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van Prooije TH, Kapteijns KCJ, van Asten JJA, IntHout J, Verbeek MM, Scheenen TWJ, van de Warrenburg BP. Multimodal, Longitudinal Profiling of SCA1 Identifies Predictors of Disease Severity and Progression. Ann Neurol 2024. [PMID: 39096063 DOI: 10.1002/ana.27032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Spinocerebellar ataxia type 1 (SCA1) is a rare autosomal dominant neurodegenerative disease. Objective surrogate markers sensitive to detect changes in disease severity are needed to reduce sample sizes in interventional trials and identification of predictors of faster disease progression would facilitate patient selection, enrichment, or stratification in such trials. METHODS We performed a prospective 1-year longitudinal, multimodal study in 34 ataxic SCA1 individuals and 21 healthy controls. We collected clinical, patient-reported outcomes, biochemical and magnetic resonance (MR) biomarkers at baseline and after 1 year. We determined 1-year progression and evaluated the potential predictive value of several baseline markers on 1-year disease progression. RESULTS At baseline, multiple structural and spectroscopic MR markers in pons and cerebellum differentiated SCA1 from healthy controls and correlated with disease severity. Plasma and cerebrospinal fluid (CSF) neurofilament light (NfL) chain and CSF glial fibrillary acidic protein (GFAP) were elevated in SCA1. In longitudinal analysis, total brainstem and pontine volume change, inventory of non-ataxia signs (INAS) count, and SCA functional index (SCAFI) showed larger responsiveness compared to the Scale for Assessment and Rating of Ataxia (SARA). Longer disease duration, longer non-expanded CAG repeat length, and higher disease burden were associated with faster SARA increase after 1-year in the SCA1 group. Similarly, lower baseline brainstem, pontine, and cerebellar volumes, as well as lower levels of N-acetylaspartate and glutamate in the cerebellar white matter, were also associated with faster SARA increase. INTERPRETATION Our results guide the selection of the most sensitive measures of disease progression in SCA1 and have identified features associated with accelerated progression that could inform the design of clinical trials. ANN NEUROL 2024.
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Affiliation(s)
- Teije H van Prooije
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kirsten C J Kapteijns
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jack J A van Asten
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
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2
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Ilg W, Milne S, Schmitz-Hübsch T, Alcock L, Beichert L, Bertini E, Mohamed Ibrahim N, Dawes H, Gomez CM, Hanagasi H, Kinnunen KM, Minnerop M, Németh AH, Newman J, Ng YS, Rentz C, Samanci B, Shah VV, Summa S, Vasco G, McNames J, Horak FB. Quantitative Gait and Balance Outcomes for Ataxia Trials: Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Biomarkers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1566-1592. [PMID: 37955812 PMCID: PMC11269489 DOI: 10.1007/s12311-023-01625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
With disease-modifying drugs on the horizon for degenerative ataxias, ecologically valid, finely granulated, digital health measures are highly warranted to augment clinical and patient-reported outcome measures. Gait and balance disturbances most often present as the first signs of degenerative cerebellar ataxia and are the most reported disabling features in disease progression. Thus, digital gait and balance measures constitute promising and relevant performance outcomes for clinical trials.This narrative review with embedded consensus will describe evidence for the sensitivity of digital gait and balance measures for evaluating ataxia severity and progression, propose a consensus protocol for establishing gait and balance metrics in natural history studies and clinical trials, and discuss relevant issues for their use as performance outcomes.
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Affiliation(s)
- Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
| | - Sarah Milne
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Melbourne University, Melbourne, VIC, Australia
- Physiotherapy Department, Monash Health, Clayton, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center for Molecular Medicine and Charité, Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Lukas Beichert
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Enrico Bertini
- Research Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, IRCCS, Rome, Italy
| | | | - Helen Dawes
- NIHR Exeter BRC, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Hasmet Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1)), Research Centre Juelich, Juelich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jane Newman
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Clara Rentz
- Institute of Neuroscience and Medicine (INM-1)), Research Centre Juelich, Juelich, Germany
| | - Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Precision Motion, Clario, Portland, OR, USA
| | - Susanna Summa
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gessica Vasco
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - James McNames
- APDM Precision Motion, Clario, Portland, OR, USA
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Precision Motion, Clario, Portland, OR, USA
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3
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Grisoli M, Nigri A, Medina Carrion JP, Palermo S, Demichelis G, Giacosa C, Mongelli A, Fichera M, Nanetti L, Mariotti C. Tracking longitudinal thalamic volume changes during early stages of SCA1 and SCA2. LA RADIOLOGIA MEDICA 2024; 129:1215-1223. [PMID: 38954239 PMCID: PMC11322486 DOI: 10.1007/s11547-024-01839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Spinocerebellar ataxia SCA1 and SCA2 are adult-onset hereditary disorders, due to triplet CAG expansion in their respective causative genes. The pathophysiology of SCA1 and SCA2 suggests alterations of cerebello-thalamo-cortical pathway and its connections to the basal ganglia. In this framework, thalamic integrity is crucial for shaping efficient whole-brain dynamics and functions. The aims of the study are to identify structural changes in thalamic nuclei in presymptomatic and symptomatic SCA1 and SCA2 patients and to assess disease progression within a 1-year interval. MATERIAL AND METHODS A prospective 1-year clinical and MRI assessment was conducted in 27 presymptomatic and 23 clinically manifest mutation carriers for SCA1 and SCA2 expansions. Cross-sectional and longitudinal changes of thalamic nuclei volume were investigated in SCA1 and SCA2 individuals and in healthy participants (n = 20). RESULTS Both SCA1 and SCA2 patients had significant atrophy in the majority of thalamic nuclei, except for the posterior and partly medial nuclei. The 1-year longitudinal evaluation showed a specific pattern of atrophy in ventral and posterior thalamus, detectable even at the presymptomatic stage of the disease. CONCLUSION For the first time in vivo, our exploratory study has shown that different thalamic nuclei are involved at different stages of the degenerative process in both SCA1 and SCA2. It is therefore possible that thalamic alterations might significantly contribute to the progression of the disease years before overt clinical manifestations occur.
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Affiliation(s)
- Marina Grisoli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
| | - Anna Nigri
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy.
| | - Jean Paul Medina Carrion
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
| | - Sara Palermo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Greta Demichelis
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
| | - Chiara Giacosa
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
| | - Alessia Mongelli
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Fichera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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4
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Chen TX, Casey HL, Lin CYR, Boyle TA, Schmahmann JD, L'Italien GJ, Kuo SH, Gomez CM. Early-Life Social Determinants of SCA6 Age at Onset, Severity, and Progression. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1449-1456. [PMID: 38217689 PMCID: PMC11269368 DOI: 10.1007/s12311-023-01655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
SCA6 patients with the same size CAG repeat allele can vary significantly in age at onset (AAO) and clinical progression. The specific external factors affecting SCA6 have yet to be investigated. We assessed the effect of early life events on AAO, severity, and progression in SCA6 patients using a social determinant of health approach. We performed a survey of biological and social factors in SCA6 patients enrolled in the SCA6 Network at the University of Chicago. AAO of ataxia symptoms and patient-reported outcome measure (PROM) of ataxia were used as primary outcome measures. Least absolute shrinkage and selection operation (LASSO) regressions were used to identify which early life factors are predictive of SCA6 AAO, severity, and progression. Multiple linear regression models were then used to assess the degree to which these determinants influence SCA6 health outcomes. A total of 105 participants with genetically confirmed SCA6 completed the assessments. SCA6 participants with maternal difficulty during pregnancy, active participation in school sports, and/or longer CAG repeats were determined to have earlier AAO. We found a 13.44-year earlier AAO for those with maternal difficulty in pregnancy than those without (p = 0.008) and a 12.31-year earlier AAO for those active in school sports than those who were not (p < 0.001). Higher education attainment was associated with decreased SCA6 severity and slower progression. Early life biological and social factors can have a strong influence on the SCA6 disease course, indicating that non-genetic factors can contribute significantly to SCA6 health outcomes.
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Affiliation(s)
- Tiffany X Chen
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Hannah L Casey
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Theresa A Boyle
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA
| | - Jeremy D Schmahmann
- Department of Neurology, Massachusetts General Hospital, Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Gilbert J L'Italien
- Global Health Outcomes and Epidemiology, Biohaven Pharmaceuticals, New Haven, CT, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA.
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5
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Weber JJ, Czisch L, Pereira Sena P, Fath F, Huridou C, Schwarz N, Incebacak Eltemur RD, Würth A, Weishäupl D, Döcker M, Blumenstock G, Martins S, Sequeiros J, Rouleau GA, Jardim LB, Saraiva-Pereira ML, França MC, Gordon CR, Zaltzman R, Cornejo-Olivas MR, van de Warrenburg BPC, Durr A, Brice A, Bauer P, Klockgether T, Schöls L, Riess O, Schmidt T. The parkin V380L variant is a genetic modifier of Machado-Joseph disease with impact on mitophagy. Acta Neuropathol 2024; 148:14. [PMID: 39088078 PMCID: PMC11294389 DOI: 10.1007/s00401-024-02762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024]
Abstract
Machado-Joseph disease (MJD) is an autosomal dominant neurodegenerative spinocerebellar ataxia caused by a polyglutamine-coding CAG repeat expansion in the ATXN3 gene. While the CAG length correlates negatively with the age at onset, it accounts for approximately 50% of its variability only. Despite larger efforts in identifying contributing genetic factors, candidate genes with a robust and plausible impact on the molecular pathogenesis of MJD are scarce. Therefore, we analysed missense single nucleotide polymorphism variants in the PRKN gene encoding the Parkinson's disease-associated E3 ubiquitin ligase parkin, which is a well-described interaction partner of the MJD protein ataxin-3, a deubiquitinase. By performing a correlation analysis in the to-date largest MJD cohort of more than 900 individuals, we identified the V380L variant as a relevant factor, decreasing the age at onset by 3 years in homozygous carriers. Functional analysis in an MJD cell model demonstrated that parkin V380L did not modulate soluble or aggregate levels of ataxin-3 but reduced the interaction of the two proteins. Moreover, the presence of parkin V380L interfered with the execution of mitophagy-the autophagic removal of surplus or damaged mitochondria-thereby compromising cell viability. In summary, we identified the V380L variant in parkin as a genetic modifier of MJD, with negative repercussions on its molecular pathogenesis and disease age at onset.
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Affiliation(s)
- Jonasz J Weber
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
- Department of Human Genetics, Ruhr University Bochum, 44801, Bochum, Germany
| | - Leah Czisch
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Priscila Pereira Sena
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Florian Fath
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
- Department of Human Genetics, Ruhr University Bochum, 44801, Bochum, Germany
| | - Chrisovalantou Huridou
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
- Department of Human Genetics, Ruhr University Bochum, 44801, Bochum, Germany
| | - Natasa Schwarz
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Rana D Incebacak Eltemur
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
- Department of Human Genetics, Ruhr University Bochum, 44801, Bochum, Germany
| | - Anna Würth
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Daniel Weishäupl
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Miriam Döcker
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, 72076, Tübingen, Germany
| | - Sandra Martins
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology, University of Porto, 4200-135, Porto, Portugal
| | - Jorge Sequeiros
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, 4050-313, Porto, Portugal
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery and The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, H3A 1A1, Canada
| | - Laura Bannach Jardim
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, 90035-903, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, 90035-003, Brazil
| | - Marcondes C França
- Universidade Estadual de Campinas (UNICAMP), Campinas, 13083-970, Brazil
| | - Carlos R Gordon
- Department of Neurology, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Roy Zaltzman
- Department of Neurology, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Mario R Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 15003, Lima, Peru
- Neurogenetics Working Group, Universidad Científica del Sur, 15067, Lima, Peru
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, 6525, Nijmegen, The Netherlands
| | - Alexandra Durr
- Department of Genetics and Cytogenetics, 4 AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, University Hospital Pitié-Salpêtrière, 75013, Paris, France
| | - Alexis Brice
- Department of Genetics and Cytogenetics, 4 AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, University Hospital Pitié-Salpêtrière, 75013, Paris, France
| | - Peter Bauer
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
- Centogene GmbH, 18055, Rostock, Germany
- Clinic for Internal Medicine, Department of Hematology, Oncology, Palliative Medicine, University Medicine Rostock, 18057, Rostock, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), 53127, Bonn, Germany
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Ludger Schöls
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076, Tübingen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany
| | - Thorsten Schmidt
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076, Tübingen, Germany.
