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Maset-Roig R, Caplliure-Llopis J, de Bernardo N, Privado J, Alarcón-Jiménez J, Martín-Ruiz J, Botella-Navas M, Villarón-Casales C, Sancho-Cantus D, de la Rubia Ortí JE. Analysis of Heart Rate Variability in Individuals Affected by Amyotrophic Lateral Sclerosis. SENSORS (BASEL, SWITZERLAND) 2024; 24:2355. [PMID: 38610566 PMCID: PMC11014346 DOI: 10.3390/s24072355] [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: 03/01/2024] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) produces alterations in the autonomic nervous system (ANS), which explains the cardiac manifestations observed in patients. The assessment of heart rate variability (HRV) is what best reflects the activity of the ANS on heart rate. The Polar H7 Bluetooth® device proves to be a non-invasive and much faster technology than existing alternatives for this purpose. OBJECTIVE The goal of this study is to determine HRV using Polar H7 Bluetooth technology in ALS patients, comparing the obtained measurements with values from healthy individuals. METHOD The sample consisted of 124 participants: 68 diagnosed with ALS and 56 healthy individuals. Using Polar H7 Bluetooth technology and the ELITE HRV application, various HRV measurements were determined for all participants, specifically the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, LF, HF, LF/HF ratio, HR average, and HF peak frequency. RESULTS Statistically significant differences were observed between ALS patients and healthy individuals in the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, HF, and LF, where healthy individuals exhibited higher scores. For the HR average, the ALS group showed a higher value. Values were similar when comparing men and women with ALS, with only a higher HF peak frequency observed in women. CONCLUSION The Polar H7 Bluetooth® device is effective in determining heart rate variability alterations in ALS, being a promising prognostic tool for the disease.
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Affiliation(s)
- Rosa Maset-Roig
- Doctoral Degree School, Catholic University San Vicente Mártir, 46001 Valencia, Spain;
| | - Jordi Caplliure-Llopis
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
| | - Nieves de Bernardo
- Department of Physiotherapy, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.A.-J.)
| | - Jesús Privado
- Department of Methodology of Behavioral Sciences, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Jorge Alarcón-Jiménez
- Department of Physiotherapy, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.A.-J.)
| | - Julio Martín-Ruiz
- Department of Health and Functional Evaluation, Faculty of Physical Activity and Sports Sciences, Catholic University San Vicente Mártir, 46001 Valencia, Spain;
| | - Marta Botella-Navas
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
| | - Carlos Villarón-Casales
- Biomechanics & Physiotherapy in Sports (BIOCAPS), Faculty of Health Sciences, Spain, European University of Valencia, 46001 Valencia, Spain
| | - David Sancho-Cantus
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
| | - José Enrique de la Rubia Ortí
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
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Li D, Zhou L, Cao Z, Wang J, Yang H, Lyu M, Zhang Y, Yang R, Wang J, Bian Y, Xu W, Wang Y. Associations of environmental factors with neurodegeneration: An exposome-wide Mendelian randomization investigation. Ageing Res Rev 2024; 95:102254. [PMID: 38430933 DOI: 10.1016/j.arr.2024.102254] [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: 07/18/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Neurodegenerative diseases (NDDs) remain a global health challenge. Previous studies have reported potential links between environmental factors and NDDs, however, findings remain controversial across studies and elusive to be interpreted as evidence of robust causal associations. In this study, we comprehensively explored the causal associations of the common environmental factors with major NDDs including Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), based on updated large-scale genome-wide association study data through two-sample Mendelian randomization (MR) approach. Our results indicated that, overall, 28 significant sets of exposure-outcome causal association evidence were detected, 12 of which were previously underestimated and newly identified, including average weekly beer plus cider intake, strenuous sports or other exercises, diastolic blood pressure, and body fat percentage with AD, alcohol intake frequency with PD, apolipoprotein B, systolic blood pressure, and forced expiratory volume in 1 s (FEV1) with ALS, and alcohol intake frequency, hip circumference, forced vital capacity, and FEV1 with MS. Moreover, the causal effects of several environmental factors on NDDs were found to overlap. From a triangulation perspective, our investigation provided insights into understanding the associations of environmental factors with NDDs, providing causality-oriented evidence to establish the risk profile of NDDs.
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Affiliation(s)
- Dun Li
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Zhi Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jida Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Hongxi Yang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Mingqian Lyu
- Department of Computer Science, RWTH Aachen University, Aachen, 52062, Germany
| | - Yuan Zhang
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Rongrong Yang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Ju Wang
- School of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, China
| | - Yuhong Bian
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Health Care Sciences and Society Karolinska Institutet and Stockholm University, Stockholm 171 65, Sweden
| | - Yaogang Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Public Health, Tianjin Medical University, Tianjin 300070, China; Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; National Institute of Health Data Science at Peking University, Peking University, Beijing 100191, China.
