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Carmody T, Park R, Bennett E, Kuret E, Klein B, Costa À, Messner S, Hursey A. An Ethnographic Study of Patient Life Experience in Early-Stage Parkinson's Disease in the United States and Germany. Neurol Ther 2024:10.1007/s40120-024-00632-7. [PMID: 38865073 DOI: 10.1007/s40120-024-00632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Existing qualitative research on early-stage Parkinson's disease draws on patients' reported disease experience, aiming to capture the symptoms and impacts most relevant to patients living with the disease. As a complement to this research, the present study investigated the patient experience of early-stage Parkinson's disease from a holistic, ethnographic perspective. We explored the attitudes, beliefs, and social structures that shape how people understand and adapt to life with early-stage Parkinson's disease. METHODS Researchers interviewed 30 people with early-stage Parkinson's disease, 10 relatives, and 10 neurologists and movement disorder specialists in the USA and Germany. Many of these interviews took place in-person, allowing researchers to spend time in participants' homes and witness their daily lives. A multidisciplinary team of social scientists, clinical researchers, and patient organization representatives led the mixed-methods study design and analysis. In-depth ethnographic interviews yielded qualitative insights, with a quantitative survey following to assess their prevalence in a larger sample of 150 patients. RESULTS In addition to developing a patient life experience pathway of early-stage Parkinson's disease, we identified five key thematic findings that provide insight into how the clinical features of the disease become meaningful to patients on the context of their daily lives, family relations, and subjective well-being: (1) People with early-stage Parkinson's disease start coming to terms with their disease before receiving a medical diagnosis; (2) Acceptance is not a finalized achievement, but a cyclical process; (3) People with early-stage Parkinson's disease "live in the moment" to make the future more manageable; (4) Slowing disease progression is an important goal driving the actions of people with early-stage Parkinson's; and (5) People with early-stage Parkinson's disease value information that is grounded in lived experience and relevant to their stage of disease progression. CONCLUSION This holistic, ethnographic approach to patient life experience provided five key thematic findings that complement insights from qualitative and quantitative datasets on early-stage Parkinson's disease. An enhanced understanding of how early-stage Parkinson's symptoms impact patients' health-related quality of life and their broader social lives can help us better understand how patients make decisions about their usage of healthcare services and therapies.
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Frequin HL, Verschuur CVM, Suwijn SR, Boel JA, Post B, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Munts AG, Dijk JM, Lang AE, Dijkgraaf MGW, Hoogland J, de Bie RMA. Long-Term Follow-Up of the LEAP Study: Early Versus Delayed Levodopa in Early Parkinson's Disease. Mov Disord 2024; 39:975-982. [PMID: 38644623 DOI: 10.1002/mds.29796] [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: 10/02/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The Levodopa in EArly Parkinson's disease study showed no effect of earlier versus later levodopa initiation on Parkinson's disease (PD) progression over 80 weeks. We now report the effects over 5 years. METHODS The Levodopa in EArly Parkinson's disease study randomly assigned patients to levodopa/carbidopa 300/75 mg daily for 80 weeks (early start) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed start). Follow-up visits were performed 3 and 5 years after baseline. We assessed the between-group differences in terms of square root transformed total Unified Parkinson's Disease Rating Scale score at 3 and 5 years with linear regression. We compared the prevalence of dyskinesia, prevalence of wearing off, and the levodopa equivalent daily dose. RESULTS A total of 321 patients completed the 5-year visit. The adjusted square root transformed total Unified Parkinson's Disease Rating Scale did not differ between treatment groups at 3 (estimated difference, 0.17; standard error, 0.13; P = 0.18) and 5 years (estimated difference, 0.24; standard error, 0.13; P = 0.07). At 5 years, 46 of 160 patients in the early-start group and 62 of 161 patients in the delayed-start group experienced dyskinesia (P = 0.06). The prevalence of wearing off and the levodopa equivalent daily dose were not significantly different between groups. CONCLUSIONS We did not find a difference in disease progression or in prevalence of motor complications between patients with early PD starting treatment with a low dose of levodopa 40 weeks earlier versus 40 weeks later over the subsequent 5 years. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Henrieke L Frequin
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Constant V M Verschuur
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Sven R Suwijn
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Judith A Boel
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bart Post
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | | | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerrit Tissingh
- Department of Neurology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Alexander G Munts
- Department of Neurology, Excellent Klinieken, Dordrecht, the Netherlands
| | - Joke M Dijk
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jeroen Hoogland
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, the Netherlands
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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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Park MS, Park S, Kang JY, Jung IC, Yoo H. The efficacy and safety of MARS-PD: Meridian activation remedy system for Parkinson's disease-A single-center, assessor and statistician-blinded, parallel-group randomized, controlled trial protocol. PLoS One 2024; 19:e0303156. [PMID: 38709746 PMCID: PMC11073687 DOI: 10.1371/journal.pone.0303156] [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: 12/08/2023] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) patients face a substantial unmet need for disease-modifying interventions. Potential approaches such as exercise and acupuncture have been investigated to slow PD progression. To address this unmet need, we developed a novel therapeutic approach that integrates acupuncture and exercise: the Meridian Activation Remedy System for PD patients (MARS-PD). Building upon promising outcomes observed in our preliminary pilot study, where MARS-PD exhibited a large clinically important difference on the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS Part III), we embark on a randomized controlled trial with the primary objective of examining the efficacy, safety, and economic impact of MARS-PD. METHODS In this single-center, assessor and statistician-blinded, parallel-group randomized controlled trial, we aim to investigate the clinical efficacy of MARS-PD through 16 interventions administered over 8 weeks in 88 PD patients. Participants will be randomly assigned to the experimental (n = 44) or control (n = 44) groups. The experimental group will receive MARS-PD intervention alongside standard care, while the control group will solely receive standard care. The intervention period spans 8 weeks, followed by a 12-week post-intervention follow-up. The primary endpoint is the change in MDS-UPDRS Part III score from baseline to the conclusion of the 8-week intervention. Secondary outcomes encompass various assessments, including MDS-UPDRS, International Physical Activity Questionnaire Short Form, Parkinson Self Questionnaire, Parkinson's Disease Sleep Scale, Timed Up and Go test, GAITRite metrics, Functional Near-Infrared Spectroscopy measurements, smart band outcomes, gut microbiome analysis results, and iris connective tissue texture. DISCUSSION Previous studies by the authors have indicated MARS-PD's safety and benefits for PD patients. Building upon this foundation, our current study aims to provide a more comprehensive and detailed confirmation of the efficacy of MARS-PD. TRIAL REGISTRATION cris.nih.go.kr KCT0006646 -First posted on 7 October 2021; ClinicalTrials.gov NCT05621772 -First posted on 11 November 2022.
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Affiliation(s)
- Miso S. Park
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - SangSoo Park
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Jie-Yoon Kang
- Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - In Chul Jung
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - HoRyong Yoo
- Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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Boogers A, Fasano A, Lang A. An Apple a Day Will Not Keep the (Parkinson Disease) Doctor at Bay! Ann Neurol 2024; 95:1012-1013. [PMID: 38553985 DOI: 10.1002/ana.26936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Alexandra Boogers
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
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Seemiller J, Morrow C, Hinkle JT, Perepezko K, Kamath V, Pontone GM, Mills KA. Impact of Acute Dopamine Replacement on Cognitive Function in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:534-542. [PMID: 38470011 PMCID: PMC11078494 DOI: 10.1002/mdc3.14017] [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: 11/02/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND PD causes striatal dopaminergic denervation in a posterior/dorsal to anterior/ventral gradient, leaving motor and associative cortico-striato-pallido-thalamic loops differentially susceptible to hyperdopaminergic effects with treatment. As the choice and titration of symptomatic PD medications are guided primarily by motor symptoms, it is important to understand their cognitive implications. OBJECTIVE To investigate the effects of acute dopaminergic medication administration on executive function in Parkinson's disease (PD). METHODS Participants with idiopathic PD were administered the oral Symbol Digit Modalities Test (SDMT; n = 181) and the Stroop test (n = 172) in the off-medication and "best on" medication states. ANCOVA was used to test for differences between off-medication and on-medication scores corrected for age and years of education. RESULTS After administration of symptomatic medications, scores worsened on the SDMT (F = 11.70, P < 0.001, d = -0.13), improved on the Stroop color (F = 26.89, P < 0.001, d = 0.184), word (F = 6.25, P = 0.013, d = 0.09), and color-word (F = 13.22, P < 0.001, d = 0.16) test components, and the Stroop difference and ratio-based interference scores did not significantly change. Longer disease duration correlated with lower scores on the SDMT, Stroop color, word, and color-word scores; however, longer disease duration and higher levodopa-equivalents correlated with higher Stroop difference-based interference scores. CONCLUSIONS Symptomatic medication differentially affects performance on two cognitive tests in PD. After acute treatment, core Stroop measures improved, Stroop interference was unchanged, and SDMT performance worsened, likely reflecting complex changes in processing speed and executive function related to acute treatment. When considering motor symptom therapies in PD, an individual's cognitive demands and expectations, especially regarding executive function, should be considered.
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Affiliation(s)
- Joseph Seemiller
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Christopher Morrow
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jared T. Hinkle
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Kate Perepezko
- National Rehabilitation Research & Training Center on Family Support, University of PittsburghPittsburghPennsylvaniaUSA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Kelly A. Mills
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Cheslow L, Byrne M, Kopenhaver JS, Iacovitti L, Smeyne RJ, Snook AE, Waldman SA. GUCY2C signaling limits dopaminergic neuron vulnerability to toxic insults. NPJ Parkinsons Dis 2024; 10:83. [PMID: 38615030 PMCID: PMC11016112 DOI: 10.1038/s41531-024-00697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/15/2024] Open
Abstract
Mitochondrial dysfunction and reactive oxygen species (ROS) accumulation within the substantia nigra pars compacta (SNpc) are central drivers of dopaminergic (DA) neuron death in Parkinson's disease (PD). Guanylyl cyclases and their second messenger cyclic (c)GMP support mitochondrial function, protecting against ROS and promoting cell survival in several tissues. However, the role of the guanylyl cyclase-cGMP axis in defining the vulnerability of DA neurons in the SNpc in PD remains unclear, in part due to the challenge of manipulating cGMP levels selectively in midbrain DA neurons. In that context, guanylyl cyclase C (GUCY2C), a receptor primarily expressed by intestinal epithelial cells, was discovered recently in midbrain DA neurons. Here, we demonstrate that GUCY2C promotes mitochondrial function, reducing oxidative stress and protecting DA neurons from degeneration in the 1-methyl-4-phenyl- 1,2,3,6-tetrahydropyridine (MPTP) mouse model. GUCY2C is overexpressed in the SNpc in PD patients and in mice treated with MPTP, possibly reflecting a protective response to oxidative stress. Moreover, cGMP signaling protects against oxidative stress, mitochondrial impairment, and cell death in cultured DA neurons. These observations reveal a previously unexpected role for the GUCY2C-cGMP signaling axis in controlling mitochondrial dysfunction and toxicity in SNpc DA neurons, highlighting the therapeutic potential of targeting DA neuron GUCY2C to prevent neurodegeneration in PD.
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Affiliation(s)
- Lara Cheslow
- Department of Pharmacology, Physiology, & Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Neurosciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Byrne
- Department of Neurosciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica S Kopenhaver
- Department of Pharmacology, Physiology, & Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lorraine Iacovitti
- Department of Neurosciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard J Smeyne
- Department of Neurosciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam E Snook
- Department of Pharmacology, Physiology, & Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Microbiology & Immunology, Thomas Jefferson University, Philadelphia, PA, USA
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott A Waldman
- Department of Pharmacology, Physiology, & Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA.