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6
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Rezende TJR, Petit E, Park YW, Tezenas du Montcel S, Joers JM, DuBois JM, Moore Arnold H, Povazan M, Banan G, Valabregue R, Ehses P, Faber J, Coupé P, Onyike CU, Barker PB, Schmahmann JD, Ratai EM, Subramony SH, Mareci TH, Bushara KO, Paulson H, Klockgether T, Durr A, Ashizawa T, Lenglet C, Öz G. Sensitivity of Advanced Magnetic Resonance Imaging to Progression over Six Months in Early Spinocerebellar Ataxia. Mov Disord 2024. [PMID: 39056163 DOI: 10.1002/mds.29934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/11/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Clinical trials for upcoming disease-modifying therapies of spinocerebellar ataxias (SCA), a group of rare movement disorders, lack endpoints sensitive to early disease progression, when therapeutics will be most effective. In addition, regulatory agencies emphasize the importance of biological outcomes. OBJECTIVES READISCA, a transatlantic clinical trial readiness consortium, investigated whether advanced multimodal magnetic resonance imaging (MRI) detects pathology progression over 6 months in preataxic and early ataxic carriers of SCA mutations. METHODS A total of 44 participants (10 SCA1, 25 SCA3, and 9 controls) prospectively underwent 3-T MR scanning at baseline and a median [interquartile range] follow-up of 6.2 [5.9-6.7] months; 44% of SCA participants were preataxic. Blinded analyses of annual changes in structural, diffusion MRI, MR spectroscopy, and the Scale for Assessment and Rating of Ataxia (SARA) were compared between groups using nonparametric testing. Sample sizes were estimated for 6-month interventional trials with 50% to 100% treatment effect size, leveraging existing large cohort data (186 SCA1, 272 SCA3) for the SARA estimate. RESULTS Rate of change in microstructural integrity (decrease in fractional anisotropy, increase in diffusivities) in the middle cerebellar peduncle, corona radiata, and superior longitudinal fasciculus significantly differed in SCAs from controls (P < 0.005), with high effect sizes (Cohen's d = 1-2) and moderate-to-high responsiveness (|standardized response mean| = 0.6-0.9) in SCAs. SARA scores did not change, and their rate of change did not differ between groups. CONCLUSIONS Diffusion MRI is sensitive to disease progression at very early-stage SCA1 and SCA3 and may provide a >5-fold reduction in sample sizes relative to SARA as endpoint for 6-month-long trials. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thiago J R Rezende
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Emilien Petit
- Sorbonne Université, Paris Brain Institute, Inserm, INRIA, CNRS, APHP, Paris, France
| | - Young Woo Park
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - James M Joers
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Michal Povazan
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Guita Banan
- Norman Fixel Center for Neurological Disorders, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Romain Valabregue
- Sorbonne Université, Paris Brain Institute, Inserm, INRIA, CNRS, APHP, Paris, France
| | - Philipp Ehses
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Pierrick Coupé
- Laboratoire Bordelais de Recherche en Informatique, Université de Bordeaux, Talence, France
| | - Chiadi U Onyike
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Peter B Barker
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Jeremy D Schmahmann
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Ataxia Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eva-Maria Ratai
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sub H Subramony
- Norman Fixel Center for Neurological Disorders, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas H Mareci
- Norman Fixel Center for Neurological Disorders, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Khalaf O Bushara
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, Inserm, INRIA, CNRS, APHP, Paris, France
| | - Tetsuo Ashizawa
- Department of Neurology, The Houston Methodist Research Institute, Houston, Texas, USA
| | - Christophe Lenglet
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gülin Öz
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
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Moura J, Oliveira J, Santos M, Costa S, Silva L, Lemos C, Barros J, Sequeiros J, Damásio J. Spinocerebellar Ataxias: Phenotypic Spectrum of PolyQ versus Non-Repeat Expansion Forms. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01723-9. [PMID: 39048885 DOI: 10.1007/s12311-024-01723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Spinocerebellar ataxias (SCA) are most frequently due to (CAG)n (coding for polyglutamine, polyQ) expansions and, less so, to expansion of other oligonucleotide repeats (non-polyQ) or other type of variants (non-repeat expansion SCA). In this study we compared polyQ and non-repeat expansion SCA, in a cohort of patients with hereditary ataxia followed at a tertiary hospital. From a prospective study, 88 patients (51 families) with SCA were selected, 74 (40 families) of whom genetically diagnosed. Thirty-eight patients (51.4%, 19 families) were confirmed as having a polyQ (no other repeat-expansions were identified) and 36 (48.6%, 21 families) a non-repeat expansion SCA. Median age-at-onset was 39.5 [30.0-45.5] for polyQ and 7.0 years [1.00-21.50] for non-repeat expansion SCA. PolyQ SCA were associated with cerebellar onset, and non-repeat expansion forms with non-cerebellar onset. Time to diagnosis was longer for non-repeat expansion SCA. The most common polyQ SCA were Machado-Joseph disease (MJD/SCA3) (73.7%) and SCA2 (15.8%); whereas in non-repeat expansion SCA ATX-CACNA1A (14.3%), ATP1A3-related ataxia, ATX-ITPR1, ATX/HSP-KCNA2, and ATX-PRKCG (9.5% each) predominated. Disease duration (up to inclusion) was significantly higher in non-repeat expansion SCA, but the difference in SARA score was not statistically significant. Cerebellar peduncles and pons atrophy were more common in polyQ ataxias, as was axonal neuropathy. SCA had a wide range of genetic etiology, age-at-onset and presentation. Proportion of polyQ and non-repeat expansion SCA was similar; the latter had a higher genetic heterogeneity. While polyQ ataxias were typically linked to cerebellar onset in adulthood, non-repeat expansion forms associated with early onset and non-cerebellar presentations.
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Affiliation(s)
- João Moura
- Neurology Department, Centro Hospitalar Universitário de Santo António, ULS de Santo António, Porto, Portugal
| | - Jorge Oliveira
- Centro de Genética Preditiva e Preventiva (CGPP), IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal
- IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Mariana Santos
- IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Sara Costa
- Neurology Department, Centro Hospitalar Universitário de Santo António, ULS de Santo António, Porto, Portugal
| | - Lénia Silva
- Neurology Department, Centro Hospitalar Universitário de Santo António, ULS de Santo António, Porto, Portugal
| | - Carolina Lemos
- IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal
| | - José Barros
- Neurology Department, Centro Hospitalar Universitário de Santo António, ULS de Santo António, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal
| | - Jorge Sequeiros
- Centro de Genética Preditiva e Preventiva (CGPP), IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal
- IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal
| | - Joana Damásio
- Neurology Department, Centro Hospitalar Universitário de Santo António, ULS de Santo António, Porto, Portugal.
- Centro de Genética Preditiva e Preventiva (CGPP), IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.
- IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal.
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8
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Rezende TJR, Adanyaguh I, Barsottini OGP, Bender B, Cendes F, Coutinho L, Deistung A, Dogan I, Durr A, Fernandez-Ruiz J, Göricke SL, Grisoli M, Hernandez-Castillo CR, Lenglet C, Mariotti C, Martinez ARM, Massuyama BK, Mochel F, Nanetti L, Nigri A, Ono SE, Öz G, Pedroso JL, Reetz K, Synofzik M, Teive H, Thomopoulos SI, Thompson PM, Timmann D, van de Warrenburg BPC, van Gaalen J, França MC, Harding IH. Genotype-specific spinal cord damage in spinocerebellar ataxias: an ENIGMA-Ataxia study. J Neurol Neurosurg Psychiatry 2024; 95:682-690. [PMID: 38383154 PMCID: PMC11187354 DOI: 10.1136/jnnp-2023-332696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Spinal cord damage is a feature of many spinocerebellar ataxias (SCAs), but well-powered in vivo studies are lacking and links with disease severity and progression remain unclear. Here we characterise cervical spinal cord morphometric abnormalities in SCA1, SCA2, SCA3 and SCA6 using a large multisite MRI dataset. METHODS Upper spinal cord (vertebrae C1-C4) cross-sectional area (CSA) and eccentricity (flattening) were assessed using MRI data from nine sites within the ENIGMA-Ataxia consortium, including 364 people with ataxic SCA, 56 individuals with preataxic SCA and 394 nonataxic controls. Correlations and subgroup analyses within the SCA cohorts were undertaken based on disease duration and ataxia severity. RESULTS Individuals in the ataxic stage of SCA1, SCA2 and SCA3, relative to non-ataxic controls, had significantly reduced CSA and increased eccentricity at all examined levels. CSA showed large effect sizes (d>2.0) and correlated with ataxia severity (r<-0.43) and disease duration (r<-0.21). Eccentricity correlated only with ataxia severity in SCA2 (r=0.28). No significant spinal cord differences were evident in SCA6. In preataxic individuals, CSA was significantly reduced in SCA2 (d=1.6) and SCA3 (d=1.7), and the SCA2 group also showed increased eccentricity (d=1.1) relative to nonataxic controls. Subgroup analyses confirmed that CSA and eccentricity are abnormal in early disease stages in SCA1, SCA2 and SCA3. CSA declined with disease progression in all, whereas eccentricity progressed only in SCA2. CONCLUSIONS Spinal cord abnormalities are an early and progressive feature of SCA1, SCA2 and SCA3, but not SCA6, which can be captured using quantitative MRI.
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Affiliation(s)
- Thiago Junqueira Ribeiro Rezende
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Isaac Adanyaguh
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Fernando Cendes
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Leo Coutinho
- Graduate program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, Department for Radiation Medicine, University Hospital Halle (Saale), University Medicine Halle, Halle (Saale), Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich GmbH, Jülich, Germany
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute (ICM), Pitié-Salpêtrière Hospital, AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Juan Fernandez-Ruiz
- Neuropsychology Laboratory, Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Marina Grisoli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto R M Martinez
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Breno K Massuyama
- Department of Neurology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Fanny Mochel
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France
| | - Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sergio E Ono
- Clínica DAPI - Diagnóstico Avançado Por Imagem, Curitiba, Brazil
| | - Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - José Luiz Pedroso
- Department of Neurology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich GmbH, Jülich, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Helio Teive
- Graduate program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, Netherlands
| | - Judith van Gaalen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, Netherlands
| | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Ian H Harding
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
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9
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De Mattei F, Ferrandes F, Gallone S, Canosa A, Calvo A, Chiò A, Vasta R. Epidemiology of Spinocerebellar Ataxias in Europe. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1176-1183. [PMID: 37698771 PMCID: PMC11102384 DOI: 10.1007/s12311-023-01600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a heterogenous group of rare neurodegenerative conditions sharing an autosomal dominant pattern of inheritance. More than 40 SCAs have been genetically determined. However, a systematic review of SCA epidemiology in Europe is still missing. Here we performed a narrative review of the literature on the epidemiology of the most common SCAs in Europe. PubMed, Embase, and MEDLINE were searched from inception until 1 April 2023. All English peer-reviewed articles published were considered and then filtered by abstract examination and subsequently by full text reading. A total of 917 original articles were retrieved. According to the inclusion criteria and after reviewing references for useful papers, a total of 35 articles were included in the review. Overall, SCA3 is the most frequent spinocerebellar ataxia in Europe. Its frequency is strikingly higher in Portugal, followed by Germany, France, and Netherlands. None or few cases were described in Italy, Russia, Poland, Serbia, Finland, and Norway. SCA1 and SCA2 globally displayed similar frequencies, and are more prevalent in Italy, United Kingdom, Poland, Serbia, and France.
