1
|
Yedke NG, Kumar P. The Neuroprotective Role of BCG Vaccine in Movement Disorders: A Review. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:30-38. [PMID: 36567299 DOI: 10.2174/1871527322666221223142813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 12/27/2022]
Abstract
Bacillus Calmette-Guérin (BCG) is the first developed vaccine to prevent tuberculosis (TB) and is the world's most widely used vaccine. It has a reconcilable defense in opposition to tuberculosis, meningitis, and miliary disease in children but changeable protection against pulmonary TB. Immune activation is responsible for regulating neural development by activating it. The effect of the BCG vaccine on neuronal disorders due to subordinate immune provocation is useful. BCG vaccine can prevent neuronal degeneration in different neurological disorders by provoking auto-reactive T-cells. In the case of TB, CD4+ T-cells effectively protect the immune response by protecting the central defense. Because of the preceding fact, BCG induces protection by creating precise T-cells like CD4+ T-cells and CD8+ T-cells. Hence, vaccination-induced protection generates specific T-cells and CD4+ T-cells, and CD8+ T-cells. The BCG vaccine may have an essential effect on motor disorders and play a crucial role in neuroprotective management. The present review describes how the BCG vaccine might be interrelated with motor disorders and play a key role in such diseases.
Collapse
Affiliation(s)
- Narhari Gangaram Yedke
- Department of Pharmaceutical Sciences and Technology Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, India
| | - Puneet Kumar
- Department of Pharmacology Central University of Punjab, Bathinda, Punjab, India
| |
Collapse
|
2
|
Yedke NG, Arthur R, Kumar P. Bacillus calmette gaurine vaccine ameliorates the neurotoxicity of quinolinic acid in rats via the modulation of antioxidant, inflammatory and apoptotic markers. J Chem Neuroanat 2023; 131:102287. [PMID: 37172828 DOI: 10.1016/j.jchemneu.2023.102287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
A mutation in the Huntingtin gene causes 'Huntington's disease, which presents as a motor and behavioral impairment. Due to the limited drug therapy for this disease, scientists are constantly searching for newer and alternative drugs that may either retard or prevent the progress of the disease. This study aims to explore the neuroprotective potential of Bacillus Calmette Gaurine (BCG) vaccine against quinolinic acid-induced (QA) neurotoxicity in rats. QA (200 nmol/2 µl, i.s) was injected bilaterally into the rat striatum, after which a single dose of BCG (2 × 10^7, cfu) was given to the rats. Animals were assessed for behavioral parameters on the 14th and 21st days. On the 22nd day, animals were sacrificed, brains were harvested, and striatum was separated to evaluate biochemical, inflammatory, and apoptotic mediators. Histopathological studies were performed using Hematoxyline and Eosin staining to assess neuronal morphology. BCG treatment reversed motor abnormalities, reduced oxidative stress and neuroinflammatory markers, apoptotic mediators and striatal lesions induced by QA treatment. In conclusion, treat' 'ing rats with BCG vaccine (2 × 10^7, cfu) mitigated the quinolinic acid-induced Huntington's disease-like symptoms. Hence, BCG vaccine (2 ×10^7, cfu) could be used as an adjuvant in managing HD.
Collapse
Affiliation(s)
- Narhari Gangaram Yedke
- Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda 151001, Punjab, India; Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Richmond Arthur
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Puneet Kumar
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India.
| |
Collapse
|
3
|
Jiang A, Handley RR, Lehnert K, Snell RG. From Pathogenesis to Therapeutics: A Review of 150 Years of Huntington's Disease Research. Int J Mol Sci 2023; 24:13021. [PMID: 37629202 PMCID: PMC10455900 DOI: 10.3390/ijms241613021] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Huntington's disease (HD) is a debilitating neurodegenerative genetic disorder caused by an expanded polyglutamine-coding (CAG) trinucleotide repeat in the huntingtin (HTT) gene. HD behaves as a highly penetrant dominant disorder likely acting through a toxic gain of function by the mutant huntingtin protein. Widespread cellular degeneration of the medium spiny neurons of the caudate nucleus and putamen are responsible for the onset of symptomology that encompasses motor, cognitive, and behavioural abnormalities. Over the past 150 years of HD research since George Huntington published his description, a plethora of pathogenic mechanisms have been proposed with key themes including excitotoxicity, dopaminergic imbalance, mitochondrial dysfunction, metabolic defects, disruption of proteostasis, transcriptional dysregulation, and neuroinflammation. Despite the identification and characterisation of the causative gene and mutation and significant advances in our understanding of the cellular pathology in recent years, a disease-modifying intervention has not yet been clinically approved. This review includes an overview of Huntington's disease, from its genetic aetiology to clinical presentation and its pathogenic manifestation. An updated view of molecular mechanisms and the latest therapeutic developments will also be discussed.
Collapse
Affiliation(s)
- Andrew Jiang
- Applied Translational Genetics Group, Centre for Brain Research, School of Biological Sciences, The University of Auckland, Auckland 1010, New Zealand; (R.R.H.); (K.L.); (R.G.S.)
| | | | | | | |
Collapse
|
4
|
Barer Y, Ribalov R, Yaari A, Maor R, Arow Q, Logan J, Chodick G, Gurevich T. Healthcare utilization, costs, and epidemiology of Huntington's disease in Israel. Clin Park Relat Disord 2023; 9:100208. [PMID: 37497383 PMCID: PMC10366633 DOI: 10.1016/j.prdoa.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Data on Huntington's disease (HD) epidemiology, treatment patterns, and economic burden in Israel are scarce. Methods Annual prevalence and incidence of HD (ICD-9-CM 333.4) were assessed in the Israel-based Maccabi Healthcare Services (MHS) database 2016-2018. Adherence (medication possession rate [MPR], proportion of disease covered) were assessed for adult people with HD (PwHD) 2013-2018. Healthcare resources utilization (HCRU) and costs related to inpatient and outpatient visits and all medications in 2018 were assessed for PwHD, who were randomly matched to MHS members without HD (1:3) by birth-year and sex. Results Overall, 164 patients had at least one HD diagnosis. Annual prevalence and incidence were 4.45 and 0.24/100,000, respectively. A total of 67.0% of adult patients (n = 106) were taking tetrabenazine (median MPR and proportion of disease covered, 74.3% and 30.2%, respectively), 65.1% benzodiazepines (75.8% and 32.3%), and 11.3% amantadine (79.2% and 6.0%). Over a 1-year follow-up, PwHD (n = 81) had significantly more neurologist, psychiatrist, physiotherapist, and speech therapist visits (P < 0.05 for each) and more hospitalization days (P < 0.0001) compared with matched controls (n = 243). Total healthcare and medication costs per patient (US dollars) were significantly higher for PwHD than controls ($7,343 vs. $3,625; P < 0.001). Discussion/Conclusion PwHD have greater annual HCRU and medical costs than MHS members without HD in Israel. Among those who have taken medications, adherence was lower than 80% (both MPR and proportion of disease covered), which may translate into suboptimal symptom relief and quality of life.