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3
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Dubbioso R, Provitera V, Pacella D, Santoro L, Manganelli F, Nolano M. Autonomic dysfunction is associated with disease progression and survival in amyotrophic lateral sclerosis: a prospective longitudinal cohort study. J Neurol 2023; 270:4968-4977. [PMID: 37358634 PMCID: PMC10511550 DOI: 10.1007/s00415-023-11832-w] [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: 04/26/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Among non-motor symptoms, autonomic disturbances have been described in amyotrophic lateral sclerosis (ALS) and reported as mild to moderate in up to 75% of patients. However, no study has systematically investigated autonomic symptoms as prognostic factors. OBJECTIVES The main aim of this longitudinal study was to examine the association of autonomic dysfunction with disease progression and survival in ALS. METHODS We enrolled newly diagnosed ALS patients and a healthy control group (HC). Time from disease onset to disease milestone (King's stage 4) and death were calculated to assess disease progression and survival. Autonomic symptoms were assessed by a dedicated questionnaire. Longitudinal evaluation of parasympathetic cardiovascular activity was performed by the heart rate variability (HRV). Multivariable Cox proportional hazards regression models on the risk of the disease milestone and death were used. A mixed-effect linear regression model was used to compare autonomic dysfunction with a HC group as well as its impairment over time. RESULTS A total of 102 patients and 41 HC were studied. ALS patients, compared with HC, complained of more autonomic symptoms, especially in bulbar onset patients. Autonomic symptoms occurred in 69 (68%) patients at diagnosis and progressed over time (post-6: p = 0.015 and post-12: p < 0.001). A higher autonomic symptom burden was an independent marker of faster development of King's stage 4 (HR 1.05; 95% CI 1.00-1.11; p = 0.022); whereas, urinary complaints were independent factors of a shorter survival (HR 3.12; 95% CI 1.22-7.97; p = 0.018). Moreover, HRV in ALS patients was lower than in HC (p = 0.018) and further decreased over time (p = 0.003), implying a parasympathetic hypofunction that progressed over time. CONCLUSION Autonomic symptoms occur in most of the ALS patients at diagnosis and progress over time, implying that autonomic dysfunction represents an intrinsic non-motor feature of the disease. A higher autonomic burden is a poor prognostic factor, associated with a more rapid development of disease milestones and shorter survival.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Vincenzo Provitera
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037, Telese Terme, Benevento, Italy
| | - Daniela Pacella
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037, Telese Terme, Benevento, Italy
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Napoli G, Rubin M, Cutillo G, Schito P, Russo T, Quattrini A, Filippi M, Riva N. Tako-Tsubo Syndrome in Amyotrophic Lateral Sclerosis: Single-Center Case Series and Brief Literature Review. Int J Mol Sci 2023; 24:12096. [PMID: 37569475 PMCID: PMC10418501 DOI: 10.3390/ijms241512096] [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: 06/21/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with variable phenotypic expressions which has been associated with autonomic dysfunction. The cardiovascular system seems to be affected especially in the context of bulbar involvement. We describe four new cases of Tako-Tsubo syndrome (TTS) in ALS patients with an appraisal of the literature. We present a late-stage ALS patient with prominent bulbar involvement that presented TTS during hospitalization. We then retrospectively identify three additional ALS-TTS cases reporting relevant clinical findings. TTS cardiomyopathy has been observed in different acute neurological conditions, and the co-occurrence of ALS and TTS has already been reported. Cardiovascular autonomic dysfunctions have been described in ALS, especially in the context of an advanced diseases and with bulbar involvement. Noradrenergic hyperfunction linked to sympathetic denervation and ventilatory deficits coupled in different instances with a trigger event could play a synergistic role in the development of TTS in ALS. Sympathetic hyperfunctioning and ventilatory deficits in conjunction with cardiac autonomic nerves impairment may play a role in the development of TTS in a context of ALS.
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Affiliation(s)
- Giovanni Napoli
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
| | - Martina Rubin
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gianni Cutillo
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
| | - Paride Schito
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Tommaso Russo
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Massimo Filippi
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Nilo Riva
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
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Mazzaro A, Vita V, Ronfini M, Casola I, Klein A, Dobrowolny G, Sorarù G, Musarò A, Mongillo M, Zaglia T. Sympathetic neuropathology is revealed in muscles affected by amyotrophic lateral sclerosis. Front Physiol 2023; 14:1165811. [PMID: 37250128 PMCID: PMC10213213 DOI: 10.3389/fphys.2023.1165811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Rationale: The anatomical substrate of skeletal muscle autonomic innervation has remained underappreciated since it was described many decades ago. As such, the structural and functional features of muscle sympathetic innervation are largely undetermined in both physiology and pathology, mainly due to methodological limitations in the histopathological analysis of small neuronal fibers in tissue samples. Amyotrophic lateral sclerosis (ALS) is a fatal neuromuscular disease which mainly targets motor neurons, and despite autonomic symptoms occurring in a significant fraction of patients, peripheral sympathetic neurons (SNs) are generally considered unaffected and, as such, poorly studied. Purpose: In this research, we compared sympathetic innervation of normal and ALS muscles, through structural analysis of the sympathetic network in human and murine tissue samples. Methods and Results: We first refined tissue processing to circumvent methodological limitations interfering with the detection of muscle sympathetic innervation. The optimized "Neuro Detection Protocol" (NDP) was validated in human muscle biopsies, demonstrating that SNs innervate, at high density, both blood vessels and skeletal myofibers, independent of the fiber metabolic type. Subsequently, NDP was exploited to analyze sympathetic innervation in muscles of SOD1G93A mice, a preclinical ALS model. Our data show that ALS murine muscles display SN denervation, which has already initiated at the early disease stage and worsened during aging. SN degeneration was also observed in muscles of MLC/SOD1G93A mice, with muscle specific expression of the SOD1G93A mutant gene. Notably, similar alterations in SNs were observed in muscle biopsies from an ALS patient, carrying the SOD1G93A mutation. Conclusion: We set up a protocol for the analysis of murine and, more importantly, human muscle sympathetic innervation. Our results indicate that SNs are additional cell types compromised in ALS and suggest that dysfunctional SOD1G93A muscles affect their sympathetic innervation.