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Affiliation(s)
- Filippo De Mattei
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Fabio Ferrandes
- Aging Brain and Memory Clinic, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - Salvatore Gallone
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Antonio Canosa
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Andrea Calvo
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Adriano Chiò
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Rosario Vasta
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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10
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Seemann J, Daghsen L, Cazier M, Lamy JC, Welter ML, Giese MA, Synofzik M, Durr A, Ilg W, Coarelli G. Digital Gait Measures Capture 1-Year Progression in Early-Stage Spinocerebellar Ataxia Type 2. Mov Disord 2024; 39:788-797. [PMID: 38419144 DOI: 10.1002/mds.29757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND With disease-modifying drugs in reach for cerebellar ataxias, fine-grained digital health measures are highly warranted to complement clinical and patient-reported outcome measures in upcoming treatment trials and treatment monitoring. These measures need to demonstrate sensitivity to capture change, in particular in the early stages of the disease. OBJECTIVE Our aim is to unravel gait measures sensitive to longitudinal change in the-particularly trial-relevant-early stage of spinocerebellar ataxia type 2 (SCA2). METHODS We performed a multicenter longitudinal study with combined cross-sectional and 1-year interval longitudinal analysis in early-stage SCA2 participants (n = 23, including nine pre-ataxic expansion carriers; median, ATXN2 CAG repeat expansion 38 ± 2; median, Scale for the Assessment and Rating of Ataxia [SARA] score 4.8 ± 4.3). Gait was assessed using three wearable motion sensors during a 2-minute walk, with analyses focused on gait measures of spatio-temporal variability that have shown sensitivity to ataxia severity (eg, lateral step deviation). RESULTS We found significant changes for gait measures between baseline and 1-year follow-up with large effect sizes (lateral step deviation P = 0.0001, effect size rprb = 0.78), whereas the SARA score showed no change (P = 0.67). Sample size estimation indicates a required cohort size of n = 43 to detect a 50% reduction in natural progression. Test-retest reliability and minimal detectable change analysis confirm the accuracy of detecting 50% of the identified 1-year change. CONCLUSIONS Gait measures assessed by wearable sensors can capture natural progression in early-stage SCA2 within just 1 year-in contrast to a clinical ataxia outcome. Lateral step deviation represents a promising outcome measure for upcoming multicenter interventional trials, particularly in the early stages of cerebellar ataxia. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jens Seemann
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Lina Daghsen
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Matthieu Cazier
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Jean-Charles Lamy
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Marie-Laure Welter
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Martin A Giese
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
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11
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Shah VV, Muzyka D, Jagodinsky A, McNames J, Casey H, El-Gohary M, Sowalsky K, Safarpour D, Carlson-Kuhta P, Schmahmann JD, Rosenthal LS, Perlman S, Horak FB, Gomez CM. Digital Measures of Postural Sway Quantify Balance Deficits in Spinocerebellar Ataxia. Mov Disord 2024; 39:663-673. [PMID: 38357985 DOI: 10.1002/mds.29742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Maintaining balance is crucial for independence and quality of life. Loss of balance is a hallmark of spinocerebellar ataxia (SCA). OBJECTIVE The aim of this study was to identify which standing balance conditions and digital measures of body sway were most discriminative, reliable, and valid for quantifying balance in SCA. METHODS Fifty-three people with SCA (13 SCA1, 13 SCA2, 14 SCA3, and 13 SCA6) and Scale for Assessment and Rating of Ataxia (SARA) scores 9.28 ± 4.36 and 31 healthy controls were recruited. Subjects stood in six test conditions (natural stance, feet together and tandem, each with eyes open [EO] and eyes closed [EC]) with an inertial sensor on their lower back for 30 seconds (×2). We compared test completion rate, test-retest reliability, and areas under the receiver operating characteristic curve (AUC) for seven digital sway measures. Pearson's correlations related sway with the SARA and the Patient-Reported Outcome Measure of Ataxia (PROM ataxia). RESULTS Most individuals with SCA (85%-100%) could stand for 30 seconds with natural stance EO or EC, and with feet together EO. The most discriminative digital sway measures (path length, range, area, and root mean square) from the two most reliable and discriminative conditions (natural stance EC and feet together EO) showed intraclass correlation coefficients from 0.70 to 0.91 and AUCs from 0.83 to 0.93. Correlations of sway with SARA were significant (maximum r = 0.65 and 0.73). Correlations with PROM ataxia were mild to moderate (maximum r = 0.56 and 0.34). CONCLUSION Inertial sensor measures of extent of postural sway in conditions of natural stance EC and feet together stance EO were discriminative, reliable, and valid for monitoring SCA. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vrutangkumar V Shah
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Muzyka
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - Adam Jagodinsky
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - James McNames
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
- Department of Electrical and Computer Engineering, Portland State University, Portland, Oregon, USA
| | - Hannah Casey
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Mahmoud El-Gohary
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - Kristen Sowalsky
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Jeremy D Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Fay B Horak
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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12
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Sobanska A, Czerwosz L, Sulek A, Rola R, Stepniak I, Rakowicz M. Quantitative Evaluation of Stance as a Sensitive Biomarker of Postural Ataxia Development in Preclinical SCA1 Mutation Carriers. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01679-w. [PMID: 38492164 DOI: 10.1007/s12311-024-01679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
The aim of this study was to determine the time between the first detection of postural control impairments and the evident manifestation of ataxia in preclinical SCA1 individuals. Twenty five preclinical SCA1 mutation carriers: 13 with estimated disease onset ≤ 6 years (SCA1 +) aged 27.8 ± 8.1 years; 12 with expected disease onset > 6 years (SCA1-) aged 26.6 ± 3.1 years and 26 age and sex matched healthy controls (HCs) underwent static posturography during 5 years of observation. The movements of the centre of feet pressure (COP) during quiet standing with eyes open (EO) and closed (EC) were quantified by calculating the mean radius (R), developed surface area (A) and mean COP movement velocity (V). Ataxia was evaluated by use of the Scale for Assessment and Rating of Ataxia (SARA).SCA1 + exhibited significantly worse quality of stance with EC vs. SCA1- (p < 0.05 for V) and HCs (p < 0.001) even 5 to 6 years before estimated disease onset. There were no statistically significant differences between SCA1- and HCs. A slow increase in Cohen's d effect size was observed for VEO up to the clinical manifestation of ataxia. VEO and AEC recorded in preclinical SCA1 individuals correlated slightly but statistically significantly with SARA (r = 0.47).The study confirms that static posturography detects COP sway changes in SCA1 preclinical gene carriers even 5 to 6 years before estimated disease onset. The quantitative evaluation of stance in preclinical SCA is a sensitive biomarker for the monitoring of the disease progression and may be useful in clinical trials.
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Affiliation(s)
- Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Leszek Czerwosz
- Laboratory of Respiration Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Sulek
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Rafal Rola
- Department of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Iwona Stepniak
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Maria Rakowicz
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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13
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Sanchez-Flores M, Corral-Juan M, Gasch-Navalón E, Cirillo D, Sanchez I, Matilla-Dueñas A. Novel genotype-phenotype correlations, differential cerebellar allele-specific methylation, and a common origin of the (ATTTC) n insertion in spinocerebellar ataxia type 37. Hum Genet 2024; 143:211-232. [PMID: 38396267 PMCID: PMC11043136 DOI: 10.1007/s00439-024-02644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
Spinocerebellar ataxia subtype 37 (SCA37) is a rare disease originally identified in ataxia patients from the Iberian Peninsula with a pure cerebellar syndrome. SCA37 patients carry a pathogenic intronic (ATTTC)n repeat insertion flanked by two polymorphic (ATTTT)n repeats in the Disabled-1 (DAB1) gene leading to cerebellar dysregulation. Herein, we determine the precise configuration of the pathogenic 5'(ATTTT)n-(ATTTC)n-3'(ATTTT)n SCA37 alleles by CRISPR-Cas9 and long-read nanopore sequencing, reveal their epigenomic signatures in SCA37 lymphocytes, fibroblasts, and cerebellar samples, and establish new molecular and clinical correlations. The 5'(ATTTT)n-(ATTTC)n-3'(ATTTT)n pathogenic allele configurations revealed repeat instability and differential methylation signatures. Disease age of onset negatively correlated with the (ATTTC)n, and positively correlated with the 3'(ATTTT)n. Geographic origin and gender significantly correlated with age of onset. Furthermore, significant predictive regression models were obtained by machine learning for age of onset and disease evolution by considering gender, the (ATTTC)n, the 3'(ATTTT)n, and seven CpG positions differentially methylated in SCA37 cerebellum. A common 964-kb genomic region spanning the (ATTTC)n insertion was identified in all SCA37 patients analysed from Portugal and Spain, evidencing a common origin of the SCA37 mutation in the Iberian Peninsula originating 859 years ago (95% CI 647-1378). In conclusion, we demonstrate an accurate determination of the size and configuration of the regulatory 5'(ATTTT)n-(ATTTC)n-3'(ATTTT)n repeat tract, avoiding PCR bias amplification using CRISPR/Cas9-enrichment and nanopore long-read sequencing, resulting relevant for accurate genetic diagnosis of SCA37. Moreover, we determine novel significant genotype-phenotype correlations in SCA37 and identify differential cerebellar allele-specific methylation signatures that may underlie DAB1 pathogenic dysregulation.
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Affiliation(s)
- Marina Sanchez-Flores
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Marc Corral-Juan
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Esther Gasch-Navalón
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | | | - Ivelisse Sanchez
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Antoni Matilla-Dueñas
- Neurogenetics Unit, Department of Neuroscience, Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain.
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14
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Faber J, Berger M, Wilke C, Hubener-Schmid J, Schaprian T, Santana MM, Grobe-Einsler M, Onder D, Koyak B, Giunti P, Garcia-Moreno H, Gonzalez-Robles C, Lima M, Raposo M, Melo ARV, de Almeida LP, Silva P, Pinto MM, van de Warrenburg BP, van Gaalen J, de Vries J, Oz G, Joers JM, Synofzik M, Schols L, Riess O, Infante J, Manrique L, Timmann D, Thieme A, Jacobi H, Reetz K, Dogan I, Onyike C, Povazan M, Schmahmann J, Ratai EM, Schmid M, Klockgether T. Stage-Dependent Biomarker Changes in Spinocerebellar Ataxia Type 3. Ann Neurol 2024; 95:400-406. [PMID: 37962377 DOI: 10.1002/ana.26824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
Spinocerebellar ataxia type 3/Machado-Joseph disease is the most common autosomal dominant ataxia. In view of the development of targeted therapies, knowledge of early biomarker changes is needed. We analyzed cross-sectional data of 292 spinocerebellar ataxia type 3/Machado-Joseph disease mutation carriers. Blood concentrations of mutant ATXN3 were high before and after ataxia onset, whereas neurofilament light deviated from normal 13.3 years before onset. Pons and cerebellar white matter volumes decreased and deviated from normal 2.2 years and 0.6 years before ataxia onset. We propose a staging model of spinocerebellar ataxia type 3/Machado-Joseph disease that includes a biomarker stage characterized by objective indicators of neurodegeneration before ataxia onset. ANN NEUROL 2024;95:400-406.
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Affiliation(s)
- Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- University of Bonn, Medical Faculty, Institute for Medical Biometry, Informatics, and Epidemiology, Bonn, Germany
| | - Carlo Wilke
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jeannette Hubener-Schmid
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Tamara Schaprian
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Magda M Santana
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Demet Onder
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Berkan Koyak
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cristina Gonzalez-Robles
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manuela Lima
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Mafalda Raposo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Ana Rosa Vieira Melo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Luís Pereira de Almeida
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Patrick Silva
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Maria M Pinto
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith van Gaalen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jeroen de Vries
- University Medical Center Groningen, Neurology, Groningen, the Netherlands
| | - Gulin Oz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - James M Joers
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Tübingen, Germany
| | - Ludger Schols
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Tübingen, Germany
| | - Olaf Riess
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Jon Infante
- University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Centro de investigación biomédica en red de enfermedades neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, Spain
| | - Leire Manrique
- University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Andreas Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Centre Juelich GmbH and RWTH Aachen University, Aachen, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Centre Juelich GmbH and RWTH Aachen University, Aachen, Germany
| | - Chiadikaobi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michal Povazan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eva-Maria Ratai
- Massachusetts General Hospital, Department of Radiology, A. A. Martinos Center for Biomedical Imaging and Harvard Medical School, Charlestown, MA, USA
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn, Medical Faculty, Institute for Medical Biometry, Informatics, and Epidemiology, Bonn, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
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15
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Pellerin D, Danzi MC, Renaud M, Houlden H, Synofzik M, Zuchner S, Brais B. Spinocerebellar ataxia 27B: A novel, frequent and potentially treatable ataxia. Clin Transl Med 2024; 14:e1504. [PMID: 38279833 PMCID: PMC10819088 DOI: 10.1002/ctm2.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024] Open
Abstract
Hereditary ataxias, especially when presenting sporadically in adulthood, present a particular diagnostic challenge owing to their great clinical and genetic heterogeneity. Currently, up to 75% of such patients remain without a genetic diagnosis. In an era of emerging disease-modifying gene-stratified therapies, the identification of causative alleles has become increasingly important. Over the past few years, the implementation of advanced bioinformatics tools and long-read sequencing has allowed the identification of a number of novel repeat expansion disorders, such as the recently described spinocerebellar ataxia 27B (SCA27B) caused by a (GAA)•(TTC) repeat expansion in intron 1 of the fibroblast growth factor 14 (FGF14) gene. SCA27B is rapidly gaining recognition as one of the most common forms of adult-onset hereditary ataxia, with several studies showing that it accounts for a substantial number (9-61%) of previously undiagnosed cases from different cohorts. First natural history studies and multiple reports have already outlined the progression and core phenotype of this novel disease, which consists of a late-onset slowly progressive pan-cerebellar syndrome that is frequently associated with cerebellar oculomotor signs, such as downbeat nystagmus, and episodic symptoms. Furthermore, preliminary studies in patients with SCA27B have shown promising symptomatic benefits of 4-aminopyridine, an already marketed drug. This review describes the current knowledge of the genetic and molecular basis, epidemiology, clinical features and prospective treatment strategies in SCA27B.
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Affiliation(s)
- David Pellerin
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and InstituteMcGill UniversityMontrealQuebecCanada
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and NeurosurgeryUniversity College LondonLondonUK
| | - Matt C. Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human GenomicsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Mathilde Renaud
- INSERM‐U1256 NGEREUniversité de LorraineNancyFrance
- Service de Neurologie, CHRU de NancyNancyFrance
- Service de Génétique Clinique, CHRU de NancyNancyFrance
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and NeurosurgeryUniversity College LondonLondonUK
| | - Matthis Synofzik
- Division of Translational Genomics of Neurodegenerative DiseasesHertie‐Institute for Clinical Brain Research and Center of Neurology, University of TübingenTübingenGermany
- German Center for Neurodegenerative Diseases (DZNE)TübingenGermany
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human GenomicsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and InstituteMcGill UniversityMontrealQuebecCanada
- Department of Human GeneticsMcGill UniversityMontrealQuebecCanada
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16
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Selvadurai LP, Perlman SL, Wilmot GR, Subramony SH, Gomez CM, Ashizawa T, Paulson HL, Onyike CU, Rosenthal LS, Sair HI, Kuo SH, Ratai EM, Zesiewicz TA, Bushara KO, Öz G, Dietiker C, Geschwind MD, Nelson AB, Opal P, Yacoubian TA, Nopoulos PC, Shakkottai VG, Figueroa KP, Pulst SM, Morrison PE, Schmahmann JD. The S-Factor, a New Measure of Disease Severity in Spinocerebellar Ataxia: Findings and Implications. CEREBELLUM (LONDON, ENGLAND) 2023; 22:790-809. [PMID: 35962273 PMCID: PMC10363993 DOI: 10.1007/s12311-022-01424-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Spinocerebellar ataxias (SCAs) are progressive neurodegenerative disorders, but there is no metric that predicts disease severity over time. We hypothesized that by developing a new metric, the Severity Factor (S-Factor) using immutable disease parameters, it would be possible to capture disease severity independent of clinical rating scales. Extracting data from the CRC-SCA and READISCA natural history studies, we calculated the S-Factor for 438 participants with symptomatic SCA1, SCA2, SCA3, or SCA6, as follows: ((length of CAG repeat expansion - maximum normal repeat length) /maximum normal repeat length) × (current age - age at disease onset) × 10). Within each SCA type, the S-Factor at the first Scale for the Assessment and Rating of Ataxia (SARA) visit (baseline) was correlated against scores on SARA and other motor and cognitive assessments. In 281 participants with longitudinal data, the slope of the S-Factor over time was correlated against slopes of scores on SARA and other motor rating scales. At baseline, the S-Factor showed moderate-to-strong correlations with SARA and other motor rating scales at the group level, but not with cognitive performance. Longitudinally the S-Factor slope showed no consistent association with the slope of performance on motor scales. Approximately 30% of SARA slopes reflected a trend of non-progression in motor symptoms. The S-Factor is an observer-independent metric of disease burden in SCAs. It may be useful at the group level to compare cohorts at baseline in clinical studies. Derivation and examination of the S-factor highlighted challenges in the use of clinical rating scales in this population.
