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Van Es MA. Amyotrophic lateral sclerosis; clinical features, differential diagnosis and pathology. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 176:1-47. [PMID: 38802173 DOI: 10.1016/bs.irn.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a late-onset syndrome characterized by the progressive degeneration of both upper motor neurons (UMN) and lower motor neurons (LMN). ALS forms a clinical continuum with frontotemporal dementia (FTD), in which there are progressive language deficits or behavioral changes. The genetics and pathology underlying both ALS and FTD overlap as well, with cytoplasmatic misvocalization of TDP-43 as the hallmark. ALS is diagnosed by exclusion. Over the years several diagnostic criteria have been proposed, which in essence all require a history of slowly progressive motor symptoms, with UMN and LMN signs on neurological examination, clear spread of symptoms through the body, the exclusion of other disorder that cause similar symptoms and an EMG that it is compatible with LMN loss. ALS is heterogeneous disorder that may present in multitude ways, which makes the diagnosis challenging. Therefore, a systematic approach in the diagnostic process is required in line with the most common presentations. Subsequently, assessing whether there are cognitive and/or behavioral changes within the spectrum of FTD and lastly determining the cause is genetic. This chapter, an outline on how to navigate this 3 step process.
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Affiliation(s)
- Michael A Van Es
- Department of Neurology, Brain Center UMC Utrecht, Utrecht, The Netherlands.
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2
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Naeini SA, Simmatis L, Jafari D, Yunusova Y, Taati B. Improving Dysarthric Speech Segmentation With Emulated and Synthetic Augmentation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2024; 12:382-389. [PMID: 38606392 PMCID: PMC11008804 DOI: 10.1109/jtehm.2024.3375323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/21/2024] [Accepted: 03/02/2024] [Indexed: 04/13/2024]
Abstract
Acoustic features extracted from speech can help with the diagnosis of neurological diseases and monitoring of symptoms over time. Temporal segmentation of audio signals into individual words is an important pre-processing step needed prior to extracting acoustic features. Machine learning techniques could be used to automate speech segmentation via automatic speech recognition (ASR) and sequence to sequence alignment. While state-of-the-art ASR models achieve good performance on healthy speech, their performance significantly drops when evaluated on dysarthric speech. Fine-tuning ASR models on impaired speech can improve performance in dysarthric individuals, but it requires representative clinical data, which is difficult to collect and may raise privacy concerns. This study explores the feasibility of using two augmentation methods to increase ASR performance on dysarthric speech: 1) healthy individuals varying their speaking rate and loudness (as is often used in assessments of pathological speech); 2) synthetic speech with variations in speaking rate and accent (to ensure more diverse vocal representations and fairness). Experimental evaluations showed that fine-tuning a pre-trained ASR model with data from these two sources outperformed a model fine-tuned only on real clinical data and matched the performance of a model fine-tuned on the combination of real clinical data and synthetic speech. When evaluated on held-out acoustic data from 24 individuals with various neurological diseases, the best performing model achieved an average word error rate of 5.7% and a mean correct count accuracy of 94.4%. In segmenting the data into individual words, a mean intersection-over-union of 89.2% was obtained against manual parsing (ground truth). It can be concluded that emulated and synthetic augmentations can significantly reduce the need for real clinical data of dysarthric speech when fine-tuning ASR models and, in turn, for speech segmentation.
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Affiliation(s)
- Saeid Alavi Naeini
- KITE, Toronto Rehabilitation Institute, University Health Network (UHN)TorontoONM5G 2A2Canada
- Institute of Biomedical Engineering, University of TorontoTorontoONM5S 3G9Canada
| | - Leif Simmatis
- KITE, Toronto Rehabilitation Institute, University Health Network (UHN)TorontoONM5G 2A2Canada
| | - Deniz Jafari
- KITE, Toronto Rehabilitation Institute, University Health Network (UHN)TorontoONM5G 2A2Canada
- Institute of Biomedical Engineering, University of TorontoTorontoONM5S 3G9Canada
| | - Yana Yunusova
- KITE, Toronto Rehabilitation Institute, University Health Network (UHN)TorontoONM5G 2A2Canada
- Department of Speech Language PathologyRehabilitation Sciences Institute, University of TorontoTorontoONM5G 1V7Canada
- Hurvitz Brain Sciences ProgramSunnybrook Research Institute (SRI)TorontoONM4N 3M5Canada
| | - Babak Taati
- KITE, Toronto Rehabilitation Institute, University Health Network (UHN)TorontoONM5G 2A2Canada
- Institute of Biomedical Engineering, University of TorontoTorontoONM5S 3G9Canada
- Department of Computer ScienceUniversity of TorontoTorontoONM5S 2E4Canada
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3
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Papadopoulou E, Pepe G, Konitsiotis S, Chondrogiorgi M, Grigoriadis N, Kimiskidis VK, Tsivgoulis G, Mitsikostas DD, Chroni E, Domouzoglou E, Tsaousis G, Nasioulas G. The evolution of comprehensive genetic analysis in neurology: Implications for precision medicine. J Neurol Sci 2023; 447:120609. [PMID: 36905813 DOI: 10.1016/j.jns.2023.120609] [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: 11/15/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Technological advancements have facilitated the availability of reliable and thorough genetic analysis in many medical fields, including neurology. In this review, we focus on the importance of selecting the appropriate genetic test to aid in the accurate identification of disease utilizing currently employed technologies for analyzing monogenic neurological disorders. Moreover, the applicability of comprehensive analysis via NGS for various genetically heterogeneous neurological disorders is reviewed, revealing its efficiency in clarifying a frequently cloudy diagnostic picture and delivering a conclusive and solid diagnosis that is essential for the proper management of the patient. The feasibility and effectiveness of medical genetics in neurology require interdisciplinary cooperation among several medical specialties and geneticists, to select and perform the most relevant test according to each patient's medical history, using the most appropriate technological tools. The prerequisites for a comprehensive genetic analysis are discussed, highlighting the utility of appropriate gene selection, variant annotation, and classification. Moreover, genetic counseling and interdisciplinary collaboration could improve diagnostic yield further. Additionally, a sub-analysis is conducted on the 1,502,769 variation records with submitted interpretations in the Clinical Variation (ClinVar) database, with a focus on neurology-related genes, to clarify the value of suitable variant categorization. Finally, we review the current applications of genetic analysis in the diagnosis and personalized management of neurological patients and the advances in the research and scientific knowledge of hereditary neurological disorders that are evolving the utility of genetic analysis towards the individualization of the treatment strategy.
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Affiliation(s)
| | - Georgia Pepe
- GeneKor Medical SA, Spaton 52, Gerakas 15344, Greece
| | - Spiridon Konitsiotis
- Department of Neurology, University of Ioannina, Stavrou Niarchou Avenue, Ioannina 45500, Greece
| | - Maria Chondrogiorgi
- Department of Neurology, University of Ioannina, Stavrou Niarchou Avenue, Ioannina 45500, Greece
| | - Nikolaos Grigoriadis
- Second Department of Neurology, "AHEPA" University Hospital, Aristotle University of Thessaloniki, St. Kiriakidis 1, Thessaloniki 54636, Greece
| | - Vasilios K Kimiskidis
- First Department of Neurology, "AHEPA" University hospital, Aristotle University of Thessaloniki, St. Kiriakidis 1, Thessaloniki 54636, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
| | - Eleni Domouzoglou
- Department of Pediatrics, University Hospital of Ioannina, Stavrou Niarchou Avenue, Ioannina 45500, Greece
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Hage M, Drui D, Francou B, Mercier S, Guiochon-Mantel A, Belaisch-Allart J, Péréon Y, Cazabat L, De Mazancourt P, Raffin-Sanson ML. Structural analysis of the impact of a novel androgen receptor gene mutation in two adult patients with mild androgen insensitivity syndrome. Andrologia 2020; 53:e13865. [PMID: 33108824 DOI: 10.1111/and.13865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
Androgen receptor gene (AR) mutations are responsible for androgen insensitivity syndrome (AIS) presenting with a clinical phenotype that ranges from gynaecomastia and/ or infertility in mild AIS (MAIS) to complete testicular feminisation in complete AIS. We report a novel AR gene mutation in two unrelated adult patients with MAIS and we studied its functional impact using 3D modelling. Patient 1, referred for infertility, presented with gynaecomastia, mild hypospadias and bilateral testicular hypotrophy contrasting with high testosterone levels, an elevated FSH, an elevated androgen sensitivity index (ASI) and oligoasthenoteratospermia. In vitro fertilisation and intracytoplasmic sperm injection resulted in a successful twin pregnancy. Patient 2 referred for a decrease in athletic performance had surgically treated gynaecomastia, oligoasthenospermia, high testosterone levels and an elevated ASI. Despite his impaired spermogram, he fathered two children without assisted reproductive technology. AR gene sequencing in the two patients revealed a common novel missense mutation, Ala699Thr, in exon 4 within the ligand-binding domain. 3D modelling studies showed that this mutation may impact dimer stability upon ligand binding or may affect allosteric changes upon dimerisation. This study illustrates the value of structural analysis for the functional study of mutations and expands the database of AR gene mutations.