Collapse
Affiliation(s)
- Yael Barer
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 27 Ha'Mered St., Tel Aviv 6812509, Israel
| | - Rinat Ribalov
- Teva Pharmaceutical Industries Ltd., Global Health Economics and Outcomes Research, P.O. 3190, 124 Deborah HaNaviya, Tel Aviv 6944020, Israel
| | - Ayelet Yaari
- Teva Pharmaceutical Industries Ltd., International Markets Medical Affairs, 124 Deborah HaNavi’a St., Tel Aviv 6944020, Israel
| | - Ron Maor
- Teva Pharmaceutical Industries Ltd., International Markets Medical Affairs, 124 Deborah HaNavi’a St., Tel Aviv 6944020, Israel
| | - Qais Arow
- Teva Pharmaceutical Industries Ltd., International Markets Medical Affairs, 124 Deborah HaNavi’a St., Tel Aviv 6944020, Israel
| | - John Logan
- Teva Branded Pharmaceutical Products R&D, Inc., SCD Statistics, 145 Brandywine Pkwy, West Chester, PA 19380, USA
| | - Gabriel Chodick
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 27 Ha'Mered St., Tel Aviv 6812509, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Sagol School of Neuroscience, Tel Aviv University, P.O. Box 39040, Ramat Aviv, Tel Aviv 69978, Israel
| |
Collapse
|
5
|
Pierron L, Tezenas du Montcel S, Heinzmann A, Coarelli G, Héron D, Heide S, Herson A, Hennessy J, Petit E, Gargiulo M, Durr A. Reproductive choices and intrafamilial communication in neurogenetic diseases with different self-estimated severities. J Med Genet 2023; 60:346-351. [PMID: 36270767 DOI: 10.1136/jmg-2022-108477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low uptake of presymptomatic testing and medically assisted reproduction in families impacted by neurogenetic diseases prompted us to investigate how reproductive options are considered and whether there is a relationship with perceived severity of the disease. We hypothesised that self-estimated severity would influence opinion on reproductive options and that prenatal/preimplantation diagnosis would be a motivation to inform relatives about their risk. METHODS We invited people impacted by neurogenetic diseases to evaluate the severity of their familial disease using analogic visual scales and to answer questionnaires about reproductive choices and intrafamilial communication. We compared answers between diseases and with the perceived severity of each disease. RESULTS We analysed 562 questionnaires. Participants were impacted by Huntington disease (n=307), spinocerebellar ataxias (n=114), Steinert myotonic dystrophy (n=82) and amyotrophic lateral sclerosis/frontotemporal dementia (n=59). Self-estimated severity differed between pathologies (p<0.0001). Overall, participants considered prenatal diagnosis (78.0±34.4 out of 100) and preimplantation diagnosis (75.2±36.1 out of 100) justified more than termination of pregnancy (68.6±38.5 out of 100). They were less in favour of gamete donation (48.3±39.8 out of 100) or pregnancy abstention (43.3±40.3 out of 100). The greater the perceived severity of the disease, the more reproductive options were considered justified, except for gamete donation. Prenatal/preimplantation diagnosis was a motivation to inform relatives for only 55.3% of participants (p=0.01). CONCLUSION Self-estimated severity minimally impacts opinions towards reproductive options. Medically assisted reproduction procedures are rarely sought and do not motivate familial communication.
Collapse
Affiliation(s)
- Lucie Pierron
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Sophie Tezenas du Montcel
- Institut Pierre Louis de Santé Publique, Medical Information Unit, Sorbonne Université, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Anna Heinzmann
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Giulia Coarelli
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Delphine Héron
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Solveig Heide
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Ariane Herson
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Juliette Hennessy
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Elodie Petit
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Marcela Gargiulo
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Université Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Alexandra Durr
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| |
Collapse
|
6
|
Medina A, Mahjoub Y, Shaver L, Pringsheim T. Prevalence and Incidence of Huntington's Disease: An Updated Systematic Review and Meta-Analysis. Mov Disord 2022; 37:2327-2335. [PMID: 36161673 PMCID: PMC10086981 DOI: 10.1002/mds.29228] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/03/2022] [Accepted: 08/29/2022] [Indexed: 01/13/2023] Open
Abstract
The incidence and prevalence of Huntington's disease (HD) based on a systematic review and meta-analysis of 20 studies published from 1985 to 2010 was estimated at 0.38 per 100,000 person-years (95% confidence interval [CI], 0.16-0.94) and 2.71 per 100,000 persons (95% CI, 1.55-4.72), respectively. Since 2010, there have been many new epidemiological studies of HD. We sought to update the global estimates of HD incidence and prevalence using data published up to February 2022 and perform additional analyses based on study continent. Medline and Embase were searched for epidemiological studies of HD published between 2010 and 2022. Risk of bias was assessed using a quality assessment tool. Estimated pooled prevalence or incidence was calculated using a random-effects meta-analysis. A total of 33 studies published between 2010 and 2022 were included. Pooled incidence was 0.48 cases per 100,000 person-years (95% CI, 0.33-0.63). Subgroup analysis by continent demonstrated a significantly higher incidence of HD in Europe and North America than in Asia. Pooled prevalence was 4.88 per 100,000 (95% CI, 3.38-7.06). Subanalyses by continent demonstrated that the prevalence of HD was significantly higher in Europe and North America than in Africa. The minor increase in prevalence (more so than incidence) demonstrated in this updated review could relate to the enhanced availability of molecular testing, earlier diagnosis, increased life expectancy, and de novo mutations. Limitations include variable case ascertainment methods and lacking case validation data. © 2022 Her Majesty the Queen in Right of Canada. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. Reproduced with the permission of the Minister of Public Health Agency of Canada.
Collapse
Affiliation(s)
- Alex Medina
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Yasamin Mahjoub
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Larry Shaver
- Adult Chronic Diseases and Conditions DivisionPublic Health Agency of CanadaNepeanOntarioCanada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Psychiatry, Pediatrics, Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| |
Collapse
|
7
|
Crowell V, Houghton R, Tomar A, Fernandes T, Squitieri F. Modeling Manifest Huntington's Disease Prevalence Using Diagnosed Incidence and Survival Time. Neuroepidemiology 2021; 55:361-368. [PMID: 34350853 DOI: 10.1159/000516767] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Understanding the epidemiology of Huntington's disease (HD) is key to assessing disease burden and the healthcare resources required to meet patients' needs. We aimed to develop and validate a model to estimate the diagnosed prevalence of manifest HD by the Shoulson-Fahn stage. METHODS A literature review identified epidemiological data from Brazil, Canada, France, Germany, Italy, Spain, the UK, and the USA. Data on staging distribution at diagnosis, progression, and mortality were derived from Enroll-HD. Newly diagnosed patients with manifest HD were simulated by applying annual diagnosed incidence rates to the total population in each country, each year from 1950 onwards. The number of diagnosed prevalent patients from the previous year who remained in each stage was estimated in line with the probability of death or progression. Diagnosed prevalence in 2020 was estimated as the sum of simulated patients, from all the incident cohorts, still alive. RESULTS The model estimates that in 2020, there were 66,787 individuals diagnosed with HD in the 8 included countries, of whom 62-63% were in Shoulson-Fahn stages 1 and 2 (with less severely limited functional capacity than those in stages 3-5). Diagnosed prevalence is estimated to be 8.2-9.0 per 100,000 in the USA, Canada, and the 5 included European countries and 3.5 per 100,000 in Brazil. CONCLUSION The modeled estimates generally accord with the previously published data. This analysis contributes to better understanding of the epidemiology of HD and highlights areas of uncertainty.