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Affiliation(s)
- Antonio Mazzaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Veronica Vita
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Marco Ronfini
- Veneto Institute of Molecular Medicine, Padua, Italy
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Irene Casola
- Laboratory Affiliated to Institute Pasteur Italia-Fondazione Cenci Bolognetti, DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Arianna Klein
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Gabriella Dobrowolny
- Laboratory Affiliated to Institute Pasteur Italia-Fondazione Cenci Bolognetti, DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Gianni Sorarù
- Department of Neuroscience, Azienda Ospedaliera di Padova, Padua, Italy
| | - Antonio Musarò
- Laboratory Affiliated to Institute Pasteur Italia-Fondazione Cenci Bolognetti, DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
- Scuola Superiore di Studi Avanzati Sapienza (SSAS), Sapienza University of Rome, Rome, Italy
| | - Marco Mongillo
- Veneto Institute of Molecular Medicine, Padua, Italy
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- CNR Institute of Neuroscience, Padua, Italy
- CIR-MYO Myology Center, University of Padua, Padua, Italy
| | - Tania Zaglia
- Veneto Institute of Molecular Medicine, Padua, Italy
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- CIR-MYO Myology Center, University of Padua, Padua, Italy
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Sensory Involvement in Amyotrophic Lateral Sclerosis. Int J Mol Sci 2022; 23:ijms232415521. [PMID: 36555161 PMCID: PMC9779879 DOI: 10.3390/ijms232415521] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/19/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Although amyotrophic lateral sclerosis (ALS) is pre-eminently a motor disease, the existence of non-motor manifestations, including sensory involvement, has been described in the last few years. Although from a clinical perspective, sensory symptoms are overshadowed by their motor manifestations, this does not mean that their pathological significance is not relevant. In this review, we have made an extensive description of the involvement of sensory and autonomic systems described to date in ALS, from clinical, neurophysiological, neuroimaging, neuropathological, functional, and molecular perspectives.
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In vivo genome editing using novel AAV-PHP variants rescues motor function deficits and extends survival in a SOD1-ALS mouse model. Gene Ther 2022; 30:443-454. [PMID: 36450833 PMCID: PMC9713118 DOI: 10.1038/s41434-022-00375-w] [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: 01/15/2022] [Revised: 10/10/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
CRISPR-based gene editing technology represents a promising approach to deliver therapies for inherited disorders, including amyotrophic lateral sclerosis (ALS). Toxic gain-of-function superoxide dismutase 1 (SOD1) mutations are responsible for ~20% of familial ALS cases. Thus, current clinical strategies to treat SOD1-ALS are designed to lower SOD1 levels. Here, we utilized AAV-PHP.B variants to deliver CRISPR-Cas9 guide RNAs designed to disrupt the human SOD1 (huSOD1) transgene in SOD1G93A mice. A one-time intracerebroventricular injection of AAV.PHP.B-huSOD1-sgRNA into neonatal H11Cas9 SOD1G93A mice caused robust and sustained mutant huSOD1 protein reduction in the cortex and spinal cord, and restored motor function. Neonatal treatment also reduced spinal motor neuron loss, denervation at neuromuscular junction (NMJ) and muscle atrophy, diminished axonal damage and preserved compound muscle action potential throughout the lifespan of treated mice. SOD1G93A treated mice achieved significant disease-free survival, extending lifespan by more than 110 days. Importantly, a one-time intrathecal or intravenous injection of AAV.PHP.eB-huSOD1-sgRNA in adult H11Cas9 SOD1G93A mice, immediately before symptom onset, also extended lifespan by at least 170 days. We observed substantial protection against disease progression, demonstrating the utility of our CRISPR editing preclinical approach for target evaluation. Our approach uncovered key parameters (e.g., AAV capsid, Cas9 expression) that resulted in improved efficacy compared to similar approaches and can also serve to accelerate drug target validation.
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Xia K, Zhang L, Tang L, Huang T, Fan D. Assessing the role of blood pressure in amyotrophic lateral sclerosis: a Mendelian randomization study. Orphanet J Rare Dis 2022; 17:56. [PMID: 35172853 PMCID: PMC8848798 DOI: 10.1186/s13023-022-02212-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/06/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Observational studies have suggested a close but controversial relationship between blood pressure (BP) and amyotrophic lateral sclerosis (ALS). It remains unclear whether this association is causal. The authors employed a bidirectional two-sample Mendelian randomization (MR) approach to evaluate the causal relationship between BP and ALS. Genetic proxies for systolic blood pressure (SBP), diastolic blood pressure (DBP), antihypertensive drugs (AHDs), ALS, and their corresponding genome-wide association study (GWAS) summary datasets were obtained from the most recent studies with the largest sample sizes. The inverse variance weighted (IVW) method was adopted as the main approach to examine the effect of BP on ALS and four other MR methods were used for sensitivity analyses. To exclude the interference between SBP and DBP, a multivariable MR approach was used. RESULTS We found that genetically determined increased DBP was a protective factor for ALS (OR = 0.978, 95% CI 0.960-0.996, P = 0.017) and that increased SBP was an independent risk factor for ALS (OR = 1.014, 95% CI 1.003-1.025, P = 0.015), which is supported by sensitivity analyses. The use of calcium channel blocker (CCB) showed a causal relationship with ALS (OR = 0.985, 95% CI 0.971-1.000, P = 0.049). No evidence was revealed that ALS caused changes in BP. CONCLUSIONS This study provides genetic support for a causal effect of BP and ALS that increased DBP has a protective effect on ALS, and increased SBP is a risk factor for ALS, which may be related to sympathetic excitability. Blood pressure management is essential in ALS, and CCB may be a promising candidate.
