1
|
Fauser M, Payonk JP, Weber H, Statz M, Winter C, Hadar R, Appali R, van Rienen U, Brandt MD, Storch A. Subthalamic nucleus but not entopeduncular nucleus deep brain stimulation enhances neurogenesis in the SVZ-olfactory bulb system of Parkinsonian rats. Front Cell Neurosci 2024; 18:1396780. [PMID: 38746080 PMCID: PMC11091264 DOI: 10.3389/fncel.2024.1396780] [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: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Deep brain stimulation (DBS) is a highly effective treatment option in Parkinson's disease. However, the underlying mechanisms of action, particularly effects on neuronal plasticity, remain enigmatic. Adult neurogenesis in the subventricular zone-olfactory bulb (SVZ-OB) axis and in the dentate gyrus (DG) has been linked to various non-motor symptoms in PD, e.g., memory deficits and olfactory dysfunction. Since DBS affects several of these non-motor symptoms, we analyzed the effects of DBS in the subthalamic nucleus (STN) and the entopeduncular nucleus (EPN) on neurogenesis in 6-hydroxydopamine (6-OHDA)-lesioned hemiparkinsonian rats. Methods In our study, we applied five weeks of continuous bilateral STN-DBS or EPN-DBS in 6-OHDA-lesioned rats with stable dopaminergic deficits compared to 6-OHDA-lesioned rats with corresponding sham stimulation. We injected two thymidine analogs to quantify newborn neurons early after DBS onset and three weeks later. Immunohistochemistry identified newborn cells co-labeled with NeuN, TH and GABA within the OB and DG. As a putative mechanism, we simulated the electric field distribution depending on the stimulation site to analyze direct electric effects on neural stem cell proliferation. Results STN-DBS persistently increased the number of newborn dopaminergic and GABAergic neurons in the OB but not in the DG, while EPN-DBS does not impact neurogenesis. These effects do not seem to be mediated via direct electric stimulation of neural stem/progenitor cells within the neurogenic niches. Discussion Our data support target-specific effects of STN-DBS on adult neurogenesis, a putative modulator of non-motor symptoms in Parkinson's disease.
Collapse
Affiliation(s)
- Mareike Fauser
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jan Philipp Payonk
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
| | - Hanna Weber
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Meike Statz
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Christine Winter
- Department of Psychiatry and Neurosciences, Charité University Medicine Berlin, Berlin, Germany
| | - Ravit Hadar
- Department of Psychiatry and Neurosciences, Charité University Medicine Berlin, Berlin, Germany
| | - Revathi Appali
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Department of Ageing of Individuals and Society, University of Rostock, Rostock, Germany
| | - Ursula van Rienen
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Department of Ageing of Individuals and Society, University of Rostock, Rostock, Germany
- Department of Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Moritz D. Brandt
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| |
Collapse
|
2
|
Zhang KK, Matin R, Gorodetsky C, Ibrahim GM, Gouveia FV. Systematic review of rodent studies of deep brain stimulation for the treatment of neurological, developmental and neuropsychiatric disorders. Transl Psychiatry 2024; 14:186. [PMID: 38605027 PMCID: PMC11009311 DOI: 10.1038/s41398-023-02727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) modulates local and widespread connectivity in dysfunctional networks. Positive results are observed in several patient populations; however, the precise mechanisms underlying treatment remain unknown. Translational DBS studies aim to answer these questions and provide knowledge for advancing the field. Here, we systematically review the literature on DBS studies involving models of neurological, developmental and neuropsychiatric disorders to provide a synthesis of the current scientific landscape surrounding this topic. A systematic analysis of the literature was performed following PRISMA guidelines. 407 original articles were included. Data extraction focused on study characteristics, including stimulation protocol, behavioural outcomes, and mechanisms of action. The number of articles published increased over the years, including 16 rat models and 13 mouse models of transgenic or healthy animals exposed to external factors to induce symptoms. Most studies targeted telencephalic structures with varying stimulation settings. Positive behavioural outcomes were reported in 85.8% of the included studies. In models of psychiatric and neurodevelopmental disorders, DBS-induced effects were associated with changes in monoamines and neuronal activity along the mesocorticolimbic circuit. For movement disorders, DBS improves symptoms via modulation of the striatal dopaminergic system. In dementia and epilepsy models, changes to cellular and molecular aspects of the hippocampus were shown to underlie symptom improvement. Despite limitations in translating findings from preclinical to clinical settings, rodent studies have contributed substantially to our current knowledge of the pathophysiology of disease and DBS mechanisms. Direct inhibition/excitation of neural activity, whereby DBS modulates pathological oscillatory activity within brain networks, is among the major theories of its mechanism. However, there remain fundamental questions on mechanisms, optimal targets and parameters that need to be better understood to improve this therapy and provide more individualized treatment according to the patient's predominant symptoms.
Collapse
Affiliation(s)
- Kristina K Zhang
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafi Matin
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - George M Ibrahim
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | | |
Collapse
|
3
|
Davidson B, Milosevic L, Kondrataviciute L, Kalia LV, Kalia SK. Neuroscience fundamentals relevant to neuromodulation: Neurobiology of deep brain stimulation in Parkinson's disease. Neurotherapeutics 2024; 21:e00348. [PMID: 38579455 PMCID: PMC11000190 DOI: 10.1016/j.neurot.2024.e00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Deep Brain Stimulation (DBS) has become a pivotal therapeutic approach for Parkinson's Disease (PD) and various neuropsychiatric conditions, impacting over 200,000 patients. Despite its widespread application, the intricate mechanisms behind DBS remain a subject of ongoing investigation. This article provides an overview of the current knowledge surrounding the local, circuit, and neurobiochemical effects of DBS, focusing on the subthalamic nucleus (STN) as a key target in PD management. The local effects of DBS, once thought to mimic a reversible lesion, now reveal a more nuanced interplay with myelinated axons, neurotransmitter release, and the surrounding microenvironment. Circuit effects illuminate the modulation of oscillatory activities within the basal ganglia and emphasize communication between the STN and the primary motor cortex. Neurobiochemical effects, encompassing changes in dopamine levels and epigenetic modifications, add further complexity to the DBS landscape. Finally, within the context of understanding the mechanisms of DBS in PD, the article highlights the controversial question of whether DBS exerts disease-modifying effects in PD. While preclinical evidence suggests neuroprotective potential, clinical trials such as EARLYSTIM face challenges in assessing long-term disease modification due to enrollment timing and methodology limitations. The discussion underscores the need for robust biomarkers and large-scale prospective trials to conclusively determine DBS's potential as a disease-modifying therapy in PD.
