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Fu J, Lai X, Wei Q, Chen X, Shang H. Associations of cerebrospinal fluid profiles with severity and mortality risk of amyotrophic lateral sclerosis. Front Neurosci 2024; 18:1375892. [PMID: 38812975 PMCID: PMC11133581 DOI: 10.3389/fnins.2024.1375892] [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: 01/24/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Background The relationship between routine cerebrospinal fluid (CSF) testing and the disease phenotype of amyotrophic lateral sclerosis (ALS) is unclear, and there are some contradictions in current studies. Methods This study aimed to analyze the relationship between CSF profiles and disease phenotype in ALS patients. We collected 870 ALS patients and 96 control subjects admitted to West China Hospital of Sichuan University. CSF microprotein, albumin, IgG, index of IgG (IgGindex), albumin quotient (QALB), and serum IgG were examined. Results In ALS patients, CSF IgG, and QALB were significantly increased, while CSF IgGindex was decreased, compared with control subjects. Approximately one-third of ALS patients had higher CSF IgG levels. The multiple linear regression analysis identified that CSF IgGindex was weakly negatively associated with ALS functional rating scale revised (ALSFRS-R) scores (β = -0.062, p = 0.041). This significance was found in male ALS but not in female ALS. The Cox survival analyses found that upregulated CSF IgG was significantly associated with the increased mortality risk in ALS [HR = 1.219 (1.010-1.470), p = 0.039]. Conclusion In the current study, the higher CFS IgG was associated with increased mortality risk of ALS. CSF IgGindex may be associated with the severity of ALS. These findings may be sex-specific.
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Affiliation(s)
- Jiajia Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Lai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, China
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Wu YS, Taniar D, Adhinugraha K, Tsai LK, Pai TW. Detection of Amyotrophic Lateral Sclerosis (ALS) Comorbidity Trajectories Based on Principal Tree Model Analytics. Biomedicines 2023; 11:2629. [PMID: 37893003 PMCID: PMC10604752 DOI: 10.3390/biomedicines11102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
The multifaceted nature and swift progression of Amyotrophic Lateral Sclerosis (ALS) pose considerable challenges to our understanding of its evolution and interplay with comorbid conditions. This study seeks to elucidate the temporal dynamics of ALS progression and its interaction with associated diseases. We employed a principal tree-based model to decipher patterns within clinical data derived from a population-based database in Taiwan. The disease progression was portrayed as branched trajectories, each path representing a series of distinct stages. Each stage embodied the cumulative occurrence of co-existing diseases, depicted as nodes on the tree, with edges symbolizing potential transitions between these linked nodes. Our model identified eight distinct ALS patient trajectories, unveiling unique patterns of disease associations at various stages of progression. These patterns may suggest underlying disease mechanisms or risk factors. This research re-conceptualizes ALS progression as a migration through diverse stages, instead of the perspective of a sequence of isolated events. This new approach illuminates patterns of disease association across different progression phases. The insights obtained from this study hold the potential to inform doctors regarding the development of personalized treatment strategies, ultimately enhancing patient prognosis and quality of life.