Collapse
Affiliation(s)
- Valerie Crowell
- Access Insights & Metrics, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Houghton
- Product Development Personalized Healthcare, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| |
Collapse
|
8
|
Muroni A, Murru MR, Ulgheri L, Sechi M, Ercoli T, Marrosu F, Scaglione CL, Bentivoglio AR, Petracca M, Soliveri P, Cocco E, Cuccu S, Deriu M, Zuccato C, Defazio G. Geographic differences in the incidence of Huntington's disease in Sardinia, Italy. Neurol Sci 2021; 42:5177-5181. [PMID: 33792825 DOI: 10.1007/s10072-021-05217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The frequency of Huntington's disease (HD) may vary considerably, with higher estimates in non-Asian populations. We have recently examined the prevalence of HD in the southern part of Sardinia, a large Italian Mediterranean island that is considered a genetic isolate. We observed regional microgeographic differences in the prevalence of HD across the study area similar to those recently reported in other studies conducted in European countries. To explore the basis for this variability, we undertook a study of the incidence of HD in Sardinia over a 10-year period, 2009 to 2018. METHODS Our research was conducted in the 5 administrative areas of Sardinia island. Case patients were ascertained through multiple sources in Sardinia and Italy. RESULTS During the incidence period 53 individuals were diagnosed with clinically manifested HD. The average annual incidence rate 2009-2018 was 2.92 per 106 persons-year (95% CI, 2.2 to 3.9). The highest incidence rate was observed in South Sardinia (6.3; 95% CI, 4.2-9.5). This rate was significantly higher (p<0.01) than the rates from Cagliari, Oristano, and Sassari provinces but did not significantly differ (p = 0.38) from the Nuoro rate. CONCLUSIONS The overall incidence of HD in Sardinia is close to the correspondent estimates in Mediterranean countries. Our findings highlight also the possibility of local microgeographic variations in the epidemiology of HD that might reflect several factors, including a possible founder effect in the rural areas of South Sardinia and Nuoro.
Collapse
Affiliation(s)
- Antonella Muroni
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, 09124, Cagliari, Italy.
| | - Maria R Murru
- Multiple Sclerosis Centre, Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Lucia Ulgheri
- S.S.D. di Genetica e Biologia dello Sviluppo, University Hospital, Sassari, Italy
| | - Margherita Sechi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesco Marrosu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Cesa L Scaglione
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Martina Petracca
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Soliveri
- Unit of Neurology I, Parkinson and Movement Disorders Unit, Fondazione IRCSS Istituto Neurologico Carlo Basta, Milan, Italy.,Parkinson Institute - CTO, Milan, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Stefania Cuccu
- Multiple Sclerosis Centre, Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Marcello Deriu
- Neurology Service, Nostra Signora della Mercede Hospital, ATS Sardegna, San Gavino Monreale, Italy
| | - Chiara Zuccato
- Department of Biosciences, University of Milan, Milan, Italy.,Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy
| | - Giovanni Defazio
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, 09124, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
9
|
Vicente E, Ruiz de Sabando A, García F, Gastón I, Ardanaz E, Ramos-Arroyo MA. Validation of diagnostic codes and epidemiologic trends of Huntington disease: a population-based study in Navarre, Spain. Orphanet J Rare Dis 2021; 16:77. [PMID: 33568143 PMCID: PMC7877055 DOI: 10.1186/s13023-021-01699-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is great heterogeneity on geographic and temporary Huntington disease (HD) epidemiological estimates. Most research studies of rare diseases, including HD, use health information systems (HIS) as data sources. This study investigates the validity and accuracy of national and international diagnostic codes for HD in multiple HIS and analyses the epidemiologic trends of HD in the Autonomous Community of Navarre (Spain). METHODS HD cases were ascertained by the Rare Diseases Registry and the reference Medical Genetics Centre of Navarre. Positive predictive values (PPV) and sensitivity with 95% confidence intervals (95% CI) were estimated. Overall and 9-year periods (1991-2017) HD prevalence, incidence and mortality rates were calculated, and trends were assessed by Joinpoint regression. RESULTS Overall PPV and sensitivity of combined HIS were 71.8% (95% CI: 59.7, 81.6) and 82.2% (95% CI: 70.1, 90.4), respectively. Primary care data was a more valuable resource for HD ascertainment than hospital discharge records, with 66% versus 50% sensitivity, respectively. It also had the highest number of "unique to source" cases. Thirty-five per cent of HD patients were identified by a single database and only 4% by all explored sources. Point prevalence was 4.94 (95% CI: 3.23, 6.65) per 100,000 in December 2017, and showed an annual 6.1% increase from 1991 to 1999. Incidence and mortality trends remained stable since 1995-96, with mean annual rates per 100,000 of 0.36 (95% CI: 0.27, 0.47) and 0.23 (95% CI: 0.16, 0.32), respectively. Late-onset HD patients (23.1%), mean age at onset (49.6 years), age at death (66.6 years) and duration of disease (16.7 years) were slightly higher than previously reported. CONCLUSION HD did not experience true temporary variations in prevalence, incidence or mortality over 23 years of post-molecular testing in our population. Ascertainment bias may largely explain the worldwide heterogeneity in results of HD epidemiological estimates. Population-based rare diseases registries are valuable instruments for epidemiological studies on low prevalence genetic diseases, like HD, as long as they include validated data from multiple HIS and genetic/family information.
Collapse
Affiliation(s)
- Esther Vicente
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain.
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain.
| | - Ainara Ruiz de Sabando
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
- Fundación Miguel Servet-Navarrabiomed, IdiSNA, Pamplona, Spain
| | - Fermín García
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Itziar Gastón
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Eva Ardanaz
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María A Ramos-Arroyo
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| |
Collapse
|
10
|
Karadag YS, Cavdarli BE, Yuksel RN. Huntington's disease in Turkey: genetic counseling, clinical features, and outcome. Neurol Res 2020; 43:381-386. [PMID: 33377823 DOI: 10.1080/01616412.2020.1866355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: This study aims to report the data of genetic counseling and to identify the clinical features of Turkish Huntington's disease (HD) patients and to investigate its possible relationship with genetic data.Method: A regular weekly outpatient clinic has been held routinely since January 2018. Patients and their referred relatives have been evaluated regarding clinical features and genetic counseling. The database of our collaborative team was used for the study.Results: Total 141 individuals have been evaluated. Among 84 subjects genetic counseling was given, diagnosis of HD was confirmed genetically in 34 (42.0%) of individuals (25 were symptomatic-HD, 9 were presymptomatic-HD). Fifty-seven patients were previously diagnosed with HD. The mean age of onset was 42.4 (11.9) years. Chorea was mostly reported initial symptom. The mean CAG repeat number of the expanded allele was 44.1 (5.1) and correlated inversely with the age of onset (p < 0.001). During a 4.8 (3.1) year follow-up, 10% of the patients were deceased. At the last visit, over half of patients had all of the movement, behavioral and cognitive problems, and 41.6% of them had required 24-hr supervision appropriate (UHDRS-independence score 64.6 (24.4)). Paternal inheritance was related to higher CAG repeats, younger age of disease onset, and higher UHDRS-motor scores.Conclusion: HD in Turkey is a severe disabling disease affecting a younger adult population. Over half of patients had all of the movement, behavioral and cognitive problems. Genetic counseling gives the opportunity to diagnose subjects at the pre-symptomatic phase. A collaborative approach is rational in the management of HD.