Collapse
Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Canada.
| | - Luka Milosevic
- KITE, Toronto, Canada; CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Laura Kondrataviciute
- CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Lorraine V Kalia
- CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Canada; KITE, Toronto, Canada; CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada
| |
Collapse
|
4
|
Lee EJ, Aguirre-Padilla DH, Fomenko A, Pawar G, Kapadia M, George J, Lozano AM, Hamani C, Kalia LV, Kalia SK. Reduction of alpha-synuclein oligomers in preclinical models of Parkinson's disease by electrical stimulation in vitro and deep brain stimulation in vivo. Brain Stimul 2024; 17:166-175. [PMID: 38342364 DOI: 10.1016/j.brs.2024.02.005] [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: 09/30/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has been widely used to manage debilitating neurological symptoms in movement disorders such as Parkinson's disease (PD). Despite its well-established symptomatic benefits, our understanding of the mechanisms underlying DBS and its possible effect on the accumulation of pathological proteins in neurodegeneration remains limited. Accumulation and oligomerization of the protein alpha-synuclein (α-Syn) are implicated in the loss of dopaminergic neurons in the substantia nigra in PD, making α-Syn a potential therapeutic target for disease modification. OBJECTIVE We examined the effects of high frequency electrical stimulation on α-Syn levels and oligomerization in cell and rodent models. METHODS High frequency stimulation, mimicking DBS parameters used for PD, was combined with viral-mediated overexpression of α-Syn in cultured rat primary cortical neurons or in substantia nigra of rats. Bimolecular protein complementation with split fluorescent protein reporters was used to detect and quantify α-Syn oligomers. RESULTS High frequency electrical stimulation reduced the expression of PD-associated mutant α-Syn and mitigated α-Syn oligomerization in cultured neurons. Furthermore, DBS in the substantia nigra, but not the subthalamic nucleus, decreased overall levels of α-Syn, including oligomer levels, in the substantia nigra. CONCLUSIONS Taken together, our results demonstrate that direct high frequency stimulation can reduce accumulation and pathological forms of α-Syn in cultured neurons in vitro and in substantia nigra in vivo. Thus, DBS therapy could have a role beyond symptomatic treatment, with potential disease-modifying properties that can be exploited to target pathological proteins in neurodegenerative diseases.
Collapse
Affiliation(s)
- Eun Jung Lee
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - David Hernán Aguirre-Padilla
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Neuromodulation and Functional Neurosurgery Program, San Borja Arriarán Hospital, Santiago, Chile; Department of Neurology and Neurosurgery, Medical School, University of Chile, Santiago, Chile; Department of Biomedical Engineering, University Medical Center Groningen, Groningen University, Groningen, Netherlands
| | - Anton Fomenko
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Grishma Pawar
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Minesh Kapadia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jimmy George
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Andres M Lozano
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Clement Hamani
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Toronto, ON, Canada
| | - Lorraine V Kalia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada.
| |
Collapse
|
5
|
Dong W, Qiu C, Lu Y, Luo B, Jiang X, Chang L, Yan J, Sun J, Liu W, Zhang L, Zhang W. Effect of deep brain stimulation compared with drug therapy alone on the progression of Parkinson's disease. Front Neurosci 2024; 17:1330752. [PMID: 38260017 PMCID: PMC10800581 DOI: 10.3389/fnins.2023.1330752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background Parkinson's disease (PD) symptoms deteriorate with disease progression. Although deep brain stimulation (DBS) can effectively improve the motor signs of PD patients, it is not yet known whether DBS surgery, which is an invasive treatment modality, may change the progression of PD. Objective The aim of this work was to compare the effect of DBS with that of drug treatment on the progression of PD. Methods A total of 77 patients with PD with the Hoehn and Yahr scale (HY) stage of 2.5 or 3 were included, and were divided into 34 in the drug therapy alone group (Drug-G) and 43 in the DBS therapy group (DBS-G). All patients were subjected to a follow-up of 2 years, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Montreal Cognitive Assessment (MOCA), the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD) scores. In addition, the quality of life of patients and the burden on their family were assessed by the 39-item PD questionnaire (PDQ-39) scores, daily levodopa equivalent dose (LED), patient's annual treatment-related costs, and the Zarit Caregiver Burden Scale (ZCBS) score. The changes in relevant scale scores between the two groups were compared at each follow-up stage. Results The UPDRS-III score of the patients in the "off" state increased from year to year in both groups, and the degree of increase of this score was greater in the DBS-G than in the Drug-G group. The MOCA score in both groups began to decline in the 2nd year of follow-up, and the decline was greater in the Drug-G than in the DBS-G group. DBS treatment did not affect patients' psychiatric disorders. The PDQ39, LED, costs, and ZCBS were negatively correlated with the follow-up time in patients in the DBS-G group, and positively correlated with the follow-up time in patients in the Drug-G. Conclusion PD is progressive regardless of treatment. The findings from this follow-up study suggest that the disease progression of patients in DBS-G may be slightly faster compared to the drug-G, but the advantages of DBS are also evident. Indeed, DBS better improves patient's motor signs and quality of life and reduces the family burden. In addition, DBS has less impact on patients in terms of cognitive and mental effects.