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Affiliation(s)
- Yang-Sheng Wu
- Department of Computer Science and Information Engineering, National Taipei University of Technology, Taipei 106, Taiwan;
| | - David Taniar
- Department of Software Systems & Cybersecurity, Monash University, Melbourne, VIC 3800, Australia;
| | - Kiki Adhinugraha
- Department of Computer Science and Information Technology, La Trobe University, Melbourne, VIC 3086, Australia;
| | - Li-Kai Tsai
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Tun-Wen Pai
- Department of Computer Science and Information Engineering, National Taipei University of Technology, Taipei 106, Taiwan;
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Alves I, Gromicho M, Oliveira Santos M, Pinto S, Pronto-Laborinho A, Swash M, de Carvalho M. Demographic changes in a large motor neuron disease cohort in Portugal: a 27 year experience. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-11. [PMID: 37295966 DOI: 10.1080/21678421.2023.2220747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
Objective: Motor Neuron Diseases (MND) have a large clinical spectrum, being the most common amyotrophic lateral sclerosis (ALS) but there is significant clinical heterogeneity. Our goal was to investigate this heterogeneity and any potential changes during a long period. Methods: We performed a retrospective cohort study among a large Portuguese cohort of MND patients (n = 1550) and investigated changing patterns in clinical and demographic characteristics over the 27-year period of our database. With that aim, patients were divided into three 9-year groups according to the date of their first visit to our unit: P1, 1994-2002; P2, 2003-2011; P3, 2012-2020. Results: The overall cohort's clinical and demographic characteristics are consistent with clinical experience, but our findings point to gradual changes over time. Time pattern analysis revealed statistically significant differences in the distribution of clinical phenotypes, the average age of onset, diagnostic delay, the proportin of patients using respiratory support with noninvasive ventilation (NIV), time to NIV, and survival. Across time, in the overall cohort, we found an increasing age at onset (p = 0.029), a decrease of two months in diagnostic delay (p < 0.001) and a higher relative frequency of progressive muscular atrophy patients. For ALS patients with spinal onset, from P1 to P2, there was a more widespread (54.8% vs 69.4%, p = 0.005) and earlier (36.9 vs 27.2 months, p = 0.05) use of NIV and a noteworthy 13-month increase in median survival (p = 0.041). Conclusions: Our results probably reflect better comprehensive care, and they are relevant for future studies exploring the impact of new treatments on ALS patients.
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Affiliation(s)
- Inês Alves
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Gromicho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Oliveira Santos
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
| | - Susana Pinto
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Pronto-Laborinho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Michael Swash
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
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Yaguchi H, Sakuta K, Mukai T, Miyagawa S. Fiberoptic laryngoscopic neurological examination of amyotrophic lateral sclerosis patients with bulbar symptoms. J Neurol Sci 2022; 440:120325. [DOI: 10.1016/j.jns.2022.120325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
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Wang F, Liu X, He J, Zhang N, Chen L, Tang L, Fan D. Analysis of ERBB4 Variants in Amyotrophic Lateral Sclerosis Within a Chinese Cohort. Front Neurol 2022; 13:865264. [PMID: 35481267 PMCID: PMC9035935 DOI: 10.3389/fneur.2022.865264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
ERBB4 is related to amyotrophic lateral sclerosis (ALS) in patients with a family history and is thought to cause ALS-19. We screened 448 ALS patients, including 364 sporadic ALS (sALS) and 84 familial ALS (fALS) patients with ERBB4 variants, in a Chinese cohort. In total, 12 missense variants were identified in this study. Of these, 3 (p.Arg106His, p.Gln164Pro, and p.Val212Leu) were absent from the in-house healthy control cohort and population databases and predicted to be likely pathogenic. Genetic burden analysis did not reveal an increase in damaging variants of the ERBB4 gene. We considered that most of the missense variants in ERBB4 were not pathogenic, but certain variants, such as p.Arg106His, p.Gln164Pro, and p.Val212Leu, were likely pathogenic. The phenotype of these three patients carrying ERBB4 variants revealed the typical clinical manifestations of ALS without cognitive dysfunction. We concluded that ERBB4 likely pathogenic variants account for ~0.67% of ALS patients in China. It is necessary to interpret the relationship between the disease and variants carefully for ALS patients with ERBB4 gene variants.
