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of life (QoL) in patients with Parkinson's disease (PD) is increasingly used as an efficacy outcome in clinical studies of PD to evaluate the impact of treatment from the patient's perspective. Studies demonstrating the treatment effect of pramipexole on QoL remain inconclusive. This study aims to evaluate the effect of pramipexole on QoL in patients with PD by conducting a systematic review and meta-analysis of existing clinical trials. METHODS A systematic literature search of PubMed, Embase and the Cochrane Library was performed from inception to 30 April 2022 to identify randomised, placebo-controlled trials of patients with idiopathic PD receiving pramipexole, who reported a change from baseline in their QoL as measured by the 39-item Parkinson's Disease Questionnaire (PDQ-39). Risk of bias was independently assessed by two reviewers using the Cochrane Collaboration's tool for bias assessment. RESULTS Of 80 eligible articles screened, six trials consisting of at least 2000 patients with early or advanced PD were included. From the synthesis of all six selected trials, a significant mean change from baseline in the PDQ-39 total score of -2.49 (95% CI, -3.43 to -1.54; p < 0.0001) was observed with pramipexole compared with placebo. A trend toward improvement in QoL was consistently observed among patients who received optimal doses of pramipexole (≥ 80% of the study population on 1.5 mg dosage), regardless of disease severity (advanced versus early) or baseline QoL levels. CONCLUSION This meta-analysis provides evidence for the potential treatment benefit of pramipexole in improving QoL in patients with PD.
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Affiliation(s)
- Tao Li
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shuang Zou
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Present Address: Information Centre, The Second Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Zijuan Zhang
- Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, People's Republic of China.,Present Address: Medical Affairs, Biogen Biotechnology (Shanghai) Co. Ltd, Shanghai, People's Republic of China
| | - Meiruo Liu
- Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, People's Republic of China
| | - Zhanhua Liang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
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28
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Li P, Luo N, Sun S, Li Y, Shen D, Zhu X, Zhou L, Zhou H, Liu J. Neuroprotective Effects of Intermittent Theta Burst Stimulation in Parkinson’s Disease (NET-PD): A Study Protocol for a Delayed-Start Randomized Double-Blind Sham-Controlled Trial. J Clin Med 2022; 11:jcm11174972. [PMID: 36078903 PMCID: PMC9456365 DOI: 10.3390/jcm11174972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background: As a typical high-disability neurodegenerative disease, Parkinson’s disease (PD) progresses variably, and patients who are clinically insensitive to dopaminergic therapy and whose symptoms fail to improve are commonly observed. As a result, achieving early neuron protection is critical. Methods/Design: The NET-PD study is a 2-year prospective single-center, double-blind, multi-arm, delayed-start, sham-controlled clinical trial assessing the long-term neuroprotective effect of intermittent theta burst stimulation (iTBS) in PD patients. Patients diagnosed with PD, aged 50–80, Hoehn–Yahr stage ≤4, and who maintain medication stability during the study will be enrolled. Clinical assessment and multi-modal markers are used to clarify the clinical improvement and dynamic neuronal changes in PD patients. With a standard deviation of 2, a test level of 0.05, a dropout rate of 10%, and a degree of certainty of 0.9, 60 PD patients are required for this study. Results: The NET-PD project was funded in March 2022, data collection began in July 2022, and is currently in the recruitment phase with two PD patients already enrolled. Data collection is expected to be completed in June 2024. The results are expected for publication in December 2024. Discussion: Previous research has demonstrated a rudimentary method for assessing and delaying PD progression in clinical medication trials. The NET-PD study adopts a rigorous methodology and specific disease-modifying designs to demonstrate the neuroprotective effect of iTBS on PD and investigate the potential mechanism of iTBS in regulating brain and motor functions. We hope to provide supposition for the subsequent exploration of diverse neuroprotection methods.
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Affiliation(s)
- Puyu Li
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ningdi Luo
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Sainan Sun
- Department of Outpatient, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Yuanyuan Li
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Dingding Shen
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Xue Zhu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Liche Zhou
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Haiyan Zhou
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
- Correspondence:
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29
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Morel T, Cleanthous S, Andrejack J, Barker RA, Blavat G, Brooks W, Burns P, Cano S, Gallagher C, Gosden L, Siu C, Slagle AF, Trenam K, Boroojerdi B, Ratcliffe N, Schroeder K. Patient Experience in Early-Stage Parkinson's Disease: Using a Mixed Methods Analysis to Identify Which Concepts Are Cardinal for Clinical Trial Outcome Assessment. Neurol Ther 2022; 11:1319-1340. [PMID: 35778541 PMCID: PMC9338202 DOI: 10.1007/s40120-022-00375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/01/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Qualitative research on patient experiences in early-stage Parkinson's disease (PD) is limited. It is increasingly acknowledged that clinical outcome assessments used in trials do not fully capture the range of symptoms/impacts that are meaningful to people with early-stage PD. We aimed to conceptualize the patient experience in early-stage PD and identify, from the patient perspective, those cardinal symptoms/impacts which might be more useful to measure in clinical trials. METHODS In a mixed-methods analysis, 50 people with early-stage PD and nine relatives were interviewed. Study design and results interpretation were led by a multidisciplinary group of patient, clinical, regulatory, and outcome measurements experts, and patient organization representatives. Identification of the cardinal concepts was informed by the relative frequency of reported concepts combined with insights from patient experts and movement disorder specialists. RESULTS A conceptual model of the patient experience of early-stage PD was developed. Concept elicitation generated 145 unique concepts mapped across motor and non-motor symptoms, function, and impacts. Bradykinesia/slowness (notably in the form of "functional slowness"), tremor, rigidity/stiffness, mobility (particularly fine motor dexterity and subtle gait abnormalities), fatigue, depression, sleep/dreams, and pain were identified as cardinal in early-stage PD. "Functional slowness" (related to discrete tasks involving the upper limbs, complex mobility tasks, and general activities) was deemed to be more relevant than "difficulty" to patients with early-stage PD, who report being slower at completing tasks rather than encountering significant impairment with task completion. CONCLUSION Patient experiences in early-stage PD are complex and wide-ranging, and the currently available patient-reported outcome (PRO) instruments do not evaluate many early-stage PD concepts such as functional slowness, fine motor skills, and subtle gait abnormalities. The development of a new PRO instrument, created in conjunction with people with PD, that fully assesses symptoms and the experience of living with early-stage PD, is required.