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Affiliation(s)
- Mirella Hage
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
| | - Delphine Drui
- Centre Hospitalier Universitaire Nantes, Service d'Endocrinologie, L'institut du Thorax, Nantes, France
| | - Bruno Francou
- Centre Hospitalier Universitaire Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Sandra Mercier
- Centre Hospitalier Universitaire Nantes, Service de Génétique Médicale, L'institut du Thorax, Nantes, France
| | - Anne Guiochon-Mantel
- Centre Hospitalier Universitaire Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Inserm UMR 1185, Faculté de médecine Paris Saclay, Université Paris-Saclay, le Kremlin-Bicêtre, France
| | - Joelle Belaisch-Allart
- Centre Hospitalier des Quatre Villes, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Sèvres, France
| | - Yann Péréon
- Centre Hospitalier Universitaire Nantes, Centre de Référence Maladies Neuromusculaires Nantes-Angers, Hôtel-Dieu, Nantes, France
| | - Laure Cazabat
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France.,EA4340, Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France
| | - Philippe De Mazancourt
- Centre Hospitalier Universitaire Ambroise Paré, Laboratoire de Biochimie-Génétique Moléculaire, UMR1179, Boulogne Billancourt, France
| | - Marie Laure Raffin-Sanson
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France.,EA4340, Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France
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5
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van de Wardt J, van der Stouwe AMM, Dirkx M, Elting JWJ, Post B, Tijssen MA, Helmich RC. Systematic clinical approach for diagnosing upper limb tremor. J Neurol Neurosurg Psychiatry 2020; 91:822-830. [PMID: 32457087 PMCID: PMC7402459 DOI: 10.1136/jnnp-2019-322676] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 12/18/2022]
Abstract
Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.
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Affiliation(s)
- Jaron van de Wardt
- Department of Neurology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands .,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Michiel Dirkx
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.,Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Rick C Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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6
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Computational analysis of androgen receptor (AR) variants to decipher the relationship between protein stability and related-diseases. Sci Rep 2020; 10:12101. [PMID: 32694570 PMCID: PMC7374729 DOI: 10.1038/s41598-020-68731-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 06/19/2020] [Indexed: 11/08/2022] Open
Abstract
Although more than 1,000 androgen receptor (AR) mutations have been identified and these mutants are pathologically important, few theoretical studies have investigated the role of AR protein folding stability in disease and its relationship with the phenotype of the patients. Here, we extracted AR variant data from four databases: ARDB, HGMD, Cosmic, and 1,000 genome. 905 androgen insensitivity syndrome (AIS)-associated loss-of-function mutants and 168 prostate cancer-associated gain-of-function mutants in AR were found. We analyzed the effect of single-residue variation on the folding stability of AR by FoldX and guanidine hydrochloride denaturation experiment, and found that genetic disease-associated mutations tend to have a significantly greater effect on protein stability than gene polymorphisms. Moreover, AR mutants in complete androgen insensitivity syndrome (CAIS) tend to have a greater effect on protein stability than in partial androgen insensitive syndrome (PAIS). This study, by linking disease phenotypes to changes in AR stability, demonstrates the importance of protein stability in the pathogenesis of hereditary disease.
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7
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Genetic Counseling for Adult-Onset Spinal and Bulbar Muscular Atrophy (Kennedy Syndrome): Multiple Cases of Prenatal Testing in a Family. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1195:199-204. [DOI: 10.1007/978-3-030-32633-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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8
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Autophagy in motor neuron diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 172:157-202. [PMID: 32620242 DOI: 10.1016/bs.pmbts.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Motor neuron diseases (MNDs) are a wide group of neurodegenerative disorders characterized by the degeneration of a specific neuronal type located in the central nervous system, the motor neuron (MN). There are two main types of MNs, spinal and cortical MNs and depending on the type of MND, one or both types are affected. Cortical MNs innervate spinal MNs and these control a variety of cellular targets, being skeletal muscle their main one which is also affected in MNDs. A correct functionality of autophagy is necessary for the survival of all cellular types and it is particularly crucial for neurons, given their postmitotic and highly specialized nature. Numerous studies have identified alterations of autophagy activity in multiple MNDs. The scientific community has been particularly prolific in reporting the role that autophagy plays in the most common adult MND, amyotrophic lateral sclerosis, although many studies have started to identify physiological and pathological functions of this catabolic system in other MNDs, such as spinal muscular atrophy and spinal and bulbar muscular atrophy. The degradation of selective cargo by autophagy and how this process is altered upon the presence of MND-causing mutations is currently also a matter of intense investigation, particularly regarding the selective autophagic clearance of mitochondria. Thorough reviews on this field have been recently published. This chapter will cover the current knowledge on the functionality of autophagy and lysosomal homeostasis in the main MNDs and other autophagy-related topics in the MND field that have risen special interest in the research community.
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Finsterer J, Scorza FA. Central nervous system abnormalities in spinal and bulbar muscular atrophy (Kennedy's disease). Clin Neurol Neurosurg 2019; 184:105426. [PMID: 31351215 DOI: 10.1016/j.clineuro.2019.105426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 01/18/2023]
Abstract
Spinal and bulbar (bulbospinal) muscular atrophy (BSMA, SBMA, Kennedy's disease) is a progressive motor neuron disease with rare involvement of structures other than the lower motor neuron, such as the endocrine system and the central nervous system (CNS). Aim of the review was to study type and frequency of clinical, imaging, and functional (CNS) abnormalities in SBMA patients. The most frequent clinical CNS manifestations in SBMA are postural or kinetic tremor predominantly of the hands and mild cognitive impairment. The most frequent instrumental CNS abnormality in SBMA patients are white matter lesions, visible on voxel-based morphometry, magnetic resonance spectroscopy, or diffusion tensor imaging. Single patients with enlarged pituitary volume, or diminished somato-sensory representation in the cortex have been also reported. Seizures, epilepsy, ataxia, spasticity, dystonia, or migraine have not been found in SBMA patients. Only supportive treatment is available for CNS manifestations in SBMA. It is concluded that the most frequent CNS abnormalities in SBMA are tremor, cognitive impairment, and white matter lesions on new imaging modalities. CNS involvement in SBMA should not be neglected as a phenotypic manifestation of SBMA and, apart from cognitive involvement, may help to differentiate clinically SBMA from other types of motor neuron disease.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria.