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
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Alrouji M, Al-Kuraishy HM, Al-Gareeb AI, Ashour NA, Jabir MS, Negm WA, Batiha GES. Metformin role in Parkinson's disease: a double-sword effect. Mol Cell Biochem 2024; 479:975-991. [PMID: 37266747 DOI: 10.1007/s11010-023-04771-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease developed due to the degeneration of dopaminergic neurons in the substantia nigra. There is no single effective treatment in the management of PD. Therefore, repurposing effective and approved drugs like metformin could be an effective strategy for managing PD. However, the mechanistic role of metformin in PD neuropathology was not fully elucidated. Metformin is an insulin-sensitizing agent used as a first-line therapy in the management of type 2 diabetes mellitus (T2DM) and has the ability to reduce insulin resistance (IR). Metformin may have a beneficial effect on PD neuropathology. The neuroprotective effect of metformin is mainly mediated by activating adenosine monophosphate protein kinase (AMPK), which reduces mitochondrial dysfunction, oxidative stress, and α-synuclein aggregation. As well, metformin mitigates brain IR a hallmark of PD and other neurodegenerative diseases. However, metformin may harm PD neuropathology by inducing hyperhomocysteinemia and deficiency of folate and B12. Therefore, this review aimed to find the potential role of metformin regarding its protective and detrimental effects on the pathogenesis of PD. The mechanistic role of metformin in PD neuropathology was not fully elucidated. Most studies regarding metformin and its effectiveness in PD neuropathology were observed in preclinical studies, which are not fully translated into clinical settings. In addition, metformin effect on PD neuropathology was previously clarified in T2DM, potentially linked to an increasing PD risk. These limitations hinder the conclusion concerning the therapeutic efficacy of metformin and its beneficial and detrimental role in PD. Therefore, as metformin does not cause hypoglycemia and is a safe drug, it should be evaluated in non-diabetic patients concerning PD risk.
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Affiliation(s)
- Mohamed Alrouji
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra, 11961, Saudi Arabia
| | - Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriyia University, P.O. Box 14132, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriyia University, P.O. Box 14132, Baghdad, Iraq
| | - Nada A Ashour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt
| | - Majid S Jabir
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Mersa Matruh, Egypt
| | - Walaa A Negm
- Department of Pharmacognosy, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt.
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt.
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Bremm RP, Pavelka L, Garcia MM, Mombaerts L, Krüger R, Hertel F. Sensor-Based Quantification of MDS-UPDRS III Subitems in Parkinson's Disease Using Machine Learning. SENSORS (BASEL, SWITZERLAND) 2024; 24:2195. [PMID: 38610406 PMCID: PMC11014392 DOI: 10.3390/s24072195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
Wearable sensors could be beneficial for the continuous quantification of upper limb motor symptoms in people with Parkinson's disease (PD). This work evaluates the use of two inertial measurement units combined with supervised machine learning models to classify and predict a subset of MDS-UPDRS III subitems in PD. We attached the two compact wearable sensors on the dorsal part of each hand of 33 people with PD and 12 controls. Each participant performed six clinical movement tasks in parallel with an assessment of the MDS-UPDRS III. Random forest (RF) models were trained on the sensor data and motor scores. An overall accuracy of 94% was achieved in classifying the movement tasks. When employed for classifying the motor scores, the averaged area under the receiver operating characteristic values ranged from 68% to 92%. Motor scores were additionally predicted using an RF regression model. In a comparative analysis, trained support vector machine models outperformed the RF models for specific tasks. Furthermore, our results surpass the literature in certain cases. The methods developed in this work serve as a base for future studies, where home-based assessments of pharmacological effects on motor function could complement regular clinical assessments.
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Affiliation(s)
- Rene Peter Bremm
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg (F.H.)
| | - Lukas Pavelka
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg; (L.P.); (R.K.)
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health, 1445 Strassen, Luxembourg
| | - Maria Moscardo Garcia
- Systems Control, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Laurent Mombaerts
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg (F.H.)
| | - Rejko Krüger
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg; (L.P.); (R.K.)
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health, 1445 Strassen, Luxembourg
| | - Frank Hertel
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg (F.H.)
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Cheslow L, Snook AE, Waldman SA. Biomarkers for Managing Neurodegenerative Diseases. Biomolecules 2024; 14:398. [PMID: 38672416 PMCID: PMC11048498 DOI: 10.3390/biom14040398] [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: 03/03/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Neurological disorders are the leading cause of cognitive and physical disability worldwide, affecting 15% of the global population. Due to the demographics of aging, the prevalence of neurological disorders, including neurodegenerative diseases, will double over the next two decades. Unfortunately, while available therapies provide symptomatic relief for cognitive and motor impairment, there is an urgent unmet need to develop disease-modifying therapies that slow the rate of pathological progression. In that context, biomarkers could identify at-risk and prodromal patients, monitor disease progression, track responses to therapy, and parse the causality of molecular events to identify novel targets for further clinical investigation. Thus, identifying biomarkers that discriminate between diseases and reflect specific stages of pathology would catalyze the discovery and development of therapeutic targets. This review will describe the prevalence, known mechanisms, ongoing or recently concluded therapeutic clinical trials, and biomarkers of three of the most prevalent neurodegenerative diseases, including Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and Parkinson's disease (PD).
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Affiliation(s)
- Lara Cheslow
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA; (L.C.); (A.E.S.)
- Department of Neurosciences, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Adam E. Snook
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA; (L.C.); (A.E.S.)
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Scott A. Waldman
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA; (L.C.); (A.E.S.)
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Shi G, Zhang C, Bai X, Sun J, Wang K, Meng Q, Li Y, Hu G, Hu R, Cai Q, Huang M. A potential mechanism clue to the periodic storm from microglia activation and progressive neuron damage induced by paraquat exposure. ENVIRONMENTAL TOXICOLOGY 2024; 39:1874-1888. [PMID: 38189626 DOI: 10.1002/tox.24053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/24/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
Paraquat (PQ), is characterized by neurotoxicity, which increases the potential risk of Parkinson's disease (PD) exposure in the long-term and low doses. Triggering microglia activation and neuroinflammation is deemed an early event resulting in PD. However, the underlying pathogenesis of PD by PQ is not clear yet. In this article, C57BL/6J mice treated with PQ could successfully act out Parkinson-like. In addition, we observed the fluorescence intensity enhancement of Iba-1 activated microglia with released pro-inflammatory, all ahead of both the damage of dopaminergic neurons in the substantia nigra and corpus striatum of the brain. Surprisingly, the injection of minocycline before PQ for many hours not only can effectively improve the neurobehavioral symptoms of mice but inhibit the activation of microglia and the release of pro-inflammatory substances, even controlling the gradual damage and loss of neurons. A further mechanism of minocycline hampered the expression levels of key signaling proteins PI3K, PDK1, p-AKT, and CD11b (the receptor of microglia membrane recognition), while a large number of inflammatory factors. Our results suggested that the CD11b/PI3K/NOX2 pathway may be a clue that microglia-mediated inflammatory responses and neuronal damage in a PQ-induced abnormal behavior Parkinson-like mouse.
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Affiliation(s)
- Ge Shi
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Chunhui Zhang
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xinghua Bai
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jian Sun
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - KaiDong Wang
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qi Meng
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yang Li
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Guiling Hu
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Rong Hu
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qian Cai
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Min Huang
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan, Ningxia, China
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12
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Zhang A, Song Z, Di A, Zhou Z, Zheng L, Zhuang L. Acupuncture for the Treatment of Neuropsychiatric Symptoms in Parkinson's Disease: A Systematic Review and Meta-Analysis. Complement Ther Med 2024; 80:103020. [PMID: 38185400 DOI: 10.1016/j.ctim.2024.103020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) of Parkinson's disease (PD) have received increasing attention, but effective treatment options remain limited. Acupuncture may have clinical benefits for NPSs in PD patients, but high-quality evidence supporting this possibility still needs to be discovered. Therefore, we conducted a meta-analysis to evaluate the effect of acupuncture treatment on NPSs in PD patients. METHODS Randomized controlled trials (RCTs) of acupuncture treatment for PD retrieved from the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and Scopus, were used to evaluate NPSs of PD patients. The Cochrane Intervention System Evaluation Manual assessed the methodological quality. RESULTS A total of 13 RCTs involving 719 patients were included. The results showed that compared with medication alone or sham acupuncture, acupuncture improved sleep quality in PD patients, with Parkinson's Disease Sleep Scale (PDSS) [standardized mean difference (SMD)= 0.48, 95% confidence interval (CI)= 0.242 to 0.793, P = 0.001]. The I scores and total scores on Unified Parkinson's Disease Rating Scale (UPDRS) indicated acupuncture treatment was effective (SMD=-0.66, 95%CI=-0.66 to -0.18, P = 0.042; SMD=-0.77, 95%CI=-1.31 to -0.23, P = 0.005). Results of the Epworth Sleepiness Scale (ESS) and Parkinson's Disease Questionnaire-39 (PDQ-39) showed no statistically significant differences (SMD=-0.27, 95%CI=-0.08 to 0.62, P = 0.128; SMD=-0.20, 95%CI=-0.42 to 0.01, P = 0.554). Anxiety and depression research had no significant differences due to the excessive inter-study bias. CONCLUSION Acupuncture treatment can improve sleep quality, psychological and behavioral alterations, and the overall condition of PD patients. However, the study revealed no significant positive intervention effects on anxiety, depression, and quality of life, underscoring the necessity for continued research to elucidate these domains' intricacies and develop productive therapeutic approaches.
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Affiliation(s)
- Anxin Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zefeng Song
- Medical Department, Dalian University of Technology, Dalian 116024, China
| | - Anqi Di
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zelin Zhou
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Liang Zheng
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Lixing Zhuang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
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13
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Huang Y, Ji W, Zhang J, Huang Z, Ding A, Bai H, Peng B, Huang K, Du W, Zhao T, Li L. The involvement of the mitochondrial membrane in drug delivery. Acta Biomater 2024; 176:28-50. [PMID: 38280553 DOI: 10.1016/j.actbio.2024.01.027] [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: 10/10/2023] [Revised: 12/23/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
Treatment effectiveness and biosafety are critical for disease therapy. Bio-membrane modification facilitates the homologous targeting of drugs in vivo by exploiting unique antibodies or antigens, thereby enhancing therapeutic efficacy while ensuring biosafety. To further enhance the precision of disease treatment, future research should shift focus from targeted cellular delivery to targeted subcellular delivery. As the cellular powerhouses, mitochondria play an indispensable role in cell growth and regulation and are closely involved in many diseases (e.g., cancer, cardiovascular, and neurodegenerative diseases). The double-layer membrane wrapped on the surface of mitochondria not only maintains the stability of their internal environment but also plays a crucial role in fundamental biological processes, such as energy generation, metabolite transport, and information communication. A growing body of evidence suggests that various diseases are tightly related to mitochondrial imbalance. Moreover, mitochondria-targeted strategies hold great potential to decrease therapeutic threshold dosage, minimize side effects, and promote the development of precision medicine. Herein, we introduce the structure and function of mitochondrial membranes, summarize and discuss the important role of mitochondrial membrane-targeting materials in disease diagnosis/treatment, and expound the advantages of mitochondrial membrane-assisted drug delivery for disease diagnosis, treatment, and biosafety. This review helps readers understand mitochondria-targeted therapies and promotes the application of mitochondrial membranes in drug delivery. STATEMENT OF SIGNIFICANCE: Bio-membrane modification facilitates the homologous targeting of drugs in vivo by exploiting unique antibodies or antigens, thereby enhancing therapeutic efficacy while ensuring biosafety. Compared to cell-targeted treatment, targeting of mitochondria for drug delivery offers higher efficiency and improved biosafety and will promote the development of precision medicine. As a natural material, the mitochondrial membrane exhibits excellent biocompatibility and can serve as a carrier for mitochondria-targeted delivery. This review provides an overview of the structure and function of mitochondrial membranes and explores the potential benefits of utilizing mitochondrial membrane-assisted drug delivery for disease treatment and biosafety. The aim of this review is to enhance readers' comprehension of mitochondrial targeted therapy and to advance the utilization of mitochondrial membrane in drug delivery.
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Affiliation(s)
- Yinghui Huang
- The Institute of Flexible Electronics (IFE, Future Technologies), Xiamen University, Xiamen 361005, China
| | - Wenhui Ji
- The Institute of Flexible Electronics (IFE, Future Technologies), Xiamen University, Xiamen 361005, China
| | - Jiaxin Zhang
- Frontiers Science Center for Flexible Electronics, Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Ze Huang
- The Institute of Flexible Electronics (IFE, Future Technologies), Xiamen University, Xiamen 361005, China; Future Display Institute in Xiamen, Xiamen 361005, China
| | - Aixiang Ding
- The Institute of Flexible Electronics (IFE, Future Technologies), Xiamen University, Xiamen 361005, China
| | - Hua Bai
- Frontiers Science Center for Flexible Electronics, Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Bo Peng
- Frontiers Science Center for Flexible Electronics, Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Kai Huang
- Future Display Institute in Xiamen, Xiamen 361005, China
| | - Wei Du
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China.
| | - Tingting Zhao
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China.
| | - Lin Li
- The Institute of Flexible Electronics (IFE, Future Technologies), Xiamen University, Xiamen 361005, China; Future Display Institute in Xiamen, Xiamen 361005, China.