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Affiliation(s)
| | | | - John Andrejack
- Patient Author, Parkinson's Foundation, New York, NY, USA
| | | | | | - William Brooks
- Patient Author, Parkinson's Foundation, New York, NY, USA
| | - Paul Burns
- Patient Author, Parkinson's UK, London, UK
| | - Stefan Cano
- Modus Outcomes, a Division of Thread, London, UK
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30
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Dorostgou Z, Yadegar N, Dorostgou Z, Khorvash F, Vakili O. Novel insights into the role of circular RNAs in Parkinson disease: An emerging renaissance in the management of neurodegenerative diseases. J Neurosci Res 2022; 100:1775-1790. [PMID: 35642104 DOI: 10.1002/jnr.25094] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/06/2022]
Abstract
Parkinson's disease (PD), as a debilitating neurodegenerative disease, particularly affects the elderly population, and is clinically identified by resting tremor, rigidity, and bradykinesia. Pathophysiologically, PD is characterized by an early loss of dopaminergic neurons in the Substantia nigra pars compacta, accompanied by the extensive aggregation of alpha-synuclein (α-Syn) in the form of Lewy bodies. The onset of PD has been reported to be influenced by multiple biological molecules. In this context, circular RNAs (circRNAs), as tissue-specific noncoding RNAs with closed structures, have been recently demonstrated to involve in a set of PD's pathogenic processes. These RNA molecules can either up- or downregulate the expression of α-Syn, as well as moderating its accumulation through different regulatory mechanisms, in which targeting microRNAs (miRNAs) is considered the most common pathway. Since circRNAs have prominent structural and biological characteristics, they could also be considered as promising candidates for PD diagnosis and treatment. Unfortunately, PD has become a global health concern, and a large number of its pathogenic processes are still unclear; thus, it is crucial to elucidate the ambiguous aspects of PD pathophysiology to improve the efficiency of diagnostic and therapeutic strategies. In line with this fact, the current review aims to highlight the interplay between circRNAs and PD pathogenesis, and then discusses the diagnostic and therapeutic potential of circRNAs in PD progression. This study will thus be the first of its kind reviewing the relationship between circRNAs and PD.
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Affiliation(s)
- Zahra Dorostgou
- Department of Biochemistry, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
| | - Negar Yadegar
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeynab Dorostgou
- Department of Biology, Kavian Institute of Higher Education, Mashhad, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Al-zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Vakili
- Department of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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31
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Mahlknecht P, Foltynie T, Limousin P, Poewe W. How Does Deep Brain Stimulation Change the Course of Parkinson's Disease? Mov Disord 2022; 37:1581-1592. [PMID: 35560443 PMCID: PMC9545904 DOI: 10.1002/mds.29052] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022] Open
Abstract
A robust body of evidence from randomized controlled trials has established the efficacy of deep brain stimulation (DBS) in reducing off time and dyskinesias in levodopa‐treated patients with Parkinson's disease (PD). These effects go along with improvements in on period motor function, activities of daily living, and quality of life. In addition, subthalamic DBS is effective in controlling drug‐refractory PD tremor. Here, we review the available data from long‐term observational and controlled follow‐up studies in DBS‐treated patients to re‐examine the persistence of motor and quality of life benefits and evaluate the effects on disease progression, major disability milestones, and survival. Although there is consistent evidence from observational follow‐up studies in DBS‐treated patients over 5–10 years and beyond showing sustained improvement of motor control, the long‐term impact of DBS on overall progression of disability in PD is less clear. Whether DBS reduces or delays the development of later motor and non‐motor disability milestones in comparison to best medical management strategies is difficult to answer by uncontrolled observational follow‐up, but there are signals from controlled long‐term observational studies suggesting that subthalamic DBS may delay some of the late‐stage disability milestones including psychosis, falls, and institutionalization, and also slightly prolongs survival compared with matched medically managed patients. These observations could be attributable to the sustained improvements in motor function and reduction in medication‐induced side effects, whereas there is no clinical evidence of direct effects of DBS on the underlying disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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P2B001 (Extended Release Pramipexole and Rasagiline): A New Treatment Option in Development for Parkinson's Disease. Adv Ther 2022; 39:1881-1894. [PMID: 35267155 PMCID: PMC9056484 DOI: 10.1007/s12325-022-02097-2] [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] [Received: 01/17/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022]
Abstract
Despite levodopa’s superior efficacy in reducing the motor symptoms of Parkinson’s disease (PD), its risk to induce motor complications requires consideration of the pros and cons of initiating treatment with levodopa-sparing strategies. The current drive toward early levodopa monotherapy is primarily driven by safety and tolerability concerns with dopamine agonists and only mild efficacy of other available approaches. Recently, P2B001, a novel once-daily combination of low-dose, extended-release formulations of pramipexole and rasagiline (0.6 mg and 0.75 mg respectively), has entered clinical development. In this drug evaluation, we review the preclinical and current clinical data for P2B001 and its components. The P2B001 combination has the potential to provide greater efficacy than either pramipexole or rasagiline alone and a better tolerability profile compared to higher dosage dopamine agonist monotherapy, while maintaining the advantage of lower motor complication risk than levodopa. Parkinson’s disease is the fastest growing neurologic disorder across the globe. Once diagnosed, it is now generally agreed that there is no clinical rationale to postpone symptomatic treatment in people who develop Parkinson’s-related disability. There are three main treatment options available for use in early Parkinson’s disease: levodopa, dopamine agonists and monoamine oxidase type B (MAO-B) inhibitors. Of these, there is a current push toward using levodopa as the main first-line therapy. This is primarily because of the significant safety and tolerability concerns with dopamine agonists and only mild efficacy of MAO-B inhibitors. Recently, P2B001, a novel drug formulation combining once-daily, extended-release, low dosages of the dopamine agonist pramipexole and the MAO-B inhibitor rasagiline (0.6 mg and 0.75 mg respectively), has entered clinical development. In this article, the authors review the preclinical and current clinical data on P2B001 and its components. The P2B001 combination has the potential to provide greater efficacy than either pramipexole or rasagiline alone and a better tolerability profile compared to higher dosage dopamine agonist monotherapy, while maintaining the advantage of lower motor complication risk than levodopa.