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Affiliation(s)
- Kailin Xia
- Department of Neurology, Peking University Third Hospital, Garden North Road No. 49, Beijing, 100191, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Garden North Road No. 49, Beijing, 100191, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Garden North Road No. 49, Beijing, 100191, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. .,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Garden North Road No. 49, Beijing, 100191, China. .,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China. .,Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China.
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Chiò A, Canosa A, Calvo A, Moglia C, Cicolin A, Mora G. Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis. Expert Rev Neurother 2021; 21:1419-1440. [PMID: 34554894 DOI: 10.1080/14737175.2021.1984883] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The burden of non-motor symptoms is a major determinant of quality of life and outcome in amyotrophic lateral sclerosis (ALS) and has profound negative effect also on caregivers. AREAS COVERED Non-motor symptoms in ALS include cognitive impairment, neurobehavioral symptoms, depression and anxiety, suicidal ideation, pain, disordered sleep, fatigue, weight loss and reduced appetite, and autonomic dysfunctions. This review summarizes the measures used for the assessment of non-motor symptoms and their properties and recaps the frequency and progression of these symptoms along the course of ALS. EXPERT OPINION Non-motor symptoms in ALS represent a major component of the disease and span over several domains. These symptoms require a high level of medical attention and should be checked at each visit using ad hoc questionnaires and proactively treated. Several instruments assessing non-motor symptoms have been used in ALS. Specific screening questionnaires for non-motor symptoms can be used for monitoring patients during telehealth visits and for remote surveillance through sensors and apps installed on smartphones. Novel trials for non-motor symptoms treatment specifically designed for ALS are necessary to increase and refine the therapeutic armamentarium. Finally, scales assessing the most frequent and burdensome non-motor symptoms should be included in clinical trials.
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Affiliation(s)
- Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Alessandro Cicolin
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Sleep Medicine Center, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Gabriele Mora
- Neurorehabilitation Department, Ics Maugeri Irccs, Institute of Milan, Milan, Italy
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Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation. Herzschrittmacherther Elektrophysiol 2021; 32:315-319. [PMID: 34236476 DOI: 10.1007/s00399-021-00780-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]
Abstract
Heart rate variability (HRV) refers to the beat-to-beat variation of the cardiac cycle. Since heart rate is modulated on a beat-to-beat basis by the combined influence of the sympathetic and parasympathetic nervous system at the sinus node level, HRV has been considered an indirect biomarker of cardiac autonomic control and widely exploited for the assessment of autonomic function in many pathological subjects. This focus article summarizes the main findings derived from HRV analysis applied to 24‑h Holter monitoring in both cardiac and non-cardiac diseases as well as in physiological conditions in the healthy population. Even if the prognostic role of HRV indices is well recognized and its use ever more widespread, its implementation in the diagnostic and prognostic processes in routine clinical practice remains limited. Several reasons for these limitations can be identified: first the lack of reliable reference values, and secondly, the low specificity of HRV indices in particular when considering the constant evolution of clinical practice and therapeutic approaches, making it difficult to refer to a specific and stable combination of clinical and HRV markers. Therefore, the clinical use of HRV should be further investigated. Finally, HRV represents a substantial tool for investigating the physiological conditions in healthy people that can have important implications in primary prevention and the understanding of gender differences, as well as in sport and occupational medicine.
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11
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da Silva TD, Fontes AMGG, de Oliveira-Furlan BS, Roque TT, Lima AII, de Souza BMM, Alberissi CADO, Silveira AC, de Moraes ÍAP, Collett J, Silva RP, Airoldi MJ, Ribeiro-Papa DC, Dawes H, Monteiro CBDM. Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial. Front Neurol 2020; 11:953. [PMID: 32982950 PMCID: PMC7492207 DOI: 10.3389/fneur.2020.00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration:ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.
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Affiliation(s)
- Talita Dias da Silva
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil.,Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Barbara Soares de Oliveira-Furlan
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Tatiane Tedeschi Roque
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Ana Izabel Izidório Lima
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Bruna Mayara Magalhães de Souza
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Camila Aparecida de Oliveira Alberissi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Ana Clara Silveira
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Íbis Ariana Peña de Moraes
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Johnny Collett
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Roger Pereira Silva
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Marina Junqueira Airoldi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Denise Cardoso Ribeiro-Papa
- Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Helen Dawes
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Carlos Bandeira de Mello Monteiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
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12
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Bravo-Hernandez M, Tadokoro T, Navarro MR, Platoshyn O, Kobayashi Y, Marsala S, Miyanohara A, Juhas S, Juhasova J, Skalnikova H, Tomori Z, Vanicky I, Studenovska H, Proks V, Chen P, Govea-Perez N, Ditsworth D, Ciacci JD, Gao S, Zhu W, Ahrens ET, Driscoll SP, Glenn TD, McAlonis-Downes M, Da Cruz S, Pfaff SL, Kaspar BK, Cleveland DW, Marsala M. Spinal subpial delivery of AAV9 enables widespread gene silencing and blocks motoneuron degeneration in ALS. Nat Med 2019; 26:118-130. [PMID: 31873312 DOI: 10.1038/s41591-019-0674-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/30/2019] [Indexed: 11/09/2022]
Abstract
Gene silencing with virally delivered shRNA represents a promising approach for treatment of inherited neurodegenerative disorders. In the present study we develop a subpial technique, which we show in adult animals successfully delivers adeno-associated virus (AAV) throughout the cervical, thoracic and lumbar spinal cord, as well as brain motor centers. One-time injection at cervical and lumbar levels just before disease onset in mice expressing a familial amyotrophic lateral sclerosis (ALS)-causing mutant SOD1 produces long-term suppression of motoneuron disease, including near-complete preservation of spinal α-motoneurons and muscle innervation. Treatment after disease onset potently blocks progression of disease and further α-motoneuron degeneration. A single subpial AAV9 injection in adult pigs or non-human primates using a newly designed device produces homogeneous delivery throughout the cervical spinal cord white and gray matter and brain motor centers. Thus, spinal subpial delivery in adult animals is highly effective for AAV-mediated gene delivery throughout the spinal cord and supraspinal motor centers.