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Sisodia V, Dubbeld L, De Bie RMA, Duarte GS, Costa J, Dijk JM. Efficacy and safety of adjunctive oral therapy in Parkinson's disease with motor complications: a systematic review and network meta-analysis. BMJ Neurol Open 2024; 6:e000573. [PMID: 38352047 PMCID: PMC10862331 DOI: 10.1136/bmjno-2023-000573] [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: 10/31/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Background The aim of this manuscript is to review the evidence and compare the efficacy and safety of catechol-O-methyltransferase inhibitors (COMT-Is), dopamine receptor agonists (DRAs) and monoamine-oxidase B inhibitors (MAOB-Is) as adjunctive treatment to levodopa in patients with Parkinson's disease (PD) experiencing motor complications. Methods In this systematic review and network meta-analysis, literature searches were performed in MEDLINE and Embase to identify eligible randomised controlled trials (RCTs) with a minimal follow-up of at least 4 weeks published in English between 1980 and 2021. RCTs were included if either a COMT-I, DRA or MAOB-I was evaluated as an adjunctive therapy to levodopa in patients with PD experiencing motor complications and dyskinesia. The main outcomes included daily off-medication time, motor and non-motor examination scales, and adverse events including dyskinesia. Results 74 RCTs reporting on 18 693 patients were included. All three studied drug classes decreased daily off-medication time compared with placebo (COMT-Is mean -0.8 hours (95% CI -1.0 to -0.6), DRAs -1.1 hours (95% CI -1.4 to -0.8), MAOB-Is -0.9 hours (95% CI -1.2 to -0.6)). Safety analysis showed an increased risk of dyskinesia for all three drug classes (COMT-Is OR 3.3 (95% CI 2.7 to 4.0), DRAs 3.0 (95% CI 2.5 to 3.5), MAOB-Is 1.6 (95% CI 1.2 to 2.2)). According to surface under the cumulative ranking curve scores, pramipexole IR was associated with the most favourable benefit-risk profile. Conclusions COMT-Is, DRAs and MAOB-Is effectively reduce motor complications and increase incidence of dyskinesia. In the network meta-analysis, adjunctive use of DRAs appeared most effective.
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Affiliation(s)
- Vibuthi Sisodia
- Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Lars Dubbeld
- Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Rob M A De Bie
- Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Gonçalo S Duarte
- Clinical Pharmacology Department, Hospital da Luz, Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon Faculty of Medicine, Lisboa, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon Faculty of Medicine, Lisboa, Portugal
- Institute of Molecular Medicine, University of Lisbon Faculty of Medicine, Lisboa, Portugal
| | - Joke M Dijk
- Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
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15
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Huang H, Lin L, Wu T, Wu C, Zhou L, Li G, Su F, Liang F, Guo W, Chen W, Jiang Q, Guan Y, Li X, Xu P, Zhang Y, Smith W, Pei Z. Phosphorylation of AQP4 by LRRK2 R1441G impairs glymphatic clearance of IFNγ and aggravates dopaminergic neurodegeneration. NPJ Parkinsons Dis 2024; 10:31. [PMID: 38296953 PMCID: PMC10831045 DOI: 10.1038/s41531-024-00643-z] [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: 08/10/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024] Open
Abstract
Aquaporin-4 (AQP4) is essential for normal functioning of the brain's glymphatic system. Impaired glymphatic function is associated with neuroinflammation. Recent clinical evidence suggests the involvement of glymphatic dysfunction in LRRK2-associated Parkinson's disease (PD); however, the precise mechanism remains unclear. The pro-inflammatory cytokine interferon (IFN) γ interacts with LRRK2 to induce neuroinflammation. Therefore, we examined the AQP4-dependent glymphatic system's role in IFNγ-mediated neuroinflammation in LRRK2-associated PD. We found that LRRK2 interacts with and phosphorylates AQP4 in vitro and in vivo. AQP4 phosphorylation by LRRK2 R1441G induced AQP4 depolarization and disrupted glymphatic IFNγ clearance. Exogeneous IFNγ significantly increased astrocyte expression of IFNγ receptor, amplified AQP4 depolarization, and exacerbated neuroinflammation in R1441G transgenic mice. Conversely, inhibiting LRRK2 restored AQP4 polarity, improved glymphatic function, and reduced IFNγ-mediated neuroinflammation and dopaminergic neurodegeneration. Our findings establish a link between LRRK2-mediated AQP4 phosphorylation and IFNγ-mediated neuroinflammation in LRRK2-associated PD, guiding the development of LRRK2 targeting therapy.
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Affiliation(s)
- Heng Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Lishan Lin
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Tengteng Wu
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cheng Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Leping Zhou
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ge Li
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Fengjuan Su
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Fengyin Liang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Wenyuan Guo
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weineng Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Qiuhong Jiang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yalun Guan
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Xuejiao Li
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Pingyi Xu
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Zhang
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Wanli Smith
- Department of Psychiatry, Division of Neurobiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
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So YJ, Lee JU, Yang GS, Yang G, Kim SW, Lee JH, Kim JU. The Potentiality of Natural Products and Herbal Medicine as Novel Medications for Parkinson's Disease: A Promising Therapeutic Approach. Int J Mol Sci 2024; 25:1071. [PMID: 38256144 PMCID: PMC10816678 DOI: 10.3390/ijms25021071] [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: 11/22/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
As the global population ages, the prevalence of Parkinson's disease (PD) is steadily on the rise. PD demonstrates chronic and progressive characteristics, and many cases can transition into dementia. This increases societal and economic burdens, emphasizing the need to find effective treatments. Among the widely recognized causes of PD is the abnormal accumulation of proteins, and autophagy dysfunction accelerates this accumulation. The resultant Lewy bodies are also commonly found in Alzheimer's disease patients, suggesting an increased potential for the onset of dementia. Additionally, the production of free radicals due to mitochondrial dysfunction contributes to neuronal damage and degeneration. The activation of astrocytes and the M1 phenotype of microglia promote damage to dopamine neurons. The drugs currently used for PD only delay the clinical progression and exacerbation of the disease without targeting its root cause, and come with various side effects. Thus, there is a demand for treatments with fewer side effects, with much potential offered by natural products. In this study, we reviewed a total of 14 articles related to herbal medicines and natural products and investigated their relevance to possible PD treatment. The results showed that the reviewed herbal medicines and natural products are effective against lysosomal disorder, mitochondrial dysfunction, and inflammation, key mechanisms underlying PD. Therefore, natural products and herbal medicines can reduce neurotoxicity and might improve both motor and non-motor symptoms associated with PD. Furthermore, these products, with their multi-target effects, enhance bioavailability, inhibit antibiotic resistance, and might additionally eliminate side effects, making them good alternative therapies for PD treatment.
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Affiliation(s)
- Yu-Jin So
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
| | - Jae-Ung Lee
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
| | - Ga-Seung Yang
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
| | - Gabsik Yang
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
| | - Sung-Wook Kim
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
| | - Jun-Ho Lee
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
- Da CaPo Co., Ltd., 303 Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Jeollabuk-do, Republic of Korea
| | - Jong-Uk Kim
- College of Korean Medicine, Woosuk University, Jeonju-si 54986, Jeollabuk-do, Republic of Korea; (Y.-J.S.); (J.-U.L.); (G.-S.Y.); (G.Y.); (S.-W.K.)
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Zalyalova ZA, Katunina EA, Pokhabov DV, Munasipova SE, Ermakova MM. [Tremor-dominant form of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:28-35. [PMID: 38676674 DOI: 10.17116/jnevro202412404128] [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] [Indexed: 04/29/2024]
Abstract
The article is of a review nature and is devoted to tremor, one of the maladaptive and difficult-to-treat symptoms of Parkinson's disease (PD). Along with the classic rest tremor, patients with PD may experience tremor of other modalities: postural tremor, kinetic tremor, which reflects a multimodal mechanism of tremor formation involving multiple neurotransmitter systems. The unpredictable response to therapeutic options, the ambiguous response to levodopa, also reflects the role of multiple underlying pathophysiological processes. Among the drug methods of tremor correction, preference is given to dopamine receptor agonists - due to the spectrum of their pharmaceutical action, high efficiency in relation to all leading motor and a number of non-motor manifestations. The evidence for advanced neurosurgical, non-invasive modalities is mixed, and there are insufficient comparative studies to assess their efficacy in patients with tremor-dominant forms of PD.
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Affiliation(s)
- Z A Zalyalova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center for Brain and Neurotechnology, Moscow, Russia
| | - D V Pokhabov
- Center for Innovative Neurology, Extrapyramidal Diseases and Botulinum Therapy, Krasnoyarsk, Russia
- Voino-Yasnevetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S E Munasipova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
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Bezard E, Gray D, Kozak R, Leoni M, Combs C, Duvvuri S. Rationale and Development of Tavapadon, a D1/D5-Selective Partial Dopamine Agonist for the Treatment of Parkinson's Disease. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:476-487. [PMID: 36999711 PMCID: PMC10909821 DOI: 10.2174/1871527322666230331121028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 04/01/2023]
Abstract
Currently, available therapeutics for the treatment of Parkinson's disease (PD) fail to provide sustained and predictable relief from motor symptoms without significant risk of adverse events (AEs). While dopaminergic agents, particularly levodopa, may initially provide strong motor control, this efficacy can vary with disease progression. Patients may suffer from motor fluctuations, including sudden and unpredictable drop-offs in efficacy. Dopamine agonists (DAs) are often prescribed during early-stage PD with the expectation they will delay the development of levodopa-associated complications, but currently available DAs are less effective than levodopa for the treatment of motor symptoms. Furthermore, both levodopa and DAs are associated with a significant risk of AEs, many of which can be linked to strong, repeated stimulation of D2/D3 dopamine receptors. Targeting D1/D5 dopamine receptors has been hypothesized to produce strong motor benefits with a reduced risk of D2/D3-related AEs, but the development of D1-selective agonists has been previously hindered by intolerable cardiovascular AEs and poor pharmacokinetic properties. There is therefore an unmet need in PD treatment for therapeutics that provide sustained and predictable efficacy, with strong relief from motor symptoms and reduced risk of AEs. Partial agonism at D1/D5 has shown promise for providing relief from motor symptoms, potentially without the AEs associated with D2/D3-selective DAs and full D1/D5-selective DAs. Tavapadon is a novel oral partial agonist that is highly selective at D1/D5 receptors and could meet these criteria. This review summarizes currently available evidence of tavapadon's therapeutic potential for the treatment of early through advanced PD.
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Affiliation(s)
- Erwan Bezard
- Université de Bordeaux, CNRS Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Motac Neuroscience, Manchester, United Kingdom
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Hansen L, Witzig V, Schulz JB, Holtbernd F. Dopaminergic treatment strategies for people with Parkinson's disease in Europe: a retrospective analysis of PRISM trial data. Neurol Sci 2023; 44:3905-3912. [PMID: 37311949 PMCID: PMC10570205 DOI: 10.1007/s10072-023-06888-5] [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: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Levodopa (LD) is the most effective drug to treat Parkinson's disease (PD). The recently concluded multinational Parkinson's Real-World Impact Assessment (PRISM) trial revealed highly variable prescription patterns of LD monotherapy across six European countries. The reasons remain unclear. METHODS In this post hoc analysis of PRISM trial data, we used multivariate logistic regression analysis to identify socio-economic factors affecting prescription practice. We applied receiver-operated characteristics and split sample validation to test model accuracy to predict treatment class (LD monotherapy vs. all other treatments). RESULTS Subject age, disease duration, and country of residence were significant predictors of treatment class. The chance of receiving LD monotherapy increased by 6.9% per year of age. In contrast, longer disease duration reduced the likelihood of receiving LD monotherapy by 9.7% per year. Compared to the other countries, PD patients in Germany were 67.1% less likely and their counterparts in the UK 86.8% more likely to receive an LD monotherapy. The model classification accuracy of treatment class assignment was 80.1%. The area under the curve to predict treatment condition was 0.758 (95% CI [0.715, 0.802]). Split sample validation revealed poor sensitivity (36.6%), but excellent specificity (92.7%) to predict treatment class. CONCLUSION The relative lack of socio-economic variables affecting prescription practice in the study sample and limited model accuracy to predict treatment class suggest the presence of additional, country-specific factors affecting prescription patterns that were not assessed in the PRISM trial. Our findings indicate that physicians still avoid prescribing LD monotherapy to younger PD patients.