| | - Fulvio A Scorza
- Disciplina de Neurociência. Escola Paulista de, Medicina/Universidade Federal de São Paulo/. (EPM/UNIFESP). São Paulo, Brazil
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Liu X, Zhu M, Li X, Tang J. Clinical manifestations and AR gene mutations in Kennedy's disease. Funct Integr Genomics 2019; 19:533-539. [PMID: 30612224 DOI: 10.1007/s10142-018-0651-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/08/2018] [Accepted: 12/02/2018] [Indexed: 11/28/2022]
Abstract
Kennedy's disease, resulted from the expansion of a CAG repeat in exon 1 of androgen receptor (AR) gene, is a motor neuron degenerative disease in the brainstem and spinal cord with the slow development of facial, bulbar, and limb muscle degeneration. To investigate the clinical manifestations and gene mutations in Han Chinese patients with Kennedy's disease. The clinical manifestations of 5 male Han Chinese patients including 2 probands and their relatives from 2 families and 1 sporadic case were retrospectively studied. The CAG repeats in the first exon of AR were screened in 5 Han Chinese people including 2 probands and their healthy relatives from 2 families and 1 sporadic case by polymerase chain reaction (PCR) and direct sequencing. The average age at onset of Kennedy's disease was 48.20 ± 8.70 (mean ± SD) years and the average duration was 7.60 ± 5.32 years. All the patients showed slow onset and progressive weakness, wasting, and fasciculations of the whole body. Four patients demonstrated decreased fertility and 1 patient showed mild gynecomastia. Serum creatine kinase and testosterone levels were elevated mildly in 2 and 1 patients, respectively. The electromyogram showed neurogenic abnormalities. Muscle magnetic resonance demonstrated reduced muscle volume and fatty infiltration. Three different enlarged CAG domains were discovered in the 2 families and 1 sporadic patient with Kennedy's disease, and the CAG repeat number was 48, 43, and 44, respectively. The clinical manifestations of Kennedy's disease in Han Chinese middle-aged men were progressive weakness and atrophy in the bulbar and spinal muscles, occasionally demonstrating incomplete androgen insensitivity syndrome. These patients were also characterized with enlarged CAG repeat number in the first exon of AR, indicating that CAG number could be used in the diagnosis of Han Chinese patients with Kennedy's disease.
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Affiliation(s)
- Xiaomin Liu
- Department of Neurology, Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China.
| | - Meijia Zhu
- Department of Neurology, Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China
| | - Xiuhua Li
- Department of Neurology, Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China
| | - Jiyou Tang
- Department of Neurology, Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China.
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Belter L, Cook SF, Crawford TO, Jarecki J, Jones CC, Kissel JT, Schroth M, Hobby K. An overview of the Cure SMA membership database: Highlights of key demographic and clinical characteristics of SMA members. J Neuromuscul Dis 2018; 5:167-176. [PMID: 29614694 PMCID: PMC6004903 DOI: 10.3233/jnd-170292] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: The Cure SMA database is one of the largest patient reported databases for people affected with SMA. Objective: The purpose of this study was to examine a subset of affected SMA persons with types I, II, and III from a patient reported database. Methods: Individuals with SMA were selected from the database using a date of first contact to Cure SMA between 2010 and 2016. Data analyzed included age at diagnosis, number of weeks from SMA diagnosis to contacting Cure SMA, and geographic distribution of individuals. Results: A total of 1,966 individuals with SMA were included in the analysis. Of these individuals, 51.9% had type I, 32.3% had type II, and 15.8% had type III. The average age of diagnosis for type I patients was 5.2 months, 22.1 months for type II, and 97.8 months for type III. From published incidence, about 59.0% of affected individuals in the US are registered in the Cure SMA database. Conclusions: The Cure SMA database is a unique and robust source of patient reported data that informs on the burden of illness and supports the development of new therapeutic modalities.
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Affiliation(s)
| | | | | | | | | | | | - Mary Schroth
- Cure SMA, Elk Grove Village, IL, USA.,University of Wisconsin, Madison, WI, USA
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12
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Fujita K, Nonomura N. Role of Androgen Receptor in Prostate Cancer: A Review. World J Mens Health 2018; 37:288-295. [PMID: 30209899 PMCID: PMC6704300 DOI: 10.5534/wjmh.180040] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022] Open
Abstract
Androgen receptor (AR) is a steroid receptor transcriptional factor for testosterone and dihydrotestosterone consisting of four main domains, the N-terminal domain, DNA-binding domain, hinge region, and ligand-binding domain. AR plays pivotal roles in prostate cancer, especially castration-resistant prostate cancer (CRPC). Androgen deprivation therapy can suppress hormone-naïve prostate cancer, but prostate cancer changes AR and adapts to survive under castration levels of androgen. These mechanisms include AR point mutations, AR overexpression, changes of androgen biosynthesis, constitutively active AR splice variants without ligand binding, and changes of androgen cofactors. Studies of AR in CRPC revealed that AR was still active in CRPC, and it remains as a potential target to treat CRPC. Enzalutamide is a second-generation antiandrogen effective in patients with CRPC before and after taxane-based chemotherapy. However, CRPC is still incurable and can develop drug resistance. Understanding the mechanisms of this resistance can enable new-generation therapies for CRPC. Several promising new AR-targeted therapies have been developed. Apalutamide is a new Food and Drug Administration-approved androgen agonist binding to the ligand-binding domain, and clinical trials of other new AR-targeted agents binding to the ligand-binding domain or N-terminal domain are underway. This review focuses on the functions of AR in prostate cancer and the development of CRPC and promising new agents against CRPC.
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Affiliation(s)
- Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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13
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Bak DH, Na J, Im SI, Oh CT, Kim JY, Park SK, Han HJ, Seok J, Choi SY, Ko EJ, Mun SK, Ahn SW, Kim BJ. Antioxidant effect of human placenta hydrolysate against oxidative stress on muscle atrophy. J Cell Physiol 2018; 234:1643-1658. [PMID: 30132871 DOI: 10.1002/jcp.27034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/25/2018] [Indexed: 01/07/2023]
Abstract
Sarcopenia, which refers to the muscle loss that accompanies aging, is a complex neuromuscular disorder with a clinically high prevalence and mortality. Despite many efforts to protect against muscle weakness and muscle atrophy, the incidence of sarcopenia and its related permanent disabilities continue to increase. In this study, we found that treatment with human placental hydrolysate (hPH) significantly increased the viability (approximately 15%) of H2 O2 -stimulated C2C12 cells. Additionally, while H2 O2 -stimulated cells showed irregular morphology, hPH treatment restored their morphology to that of cells cultured under normal conditions. We further showed that hPH treatment effectively inhibited H2 O2 -induced cell death. Reactive oxygen species (ROS) generation and Mstn expression induced by oxidative stress are closely associated with muscular dysfunction followed by atrophy. Exposure of C2C12 cells to H2 O2 induced abundant production of intracellular ROS, mitochondrial superoxide, and mitochondrial dysfunction as well as myostatin expression via nuclear factor-κB (NF-κB) signaling; these effects were attenuated by hPH. Additionally, hPH decreased mitochondria fission-related gene expression (Drp1 and BNIP3) and increased mitochondria biogenesis via the Sirt1/AMPK/PGC-1α pathway and autophagy regulation. In vivo studies revealed that hPH-mediated prevention of atrophy was achieved predominantly through regulation of myostatin and PGC-1α expression and autophagy. Taken together, our findings indicate that hPH is potentially protective against muscle atrophy and oxidative cell death.
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Affiliation(s)
- Dong-Ho Bak
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.,Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Jungtae Na
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Song I Im
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.,Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Chang Taek Oh
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Jeom-Yong Kim
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Sun-Kyu Park
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Hae Jung Han
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Joon Seok
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sun Young Choi
- Department of Dermatology, College of Medicine, Seoul Paik Hospital Inje University, Seoul, Korea
| | - Eun Jung Ko
- Myongji Hospital, College of Medicine, Seonam University, Goyang, Korea
| | - Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Suk-Won Ahn
- Department of Neurology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.,Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
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Kennedy’s disease (spinal and bulbar muscular atrophy): a clinically oriented review of a rare disease. J Neurol 2018; 266:565-573. [DOI: 10.1007/s00415-018-8968-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 01/18/2023]
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15
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Driven to decay: Excitability and synaptic abnormalities in amyotrophic lateral sclerosis. Brain Res Bull 2018; 140:318-333. [PMID: 29870780 DOI: 10.1016/j.brainresbull.2018.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron (MN) disease and is clinically characterised by the death of corticospinal motor neurons (CSMNs), spinal and brainstem MNs and the degeneration of the corticospinal tract. Degeneration of CSMNs and MNs leads inexorably to muscle wastage and weakness, progressing to eventual death within 3-5 years of diagnosis. The CSMNs, located within layer V of the primary motor cortex, project axons constituting the corticospinal tract, forming synaptic connections with brainstem and spinal cord interneurons and MNs. Clinical ALS may be divided into familial (∼10% of cases) or sporadic (∼90% of cases), based on apparent random incidence. The emergence of transgenic murine models, expressing different ALS-associated mutations has accelerated our understanding of ALS pathogenesis, although precise mechanisms remain elusive. Multiple avenues of investigation suggest that cortical electrical abnormalities have pre-eminence in the pathophysiology of ALS. In addition, glutamate-mediated functional and structural alterations in both CSMNs and MNs are present in both sporadic and familial forms of ALS. This review aims to promulgate debate in the field with regard to the common aetiology of sporadic and familial ALS. A specific focus on a nexus point in ALS pathogenesis, namely, the synaptic and intrinsic hyperexcitability of CSMNs and MNs and alterations to their structure are comprehensively detailed. The association of extramotor dysfunction with neuronal structural/functional alterations will be discussed. Finally, the implications of the latest research on the dying-forward and dying-back controversy are considered.