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Affiliation(s)
- Louisa P Selvadurai
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan L Perlman
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - George R Wilmot
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sub H Subramony
- Department of Neurology, University of Florida College of Medicine, McKnight Brain Institute, Gainesville, FL, USA
| | | | - Tetsuo Ashizawa
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris I Sair
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Eva-Maria Ratai
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Theresa A Zesiewicz
- Department of Neurology, Ataxia Research Center, University of South Florida, Tampa, FL, USA
| | - Khalaf O Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Cameron Dietiker
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Alexandra B Nelson
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Puneet Opal
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Talene A Yacoubian
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Vikram G Shakkottai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Peter E Morrison
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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17
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Jacobi H, Schaprian T, Schmitz‐Hübsch T, Schmid M, Klockgether T. Disease progression of spinocerebellar ataxia types 1, 2, 3 and 6 before and after ataxia onset. Ann Clin Transl Neurol 2023; 10:1833-1843. [PMID: 37592453 PMCID: PMC10578893 DOI: 10.1002/acn3.51875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE Our aim was to study the evolution of ataxia and neurological symptoms before and after ataxia onset in the most common spinocerebellar ataxias (SCAs), SCA1, SCA2, SCA3 and SCA6. We therefore jointly analysed the data of the EUROSCA and RISCA studies, which recruited ataxic and non-ataxic mutation carriers. METHODS We used mixed effect models to analyse the evolution of Scale for the Rating and Assessment of Ataxia (SARA) scores, SCA Functional Index (SCAFI) and Inventory of Non-Ataxia Signs (INAS) counts. We applied multivariable modelling to identify factors associated with SARA progression. In the time interval 5 years prior to and after ataxia onset, we calculated sensitivity to change ratios (SCS) of SARA, SCAFI and INAS. RESULTS 2740 visits of 677 participants were analysed. All measures showed non-linear progression that was best fitted by linear mixed models with linear, quadratic and cubic time effects. R2 values indicating quality of the fit ranged from 0.70 to 0.97. CAG repeat was associated with faster progression in SCA1, SCA2 and SCA3, but not SCA6. 5 years prior to and after ataxia onset, SARA had the highest SCS of all measures with a mean of 1.21 (95% CI: 1.20, 1.21) in SCA1, 0.94 (0.93, 0.94) in SCA2 and 1.23 (1.22, 1.23) in SCA3. INTERPRETATION Our data have important implications for the understanding of disease progression in SCA1, SCA2, SCA3 and SCA6 across the lifespan. Furthermore, our study provides information for the design of interventional trials, especially in pre-ataxic mutation carriers close to ataxia onset and patients in early disease stages.
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Affiliation(s)
- Heike Jacobi
- Department of NeurologyUniversity Hospital HeidelbergHeidelbergGermany
| | | | - Tanja Schmitz‐Hübsch
- Experimental and Clinical Research Center, a cooperation of Max‐Delbrueck Center for Molecular Medicine and Charité – Univeristätsmedizin BerlinBerlinGermany
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of Medical Biometry, Informatics and Epidemiology, Medical FacultyUniversity of BonnBonnGermany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital of BonnBonnGermany
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18
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Coarelli G, Coutelier M, Durr A. Autosomal dominant cerebellar ataxias: new genes and progress towards treatments. Lancet Neurol 2023; 22:735-749. [PMID: 37479376 DOI: 10.1016/s1474-4422(23)00068-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/07/2023] [Accepted: 02/22/2023] [Indexed: 07/23/2023]
Abstract
Dominantly inherited spinocerebellar ataxias (SCAs) are associated with phenotypes that range from pure cerebellar to multisystemic. The list of implicated genes has lengthened in the past 5 years with the inclusion of SCA37/DAB1, SCA45/FAT2, SCA46/PLD3, SCA47/PUM1, SCA48/STUB1, SCA50/NPTX1, SCA25/PNPT1, SCA49/SAM9DL, and SCA27B/FGF14. In some patients, co-occurrence of multiple potentially pathogenic variants can explain variable penetrance or more severe phenotypes. Given this extreme clinical and genetic heterogeneity, genome sequencing should become the diagnostic tool of choice but is still not available in many clinical settings. Treatments tested in phase 2 and phase 3 studies, such as riluzole and transcranial direct current stimulation of the cerebellum and spinal cord, have given conflicting results. To enable early intervention, preataxic carriers of pathogenic variants should be assessed with biomarkers, such as neurofilament light chain and brain MRI; these biomarkers could also be used as outcome measures, given that clinical outcomes are not useful in the preataxic phase. The development of bioassays measuring the concentration of the mutant protein (eg, ataxin-3) might facilitate monitoring of target engagement by gene therapies.
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Affiliation(s)
- Giulia Coarelli
- Sorbonne Université, ICM Institut du Cerveau, Pitié-Salpeêtrieère University Hospital, Paris, France; Institut National de la Santé Et de la Recherche Médicale, Paris, France; Centre National de la Recherche Scientifique, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Coutelier
- Sorbonne Université, ICM Institut du Cerveau, Pitié-Salpeêtrieère University Hospital, Paris, France; Institut National de la Santé Et de la Recherche Médicale, Paris, France; Centre National de la Recherche Scientifique, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandra Durr
- Sorbonne Université, ICM Institut du Cerveau, Pitié-Salpeêtrieère University Hospital, Paris, France; Institut National de la Santé Et de la Recherche Médicale, Paris, France; Centre National de la Recherche Scientifique, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France.
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19
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Hatano Y, Ishihara T, Hirokawa S, Onodera O. Machine Learning Approach for the Prediction of Age-Specific Probability of SCA3 and DRPLA by Survival Curve Analysis. Neurol Genet 2023; 9:e200075. [PMID: 37152445 PMCID: PMC10159758 DOI: 10.1212/nxg.0000000000200075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/23/2023] [Indexed: 05/09/2023]
Abstract
Background and Objectives As the number of repeats in the expansion increases, polyglutamine diseases tend to show at a younger age. From this relationship, attempts have been made to predict age at onset by parametric survival analysis. However, a method for a more accurate prediction has been desirable. In this study, we examined 2 methods for survival analysis using machine learning and 6 conventional methods for parametric survival analysis of spinocerebellar ataxia (SCA)3 and dentatorubral-pallidoluysian atrophy (DRPLA). Methods We compared the performance of 2 machine learning methods of survival analysis (random survival forest [RSF] and DeepSurv) and 6 methods of parametric survival analysis (Weibull, exponential, Gaussian, logistic, loglogistic, and log Gaussian). Training and evaluation were performed using the leave-one-out cross-validation method, and evaluation criteria included root mean squared error (RMSE), mean absolute error (MAE), and the integrated Brier score. The latter was used as the primary end point, and the survival analysis model yielding the best result was used to predict the asymptomatic probability. Results Among the models examined, the RSF and DeepSurv machine learning methods had a higher prediction accuracy than the parametric methods of survival analysis. For both SCA3 and DRPLA, RSF had a higher accuracy than DeepSurv for the assessment of RMSE (SCA3: 7.37, DRPLA: 10.78), MAE (SCA3: 5.52, DRPLA: 8.17), and the integrated Brier score (SCA3: 0.05, DRPLA: 0.077). Using RSF, we determined the age-specific probability distribution of age at onset based on CAG repeat size and current age. Discussion In this study, we have demonstrated the superiority of machine learning methods for predicting age at onset of SCA3 and DRPLA using survival analysis. Such accurate prediction of onset will be useful for genetic counseling of carriers and for devising methods to verify the effects of interventions for unaffected individuals.
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Affiliation(s)
- Yuya Hatano
- Department of Neurology, Brain Research Institute, Niigata University, Niigata-shi, Japan
| | - Tomohiko Ishihara
- Department of Neurology, Brain Research Institute, Niigata University, Niigata-shi, Japan
| | - Sachiko Hirokawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata-shi, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata-shi, Japan
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20
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Faber J, Berger M, Carlo W, Hübener-Schmid J, Schaprian T, Santana MM, Grobe-Einsler M, Onder D, Koyak B, Giunti P, Garcia-Moreno H, Gonzalez-Robles C, Lima M, Raposo M, Melo ARV, de Almeida LP, Silva P, Pinto MM, van de Warrenburg BP, van Gaalen J, de Vries J, Jeroen, Oz G, Joers JM, Synofzik M, Schöls L, Riess O, Infante J, Manrique L, Timmann D, Thieme A, Jacobi H, Reetz K, Dogan I, Onyike C, Povazan M, Schmahmann J, Ratai EM, Schmid M, Klockgether T. Stage-dependent biomarker changes in spinocerebellar ataxia type 3. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.21.23287817. [PMID: 37163081 PMCID: PMC10168503 DOI: 10.1101/2023.04.21.23287817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3) is the most common autosomal dominant ataxia. In view of the development of targeted therapies for SCA3, precise knowledge of stage-dependent fluid and MRI biomarker changes is needed. We analyzed cross-sectional data of 292 SCA3 mutation carriers including 57 pre-ataxic individuals, and 108 healthy controls from the European Spinocerebellar ataxia type 3/Machado-Joseph Disease Initiative (ESMI) cohort. Blood concentrations of mutant ATXN3 and neurofilament light (NfL) were determined, and volumes of pons, cerebellar white matter (CWM) and cerebellar grey matter (CGM) were measured on MRI. Mutant ATXN3 concentrations were high before and after ataxia onset, while NfL continuously increased and deviated from normal 11.9 years before onset. Pons and CWM volumes decreased, but the deviation from normal was only 2.0 years (pons) and 0.3 years (CWM) before ataxia onset. We propose a staging model of SCA3 that includes an initial asymptomatic carrier stage followed by the biomarker stage defined by absence of ataxia, but a significant rise of NfL. The biomarker stage leads into the ataxia stage, defined by manifest ataxia. The present analysis provides a robust framework for further studies aiming at elaboration and differentiation of the staging model of SCA3.
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Affiliation(s)
- Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- University of Bonn, Medical Faculty, Institute for Medical Biometry, Informatics and Epidemiology
| | - Wilke Carlo
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jeannette Hübener-Schmid
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Tamara Schaprian
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Magda M Santana
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Dement Onder
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Berkan Koyak
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Cristina Gonzalez-Robles
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Manuela Lima
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Mafalda Raposo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Ana Rosa Vieira Melo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Luis Pereira de Almeida
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Patrick Silva
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Maria M Pinto
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center for Innovative in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Bart P. van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud university medical center
| | - Judith van Gaalen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud university medical center
- Department of Neurology, Rinjstate Hospital, Arnhem, The Netherlands
| | | | - Jeroen
- University Medical Center Groningen, Neurology
| | - Gulin Oz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - James M. Joers
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Ludger Schöls
- Division Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Olaf Riess
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Jon Infante
- University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Centro de investigación biomédica en red de enfermedades neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, Spain
| | - Leire Manrique
- University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
| | - Andreas Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
| | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Centre Juelich GmbH and RWTH Aachen University, 52074 Aachen, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Centre Juelich GmbH and RWTH Aachen University, 52074 Aachen, Germany
| | - Chiadikaobi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Michal Povazan
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jeremy Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School
| | - Eva-Maria Ratai
- Massachusetts General Hospital, Department of Radiology, A. A. Martinos Center for Biomedical Imaging and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn, Medical Faculty, Institute for Medical Biometry, Informatics and Epidemiology
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
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21
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Tezenas du Montcel S, Petit E, Olubajo T, Faber J, Lallemant-Dudek P, Bushara K, Perlman S, Subramony SH, Morgan D, Jackman B, Figueroa KP, Pulst SM, Fauret-Amsellem AL, Dufke C, Paulson HL, Öz G, Klockgether T, Durr A, Ashizawa T. Baseline Clinical and Blood Biomarkers in Patients With Preataxic and Early-Stage Disease Spinocerebellar Ataxia 1 and 3. Neurology 2023; 100:e1836-e1848. [PMID: 36797067 PMCID: PMC10136009 DOI: 10.1212/wnl.0000000000207088] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In spinocerebellar ataxia, ataxia onset can be preceded by mild clinical manifestation, cerebellar and/or brainstem alterations, or biomarker modifications. READISCA is a prospective, longitudinal observational study of patients with spinocerebellar ataxia type 1 (SCA1) and 3 (SCA3) to provide essential markers for therapeutic interventions. We looked for clinical, imaging, or biological markers that are present at an early stage of the disease. METHODS We enrolled carriers of a pathologic ATXN1 or ATXN3 expansion and controls from 18 US and 2 European ataxia referral centers. Clinical, cognitive, quantitative motor, neuropsychological measures and plasma neurofilament light chain (NfL) measurements were compared between expansion carriers with and without ataxia and controls. RESULTS We enrolled 200 participants: 45 carriers of a pathologic ATXN1 expansion (31 patients with ataxia [median Scale for the Assessment and Rating of Ataxia: 9; 7-10] and 14 expansion carriers without ataxia [1; 0-2]) and 116 carriers of a pathologic ATXN3 expansion (80 patients with ataxia [7; 6-9] and 36 expansion carriers without ataxia [1; 0-2]). In addition, we enrolled 39 controls who did not carry a pathologic expansion in ATXN1 or ATXN3. Plasma NfL levels were significantly higher in expansion carriers without ataxia than controls, despite similar mean age (controls: 5.7 pg/mL, SCA1: 18.0 pg/mL [p < 0.0001], SCA3: 19.8 pg/mL [p < 0.0001]). Expansion carriers without ataxia differed from controls by significantly more upper motor signs (SCA1 p = 0.0003, SCA3 p = 0.003) and by the presence of sensor impairment and diplopia in SCA3 (p = 0.0448 and 0.0445, respectively). Functional scales, fatigue and depression scores, swallowing difficulties, and cognitive impairment were worse in expansion carriers with ataxia than those without ataxia. Ataxic SCA3 participants showed extrapyramidal signs, urinary dysfunction, and lower motor neuron signs significantly more often than expansion carriers without ataxia. DISCUSSION READISCA showed the feasibility of harmonized data acquisition in a multinational network. NfL alterations, early sensory ataxia, and corticospinal signs were quantifiable between preataxic participants and controls. Patients with ataxia differed in many parameters from controls and expansion carriers without ataxia, with a graded increase of abnormal measures from control to preataxic to ataxic cohorts. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03487367.