Collapse
Affiliation(s)
- Yesim Sucullu Karadag
- University of Health Sciences (Turkey) Ankara City Hospital Huntington's Disease Multidisciplinary Team (MDT), Ankara, Turkey.,Ankara City Hospital Neurology Clinic, University of Health Sciences, Ankara, Turkey
| | - Busranur Erozan Cavdarli
- University of Health Sciences (Turkey) Ankara City Hospital Huntington's Disease Multidisciplinary Team (MDT), Ankara, Turkey.,University of Health Sciences (Turkey) Ankara City Hospital Medical Genetics Clinic, Ankara, Turkey
| | - Rabia Nazik Yuksel
- University of Health Sciences (Turkey) Ankara City Hospital Huntington's Disease Multidisciplinary Team (MDT), Ankara, Turkey.,University of Health Sciences (Turkey) Ankara City Hospital Psychiatry Clinic, Ankara, Turkey
| |
Collapse
|
11
|
Pierron L, Hennessy J, Tezenas du Montcel S, Coarelli G, Heinzmann A, Schaerer E, Herson A, Petit E, Gargiulo M, Durr A. Informing about genetic risk in families with Huntington disease: comparison of attitudes across two decades. Eur J Hum Genet 2020; 29:672-679. [PMID: 33299145 DOI: 10.1038/s41431-020-00776-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/09/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023] Open
Abstract
The low uptake of presymptomatic testing in Huntington disease prompted us to question family members on how they handle the transmission of information regarding genetic risk. We hypothesised that in 2019, parents would inform their at-risk children about their genetic risk more and at a younger age than in 2000, given the availability of prenatal diagnosis, French legislation changes since 2011, and recent therapeutic advances. We made a questionnaire available about the transmission of genetic information within families with Huntington disease in 2000 and 2019. We obtained 443 questionnaires (295 in 2019 and 148 in 2000). Participants were mainly at-risk for Huntington disease (n = 113), affected (n = 85), and spouses (n = 154). In 2019, participants had a higher mean education level (p < 0.01) and a mean age of 44.1 ± 15.1 years (vs 48.1 ± 11.4 years in 2000, p < 0.01). They had been informed about the risk of being a carrier at around 30 years of age (29.0 ± 14.2 in 2019 vs 32.2 ± 13.8 in 2000, p = 0.09). However, they would inform at an earlier age (≤18 years, 67% vs 59%, p = 0.16). Information on transmission risk had been given primarily by parents (45% vs 30%, p = 0.06). In addition, genetic testing for relatives unaware of their status was recommended more frequently in 2019 (46% vs 32%, p < 0.001). Respondents in 2019 recommended genetic testing more often but overall attitudes towards information and testing have not changed significantly over the 19-year time period since the questionnaire was first delivered even despite recent clinical trials potential disease modifying therapies.
Collapse
Affiliation(s)
- Lucie Pierron
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Juliette Hennessy
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Sophie Tezenas du Montcel
- Sorbonne Université, Medical Information Unit, AP-HP, INSERM, Institut Pierre Louis de Santé Publique, Pitié-Salpêtrière University Hospital, Paris, France
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Anna Heinzmann
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Elodie Schaerer
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.,AP-HP, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Ariane Herson
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.,AP-HP, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Elodie Petit
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Marcela Gargiulo
- AP-HP, Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France. .,AP-HP, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France. .,Université de Paris, Laboratoire de Psychologie Clinique et Psychopathologie, Sorbonne Paris Cité, Institut de Psychologie, EA 4056, Paris, France.
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France.
| |
Collapse
|
12
|
Sienes Bailo P, Lahoz R, Sánchez Marín JP, Izquierdo Álvarez S. Incidence of Huntington disease in a northeastern Spanish region: a 13-year retrospective study at tertiary care centre. BMC MEDICAL GENETICS 2020; 21:233. [PMID: 33228555 PMCID: PMC7684714 DOI: 10.1186/s12881-020-01174-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022]
Abstract
Background Despite the progress in the knowledge of Huntington disease (HD) in recent years, the epidemiology continues uncertain, so the study of incidence becomes relevant. This is important since various factors (type of population, diagnostic criteria, disease-modifying factors, etc.) make these data highly variable. Therefore, the genetic diagnosis of these patients is important, since it unequivocally allows the detection of new cases. Methods Descriptive retrospective study with 179 individuals. Incidence of HD was calculated from the ratio of number of symptomatic cases newly diagnosed per 100,000 inhabitants per year during the period 2007–2019 in Aragon (Spain). Results 50 (27.9%) incident cases of HD (CAG repeat length ≥ 36) were identified from a total of 179 persons studied. The remaining 129/179 (72.1%) were HD negative (CAG repeat length < 36). 29 (58.0%) females and 21 (42.0%) males were confirmed as HD cases. The overall incidence was 0.648 per 100,000 patient-years. 11/50 positive HD cases (22.0%) were identified by performing a predictive test, without clinical symptoms. The minimum number of CAG repeats found was 9 and the most common CAG length among HD negative individuals was 16. Conclusions Our incidence lied within the range reported for other Caucasian populations. Implementation of new techniques has allowed to determine the exact number of CAG repeats, which is especially important in patients with triplet expansions in an HD intermediate and/or incomplete penetrance allele, both in diagnostic, predictive and prenatal tests. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01174-z.
Collapse
Affiliation(s)
- Paula Sienes Bailo
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| | - Raquel Lahoz
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain.
| | - Juan Pelegrín Sánchez Marín
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| | - Silvia Izquierdo Álvarez
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| |
Collapse
|
13
|
Rahman MS, Pang MG. New Biological Insights on X and Y Chromosome-Bearing Spermatozoa. Front Cell Dev Biol 2020; 7:388. [PMID: 32039204 PMCID: PMC6985208 DOI: 10.3389/fcell.2019.00388] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/23/2019] [Indexed: 12/28/2022] Open
Abstract
A spermatozoon is a male germ cell capable of fertilizing an oocyte and carries genetic information for determining the sex of the offspring. It comprises autosomes and an X (X spermatozoa) or a Y chromosome (Y spermatozoa). The origin and maturation of both X and Y spermatozoa are the same, however, certain differences may exist. Previous studies proposed a substantial difference between X and Y spermatozoa, however, recent studies suggest negligible or no differences between these spermatozoa with respect to ratio, shape and size, motility and swimming pattern, strength, electric charge, pH, stress response, and aneuploidy. The only difference between X and Y spermatozoa lies in their DNA content. Moreover, recent proteomic and genomic studies have identified a set of proteins and genes that are differentially expressed between X and Y spermatozoa. Therefore, the difference in DNA content might be responsible for the differential expression of certain genes and proteins between these cells. In this review, we have compiled our present knowledge to compare X and Y spermatozoa with respect to their structural, functional, and molecular features. In addition, we have highlighted several areas that could be explored in future studies in this field.
Collapse
Affiliation(s)
- Md Saidur Rahman
- Department of Animal Science and Technology and BET Research Institute, Chung-Ang University, Anseong, South Korea
| | - Myung-Geol Pang
- Department of Animal Science and Technology and BET Research Institute, Chung-Ang University, Anseong, South Korea
| |
Collapse
|
14
|
Ramond F, Quadrio I, Le Vavasseur L, Chaumet H, Boyer F, Bost M, Ollagnon-Roman E. Predictive testing for Huntington disease over 24 years: Evolution of the profile of the participants and analysis of symptoms. Mol Genet Genomic Med 2019; 7:e00881. [PMID: 31436908 PMCID: PMC6785454 DOI: 10.1002/mgg3.881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Huntington disease (HD) is a devastating neurodegenerative autosomal dominant genetic condition. Predictive testing (PT) is available through a defined protocol for at-risk individuals. We analyzed the over-24-years evolution of practices regarding PT for HD in a single center. METHODS We gathered data from the files of all individuals seeking PT for HD in Lyon, France, from 1994 to 2017. RESULTS 448 out of 567 participants had exploitable data. Age at consultation dichotomized over 24 years toward an eightfold increase in individuals aged >55 (2/94 vs. 30/183; 2% to 16%; p < .0001) and twice as many individuals aged 18-20 (3/94 vs. 12/183; 3%-7%; p < .05). Motives for testing remained stable. The rate of withdrawal doubled over 24 years (9/94 vs. 38/183; 9%-21%; p < .02). Independently of the time period, less withdrawal was observed for married, accompanied, at 50% risk, and symptomatic individuals, and in those able to explicit the motives for testing or taking the test to inform their children. We also assessed the consistency between the presence of subtle symptoms compatible with HD found before the test by the team's neurologist, and the positivity of the molecular test. The concordance was 100% (17/17) for associated motor and cognitive signs, 87% (27/31) for isolated motor signs, and 70% (7/10) for isolated cognitive signs. Furthermore, 91% (20/22) of individuals who requested testing because they thought they had symptoms, were indeed found carriers. CONCLUSION This over-24 years study underlines an increasing withdrawal from protocol and a dichotomization of participants' age. We also show a strong concordance between symptoms perceived by the neurologist or by the patient, and the subsequent positivity of the predictive molecular test.