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Affiliation(s)
- Mariana Bravo-Hernandez
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Takahiro Tadokoro
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,Department of Anesthesiology, University of the Ryukyus, Okinawa, Japan
| | - Michael R Navarro
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Oleksandr Platoshyn
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Yoshiomi Kobayashi
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Silvia Marsala
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Atsushi Miyanohara
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,Vector Core Laboratory, University of California San Diego, La Jolla, CA, USA
| | - Stefan Juhas
- Institute of Animal Physiology and Genetics, AS CR v.v.i., Liběchov, Czech Republic
| | - Jana Juhasova
- Institute of Animal Physiology and Genetics, AS CR v.v.i., Liběchov, Czech Republic
| | - Helena Skalnikova
- Institute of Animal Physiology and Genetics, AS CR v.v.i., Liběchov, Czech Republic
| | - Zoltan Tomori
- Dept. of Biophysics, Institute of Experimental Physics, Slovak Academy of Sciences, Kosice, Slovakia
| | - Ivo Vanicky
- Institute of Neurobiology, Slovak Academy of Sciences, Kosice, Slovakia
| | - Hana Studenovska
- Department of Biomaterials and Bioanalogous System, Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Vladimir Proks
- Department of Biomaterials and Bioanalogous System, Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - PeiXi Chen
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Noe Govea-Perez
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,Ludwig Institute for Cancer Research and Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dara Ditsworth
- Ludwig Institute for Cancer Research and Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph D Ciacci
- Department of Neurosurgery, University of California San Diego, La Jolla, CA, USA
| | - Shang Gao
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Wenlian Zhu
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Eric T Ahrens
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Shawn P Driscoll
- Gene Expression Laboratory and the Howard Hughes Medical Institute, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Thomas D Glenn
- Gene Expression Laboratory and the Howard Hughes Medical Institute, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Melissa McAlonis-Downes
- Ludwig Institute for Cancer Research and Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sandrine Da Cruz
- Ludwig Institute for Cancer Research and Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Samuel L Pfaff
- Gene Expression Laboratory and the Howard Hughes Medical Institute, Salk Institute for Biological Studies, La Jolla, CA, USA
| | | | - Don W Cleveland
- Ludwig Institute for Cancer Research and Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Martin Marsala
- Neuroregeneration Laboratory, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA. .,Institute of Neurobiology, Slovak Academy of Sciences, Kosice, Slovakia.
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13
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Cairo B, De Maria B, Bari V, Vaini E, Heusser K, Tank J, Jordan J, Barbic F, Furlan R, Marinou K, Dalla Vecchia L, Porta A. Information-domain method for the quantification of the complexity of the sympathetic baroreflex regulation in healthy subjects and amyotrophic lateral sclerosis patients. Physiol Meas 2019; 40:034004. [PMID: 30840931 DOI: 10.1088/1361-6579/ab0d4b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The sympathetic baroreflex (sBR) adjusts muscle sympathetic nerve activity (MSNA) in response to arterial pressure changes but the relevance of assessing sBR control complexity is unclear. OBJECTIVE We propose a method for the evaluation of sBR control complexity. APPROACH The approach comprises the quantification of complexity of the sBR latency regulation and the assessment of complexity of the relationship linking MSNA burst to R-wave peak regardless of the variability of the sBR latency. The Shannon entropy (SE) of the sBR latency distribution is taken as an estimate of complexity of the sBR latency regulation. The conditional entropy (CE) of the beat-to-beat binary series obtained by coding the presence/absence of the MSNA burst after an R-wave peak is taken as an estimate of complexity of the sBR control regardless of the sBR latency variability. Surrogate analysis was utilized to set the level of inactive or impaired sBR. The approach was applied to 10 young healthy subjects undergoing head-up tilt (HUT) followed by lower body negative pressure to evoke presyncope (preSYNC) before and after 21 d head-down bed rest (HDBR), and to five amyotrophic lateral sclerosis (ALS) patients undergoing HUT. MAIN RESULTS In healthy subjects the surrogate analysis suggested that HUT and preSYNC significantly activated the sBR control but its response was weakened after 21 d HDBR. During preSYNC sBR latency increased significantly only after 21 d HDBR. In ALS patients the complexity of the sBR latency regulation was close to the level set by surrogate analysis and HUT did not trigger any sBR control response. SIGNIFICANCE The proposed method for sBR control complexity quantification was useful in detecting the impairment of the sBR control after 21 d HDBR in healthy subjects and the dysfunction of the sBR regulation in ALS patients.