Collapse
Affiliation(s)
- Wenwen Dong
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Qiu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Lu
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Bei Luo
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Jiang
- Department of Geriatric Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Chang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiuqi Yan
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Sun
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatric Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
6
|
Statz M, Schleuter F, Weber H, Kober M, Plocksties F, Timmermann D, Storch A, Fauser M. Subthalamic nucleus deep brain stimulation does not alter growth factor expression in a rat model of stable dopaminergic deficiency. Neurosci Lett 2023; 814:137459. [PMID: 37625613 DOI: 10.1016/j.neulet.2023.137459] [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: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been a highly effective treatment option for mid-to-late-stage Parkinson's disease (PD) for decades. Besides direct effects on brain networks, neuroprotective effects of STN-DBS - potentially via alterations of growth factor expression levels - have been proposed as additional mechanisms of action. OBJECTIVE In the context of clarifying DBS mechanisms, we analyzed brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) levels in the basal ganglia, motor and parietal cortices, and dentate gyrus in an animal model of stable, severe dopaminergic deficiency. METHODS We applied one week of continuous unilateral STN-DBS in a group of stable 6-hydroxydopamine (6-OHDA) hemiparkinsonian rats (6-OHDASTIM) in comparison to a 6-OHDA control group (6-OHDASHAM) as well as healthy controls (CTRLSTIM and CTRLSHAM). BDNF and GDNF levels were determined via ELISAs. RESULTS The 6-OHDA lesion did not result in a persistent alteration in either BDNF or GDNF levels in a model of severe dopaminergic deficiency after completion of the dopaminergic degeneration. STN-DBS modestly increased BDNF levels in the entopeduncular nucleus, but even impaired BDNF and GDNF expression in cortical areas. CONCLUSIONS STN-DBS does not increase growth factor expression when applied to a model of completed, severe dopaminergic deficiency in contrast to other studies in models of modest and ongoing dopaminergic degeneration. In healthy controls, STN-DBS does not influence BDNF or GDNF expression. We consider these findings relevant for clinical purposes since DBS in PD is usually applied late in the course of the disease.
Collapse
Affiliation(s)
- Meike Statz
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Frederike Schleuter
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Hanna Weber
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Maria Kober
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Franz Plocksties
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, Albert-Einstein-Str. 26, 18119 Rostock, Germany
| | - Dirk Timmermann
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, Albert-Einstein-Str. 26, 18119 Rostock, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany; German Centre for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Mareike Fauser
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| |
Collapse
|
7
|
Helf C, Kober M, Markert F, Lanto J, Overhoff L, Badstübner-Meeske K, Storch A, Fauser M. Subthalamic nucleus deep brain stimulation induces nigrostriatal dopaminergic plasticity in a stable rat model of Parkinson's disease. Neuroreport 2023; 34:506-511. [PMID: 37270842 DOI: 10.1097/wnr.0000000000001917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been a highly effective treatment option for middle to late stage Parkinson's disease for decades. Though, the underlying mechanisms of action, particularly effects on the cellular level, remain in part unclear. In the context of identifying disease-modifying effects of STN-DBS by prompting cellular plasticity in midbrain dopaminergic systems, we analyzed neuronal tyrosine hydroxylase and c-Fos expression in the substantia nigra pars compacta (SNpc) and ventral tegmental area (VTA). METHODS We applied 1 week of continuous unilateral STN-DBS in a group of stable 6-hydroxydopamine (6-OHDA) hemiparkinsonian rats (STNSTIM) in comparison to a 6-OHDA control group (STNSHAM). Immunohistochemistry identified NeuN+, tyrosine hydroxylase+ and c-Fos+ cells within the SNpc and VTA. RESULTS After 1 week, rats in the STNSTIM group had 3.5-fold more tyrosine hydroxylase+ neurons within the SNpc (P = 0.010) but not in the VTA compared to sham controls. There was no difference in basal cell activity as indicated by c-Fos expression in both midbrain dopaminergic systems. CONCLUSION Our data support a neurorestorative effect of STN-DBS in the nigrostriatal dopaminergic system already after 7 days of continuous STN-DBS in the stable Parkinson's disease rat model without affecting basal cell activity.
Collapse
Affiliation(s)
| | - Maria Kober
- Department of Neurology, University of Rostock
| | | | | | | | | | - Alexander Storch
- Department of Neurology, University of Rostock
- German Centre for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | | |
Collapse
|
8
|
Protective mechanisms by glial cell line-derived neurotrophic factor and cerebral dopamine neurotrophic factor against the α-synuclein accumulation in Parkinson's disease. Biochem Soc Trans 2023; 51:245-257. [PMID: 36794783 DOI: 10.1042/bst20220770] [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: 10/13/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Abstract
Synucleinopathies constitute a disease family named after alpha-synuclein protein, which is a significant component of the intracellular inclusions called Lewy bodies. Accompanying the progressive neurodegeneration, Lewy bodies and neurites are the main histopathologies of synucleinopathies. The complicated role of alpha-synuclein in the disease pathology makes it an attractive therapeutic target for disease-modifying treatments. GDNF is one of the most potent neurotrophic factors for dopamine neurons, whereas CDNF is protective and neurorestorative with entirely different mechanisms of action. Both have been in the clinical trials for the most common synucleinopathy, Parkinson's disease. With the AAV-GDNF clinical trials ongoing and the CDNF trial being finalized, their effects on abnormal alpha-synuclein accumulation are of great interest. Previous animal studies with an alpha-synuclein overexpression model have shown that GDNF was ineffective against alpha-synuclein accumulation. However, a recent study with cell culture and animal models of alpha-synuclein fibril inoculation has demonstrated the opposite by revealing that the GDNF/RET signaling cascade is required for the protective effect of GDNF on alpha-synuclein aggregation. CDNF, an ER resident protein, was shown to bind alpha-synuclein directly. CDNF reduced the uptake of alpha-synuclein fibrils by the neurons and alleviated the behavioral deficits induced by fibrils injected into the mouse brain. Thus, GDNF and CDNF can modulate different symptoms and pathologies of Parkinson's disease, and perhaps, similarly for other synucleinopathies. Their unique mechanisms for preventing alpha-synuclein-related pathology should be studied more carefully to develop disease-modifying therapies.