Collapse
Affiliation(s)
- Francis Ramond
- Service de neurogénétique et médecine prédictive, GH Nord-Hôpital de la Croix Rousse, Hospices civils de Lyon, Lyon, France.,Service de Génétique, CHU-Hôpital Nord, Saint-Etienne, France
| | - Isabelle Quadrio
- Unité des Pathologies Neurogénétiques Héréditaires - Service de biochimie et biologie moléculaire Grand Est, CBPE, Hospices Civils de Lyon, Lyon, France.,BIORAN Team, CNRS UMR 5292, INSERM U1028, Lyon Neuroscience Research Center, Lyon 1 University, Bron, France
| | - Laurence Le Vavasseur
- Service de neurogénétique et médecine prédictive, GH Nord-Hôpital de la Croix Rousse, Hospices civils de Lyon, Lyon, France
| | - Hélène Chaumet
- Service de neurogénétique et médecine prédictive, GH Nord-Hôpital de la Croix Rousse, Hospices civils de Lyon, Lyon, France
| | - Fabrice Boyer
- Service de neurogénétique et médecine prédictive, GH Nord-Hôpital de la Croix Rousse, Hospices civils de Lyon, Lyon, France
| | - Muriel Bost
- Unité des Pathologies Neurogénétiques Héréditaires - Service de biochimie et biologie moléculaire Grand Est, CBPE, Hospices Civils de Lyon, Lyon, France
| | - Elisabeth Ollagnon-Roman
- Service de neurogénétique et médecine prédictive, GH Nord-Hôpital de la Croix Rousse, Hospices civils de Lyon, Lyon, France
| |
Collapse
|
15
|
Demetriou CA, Heraclides A, Salafori C, Tanteles GA, Christodoulou K, Christou Y, Zamba-Papanicolaou E. Epidemiology of Huntington disease in Cyprus: A 20-year retrospective study. Clin Genet 2018; 93:656-664. [PMID: 29105741 DOI: 10.1111/cge.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
Abstract
Huntington disease (HD) is most prevalent among populations of western European descent and isolated populations where founder effects may operate. The aim of this study was to examine the epidemiology of HD in Cyprus, an island in southern Europe with extensive western European colonization in the past. All registered HD patients in the Cyprus, since 1994, were included. Detailed pedigrees and clinical information were recorded and maps, showing the geographic distribution of HD, were constructed. Requests for genetic testing were also examined. The project identified 58 clinically manifested cases of HD belonging to 19 families. The 16 families of Cypriot origin were concentrated in a confined geographical cluster in southeast Cyprus. In 2015, prevalence of symptomatic HD was 4.64/100 000 population, while incidence was 0.12/100 000 person-years. Prevalence displayed a marked increase during the past 20 years. Disease characteristics of HD patients were similar to those reported in western European populations. Lastly, the uptake of predictive and/or prenatal testing was limited. HD disease characteristics, incidence and prevalence in Cyprus were comparable to western European populations. Together with the geographical clustering observed, these results support the possibility for a relatively recent founder effect of HD in Cyprus, potentially of western European origin.
Collapse
Affiliation(s)
- C A Demetriou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - A Heraclides
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - C Salafori
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - G A Tanteles
- Clinical Genetics Clinic, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - K Christodoulou
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Y Christou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - E Zamba-Papanicolaou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| |
Collapse
|
16
|
Abstract
Many neurogenetic conditions are inherited and therefore diagnosis of a patient will have implications for the patient's relatives and can raise ethical issues. Predictive genetic testing offers asymptomatic relatives the opportunity to determine their risk status for a neurogenetic condition, and professional guidelines emphasize patients' autonomy and informed, voluntary decision making. Beneficence and nonmaleficence both need to be considered when making decisions about disclosure and nondisclosure of genetic information and test results. There can be disclosure concerns and challenges in determining whose autonomy to prioritize when a patient makes a genetic testing decision that can reveal the genetic status of a relative (e.g., testing an adult child when the at-risk parent has not been tested). Ethical issues are prominent when genetic testing for neurogenetic conditions is requested prenatally, on minors, adoptees, adult children at 25% risk, and for individuals with psychiatric issues or cognitive impairment. Neurogenetic conditions can result in cognitive decline which can affect decisional capacity and lead to ethical challenges with decision making, informed consent, and determining the patient's ability to comprehend test results. The ethical implications of genetic testing and emerging issues, including direct-to-consumer genetic testing, disclosure of secondary findings from genomic sequencing, and use of apolipoprotein E testing in clinical and research settings, are also discussed. Resources for information about genetic testing practice guidelines, insurance laws, and directories of genetics clinics are included.
Collapse
Affiliation(s)
- Wendy R Uhlmann
- Departments of Internal Medicine and Human Genetics, University of Michigan Medical School, Ann Arbor, MI, United States; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| |
Collapse
|
17
|
Carrassi E, Pugliatti M, Govoni V, Sensi M, Casetta I, Granieri E. Epidemiological Study of Huntington's Disease in the Province of Ferrara, Italy. Neuroepidemiology 2017; 49:18-23. [PMID: 28803251 DOI: 10.1159/000479697] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by the abnormal expansion of CAG triplet repeat. We aimed to reappraise HD epidemiology in a northern Italian population, in relation to introduction of genetic testing. METHODS Through ICD-9M code 333.4 and medical fare exemption code RF0080, HD cases were identified from administrative health data and medical records from the Units of Neurology and Genetics, Ferrara University Hospital, and from other provincial neurological structures. RESULTS HD mean annual incidence rate in 1990-2009 was 0.3 per 100,000 (95% CI 0.2-0.5). All incident cases were found to have symptoms of the disease's classic form, and neither juvenile nor the rigid Westphal variant was detected. The mean (SD) age at onset was 50.2 (12.7 years; range 32-82 years), 54.9 (14.6) for men and 45.8 (9.4) for women. On prevalence day, December 31, 2014, HD prevalence was 4.2 per 100,000 (95% CI 2.4-7.0), with a male:female ratio of 1:2. CONCLUSIONS The prevalence and incidence of HD in our population were lower than the prevalence and incidence reported for other European and Italian populations, but higher compared to those of Asia, Africa, and Eastern Europe. Compared to previous studies, HD incidence and prevalence did not change significantly.