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Ji N, Meng P, Xu B, Zhou X. Efficacy and safety of pramipexole in Parkinson's disease with anxiety or depression: a meta-analysis of randomized clinical trials. Am J Transl Res 2022; 14:1757-1764. [PMID: 35422951 PMCID: PMC8991111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To investigate the efficacy and safety of pramipexole in Parkinson's disease with anxiety or depression by analyzing the randomized clinical trials (RCTs). METHODS National Library of Medicine (PubMed), Cochrane Library of EMBASE, CNKI, VIP and Wanfang database were retrieved to conduct a meta-analysis. We performed sensitivity analysis to assess the efficacy and safety of pramipexole in Parkinson's disease with anxiety or depression. RESULTS In our study, the results showed that the efficiency was significantly improved in patients with Parkinson's disease of the experimental group (fixed effect model, SMD = 3.45, 95% CI = [2.50, 4.76]). The HAMD score of experimental group was lower than that of control group. Moreover, adverse events of experimental group were lower than that of control group. CONCLUSIONS The research demonstrated that pramipexole may improve the efficacy and HAMD score of Parkinson's disease with anxiety or depression. Due to the limited number of included studies, more RCTs are needed to investigate the effect of pramipexole in Parkinson's disease with anxiety or depression.
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Affiliation(s)
- Niu Ji
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang 222000, Jiangsu, China
| | - Pin Meng
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang 222000, Jiangsu, China
| | - Bingchao Xu
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang 222000, Jiangsu, China
| | - Xinyu Zhou
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang 222000, Jiangsu, China
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Mahlknecht P, Marini K, Werkmann M, Poewe W, Seppi K. Prodromal Parkinson's disease: hype or hope for disease-modification trials? Transl Neurodegener 2022; 11:11. [PMID: 35184752 PMCID: PMC8859908 DOI: 10.1186/s40035-022-00286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/01/2022] [Indexed: 12/24/2022] Open
Abstract
The ultimate goal in Parkinson's disease (PD) research remains the identification of treatments that are capable of slowing or even halting the progression of the disease. The failure of numerous past disease-modification trials in PD has been attributed to a variety of factors related not only to choosing wrong interventions, but also to using inadequate trial designs and target populations. In patients with clinically established PD, neuronal pathology may already have advanced too far to be modified by any intervention. Based on such reasoning, individuals in yet prediagnostic or prodromal disease stages, may provide a window of opportunity to test disease-modifying strategies. There is now sufficient evidence from prospective studies to define diagnostic criteria for prodromal PD and several approaches have been studied in observational cohorts. These include the use of PD-risk algorithms derived from multiple established risk factors for disease as well as follow-up of cohorts with single defined prodromal markers like hyposmia, rapid eye movement sleep behavior disorders, or PD gene carriers. In this review, we discuss recruitment strategies for disease-modification trials in various prodromal PD cohorts, as well as potential trial designs, required trial durations, and estimated sample sizes. We offer a concluding outlook on how the goal of implementing disease-modification trials in prodromal cohorts might be achieved in the future.
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A critical appraisal of MAO-B inhibitors in the treatment of Parkinson's disease. J Neural Transm (Vienna) 2022; 129:723-736. [PMID: 35107654 PMCID: PMC9188534 DOI: 10.1007/s00702-022-02465-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 10/31/2022]
Abstract
Since the 1980s, the MAO-B inhibitors have gained considerable status in the therapy of the Parkinson's disease. In addition to the symptomatic effect in mono- and combination therapies, a neuroprotective effect has repeatedly been a matter of some discussion, which has unfortunately led to a good many misunderstandings. Due to potential interactions, selegiline has declined in significance in the field. For the MAO-B inhibitor safinamide, recently introduced to the market, an additional inhibition of pathological release of glutamate has been postulated. At present, rasagiline and selegiline are being administered in early therapy as well as in combination with levodopa. Safinamide has been approved only for combination therapy with levodopa when motor fluctuations have occurred. MAO-B inhibitors are a significant therapeutic option for Parkinson's disease, an option which is too often not appreciated properly.