Collapse
|
9
|
Neuroprotection and Non-Invasive Brain Stimulation: Facts or Fiction? Int J Mol Sci 2022; 23:ijms232213775. [PMID: 36430251 PMCID: PMC9692544 DOI: 10.3390/ijms232213775] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
Non-Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and repetitive Magnetic Transcranial Stimulation (rTMS), are well-known non-pharmacological approaches to improve both motor and non-motor symptoms in patients with neurodegenerative disorders. Their use is of particular interest especially for the treatment of cognitive impairment in Alzheimer's Disease (AD), as well as axial disturbances in Parkinson's (PD), where conventional pharmacological therapies show very mild and short-lasting effects. However, their ability to interfere with disease progression over time is not well understood; recent evidence suggests that NIBS may have a neuroprotective effect, thus slowing disease progression and modulating the aggregation state of pathological proteins. In this narrative review, we gather current knowledge about neuroprotection and NIBS in neurodegenerative diseases (i.e., PD and AD), just mentioning the few results related to stroke. As further matter of debate, we discuss similarities and differences with Deep Brain Stimulation (DBS)-induced neuroprotective effects, and highlight possible future directions for ongoing clinical studies.
Collapse
|
10
|
Sriram S, Root K, Chacko K, Patel A, Lucke-Wold B. Surgical Management of Synucleinopathies. Biomedicines 2022; 10:biomedicines10102657. [PMID: 36289920 PMCID: PMC9599076 DOI: 10.3390/biomedicines10102657] [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: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
Synucleinopathies represent a diverse set of pathologies with significant morbidity and mortality. In this review, we highlight the surgical management of three synucleinopathies: Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). After examining underlying molecular mechanisms and the medical management of these diseases, we explore the role of deep brain stimulation (DBS) in the treatment of synuclein pathophysiology. Further, we examine the utility of focused ultrasound (FUS) in the treatment of synucleinopathies such as PD, including its role in blood–brain barrier (BBB) opening for the delivery of novel drug therapeutics and gene therapy vectors. We also discuss other recent advances in the surgical management of MSA and DLB. Together, we give a diverse overview of current techniques in the neurosurgical management of these pathologies.
Collapse
|
11
|
Mazumder S, Bahar AY, Shepherd CE, Prasad AA. Post-mortem brain histological examination in the substantia nigra and subthalamic nucleus in Parkinson’s disease following deep brain stimulation. Front Neurosci 2022; 16:948523. [PMID: 36188463 PMCID: PMC9516394 DOI: 10.3389/fnins.2022.948523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disorder, pathologically hallmarked by the loss of dopamine neurons in the substantia nigra (SN) and alpha-synuclein aggregation. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a common target to treat the motor symptoms in PD. However, we have less understanding of the cellular changes in the STN during PD, and the impact of DBS on the STN and SN is limited. We examined cellular changes in the SN and STN in PD patients with and without STN-DBS treatment. Post-mortem brain tissues from 6 PD non-STN-DBS patients, 5 PD STN-DBS patients, and 6 age-matched controls were stained with markers for neurodegeneration (tyrosine hydroxylase, alpha-synuclein, and neuronal loss) and astrogliosis (glial fibrillary acidic protein). Changes were assessed using quantitative and semi-quantitative microscopy techniques. As expected, significant neuronal cell loss, alpha-synuclein pathology, and variable astrogliosis were observed in the SN in PD. No neuronal cell loss or astrogliosis was observed in the STN, although alpha-synuclein deposition was present in the STN in all PD cases. DBS did not alter neuronal loss, astrogliosis, or alpha-synuclein pathology in either the SN or STN. This study reports selective pathology in the STN with deposits of alpha-synuclein in the absence of significant neuronal cell loss or inflammation in PD. Despite being effective for the treatment of PD, this small post-mortem study suggests that DBS of the STN does not appear to modulate histological changes in astrogliosis or neuronal survival, suggesting that the therapeutic effects of DBS mechanism may transiently affect STN neural activity.
Collapse
Affiliation(s)
- Srestha Mazumder
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | | | - Claire E. Shepherd
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Asheeta A. Prasad
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Asheeta A. Prasad,
| |
Collapse
|
12
|
Ruiz MCM, Guimarães RP, Mortari MR. Parkinson’s Disease Rodent Models: are they suitable for DBS research? J Neurosci Methods 2022; 380:109687. [DOI: 10.1016/j.jneumeth.2022.109687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
|
13
|
Mahlknecht P, Foltynie T, Limousin P, Poewe W. How Does Deep Brain Stimulation Change the Course of Parkinson's Disease? Mov Disord 2022; 37:1581-1592. [PMID: 35560443 PMCID: PMC9545904 DOI: 10.1002/mds.29052] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022] Open
Abstract
A robust body of evidence from randomized controlled trials has established the efficacy of deep brain stimulation (DBS) in reducing off time and dyskinesias in levodopa‐treated patients with Parkinson's disease (PD). These effects go along with improvements in on period motor function, activities of daily living, and quality of life. In addition, subthalamic DBS is effective in controlling drug‐refractory PD tremor. Here, we review the available data from long‐term observational and controlled follow‐up studies in DBS‐treated patients to re‐examine the persistence of motor and quality of life benefits and evaluate the effects on disease progression, major disability milestones, and survival. Although there is consistent evidence from observational follow‐up studies in DBS‐treated patients over 5–10 years and beyond showing sustained improvement of motor control, the long‐term impact of DBS on overall progression of disability in PD is less clear. Whether DBS reduces or delays the development of later motor and non‐motor disability milestones in comparison to best medical management strategies is difficult to answer by uncontrolled observational follow‐up, but there are signals from controlled long‐term observational studies suggesting that subthalamic DBS may delay some of the late‐stage disability milestones including psychosis, falls, and institutionalization, and also slightly prolongs survival compared with matched medically managed patients. These observations could be attributable to the sustained improvements in motor function and reduction in medication‐induced side effects, whereas there is no clinical evidence of direct effects of DBS on the underlying disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Collapse
Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| |
Collapse
|
14
|
Ashkan K, Velicu MA, Furlanetti L. Deep brain stimulation-induced neuroprotection: A critical appraisal. Eur J Paediatr Neurol 2022; 37:114-122. [PMID: 35189499 DOI: 10.1016/j.ejpn.2022.02.001] [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: 08/12/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
Over the last two decades deep brain stimulation (DBS) has become a widely used therapeutic alternative for a variety of neurological and psychiatric diseases. The extensive experience in the field of movement disorders has provided valuable knowledge and has led the path to its application to other hard-to-treat conditions. Despite the recognised symptomatic beneficial effects, its capacity to modify the course of a disease has been in constant debate. The ability to demonstrate neuroprotection relies on a thorough understanding of the functioning of both normal and pathological neural structures, as well as their stimulation induced alterations, all of which to this date remain incomplete. Consequently, there is no consensus over the definition of neuroprotection nor its means of quantification or evaluation. Additionally, neuroprotection has been indirectly addressed in most of the literature, challenging the efforts to narrow its interpretation. As such, a broad spectrum of evidence has been considered to demonstrate disease modifying interventions. This paper aims to provide a critical appraisal of the current evidence on potential neuroprotective effects of DBS in neurodegenerative brain disorders.