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Affiliation(s)
- Sophie Tezenas du Montcel
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis.
| | - Emilien Petit
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Titilayo Olubajo
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Jennifer Faber
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Pauline Lallemant-Dudek
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Khalaf Bushara
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Susan Perlman
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Sub H Subramony
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - David Morgan
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Brianna Jackman
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Karla P. Figueroa
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Stefan M. Pulst
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Anne-Laure Fauret-Amsellem
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Claudia Dufke
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Henry Lauris Paulson
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Gülin Öz
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Thomas Klockgether
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Alexandra Durr
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
| | - Tetsuo Ashizawa
- From the Sorbonne Universite (S.T.d.M., E.P., P.L.-D., A.D.), Paris Brain Institute, Inserm, INRIA, CNRS, APHP, France; The Houston Methodist Research Institute (T.O., T.A.), TX; Department of Neurology (J.F., T.K.), University Hospital of Bonn; German Center for Neurodegenerative Diseases (DZNE) (J.F., T.K.), Bonn, Germany; Department of Neurology (K.B.), University of Minnesota, Minneapolis; University of California, Los Angeles (S.P.); Norman Fixel Center for Neurological Disorders (S.H.S.), College of Medicine, University of Florida, Gainesville; Department of Translational Neuroscience (D.M., B.J.), Michigan State University, Grand Rapids; Department of Neurology (K.P.F., S.M.P.), University of Utah, Salt Lake City; Functional Unit of Cellular and Molecular Neurogenetics (A.-L.F.-A.), Genetic Department, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France; Institute of Medical Genetics and Applied Genomics (C.D.), University of Tubingen, Tübingen, Germany; Department of Neurology (H.L.P.), University of Michigan, Ann Arbor; and Center for Magnetic Resonance Research (G.O.), Department of Radiology, University of Minnesota, Minneapolis
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22
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Chandrasekaran J, Petit E, Park YW, Tezenas du Montcel S, Joers JM, Deelchand DK, Považan M, Banan G, Valabregue R, Ehses P, Faber J, Coupé P, Onyike CU, Barker PB, Schmahmann JD, Ratai EM, Subramony SH, Mareci TH, Bushara KO, Paulson H, Durr A, Klockgether T, Ashizawa T, Lenglet C, Öz G. Clinically Meaningful Magnetic Resonance Endpoints Sensitive to Preataxic Spinocerebellar Ataxia Types 1 and 3. Ann Neurol 2023; 93:686-701. [PMID: 36511514 PMCID: PMC10261544 DOI: 10.1002/ana.26573] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study was undertaken to identify magnetic resonance (MR) metrics that are most sensitive to early changes in the brain in spinocerebellar ataxia type 1 (SCA1) and type 3 (SCA3) using an advanced multimodal MR imaging (MRI) protocol in the multisite trial setting. METHODS SCA1 or SCA3 mutation carriers and controls (n = 107) underwent MR scanning in the US-European READISCA study to obtain structural, diffusion MRI, and MR spectroscopy data using an advanced protocol at 3T. Morphometric, microstructural, and neurochemical metrics were analyzed blinded to diagnosis and compared between preataxic SCA (n = 11 SCA1, n = 28 SCA3), ataxic SCA (n = 14 SCA1, n = 37 SCA3), and control (n = 17) groups using nonparametric testing accounting for multiple comparisons. MR metrics that were most sensitive to preataxic abnormalities were identified using receiver operating characteristic (ROC) analyses. RESULTS Atrophy and microstructural damage in the brainstem and cerebellar peduncles and neurochemical abnormalities in the pons were prominent in both preataxic groups, when patients did not differ from controls clinically. MR metrics were strongly associated with ataxia symptoms, activities of daily living, and estimated ataxia duration. A neurochemical measure was the most sensitive metric to preataxic changes in SCA1 (ROC area under the curve [AUC] = 0.95), and a microstructural metric was the most sensitive metric to preataxic changes in SCA3 (AUC = 0.92). INTERPRETATION Changes in cerebellar afferent and efferent pathways underlie the earliest symptoms of both SCAs. MR metrics collected with a harmonized advanced protocol in the multisite trial setting allow detection of disease effects in individuals before ataxia onset with potential clinical trial utility for subject stratification. ANN NEUROL 2023;93:686-701.
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Affiliation(s)
- Jayashree Chandrasekaran
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Emilien Petit
- Sorbonne Université, Paris Brain Institute, Inserm, INRIA, CNRS, APHP, 75013 Paris, France
| | - Young-Woo Park
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - James M. Joers
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Dinesh K. Deelchand
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michal Považan
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Guita Banan
- Norman Fixel Center for Neurological Disorders, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Romain Valabregue
- Sorbonne Université, Paris Brain Institute, Inserm, INRIA, CNRS, APHP, 75013 Paris, France
| | - Philipp Ehses
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Pierrick Coupé
- Laboratoire Bordelais de Recherche en Informatique, Université de Bordeaux, 33405 France
| | - Chiadi U. Onyike
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Peter B. Barker
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jeremy D. Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Eva-Maria Ratai
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02114, USA
| | - S. H. Subramony
- Norman Fixel Center for Neurological Disorders, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Thomas H. Mareci
- Norman Fixel Center for Neurological Disorders, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Khalaf O. Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, Inserm, INRIA, CNRS, APHP, 75013 Paris, France
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Tetsuo Ashizawa
- The Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
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23
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Rummey C, Harding IH, Delatycki MB, Tai G, Rezende T, Corben LA. Harmonizing results of ataxia rating scales: mFARS, SARA, and ICARS. Ann Clin Transl Neurol 2022; 9:2041-2046. [PMID: 36394163 PMCID: PMC9735370 DOI: 10.1002/acn3.51686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022] Open
Abstract
The ever-increasing body of ataxia research provides opportunities for large-scale meta-analyses, systematic reviews, and data aggregation. Because multiple standardized scales are used to quantify ataxia severity, harmonization of these measures is necessary for quantitative data pooling. We applied the modified Friedreich Ataxia Rating Scale (mFARS), the Scale for the Assessment and Rating of Ataxia (SARA), and the International Cooperative Ataxia Rating Scale (ICARS) to a large cohort of people with Friedreich's ataxia. We provide regression coefficients for scale interconversion and discuss the reliability of this approach, together with insights into the differential sensitivities of mFARS and SARA to disease progression.
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Affiliation(s)
| | - Ian H. Harding
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Martin B. Delatycki
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkville3052VictoriaAustralia,Department of PaediatricsUniversity of MelbourneParkville3052VictoriaAustralia
| | - Geneieve Tai
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkville3052VictoriaAustralia
| | - Thiago Rezende
- Department of NeurologyUniversity of CampinasCampinasBrazil
| | - Louise A. Corben
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Children's Research InstituteParkville3052VictoriaAustralia,Department of PaediatricsUniversity of MelbourneParkville3052VictoriaAustralia
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24
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Park YW, Joers JM, Guo B, Hutter D, Bushara K, Adanyeguh IM, Eberly LE, Öz G, Lenglet C. Corrigendum: Assessment of cerebral and cerebellar white matter microstructure in spinocerebellar ataxias 1, 2, 3, and 6 using diffusion MRI. Front Neurol 2022; 13:1038298. [PMID: 36247785 PMCID: PMC9559733 DOI: 10.3389/fneur.2022.1038298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Young Woo Park
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
- *Correspondence: Young Woo Park
| | - James M. Joers
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bin Guo
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Diane Hutter
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Isaac M. Adanyeguh
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Lynn E. Eberly
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Gülin Öz
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Christophe Lenglet
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
- Christophe Lenglet
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25
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Ilg W, Müller B, Faber J, van Gaalen J, Hengel H, Vogt IR, Hennes G, van de Warrenburg B, Klockgether T, Schöls L, Synofzik M. Digital Gait Biomarkers Allow to Capture 1-Year Longitudinal Change in Spinocerebellar Ataxia Type 3. Mov Disord 2022; 37:2295-2301. [PMID: 36043376 DOI: 10.1002/mds.29206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/19/2022] Open
Abstract
Measures of step variability and body sway during gait have shown to correlate with clinical ataxia severity in several cross-sectional studies. However, to serve as a valid progression biomarker, these gait measures have to prove their sensitivity to robustly capture longitudinal change, ideally within short time frames (eg, 1 year). We present the first multicenter longitudinal gait analysis study in spinocerebellar ataxias. We performed a combined cross-sectional (n = 28) and longitudinal (1-year interval, n = 17) analysis in Spinocerebellar Ataxia type 3 subjects (including seven preataxic mutation carriers). Longitudinal analysis showed significant change in gait measures between baseline and 1-year follow-up, with high effect sizes (stride length variability: P = 0.01, effect size rprb = 0.66; lateral sway: P = 0.007, rprb = 0.73). Sample size estimation for lateral sway indicates a required cohort size of n = 43 for detecting a 50% reduction of natural progression, compared with n = 240 for the clinical ataxia score Scale for the Assessment and Rating of Ataxia (SARA). These measures thus present promising motor biomarkers for upcoming interventional studies. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Björn Müller
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Jennifer Faber
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Judith van Gaalen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Holger Hengel
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Ina R Vogt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Guido Hennes
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Klockgether
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Ludger Schöls
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
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26
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Ru D, Li J, Xie O, Peng L, Jiang H, Qiu R. Explainable artificial intelligence based on feature optimization for age at onset prediction of spinocerebellar ataxia type 3. Front Neuroinform 2022; 16:978630. [PMID: 36110986 PMCID: PMC9468717 DOI: 10.3389/fninf.2022.978630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Existing treatments can only delay the progression of spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) after onset, so the prediction of the age at onset (AAO) can facilitate early intervention and follow-up to improve treatment efficacy. The objective of this study was to develop an explainable artificial intelligence (XAI) based on feature optimization to provide an interpretable and more accurate AAO prediction. A total of 1,008 affected SCA3/MJD subjects from mainland China were analyzed. The expanded cytosine-adenine-guanine (CAG) trinucleotide repeats of 10 polyQ-related genes were genotyped and included in related models as potential AAO modifiers. The performance of 4 feature optimization methods and 10 machine learning (ML) algorithms were compared, followed by building the XAI based on the SHapley Additive exPlanations (SHAP). The model constructed with an artificial neural network (ANN) and feature optimization of Crossing-Correlation-StepSVM performed best and achieved a coefficient of determination (R2) of 0.653 and mean absolute error (MAE), root mean square error (RMSE), and median absolute error (MedianAE) of 4.544, 6.090, and 3.236 years, respectively. The XAI explained the predicted results, which suggests that the factors affecting the AAO were complex and associated with gene interactions. An XAI based on feature optimization can improve the accuracy of AAO prediction and provide interpretable and personalized prediction.