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Affiliation(s)
- Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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14
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Abstract
More than four decades passed since sigma receptors were first mentioned. Since then, existence of at least two receptor subtypes and their tissue distributions have been proposed. Nowadays, it is clear, that sigma receptors are unique ubiquitous proteins with pluripotent function, which can interact with so many different classes of proteins. As the endoplasmic resident proteins, they work as molecular chaperones - accompany various proteins during their folding, ensure trafficking of the maturated proteins between cellular organelles and regulate their functions. In the heart, sigma receptor type 1 is more dominant. Cardiac sigma 1 receptors regulate response to endoplasmic reticulum stress, modulates calcium signaling in cardiomyocyte and can affect function of voltage-gated ion channels. They contributed in pathophysiology of cardiac hypertrophy, heart failure and many other cardiovascular disorders. Therefore, sigma receptors are potential novel targets for specific treatment of cardiovascular diseases.
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Affiliation(s)
- T Stracina
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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15
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Crescimanno G, Greco F, Arrisicato S, Marrone O. Reliability of autonomic activations as surrogates of cortical arousals in ventilated patients affected by amyotrophic lateral sclerosis. Sleep Breath 2018; 23:433-438. [PMID: 30043387 DOI: 10.1007/s11325-018-1699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The study aims to evaluate the performance of autonomic activations as a tool to assess sleep fragmentation and to recognize hypopneas in patients with amyotrophic lateral sclerosis (ALS) under non-invasive mechanical ventilation and secondarily, to evaluate, in patients with the same disease, the relationship between disruption of autonomic nervous system (ANS) activity and the usefulness of the autonomic activations as surrogates of cortical arousals. METHODS Sixteen ALS patients underwent simultaneous polysomnography and portable cardiorespiratory monitoring (PM). On the polysomnography, standard rules were used for scoring arousals and respiratory events. On the PM, autonomic arousals were scored as ≥ 15% heart rate (HR) increase with a ≥ 35% pulse wave amplitude (PWA) reduction, HR increase ≥ 20%, or PWA decrease ≥ 40%. Nocturnal HR variability was analyzed in the ALS patients and in 11 control subjects as an index of ANS activity. RESULTS Synchronized epoch by epoch analysis of the polysomnography and PM recordings showed that only 31.0 (22.5-58.7)% cortical and 36.1 (20.5-47.2)% autonomic arousals were associated with one another. Among hypopneas scored at polysomnography, 71.7% were associated with a cortical arousal but not with a desaturation. On average, HR variability in ALS showed signs of depressed ANS activity that was particularly evident in the patients where the cortical arousals exceeded the autonomic ones. CONCLUSIONS In ventilated ALS patients, autonomic activations may hardly have a role as surrogates of cortical arousals for assessment of sleep fragmentation and for respiratory scoring. Depression of ANS activity may be related to their poor performance.
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Affiliation(s)
- Grazia Crescimanno
- Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Via Ugo La Malfa, 153 90146, Palermo, Italy.
- Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
| | - Francesca Greco
- Italian Union Against Muscular Dystrophy (UILDM), Section of Palermo, Palermo, Italy
| | - Salvatore Arrisicato
- Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Via Ugo La Malfa, 153 90146, Palermo, Italy
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16
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Ren Y, Liu W, Li Y, Sun B, Li Y, Yang F, Wang H, Li M, Cui F, Huang X. Cutaneous somatic and autonomic nerve TDP-43 deposition in amyotrophic lateral sclerosis. J Neurol 2018; 265:1753-1763. [PMID: 29804146 DOI: 10.1007/s00415-018-8897-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the involvement of the sensory and autonomic nervous system in amyotrophic lateral sclerosis (ALS) and to determine whether TDP-43/pTDP-43 deposits in skin nerve fibers signify a valuable biomarker for ALS. METHODS Eighteen patients with ALS and 18 age- and sex-matched control subjects underwent physical examinations, in addition to donating skin biopsies from the distal leg. The density of epidermal, Meissner's corpuscle (MC), sudomotor, and pilomotor nerve fibers were measured. Confocal microscopy was used to determine the cutaneous somatic and autonomic nerve fiber density and TDP-43/pTDP-43 deposition. RESULTS Intraepidermal nerve fiber density (IENFD) was reduced in individuals with ALS (P < 0.001). MC density (MCD) (P = 0.001), sweat gland nerve fiber density (SGNFD) (P < 0.001), and pilomotor nerve fiber density (PNFD) (P < 0.001) were all reduced in ALS patients. The SGNFD correlated with the small-fiber neuropathy Symptoms Inventory Questionnaire (SFN-SIQ), VAS and age. The SFN-SIQ was higher in ALS with sensory symptoms than without sensory symptoms (P = 0.000). Furthermore, the SFN-SIQ was higher in ALS with autonomic symptoms than without autonomic symptoms (P = 0.002). SFN-SIQ was higher in ALS patients that were pTDP-43 positive than pTDP-43 negative (P = 0.04), respectively. CONCLUSIONS We established in the peripheral nervous system that higher SFN-SIQ and VAS was involved in ALS, indicating the loss of SGNF. The deposition of TDP-43/pTDP-43 in ALS nerve fibers may indicate an important role in the underlying pathogenesis of ALS. This observation might be used as a potential biomarker for diagnosing ALS.