Collapse
Affiliation(s)
- Erika Carrassi
- Department of Biomedical and Specialty Surgery, Section of Neurology, University of Ferrara, Ferrara, Italy
| | | | | | | | | | | |
Collapse
|
18
|
Mandich P, Lamp M, Gotta F, Gulli R, Iacometti A, Marchese R, Bellone E, Abbruzzese G, Ferrandes G. 1993-2014: two decades of predictive testing for Huntington's disease at the Medical Genetics Unit of the University of Genoa. Mol Genet Genomic Med 2017; 5:473-480. [PMID: 28944231 PMCID: PMC5606876 DOI: 10.1002/mgg3.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Predictive testing for Huntington's disease has been available at the Medical Genetics Unit of the University of Genoa from 1987. In 1989, an integrated counseling protocol (geneticist, psychologist, and neurologist) was developed following International Guidelines. Methods This is a retrospective analysis of the clinical charts and motivation questionnaires of persons seeking predictive testing through direct DNA analysis from 1993 until 2014, with the aim to evaluate their individual characteristics, motivations, and the outcomes of the counseling protocol. Results A total of 299 persons (164 women, 135 men) applied for predictive testing. Most applicants’ features and motivations were similar to those previously described, but surprisingly the percentage of completed protocols was higher among men, 68.5% versus 53.5% (P = 0.011). Likewise, persons over 25 years of age were more likely to take the test than younger applicants (18–25 years): 63.4% versus 48.1% (P = 0.043). In addition, relationship status, having children, and the gender of the affected parent showed different effects on the decision about testing in males and females. No catastrophic reactions were reported during the study period. Conclusions We observed that factors influencing the decision‐making process might differ between males and females, and that predictive testing appears a safe procedure if framed within an integrated counseling protocol.
Collapse
Affiliation(s)
- Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Merit Lamp
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Fabio Gotta
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Rossella Gulli
- Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Ariela Iacometti
- Unit of Clinical Psychology and PsychotherapyIRCCS AOU San Martino-ISTGenoaItaly
| | | | - Emilia Bellone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Clinical Neurology UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Giovanna Ferrandes
- Unit of Clinical Psychology and PsychotherapyIRCCS AOU San Martino-ISTGenoaItaly
| |
Collapse
|
19
|
Kay C, Hayden MR, Leavitt BR. Epidemiology of Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:31-46. [DOI: 10.1016/b978-0-12-801893-4.00003-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
20
|
|
21
|
|
22
|
Baig SS, Strong M, Rosser E, Taverner NV, Glew R, Miedzybrodzka Z, Clarke A, Craufurd D, Quarrell OW. 22 Years of predictive testing for Huntington's disease: the experience of the UK Huntington's Prediction Consortium. Eur J Hum Genet 2016; 24:1396-402. [PMID: 27165004 PMCID: PMC5027682 DOI: 10.1038/ejhg.2016.36] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/06/2016] [Accepted: 03/29/2016] [Indexed: 11/09/2022] Open
Abstract
Huntington's disease (HD) is a progressive neurodegenerative condition. At-risk individuals have accessed predictive testing via direct mutation testing since 1993. The UK Huntington's Prediction Consortium has collected anonymised data on UK predictive tests, annually, from 1993 to 2014: 9407 predictive tests were performed across 23 UK centres. Where gender was recorded, 4077 participants were male (44.3%) and 5122 were female (55.7%). The median age of participants was 37 years. The most common reason for predictive testing was to reduce uncertainty (70.5%). Of the 8441 predictive tests on individuals at 50% prior risk, 4629 (54.8%) were reported as mutation negative and 3790 (44.9%) were mutation positive, with 22 (0.3%) in the database being uninterpretable. Using a prevalence figure of 12.3 × 10(-5), the cumulative uptake of predictive testing in the 50% at-risk UK population from 1994 to 2014 was estimated at 17.4% (95% CI: 16.9-18.0%). We present the largest study conducted on predictive testing in HD. Our findings indicate that the vast majority of individuals at risk of HD (>80%) have not undergone predictive testing. Future therapies in HD will likely target presymptomatic individuals; therefore, identifying the at-risk population whose gene status is unknown is of significant public health value.
Collapse
Affiliation(s)
- Sheharyar S Baig
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elisabeth Rosser
- Great Ormond Street Hospital for Children, NE Thames Regional Genetics Service, London, UK
| | - Nicola V Taverner
- Institute of Cancer and Genetics, University of Cardiff, Cardiff, UK
| | - Ruth Glew
- MND Care Centre, Morriston Hospital, Swansea, UK
| | - Zosia Miedzybrodzka
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Angus Clarke
- Institute of Cancer and Genetics, University of Cardiff, Cardiff, UK
| | - David Craufurd
- Faculty of Medical Sciences, Institute of Human Development, University of Manchester, Manchester, UK
- St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - UK Huntington's Disease Prediction Consortium
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Great Ormond Street Hospital for Children, NE Thames Regional Genetics Service, London, UK
- Institute of Cancer and Genetics, University of Cardiff, Cardiff, UK
- MND Care Centre, Morriston Hospital, Swansea, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Faculty of Medical Sciences, Institute of Human Development, University of Manchester, Manchester, UK
- St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Oliver W Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| |
Collapse
|
23
|
Baig SS, Strong M, Quarrell OW. The global prevalence of Huntington's disease: a systematic review and discussion. Neurodegener Dis Manag 2016; 6:331-43. [PMID: 27507223 DOI: 10.2217/nmt-2016-0008] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The ascertained prevalence of Huntington's disease (HD) increased significantly following the provision of diagnostic testing. A systematic review was conducted to estimate the prevalence of HD in the post-diagnostic testing era. 22 studies with original data pertaining to the prevalence of HD (1993-2015) were included and analyzed. A global meta-analysis was not performed due to heterogeneity in study methods and geographical variation. The prevalence of HD is significantly lower in Asian populations compared with western Europe, North America and Australia. The global variation in HD prevalence is partly explained by the average CAG repeat lengths and frequency of different HTT gene haplotypes in the general population. Understanding the prevalence of HD has significant implications for healthcare resource planning.
Collapse
Affiliation(s)
| | - Mark Strong
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Oliver Wj Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| |
Collapse
|
24
|
Wexler NS, Collett L, Wexler AR, Rawlins MD, Tabrizi SJ, Douglas I, Smeeth L, Evans SJ. Incidence of adult Huntington's disease in the UK: a UK-based primary care study and a systematic review. BMJ Open 2016; 6:e009070. [PMID: 26908513 PMCID: PMC4769413 DOI: 10.1136/bmjopen-2015-009070] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/24/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The prevalence of Huntington's disease (HD) recorded in the UK primary care records has increased twofold between 1990 and 2010. This investigation was undertaken to assess whether this might be due to an increased incidence. We have also undertaken a systematic review of published estimates of the incidence of HD. SETTING Incident patients with a new diagnosis of HD were identified from the primary care records of the Clinical Practice Research Datalink (CPRD). The systematic review included all published estimates of the incidence of HD in defined populations. PARTICIPANTS A total of 393 incident cases of HD were identified from the CPRD database between 1990 and 2010 from a total population of 9,282,126 persons. PRIMARY AND SECONDARY OUTCOME MEASURES The incidence of HD per million person-years was estimated. From the systematic review, the extent of heterogeneity of published estimates of the incidence of HD was examined using the I(2) statistic. RESULTS The data showed that the incidence of HD has remained constant between 1990 and 2010 with an overall rate of 7.2 (95% CI 6.5 to 7.9) per million person-years. The systematic review identified 14 independent estimates of incidence with substantial heterogeneity and consistently lower rates reported in studies from East Asia compared with those from Australia, North America and some--though not all--those from Europe. Differences in incidence estimates did not appear to be explained solely by differences in case ascertainment or diagnostic methods. CONCLUSIONS The rise in the prevalence of diagnosed HD in the UK, between 1990 and 2010, cannot be attributed to an increase in incidence. Globally, estimates of the incidence of HD show evidence of substantial heterogeneity with consistently lower rates in East Asia and parts of Europe. Modifiers may play an important role in determining the vulnerability of different populations to expansions of the HD allele.