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Affiliation(s)
- Lara Hansen
- Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Victoria Witzig
- Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Juelich Research Center GmbH and RWTH Aachen University, Aachen, Germany
| | - Florian Holtbernd
- Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Juelich Research Center GmbH and RWTH Aachen University, Aachen, Germany.
- Juelich Research Center, Institutes of Neuroscience and Medicine (INM-4, INM-11), Juelich, Germany.
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20
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Moes HR, Henriksen T, Sławek J, Phokaewvarangkul O, Buskens E, van Laar T. Tools and criteria to select patients with advanced Parkinson's disease for device-aided therapies: a narrative review. J Neural Transm (Vienna) 2023; 130:1359-1377. [PMID: 37500937 PMCID: PMC10645650 DOI: 10.1007/s00702-023-02656-z] [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: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This article provides an overview of the various screening and selection tools which have been developed over the past 25 years to identify patients with Parkinson's disease (PD) possibly eligible for device-aided therapies (DATs). For the available screening tools, we describe the target therapies (subtypes of DAT), development methods, validation data, and their use in clinical practice. In addition, the historical background and potential utility of these screening tools are discussed. The challenges in developing and validating these tools are also addressed, taking into account the differences in population, the local health care organization, and resource availability.
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Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jarosław Sławek
- Department of Neurology, St Adalbert Hospital Copernicus, Gdansk, Poland
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands.
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21
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Khanna A, Jones G. Toward Personalized Medicine Approaches for Parkinson Disease Using Digital Technologies. JMIR Form Res 2023; 7:e47486. [PMID: 37756050 PMCID: PMC10568402 DOI: 10.2196/47486] [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: 03/21/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Parkinson disease (PD) is a complex neurodegenerative disorder that afflicts over 10 million people worldwide, resulting in debilitating motor and cognitive impairment. In the United States alone (with approximately 1 million cases), the economic burden for treating and caring for persons with PD exceeds US $50 billion and myriad therapeutic approaches are under development, including both symptomatic- and disease-modifying agents. The challenges presented in addressing PD are compounded by observations that numerous, statistically distinct patient phenotypes present with a wide variety of motor and nonmotor symptomatic profiles, varying responses to current standard-of-care symptom-alleviating medications (L-DOPA and dopaminergic agonists), and different disease trajectories. The existence of these differing phenotypes highlights the opportunities in personalized approaches to symptom management and disease control. The prodromal period of PD can span across several decades, allowing the potential to leverage the unique array of composite symptoms presented to trigger early interventions. This may be especially beneficial as disease progression in PD (alongside Alzheimer disease and Huntington disease) may be influenced by biological processes such as oxidative stress, offering the potential for individual lifestyle factors to be tailored to delay disease onset. In this viewpoint, we offer potential scenarios where emerging diagnostic and monitoring strategies might be tailored to the individual patient under the tenets of P4 medicine (predict, prevent, personalize, and participate). These approaches may be especially relevant as the causative factors and biochemical pathways responsible for the observed neurodegeneration in patients with PD remain areas of fluid debate. The numerous observational patient cohorts established globally offer an excellent opportunity to test and refine approaches to detect, characterize, control, modify the course, and ultimately stop progression of this debilitating disease. Such approaches may also help development of parallel interventive strategies in other diseases such as Alzheimer disease and Huntington disease, which share common traits and etiologies with PD. In this overview, we highlight near-term opportunities to apply P4 medicine principles for patients with PD and introduce the concept of composite orthogonal patient monitoring.
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Affiliation(s)
- Amit Khanna
- Neuroscience Global Drug Development, Novartis Pharma AG, Basel, Switzerland
| | - Graham Jones
- GDD Connected Health and Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ, United States
- Clinical and Translational Science Institute, Tufts University Medical Center, Boston, MA, United States
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22
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Constantin VA, Szász JA, Dulamea AO, Valkovic P, Kulisevsky J. Impact of Infusion Therapies on Quality of Life in Advanced Parkinson's Disease. Neuropsychiatr Dis Treat 2023; 19:1959-1972. [PMID: 37727253 PMCID: PMC10506606 DOI: 10.2147/ndt.s422717] [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: 07/03/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
A high burden of motor and non-motor parkinsonian symptoms is known to have a significant negative impact on the quality of life (QoL) of people with Parkinson's disease (PD). Effective control of these symptoms with therapies that enable patients to maintain a good QoL is therefore a key treatment goal in PD management. When symptom control can no longer be accomplished with oral or transdermal PD treatment regimens, device-aided therapies (DAT), namely levodopa and apomorphine infusion therapies, and deep brain stimulation, are valuable options to consider. DAT options may also help reduce pill burden and thereby improve compliance with treatment. Since PD therapy relies on symptomatic management, the efficacy and tolerability of any intervention is undoubtedly important, however the impact of different therapies on patient-related outcome measures, in particular health-related QoL, is also a critical consideration for those living with a chronic and disabling condition. This review discusses clinical evidence and ongoing research regarding the QoL benefits of levodopa and apomorphine infusion therapies from studies that have used validated QoL outcome measures. The data suggest that timing of these interventions is important to achieve optimal treatment effects, and that early initiation onto infusion therapies at the point when motor fluctuations emerge, and before patient QoL and functioning have significantly declined, may provide the best long-term outcomes. Healthcare professionals caring for people with PD should therefore discuss all available DAT options with them at an early stage in the course of their disease so they can make informed and timely choices that best suit them, their families and care network.
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Affiliation(s)
- Viorelia A Constantin
- Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - József A Szász
- Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
| | - Adriana Octaviana Dulamea
- Neurology Clinic, Fundeni Clinical Institute, Bucharest, Romania
- University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
| | - Peter Valkovic
- Second Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia
| | - Jaime Kulisevsky
- Movement Disorders Unit at the Neurology Department of Sant Pau Hospital, Barcelona, Spain
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23
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Isaacson SH, Hauser RA, Pahwa R, Gray D, Duvvuri S. Dopamine agonists in Parkinson's disease: Impact of D1-like or D2-like dopamine receptor subtype selectivity and avenues for future treatment. Clin Park Relat Disord 2023; 9:100212. [PMID: 37497384 PMCID: PMC10366643 DOI: 10.1016/j.prdoa.2023.100212] [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: 02/10/2023] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023] Open
Abstract
Dopamine agonists (DAs) have demonstrated efficacy for the treatment of Parkinson's disease (PD) but are limited by adverse effects (AEs). DAs can vary considerably in their receptor subtype selectivity and affinity, chemical composition, receptor occupancy, and intrinsic activity on the receptor. Most currently approved DAs for PD treatment primarily target D2/D3 (D2-like) dopamine receptors. However, selective activation of D1/D5 (D1-like) dopamine receptors may enable robust activation of motor function while avoiding AEs related to D2/D3 receptor agonism. Full D1/D5 receptor-selective agonists have been explored in small, early-phase clinical studies, and although their efficacy for motor symptoms was robust, challenges with pharmacokinetics, bioavailability, cardiovascular AEs, and dyskinesia rates similar to levodopa prevented clinical advancement. Generally, repeated dopaminergic stimulation with full DAs is associated with frontostriatal dysfunction and sensitization that may induce plastic changes in the motor system, and neuroadaptations that produce long-term motor and nonmotor complications, respectively. Recent preclinical and clinical studies suggest that a D1/D5 receptor-selective partial agonist may hold promise for providing sustained, predictable, and robust motor control, while reducing risk for motor complications (e.g., levodopa-induced dyskinesia) and nonmotor AEs (e.g., impulse control disorders and excessive daytime sleepiness). Clinical trials are ongoing to evaluate this hypothesis. The potential emerging availability of novel dopamine receptor agonists with selective dopamine receptor pharmacology suggests that the older terminology "dopamine agonist" may need revision to distinguish older-generation D2/D3-selective agonists from D1/D5-selective agonists with distinct efficacy and tolerability characteristics.
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Affiliation(s)
- Stuart H. Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | - Robert A. Hauser
- Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, University of South Florida, Tampa, FL, USA
| | - Rajesh Pahwa
- Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - David Gray
- Vigil Neuroscience, Inc, Watertown, MA, USA
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Li M, Zhang J, Jiang L, Wang W, Feng X, Liu M, Yang D. Neuroprotective effects of morroniside from Cornus officinalis sieb. Et zucc against Parkinson's disease via inhibiting oxidative stress and ferroptosis. BMC Complement Med Ther 2023; 23:218. [PMID: 37393274 DOI: 10.1186/s12906-023-03967-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/19/2023] [Indexed: 07/03/2023] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenera-tive disorder after Alzheimer disease accompanied by the death of dopaminergic neurons and brain nigrostriatal mitochondrial damage in the elderly population. The features of the disease include tremor, rigidity, postural instability, and motor retardation. The pathogenesis of Parkinson's disease is complex, and abnormal lipid metabolism resulting in ferroptosis due to the excessive accumulation of free radicals from oxidative stress in the substantia nigra of the brain was thought to be one of the factors causing the disease. Morroniside has been reported to have significant neuroprotective effects, although it has not been studied in PD. Therefore, this study focused on determining the neuroprotective effects of morroniside (25, 50, and 100 mg/kg) on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 30 mg/kg)-induced mice models of PD and explored 1-methyl-4-phenylpyridinium MPP+-induced ferroptosis in PC12 cells. Morroniside restored impaired motor function in the PD mice models while reducing neuronal injury. The activation of nuclear factor erythroid 2-related factor 2/antioxidant response elements (Nrf2/ARE) by morroniside promoted antioxidation, the content of reducing agent glutathione (GSH) increased, and the level of the lipid metabolite malondialdehyde (MDA) decreased. Notably, morroniside inhibited ferroptosis in substantia nigra of the brain and PC12 cells, reduced iron levels, and upregulated the expression of the iron-regulated proteins glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), ferritin heavy chain 1 (FTH-1), and ferroportin (FPN). More importantly, morroniside repaired the mitochondrial damage, restored the mitochondrial respiratory chain, and inhibited the production of reactive oxygen species (ROS). These data indicated that morroniside could activate the Nrf2/ARE signaling pathway to increase the antioxidant capacity, thereby inhibiting abnormal lipid metabolism and protecting dopaminergic neurons from ferroptosis in PD.
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Affiliation(s)
- Mao Li
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Junli Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lianyan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wujun Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Xianrong Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Meijun Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Dongdong Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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25
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Zhang Q, Chen XT, Chen FF, Wen SY, Zhou CQ. Dopamine agonists versus levodopa monotherapy in early Parkinson's disease for the potential risks of motor complications: A network meta-analysis. Eur J Pharmacol 2023:175884. [PMID: 37385577 DOI: 10.1016/j.ejphar.2023.175884] [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: 11/19/2022] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Compared with levodopa, dopamine agonists (DAs) as initial treatment are associated with lower incidences of motor complications in early Parkinson's disease (PD). There is no strong evidence that a given DA is more potent in lower incidences of motor complications than another. OBJECTIVE We performed a network meta-analysis of levodopa versus DAs as monotherapy in early PD to access the risk of motor complications. METHODS Databases were searched up to June 2022 for eligible RCTs. Levodopa and four DAs (pramipexole, ropinirole, bromocriptine and pergolide) were investigated. The incidences of motor complications and efficacy, tolerability and safety outcomes were analyzed. RESULTS Nine RCTs (2112 patients) were included in the current study. The surface under the cumulative ranking curve (SUCRA) indicated that levodopa ranked first in the incidence of dyskinesia (0.988), followed by pergolide, pramipexole, ropinirole, and bromocriptine (0.704, 0.408, 0.240, 0.160). Pramipexole was least prone to wearing-off (0.109) and on-off fluctuation (0.041). Levodopa performed best in improvements of UPDRS-II, UPDRS-III, and UPDRS-II + III (0.925, 0.952, 0.934). Bromocriptine ranked first in total withdrawals and withdrawals due to adverse events (0.736, 0.751). Four DAs showed different adverse events profiles. CONCLUSION In the two non-ergot DAs, ropinirole is associated with a lower risk of dyskinesia while pramipexole is associated with lower risks of wearing-off and on-off fluctuations. Our research may facilitate head-to-head research, larger sample sizes, long following-up time RCTs to confirm the findings of this network meta-analysis.