Collapse
Affiliation(s)
- Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK; Department of Basic and Clinical Neuroscience, IoPPN, King's College London, UK; King's Health Partners Academic Health Sciences Centre, London, UK
| | - Maria Alexandra Velicu
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK; King's Health Partners Academic Health Sciences Centre, London, UK
| | - Luciano Furlanetti
- Department of Basic and Clinical Neuroscience, IoPPN, King's College London, UK; King's Health Partners Academic Health Sciences Centre, London, UK.
| |
Collapse
|
15
|
Knorr S, Musacchio T, Paulat R, Matthies C, Endres H, Wenger N, Harms C, Ip CW. Experimental deep brain stimulation in rodent models of movement disorders. Exp Neurol 2021; 348:113926. [PMID: 34793784 DOI: 10.1016/j.expneurol.2021.113926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 12/21/2022]
Abstract
Deep brain stimulation (DBS) is the preferred treatment for therapy-resistant movement disorders such as dystonia and Parkinson's disease (PD), mostly in advanced disease stages. Although DBS is already in clinical use for ~30 years and has improved patients' quality of life dramatically, there is still limited understanding of the underlying mechanisms of action. Rodent models of PD and dystonia are essential tools to elucidate the mode of action of DBS on behavioral and multiscale neurobiological levels. Advances have been made in identifying DBS effects on the central motor network, neuroprotection and neuroinflammation in DBS studies of PD rodent models. The phenotypic dtsz mutant hamster and the transgenic DYT-TOR1A (ΔETorA) rat proved as valuable models of dystonia for preclinical DBS research. In addition, continuous refinements of rodent DBS technologies are ongoing and have contributed to improvement of experimental quality. We here review the currently existing literature on experimental DBS in PD and dystonia models regarding the choice of models, experimental design, neurobiological readouts, as well as methodological implications. Moreover, we provide an overview of the technical stage of existing DBS devices for use in rodent studies.
Collapse
Affiliation(s)
- Susanne Knorr
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| | - Thomas Musacchio
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| | - Raik Paulat
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| | - Heinz Endres
- University of Applied Science Würzburg-Schweinfurt, Schweinfurt, Germany.
| | - Nikolaus Wenger
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
| | - Christoph Harms
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| |
Collapse
|
16
|
Plocksties F, Kober M, Niemann C, Heller J, Fauser M, Nüssel M, Uster F, Franz D, Zwar M, Lüttig A, Kröger J, Harloff J, Schulz A, Richter A, Köhling R, Timmermann D, Storch A. The software defined implantable modular platform (STELLA) for preclinical deep brain stimulation research in rodents. J Neural Eng 2021; 18. [PMID: 34542029 DOI: 10.1088/1741-2552/ac23e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/06/2021] [Indexed: 11/11/2022]
Abstract
Context.Long-term deep brain stimulation (DBS) studies in rodents are of crucial importance for research progress in this field. However, most stimulation devices require jackets or large head-mounted systems which severely affect mobility and general welfare influencing animals' behavior.Objective.To develop a preclinical neurostimulation implant system for long-term DBS research in small animal models.Approach.We propose a low-cost dual-channel DBS implant called software defined implantable platform (STELLA) with a printed circuit board size of Ø13 × 3.3 mm, weight of 0.6 g and current consumption of 7.6µA/3.1 V combined with an epoxy resin-based encapsulation method.Main results.STELLA delivers charge-balanced and configurable current pulses with widely used commercial electrodes. Whilein vitrostudies demonstrate at least 12 weeks of error-free stimulation using a CR1225 battery, our calculations predict a battery lifetime of up to 3 years using a CR2032. Exemplary application for DBS of the subthalamic nucleus in adult rats demonstrates that fully-implanted STELLA neurostimulators are very well-tolerated over 42 days without relevant stress after the early postoperative phase resulting in normal animal behavior. Encapsulation, external control and monitoring of function proved to be feasible. Stimulation with standard parameters elicited c-Fos expression by subthalamic neurons demonstrating biologically active function of STELLA.Significance.We developed a fully implantable, scalable and reliable DBS device that meets the urgent need for reverse translational research on DBS in freely moving rodent disease models including sensitive behavioral experiments. We thus add an important technology for animal research according to 'The Principle of Humane Experimental Technique'-replacement, reduction and refinement (3R). All hardware, software and additional materials are available under an open source license.