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Affiliation(s)
- Yuting Ren
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenxiu Liu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yifan Li
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Sun
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yanran Li
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fei Yang
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hongfen Wang
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mao Li
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fang Cui
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xusheng Huang
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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17
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Dharmadasa T, Matamala JM, Huynh W, Zoing MC, Kiernan MC. Motor neurone disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:345-357. [PMID: 30482326 DOI: 10.1016/b978-0-444-63916-5.00022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Motor neurone disease (MND) patients exhibit poor gait, balance, and postural control, all of which significantly increases their risk of falling. Falls are frequent in the MND population, and are associated with an increased burden of disease. The complex interplay of both motor and extramotor manifestations in this disease contributes to the heterogeneous and multifactorial causes of such dysfunction. This review highlights the pathophysiologic influence of motor degeneration in gait disturbance, but also the additional influence on postural instability from other inputs such as cognitive impairment, autonomic dysregulation, cerebellar dysfunction, sensory impairment, and extrapyramidal involvement. In various combinations, these impairments are responsible for reduced gait speed and alteration in gait cycle, as well as structurally more variable and disorganized gait patterns. Based on these features, this chapter will also provide disease-specific interventions to assess, manage, and prevent falls in the MND cohort.
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Affiliation(s)
| | | | - William Huynh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Margaret C Zoing
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
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18
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GRAHAM BRITNEYE, DARABOS CHRISTIAN, HUANG MINJUN, MUGLIA LOUISJ, MOORE JASONH, WILLIAMS SCOTTM. Evolutionarily derived networks to inform disease pathways. Genet Epidemiol 2017; 41:866-875. [PMID: 28944497 PMCID: PMC5696086 DOI: 10.1002/gepi.22078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/24/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
Abstract
Methods to identify genes or pathways associated with complex diseases are often inadequate to elucidate most risk because they make implicit and oversimplified assumptions about underlying models of disease etiology. These can lead to incomplete or inadequate conclusions. To address this, we previously developed human phenotype networks (HPN), linking phenotypes based on shared biology. However, such visualization alone is often uninterpretable, and requires additional filtering. Here, we expand the HPN to include another method, evolutionary triangulation (ET). ET utilizes the hypothesis that alleles affecting disease risk in multiple populations are distributed consistently with differences in disease prevalence and compares allele frequencies among populations and their relationship to phenotype prevalence. We hypothesized that combining these methods will increase our ability to detect genetic patterns of association in complex diseases. We combined HPN and ET to identify network patterns associated with type 2 diabetes mellitus (T2DM), a leading cause of death worldwide. Fasting glucose, a continuous trait, was used as a proxy for T2DM and differs significantly among continental populations. The combined method identified several diabetes-related traits and several phenotypes related to cardiovascular diseases, for which diabetes is a major risk factor. ET-HPN found more phenotypes related to our target and related phenotypes than the application of either method alone. Not only could we detect phenotype connections related to T2DM, but we also identified phenotypes that are distributed in parallel to it, e.g., amyotrophic lateral sclerosis. Our analyses showed that ET-filtered HPN provides information that neither technique can individually.
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Affiliation(s)
- BRITNEY E. GRAHAM
- Department of Genetics, The Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, U.S.A
- Case Western Reserve University, Systems Biology and Bioinformatics, Cleveland, OH 44106, U.S.A
| | - CHRISTIAN DARABOS
- Department of Genetics, The Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, U.S.A
- Institute for Biomedical Informatics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, U.S.A
- Dartmouth College, Research Computing Services, Hanover, NH 03755, U.S.A
| | - MINJUN HUANG
- Department of Genetics, The Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, U.S.A
| | - LOUIS J. MUGLIA
- Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center and March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, OH 45229, U.S.A
| | - JASON H. MOORE
- Institute for Biomedical Informatics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, U.S.A
| | - SCOTT M. WILLIAMS
- Department of Genetics, The Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, U.S.A
- Case Western Reserve University, Department of Population and Quantitative Health Science, Cleveland, OH 44106, U.S.A
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19
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Rosenbohm A, Schmid B, Buckert D, Rottbauer W, Kassubek J, Ludolph AC, Bernhardt P. Cardiac Findings in Amyotrophic Lateral Sclerosis: A Magnetic Resonance Imaging Study. Front Neurol 2017; 8:479. [PMID: 29021775 PMCID: PMC5623666 DOI: 10.3389/fneur.2017.00479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/29/2017] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to investigate the potential involvement of cardiac structure and function by cardiac magnetic resonance (CMR) imaging in amyotrophic lateral sclerosis (ALS) patients. Our study included 35 patients with ALS without a history of cardiac disease and an age- and gender-matched healthy control group (n = 34). All subjects received a CMR in a 1.5-T whole-body scanner. Patients were also screened with Holter monitoring, echocardiography, and a blood test of cardiac markers. Myocardial mass in ALS hearts was reduced compared to the control group, and ejection volumes in the left and right heart were severely decreased in ALS patients, as shown by echocardiography and CMR. The myocardium showed increased T1 enhancement in 77% of the patients compared to 27% of controls (p = 0.0001). A trend toward late gadolinium enhancement patterns consistent with myocardial fibrosis was observed in 23.5% of the patients (9.1% of controls). Holter monitoring was normal in all patients as well as troponin T. Cardiac involvement seems to be present in ALS patients without clinical cardiac symptoms and with a normal cardiac routine assessment. Structural myocardial defects in CMR may be due to sympathetic dysfunction and may account for reported cardiac deaths in late-stage ALS patients.