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Affiliation(s)
- Qian Zhang
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Xiang-Ting Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Fei-Fei Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Si-Yuan Wen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
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26
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Habets JGV, Spooner RK, Mathiopoulou V, Feldmann LK, Busch JL, Roediger J, Bahners BH, Schnitzler A, Florin E, Kühn AA. A First Methodological Development and Validation of ReTap: An Open-Source UPDRS Finger Tapping Assessment Tool Based on Accelerometer-Data. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115238. [PMID: 37299968 DOI: 10.3390/s23115238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Bradykinesia is a cardinal hallmark of Parkinson's disease (PD). Improvement in bradykinesia is an important signature of effective treatment. Finger tapping is commonly used to index bradykinesia, albeit these approaches largely rely on subjective clinical evaluations. Moreover, recently developed automated bradykinesia scoring tools are proprietary and are not suitable for capturing intraday symptom fluctuation. We assessed finger tapping (i.e., Unified Parkinson's Disease Rating Scale (UPDRS) item 3.4) in 37 people with Parkinson's disease (PwP) during routine treatment follow ups and analyzed their 350 sessions of 10-s tapping using index finger accelerometry. Herein, we developed and validated ReTap, an open-source tool for the automated prediction of finger tapping scores. ReTap successfully detected tapping blocks in over 94% of cases and extracted clinically relevant kinematic features per tap. Importantly, based on the kinematic features, ReTap predicted expert-rated UPDRS scores significantly better than chance in a hold out validation sample (n = 102). Moreover, ReTap-predicted UPDRS scores correlated positively with expert ratings in over 70% of the individual subjects in the holdout dataset. ReTap has the potential to provide accessible and reliable finger tapping scores, either in the clinic or at home, and may contribute to open-source and detailed analyses of bradykinesia.
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Affiliation(s)
- Jeroen G V Habets
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Rachel K Spooner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Varvara Mathiopoulou
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Lucia K Feldmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Johannes L Busch
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Jan Roediger
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
| | - Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Universitaetsmedizin Berlin, 10117 Berlin, Germany
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Molteni L, Charlier B, Izzo V, Coglianese A, Conti V, Eleopra R, Cilia R, Capelli C, D'Urso A, de Grazia U. Development and Validation of a New LC-MS/MS Bioanalytical Method for the Simultaneous Determination of Levodopa, Levodopa Methyl Ester, and Carbidopa in Human Plasma Samples. Molecules 2023; 28:molecules28114264. [PMID: 37298741 DOI: 10.3390/molecules28114264] [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: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Levodopa (L-DOPA) treatment, combined with the administration of dopa-decarboxylase inhibitors (DDCIs), is still the most effective symptomatic treatment of Parkinson's disease (PD). Although its efficacy in the early stage of the disease has been confirmed, its complex pharmacokinetics (PK) increases the variability of the intra-individual motor response, thus amplifying the risk of motor/non-motor fluctuations and dyskinesia. Moreover, it has been demonstrated that L-DOPA PK is strongly influenced by several clinical, therapeutic, and lifestyle variables (e.g., dietary proteins). L-DOPA therapeutic monitoring is therefore crucial to provide personalized therapy, hence improving drug efficacy and safety. To this aim, we have developed and validated an ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method to quantify L-DOPA, levodopa methyl ester (LDME), and the DDCI carbidopa in human plasma. The compounds were extracted by protein precipitation and samples were analyzed with a triple quadrupole mass spectrometer. The method showed good selectivity and specificity for all compounds. No carryover was observed, and dilution integrity was demonstrated. No matrix effect could be retrieved; intra-day and inter-day precision and accuracy values met the acceptance criteria. Reinjection reproducibility was assessed. The described method was successfully applied to a 45-year-old male patient to compare the pharmacokinetic behavior of an L-DOPA-based medical treatment involving commercially available Mucuna pruriens extracts and an LDME/carbidopa (100/25 mg) formulation.
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Affiliation(s)
- Linda Molteni
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Bruno Charlier
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy
| | - Viviana Izzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy
| | - Albino Coglianese
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- Graduate School in Clinical Pathology and Clinical Biochemistry, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Roberto Cilia
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Chiara Capelli
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Annachiara D'Urso
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Ugo de Grazia
- Laboratory of Neurological Biochemistry and Neuropharmacology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
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28
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Kim SW, Lee JH, Kim B, Yang G, Kim JU. Natural Products as the Potential to Improve Alzheimer's and Parkinson's Disease. Int J Mol Sci 2023; 24:ijms24108827. [PMID: 37240173 DOI: 10.3390/ijms24108827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Alzheimer's disease and Parkinson's disease are the two most common neurodegenerative diseases in the world, and their incidence rates are increasing as our society ages. This creates a significant social and economic burden. Although the exact cause and treatment methods for these diseases are not yet known, research suggests that Alzheimer's disease is caused by amyloid precursor protein, while α-synuclein acts as a causative agent in Parkinson's disease. The accumulation of abnormal proteins such as these can lead to symptoms such as loss of protein homeostasis, mitochondrial dysfunction, and neuroinflammation, which ultimately result in the death of nerve cells and the progression of neurodegenerative diseases. The medications currently available for these diseases only delay their progression and have many adverse effects, which has led to increased interest in developing natural products with fewer adverse effects. In this study, we selected specific keywords and thesis content to investigate natural products that are effective in treating Alzheimer's and Parkinson's diseases. We reviewed 16 papers on natural products and found that they showed promising mechanisms of action such as antioxidant, anti-inflammatory, and mitochondrial function improvement. Other natural products with similar properties could also be considered potential treatments for neurodegenerative diseases, and they can be consumed as part of a healthy diet rather than as medicine.
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Affiliation(s)
- Sung Wook Kim
- College of Korea Medicine, Woosuk University, Jeonju-si 54986, Republic of Korea
| | - Jun Ho Lee
- College of Korea Medicine, Woosuk University, Jeonju-si 54986, Republic of Korea
- Da Capo Co., Ltd., Jeonju-si 54986, Republic of Korea
| | - Bumjung Kim
- Department of Oriental Health Management, Kyung Hee Cyber University, Seoul 02447, Republic of Korea
| | - Gabsik Yang
- College of Korea Medicine, Woosuk University, Jeonju-si 54986, Republic of Korea
| | - Jong Uk Kim
- College of Korea Medicine, Woosuk University, Jeonju-si 54986, Republic of Korea
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Sharafeldin M, Yan S, Jiang C, Tofaris GK, Davis JJ. Alternating Magnetic Field-Promoted Nanoparticle Mixing: The On-Chip Immunocapture of Serum Neuronal Exosomes for Parkinson's Disease Diagnostics. Anal Chem 2023; 95:7906-7913. [PMID: 37167073 DOI: 10.1021/acs.analchem.3c00357] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The analysis of cargo proteins in exosome subpopulations has considerable value in diagnostics but a translatable impact has been limited by lengthy or complex exosome extraction protocols. We describe herein a scalable, fast, and low-cost exosome extraction using an alternating (AC) magnetic field to support the dynamic mixing of antibody-coated magnetic beads (MBs) with serum samples within 3D-printed microfluidic chips. Zwitterionic polymer-coated MBs are, specifically, magnetically agitated and support ultraclean exosome capture efficiencies >70% from <50 μL of neat serum in 30 min. Applied herein to the immunocapture of neuronal exosomes using anti-L1CAM antibodies, prior to the array-based assaying of α-synuclein (α-syn) content by a standard duplex electrochemical sandwich ELISA, sub pg/mL detection was possible with an excellent coefficient of variation and a sample-to-answer time of ∼75 min. The high performance and semiautomation of this approach hold promise in underpinning low-cost Parkinson's disease diagnostics and is of value in exosomal biomarker analyses more generally.
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Affiliation(s)
- Mohamed Sharafeldin
- Department of Chemistry, University of Oxford, South Parks Road, Oxford OX1 3QZ, U.K
- Department of Chemistry, University of Otago, Dunedin 9054, New Zealand
| | - Shijun Yan
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, U.K
- Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, Oxford OX1 3QU, U.K
| | - Cheng Jiang
- Department of Chemistry, University of Oxford, South Parks Road, Oxford OX1 3QZ, U.K
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, U.K
- Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, Oxford OX1 3QU, U.K
| | - George K Tofaris
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, U.K
- Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, Oxford OX1 3QU, U.K
| | - Jason J Davis
- Department of Chemistry, University of Oxford, South Parks Road, Oxford OX1 3QZ, U.K
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Rani L, Ghosh B, Ahmad MH, Mondal AC. Evaluation of Potential Neuroprotective Effects of Vanillin Against MPP +/MPTP-Induced Dysregulation of Dopaminergic Regulatory Mechanisms in SH-SY5Y Cells and a Mouse Model of Parkinson's Disease. Mol Neurobiol 2023:10.1007/s12035-023-03358-z. [PMID: 37145378 DOI: 10.1007/s12035-023-03358-z] [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: 06/23/2022] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative condition. The pathogenesis of PD is still unknown, and drugs available for PD treatment either have side effects or have suboptimal efficacy. Flavonoids are potent antioxidants having little toxicity with extended use, suggesting they might hold promising therapeutic potential against PD. Vanillin (Van) is a phenolic compound that has exhibited neuroprotective properties in various neurological disorders, including PD. However, the neuroprotective role of Van in PD and its underlying mechanisms are scarce and therefore need more exploration. Here, we evaluated the neuroprotective potential of Van and its associated mechanisms against MPP+/MPTP-induced neuronal loss in differentiated human neuroblastoma (SH-SY5Y) cells and the mouse model of PD. In the present study, Van treatment significantly enhanced the cell viability and alleviated oxidative stress, mitochondrial membrane potential, and apoptosis in MPP+-intoxicated SH-SY5Y cells. Moreover, Van significantly ameliorated the MPP+-induced dysregulations in protein expression of tyrosine hydroxylase (TH) and mRNA expressions of GSK-3β, PARP1, p53, Bcl-2, Bax, and Caspase-3 genes in SH-SY5Y cells. Similar to our in vitro results, Van significantly alleviated MPTP-induced neurobehavioral dysregulations, oxidative stress, aberrant TH protein expressions, and immunoreactivity in SNpc of mice brains. Treatment of Van also prevented MPTP-mediated loss of TH-positive intrinsic dopaminergic neurons to SNpc and TH-fibers projecting to the striatum of mice. Thus, Van exhibited promising neuroprotective properties in the current study against MPP+/MPTP-intoxicated SH-SY5Y cells and mice, indicating its potential therapeutic properties against PD pathology.
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Affiliation(s)
- Linchi Rani
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India, 110067
| | - Balaram Ghosh
- Midnapore Medical College and Hospital, West Medinipur, Kolkata, West Bengal, India
| | - Mir Hilal Ahmad
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India, 110067
| | - Amal Chandra Mondal
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India, 110067.
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Zhang C, Xue Z, Zhu L, Zhou J, Zhuo L, Zhang J, Zhang X, Liu W, Han L, Liao W. Rhynchophylline alleviates neuroinflammation and regulates metabolic disorders in a mouse model of Parkinson's disease. Food Funct 2023; 14:3208-3219. [PMID: 36919954 DOI: 10.1039/d2fo02939a] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder with limited therapeutic agents. Rhynchophylline (RIN), a tetracyclic oxindole alkaloid isolated from Uncaria rhynchophylla, has multiple neuropharmacological activities, including anti-inflammatory, anti-depression, anti-neurodegenerative disease, and anti-drug addiction. Though it is reported that RIN exerts a neuroprotective effect against PD, the underlying protective mechanism remains obscure. In this study, a mass spectrometry-based metabolomic strategy combined with neurobehavioral tests, serum biochemical assays, and immunohistochemistry were employed to decipher the protective mechanism of RIN against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP)-induced subacute PD in mice. Our results indicated that RIN significantly improved the MPTP-induced behavioral abnormalities, reduced the loss of dopaminergic neurons, and reversed the secretion of inflammatory cytokines and oxidative stress indicators. Further studies showed that RIN significantly suppressed the expression of toll-like receptor 4, NOD-like receptor protein 3, and cyclooxygenase 2 in the mouse striatum. The results of serum metabolomics showed that RIN could ameliorate metabolic disorders in PD mainly through the regulation of retinol metabolism, arachidonic acid metabolism, glycerophospholipid metabolism, and purine metabolism. These pieces of evidence revealed that RIN is a promising drug candidate for PD by alleviating neuroinflammation and maintaining metabolic homeostasis.