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Isaacson SH, Pagan FL, Lew MF, Pahwa R. Should “on-demand” treatments for Parkinson’s disease OFF episodes be used earlier? Clin Park Relat Disord 2022; 7:100161. [PMID: 36033905 PMCID: PMC9405081 DOI: 10.1016/j.prdoa.2022.100161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 02/07/2023] Open
Abstract
OFF episodes are common in patients as Parkinson’s disease progresses. OFF episodes are typically managed with “ON-extenders” and changes in levodopa dosing. OFF episodes persist despite conventional treatment. “On-demand” therapies can rapidly improve OFF symptoms. A shift to earlier complementary use of “on-demand” therapies should be considered.
We discuss a shift in the treatment paradigm for OFF episode management in patients with Parkinson’s disease, based on clinical experience in the United States (US). Three “on-demand” treatments are currently available in the US as follows: subcutaneous apomorphine, levodopa inhalation powder, and sublingual apomorphine. We empirically propose that “on-demand” treatments can be utilized as a complementary treatment when OFF episodes emerge and can be utilized when needed rather than reserving these treatments only until other treatment approaches (adjustment of baseline treatment and/or addition of adjunctive treatment with “ON-extenders”) have failed. Current treatment approaches combine “ON-extenders” with increasing levodopa dosing and/or frequency to treat OFF episodes. Yet, OFF episodes often persist, with a substantial amount of daily OFF time. OFF episode treatment is hindered by variable gastrointestinal (GI) absorption of oral levodopa, reflecting GI dysmotility and protein competition. Novel “on-demand” treatments bypass the gut and can improve OFF symptoms more rapidly and reliably than oral levodopa. With the emergence of novel “on-demand” treatments, we conclude that a shift in treatment paradigm to the earlier, complementary use of these medications be considered.
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Pringsheim T, Day GS, Smith DB, Rae-Grant A, Licking N, Armstrong MJ, de Bie RMA, Roze E, Miyasaki JM, Hauser RA, Espay AJ, Martello JP, Gurwell JA, Billinghurst L, Sullivan K, Fitts MS, Cothros N, Hall DA, Rafferty M, Hagerbrant L, Hastings T, O'Brien MD, Silsbee H, Gronseth G, Lang AE. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology 2021; 97:942-957. [PMID: 34782410 PMCID: PMC8672433 DOI: 10.1212/wnl.0000000000012868] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians. METHODS A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.
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Affiliation(s)
- Tamara Pringsheim
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Gregory S Day
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Don B Smith
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Alex Rae-Grant
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Nicole Licking
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Melissa J Armstrong
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Rob M A de Bie
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Emmanuel Roze
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Janis M Miyasaki
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Robert A Hauser
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Alberto J Espay
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Justin P Martello
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Julie A Gurwell
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Lori Billinghurst
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Kelly Sullivan
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Michael S Fitts
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Nicholas Cothros
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Deborah A Hall
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Miriam Rafferty
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Lynn Hagerbrant
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Tara Hastings
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Mary Dolan O'Brien
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Heather Silsbee
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Gary Gronseth
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Anthony E Lang
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
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Pirooznia SK, Rosenthal LS, Dawson VL, Dawson TM. Parkinson Disease: Translating Insights from Molecular Mechanisms to Neuroprotection. Pharmacol Rev 2021; 73:33-97. [PMID: 34663684 DOI: 10.1124/pharmrev.120.000189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Parkinson disease (PD) used to be considered a nongenetic condition. However, the identification of several autosomal dominant and recessive mutations linked to monogenic PD has changed this view. Clinically manifest PD is then thought to occur through a complex interplay between genetic mutations, many of which have incomplete penetrance, and environmental factors, both neuroprotective and increasing susceptibility, which variably interact to reach a threshold over which PD becomes clinically manifested. Functional studies of PD gene products have identified many cellular and molecular pathways, providing crucial insights into the nature and causes of PD. PD originates from multiple causes and a range of pathogenic processes at play, ultimately culminating in nigral dopaminergic loss and motor dysfunction. An in-depth understanding of these complex and possibly convergent pathways will pave the way for therapeutic approaches to alleviate the disease symptoms and neuroprotective strategies to prevent disease manifestations. This review is aimed at providing a comprehensive understanding of advances made in PD research based on leveraging genetic insights into the pathogenesis of PD. It further discusses novel perspectives to facilitate identification of critical molecular pathways that are central to neurodegeneration that hold the potential to develop neuroprotective and/or neurorestorative therapeutic strategies for PD. SIGNIFICANCE STATEMENT: A comprehensive review of PD pathophysiology is provided on the complex interplay of genetic and environmental factors and biologic processes that contribute to PD pathogenesis. This knowledge identifies new targets that could be leveraged into disease-modifying therapies to prevent or slow neurodegeneration in PD.