Collapse
Affiliation(s)
- Nancy S Wexler
- Department of Neurology and Psychiatry, Columbia University, New York, New York, USA
- Hereditary Disease Foundation, New York, New York, USA
| | - Laura Collett
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine,London, UK
| | | | - Michael D Rawlins
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, UK
| | - Sarah J Tabrizi
- Department of Neurodegenerative Diseases, Institute of Neurology, University College London,London, UK
| | - Ian Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, UK
| | - Stephen J Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine,London, UK
| |
Collapse
|
25
|
Epidemiology of Huntington's disease in Finland. Parkinsonism Relat Disord 2015; 21:46-9. [DOI: 10.1016/j.parkreldis.2014.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/22/2014] [Accepted: 10/27/2014] [Indexed: 11/24/2022]
|
26
|
Owen J, Beck J, Campbell T, Adamson G, Gorham M, Thompson A, Smithson S, Rosser E, Rudge P, Collinge J, Mead S. Predictive testing for inherited prion disease: report of 22 years experience. Eur J Hum Genet 2014; 22:1351-6. [PMID: 24713662 PMCID: PMC4091984 DOI: 10.1038/ejhg.2014.42] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 11/29/2013] [Accepted: 12/18/2013] [Indexed: 11/08/2022] Open
Abstract
The inherited prion diseases (IPD) are a group of untreatable neurodegenerative diseases that segregate as autosomal dominant traits. Mutations in the prion protein gene (PRNP) were first found to be causal of IPD in 1989, before the molecular genetic characterisation of any other neurodegenerative disease. Predictive testing for IPD has subsequently been carried out at a single UK clinical and research centre for 22 years. We have analysed the uptake, consequences and factors influencing the decision for predictive testing over this period. In all, 104 predictive tests were done on individuals at 50% risk, compared with 135 positive diagnostic tests. Using genealogies from clinical records, we estimated that 23% of those at 50% risk have completed testing. There was no gender bias, and unsurprisingly, there was a slight excess of normal results because some patients were already partly through the risk period because of their age. An unexpectedly large number of patients developed symptoms shortly after predictive testing, suggesting that undisclosed early symptoms of disease may prompt some patients to come forward for predictive testing. Fifteen per cent of predictive tests were done >10 years after molecular diagnosis in a proband. A strong determinant of the timing of testing in these patients was a second diagnosis in the family. IPD may generate infectious prions that might be transmitted by surgical procedures; however, we found no evidence that public health information influenced decisions about predictive testing.
Collapse
Affiliation(s)
- Jane Owen
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - Jon Beck
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Tracy Campbell
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Gary Adamson
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Michele Gorham
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - Andrew Thompson
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
27
|
Late-onset Huntington's disease: diagnostic and prognostic considerations. Parkinsonism Relat Disord 2014; 20:726-30. [PMID: 24721491 DOI: 10.1016/j.parkreldis.2014.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/10/2014] [Accepted: 03/18/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To address diagnostic and prognostic issues in patients with late-onset Huntington's disease (HD). METHODS We analyzed a cohort of 41 late-onset (≥60 years) HD patients and compared them to 39 late-onset patients referred for HD testing that were negative for the HD-expansion and to 290 usual-onset (20-59 years) HD patients. Disease severity was assessed by the Total Functional Capacity Scale. RESULTS Late-onset HD comprised 11.5% of our HD cohort. In total, 70.7% of late-onset HD patients had positive family history compared to 15.4% of late-onset expansion-negative patients (p < 0.001). Clinical features at onset or presentation could not usefully distinguish between late-onset expansion-positive and negative patients, excepting hemichorea, which was absent from the HD group (p = 0.024). Chorea was the first clinical feature in 53.7% and a presenting feature in 90.2% of late-onset HD. The mutation hit rate for late-onset patients was 51.3%, lower than in usual-onset patients (p = 0.04). Frequencies of chorea, cognitive impairment and psychiatric manifestations at onset or presentation were not significantly different between late-onset and usual-onset HD patients. Gait unsteadiness however was more common at presentation in late-onset HD (p = 0.007). Late-onset HD patients reached a severe stage of illness on average 2.8 years earlier than usual-onset HD patients (p = 0.046). CONCLUSIONS A positive family history suggestive of HD, although absent in a third of patients, remains a helpful clue in diagnosing late-onset HD. Prognosis of late-onset HD in terms of Total Functional Capacity appears no better and shows a trend of being somewhat less favorable compared to usual-onset HD.
Collapse
|
28
|
Koutsis G, Kladi A, Karadima G, Houlden H, Wood NW, Christodoulou K, Panas M. Friedreich's ataxia and other hereditary ataxias in Greece: An 18-year perspective. J Neurol Sci 2014; 336:87-92. [DOI: 10.1016/j.jns.2013.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/18/2013] [Accepted: 10/07/2013] [Indexed: 12/20/2022]
|
29
|
Krukenberg RC, Koller DL, Weaver DD, Dickerson JN, Quaid KA. Two decades of Huntington disease testing: patient's demographics and reproductive choices. J Genet Couns 2013; 22:643-53. [PMID: 23709094 DOI: 10.1007/s10897-013-9596-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 04/14/2013] [Indexed: 10/26/2022]
Abstract
Predictive testing for Huntington disease (HD) has been available in the United States (US) since 1987, and the Indiana University Predictive Testing Program has been providing this testing since 1990. To date there has been no published description of those who present for such testing in the US. Here we describe demographics of 141 individuals and reproductive decision making of a subset of 16 of those individuals who underwent predictive HD testing between 1990 and 2010 at one site in the US. This study is a retrospective chart review of the "Personal History Questionnaire" participants completed prior to testing. As seen in other studies, most participants were female (64.5 %), in their mid-30s (mean = 34), and had at least one child prior to testing (54 %). Multiple demographic datum points are described, and the reproductive decision making of these at-risk individuals was analyzed using Fisher's Exact Tests. Of those women who had children before learning of their risk to inherit HD, those who attended church more frequently, had three or more children total, or whose mother was affected with HD were more likely to be comfortable with their choice to have children. We conclude that these demographic factors influence the reproductive decision-making of individuals at risk for HD. Psychologists, clinical geneticists, and genetic counselors may be able to use this information to help counsel at-risk patients regarding current or past reproductive decision making.
Collapse
Affiliation(s)
- Rebekah C Krukenberg
- Breast Care, Community Physician Network, 8040 Clearvista Parkway, Suite 550, Indianapolis, IN, 46256, USA
| | | | | | | | | |
Collapse
|
30
|
Cruz-Mariño T, Velázquez-Pérez L, González-Zaldivar Y, Aguilera-Rodríguez R, Velázquez-Santos M, Vázquez-Mojena Y, Estupiñán-Rodríguez A, Reynaldo-Armiñán R, Almaguer-Mederos LE, Laffita-Mesa JM, Tamayo-Chiang V, Paneque M. Couples at risk for spinocerebellar ataxia type 2: the Cuban prenatal diagnosis experience. J Community Genet 2013; 4:451-60. [PMID: 23673432 DOI: 10.1007/s12687-013-0147-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/03/2013] [Indexed: 12/19/2022] Open
Abstract
Cuba reports the highest worldwide prevalence of spinocerebellar ataxia type 2 (SCA2) and the greatest number of descendants at risk. A protocol for genetic counseling, presymptomatic testing, and prenatal diagnosis of hereditary ataxias has been under development since 2001. Considering that the revision of the experience with prenatal diagnosis for SCA2 in Cuba would enable comparison of ours with international findings, we designed a descriptive study, based on the retrospective revision of the medical records belonging to the 58 couples that requested their inclusion in the program, during an 11-year period (2001-2011). Most of the participants in the prenatal diagnosis program were known presymptomatic carriers, diagnosed through the presymptomatic testing in the same period of study, for an uptake among them of 22.87 % (51 out of 223). In 28 cases, the fetuses were carriers, 20 of these couples (71.43 %) decided to terminate the pregnancy; the rest continued the pregnancy to term, this resulting in a predictive test for their unborn children. A predominance of females as the at-risk progenitor was observed. Except for a slightly lower average age, the results attained in the Cuban SCA2 prenatal diagnosis program resulted similar to the ones reported for Huntington disease in other countries. It is necessary to have easy access to the Cuban program through its expansion to other genetic centers along the island. Future research is needed to evaluate the long-term impact of both the predictive testing in unborn children and the selection of other reproductive options by the at-risk couples.