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Pedroso JL, Vale TC, Barsottini OG, Oliveira ASB, Espay AJ. Perioral and tongue fasciculations in Kennedy’s disease. Neurol Sci 2017; 39:777-779. [DOI: 10.1007/s10072-017-3170-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
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17
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Juntas Morales R, Pageot N, Taieb G, Camu W. Adult-onset spinal muscular atrophy: An update. Rev Neurol (Paris) 2017; 173:308-319. [DOI: 10.1016/j.neurol.2017.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 03/01/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
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18
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Lee S, Cha E, Lee J, Lee J, Song I, Kim S. The Use of Korean Medicine to Treat Patients with Spinobulbar Muscular Atrophy, Kennedy's Disease - A Case Study. J Pharmacopuncture 2017; 20:57-60. [PMID: 28392964 PMCID: PMC5374340 DOI: 10.3831/kpi.2017.20.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: Studies involving patients with spinobulbar muscular atrophy (SBMA), which is often referred to as Kennedy’s disease, similar to those involving patients with progressive muscular disease (PMD), are rare. This paper reports a case study involving the use of Korean medicine to treat a patient with SBMA. Methods: We treated a patient with SBMA with unique symptoms by using various kinds of pharmacopuncture and herbal medicines for about two and a half years. After the treatment had ended, we evaluated the patient’s conditions and the side effects of the treatment. Results: After treatment, the patient’s symptoms were stabilized, and the patient suffered no abnormalities or side effects. No special changes in condition were noted during treatment period, and the patient was very satisfied with his response to treatment. Conclusion: Existing treatments have some considerable after effects and are difficult to apply in domestic clinics. In this regard, our findings should open possibilities for new clinical guidelines. Nevertheless, the limitations associated with this case study should be resolved, and more studies need to be conducted.
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Affiliation(s)
- Seongjin Lee
- Department of Acupuncture & Moxibustion Medicine, Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea; Clinical Research Center of Nervous & Muscular System Disease of Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea
| | - Eunhye Cha
- Department of Acupuncture & Moxibustion Medicine, Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea; Clinical Research Center of Nervous & Muscular System Disease of Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea
| | - Jongcheol Lee
- Department of Acupuncture & Moxibustion Medicine, Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea; Clinical Research Center of Nervous & Muscular System Disease of Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea
| | - Jongdeok Lee
- Department of Radiology, Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea
| | - Inja Song
- Department of Nursing, Gwang-Ju Womens University, Gwangju, Korea
| | - Sungchul Kim
- Department of Acupuncture & Moxibustion Medicine, Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea; Clinical Research Center of Nervous & Muscular System Disease of Wonkwang University Gwangju Korean Medical Hospital, Gwangju, Korea
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Mano T, Katsuno M, Banno H, Suzuki K, Suga N, Hashizume A, Araki A, Hijikata Y, Tanaka S, Takatsu J, Watanabe H, Yamamoto M, Sobue G. Head Lift Exercise Improves Swallowing Dysfunction in Spinal and Bulbar Muscular Atrophy. Eur Neurol 2015; 74:251-8. [DOI: 10.1159/000431088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/03/2015] [Indexed: 11/19/2022]
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20
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Fasciculations in human hereditary disease. Acta Neurol Belg 2015; 115:91-5. [PMID: 25073774 DOI: 10.1007/s13760-014-0335-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/13/2014] [Indexed: 12/11/2022]
Abstract
Fasciculations are a manifestation of peripheral nerve hyperexcitability in addition to myokymia, neuromyotonia, cramps, or tetany. Fasciculations occur in hereditary and non-hereditary diseases. Among the hereditary diseases, fasciculations are most frequently reported in familial amyotrophic lateral sclerosis (FALS), and spinal muscular atrophy (SMA). Among the non-hereditary diseases, fasciculations occur most frequently in peripheral nerve hyperexcitability syndromes (Isaac's syndrome, voltage-gated potassium channelopathy, cramp fasciculation syndrome, Morvan syndrome). If the cause of fasciculations remains unknown, they are called benign. Systematically reviewing the literature about fasciculations in hereditary disease shows that fasciculations can be a phenotypic feature in bulbospinal muscular atrophy (BSMA), GM2-gangliosidosis, triple-A syndrome, or hereditary neuropathy. Additionally, fasciculations have been reported in familial amyloidosis, spinocerebellar ataxias, Huntington's disease, Rett syndrome, central nervous system disease due to L1-cell adhesion molecule (L1CAM) mutations, Fabry's disease, or Gerstmann-Sträussler disease. Rarely, fasciculations may be a phenotypic feature in patients with mitochondrial disorders or other myopathies. Fasciculations are part of the phenotype in much more genetic disorders than commonly assumed. Fasciculations not only occur in motor neuron disease, but also in hereditary neuropathy, spinocerebellar ataxia, GM2-gangliosidosis, Huntington's disease, Rett syndrome, Fabry's disease, Gerstmann-Sträussler disease, mitochondrial disorders, or muscular dystrophies.
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Garaci F, Toschi N, Lanzafame S, Marfia GA, Marziali S, Meschini A, Di Giuliano F, Simonetti G, Guerrisi M, Massa R, Floris R. Brain MR diffusion tensor imaging in Kennedy's disease. Neuroradiol J 2015; 28:126-32. [PMID: 25963157 DOI: 10.1177/1971400915581740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Kennedy's disease (KD) is a progressive degenerative disorder affecting lower motor neurons. We investigated the correlation between disease severity and whole brain white matter microstructure, including upper motor neuron tracts, by using diffusion-tensor imaging (DTI) in eight patients with KD in whom disease severity was evaluated using the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS). METHODS From DTI acquisitions we obtained maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (L1) and radial diffusivities (L2, L3). We then employed tract-based spatial statistics (TBSS) to investigate within-patient correlations of DTI invariants with ALSFRS and disease duration (DD). RESULTS We found a significant correlation between low ALSFRS and 1) low FA values in association commissural and projection fibers, and 2) high L3 values in commissural tracts and fronto-parietal white matter. Additionally, we found a significant association between longer DD and 1) low FA in the genu and body of corpus callosum, association fibers and midbrain and 2) high L1 in projection and association tracts. CONCLUSIONS The associations between clinical variables and white matter microstructural changes in areas thought to be spared by the disease process support the hypothesis of a multisystem involvement in the complex pathogenic mechanisms responsible for the clinical disability of these patients.