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Affiliation(s)
- Sheila K Pirooznia
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Liana S Rosenthal
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Valina L Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
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Zhu S, Li H, Xu X, Luo Y, Deng B, Guo X, Guo Y, Yang W, Wei X, Wang Q. The Pathogenesis and Treatment of Cardiovascular Autonomic Dysfunction in Parkinson's Disease: What We Know and Where to Go. Aging Dis 2021; 12:1675-1692. [PMID: 34631214 PMCID: PMC8460297 DOI: 10.14336/ad.2021.0214] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/14/2021] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular autonomic dysfunctions (CAD) are prevalent in Parkinson’s disease (PD). It contributes to the development of cognitive dysfunction, falls and even mortality. Significant progress has been achieved in the last decade. However, the underlying mechanisms and effective treatments for CAD have not been established yet. This review aims to help clinicians to better understand the pathogenesis and therapeutic strategies. The literatures about CAD in patients with PD were reviewed. References for this review were identified by searches of PubMed between 1972 and March 2021, with the search term “cardiovascular autonomic dysfunctions, postural hypotension, orthostatic hypotension (OH), supine hypertension (SH), postprandial hypotension, and nondipping”. The pathogenesis, including the neurogenic and non-neurogenic mechanisms, and the current pharmaceutical and non-pharmaceutical treatment for CAD, were analyzed. CAD mainly includes four aspects, which are OH, SH, postprandial hypotension and nondipping, among them, OH is the main component. Both non-neurogenic and neurogenic mechanisms are involved in CAD. Failure of the baroreflex circulate, which includes the lesions at the afferent, efferent or central components, is an important pathogenesis of CAD. Both non-pharmacological and pharmacological treatment alleviate CAD-related symptoms by acting on the baroreflex reflex circulate. However, pharmacological strategy has the limitation of failing to enhance baroreflex sensitivity and life quality. Novel OH treatment drugs, such as pyridostigmine and atomoxetine, can effectively improve OH-related symptoms via enhancing residual sympathetic tone, without adverse reactions of supine hypertension. Baroreflex impairment is a crucial pathological mechanism associated with CAD in PD. Currently, non-pharmacological strategy was the preferred option for its advantage of enhancing baroreflex sensitivity. Pharmacological treatment is a second-line option. Therefore, to find drugs that can enhance baroreflex sensitivity, especially via acting on its central components, is urgently needed in the scientific research and clinical practice.
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Affiliation(s)
- Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hualing Li
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoyan Xu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuqi Luo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xingfang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wucheng Yang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaobo Wei
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Lee MTW, Mahy W, Rackham MD. The medicinal chemistry of mitochondrial dysfunction: a critical overview of efforts to modulate mitochondrial health. RSC Med Chem 2021; 12:1281-1311. [PMID: 34458736 PMCID: PMC8372206 DOI: 10.1039/d1md00113b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022] Open
Abstract
Mitochondria are subcellular organelles that perform a variety of critical biological functions, including ATP production and acting as hubs of immune and apoptotic signalling. Mitochondrial dysfunction has been extensively linked to the pathology of multiple neurodegenerative disorders, resulting in significant investment from the drug discovery community. Despite extensive efforts, there remains no disease modifying therapies for neurodegenerative disorders. This manuscript aims to review the compounds historically used to modulate the mitochondrial network through the lens of modern medicinal chemistry, and to offer a perspective on the evidence that relevant exposure was achieved in a representative model and that exposure was likely to result in target binding and engagement of pharmacology. We hope this manuscript will aid the community in identifying those targets and mechanisms which have been convincingly (in)validated with high quality chemical matter, and those for which an opportunity exists to explore in greater depth.
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Affiliation(s)
| | - William Mahy
- MSD The Francis Crick Institute 1 Midland Road London NW1 1AT UK
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Asanuma M, Miyazaki I. Glutathione and Related Molecules in Parkinsonism. Int J Mol Sci 2021; 22:ijms22168689. [PMID: 34445395 PMCID: PMC8395390 DOI: 10.3390/ijms22168689] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Glutathione (GSH) is the most abundant intrinsic antioxidant in the central nervous system, and its substrate cysteine readily becomes the oxidized dimeric cystine. Since neurons lack a cystine transport system, neuronal GSH synthesis depends on cystine uptake via the cystine/glutamate exchange transporter (xCT), GSH synthesis, and release in/from surrounding astrocytes. Transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2), a detoxifying master transcription factor, is expressed mainly in astrocytes and activates the gene expression of various phase II drug-metabolizing enzymes or antioxidants including GSH-related molecules and metallothionein by binding to the antioxidant response element (ARE) of these genes. Accumulating evidence has shown the involvement of dysfunction of antioxidative molecules including GSH and its related molecules in the pathogenesis of Parkinson’s disease (PD) or parkinsonian models. Furthermore, we found several agents targeting GSH synthesis in the astrocytes that protect nigrostriatal dopaminergic neuronal loss in PD models. In this article, the neuroprotective effects of supplementation and enhancement of GSH and its related molecules in PD pathology are reviewed, along with introducing new experimental findings, especially targeting of the xCT-GSH synthetic system and Nrf2–ARE pathway in astrocytes.
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Perspective: Treatment for Disease Modification in Chronic Neurodegeneration. Cells 2021; 10:cells10040873. [PMID: 33921342 PMCID: PMC8069143 DOI: 10.3390/cells10040873] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 02/07/2023] Open
Abstract
Symptomatic treatments are available for Parkinson's disease and Alzheimer's disease. An unmet need is cure or disease modification. This review discusses possible reasons for negative clinical study outcomes on disease modification following promising positive findings from experimental research. It scrutinizes current research paradigms for disease modification with antibodies against pathological protein enrichment, such as α-synuclein, amyloid or tau, based on post mortem findings. Instead a more uniform regenerative and reparative therapeutic approach for chronic neurodegenerative disease entities is proposed with stimulation of an endogenously existing repair system, which acts independent of specific disease mechanisms. The repulsive guidance molecule A pathway is involved in the regulation of peripheral and central neuronal restoration. Therapeutic antagonism of repulsive guidance molecule A reverses neurodegeneration according to experimental outcomes in numerous disease models in rodents and monkeys. Antibodies against repulsive guidance molecule A exist. First clinical studies in neurological conditions with an acute onset are under way. Future clinical trials with these antibodies should initially focus on well characterized uniform cohorts of patients. The efficiency of repulsive guidance molecule A antagonism and associated stimulation of neurogenesis should be demonstrated with objective assessment tools to counteract dilution of therapeutic effects by subjectivity and heterogeneity of chronic disease entities. Such a research concept will hopefully enhance clinical test strategies and improve the future therapeutic armamentarium for chronic neurodegeneration.