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Affiliation(s)
- Danlei Ru
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Jinchen Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ouyi Xie
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Linliu Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Jiang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- School of Basic Medical Science, Central South University, Changsha, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
| | - Rong Qiu
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
- *Correspondence: Rong Qiu
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27
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Garcia‐Moreno H, Prudencio M, Thomas‐Black G, Solanky N, Jansen‐West KR, Hanna AL‐Shaikh R, Heslegrave A, Zetterberg H, Santana MM, Pereira de Almeida L, Vasconcelos‐Ferreira A, Januário C, Infante J, Faber J, Klockgether T, Reetz K, Raposo M, Ferreira AF, Lima M, Schöls L, Synofzik M, Hübener‐Schmid J, Puschmann A, Gorcenco S, Wszolek ZK, Petrucelli L, Giunti P. Tau and neurofilament light-chain as fluid biomarkers in spinocerebellar ataxia type 3. Eur J Neurol 2022; 29:2439-2452. [PMID: 35478426 PMCID: PMC9543545 DOI: 10.1111/ene.15373] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/06/2022] [Accepted: 04/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Clinical trials in spinocerebellar ataxia type 3 (SCA3) will require biomarkers for use as outcome measures. METHODS To evaluate total tau (t-tau), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCHL1) and neurofilament light-chain (NfL) as fluid biomarkers in SCA3, ATXN3 mutation carriers (n = 143) and controls (n = 172) were clinically assessed, and the plasma concentrations of the four proteins were analysed on the Simoa HD-1 platform. Eleven ATXN3 mutation carrier cerebrospinal fluid samples were analysed for t-tau and phosphorylated tau (p-tau181 ). A transgenic SCA3 mouse model (MJDTg) was used to measure cerebellar t-tau levels. RESULTS Plasma t-tau levels were higher in mutation carriers below the age of 50 compared to controls, and the Inventory of Non-Ataxia Signs was associated with t-tau in ataxic patients (p = 0.004). Pre-ataxic carriers showed higher cerebrospinal fluid t-tau and p-tau181 concentrations compared to ataxic patients (p = 0.025 and p = 0.014, respectively). Cerebellar t-tau was elevated in MJDTg mice compared to wild-type (p = 0.033) only in the early stages of the disease. GFAP and UCHL1 did not show higher levels in mutation carriers compared to controls. Plasma NfL concentrations were higher in mutation carriers compared to controls, and differences were greater for younger carriers. The Scale for the Assessment and Rating of Ataxia was the strongest predictor of NfL in ataxic patients (p < 0.001). CONCLUSION Our results suggest that tau might be a marker of early disease stages in SCA3. NfL can discriminate mutation carriers from controls and is associated with different clinical variables. Longitudinal studies are required to confirm their potential role as biomarkers in clinical trials.
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Affiliation(s)
- Hector Garcia‐Moreno
- Ataxia CentreDepartment of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK,Department of NeurogeneticsNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Mercedes Prudencio
- Department of NeuroscienceMayo ClinicJacksonvilleFloridaUSA,Neuroscience Graduate ProgramMayo Clinic Graduate School of Biomedical SciencesJacksonvilleFloridaUSA
| | - Gilbert Thomas‐Black
- Ataxia CentreDepartment of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK,Department of NeurogeneticsNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Nita Solanky
- Ataxia CentreDepartment of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK,Department of NeurogeneticsNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | | | | | - Amanda Heslegrave
- Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK,UK Dementia Research Institute at UCLLondonUK
| | - Henrik Zetterberg
- Department of Neurodegenerative DiseaseUCL Queen Square Institute of NeurologyLondonUK,UK Dementia Research Institute at UCLLondonUK,Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgMölndalSweden,Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Magda M. Santana
- Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
| | | | | | | | - Jon Infante
- Neurology ServiceUniversity Hospital Marqués de Valdecilla‐IDIVALUniversity of CantabriaCentro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED)SantanderSpain
| | - Jennifer Faber
- Department of NeurologyUniversity Hospital BonnBonnGermany,German Center for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Thomas Klockgether
- Department of NeurologyUniversity Hospital BonnBonnGermany,German Center for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Kathrin Reetz
- Department of NeurologyRWTH Aachen UniversityAachenGermany,JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum JülichRWTH Aachen UniversityAachenGermany
| | - Mafalda Raposo
- Faculdade de Ciências e TecnologiaUniversidade dos AçoresPonta DelgadaPortugal,Instituto de Biologia Molecular e Celular (IBMC)Instituto de Investigação e Inovação em Saúde (i3S)Universidade do PortoPortoPortugal
| | - Ana F. Ferreira
- Faculdade de Ciências e TecnologiaUniversidade dos AçoresPonta DelgadaPortugal,Instituto de Biologia Molecular e Celular (IBMC)Instituto de Investigação e Inovação em Saúde (i3S)Universidade do PortoPortoPortugal
| | - Manuela Lima
- Faculdade de Ciências e TecnologiaUniversidade dos AçoresPonta DelgadaPortugal,Instituto de Biologia Molecular e Celular (IBMC)Instituto de Investigação e Inovação em Saúde (i3S)Universidade do PortoPortoPortugal
| | - Ludger Schöls
- Department for Neurodegenerative DiseasesHertie‐Institute for Clinical Brain Research and Center for NeurologyUniversity of TübingenTübingenGermany,German Center for Neurodegenerative Diseases (DZNE)TübingenGermany
| | - Matthis Synofzik
- Department for Neurodegenerative DiseasesHertie‐Institute for Clinical Brain Research and Center for NeurologyUniversity of TübingenTübingenGermany,German Center for Neurodegenerative Diseases (DZNE)TübingenGermany
| | | | - Andreas Puschmann
- Lund University, Skåne University HospitalClinical Sciences, NeurologyLundSweden
| | - Sorina Gorcenco
- Lund University, Skåne University HospitalClinical Sciences, NeurologyLundSweden
| | | | - Leonard Petrucelli
- Department of NeuroscienceMayo ClinicJacksonvilleFloridaUSA,Neuroscience Graduate ProgramMayo Clinic Graduate School of Biomedical SciencesJacksonvilleFloridaUSA
| | - Paola Giunti
- Ataxia CentreDepartment of Clinical and Movement NeurosciencesUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK,Department of NeurogeneticsNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
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Scarabino D, Veneziano L, Fiore A, Nethisinghe S, Mantuano E, Garcia-Moreno H, Bellucci G, Solanky N, Morello M, Zanni G, Corbo RM, Giunti P. Leukocyte Telomere Length Variability as a Potential Biomarker in Patients with PolyQ Diseases. Antioxidants (Basel) 2022; 11:antiox11081436. [PMID: 35892638 PMCID: PMC9332235 DOI: 10.3390/antiox11081436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
SCA1, SCA2, and SCA3 are the most common forms of SCAs among the polyglutamine disorders, which include Huntington’s Disease (HD). We investigated the relationship between leukocyte telomere length (LTL) and the phenotype of SCA1, SCA2, and SCA3, comparing them with HD. The results showed that LTL was significantly reduced in SCA1 and SCA3 patients, while LTL was significantly longer in SCA2 patients. A significant negative relationship between LTL and age was observed in SCA1 but not in SCA2 subjects. LTL of SCA3 patients depend on both patient’s age and disease duration. The number of CAG repeats did not affect LTL in the three SCAs. Since LTL is considered an indirect marker of an inflammatory response and oxidative damage, our data suggest that in SCA1 inflammation is present already at an early stage of disease similar to in HD, while in SCA3 inflammation and impaired antioxidative processes are associated with disease progression. Interestingly, in SCA2, contrary to SCA1 and SCA3, the length of leukocyte telomeres does not reduce with age. We have observed that SCAs and HD show a differing behavior in LTL for each subtype, which could constitute relevant biomarkers if confirmed in larger cohorts and longitudinal studies.
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Affiliation(s)
- Daniela Scarabino
- Institute of Molecular Biology and Pathology, National Research Council, 00185 Rome, Italy
- Correspondence: (D.S.); (L.V.)
| | - Liana Veneziano
- Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy;
- Correspondence: (D.S.); (L.V.)
| | - Alessia Fiore
- Department of Biology and Biotechnology, Sapienza University of Rome, 00185 Rome, Italy; (A.F.); (R.M.C.)
| | - Suran Nethisinghe
- Ataxia Center, Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College, London WC1N 3BG, UK; (S.N.); (H.G.-M.); (N.S.); (P.G.)
| | - Elide Mantuano
- Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy;
| | - Hector Garcia-Moreno
- Ataxia Center, Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College, London WC1N 3BG, UK; (S.N.); (H.G.-M.); (N.S.); (P.G.)
| | - Gianmarco Bellucci
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, 00185 Rome, Italy;
| | - Nita Solanky
- Ataxia Center, Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College, London WC1N 3BG, UK; (S.N.); (H.G.-M.); (N.S.); (P.G.)
| | - Maria Morello
- Department of Experimental Medicine and Surgery, Tor Vergata University, 00133 Rome, Italy;
| | - Ginevra Zanni
- Unit of Neuromuscolar and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Research Hospital, IRCCS, 00100 Rome, Italy;
| | - Rosa Maria Corbo
- Department of Biology and Biotechnology, Sapienza University of Rome, 00185 Rome, Italy; (A.F.); (R.M.C.)
| | - Paola Giunti
- Ataxia Center, Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College, London WC1N 3BG, UK; (S.N.); (H.G.-M.); (N.S.); (P.G.)
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29
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Wilke C, Mengel D, Schöls L, Hengel H, Rakowicz M, Klockgether T, Durr A, Filla A, Melegh B, Schüle R, Reetz K, Jacobi H, Synofzik M. Levels of Neurofilament Light at the Preataxic and Ataxic Stages of Spinocerebellar Ataxia Type 1. Neurology 2022; 98:e1985-e1996. [PMID: 35264424 DOI: 10.1212/wnl.0000000000200257] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/04/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neurofilament light (NfL) appears to be a promising fluid biomarker in repeat-expansion spinocerebellar ataxias (SCAs), with piloting studies in mixed SCA cohorts suggesting that NfL might be increased at the ataxic stage of SCA type 1 (SCA1). We here hypothesized that NfL is increased not only at the ataxic stage of SCA1, but also at its (likely most treatment-relevant) preataxic stage. METHODS We assessed serum NfL (sNfL) and CSF NfL (cNfL) levels in both preataxic and ataxic SCA1, leveraging a multicentric cohort recruited at 6 European university centers, and clinical follow-up data, including actually observed (rather than only predicted) conversion to the ataxic stage. Levels of sNfL and cNfL were assessed by single-molecule array and ELISA technique, respectively. RESULTS Forty individuals with SCA1 (23 preataxic, 17 ataxic) and 89 controls were enrolled, including 11 preataxic individuals converting to the ataxic stage. sNfL levels were increased at the preataxic (median 15.5 pg/mL [interquartile range 10.5-21.1 pg/mL]) and ataxic stage (31.6 pg/mL [26.2-37.7 pg/mL]) compared to controls (6.0 pg/mL [4.7-8.6 pg/mL]), yielding high age-corrected effect sizes (preataxic: r = 0.62, ataxic: r = 0.63). sNfL increases were paralleled by increases of cNfL at both the preataxic and ataxic stage. In preataxic individuals, sNfL levels increased with proximity to predicted ataxia onset, with significant sNfL elevations already 5 years before onset, and confirmed in preataxic individuals with actually observed ataxia onset. sNfL increases were detected already in preataxic individuals with SCA1 without volumetric atrophy of cerebellum or pons, suggesting that sNfL might be more sensitive to early preataxic neurodegeneration than the currently known most change-sensitive regions in volumetric MRI. Using longitudinal sNfL measurements, we estimated sample sizes for clinical trials with the reduction of sNfL as the endpoint. DISCUSSION sNfL levels might provide easily accessible peripheral biomarkers in both preataxic and ataxic SCA1, allowing stratification of preataxic individuals regarding proximity to onset, early detection of neurodegeneration even before volumetric MRI alterations, and potentially capture of treatment response in clinical trials. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT01037777. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that NfL levels are increased in both ataxic and preataxic SCA1 and are associated with ataxia onset.
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Affiliation(s)
- Carlo Wilke
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - David Mengel
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Ludger Schöls
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Holger Hengel
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Maria Rakowicz
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Thomas Klockgether
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Alexandra Durr
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Alessandro Filla
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Bela Melegh
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Rebecca Schüle
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Kathrin Reetz
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Heike Jacobi
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
| | - Matthis Synofzik
- From the Division Translational Genomics of Neurodegenerative Diseases (C.W., D.M., M.S.) and Department of Neurodegenerative Diseases (L.S., H.H., R.S.), Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen; German Center for Neurodegenerative Diseases (DZNE) (C.W., D.M., L.S., H.H., R.S., M.S.), Tübingen, Germany; First Department of Neurology (M.R.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (T.K.), University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE) (T.K., H.J.), Bonn, Germany; Sorbonne Université (A.D.), Paris Brain Institute, APHP, INSERM, CNRS, France; Department of Neuroscience and Reproductive and Odontostomatological Sciences (A.F.), Federico II University Naples, Italy; Department of Medical Genetics and Szentagothai Research Center (B.M.), University of Pécs Medical School, Hungary; Department of Neurology (K.R.), RWTH Aachen University; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging (K.R.), Forschungszentrum Jülich, RWTH Aachen; and Department of Neurology (H.J.), University Hospital of Heidelberg, Germany
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30
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Consensus Paper: Ataxic Gait. CEREBELLUM (LONDON, ENGLAND) 2022; 22:394-430. [PMID: 35414041 DOI: 10.1007/s12311-022-01373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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Affiliation(s)
- Pierre Cabaraux
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Université Versailles Saint-Quentin, Versailles, France.,Service de NeuroImagerie, Centre Hospitalier National des 15-20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.,Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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31
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Jang JH, Yoon SJ, Kim SK, Cho JW, Kim JW. Detection Methods and Status of CAT Interruption of ATXN1 in Korean Patients With Spinocerebellar Ataxia Type 1. Ann Lab Med 2022; 42:274-277. [PMID: 34635619 PMCID: PMC8548249 DOI: 10.3343/alm.2022.42.2.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/09/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022] Open
Abstract
Spinocerebellar ataxia type 1 (SCA1) is an autosomal dominant disease caused by abnormal CAG repeat expansion in the ataxin 1 gene (ATXN1). The presence of CAT interruption(s) is important for diagnosing SCA1 in patients with 39–44 repeat alleles, as only uninterrupted alleles are considered abnormal. Determining the CAT interruption status might also be important for patients with >44 repeats, as the length of the longest uninterrupted CAG repeat stretch has been correlated with age at SCA1 onset. We detected CAT interruption(s) in the archived samples of Korean SCA1 patients using a traditional restriction enzyme method and validated the usefulness of a fluorescence-based tethering PCR procedure. Among the 2,312 alleles analyzed from 1,156 patients, we found 17 expanded alleles with ≥39 repeats, 71% of which harbored 39–44 repeats. Restriction enzyme method of six samples (four with 39–44 repeats and two with >44 repeats) revealed that none of the expanded alleles had CAT interruption(s). Tethering PCR showed the characteristic electropherogram pattern expected without CAT interruption(s). Along with the enzyme restriction method, tethering PCR can be applied to determine the number of allele repeats and provide information on CAT interruption(s) in clinical laboratories.