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Affiliation(s)
- Francesco Garaci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital Tor Vergata, Italy Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, USA and Harvard Medical School, USA
| | - Simona Lanzafame
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy
| | - Girolama A Marfia
- Department of Systems Medicine, Section Neurology, University of Rome Tor Vergata, Italy
| | - Simone Marziali
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital Tor Vergata, Italy
| | - Alessandro Meschini
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital Tor Vergata, Italy
| | - Francesca Di Giuliano
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital Tor Vergata, Italy
| | - Giovanni Simonetti
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital Tor Vergata, Italy Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy
| | - Maria Guerrisi
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy
| | - Roberto Massa
- Department of Systems Medicine, Section Neurology, University of Rome Tor Vergata, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital Tor Vergata, Italy Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, Italy
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Valera Yepes R, Virgili Casas M, Povedano Panades M, Guerrero Gual M, Villabona Artero C. Enfermedad de Kennedy y resistencia parcial androgénica. Descripción de 4 casos y revisión de la literatura. ACTA ACUST UNITED AC 2015; 62:224-30. [DOI: 10.1016/j.endonu.2015.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 01/14/2023]
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23
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Androgen receptor: structure, role in prostate cancer and drug discovery. Acta Pharmacol Sin 2015; 36:3-23. [PMID: 24909511 PMCID: PMC4571323 DOI: 10.1038/aps.2014.18] [Citation(s) in RCA: 523] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/05/2014] [Indexed: 12/15/2022] Open
Abstract
Androgens and androgen receptors (AR) play a pivotal role in expression of the male phenotype. Several diseases, such as androgen insensitivity syndrome (AIS) and prostate cancer, are associated with alterations in AR functions. Indeed, androgen blockade by drugs that prevent the production of androgens and/or block the action of the AR inhibits prostate cancer growth. However, resistance to these drugs often occurs after 2–3 years as the patients develop castration-resistant prostate cancer (CRPC). In CRPC, a functional AR remains a key regulator. Early studies focused on the functional domains of the AR and its crucial role in the pathology. The elucidation of the structures of the AR DNA binding domain (DBD) and ligand binding domain (LBD) provides a new framework for understanding the functions of this receptor and leads to the development of rational drug design for the treatment of prostate cancer. An overview of androgen receptor structure and activity, its actions in prostate cancer, and how structural information and high-throughput screening have been or can be used for drug discovery are provided herein.
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Cruccu G, Pennisi EM, Antonini G, Biasiotta A, di Stefano G, La Cesa S, Leone C, Raffa S, Sommer C, Truini A. Trigeminal isolated sensory neuropathy (TISN) and FOSMN syndrome: despite a dissimilar disease course do they share common pathophysiological mechanisms? BMC Neurol 2014; 14:248. [PMID: 25527047 PMCID: PMC4301795 DOI: 10.1186/s12883-014-0248-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/11/2014] [Indexed: 12/15/2022] Open
Abstract
Background Patients presenting with bilateral trigeminal hypoesthesia may go on to have trigeminal isolated sensory neuropathy, a benign, purely trigeminal neuropathy, or facial-onset sensory motor neuronopathy (FOSMN), a malignant life-threatening condition. No diagnostic criteria can yet differentiate the two conditions at their onset. Nor is it clear whether the two diseases are distinct entities or share common pathophysiological mechanisms. Methods Seeking pathophysiological and diagnostic information to distinguish these two conditions at their onset, in this neurophysiological and morphometric study we neurophysiologically assessed function in myelinated and unmyelinated fibres and histologically examined supraorbital nerve biopsy specimens with optic and electron microscopy in 13 consecutive patients with recent onset trigeminal hypoesthesia and pain. Results The disease course distinctly differed in the 13 patients. During a mean 10 year follow-up whereas in eight patients the disease remained relatively stable, in the other five it progressed to possibly life-threatening motor disturbances and extra-trigeminal spread. From two to six years elapsed between the first sensory symptoms and the onset of motor disorders. In patients with trigeminal isolated sensory neuropathy (TISN) and in those with FOSMN neurophysiological and histological examination documented a neuronopathy manifesting with trigeminal nerve damage selectively affecting myelinated fibres, but sparing the Ia-fibre-mediated proprioceptive reflex. Conclusions Although no clinical diagnostic criteria can distinguish the two conditions at onset, neurophysiological and nerve-biopsy findings specify that in both disorders trigeminal nerve damage manifests as a dissociated neuronopathy affecting myelinated and sparing unmyelinated fibres, thus suggesting similar pathophysiological mechanisms.
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Affiliation(s)
- Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Elena M Pennisi
- Neurology Division, Neurosciences Department, San Filippo Neri Hospital, Rome, Italy.
| | | | | | - Giulia di Stefano
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Caterina Leone
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Salvatore Raffa
- Cellular Diagnostics Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Rome, Italy.
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany.
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
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25
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Di Rosa E, Sorarù G, Kleinbub JR, Calvo V, Vallesi A, Querin G, Marcato S, Grasso I, Palmieri A. Theory of mind, empathy and neuropsychological functioning in X-linked spinal and bulbar muscular atrophy: a controlled study of 20 patients. J Neurol 2014; 262:394-401. [PMID: 25408365 DOI: 10.1007/s00415-014-7567-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 01/18/2023]
Abstract
Recent studies have described brain involvement, mainly at frontal level, in patients with spinal and bulbar muscular atrophy (SBMA), a rare adult-onset motor neuron disease caused by a CAG repeat in the androgen receptor (AR) gene. The aim of our research was to investigate the poorly characterized neuropsychological and psychological profile of these patients, on the basis of previous literature. We administered a neuropsychological screening and tests relating to cognitive and affective empathy, attributed to the theory of mind (ToM) framework, to 20 males with SBMA, and to age- and education-matched controls. Although patients' neuropsychological performance was unimpaired, a clear dissociation emerged between their cognitive and affective empathy. Patients had distinctive deficits in mentalizing, as assessed with the Faux Pas Test, whilst affective empathy (i.e., sharing experience), assessed with the Reading the Mind in the Eyes test, appeared to be preserved. The likely implications of subtle frontal lobe impairments on the one hand, and a protective influence of androgen insensitivity in these patients on the other, are discussed in the light of our results.
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Affiliation(s)
- Elisa Di Rosa
- Department of General Psychology, University of Padova, Via Venezia 12, 35131, Padua, Italy
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Babin PJ, Goizet C, Raldúa D. Zebrafish models of human motor neuron diseases: advantages and limitations. Prog Neurobiol 2014; 118:36-58. [PMID: 24705136 DOI: 10.1016/j.pneurobio.2014.03.001] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 01/08/2023]
Abstract
Motor neuron diseases (MNDs) are an etiologically heterogeneous group of disorders of neurodegenerative origin, which result in degeneration of lower (LMNs) and/or upper motor neurons (UMNs). Neurodegenerative MNDs include pure hereditary spastic paraplegia (HSP), which involves specific degeneration of UMNs, leading to progressive spasticity of the lower limbs. In contrast, spinal muscular atrophy (SMA) involves the specific degeneration of LMNs, with symmetrical muscle weakness and atrophy. Amyotrophic lateral sclerosis (ALS), the most common adult-onset MND, is characterized by the degeneration of both UMNs and LMNs, leading to progressive muscle weakness, atrophy, and spasticity. A review of the comparative neuroanatomy of the human and zebrafish motor systems showed that, while the zebrafish was a homologous model for LMN disorders, such as SMA, it was only partially relevant in the case of UMN disorders, due to the absence of corticospinal and rubrospinal tracts in its central nervous system. Even considering the limitation of this model to fully reproduce the human UMN disorders, zebrafish offer an excellent alternative vertebrate model for the molecular and genetic dissection of MND mechanisms. Its advantages include the conservation of genome and physiological processes and applicable in vivo tools, including easy imaging, loss or gain of function methods, behavioral tests to examine changes in motor activity, and the ease of simultaneous chemical/drug testing on large numbers of animals. This facilitates the assessment of the environmental origin of MNDs, alone or in combination with genetic traits and putative modifier genes. Positive hits obtained by phenotype-based small-molecule screening using zebrafish may potentially be effective drugs for treatment of human MNDs.