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Affiliation(s)
| | - Benjamin Schmid
- Department of Neurology, University of Ulm, Ulm, Germany.,Department of Internal Medicine, Kreiskrankenhaus Ehingen, Ehingen, Germany
| | - Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Vucic S. Sensory and autonomic nervous system dysfunction in amyotrophic lateral sclerosis. Neuropathol Appl Neurobiol 2017; 43:99-101. [PMID: 27333192 DOI: 10.1111/nan.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S Vucic
- Western Clinical School, University of Sydney, Sydney, Australia
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Porta A, De Maria B, Bari V, Marchi A, Marinou K, Sideri R, Mora G, Dalla Vecchia L. Comparison between K-nearest-neighbor approaches for conditional entropy estimation: Application to the assessment of the cardiac control in amyotrophic lateral sclerosis patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2933-2936. [PMID: 28268928 DOI: 10.1109/embc.2016.7591344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The study evaluates the k-nearest-neighbor (KNN) strategy for the assessment of complexity of the cardiac neural control from spontaneous fluctuations of heart period (HP). Two different procedures were assessed: i) the KNN estimation of the conditional entropy (CE) proposed by Porta et al; ii) the KNN estimation of mutual information proposed by Kozachenko-Leonenko, refined by Kraskov-Stögbauer-Grassberger and here adapted for the CE estimation. The two procedures were compared over HP variability recordings obtained at rest in supine position and during head-up tilt (HUT) in amyotrophic lateral sclerosis patients and healthy subjects. We found that the indexes derived from the two procedures were significantly correlated and both methods were able to detect the effect of HUT on HP complexity within the same group and distinguish the two populations within the same experimental condition. We recommend the use of the KNN strategy to quantify the dynamical complexity of cardiac neural control in addition to more traditional approaches.
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McCombe PA, Wray NR, Henderson RD. Extra-motor abnormalities in amyotrophic lateral sclerosis: another layer of heterogeneity. Expert Rev Neurother 2017; 17:561-577. [PMID: 27983884 DOI: 10.1080/14737175.2017.1273772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease defined by the presence of muscle weakness. The motor features of disease are heterogeneous in site of onset and progression. There are also extra-motor features in some patients. The genetic basis for extra-motor features is uncertain. The heterogeneity of ALS is an issue for clinical trials. Areas covered: This paper reviews the range and prevalence of extra-motor features associated with ALS, and highlights the current information about genetic associations with extra-motor features. Expert commentary: There are extra-motor features of ALS, but these are not found in all patients. The most common is cognitive abnormality. More data is required to ascertain whether extra-motor features arise with progression of disease. Extra-motor features are reported in patients with a range of causative genetic mutations, but are not found in all patients with these mutations. Further studies are required of the heterogeneity of ALS, and genotype/phenotype correlations are required, taking note of extra-motor features.
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Affiliation(s)
- P A McCombe
- a The University of Queensland Centre for Clinical Research and Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - N R Wray
- b The University of Queensland Institute for Molecular Bioscience , Brisbane , Australia
| | - R D Henderson
- a The University of Queensland Centre for Clinical Research and Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia
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Nolano M, Provitera V, Manganelli F, Iodice R, Caporaso G, Stancanelli A, Marinou K, Lanzillo B, Santoro L, Mora G. Non-motor involvement in amyotrophic lateral sclerosis: new insight from nerve and vessel analysis in skin biopsy. Neuropathol Appl Neurobiol 2016; 43:119-132. [DOI: 10.1111/nan.12332] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/03/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
Affiliation(s)
- M. Nolano
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Telese Terme; Telese Terme (BN) Italy
| | - V. Provitera
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Telese Terme; Telese Terme (BN) Italy
| | - F. Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - R. Iodice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - G. Caporaso
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Telese Terme; Telese Terme (BN) Italy
| | - A. Stancanelli
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Telese Terme; Telese Terme (BN) Italy
| | - K. Marinou
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Milan; Milan Italy
| | - B. Lanzillo
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Telese Terme; Telese Terme (BN) Italy
| | - L. Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - G. Mora
- Neurology Department ‘Salvatore Maugeri’ Foundation; IRCCS, Institute of Milan; Milan Italy
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De Maria B, Bari V, Marchi A, Barbic F, Furlan R, Mora G, Dalla Vecchia L, Porta A. Cardiovascular control indexes in amyotrophic lateral sclerosis patients and their relation with clinical markers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:2055-8. [PMID: 26736691 DOI: 10.1109/embc.2015.7318791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the autonomic response to an orthostatic challenge (i.e. head-up tilt) in 52 amyotrophic lateral sclerosis (ALS) patients and 16 healthy subjects by means of power spectral analysis of heart period (HP) and systolic arterial pressure (SAP) variability. In addition, we verified the correlation of spectral indexes with clinical features of the ALS patients. Results showed that cardiovascular control of the ALS patients was impaired and this impairment was more evident from SAP series. While the revised Functional Rating Scale score, its bulbar subscore, and disease duration were uncorrelated with spectral indexes, the rate of the disease progression was positively correlated with the absolute low frequency power of SAP variability at rest and negatively correlated with the normalized high frequency power of HP variability during head-up tilt. We conclude that: i) spectral analysis of HP and SAP variability provides indexes helpful to quantify the impairment of the cardiovascular neural control in ALS patients; ii) patients with a faster disease progression are characterized by a higher vascular sympathetic drive and/or a depressed vagal cardiac regulation.
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Porta A, Nollo G, Faes L. Bridging the gap between the development of advanced biomedical signal processing tools and clinical practice. Preface. Physiol Meas 2015; 36:627-31. [PMID: 25798722 DOI: 10.1088/0967-3334/36/4/627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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