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Affiliation(s)
- Ja-Hyun Jang
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Joo Yoon
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Kyung Kim
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jong-Won Kim
- Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
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32
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Kollmer J, Weiler M, Sam G, Faber J, Hayes JM, Heiland S, Bendszus M, Wick W, Jacobi H. Quantitative magnetic resonance neurographic characterization of peripheral nerve involvement in manifest and pre‐ataxic spinocerebellar ataxia type 3. Eur J Neurol 2022; 29:1782-1790. [DOI: 10.1111/ene.15305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer Kollmer
- Department of Neuroradiology Heidelberg University Hospital Heidelberg Germany
| | - Markus Weiler
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
| | - Georges Sam
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
| | - Jennifer Faber
- Department of Neurology Bonn University Hospital Bonn Germany
- German Center for Neurodegenerative Diseases Bonn Germany
| | - John M. Hayes
- Department of Neurology University of Michigan Ann Arbor USA
| | - Sabine Heiland
- Department of Neuroradiology Heidelberg University Hospital Heidelberg Germany
- Division of Experimental Radiology Department of Neuroradiology Heidelberg University Hospital Heidelberg Germany
| | - Martin Bendszus
- Department of Neuroradiology Heidelberg University Hospital Heidelberg Germany
| | - Wolfgang Wick
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
- Clinical Cooperation Unit Neurooncology German Cancer Research Center/DKTK Heidelberg Germany
| | - Heike Jacobi
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
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Abstract
Internet-connected devices, including personal computers, smartphones, smartwatches, and voice assistants, have evolved into powerful multisensor technologies that billions of people interact with daily to connect with friends and colleagues, access and share information, purchase goods, play games, and navigate their environment. Digital phenotyping taps into the data streams captured by these devices to characterize and understand health and disease. The purpose of this article is to summarize opportunities for digital phenotyping in neurology, review studies using everyday technologies to obtain motor and cognitive information, and provide a perspective on how neurologists can embrace and accelerate progress in this emerging field.
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Affiliation(s)
- Anoopum S. Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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34
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Nobre RJ, Lobo DD, Henriques C, Duarte SP, Lopes SM, Silva AC, Lopes MM, Mariet F, Schwarz LK, Baatje MS, Ferreira V, Vallès A, Pereira de Almeida L, Evers MM, Toonen LJA. MiRNA-Mediated Knockdown of ATXN3 Alleviates Molecular Disease Hallmarks in a Mouse Model for Spinocerebellar Ataxia Type 3. Nucleic Acid Ther 2021; 32:194-205. [PMID: 34878314 PMCID: PMC9221165 DOI: 10.1089/nat.2021.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Spinocerebellar ataxia type 3 (SCA3) is a neurodegenerative disorder caused by the expansion of a CAG repeat in the ATXN3 gene. This mutation leads to a toxic gain of function of the ataxin-3 protein, resulting in neuronal dysfunction and atrophy of specific brain regions over time. As ataxin-3 is a dispensable protein in rodents, ataxin-3 knockdown by gene therapy may be a powerful approach for the treatment of SCA3. In this study, we tested the feasibility of an adeno-associated viral (AAV) vector carrying a previously described artificial microRNA against ATXN3 in a striatal mouse model of SCA3. Striatal injection of the AAV resulted in good distribution throughout the striatum, with strong dose-dependent ataxin-3 knockdown. The hallmark intracellular ataxin-3 inclusions were almost completely alleviated by the microRNA-induced ATXN3 knockdown. In addition, the striatal lesion of dopamine- and cAMP-regulated neuronal phosphoprotein (DARPP-32) in the SCA3 mice was rescued by ATXN3 knockdown, indicating functional rescue of neuronal signaling and health upon AAV treatment. Together, these data suggest that microRNA-induced ataxin-3 knockdown is a promising therapeutic strategy in the treatment of SCA3.
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Affiliation(s)
- Rui Jorge Nobre
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,ViraVector-Viral Vector for Gene Transfer Core Facility and University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (III), University of Coimbra, Coimbra, Portugal
| | - Diana D Lobo
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (III), University of Coimbra, Coimbra, Portugal
| | - Carina Henriques
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,ViraVector-Viral Vector for Gene Transfer Core Facility and University of Coimbra, Coimbra, Portugal.,Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Sonia P Duarte
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (III), University of Coimbra, Coimbra, Portugal
| | - Sara M Lopes
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (III), University of Coimbra, Coimbra, Portugal
| | - Ana C Silva
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (III), University of Coimbra, Coimbra, Portugal
| | - Miguel M Lopes
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (III), University of Coimbra, Coimbra, Portugal
| | - Fanny Mariet
- uniQure Biopharma b.v., Amsterdam, the Netherlands
| | | | - M S Baatje
- uniQure Biopharma b.v., Amsterdam, the Netherlands
| | | | | | - Luis Pereira de Almeida
- Center for Neuroscience and Cell Biology (CNC), Molecular Therapy of Brain Disorders Group, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), Vectors, Gene and Cell Therapy Group, University of Coimbra, Coimbra, Portugal.,ViraVector-Viral Vector for Gene Transfer Core Facility and University of Coimbra, Coimbra, Portugal.,Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
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Hengel H, Martus P, Faber J, Garcia-Moreno H, Solanky N, Giunti P, Klockgether T, Reetz K, van de Warrenburg BP, Pereira de Almeida L, Santana MM, Januário C, Silva P, Thieme A, Infante J, de Vries J, Lima M, Ferreira AF, Bushara K, Jacobi H, Onyike C, Schmahmann JD, Hübener-Schmid J, Synofzik M, Schöls L. Characterization of Lifestyle in Spinocerebellar Ataxia Type 3 and Association with Disease Severity. Mov Disord 2021; 37:405-410. [PMID: 34713931 DOI: 10.1002/mds.28844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/03/2021] [Accepted: 10/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lifestyle could influence the course of hereditary ataxias, but representative data are missing. OBJECTIVE The objective of this study was to characterize lifestyle in spinocerebellar ataxia type 3 (SCA3) and investigate possible associations with disease parameters. METHODS In a prospective cohort study, data on smoking, alcohol consumption, physical activity, physiotherapy, and body mass index (BMI) were collected from 243 patients with SCA3 and 119 controls and tested for associations with age of onset, disease severity, and progression. RESULTS Compared with controls, patients with SCA3 were less active and consumed less alcohol. Less physical activity and alcohol abstinence were associated with more severe disease, but not with progression rates or age of onset. Smoking, BMI, or physiotherapy did not correlate with disease parameters. CONCLUSION Differences in lifestyle factors of patients with SCA3 and controls as well as associations of lifestyle factors with disease severity are likely driven by the influence of symptoms on behavior. No association between lifestyle and disease progression was detected. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Holger Hengel
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London (UCL), London, United Kingdom.,Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals (UCLH) National Health Service Foundation Trust, London, United Kingdom
| | - Nita Solanky
- Ataxia Centre, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London (UCL), London, United Kingdom.,Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals (UCLH) National Health Service Foundation Trust, London, United Kingdom
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London (UCL), London, United Kingdom.,Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals (UCLH) National Health Service Foundation Trust, London, United Kingdom
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Kathrin Reetz
- Department of Neurology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) Brain Institute: Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich, Jülich, Germany
| | - Bart P van de Warrenburg
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Luís Pereira de Almeida
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,Center for Innovation in Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Magda M Santana
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,Center for Innovation in Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Cristina Januário
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,Center for Innovation in Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Patrick Silva
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,Center for Innovation in Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Andreas Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla - Instituto de investigación sanitaria Valdecilla (IDIVAL), University of Cantabria, Santander, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Barcelona, Spain
| | - Jeroen de Vries
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Manuela Lima
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Ana F Ferreira
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Chiadi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeannette Hübener-Schmid
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany.,Centre for Rare Diseases, University of Tuebingen, Tuebingen, Germany
| | - Matthis Synofzik
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Ludger Schöls
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Yang L, Shao YR, Li XY, Ma Y, Dong Y, Wu ZY. Association of the Level of Neurofilament Light With Disease Severity in Patients With Spinocerebellar Ataxia Type 2. Neurology 2021; 97:e2404-e2413. [PMID: 34706976 PMCID: PMC8673719 DOI: 10.1212/wnl.0000000000012945] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few biochemical markers have been identified in spinocerebellar ataxia type 2 (SCA2). This study aimed to determine the levels of neurofilament light (NfL) in patients with SCA2 and identify whether they were associated with disease severity. METHODS Participants were recruited from one medical center in China, and individuals with SCA2 were genetically diagnosed. NfL levels were assessed using the single molecule array method. Disease severity was evaluated using the Scale for the Assessment and Rating of Ataxia (SARA), the International Cooperative Ataxia Rating Scale (ICARS), and the Inventory of Non-Ataxia Symptoms (INAS). Cerebellum and brainstem volumes were calculated using neuroimaging measurements. We used Pearson's correlation and partial correlation for correlation analyses. RESULTS Forty-nine manifest patients with SCA2, 10 preclinical individuals with SCA2 and 92 controls were enrolled. A high consistency was identified between serum and CSF NfL (r = 0.868, p < 0.0001). In individuals with SCA2, levels of serum NfL were associated with disease severity (SARA, r = 0.425, p = 0.003; ICARS, r = 0.383, p = 0.009; INAS, r = 0.390, p = 0.007; cerebellum volume, r = - 0.393, p = 0.024) after adjustment for age. NfL levels were higher close to the expected age of onset in preclinical individuals with SCA2 (R 2 = 0.43, p = 0.04). DISCUSSION Levels of serum NfL were correlated with disease intensity in individuals with SCA2, and were higher close to the estimated age of onset in preclinical SCA2. Therefore, NfL is a potential serum biomarker of disease severity in SCA2. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that elevated NfL levels are associated with disease severity in individuals with SCA2.