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Affiliation(s)
- Chunxia Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Zhen Xue
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Lingmeng Zhu
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Jiayu Zhou
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Lingxin Zhuo
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Jiayi Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Xinchen Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Wenyuan Liu
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Zhejiang Center for Safety Study of Drug Substances (Industrial Technology Innovation Platform), Hangzhou, 310018, China
| | - Lingfei Han
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
| | - Wenting Liao
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, Nanjing 210009, China. .,Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing 210009, China
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Kim MS, Park DG, Gil YE, Shin IJ, Yoon JH. The effect of levodopa treatment on vascular endothelial function in Parkinson's disease. J Neurol 2023; 270:2964-2968. [PMID: 36790545 DOI: 10.1007/s00415-023-11622-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE There has been increasing awareness that micro-vascular alteration or vascular inflammation has been associated with levodopa-induced dyskinesia in PD. Vascular endothelial function assessed by flow mediated dilation (FMD) is known to reflect early microvascular change. We compare the impact of levodopa or dopamine agonist treatment on the change of FMD in de novo PD patients. METHODS This retrospective study used a selected sample from registry. We identified de-novo PD patients who underwent FMD at baseline, and follow-up FMD after 1 year (± 2 month) of levodopa (n = 18) or dopamine agonist (n = 18) treatment. RESULTS FMD decreased after levodopa (8.60 ± 0.46 to 7.21 ± 0.4, p = 0.002) but there were no significant changes after DA treatment (8.33 ± 0.38 to 8.22 ± 0.33, p = 0.26). Homocysteine rose (11.52 ± 0.45 to 14.33 ± 0.68, p < 0.05) during levodopa treatment, but dopamine agonist had no effect (10.59 ± 0.38 to 11.38 ± 0.67, p = 0.184). Correlation analysis revealed that the changes in homocysteine level had non-significant correlation with FMD change (r = - 0.30, p = 0.06). FMD change was not associated with age (p = 0.47), disease duration (p = 0.81), baseline motor UPDRS (p = 0.43), motor UPDRS change (p = 0.64), levodopa equivalent dose change (p = 0.65). CONCLUSIONS We found that 1-year levodopa treatment may adversely affect vascular endothelial function in de novo PD. Further studies are needed to clarify the exact pathogenesis and clinical implication of levodopa-induced endothelial dysfunction in PD.
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Affiliation(s)
- Min Seung Kim
- Department of Neurology, Ajou University School of Medicine, 5 San, Woncheon-dong, Yongtong-gu, World Cup ro, Suwon-si, Kyunggi-do, 442-749, South Korea
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Don Gueu Park
- Department of Neurology, Ajou University School of Medicine, 5 San, Woncheon-dong, Yongtong-gu, World Cup ro, Suwon-si, Kyunggi-do, 442-749, South Korea
| | - Young Eun Gil
- Department of Neurology, Ajou University School of Medicine, 5 San, Woncheon-dong, Yongtong-gu, World Cup ro, Suwon-si, Kyunggi-do, 442-749, South Korea
| | - In Ja Shin
- Department of Neurology, Ajou University School of Medicine, 5 San, Woncheon-dong, Yongtong-gu, World Cup ro, Suwon-si, Kyunggi-do, 442-749, South Korea
| | - Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, 5 San, Woncheon-dong, Yongtong-gu, World Cup ro, Suwon-si, Kyunggi-do, 442-749, South Korea.
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Dorahy G, Chen JZ, Balle T. Computer-Aided Drug Design towards New Psychotropic and Neurological Drugs. Molecules 2023; 28:molecules28031324. [PMID: 36770990 PMCID: PMC9921936 DOI: 10.3390/molecules28031324] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Central nervous system (CNS) disorders are a therapeutic area in drug discovery where demand for new treatments greatly exceeds approved treatment options. This is complicated by the high failure rate in late-stage clinical trials, resulting in exorbitant costs associated with bringing new CNS drugs to market. Computer-aided drug design (CADD) techniques minimise the time and cost burdens associated with drug research and development by ensuring an advantageous starting point for pre-clinical and clinical assessments. The key elements of CADD are divided into ligand-based and structure-based methods. Ligand-based methods encompass techniques including pharmacophore modelling and quantitative structure activity relationships (QSARs), which use the relationship between biological activity and chemical structure to ascertain suitable lead molecules. In contrast, structure-based methods use information about the binding site architecture from an established protein structure to select suitable molecules for further investigation. In recent years, deep learning techniques have been applied in drug design and present an exciting addition to CADD workflows. Despite the difficulties associated with CNS drug discovery, advances towards new pharmaceutical treatments continue to be made, and CADD has supported these findings. This review explores various CADD techniques and discusses applications in CNS drug discovery from 2018 to November 2022.
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Affiliation(s)
- Georgia Dorahy
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Jake Zheng Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Thomas Balle
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia
- Correspondence:
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34
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Frequin HL, Schouten J, Verschuur CVM, Suwijn SR, Boel JA, Post B, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Munts AG, Dijk JM, Deuschl G, Lang A, Dijkgraaf MGW, de Haan RJ, de Bie RMA. Levodopa Response in Patients With Early Parkinson Disease: Further Observations of the LEAP Study. Neurology 2023; 100:e367-e376. [PMID: 36253105 DOI: 10.1212/wnl.0000000000201448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 09/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Levodopa in EArly Parkinson's Disease (LEAP) study enabled us to conduct post hoc analyses concerning the effects of levodopa in patients with early Parkinson disease. METHODS The LEAP study was a double-blind, placebo-controlled, randomized, delayed-start trial in which patients with early Parkinson disease were randomized to receive levodopa/carbidopa 300/75 mg daily for 80 weeks (early-start group) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed-start group). We analyzed the effect of levodopa with the Unified Parkinson's Disease Rating Scale on bradykinesia, rigidity, and tremor. At week 80, participants answered 3 questions regarding motor response fluctuations. RESULTS A total of 222 patients were randomized to the early-start group (mean ± SD age at baseline 64.8 ± 8.7 years; 71% male) and 223 to the delayed-start group (mean ± SD age at baseline 65.5 ± 8.8 years; 69% male). The difference between the early- and delayed-start groups in mean change from baseline to week 4, expressed as Hedges g effect size, was -0.33 for bradykinesia, -0.29 for rigidity, and -0.25 for tremor (for all symptoms indicating a small effect in favor of the early-start group); from baseline to week 22, respectively, -0.49, -0.36, and -0.44 (small to medium effect); and from baseline to week 40, respectively, -0.32, -0.19, and -0.27 (small effect). At 80 weeks, fewer patients in the early-start group (46 of 205 patients, 23%) experienced motor response fluctuations than patients in the delayed-start group (81 of 211, 38%; p < 0.01). DISCUSSION In patients with early Parkinson disease, levodopa improves bradykinesia, rigidity, and tremor to the same order of magnitude. For all 3 symptoms, effects were larger at 22 weeks compared with 4 weeks. At 80 weeks, there were fewer patients with motor response fluctuations in the group that had started levodopa earlier. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the effect of levodopa on bradykinesia, rigidity, and tremor is larger after 22 weeks compared with 4 weeks of treatment. TRIAL REGISTRATION INFORMATION ISRCTN30518857, EudraCT number 2011-000678-72.
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Affiliation(s)
- Henrieke L Frequin
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Jason Schouten
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Constant V M Verschuur
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Sven R Suwijn
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Judith A Boel
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Bart Post
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Bastiaan R Bloem
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Johannes J van Hilten
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Teus van Laar
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Gerrit Tissingh
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Alexander G Munts
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Joke M Dijk
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Günther Deuschl
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Anthony Lang
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Marcel G W Dijkgraaf
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Rob J de Haan
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Rob M A de Bie
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
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Leveraging Computational Intelligence Techniques for Diagnosing Degenerative Nerve Diseases: A Comprehensive Review, Open Challenges, and Future Research Directions. Diagnostics (Basel) 2023; 13:diagnostics13020288. [PMID: 36673100 PMCID: PMC9858227 DOI: 10.3390/diagnostics13020288] [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: 11/04/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Degenerative nerve diseases such as Alzheimer's and Parkinson's diseases have always been a global issue of concern. Approximately 1/6th of the world's population suffers from these disorders, yet there are no definitive solutions to cure these diseases after the symptoms set in. The best way to treat these disorders is to detect them at an earlier stage. Many of these diseases are genetic; this enables machine learning algorithms to give inferences based on the patient's medical records and history. Machine learning algorithms such as deep neural networks are also critical for the early identification of degenerative nerve diseases. The significant applications of machine learning and deep learning in early diagnosis and establishing potential therapies for degenerative nerve diseases have motivated us to work on this review paper. Through this review, we covered various machine learning and deep learning algorithms and their application in the diagnosis of degenerative nerve diseases, such as Alzheimer's disease and Parkinson's disease. Furthermore, we also included the recent advancements in each of these models, which improved their capabilities for classifying degenerative nerve diseases. The limitations of each of these methods are also discussed. In the conclusion, we mention open research challenges and various alternative technologies, such as virtual reality and Big data analytics, which can be useful for the diagnosis of degenerative nerve diseases.
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Buzoianu AD, Sharma A, Muresanu DF, Feng L, Huang H, Chen L, Tian ZR, Nozari A, Lafuente JV, Wiklund L, Sharma HS. Nanodelivery of Histamine H3/H4 Receptor Modulators BF-2649 and Clobenpropit with Antibodies to Amyloid Beta Peptide in Combination with Alpha Synuclein Reduces Brain Pathology in Parkinson's Disease. ADVANCES IN NEUROBIOLOGY 2023; 32:55-96. [PMID: 37480459 DOI: 10.1007/978-3-031-32997-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Parkinson's disease (PD) in military personnel engaged in combat operations is likely to develop in their later lives. In order to enhance the quality of lives of PD patients, exploration of novel therapy based on new research strategies is highly warranted. The hallmarks of PD include increased alpha synuclein (ASNC) and phosphorylated tau (p-tau) in the cerebrospinal fluid (CSF) leading to brain pathology. In addition, there are evidences showing increased histaminergic nerve fibers in substantia niagra pars compacta (SNpc), striatum (STr), and caudate putamen (CP) associated with upregulation of histamine H3 receptors and downregulation of H4 receptors in human brain. Previous studies from our group showed that modulation of potent histaminergic H3 receptor inverse agonist BF-2549 or clobenpropit (CLBPT) partial histamine H4 agonist with H3 receptor antagonist induces neuroprotection in PD brain pathology. Recent studies show that PD also enhances amyloid beta peptide (AβP) depositions in brain. Keeping these views in consideration in this review, nanowired delivery of monoclonal antibodies to AβP together with ASNC and H3/H4 modulator drugs on PD brain pathology is discussed based on our own observations. Our investigation shows that TiO2 nanowired BF-2649 (1 mg/kg, i.p.) or CLBPT (1 mg/kg, i.p.) once daily for 1 week together with nanowired delivery of monoclonal antibodies (mAb) to AβP and ASNC induced superior neuroprotection in PD-induced brain pathology. These observations are the first to show the modulation of histaminergic receptors together with antibodies to AβP and ASNC induces superior neuroprotection in PD. These observations open new avenues for the development of novel drug therapies for clinical strategies in PD.
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Affiliation(s)
- Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan, Hebei Province, China
| | - Hongyun Huang
- Beijing Hongtianji Neuroscience Academy, Beijing, China
| | - Lin Chen
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Greenland JC, Camacho M, Williams-Gray CH. The dilemma between milestones of progression versus clinical scales in Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 192:169-185. [PMID: 36796941 DOI: 10.1016/b978-0-323-85538-9.00010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
There are significant challenges in accurately documenting the progression of Parkinson's disease (PD). The disease course is highly heterogeneous, there are no validated biomarkers, and we are reliant on repeated clinical measures to assess disease state over time. Yet, the ability to chart disease progression accurately is vital in both observational and interventional study designs, where reliable measures are critical to determine whether an outcome has been met. In this chapter, we first discuss the natural history of PD, including the spectrum of clinical presentation and expected developments through the course of the disease. We then explore in detail the current strategies for measuring disease progression, which can be broadly divided into: (i) the use of quantitative clinical scales; and (ii) determination of the onset time of key milestones. We discuss the strengths and limitations of these approaches for use in clinical trials, with a particular focus on disease modification trials. The selection of outcome measures for a particular study will depend on multiple factors, but trial duration is an important determinant. Milestones are reached over a course of years rather than months, and hence clinical scales with sensitivity to change are needed for short-term studies. However, milestones represent important markers of disease stage which are not confounded by symptomatic therapies and are of critical relevance to the patient. Prolonged but low intensity follow-up beyond a limited period of treatment with a putative disease-modifying agent may allow milestones to be incorporated into evaluation of efficacy in a practical and cost-effective way.