Collapse
Affiliation(s)
- Franz Plocksties
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, 18119 Rostock, Germany
| | - Maria Kober
- Department of Neurology, University of Rostock, 18147 Rostock, Germany
| | - Christoph Niemann
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, 18119 Rostock, Germany
| | - Jakob Heller
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, 18119 Rostock, Germany
| | - Mareike Fauser
- Department of Neurology, University of Rostock, 18147 Rostock, Germany
| | - Martin Nüssel
- Department of Neurology, University of Rostock, 18147 Rostock, Germany
| | - Felix Uster
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, 18119 Rostock, Germany
| | - Denise Franz
- Institute of Physiology, University of Rostock, 18057 Rostock, Germany
| | - Monique Zwar
- Institute of Physiology, University of Rostock, 18057 Rostock, Germany
| | - Anika Lüttig
- Institute of Pharmacology, Pharmacy and Toxicology, University of Leipzig, 04103 Leipzig, Germany
| | - Justin Kröger
- Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
| | - Jörg Harloff
- Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
| | - Axel Schulz
- Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
| | - Angelika Richter
- Institute of Pharmacology, Pharmacy and Toxicology, University of Leipzig, 04103 Leipzig, Germany
| | - Rüdiger Köhling
- Department of Neurology, University of Rostock, 18147 Rostock, Germany
| | - Dirk Timmermann
- Institute of Applied Microelectronics and Computer Engineering, University of Rostock, 18119 Rostock, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, 18147 Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, 18147 Rostock, Germany
| |
Collapse
|
17
|
Fauser M, Ricken M, Markert F, Weis N, Schmitt O, Gimsa J, Winter C, Badstübner-Meeske K, Storch A. Subthalamic nucleus deep brain stimulation induces sustained neurorestoration in the mesolimbic dopaminergic system in a Parkinson's disease model. Neurobiol Dis 2021; 156:105404. [PMID: 34044146 DOI: 10.1016/j.nbd.2021.105404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapeutic principle in Parkinson's disease, but the underlying mechanisms, particularly mediating non-motor actions, remain largely enigmatic. OBJECTIVE/HYPOTHESIS The delayed onset of neuropsychiatric actions in conjunction with first experimental evidence that STN-DBS causes disease-modifying effects prompted our investigation on how cellular plasticity in midbrain dopaminergic systems is affected by STN-DBS. METHODS We applied unilateral or bilateral STN-DBS in two independent cohorts of 6-hydroxydopamine hemiparkinsonian rats four to eight weeks after dopaminergic lesioning to allow for the development of a stable dopaminergic dysfunction prior to DBS electrode implantation. RESULTS After 5 weeks of STN-DBS, stimulated animals had significantly more TH+ dopaminergic neurons and fibres in both the nigrostriatal and the mesolimbic systems compared to sham controls with large effect sizes of gHedges = 1.9-3.4. DBS of the entopeduncular nucleus as the homologue of the human Globus pallidus internus did not alter the dopaminergic systems. STN-DBS effects on mesolimbic dopaminergic neurons were largely confirmed in an independent animal cohort with unilateral STN stimulation for 6 weeks or for 3 weeks followed by a 3 weeks washout period. The latter subgroup even demonstrated persistent mesolimbic dopaminergic plasticity after washout. Pilot behavioural testing showed that augmentative dopaminergic effects on the mesolimbic system by STN-DBS might translate into improvement of sensorimotor neglect. CONCLUSIONS Our data support sustained neurorestorative effects of STN-DBS not only in the nigrostriatal but also in the mesolimbic system as a potential factor mediating long-latency neuropsychiatric effects of STN-DBS in Parkinson's disease.
Collapse
Affiliation(s)
- Mareike Fauser
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Manuel Ricken
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Franz Markert
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Nikolai Weis
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Oliver Schmitt
- Department of Anatomy, University of Rostock, Gertrudenstraße 9, 18057 Rostock, Germany
| | - Jan Gimsa
- Department of Biophysics, University of Rostock, Gertrudenstraße 11A, 18057 Rostock, Germany
| | - Christine Winter
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Alexander Storch
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany; German Centre for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Gehlsheimer Straße 20, 18147 Rostock, Germany.
| |
Collapse
|
18
|
Striatal Afferent BDNF Is Disrupted by Synucleinopathy and Partially Restored by STN DBS. J Neurosci 2021; 41:2039-2052. [PMID: 33472823 PMCID: PMC7939095 DOI: 10.1523/jneurosci.1952-20.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/07/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
Preclinical studies show a link between subthalamic nucleus (STN) deep brain stimulation (DBS) and neuroprotection of nigrostriatal dopamine (DA) neurons, potentially through brain-derived neurotrophic factor (BDNF) signaling. However, the question of whether DBS of the STN can be disease-modifying in Parkinson's disease (PD) remains unanswered. In particular, the impact of STN DBS on α-synuclein (α-syn) aggregation, inclusion-associated neuroinflammation, and BDNF levels has yet to be examined in the context of synucleinopathy. To address this, we examined the effects of STN DBS on BDNF using the α-syn preformed fibril (PFF) model in male rats. While PFF injection resulted in accumulation of phosphorylated α-syn (pSyn) inclusions in the substantia nigra pars compacta (SNpc) and cortical areas, STN DBS did not impact PFF-induced accumulation of pSyn inclusions in the SNpc. In addition, nigral pSyn inclusions were associated with increased microgliosis and astrogliosis; however, the magnitude of these processes was not altered by STN DBS. Total BDNF protein was not impacted by pSyn inclusions, but the normally positive association of nigrostriatal and corticostriatal BDNF was reversed in rats with PFF-induced nigrostriatal and corticostriatal inclusions. Despite this, rats receiving both STN DBS and PFF injection showed increased BDNF protein in the striatum, which partially restored the normal corticostriatal relationship. Our results suggest that pathologic α-syn inclusions disrupt anterograde BDNF transport within nigrostriatal and corticostriatal circuitry. Further, STN DBS has the potential to exert protective effects by modifying the long-term neurodegenerative consequences of synucleinopathy. SIGNIFICANCE STATEMENT An increase in brain-derived neurotrophic factor (BDNF) has been linked to the neuroprotection elicited by subthalamic nucleus (STN) deep brain stimulation (DBS) in neurotoxicant models of Parkinson's disease (PD). However, whether STN DBS can similarly increase BDNF in nigrostriatal and corticostriatal circuitry in the presence of α-synuclein (α-syn) inclusions has not been examined. We examined the impact of STN DBS on rats in which accumulation of α-syn inclusions is induced by injection of α-syn preformed fibrils (PFFs). STN DBS significantly increased striatal BDNF protein in rats seeded with α-syn inclusions and partially restored the normal corticostriatal BDNF relationship. These findings suggest that STN DBS can drive BDNF in the parkinsonian brain and retains the potential for neuroprotection in PD.