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Affiliation(s)
- Patrick J Babin
- Univ. Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), EA 4576, Talence, France.
| | - Cyril Goizet
- Univ. Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), EA 4576, Talence, France; CHU Bordeaux, Hôpital Pellegrin, Service de Génétique Médicale, Bordeaux, France
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27
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Karapanou O, Vlassopoulou B, Tzanela M, Papadopoulos D, Angelidakis P, Michelakakis H, Ioannidis G, Mihalatos M, Kamakari S, Tsagarakis S. X-linked adrenoleukodystrophy: are signs of hypogonadism always due to testicular failure? Hormones (Athens) 2014; 13:146-52. [PMID: 24722136 DOI: 10.1007/bf03401330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present the clinical and hormonal findings of a young male with X-linked adrenoleukodystrophy (X-ALD), with special emphasis on the biochemical and clinical pattern of hypogonadism. A patient, with primary adrenal insufficiency since the age of 5 years, developed progressive neurological symptoms at the age of 29. Diagnosis of X-ALD was established by elevated serum very long chain fatty acids (VLCFAs) and genetic testing. His sexual body hair was sparse. Hormonal investigations revealed normal testosterone and inappropriately elevated LH levels. Androgen receptor gene analysis was negative for mutations or polymorphic variants associated with decreased receptor activity. Signs of hypogonadism in patients with confirmed X-ALD are not exclusively due to primary testicular failure. Tissue specific androgen resistance represents an alternative possibility. Since no loss-of-function mutations were detected in the androgen receptor, it is speculated that the patient's androgen resistance could be part of a functional defect mediated through VLCFA accumulation at the testosterone receptor and/or post-receptor levels.
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Affiliation(s)
- Olga Karapanou
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | - Barbara Vlassopoulou
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | - Marinella Tzanela
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | | | | | - Helen Michelakakis
- Department of Metabolic Diseases, Institute of Child's Health, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George Ioannidis
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | - Markos Mihalatos
- BioGenomica SA, Center for Genetic Analysis and Research; Athens, Greece
| | - Smaragda Kamakari
- BioGenomica SA, Center for Genetic Analysis and Research; Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
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Diaz-Abad M, Porter NC. Rapidly worsening bulbar symptoms in a patient with spinobulbar muscular atrophy. Neurol Int 2013; 5:e21. [PMID: 24416485 PMCID: PMC3883066 DOI: 10.4081/ni.2013.e21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 11/23/2022] Open
Abstract
X-linked spinobulbar muscular atrophy (Kennedy's disease) affects muscles and motor neurons, manifesting as weakness and wasting of bulbar, facial, and proximal limb muscles due to loss of anterior horn cells in the brain and spinal cord. We present the case of a patient with X-linked spinobulbar muscular atrophy with rapidly worsening bulbar symptoms caused by laryngopharyngeal irritation associated with a viral upper respiratory tract infection, seasonal allergies and laryngopharyngeal reflux, who dramatically improved with multimodality therapy.
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Affiliation(s)
| | - Neil C Porter
- Department of Neurology, Division of Neuromuscular Diseases, University of Maryland School of Medicine , Baltimore, MD, USA
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Kasper E, Wegrzyn M, Marx I, Korp C, Kress W, Benecke R, Teipel SJ, Prudlo J. Minor cognitive disturbances in X-linked spinal and bulbar muscular atrophy, Kennedy's disease. Amyotroph Lateral Scler Frontotemporal Degener 2013; 15:15-20. [PMID: 24200287 DOI: 10.3109/21678421.2013.837927] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Spinal and bulbar muscular atrophy (SBMA), Kennedy's disease, is an adult-onset hereditary neurodegenerative disorder, associated predominantly with a lower motor neuron syndrome and eventually endocrine and sensory disturbances. In contrast to other motor neuron diseases such as amyotrophic lateral sclerosis (ALS), the impairment of cognition in SBMA is not well documented. We conducted a systematic cross-sectional neuropsychological study in order to investigate cognition in SBMA patients more thoroughly. We investigated 20 genetically proven SBMA patients compared to 20 age- and education-matched control subjects using a comprehensive neuropsychological test battery, measuring executive functioning, attention, memory and visuospatial abilities. The SBMA patients performed significantly worse than healthy controls in three sub-tests in the executive and attention domains. This low performance was in the working memory (digit span backward task), verbal fluency category (single letter fluency task) and memory storage capacity (digit span forward task). No disturbances were detected in other cognitive domains. The impairments were subclinical and not relevant to the patients' everyday functioning. In addition, no correlations were found between cognitive scores and the CAG repeat length. In conclusion, we found minor cognitive disturbances in patients with SBMA, which could indicate subtle frontal lobe dysfunction. These findings extend our neurobiological understanding of SBMA.
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Affiliation(s)
- Elisabeth Kasper
- German Centre for Neurodegenerative Diseases (DZNE) , Site Rostock/Greifswald, Rostock
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Beitel LK, Alvarado C, Mokhtar S, Paliouras M, Trifiro M. Mechanisms mediating spinal and bulbar muscular atrophy: investigations into polyglutamine-expanded androgen receptor function and dysfunction. Front Neurol 2013; 4:53. [PMID: 23720649 PMCID: PMC3654311 DOI: 10.3389/fneur.2013.00053] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 04/26/2013] [Indexed: 11/13/2022] Open
Abstract
Spinal and bulbar muscular atrophy (SBMA, Kennedy’s disease), a late-onset neuromuscular disorder, is caused by expansion of the polymorphic polyglutamine tract in the androgen receptor (AR). The AR is a ligand-activated transcription factor, but plays roles in other cellular pathways. In SBMA, selective motor neuron degeneration occurs in the brainstem and spinal cord, thus the causes of neuronal dysfunction have been studied. However, pathogenic pathways in muscles may also be involved. Cultured cells, fly and mouse models are used to study the molecular mechanisms leading to SBMA. Both the structure of the polyglutamine-expanded AR (polyQ AR) and its interactions with other proteins are altered relative to the normal AR. The ligand-dependent translocation of the polyQ AR to the nucleus appears to be critical, as are interdomain interactions. The polyQ AR, or fragments thereof, can form nuclear inclusions, but their pathogenic or protective nature is unclear. Other data suggests soluble polyQ AR oligomers can be harmful. Post-translational modifications such as phosphorylation, acetylation, and ubiquitination influence AR function and modulate the deleterious effects of the polyQ AR. Transcriptional dysregulation is highly likely to be a factor in SBMA; deregulation of non-genomic AR signaling may also be involved. Studies on polyQ AR-protein degradation suggest inhibition of the ubiquitin proteasome system and changes to autophagic pathways may be relevant. Mitochondrial function and axonal transport may also be affected by the polyQ AR. Androgens, acting through the AR, can be neurotrophic and are important in muscle development; hence both loss of normal AR functions and gain of novel harmful functions by the polyQ AR can contribute to neurodegeneration and muscular atrophy. Thus investigations into polyQ AR function have shown that multiple complex mechanisms lead to the initiation and progression of SBMA.
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Affiliation(s)
- Lenore K Beitel
- Lady Davis Institute for Medical Research, Jewish General Hospital Montreal, QC, Canada ; Department of Medicine, McGill University Montreal, QC, Canada ; Department of Human Genetics, McGill University Montreal, QC, Canada
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How do C9ORF72 repeat expansions cause amyotrophic lateral sclerosis and frontotemporal dementia: can we learn from other noncoding repeat expansion disorders? Curr Opin Neurol 2013; 25:689-700. [PMID: 23160421 DOI: 10.1097/wco.0b013e32835a3efb] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe disease mechanisms by which chromosome 9 open reading frame 72 (C9ORF72) repeat expansions could lead to amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) and to discuss these diseases in relation to other noncoding repeat expansion disorders. RECENT FINDINGS ALS and FTD are complex neurodegenerative disorders with a considerable clinical and pathological overlap, and this overlap is further substantiated by the recent discovery of C9ORF72 repeat expansions. These repeat expansions are currently the most important genetic cause of familial ALS and FTD, accounting for approximately 34.2 and 25.9% of the cases. Clinical phenotypes associated with these repeat expansions are highly variable, and combinations with mutations in other ALS-associated and/or FTD-associated genes may contribute to this pleiotropy. It is challenging, however, to diagnose patients with C9ORF72 expansions, not only because of large repeat sizes, but also due to somatic heterogeneity. Most other noncoding repeat expansion disorders share an RNA gain-of-function disease mechanism, a mechanism that could underlie the development of ALS and/or FTD as well. SUMMARY The discovery of C9ORF72 repeat expansions provides novel insights into the pathogenesis of ALS and FTD and highlights the importance of noncoding repeat expansions and RNA toxicity in neurodegenerative diseases.