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Affiliation(s)
- Julia C Greenland
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Marta Camacho
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
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Gaertner Z, Azcorra M, Dombeck DA, Awatramani R. Molecular heterogeneity in the substantia nigra: A roadmap for understanding PD motor pathophysiology. Neurobiol Dis 2022; 175:105925. [DOI: 10.1016/j.nbd.2022.105925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
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Máñez‐Miró JU, Vivancos‐Matellano F, Alonso‐Frech F, Vela‐Desojo L, López‐Ariztegui N, López‐Manzanares L, Balaguer E, Martínez‐Castrillo JC, Herrero‐Infante Y, Gasca‐Salas C, Morales‐Casado MI, Casas E, Hernández A, Pareés I, Tegel‐Ayuela I, Martínez‐Fernández R, Martinez‐Martin P. Validation of the OPTIMIPARK Questionnaire: A Tool to Optimize Treatment in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:1085-1093. [PMID: 36339297 PMCID: PMC9631843 DOI: 10.1002/mdc3.13581] [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: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dopamine replacement therapy reduces most motor and nonmotor features of Parkinson's disease. However, with disease progression, adjustments of dopaminergics and the application of advanced therapies must be considered. Objectives To validate the OPTIMIPARK questionnaire as a tool to help clinicians make therapeutic decisions on patients treated with levodopa. Methods We tested a questionnaire including 9 items encompassing motor and nonmotor signs, complications, and disability in a multicenter, observational, cross-sectional study. A neurologist (neurologist 1 [N1]) assessed patients according to regular clinical practice and blinded to the OPTIMIPARK questionnaire score. Therapeutic decisions were classified as "no changes," "adjustment of conventional treatment," and "advanced therapy indicated." External neurologists (neurologist 3 [N3] and neurologist 4 [N4]), who only knew the patient age, years of disease, and current treatment, made their therapeutic decisions based on the OPTIMIPARK score. Concordance between the criterion of the N1 versus the OPTIMIPARK-based N3-N4 consensus was analyzed applying weighted κ. The area under Receiving Operating Characteristic (ROC) curves was calculated for OPTIMIPARK scores. Results A total of 113 patients with Parkinson's disease were included. The OPTIMIPARK-based decision led to a higher proportion of patients requiring therapeutic modification than N1 assessment (74% vs. 60%; P = 0.002). Concordance between the N1 and N3-N4 decisions was moderate, whereas interobserver agreement among N3 and N4 was high. Area Under the Curve(AUC) values of 0.83 and 0.82 were found for "no changes" and "advanced therapy indicated" decisions by the N1 neurologist. Conclusions OPTIMIPARK might be more sensitive than regular clinical practice in suggesting the need for a therapeutic change. Furthermore, the low and high scores identify with high accuracy well-adjusted patients and candidates for advanced therapy, respectively.
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Affiliation(s)
| | - Francisco Vivancos‐Matellano
- Department of Neurology, Movement Disorders Unit, Hospital Universitario La PazUniversidad Autónoma de MadridMadridSpain
| | - Fernando Alonso‐Frech
- Department of Neurology, Movement Disorders Unit, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC)Universidad ComplutenseMadridSpain
| | - Lydia Vela‐Desojo
- Department of NeurologyHospital Universitario Fundación AlcorcónMadridSpain
| | - Nuria López‐Ariztegui
- Department of Neurology, Movement Disorders UnitHospital Universitario de ToledoToledoSpain
| | - Lydia López‐Manzanares
- Department of Neurology, Movement Disorders UnitHospital Universitario La PrincesaMadridSpain
| | - Ernest Balaguer
- Department of NeurologyHospital General de Catalunya, Sant Cugat del Vallés Research Director, Hospital Universitari General de Catalunya, Hospital Universitari Sagrat Cor, Hospital Quirónsalud del VallèsBarcelonaSpain
| | | | - Yolanda Herrero‐Infante
- Department of Neurology, Movement Disorders Unit, Hospital Universitario La PazUniversidad Autónoma de MadridMadridSpain
| | - Carmen Gasca‐Salas
- HM CINAC Madrid (Centro Integral de Neurociencias Abarca Campal)Hospital Universitario HM Puerta del Sur, HM HospitalesMadridSpain
| | | | - Elena Casas
- Department of Neurology, Movement Disorders UnitHospital Universitario La PrincesaMadridSpain
| | - Antonio Hernández
- Department of NeurologyHospital General de Catalunya, Sant Cugat del Vallés Research Director, Hospital Universitari General de Catalunya, Hospital Universitari Sagrat Cor, Hospital Quirónsalud del VallèsBarcelonaSpain
| | - Isabel Pareés
- Movement Disorders and Neurodegenerative Diseases Unit, IRYCISHospital Ramón y CajalMadridSpain
| | | | - Raul Martínez‐Fernández
- HM CINAC Madrid (Centro Integral de Neurociencias Abarca Campal)Hospital Universitario HM Puerta del Sur, HM HospitalesMadridSpain
| | - Pablo Martinez‐Martin
- Centre for Networked Biomedical Research in Neurodegenerative DiseasesCarlos III Institute of HealthMadridSpain
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Sadaei HJ, Cordova-Palomera A, Lee J, Padmanabhan J, Chen SF, Wineinger NE, Dias R, Prilutsky D, Szalma S, Torkamani A. Genetically-informed prediction of short-term Parkinson's disease progression. NPJ Parkinsons Dis 2022; 8:143. [PMID: 36302787 PMCID: PMC9613892 DOI: 10.1038/s41531-022-00412-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) treatments modify disease symptoms but have not been shown to slow progression, characterized by gradual and varied motor and non-motor changes overtime. Variation in PD progression hampers clinical research, resulting in long and expensive clinical trials prone to failure. Development of models for short-term PD progression prediction could be useful for shortening the time required to detect disease-modifying drug effects in clinical studies. PD progressors were defined by an increase in MDS-UPDRS scores at 12-, 24-, and 36-months post-baseline. Using only baseline features, PD progression was separately predicted across all timepoints and MDS-UPDRS subparts in independent, optimized, XGBoost models. These predictions plus baseline features were combined into a meta-predictor for 12-month MDS UPDRS Total progression. Data from the Parkinson's Progression Markers Initiative (PPMI) were used for training with independent testing on the Parkinson's Disease Biomarkers Program (PDBP) cohort. 12-month PD total progression was predicted with an F-measure 0.77, ROC AUC of 0.77, and PR AUC of 0.76 when tested on a hold-out PPMI set. When tested on PDBP we achieve a F-measure 0.75, ROC AUC of 0.74, and PR AUC of 0.73. Exclusion of genetic predictors led to the greatest loss in predictive accuracy; ROC AUC of 0.66, PR AUC of 0.66-0.68 for both PPMI and PDBP testing. Short-term PD progression can be predicted with a combination of survey-based, neuroimaging, physician examination, and genetic predictors. Dissection of the interplay between genetic risk, motor symptoms, non-motor symptoms, and longer-term expected rates of progression enable generalizable predictions.
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Affiliation(s)
- Hossein J Sadaei
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | | | - Jonghun Lee
- Takeda Development Center Americas, Inc., Cambridge, MA, 02139, USA
| | - Jaya Padmanabhan
- Takeda Development Center Americas, Inc., Cambridge, MA, 02139, USA
| | - Shang-Fu Chen
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Nathan E Wineinger
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA
| | - Raquel Dias
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Daria Prilutsky
- Takeda Development Center Americas, Inc., Cambridge, MA, 02139, USA
| | - Sandor Szalma
- Takeda Development Center Americas, Inc., San Diego, CA, 92121, USA
| | - Ali Torkamani
- Scripps Research Translational Institute, La Jolla, CA, 92037, USA.
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA, 92037, USA.
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Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson's Disease: From Pathophysiology to Advanced Therapies. Tremor Other Hyperkinet Mov (N Y) 2022; 12:29. [PMID: 36211804 PMCID: PMC9504742 DOI: 10.5334/tohm.712] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic agents might be relatively poor, particularly in patients with tremor-dominant PD compared to the akinetic/rigid subtype. In this review, we aim to highlight recent advances in the underlying pathogenesis and treatment modalities for tremor in PD. Methods A structured literature search through Embase was conducted using the terms "Parkinson's Disease" AND "tremor" OR "etiology" OR "management" OR "drug resistance" OR "therapy" OR "rehabilitation" OR "surgery." After initial screening, eligible articles were selected with a focus on published literature in the last 10 years. Discussion The underlying pathophysiology of tremor in PD remains complex and incompletely understood. Neurodegeneration of dopaminergic neurons in the retrorubral area, in addition to high-power neural oscillations in the cerebello-thalamo-cortical circuit and the basal ganglia, play a major role. Levodopa is the first-line therapeutic option for all motor symptoms, including tremor. The addition of dopamine agonists or anticholinergics can lead to further tremor reduction. Botulinum toxin injection is an effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies. Deep brain stimulation is the most well-established advanced therapy owing to its long-term efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations. Magnetic resonance-guided focused ultrasound is a promising modality, which has the advantage of being incisionless. Cortical and peripheral electrical stimulation are non-invasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor.
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Affiliation(s)
- Ali H. Abusrair
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Neurology, Department of Internal Medicine, Qatif Health Network, Qatif, Saudi Arabia
| | - Walaa Elsekaily
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Saeed Bohlega
- Movement Disorders Program, Neurosciences Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Eteläinen TS, Kilpeläinen TP, Ignatius A, Auno S, De Lorenzo F, Uhari-Väänänen JK, Julku UH, Myöhänen TT. Removal of proteinase K resistant αSyn species does not correlate with cell survival in a virus vector-based Parkinson's disease mouse model. Neuropharmacology 2022; 218:109213. [PMID: 35964686 DOI: 10.1016/j.neuropharm.2022.109213] [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: 06/28/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 10/31/2022]
Abstract
Parkinson's disease (PD) is characterized by degeneration of nigrostriatal dopaminergic neurons and accumulation of α-synuclein (αSyn) as Lewy bodies. Currently, there is no disease-modifying therapy available for PD. We have shown that a small molecular inhibitor for prolyl oligopeptidase (PREP), KYP-2047, relieves αSyn-induced toxicity in various PD models by inducing autophagy and preventing αSyn aggregation. In this study, we wanted to study the effects of PREP inhibition on different αSyn species by using cell culture and in vivo models. We used Neuro2A cells with transient αSyn overexpression and oxidative stress or proteasomal inhibition-induced αSyn aggregation to assess the effect of KYP-2047 on soluble αSyn oligomers and on cell viability. Here, the levels of soluble αSyn were measured by using ELISA, and the impact of KYP-2047 was compared to anle138b, nilotinib and deferiprone. To evaluate the effect of KYP-2047 on αSyn fibrillization in vivo, we used unilateral nigral AAV1/2-A53T-αSyn mouse model, where the KYP-2047 treatment was initiated two- or four-weeks post injection. KYP-2047 and anle138b protected cells from αSyn toxicity but interestingly, KYP-2047 did not reduce soluble αSyn oligomers. In AAV-A53T-αSyn mouse model, KYP-2047 reduced significantly proteinase K-resistant αSyn oligomers and oxidative damage related to αSyn aggregation. However, the KYP-2047 treatment that was initiated at the time of symptom onset, failed to protect the nigrostriatal dopaminergic neurons. Our results emphasize the importance of whole αSyn aggregation process in the pathology of PD and raise an important question about the forms of αSyn that are reasonable targets for PD drug therapy.
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Affiliation(s)
- Tony S Eteläinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Tommi P Kilpeläinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Adele Ignatius
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Samuli Auno
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Francesca De Lorenzo
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Johanna K Uhari-Väänänen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Ulrika H Julku
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Timo T Myöhänen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland; School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Finland.