Collapse
|
19
|
Abstract
Parkinson disease (PD) treatment options have conventionally focused on dopamine replacement and provision of symptomatic relief. Current treatments cause undesirable adverse effects, and a large unmet clinical need remains for treatments that offer disease modification and that address symptoms resistant to levodopa. Advances in high-throughput drug screening methods for small molecules, developments in disease modelling and improvements in analytical technologies have collectively contributed to the emergence of novel compounds, repurposed drugs and new technologies. In this Review, we focus on disease-modifying and symptomatic therapies under development for PD. We review cellular therapies and repurposed drugs, such as nilotinib, inosine, isradipine, iron chelators and anti-inflammatories, and discuss how their success in preclinical models has paved the way for clinical trials. We provide an update on immunotherapies and vaccines. In addition, we review non-pharmacological interventions targeting motor symptoms, including gene therapy, adaptive deep brain stimulation (DBS) and optogenetically inspired DBS. Given the many clinical phenotypes of PD, individualization of therapy and precision of treatment are likely to become important in the future.
Collapse
|
20
|
Jakobs M, Lee DJ, Lozano AM. Modifying the progression of Alzheimer's and Parkinson's disease with deep brain stimulation. Neuropharmacology 2019; 171:107860. [PMID: 31765650 DOI: 10.1016/j.neuropharm.2019.107860] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
At times of an aging population and increasing prevalence of neurodegenerative disorders, effective medical treatments remain limited. Therefore, there is an urgent need for new therapies to treat Alzheimer's disease (AD). Deep brain stimulation (DBS) is thought to address the neuronal network dysfunction of this disorder and may offer new therapeutic options. Preliminary evidence suggests that DBS of the fornix may have effects on cognitive decline, brain glucose metabolism, hippocampal volume and cortical grey matter volume in certain patients with mild AD. Rodent studies have shown that increase of cholinergic neurotransmitters, hippocampal neurogenesis, synaptic plasticity and reduction of amyloid plaques are associated with DBS. Currently a large phase III study of fornix DBS is assessing efficacy in patients with mild AD aged 65 years and older. The Nucleus basalis of Meynert has also been explored in a phase I study in of mild to moderate AD and was tolerated well regardless of the lack of benefit. Being an established therapy for Parkinson's Disease (PD), DBS may exert some disease-modifying traits rather than being a purely symptomatic treatment. There is evidence of dopaminergic neuroprotection in animal models and some suggestion that DBS may influence the natural progression of the disorder. Neuromodulation may possibly have beneficial effects on course of different neurodegenerative disorders compared to medical therapy alone. For dementias, functional neurosurgery may provide an adjunctive option in patient care. This article is part of the special issue entitled 'The Quest for Disease-Modifying Therapies for Neurodegenerative Disorders'.
Collapse
Affiliation(s)
- Martin Jakobs
- Department of Neurosurgery, Division of Stereotactic Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Darrin J Lee
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
21
|
Magno LAV, Collodetti M, Tenza-Ferrer H, Romano-Silva MA. Cylinder Test to Assess Sensory-motor Function in a Mouse Model of Parkinson's Disease. Bio Protoc 2019; 9:e3337. [PMID: 33654842 DOI: 10.21769/bioprotoc.3337] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease is a progressive neurodegenerative movement disorder that happens due to the loss of dopaminergic neurons in the substantia nigra. The deficiency of dopamine in the basal nuclei drives cardinal motor symptoms such as bradykinesia and hypokinesia. The current protocol describes the cylinder test, which is a relatively simple behavioral assessment that evaluates the motor deficits upon unilateral degeneration of the nigrostriatal pathway in experimental models of Parkinson's disease. Since dopamine-depleted mice exhibit the preferential use of the forelimb ipsilateral to the lesion, here researchers perform the cylinder test to investigate the therapeutic effects of antiparkinsonian treatments on the performance of the contralateral (injured) limb.
Collapse
Affiliation(s)
- Luiz Alexandre Viana Magno
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, CEP 30130-100, Brazil
| | - Mélcar Collodetti
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, CEP 30130-100, Brazil
| | - Helia Tenza-Ferrer
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, CEP 30130-100, Brazil
| | - Marco Aurélio Romano-Silva
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, CEP 30130-100, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, CEP 30130-100, Brazil
| |
Collapse
|
22
|
Foffani G, Trigo‐Damas I, Pineda‐Pardo JA, Blesa J, Rodríguez‐Rojas R, Martínez‐Fernández R, Obeso JA. Focused ultrasound in Parkinson's disease: A twofold path toward disease modification. Mov Disord 2019; 34:1262-1273. [DOI: 10.1002/mds.27805] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/14/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guglielmo Foffani
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- Hospital Nacional de Parapléjicos Toledo Spain
| | - Inés Trigo‐Damas
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- CIBERNEDInstituto de Salud Carlos III Madrid Spain
| | - José A. Pineda‐Pardo
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- CIBERNEDInstituto de Salud Carlos III Madrid Spain
| | - Javier Blesa
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- CIBERNEDInstituto de Salud Carlos III Madrid Spain
| | - Rafael Rodríguez‐Rojas
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- CIBERNEDInstituto de Salud Carlos III Madrid Spain
| | - Raul Martínez‐Fernández
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- CIBERNEDInstituto de Salud Carlos III Madrid Spain
| | - José A. Obeso
- CINACHospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU‐San Pablo Madrid Spain
- CIBERNEDInstituto de Salud Carlos III Madrid Spain
| |
Collapse
|
23
|
McKinnon C, Gros P, Lee DJ, Hamani C, Lozano AM, Kalia LV, Kalia SK. Deep brain stimulation: potential for neuroprotection. Ann Clin Transl Neurol 2019; 6:174-185. [PMID: 30656196 PMCID: PMC6331208 DOI: 10.1002/acn3.682] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/12/2018] [Accepted: 09/28/2018] [Indexed: 12/28/2022] Open
Abstract
Over the last two decades there has been an exponential rise in the number of patients receiving deep brain stimulation (DBS) to manage debilitating neurological symptoms in conditions such as Parkinson's disease, essential tremor, and dystonia. Novel applications of DBS continue to emerge including treatment of various psychiatric conditions (e.g. obsessive-compulsive disorder, major depression) and cognitive disorders such as Alzheimer's disease. Despite widening therapeutic applications, our understanding of the mechanisms underlying DBS remains limited. In addition to modulation of local and network-wide neuronal activity, growing evidence suggests that DBS may also have important neuroprotective effects in the brain by limiting synaptic dysfunction and neuronal loss in neurodegenerative disorders. In this review, we consider evidence from preclinical and clinical studies of DBS in Parkinson's disease, Alzheimer's disease, and epilepsy that suggest chronic stimulation has the potential to mitigate neuronal loss and disease progression.