Collapse
Affiliation(s)
- Tania Cruz-Mariño
- Center for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
van Rij MC, de Koning Gans PAM, Aalfs CM, Elting M, Ippel PF, Maat-Kievit JA, Vermeer S, Verschuuren-Bemelmans CC, van Belzen MJ, Belfroid RDM, Losekoot M, Geraedts JPM, Roos RAC, Tibben A, de Die-Smulders CEM, Bijlsma EK. Prenatal testing for Huntington's disease in the Netherlands from 1998 to 2008. Clin Genet 2013; 85:78-86. [PMID: 23350614 DOI: 10.1111/cge.12090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/27/2012] [Accepted: 12/31/2012] [Indexed: 11/27/2022]
Abstract
This study aims to give an overview of the number of prenatal tests for Huntington's disease (HD), test results, and pregnancy outcomes in the Netherlands between 1998 and 2008 and to compare them with available data from the period 1987 to 1997. A total of 126 couples underwent prenatal diagnosis (PND) on 216 foetuses: 185 (86%) direct tests and 31 (14%) exclusion tests. In 9% of direct tests the risk for the foetus was 25%. Four at-risk parents (4%) carried intermediate alleles. Ninety-one foetuses had CAG expansions ≥36% or 50% risk haplotypes: 75 (82%) were terminated for HD, 12 (13%) were carried to term; four pregnancies were miscarried, terminated for other reasons or lost to follow-up. Unaffected pregnancies (122 foetuses) resulted in the birth of 112 children. The estimated uptake of PND was 22% of CAG expansion carriers (≥36 repeats) at reproductive age. PND was used by two new subgroups: carriers of intermediate alleles and 50% at-risk persons opting for a direct prenatal test of the foetus. A significant number of HD expansion or 50% risk pregnancies were continued. Speculations were made on causative factors contributing to these continuations. Further research on these couples' motives is needed.
Collapse
Affiliation(s)
- M C van Rij
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
van Rij MC, de Koning Gans PAM, van Belzen MJ, Roos RAC, Geraedts JPM, De Rademaeker M, Bijlsma EK, de Die-Smulders CEM. The uptake and outcome of prenatal and pre-implantation genetic diagnosis for Huntington's disease in the Netherlands (1998-2008). Clin Genet 2013; 85:87-95. [DOI: 10.1111/cge.12089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/31/2012] [Accepted: 12/31/2012] [Indexed: 11/30/2022]
Affiliation(s)
- MC van Rij
- Department of Clinical Genetics; Maastricht University Medical Centre (MUMC); Maastricht The Netherlands
| | - PAM de Koning Gans
- Department of Clinical Genetics; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | - MJ van Belzen
- Department of Clinical Genetics; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | | | - JPM Geraedts
- Department of Clinical Genetics; Maastricht University Medical Centre (MUMC); Maastricht The Netherlands
- GROW, Research School for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| | - M De Rademaeker
- Centre for Medical Genetics; University Hospital Brussels; Brussels Belgium
| | - EK Bijlsma
- Department of Clinical Genetics; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | - CEM de Die-Smulders
- Department of Clinical Genetics; Maastricht University Medical Centre (MUMC); Maastricht The Netherlands
- GROW, Research School for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| |
Collapse
|
33
|
Koutsis G, Karadima G, Pandraud A, Sweeney MG, Paudel R, Houlden H, Wood NW, Panas M. Genetic screening of Greek patients with Huntington’s disease phenocopies identifies an SCA8 expansion. J Neurol 2013; 259:1874-8. [PMID: 22297462 DOI: 10.1007/s00415-012-6430-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 02/06/2023]
Abstract
Huntington’s disease (HD) is an autosomal dominant disorder characterized by a triad of chorea, psychiatric disturbance and cognitive decline. Around 1% of patients with HD-like symptoms lack the causative HD expansion and are considered HD phenocopies. Genetic diseases that can present as HD phenocopies include HD-like syndromes such as HDL1, HDL2 and HDL4 (SCA17), some spinocerebellar ataxias (SCAs) and dentatorubral-pallidoluysian atrophy (DRPLA). In this study we screened a cohort of 21 Greek patients with HD phenocopy syndromes formutations causing HDL2, SCA17, SCA1, SCA2, SCA3,SCA8, SCA12 and DRPLA. Fifteen patients (71%) had a positive family history. We identified one patient (4.8% of the total cohort) with an expansion of 81 combined CTA/CTG repeats at the SCA8 locus. This falls within what is believed to be the high-penetrance allele range. In addition to the classic HD triad, the patient had features of dystonia and oculomotor apraxia. There were no cases of HDL2, SCA17, SCA1, SCA2, SCA3, SCA12 or DRPLA. Given the controversy surrounding the SCA8 expansion, the present finding may be incidental. However, if pathogenic, it broadens the phenotype that may be associated with SCA8 expansions. The absence of any other mutations in our cohort is not surprising, given the low probability of reaching a genetic diagnosis in HD phenocopy patients.
Collapse
Affiliation(s)
- G Koutsis
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
van Rij MC, de Die-Smulders CEM, Bijlsma EK, de Wert GMWR, Geraedts JP, Roos RAC, Tibben A. Evaluation of exclusion prenatal and exclusion preimplantation genetic diagnosis for Huntington's disease in the Netherlands. Clin Genet 2012; 83:118-24. [PMID: 23137131 DOI: 10.1111/cge.12058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Individuals at 50% risk of Huntington's disease (HD) who prefer not to know their carrier status, might opt for exclusion prenatal diagnosis (ePND) or exclusion preimplantation genetic diagnosis (ePGD). This study aims to provide a better understanding of couples' motives for choosing ePND or ePND, and surveys couples' experiences in order to make recommendations for the improvement of counselling for exclusion testing. This qualitative retrospective interview study focussed on couples who underwent ePND or ePGD for HD in the period 1996-2010. Seventeen couples were included of which 13 had experienced ePND and 6 ePGD. Mean time-interval since exclusion-testing was 3.9 years. Couples' moral reservations regarding termination of pregnancy (TOP) or discarding healthy embryos were counterbalanced by the wish to protect their future child against HD. Seven couples had terminated a total of 11 pregnancies with a 50% HD risk, none showed regret. ePGD was used by couples who wanted to avoid (another) TOP. ePND and ePGD are acceptable reproductive options for a specific group of counsellees. To guarantee sound standards of care, it is imperative that candidate couples be given in-depth non-directive counselling about all possible scenarios, and adequate professional and psychological support prior to, during and after ePND/ePGD.
Collapse
Affiliation(s)
- M C van Rij
- Department of Clinical Genetics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|