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Müller T. Experimental Dopamine Reuptake Inhibitors in Parkinson's Disease: A Review of the Evidence. J Exp Pharmacol 2021; 13:397-408. [PMID: 33824605 PMCID: PMC8018398 DOI: 10.2147/jep.s267032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
Parkinson’s disease (PD) is the second most chronic neurodegenerative disorder worldwide. Deficit of monoamines, particularly dopamine, causes an individually varying compilation of motor and non-motor features. Constraint of presynaptic uptake extends monoamine stay in the synaptic cleft. This review discusses possible benefits of dopamine reuptake inhibition for the treatment of PD. Translation of this pharmacologic principle into positive clinical study results failed to date. Past clinical trial designs did not consider a mandatory, concomitant stable inhibition of glial monoamine turnover, i.e. with monoamine oxidase B inhibitors. These studies focused on improvement of motor behavior and levodopa associated motor complications, which are fluctuations of motor and non-motor behavior. Future clinical investigations in early, levodopa- and dopamine agonist naïve patients shall also aim on alleviation of non-motor symptoms, like fatigue, apathy or cognitive slowing. Oral levodopa/dopa decarboxylase inhibitor application is inevitably necessary with advance of PD. Monoamine reuptake (MRT) inhibition improves the efficacy of levodopa, the blood brain barrier crossing metabolic precursor of dopamine. The pulsatile brain delivery pattern of orally administered levodopa containing formulations results in synaptic dopamine variability. Ups and downs of dopamine counteract the physiologic principle of continuous neurotransmission, particularly in nigrostriatal, respectively mesocorticolimbic pathways, both of which regulate motor respectively non-motor behavior. Thus synaptic dopamine pulsatility overwhelms the existing buffering capacity. Onset of motor and non-motor complications occurs. Future MRT inhibitor studies shall focus on a stabilizing and preventive effect on levodopa related fluctuations of motor and non-motor behavior. Their long-term study designs in advanced levodopa treated patients shall allow a cautious adaptation of oral l-dopa therapy combined with a mandatory inhibition of glial monoamine turnover. Then the evidence for a preventive and beneficial, symptomatic effect of MRT inhibition on motor and non-motor complications will become more likely.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Berlin, 13088, Germany
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Kumar B, Pandey M, Pottoo FH, Fayaz F, Sharma A, Sahoo PK. Liposomes: Novel Drug Delivery Approach for Targeting Parkinson's Disease. Curr Pharm Des 2021; 26:4721-4737. [PMID: 32003666 DOI: 10.2174/1381612826666200128145124] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022]
Abstract
Parkinson's disease is one of the most severe progressive neurodegenerative disorders, having a mortifying effect on the health of millions of people around the globe. The neural cells producing dopamine in the substantia nigra of the brain die out. This leads to symptoms like hypokinesia, rigidity, bradykinesia, and rest tremor. Parkinsonism cannot be cured, but the symptoms can be reduced with the intervention of medicinal drugs, surgical treatments, and physical therapies. Delivering drugs to the brain for treating Parkinson's disease is very challenging. The blood-brain barrier acts as a highly selective semi-permeable barrier, which refrains the drug from reaching the brain. Conventional drug delivery systems used for Parkinson's disease do not readily cross the blood barrier and further lead to several side-effects. Recent advancements in drug delivery technologies have facilitated drug delivery to the brain without flooding the bloodstream and by directly targeting the neurons. In the era of Nanotherapeutics, liposomes are an efficient drug delivery option for brain targeting. Liposomes facilitate the passage of drugs across the blood-brain barrier, enhances the efficacy of the drugs, and minimize the side effects related to it. The review aims at providing a broad updated view of the liposomes, which can be used for targeting Parkinson's disease.
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Affiliation(s)
- Bhumika Kumar
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Mukesh Pandey
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Faheem H Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, P.O. BOX 1982, Dammam 31441, Saudi Arabia
| | - Faizana Fayaz
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Anjali Sharma
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - P K Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
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Kimber TE. Approach to the patient with early Parkinson disease: diagnosis and management. Intern Med J 2021; 51:20-26. [DOI: 10.1111/imj.15148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Thomas E. Kimber
- Neurology Unit Royal Adelaide Hospital Adelaide South Australia Australia
- University Department of Medicine, Faculty of Health and Medical Sciences University of Adelaide Adelaide South Australia Australia
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Lastennet D, Mariani LL, Rascol O, Turc JD, Alfaisal H, Lapeyre-Mestre M, Corvol JC, Tubach F. Evaluation of Prescription Practices of Domperidone in Parkinson's Disease: A Cross Sectional Study Among French Neurologists. CNS Drugs 2020; 34:1267-1274. [PMID: 33278018 DOI: 10.1007/s40263-020-00774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 02/28/2023]
Abstract
BACKGROUND Domperidone is used to treat gastrointestinal symptoms in patients with Parkinson's disease. Because of an increased risk of cardiac adverse events, the European Medicines Agency has issued recommendations restricting its use mainly in terms of age, dose, and treatment duration. OBJECTIVE The aim of this study was to investigate current prescription practices of domperidone in Parkinson's disease among French neurologists. METHODS A cross-sectional study based on a questionnaire was conducted among French neurologists from Parkinson's disease expert centers from the French NS-Park/FCRIN network, general hospitals, and private practice. RESULTS Among the 253 neurologists who completed the questionnaire, 86 (34%) were physicians from expert centers and 167 (66%) were from other healthcare settings; 209 (83%) were aware of recommendations restricting domperidone use. The majority of neurologists (92%) declared prescribing domperidone regardless of the age of the patients. Sixty-one percent of neurologists prescribed domperidone beyond 7 days in newly diagnosed patients, 33% in patients with orthostatic hypotension, and 79% in patients receiving continuous apomorphine treatment. They did not follow the recommendation on posology in newly diagnosed patients (7% of neurologists), patients with orthostatic hypotension (10%), and patients receiving continuous apomorphine therapy (25%). Finally, only 58% of neurologists declared taking specific precautions before prescribing domperidone. CONCLUSIONS These findings show most French neurologists who responded to our questionnaire do not fully follow the restrictions on domperidone use, particularly in terms of treatment duration, and in patients receiving continuous apomorphine treatment. This may reflect the unmet need to prevent nausea in patients with Parkinson's disease treated with dopaminergic drugs, particularly continuous apomorphine therapy.