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Joy D, Jose J, Bibi S, Bandiwadekar A, Gopan G, Mariana Gonçalves Lima C, Bin Emran T, A. Alhumaydhi F, Ashtekar H, D. S S, Adam Conte-Junior C. Development of Microneedle Patch Loaded with Bacopa monnieri Solid Lipid Nanoparticles for the Effective Management of Parkinson's Disease. Bioinorg Chem Appl 2022; 2022:9150205. [PMID: 35992047 PMCID: PMC9385340 DOI: 10.1155/2022/9150205] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
The demand for drug delivery systems (DDS) to treat Parkinson's disease (PD) is still high, and microneedle (MN) assisted transdermal DDS offers enormous potential. Herbal products for PD have been shown to have antioxidant effects in reducing dopaminergic neurons from degeneration. Here, we attempted to incorporate solid lipid nanoparticles (SLNs) of Bacopa monnieri into dissolvable microneedle arrays and evaluate its neuroprotective activity. The bloodless and painless microneedle arrays through the transdermal route deliver the drug across the blood-brain barrier at the desired concentration. The quality by design (QbD) approach was employed for optimizing the SLNs formulations. The mechanical strength, in vitro release studies, ex-vivo permeation investigation, skin irritation test, histopathological studies, biochemical studies, and behavioural tests SLNs loaded microneedle arrays were performed. The microneedle patches obtained were shown to be mechanically robust and were also found to be nonirritant with a decreased degree of bradykinesia, high motor coordination, and balance ability. Compared to systemic delivery systems, such an MN method can achieve a considerably lower effective dose and allow long-term home-based treatment.
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Affiliation(s)
- Delna Joy
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmaceutics, Mangalore 575018, India
| | - Jobin Jose
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmaceutics, Mangalore 575018, India
| | - Shabana Bibi
- Yunnan Herbal Laboratory, College of Ecology and Environmental Sciences, Yunnan University, Kunming 650091, Yunnan, China
- Department of Biosciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Akshay Bandiwadekar
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmaceutics, Mangalore 575018, India
| | - Gopika Gopan
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmaceutics, Mangalore 575018, India
| | | | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
| | - Fahad A. Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 52571, Saudi Arabia
| | - Harsha Ashtekar
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmacology, Mangalore 575018, India
| | - Sandeep D. S
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmaceutics, Mangalore 575018, India
| | - Carlos Adam Conte-Junior
- Center for Food Analysis (NAL), Technological Development Support Laboratory (LADETEC), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro 21941-598, Brazil
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Weiss D, Ebersbach G, Möller JC, Schwarz J, Arlt C, Fritz B, Sensken SC, Eggert K. Do we start too late? Insights from the real-world non-interventional BALANCE study on the present use of levodopa/carbidopa intestinal gel in advanced Parkinson's disease in Germany and Switzerland. Parkinsonism Relat Disord 2022; 103:85-91. [DOI: 10.1016/j.parkreldis.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
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Mosilhy EA, Alshial EE, Eltaras MM, Rahman MMA, Helmy HI, Elazoul AH, Hamdy O, Mohammed HS. Non-invasive transcranial brain modulation for neurological disorders treatment: A narrative review. Life Sci 2022; 307:120869. [DOI: 10.1016/j.lfs.2022.120869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
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46
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Di Luca DG, Reyes NGD, Fox SH. Newly Approved and Investigational Drugs for Motor Symptom Control in Parkinson's Disease. Drugs 2022; 82:1027-1053. [PMID: 35841520 PMCID: PMC9287529 DOI: 10.1007/s40265-022-01747-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 12/11/2022]
Abstract
Motor symptoms are a core feature of Parkinson’s disease (PD) and cause a significant burden on patients’ quality of life. Oral levodopa is still the most effective treatment, however, the motor benefits are countered by inherent pharmacologic limitations of the drug. Additionally, with disease progression, chronic levodopa leads to the appearance of motor complications including motor fluctuations and dyskinesia. Furthermore, several motor abnormalities of posture, balance, and gait may become less responsive to levodopa. With these unmet needs and our evolving understanding of the neuroanatomic and pathophysiologic underpinnings of PD, several advances have been made in defining new therapies for motor symptoms. These include newer levodopa formulations and drug delivery systems, refinements in adjunctive medications, and non-dopaminergic treatment strategies. Although some are in early stages of development, these novel treatments potentially widen the available options for the management of motor symptoms allowing clinicians to provide an individually tailored care for PD patients. Here, we review the existing and emerging interventions for PD with focus on newly approved and investigational drugs for motor symptoms, motor fluctuations, dyskinesia, and balance and gait dysfunction.
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Affiliation(s)
- Daniel Garbin Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nikolai Gil D Reyes
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Susan H Fox
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada.
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Ronconi G, Calabria S, Piccinni C, Dondi L, Pedrini A, Esposito I, Addesi A, Sambati L, Martini N. Prescription Pattern of Monoamine Oxidase B Inhibitors Combined with Levodopa: A Retrospective Observational Analysis of Italian Healthcare Administrative Databases. Drugs Real World Outcomes 2022; 9:391-401. [PMID: 35696024 PMCID: PMC9392820 DOI: 10.1007/s40801-022-00308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background Parkinson’s disease is still incurable, and several factors are considered when defining pharmacological therapy. Objective The aim of this study was to describe the prescription pattern of monoamine oxidase B inhibitors (MAO-BIs) marketed in Italy (selegiline, rasagiline, safinamide) as an add-on to levodopa among new users of MAO-BIs, from the perspective of the Italian National Health Service. Patients and Methods Through cross-linkage of administrative healthcare data in the Ricerca e Salute (ReS) database, adults with a supply of one or more MAO-BIs in 2017, and with no other MAO-BI use since 2013, were selected. Levodopa had to be supplied within 30 days before/after the MAO-BI. The incidence, use, sex, age, comorbidities, 2-year prescription patterns (i.e., switches, proportion of treated patients per semester/year, mean daily milligrams/monthly tablets supplied, discontinuation, change to other anti-Parkinson drug) of patients taking MAO-BIs were provided. Results In 2017, 1059 new users received an MAO-BI (incidence 22.6 × 100,000 adults) combined with levodopa: 502 subjects (10.7 × 100,000) were treated with selegiline, 161 (3.4 × 100,000) were treated with rasagiline, and 396 (8.4 × 100,000) were treated with safinamide. The cohorts mainly consisted of males with a median age of ≥ 74 years. Treatment incidences increased with age. Switches occurred in 18.0%, 11.0%, and 4.3% of the selegiline, rasagiline, and safinamide cohorts, respectively. Most of the patients switching from selegiline/safinamide changed to rasagiline, while most of the patients switching from rasagiline changed to safinamide. From the first to second years, patient numbers reduced by ≤ 50%, and the daily milligrams/monthly tablets slightly increased. Six-month discontinuation occurred in > 50% of all cohorts, and ≥ 65% of discontinuing patients changed to another anti-Parkinson drug. Conclusions This analysis described the heterogeneous use of MAO-BIs as an add-on to levodopa in Italy. Further clinical trials and real-world studies are encouraged to update the few existing guidelines and to align clinical practice strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00308-4.
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Affiliation(s)
- Giulia Ronconi
- Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy
| | - Silvia Calabria
- Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy.
| | - Carlo Piccinni
- Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy
| | - Letizia Dondi
- Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy
| | - Antonella Pedrini
- Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy
| | | | | | - Luisa Sambati
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Nello Martini
- Fondazione ReS (Ricerca e Salute), Research and Health Foundation, Casalecchio di Reno, Via Magnanelli 6/3, 40033, Bologna, Italy
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Ulivelli M, Bezzini D, Kundisova L, Grazi I, Battaglia MA, Nante N, Rossi S. Mortality of Parkinson's disease in Italy from 1980 to 2015. Neurol Sci 2022; 43:3603-3611. [PMID: 35094172 DOI: 10.1007/s10072-021-05854-3] [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: 11/06/2021] [Accepted: 12/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate mortality for Parkinson's disease (PD) in Italy during a long time period (1980-2015) and to discuss the role of possible general and specific influencing factors. METHODS Based on mortality data provided by the Italian National Institute of Statistics, sex- and age-specific crude mortality rates were computed, for the whole country and for its main geographical sub-areas. Rates were standardized using both direct (annual mortality rates AMRs) and indirect (standardized mortality rates SMRs) methods. SMRs were used to evaluate geographical differences, whereas AMRs and joinpoint linear regression analysis to study mortality trends. RESULTS Considering the entire period, highest mortality rates were observed in males (AMR/100,000: 9.0 in males, 5.25 in females), in North-West and Central Italy (SMR > 100). Overall PD mortality decreased from mid-eighties onwards and then rapidly reversed the trend in the period 1998-2002, rising up to a maximum in 2015, with some differences according to sex and geographical areas. CONCLUSIONS Several factors may have contributed to the rapid inversion of decreasing trend in mortality observed in the last part of XX century. Possible explanations of this rising trend are related to the increasing burden of PD (especially in males and in certain Italian regions), caused by different factors as population aging, physiological prevalence rise due to incidence exceeding mortality, and growing exposure to environmental or occupational risk factors. In addition, the accuracy of death certificate compilation could account for geographical differences and for the temporal trend. The role of levodopa and recently introduced dopaminergic drugs is also discussed.
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Affiliation(s)
- Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Lucia Kundisova
- Postgradual School of Public Health, University of Siena, Siena, Italy
| | - Ilaria Grazi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy.,Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Nicola Nante
- Postgradual School of Public Health, University of Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
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Frouni I, Huot P. Glutamate modulation for the treatment of levodopa induced dyskinesia: a brief review of the drugs tested in the clinic. Neurodegener Dis Manag 2022; 12:203-214. [PMID: 35587024 DOI: 10.2217/nmt-2021-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Levodopa is the standard treatment for Parkinson's disease, but its use is marred by the emergence of dyskinesia, for which treatment options remain limited. Here, we review the glutamatergic modulators that were assessed for their antidyskinetic potential in clinical trials, including N-methyl-D-aspartate (NMDA) antagonists, agonists at the glycine-binding site on NMDA receptors, metabotropic glutamate (mGlu) 4 agonists, mGlu5 antagonists, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) antagonists and glutamate release inhibitors. Several agents that were investigated are not selective for their targets, raising uncertainty about the extent to which glutamatergic modulation contributed to their effects. Except for amantadine, the use of glutamatergic modulators for the treatment of dyskinesia in Parkinson's disease remains largely investigational, with promising results obtained with mGlu5 negative allosteric modulation.
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Affiliation(s)
- Imane Frouni
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, H3A 2B4, Canada.,Département de Pharmacologie et Physiologie, Université de Montréal, Montreal, QC, H3C 3J7, Canada
| | - Philippe Huot
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, H3A 2B4, Canada.,Département de Pharmacologie et Physiologie, Université de Montréal, Montreal, QC, H3C 3J7, Canada.,Department of Neurology & Neurosurgery, McGill University, Montreal, QC, H3A 2B4, Canada.,Department of Neuroscience, Division of Neurology, McGill University Health Centre, Montreal, QC, H3A 2B4, Canada
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Tan YY, Jenner P, Chen SD. Monoamine Oxidase-B Inhibitors for the Treatment of Parkinson's Disease: Past, Present, and Future. JOURNAL OF PARKINSON'S DISEASE 2022; 12:477-493. [PMID: 34957948 PMCID: PMC8925102 DOI: 10.3233/jpd-212976] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Monoamine oxidase-B (MAO-B) inhibitors are commonly used for the symptomatic treatment of Parkinson’s disease (PD). MAO-B inhibitor monotherapy has been shown to be effective and safe for the treatment of early-stage PD, while MAO-B inhibitors as adjuvant drugs have been widely applied for the treatment of the advanced stages of the illness. MAO-B inhibitors can effectively improve patients’ motor and non-motor symptoms, reduce “OFF” time, and may potentially prevent/delay disease progression. In this review, we discuss the effects of MAO-B inhibitors on motor and non-motor symptoms in PD patients, their mechanism of action, and the future development of MAO-B inhibitor therapy.
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Affiliation(s)
- Yu-Yan Tan
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peter Jenner
- Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Sciences, Faculty of Health Sciences and Medicine, King's College, London, UK
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Lab for Translational Research of Neurodegenerative Diseases, Institute of Immunochemistry, Shanghai Tech University, Shanghai, China
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