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Affiliation(s)
- Fan Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Ji He
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Nan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, 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
- *Correspondence: Dongsheng Fan
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Xu K, Ji H, Hu N. Cardiovascular comorbidities in amyotrophic lateral sclerosis: A systematic review. J Clin Neurosci 2021; 96:43-49. [PMID: 34974247 DOI: 10.1016/j.jocn.2021.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/10/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To summarize the prevalence of the cardiovascular comorbidities in patients with amyotrophic lateral sclerosis (ALS) and explore the impacts of cardiovascular diseases on ALS. METHODS PubMed, EMBASE, OVID and Web of Science were searched systematically until July 2021 for studies on the prevalence of cardiovascular diseases among ALS patients or quantitatively investigating the effects of cardiovascular comorbidities on incidence, progression or survival of ALS. We conducted a fixed-effects or random-effects meta-analysis to calculate the summary rate or ORs (odds ratios) with 95 %CIs (confidence intervals). RESULTS The comorbidity of hypertension in France (56.9%) was the highest, followed by Portugal (48%). Only 15% of Chinese ALS patients suffered from hypertension. A quarter of ALS patients in America had coronary heart disease while only 4-5% of patients with ALS in Australia or the Netherlands suffered from coronary heart disease. There was significant relationship between hypertension and survival of ALS (OR: 1.04, 95%CI: 1.01, 1.07). Coronary heart disease was considerably related to ALS onset (OR: 1.19, 95%CI: 1.14, 1.24) and heart failure could noticeably accelerate the progression rate of ALS (OR: 6.33, 95%CI: 1.55, 24.84). CONCLUSIONS Cardiovascular comorbidities in ALS patients varied significantly with different regions. Hypertension could reduce the survival of ALS so the intensive treatment of chronic hypertension should be recommended to ALS patients in clinical practice. Coronary heart disease could increase the risk of ALS and heart failure was a negative prognostic factor for ALS, which deserved more attention of clinicians.
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Affiliation(s)
- Ke Xu
- Department of Cardiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Hongyan Ji
- Department of Hematopathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China.
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Chen LX, Xu HF, Wang PS, Yang XX, Wu ZY, Li HF. SOD1 Mutation Spectrum and Natural History of ALS Patients in a 15-Year Cohort in Southeastern China. Front Genet 2021; 12:746060. [PMID: 34721532 PMCID: PMC8551486 DOI: 10.3389/fgene.2021.746060] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Mutations in superoxide dismutase 1 gene (SOD1) are the most frequent high penetrant genetic cause for amyotrophic lateral sclerosis (ALS) in the Chinese population. A detailed natural history of SOD1-mutated ALS patients will provide key information for ongoing genetic clinical trials. Methods: We screened for SOD1 mutations using whole exome sequencing (WES) in Chinese ALS cases from 2017 to 2021. Functional studies were then performed to confirm the pathogenicity of novel variants. In addition, we enrolled previously reported SOD1 mutations in our centers from 2007 to 2017. The SOD1 mutation spectrum, age at onset (AAO), diagnostic delay, and survival duration were analyzed. Results: We found two novel SOD1 variants (p.G17H and p.E134*) that exerted both gain-of-function and loss-of-function effects in vitro. Combined with our previous SOD1-mutated patients, 32 probands with 21 SOD1 mutations were included with the four most frequently occurring mutations of p.V48A, p.H47R, p.C112Y, and p.G148D. SOD1 mutations account for 58.9% of familial ALS (FALS) cases. The mean (SD) AAO was 46 ± 11.4 years with a significant difference between patients carrying mutations in exon 1 [n = 5, 34.6 (12.4) years] and exon 2 [n = 8, 51.4 (8.2) years] (p = 0.038). The mean of the diagnostic delay of FALS patients is significantly earlier than the sporadic ALS (SALS) patients [9.5 (4.8) vs. 20.3 (9.3) years, p = 0.0026]. In addition, male patients survived longer than female patients (40 vs. 16 months, p = 0.05). Conclusion: Our results expanded the spectrum of SOD1 mutations, highlighted the mutation distribution, and summarized the natural history of SOD1-mutated patients in southeastern China. Male patients were found to have better survival, and FALS patients received an earlier diagnosis. Our findings assist in providing a detailed clinical picture, which is important for ongoing genetic clinical trials.
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Affiliation(s)
- Lu-Xi Chen
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hai-Feng Xu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Pei-Shan Wang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Xia Yang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Fu Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
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