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Abstract
The misdiagnosis of MND (particularly of the ALS phenotype), is uncommon. Atypical presentations, particularly of focal onset and with pure LMN or UMN signs, present a more difficult diagnostic challenge, although perhaps reassuringly, treatable mimics are rare. A working knowledge of potential alternative conditions and MND diagnostic pitfalls should help to reduce the misdiagnosis rate, particularly if the key points are considered.
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Abstract
Amyotrophic lateral sclerosis (ALS), the most common adult motor neuron disease, is an acquired disorder that results in loss of function in multiple domains. Although there is no treatment that can halt or reverse this progressive condition, there are many opportunities for interventions that can lead to improved quality of life for the patient and caregiver. Physical and occupational therapy can assist with mobility and activities of daily living. Interventions by speech pathology can optimize nutrition and communication. Respiratory function can be managed noninvasively or invasively. Depression, hopelessness, anxiety, and other mental health issues can and should be aggressively addressed and treated. Many symptoms such as pseudobulbar affect, sialorrhea, constipation, spasticity, and cramps can be treated effectively with medications. Spirituality and religion are important issues to address, as are end-of-life concerns, including advance directives, hospice, and the dying process. In contrast to the discouraging view that "there is nothing we can do," a broad approach to management, through collaboration with a multidisciplinary team, will permit the ALS physician to make a meaningful difference in the lives of individuals living with ALS.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Abstract
Androgen insensitivity syndrome in its complete form is a disorder of hormone resistance characterised by a female phenotype in an individual with an XY karyotype and testes producing age-appropriate normal concentrations of androgens. Pathogenesis is the result of mutations in the X-linked androgen receptor gene, which encodes for the ligand-activated androgen receptor--a transcription factor and member of the nuclear receptor superfamily. This Seminar describes the clinical manifestations of androgen insensitivity syndrome from infancy to adulthood, reviews the mechanism of androgen action, and shows examples of how mutations of the androgen receptor gene cause the syndrome. Management of androgen insensitivity syndrome should be undertaken by a multidisciplinary team and include gonadectomy to avoid gonad tumours in later life, appropriate sex-hormone replacement at puberty and beyond, and an emphasis on openness in disclosure.
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Affiliation(s)
- Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK.
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Skoretz SA, Yee MS, Martino R. Complications after cardiovascular surgery in a case of undiagnosed spinal-bulbar muscular atrophy (Kennedy disease). Am J Crit Care 2012; 21:139-8. [PMID: 22381992 DOI: 10.4037/ajcc2012453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Neurodegenerative diseases are often associated with life-threatening declines in respiratory and swallowing mechanisms. We report the case of a 70-year-old man who had postoperative dysphagia and respiratory failure that required reintubation after coronary artery bypass surgery. Impairment of the patient's speech, swallowing, and respiratory mechanisms identified during postoperative clinical and instrumental examinations was suggestive of a neurodegenerative disease. Genetic testing confirmed a diagnosis of spinal-bulbar muscular atrophy (Kennedy disease). This case report aims to highlight increased morbidity in patients with undiagnosed neuromuscular disorders in the critical care setting and the benefits of vigilant postoperative monitoring and multidisciplinary involvement throughout the care of complex patients.
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Affiliation(s)
- Stacey A. Skoretz
- Stacey A. Skoretz is a doctoral candidate in the Department of Speech-Language Pathology at the University of Toronto in Ontario, Canada. May-Sann Yee is an anesthesiologist at Southlake Regional Health Centre in Newmarket, Ontario, Canada. Rosemary Martino is an associate professor in the Department of Speech-Language Pathology at the University of Toronto and an affiliated scientist at the Toronto Western Research Institute, University Health Network in Toronto, Ontario, Canada
| | - May-Sann Yee
- Stacey A. Skoretz is a doctoral candidate in the Department of Speech-Language Pathology at the University of Toronto in Ontario, Canada. May-Sann Yee is an anesthesiologist at Southlake Regional Health Centre in Newmarket, Ontario, Canada. Rosemary Martino is an associate professor in the Department of Speech-Language Pathology at the University of Toronto and an affiliated scientist at the Toronto Western Research Institute, University Health Network in Toronto, Ontario, Canada
| | - Rosemary Martino
- Stacey A. Skoretz is a doctoral candidate in the Department of Speech-Language Pathology at the University of Toronto in Ontario, Canada. May-Sann Yee is an anesthesiologist at Southlake Regional Health Centre in Newmarket, Ontario, Canada. Rosemary Martino is an associate professor in the Department of Speech-Language Pathology at the University of Toronto and an affiliated scientist at the Toronto Western Research Institute, University Health Network in Toronto, Ontario, Canada
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Toxic and non-toxic aggregates from the SBMA and normal forms of androgen receptor have distinct oligomeric structures. Biochim Biophys Acta Mol Basis Dis 2012; 1822:1070-8. [PMID: 22366762 DOI: 10.1016/j.bbadis.2012.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/20/2012] [Accepted: 02/08/2012] [Indexed: 11/24/2022]
Abstract
Hormone-dependent aggregation of the androgen receptor (AR) with a polyglutamine (polyQ) stretch amplification (>38) is considered to be the causative agent of the neurodegenerative disorder spinal and bulbar muscular atrophy (SBMA), consistent with related neurodegenerative diseases involving polyQ-extended proteins. In spite of the widespread acceptance of this common causal hypothesis, little attention has been paid to its apparent incompatibility with the observation of AR aggregation in healthy individuals with no polyQ stretch amplification. Here we used atomic force microscopy (AFM) to characterize sub-micrometer scale aggregates of the wild-type (22 glutamines) and the SBMA form (65 glutamines), as well as a polyQ deletion mutant (1 glutamine) and a variant with a normal length polyQ stretch but with a serine to alanine double mutation elsewhere in the protein. We used a baculovirus-insect cell expression system to produce full-length proteins for these structural analyses. We related the AFM findings to cytotoxicity as measured by expression of the receptors in Drosophila motoneurons or in neuronal cells in culture. We found that the pathogenic AR mutants formed oligomeric fibrils up to 300-600nm in length. These were clearly different from annular oligomers 120-180nm in diameter formed by the nonpathogenic receptors. We could also show that melatonin, which is known to ameliorate the pathological phenotype in the fly model, caused polyQ-extended AR to form annular oligomers. Further comparative investigation of these reproducibly distinct toxic and non-toxic oligomers could advance our understanding of the molecular basis of the polyQ pathologies.
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Parada-Bustamante A, Lardone MC, Madariaga M, Johnson MC, Codner E, Cassorla F, Castro A. Androgen receptor CAG and GGN polymorphisms in boys with isolated hypospadias. J Pediatr Endocrinol Metab 2012; 25:157-62. [PMID: 22570967 DOI: 10.1515/jpem.2011.379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The etiology of hypospadias is multifactorial. Abnormal androgenic secretion and/or action during the development of external genitalia may be involved in the etiology of this congenital malformation. This study explored CAG and GGN polymorphisms in the androgen receptor (AR) gene, which may affect its transcriptional activity, in patients with isolated hypospadias. METHODS The length of the CAG/GGN polymorphisms was determined in 44 boys with non-severe (glandular) or severe (penile or penoscrotal) isolated hypospadias and with a normal hormonal evaluation. In addition, 79 healthy men, as controls, were studied. RESULTS Mean CAG repeats were significantly higher in total and severe cases compared to controls (24.4 +/- 2.8 and 24.7 +/- 3.1 vs. 22.7 +/- 3.3, respectively; p<0.05, Student's t and Bonferroni test). In addition, a frequency of CAG alleles >23 was significantly different in total and severe cases compared to controls (70.5% and 74.1% vs. 39.2%, respectively, p<0.05, chi2 and Bonferroni test). The median number and the distribution of GGN polymorphisms were similar in cases and controls. CONCLUSION Boys with isolated hypospadias have longer CAG alleles in their AR, which may be related with the development of this congenital malformation.