Collapse
Affiliation(s)
- Chris McKinnon
- Krembil Research InstituteUniversity Health NetworkToronto Western HospitalTorontoOntarioCanada
| | - Priti Gros
- Division of NeurologyToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | - Darrin J. Lee
- Krembil Research InstituteUniversity Health NetworkToronto Western HospitalTorontoOntarioCanada
- Division of NeurosurgeryToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | - Clement Hamani
- Harquail Centre for NeuromodulationDivision of NeurosurgerySunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Andres M. Lozano
- Krembil Research InstituteUniversity Health NetworkToronto Western HospitalTorontoOntarioCanada
- Division of NeurosurgeryToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | - Lorraine V. Kalia
- Krembil Research InstituteUniversity Health NetworkToronto Western HospitalTorontoOntarioCanada
- Division of NeurologyToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
- Tanz Centre for Research in Neurodegenerative DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Suneil K. Kalia
- Krembil Research InstituteUniversity Health NetworkToronto Western HospitalTorontoOntarioCanada
- Division of NeurosurgeryToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
24
|
Fischer DL, Sortwell CE. BDNF provides many routes toward STN DBS-mediated disease modification. Mov Disord 2018; 34:22-34. [PMID: 30440081 PMCID: PMC6587505 DOI: 10.1002/mds.27535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/18/2018] [Accepted: 09/23/2018] [Indexed: 01/05/2023] Open
Abstract
The concept that subthalamic nucleus deep brain stimulation (STN DBS) may be disease modifying in Parkinson's disease (PD) is controversial. Several clinical trials that enrolled subjects with late‐stage PD have come to disparate conclusions on this matter. In contrast, some clinical studies in early‐ to midstage subjects have suggested a disease‐modifying effect. Dopaminergic innervation of the putamen is essentially absent in PD subjects within 4 years after diagnosis, indicating that any neuroprotective therapy, including STN DBS, will require intervention within the immediate postdiagnosis interval. Preclinical prevention and early intervention paradigms support a neuroprotective effect of STN DBS on the nigrostriatal system via increased brain‐derived neurotrophic factor (BDNF). STN DBS‐induced increases in BDNF provide a multitude of mechanisms capable of ameliorating dysfunction and degeneration in the parkinsonian brain. A biomarker for measuring brain‐derived neurotrophic factor‐trkB signaling, though, is not available for clinical research. If a prospective clinical trial were to examine whether STN DBS is disease modifying, we contend the strongest rationale is not dependent on a preclinical neuroprotective effect per se, but on the myriad potential mechanisms whereby STN DBS‐elicited brain‐derived neurotrophic factor‐trkB signaling could provide disease modification. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- D Luke Fischer
- Department of Translational Science & Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Caryl E Sortwell
- Department of Translational Science & Molecular Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Hauenstein Neuroscience Center, Mercy Health St. Mary's, Grand Rapids, Michigan, USA
| |
Collapse
|
25
|
Duffy MF, Collier TJ, Patterson JR, Kemp CJ, Fischer DL, Stoll AC, Sortwell CE. Quality Over Quantity: Advantages of Using Alpha-Synuclein Preformed Fibril Triggered Synucleinopathy to Model Idiopathic Parkinson's Disease. Front Neurosci 2018; 12:621. [PMID: 30233303 PMCID: PMC6132025 DOI: 10.3389/fnins.2018.00621] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/17/2018] [Indexed: 12/21/2022] Open
Abstract
Animal models have significantly advanced our understanding of Parkinson's disease (PD). Alpha-synuclein (α-syn) has taken center stage due to its genetic connection to familial PD and localization to Lewy bodies, one pathological hallmark of PD. Animal models developed on the premise of elevated alpha-synuclein via germline manipulation or viral vector-mediated overexpression are used to investigate PD pathophysiology and vet novel therapeutics. While these models represented a step forward compared to their neurotoxicant model predecessors, they rely on overexpression of supraphysiological levels of α-syn to trigger toxicity. However, whereas SNCA-linked familial PD is associated with elevated α-syn, elevated α-syn is not associated with idiopathic PD. Therefore, the defining feature of the α-syn overexpression models may fail to appropriately model idiopathic PD. In the last several years a new model has been developed in which α-syn preformed fibrils are injected intrastriatally and trigger normal endogenous levels of α-syn to misfold and accumulate into Lewy body-like inclusions. Following a defined period of inclusion accumulation, distinct phases of neuroinflammation and progressive degeneration can be detected in the nigrostriatal system. In this perspective, we highlight the fact that levels of α-syn achieved in overexpression models generally exceed those observed in idiopathic and even SNCA multiplication-linked PD. This raises the possibility that supraphysiological α-syn expression may drive pathophysiological mechanisms not relevant to idiopathic PD. We argue in this perspective that synucleinopathy triggered to form within the context of normal α-syn expression represents a more faithful animal model of idiopathic PD when examining the role of neuroinflammation or the relationship between a-syn aggregation and toxicity.
Collapse
Affiliation(s)
- Megan F. Duffy
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Timothy J. Collier
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
- Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, United States
| | - Joseph R. Patterson
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Christopher J. Kemp
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
| | - D. Luke Fischer
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Anna C. Stoll
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Caryl E. Sortwell
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, United States
- Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, United States
| |
Collapse
|