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Affiliation(s)
- Diane Lastennet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France
| | - Louise-Laure Mariani
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Département de Neurologie, Centre d'Investigation Clinique Neurosciences, 75013, Paris, France
| | - Olivier Rascol
- University of Toulouse 3, Clinical Investigation Center CIC1436, Parkinson Disease Expert Center, Department of Clinical Pharmacology, NS-Park/FCRIN Network, NeuroToul COEN Center, University Hospital of Toulouse, INSERM, Toulouse, France
| | - Jean-Denis Turc
- Association des Neurologues Libéraux de Langue Française (ANLLF), Fédération Française de Neurologie (FFN), Cabinet de Neurologie, Martigues, France
| | - Hala Alfaisal
- AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France
| | - Maryse Lapeyre-Mestre
- University of Toulouse 3, Clinical Investigation Center CIC1436, Parkinson Disease Expert Center, Department of Clinical Pharmacology, NS-Park/FCRIN Network, University Hospital of Toulouse, INSERM, Toulouse, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Département de Neurologie, Centre d'Investigation Clinique Neurosciences, 75013, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France.
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Binde CD, Tvete IF, Gåsemyr JI, Natvig B, Klemp M. Comparative effectiveness of dopamine agonists and monoamine oxidase type-B inhibitors for Parkinson's disease: a multiple treatment comparison meta-analysis. Eur J Clin Pharmacol 2020; 76:1731-1743. [PMID: 32710141 PMCID: PMC7661406 DOI: 10.1007/s00228-020-02961-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the comparative effectiveness of dopamine agonists and monoamine oxidase type-B (MAO-B) inhibitors available for treatment of Parkinson's disease. METHODS We performed a systematic literature search identifying randomized controlled trials investigating 4 dopamine agonists (cabergoline, pramipexole, ropinirole, rotigotine) and 3 MAO-B inhibitors (selegiline, rasagiline, safinamide) for Parkinson's disease. We extracted and pooled data from included clinical trials in a joint model allowing both direct and indirect comparison of the seven drugs. We considered dopamine agonists and MAO-B inhibitors given as monotherapy or in combination with levodopa. Selected endpoints were change in the Unified Parkinson's Disease Rating Scale (UPDRS) score, serious adverse events and withdrawals. We estimated the relative effectiveness of each dopamine agonist and MAO-B inhibitor versus comparator drug. RESULTS Altogether, 79 publications were included in the analysis. We found all the investigated drugs to be effective compared with placebo when given as monotherapy except safinamide. When considering combination treatment, the estimated relative effects of selegiline, pramipexole, ropinirole, rotigotine, cabergoline, rasagiline and safinamide were 2.316 (1.819, 2.951), 2.091 (1.889, 2.317), 2.037 (1.804, 2.294), 1.912 (1.716, 2.129), 1.664 (1.113, 2.418), 1.584 (1.379, 1.820) and 1.179 (1.031, 1.352), respectively, compared with joint placebo and levodopa treatment. CONCLUSIONS Dopamine agonists were found to be effective as treatment for Parkinson's disease, both when given as monotherapy and in combination with levodopa. Selegiline and rasagiline were also found to be effective for treating Parkinson's disease, and selegiline was the best option in combination with levodopa among all the drugs investigated.
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Affiliation(s)
| | | | | | - Bent Natvig
- Department of Mathematics, University of Oslo, Oslo, Norway
| | - Marianne Klemp
- Department of Pharmacology, University of Oslo, Oslo, Norway.