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Affiliation(s)
- Alexis Parada-Bustamante
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Schrijvers EMC, Schürmann B, Koudstaal PJ, van den Bussche H, Van Duijn CM, Hentschel F, Heun R, Hofman A, Jessen F, Kölsch H, Kornhuber J, Peters O, Rivadeneira F, Rüther E, Uitterlinden AG, Riedel-Heller S, Dichgans M, Wiltfang J, Maier W, Breteler MMB, Ikram MA. Genome-wide association study of vascular dementia. Stroke 2011; 43:315-9. [PMID: 22116812 DOI: 10.1161/strokeaha.111.628768] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Most studies investigating the genetics of dementia have focused on Alzheimer disease, but little is known about the genetics of vascular dementia. The aim of our study was to identify new loci associated with vascular dementia. METHODS We performed a genome-wide association study in the Rotterdam Study, a large prospective population-based cohort study in the Netherlands. We sought to replicate genome-wide significant loci in 2 independent replication samples. RESULTS In the discovery analysis of 5700 dementia-free individuals, 67 patients developed incident vascular dementia over a mean follow-up time of 9.3 ± 3.2 years. We showed genome-wide significance for rs12007229, which is located on the X chromosome near the androgen receptor gene (OR, 3.7; 95% CI, 2.3-5.8, per copy of the minor allele; P=1.3 × 10(-8)). This association was further confirmed in 2 independent populations (probability value of combined replication samples=0.024). CONCLUSIONS Our study shows a novel genetic locus for vascular dementia on the X chromosome. Further replication of this finding is required.
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Shoesmith C. Approach to Diseases of the Motor Neurons. Neuromuscul Disord 2011. [DOI: 10.1002/9781119973331.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Praline J, Blasco H, Vourc'h P, Garrigue MA, Gordon PH, Camu W, Corcia P, Andres CR. APOE ε4 allele is associated with an increased risk of bulbar-onset amyotrophic lateral sclerosis in men. Eur J Neurol 2011; 18:1046-52. [PMID: 21251163 DOI: 10.1111/j.1468-1331.2010.03330.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Several association studies have identified possible susceptibility factors for sporadic amyotrophic lateral sclerosis (SALS). Studies on the APOE gene provided conflicting results, especially about the effect on bulbar onset. We assessed the possible role of APOE gene in a large cohort of patients with ALS and matched controls. METHODS The APOE alleles were determined in 1482 patients with SALS and 955 controls and analysed by univariate and multivariate statistics, taking into account gender, site-of-onset and age-at-onset. RESULTS Patients with bulbar onset were more likely to be women [odds ratio (OR)=2.17; 95% CI: 1.74-2.72] and to be older (OR=3.47; 95% CI: 2.58-4.67). The ε4-carriers were more frequent in the bulbar-onset group than in the limb-onset group (OR=1.39 bulbar onset versus limb onset; 95% CI: 1.08-1.80) but this association was observed amongst men (OR=1.78; 95% CI: 1.25-2.53) and not women (OR=1.09; 95% CI: 0.75-1.59). CONCLUSION Our study provides evidence for a contribution of the ε4 allele in the occurrence of bulbar-onset ALS amongst men. We propose that men are normally protected by androgens against bulbar onset and that the ε4 allele inhibits this protection, perhaps by interfering with the androgen pathway.
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Affiliation(s)
- J Praline
- UMR INSERM U930, Université François-Rabelais, Tours Centre SLA, Service de Neurologie et Neurophysiologie Clinique, CHRU de Tours, Tours Cedex 2, France.
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Dias FA, Munhoz RP, Raskin S, Werneck LC, Teive HAG. Tremor in X-linked recessive spinal and bulbar muscular atrophy (Kennedy's disease). Clinics (Sao Paulo) 2011; 66:955-7. [PMID: 21808858 PMCID: PMC3129962 DOI: 10.1590/s1807-59322011000600006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 02/25/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To study tremor in patients with X-linked recessive spinobulbar muscular atrophy or Kennedy's disease. METHODS Ten patients (from 7 families) with a genetic diagnosis of Kennedy's disease were screened for the presence of tremor using a standardized clinical protocol and followed up at a neurology outpatient clinic. All index patients were genotyped and showed an expanded allele in the androgen receptor gene. RESULTS Mean patient age was 37.6 years and mean number of CAG repeats 47 (44-53). Tremor was present in 8 (80%) patients and was predominantly postural hand tremor. Alcohol responsiveness was detected in 7 (88%) patients with tremor, who all responded well to treatment with a β-blocker (propranolol). CONCLUSION Tremor is a common feature in patients with Kennedy's disease and has characteristics similar to those of essential tremor.
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Affiliation(s)
- Francisco A Dias
- Neurology Service, Internal Medicine Department, Hospital de Clínicas, University of Paraná, Curitiba, PR, Brazil
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Simmons BJ, Cohen TJ, Bedlack R, Yao TP. HDACs in skeletal muscle remodeling and neuromuscular disease. Handb Exp Pharmacol 2011; 206:79-101. [PMID: 21879447 DOI: 10.1007/978-3-642-21631-2_5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Skeletal muscle is made of heterogeneous myofibers with different contractile and metabolic properties. The diverse functionality of myofibers enables skeletal muscle to carry out different tasks from maintaining body posture to performing active movements. In addition to motility, skeletal muscle, which constitutes 40% of body mass, is also a key target of insulin action and performs an essential function in glucose metabolism. Adult skeletal muscle is a highly adaptive organ system and can undergo specific changes in contractile and metabolic properties to meet different functional demands. This plasticity of myofibers reflects a highly coordinated change in gene expression program that is controlled by neural activity. The capacity for on-demand remodeling confers skeletal muscle the remarkable adaptability important for animal survival; its dysregulation, however, could contribute to muscle and metabolic diseases. How neural activity dictates transcriptional programming to modify muscle functionality and diversity is a fundamental issue. Recent studies have identified members of class IIa HDACs as important effectors in both physiological and pathological muscle remodeling. By way of modifying myofiber properties, pharmacological manipulation of IIa HDACs activity could have potential therapeutic utility in the treatment of muscle disorders.
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Affiliation(s)
- Bryan J Simmons
- Department of Pharmacology and Cancer Biology, Duke University, C325 LSRC, DUMC, 3813, Durham, NC 27710, USA
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Bélénotti P, Benyamine A, Bensahla H, Ene N, Sevy A, Attarian S, Serratrice J, Pouget J, Weiller PJ, Krolak-Salmon P. [Bilateral xerophthalmia in a 60-year-old man]. Rev Med Interne 2010; 31:784-7. [PMID: 20889242 DOI: 10.1016/j.revmed.2010.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 08/16/2010] [Indexed: 11/19/2022]
Affiliation(s)
- P Bélénotti
- Service de médecine interne, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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Ranganathan S, Fischbeck KH. Therapeutic approaches to spinal and bulbar muscular atrophy. Trends Pharmacol Sci 2010; 31:523-7. [PMID: 20863580 PMCID: PMC2963653 DOI: 10.1016/j.tips.2010.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 12/01/2022]
Abstract
Spinal and bulbar muscular atrophy is a hereditary motor neuron disease caused by trinucleotide repeat expansion in the androgen receptor gene. The disease mechanism probably involves a toxic gain of function in the mutant protein, because other mutations that cause a loss of androgen receptor function result in a different phenotype and the mutant protein is toxic in mouse models. In these models, the toxicity is ligand-dependent and is associated with protein aggregation, as well as altered transcriptional regulation, axonal transport and mitochondrial function. Various therapeutic approaches have shown efficacy in mouse models, including androgen reduction, heat shock protein 90 (HSP90) inhibition and insulin-like growth factor (IGF)-1 overexpression. Clinical trials of androgen-reducing agents have had mixed results, with indications of efficacy but no proof of clinically meaningful benefit to date. These clinical studies have established outcome measures for future trials of other agents that have been beneficial in animal studies.
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Affiliation(s)
- Srikanth Ranganathan
- Neuronal Survival Unit, Wallenberg Neuroscience Center, Lund University, BMC A10, 221 84 Lund, Sweden
| | - Kenneth H. Fischbeck
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
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