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Du W, Liang X, Wang S, Lee P, Zhang Y. The Underlying Mechanism of Paeonia lactiflora Pall. in Parkinson's Disease Based on a Network Pharmacology Approach. Front Pharmacol 2020; 11:581984. [PMID: 33381034 PMCID: PMC7768820 DOI: 10.3389/fphar.2020.581984] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Parkinson's disease (PD) is the second most common neurodegenerative disease worldwide, yet as of currently, there is no disease-modifying therapy that could delay its progression. Paeonia lactiflora Pall. is the most frequently used herb in formulas for PD in Traditional Chinese Medicine and also a potential neuroprotective agent for neurodegenerative diseases, while its mechanisms remain poorly understood. In this study, we aim to explore the underlying mechanism of P. lactiflora in treating PD utilizing a network pharmacology approach. Methods: The protein targets of P. lactiflora ingredients and PD were first obtained from several databases. To clarify the key targets, a Protein-Protein-Interaction (PPI) network was constructed and analyzed on the String database, and then enrichment analysis was performed by the Metascape platform to determine the main Gene Ontology biological processes and Kyoto Encyclopedia of Genes and Genomes pathways. Finally, the Ingredient-Target-Pathway (I-T-P) network was constructed and analyzed by Cytoscape software. Results: Six active ingredients of P. lactiflora (kaempferol, ß-sitosterol, betulinic acid, palbinone, paeoniflorin and (+)-catechin) as well as six core targets strongly related to PD treatment [AKT1, interleukin-6, CAT, Tumor necrosis factor (TNF), CASP3, and PTGS2] were identified. The main pathways were shown to involve neuroactive ligand-receptor interaction, Calcium signaling pathway, PI3-Akt signaling pathway, TNF signaling pathway, and apoptosis signaling pathway. The main biological process included the regulation of neurotransmitter levels. Conclusion: P. lactiflora may retard neurodegeneration by reducing neuroinflammation, inhibiting intrinsic and extrinsic apoptosis, and may improve motor and non-motor symptoms by regulating the levels of neurotransmitters. Our study has revealed the mechanism of P. lactiflora in the treatment of PD and may contribute to novel drug development for PD.
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Affiliation(s)
- Wanqing Du
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao Liang
- Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shanze Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Philip Lee
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yunling Zhang
- Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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49
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van den Heuvel L, Evers LJW, Meinders MJ, Post B, Stiggelbout AM, Heskes TM, Bloem BR, Krijthe JH. Estimating the Effect of Early Treatment Initiation in Parkinson's Disease Using Observational Data. Mov Disord 2020; 36:407-414. [PMID: 33107639 PMCID: PMC7984449 DOI: 10.1002/mds.28339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/19/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Both patients and physicians may choose to delay initiation of dopamine replacement therapy in Parkinson's disease (PD) for various reasons. We used observational data to estimate the effect of earlier treatment in PD. Observational data offer a valuable source of evidence, complementary to controlled trials. Method We studied the Parkinson's Progression Markers Initiative cohort of patients with de novo PD to estimate the effects of duration of PD treatment during the first 2 years of follow‐up, exploiting natural interindividual variation in the time to start first treatment. We estimated the Movement Disorder Society–Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) Part III (primary outcome) and several functionally relevant outcomes at 2, 3, and 4 years after baseline. To adjust for time‐varying confounding, we used marginal structural models with inverse probability of treatment weighting and the parametric g‐formula. Results We included 302 patients from the Parkinson's Progression Markers Initiative cohort. There was a small improvement in MDS‐UPDRS Part III scores after 2 years of follow‐up for patients who started treatment earlier, and similar, but nonstatistically significant, differences in subsequent years. We found no statistically significant differences in most secondary outcomes, including the presence of motor fluctuations, nonmotor symptoms, MDS‐UPDRS Part II scores, and the Schwab and England Activities of Daily Living Scale. Conclusion Earlier treatment initiation does not lead to worse MDS‐UPDRS motor scores and may offer small improvements. These findings, based on observational data, are in line with earlier findings from clinical trials. Observational data, when combined with appropriate causal methods, are a valuable source of additional evidence to support real‐world clinical decisions. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Lieneke van den Heuvel
- Center of Expertise for Parkinson & Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luc J W Evers
- Center of Expertise for Parkinson & Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart Post
- Center of Expertise for Parkinson & Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tom M Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Center of Expertise for Parkinson & Movement Disorders, department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jesse H Krijthe
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands.,Department of Intelligent Systems, Delft University of Technology, Delft, the Netherlands
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50
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Mallah K, Couch C, Borucki DM, Toutonji A, Alshareef M, Tomlinson S. Anti-inflammatory and Neuroprotective Agents in Clinical Trials for CNS Disease and Injury: Where Do We Go From Here? Front Immunol 2020; 11:2021. [PMID: 33013859 PMCID: PMC7513624 DOI: 10.3389/fimmu.2020.02021] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Neurological disorders are major contributors to death and disability worldwide. The pathology of injuries and disease processes includes a cascade of events that often involve molecular and cellular components of the immune system and their interaction with cells and structures within the central nervous system. Because of this, there has been great interest in developing neuroprotective therapeutic approaches that target neuroinflammatory pathways. Several neuroprotective anti-inflammatory agents have been investigated in clinical trials for a variety of neurological diseases and injuries, but to date the results from the great majority of these trials has been disappointing. There nevertheless remains great interest in the development of neuroprotective strategies in this arena. With this in mind, the complement system is being increasingly discussed as an attractive therapeutic target for treating brain injury and neurodegenerative conditions, due to emerging data supporting a pivotal role for complement in promoting multiple downstream activities that promote neuroinflammation and degeneration. As we move forward in testing additional neuroprotective and immune-modulating agents, we believe it will be useful to review past trials and discuss potential factors that may have contributed to failure, which will assist with future agent selection and trial design, including for complement inhibitors. In this context, we also discuss inhibition of the complement system as a potential neuroprotective strategy for neuropathologies of the central nervous system.
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Affiliation(s)
- Khalil Mallah
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
| | - Christine Couch
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Davis M. Borucki
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
- Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, United States
| | - Amer Toutonji
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
- Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, United States
| | - Mohammed Alshareef
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Stephen Tomlinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Ralph Johnson VA Medical Center, Charleston, SC, United States
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