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Affiliation(s)
- Lu Yang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Ru Shao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yan Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Ma
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Dong
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China .,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China
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Shah VV, Rodriguez-Labrada R, Horak FB, McNames J, Casey H, Hansson Floyd K, El-Gohary M, Schmahmann JD, Rosenthal LS, Perlman S, Velázquez-Pérez L, Gomez CM. Gait Variability in Spinocerebellar Ataxia Assessed Using Wearable Inertial Sensors. Mov Disord 2021; 36:2922-2931. [PMID: 34424581 DOI: 10.1002/mds.28740] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Quantitative assessment of severity of ataxia-specific gait impairments from wearable technology could provide sensitive performance outcome measures with high face validity to power clinical trials. OBJECTIVES The aim of this study was to identify a set of gait measures from body-worn inertial sensors that best discriminate between people with prodromal or manifest spinocerebellar ataxia (SCA) and age-matched, healthy control subjects (HC) and determine how these measures relate to disease severity. METHODS One hundred and sixty-three people with SCA (subtypes 1, 2, 3, and 6), 42 people with prodromal SCA, and 96 HC wore 6 inertial sensors while performing a natural pace, 2-minute walk. Areas under the receiver operating characteristic curves (AUC) were compared for 25 gait measures, including standard deviations as variability, to discriminate between ataxic and normal gait. Pearson's correlation coefficient assessed the relationships between the gait measures and severity of ataxia. RESULTS Increased gait variability was the most discriminative gait feature of SCA; toe-out angle variability (AUC = 0.936; sensitivity = 0.871; specificity = 0.896) and double-support time variability (AUC = 0.932; sensitivity = 0.834; specificity = 0.865) were the most sensitive and specific measures. These variability measures were also significantly correlated with the scale for the assessment and rating of ataxia (SARA) and disease duration. The same gait measures discriminated gait of people with prodromal SCA from the gait of HC (AUC = 0.610, and 0.670, respectively). CONCLUSIONS Wearable inertial sensors provide sensitive and specific measures of excessive gait variability in both manifest and prodromal SCAs that are reliable and related to the severity of the disease, suggesting they may be useful as clinical trial performance outcome measures. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Roberto Rodriguez-Labrada
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Cuban Center for Neuroscience, Havana, Cuba
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,APDM Wearable Technologies, an ERT company, Portland, Oregon, USA
| | - James McNames
- APDM Wearable Technologies, an ERT company, Portland, Oregon, USA.,Department of Electrical and Computer Engineering, Portland State University, Portland, Oregon, USA
| | - Hannah Casey
- The University of Chicago, Chicago, Illinois, USA
| | | | | | - Jeremy D Schmahmann
- Department of Neurology, Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Cuban Academy of Sciences, La Habana, Cuba
| | - Christopher M Gomez
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,The University of Chicago, Chicago, Illinois, USA
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Hübener-Schmid J, Kuhlbrodt K, Peladan J, Faber J, Santana MM, Hengel H, Jacobi H, Reetz K, Garcia-Moreno H, Raposo M, van Gaalen J, Infante J, Steiner KM, de Vries J, Verbeek MM, Giunti P, Pereira de Almeida L, Lima M, van de Warrenburg B, Schöls L, Klockgether T, Synofzik M, Riess O. Polyglutamine-Expanded Ataxin-3: A Target Engagement Marker for Spinocerebellar Ataxia Type 3 in Peripheral Blood. Mov Disord 2021; 36:2675-2681. [PMID: 34397117 DOI: 10.1002/mds.28749] [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: 04/14/2021] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxia type 3 is a rare neurodegenerative disease caused by a CAG repeat expansion in the ataxin-3 gene. Although no curative therapy is yet available, preclinical gene-silencing approaches to reduce polyglutamine (polyQ) toxicity demonstrate promising results. In view of upcoming clinical trials, quantitative and easily accessible molecular markers are of critical importance as pharmacodynamic and particularly as target engagement markers. OBJECTIVE We aimed at developing an ultrasensitive immunoassay to measure specifically polyQ-expanded ataxin-3 in plasma and cerebrospinal fluid (CSF). METHODS Using the novel single molecule counting ataxin-3 immunoassay, we analyzed cross-sectional and longitudinal patient biomaterials. RESULTS Statistical analyses revealed a correlation with clinical parameters and a stability of polyQ-expanded ataxin-3 during conversion from the pre-ataxic to the ataxic phases. CONCLUSIONS The novel immunoassay is able to quantify polyQ-expanded ataxin-3 in plasma and CSF, whereas ataxin-3 levels in plasma correlate with disease severity. Longitudinal analyses demonstrated a high stability of polyQ-expanded ataxin-3 over a short period. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jeannette Hübener-Schmid
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | | | | | - Jennifer Faber
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Magda M Santana
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal.,Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,IIIUC-Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Holger Hengel
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Jülich, Germany
| | - Hector Garcia-Moreno
- Department of Clinical and Movement Neuroscience, Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mafalda Raposo
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal & Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Judith van Gaalen
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jon Infante
- Service of Neurology, University Hospital Marqués de Valdecilla (IDIVAL), University of Cantabria (UC), Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - Katharina M Steiner
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Jeroen de Vries
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paola Giunti
- Department of Clinical and Movement Neuroscience, Ataxia Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurogenetics, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Luis Pereira de Almeida
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal.,Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Manuela Lima
- Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal & Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Bart van de Warrenburg
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Ludger Schöls
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Thomas Klockgether
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
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Nigri A, Sarro L, Mongelli A, Castaldo A, Porcu L, Pinardi C, Grisoli M, Ferraro S, Canafoglia L, Visani E, Bruzzone MG, Nanetti L, Taroni F, Mariotti C. Spinocerebellar Ataxia Type 1: One-Year Longitudinal Study to Identify Clinical and MRI Measures of Disease Progression in Patients and Presymptomatic Carriers. THE CEREBELLUM 2021; 21:133-144. [PMID: 34106418 DOI: 10.1007/s12311-021-01285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
Spinocerebellar ataxias type 1 (SCA1) is an autosomal dominant disease usually manifesting in adulthood. We performed a prospective 1-year longitudinal study in 14 presymptomatic mutation carriers (preSCA1), 11 ataxic patients, and 21 healthy controls. SCA1 patients had a median disease duration of 6 years (range 2-16) and SARA score of 7 points (range 3.5-20). PreSCA1 had an estimated time before disease onset of 9.7 years (range 4-30), and no signs of ataxia. At baseline, SCA1 patients significantly differed from controls in SARA score (Scale for Assessment and Rating of Ataxia), cognitive tests, and structural MRI measures. Significant volume loss was found in cerebellum, brainstem, basal ganglia, and cortical thinning in frontal, temporal, and occipital regions. PreSCA1 did not differ from controls. At 1-year follow-up, SCA1 patients showed significant increase in SARA score, and decreased volume of cerebellum (- 0.6%), pons (- 5.5%), superior cerebellar peduncles (- 10.7%), and midbrain (- 3.0%). Signs of disease progression were also observed in preSCA1 subjects, with increased SARA score and reduced total cerebellar volume. Our exploratory study suggests that clinical scores and MRI measures provide valuable data to monitor and quantify the earliest changes associated with the preclinical and the symptomatic phases of SCA1 disease.
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Affiliation(s)
- Anna Nigri
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lidia Sarro
- Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy.,Neurology Unit, Martini Hospital, Turin, Italy
| | - Alessia Mongelli
- Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Anna Castaldo
- Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Luca Porcu
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Pinardi
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefania Ferraro
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Canafoglia
- Neurophysiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Visani
- Neurophysiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Lorenzo Nanetti
- Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Franco Taroni
- Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Caterina Mariotti
- Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy.
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40
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Brooker SM, Edamakanti CR, Akasha SM, Kuo SH, Opal P. Spinocerebellar ataxia clinical trials: opportunities and challenges. Ann Clin Transl Neurol 2021; 8:1543-1556. [PMID: 34019331 PMCID: PMC8283160 DOI: 10.1002/acn3.51370] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
The spinocerebellar ataxias (SCAs) are a group of dominantly inherited diseases that share the defining feature of progressive cerebellar ataxia. The disease process, however, is not confined to the cerebellum; other areas of the brain, in particular, the brainstem, are also affected, resulting in a high burden of morbidity and mortality. Currently, there are no disease‐modifying treatments for the SCAs, but preclinical research has led to the development of therapeutic agents ripe for testing in patients. Unfortunately, due to the rarity of these diseases and their slow and variable progression, there are substantial hurdles to overcome in conducting clinical trials. While the epidemiological features of the SCAs are immutable, the feasibility of conducting clinical trials is being addressed through a combination of strategies. These include improvements in clinical outcome measures, the identification of imaging and fluid biomarkers, and innovations in clinical trial design. In this review, we highlight current challenges in initiating clinical trials for the SCAs and also discuss pathways for researchers and clinicians to mitigate these challenges and harness opportunities for clinical trial development.
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Affiliation(s)
- Sarah M Brooker
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sara M Akasha
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, USA.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
| | - Puneet Opal
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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41
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Faber J, Schaprian T, Berkan K, Reetz K, França MC, de Rezende TJR, Hong J, Liao W, van de Warrenburg B, van Gaalen J, Durr A, Mochel F, Giunti P, Garcia-Moreno H, Schoels L, Hengel H, Synofzik M, Bender B, Oz G, Joers J, de Vries JJ, Kang JS, Timmann-Braun D, Jacobi H, Infante J, Joules R, Romanzetti S, Diedrichsen J, Schmid M, Wolz R, Klockgether T. Regional Brain and Spinal Cord Volume Loss in Spinocerebellar Ataxia Type 3. Mov Disord 2021; 36:2273-2281. [PMID: 33951232 PMCID: PMC9521507 DOI: 10.1002/mds.28610] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Given that new therapeutic options for spinocerebellar ataxias are on the horizon, there is a need for markers that reflect disease-related alterations, in particular, in the preataxic stage, in which clinical scales are lacking sensitivity. Objective: The objective of this study was to quantify regional brain volumes and upper cervical spinal cord areas in spinocerebellar ataxia type 3 in vivo across the entire time course of the disease. Methods: We applied a brain segmentation approach that included a lobular subsegmentation of the cerebellum to magnetic resonance images of 210 ataxic and 48 preataxic spinocerebellar ataxia type 3 mutation carriers and 63 healthy controls. In addition, cervical cord cross-sectional areas were determined at 2 levels. Results: The metrics of cervical spinal cord segments C3 and C2, medulla oblongata, pons, and pallidum, and the cerebellar anterior lobe were reduced in preataxic mutation carriers compared with controls. Those of cervical spinal cord segments C2 and C3, medulla oblongata, pons, midbrain, cerebellar lobules crus II and X, cerebellar white matter, and pallidum were reduced in ataxic compared with nonataxic carriers. Of all metrics studied, pontine volume showed the steepest decline across the disease course. It covaried with ataxia severity, CAG repeat length, and age. The multivariate model derived from this analysis explained 46.33% of the variance of pontine volume. Conclusion: Regional brain and spinal cord tissue loss in spinocerebellar ataxia type 3 starts before ataxia onset. Pontine volume appears to be the most promising imaging biomarker candidate for interventional trials that aim at slowing the progression of spinocerebellar ataxia type 3.
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Affiliation(s)
- Jennifer Faber
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Tamara Schaprian
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Koyak Berkan
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Bonn, Germany.,JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich, Jülich, Germany
| | - Marcondes Cavalcante França
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | - Thiago Junqueira Ribeiro de Rezende
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | - Jiang Hong
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Bart van de Warrenburg
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Judith van Gaalen
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Fanny Mochel
- Sorbonne Université, Paris Brain Institute, AP-HP, INSERM, CNRS, Pitié-Salpêtrière University Hospital, Paris, France
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ludger Schoels
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Holger Hengel
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Gulin Oz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - James Joers
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jereon J de Vries
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jun-Suk Kang
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | | | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jon Infante
- Neurology Service, University Hospital Marques de Valdecilla-IDIVAL, University of Cantabria, Centro de Investigacion Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | | | - Sandro Romanzetti
- JARA-Brain Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich, Jülich, Germany
| | - Jorn Diedrichsen
- Brain Mind Institute, Departmentof Computer Science, Department of Statistics, University of Western Ontario, London, Canada
| | - Matthias Schmid
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.,Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | | | - Thomas Klockgether
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
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Peng L, Chen Z, Long Z, Liu M, Lei L, Wang C, Peng H, Shi Y, Peng Y, Deng Q, Wang S, Zou G, Wan L, Yuan H, He L, Xie Y, Tang Z, Wan N, Gong Y, Hou X, Shen L, Xia K, Li J, Chen C, Qiu R, Klockgether T, Tang B, Jiang H. New Model for Estimation of the Age at Onset in Spinocerebellar Ataxia Type 3. Neurology 2021; 96:e2885-e2895. [PMID: 33893204 DOI: 10.1212/wnl.0000000000012068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to develop an appropriate parametric survival model to predict patient's age at onset (AAO) for spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) populations from mainland China. METHODS We compared the efficiency and performance of 6 parametric survival analysis methods (exponential, weibull, log-gaussian, gaussian, log-logistic, and logistic) based on cytosine-adenine-guanine (CAG) repeat length at ATXN3 to predict the probability of AAO in the largest cohort of patients with SCA3/MJD. A set of evaluation criteria, including -2 log-likelihood statistic, Akaike information criterion (AIC), bayesian information criterion (BIC), Nagelkerke R-squared (Nagelkerke R^2), and Cox-Snell residual plot, were used to identify the best model. RESULTS Among these 6 parametric survival models, the logistic model had the lowest -2 log-likelihood (6,560.12), AIC (6,566.12), and BIC (6,566.14) and the highest value of Nagelkerke R^2 (0.54), with the closest graph to the bisector Cox-Snell residual graph. Therefore, the logistic survival model was the best fit to the studied data. Using the optimal logistic survival model, we indicated the age-specific probability distribution of AAO according to the CAG repeat size and current age. CONCLUSIONS We first demonstrated that the logistic survival model provided the best fit for AAO prediction in patients with SCA3/MJD from mainland China. This optimal model can be valuable in clinical and research. However, the rigorous clinical testing and practice of other independent cohorts are needed for its clinical application. A unified model across multiethnic cohorts is worth further exploration by identifying regional differences and significant modifiers in AAO determination.
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Affiliation(s)
- Linliu Peng
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Zhao Chen
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Zhe Long
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Mingjie Liu
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Lijing Lei
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Chunrong Wang
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Huirong Peng
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Yuting Shi
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Yun Peng
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Qi Deng
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Shang Wang
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Guangdong Zou
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Linlin Wan
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Hongyu Yuan
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Lang He
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Yue Xie
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Zhichao Tang
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Na Wan
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Yiqing Gong
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Xuan Hou
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Lu Shen
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Kun Xia
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Jinchen Li
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Chao Chen
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Rong Qiu
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Thomas Klockgether
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Beisha Tang
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Hong Jiang
- From the Department of Neurology (L.P., Z.C., M.L., L.L., H.P., Y.S., Y.P., Q.D., S.W., G.Z., L.W., H.Y., L.H., Y.X., Z.T., N.W., Y.G., X.H., L.S., J.L., B.T., H.J.), Department of Pathology (C.W.), National Clinical Research Center for Geriatric Disorders (Z.C., L.S., B.T., H.J.), Xiangya Hospital, Central South University; Department of Neurology (Z.L.), The Second Xiangya Hospital, Central South University; Key Laboratory of Hunan Province in Neurodegenerative Disorders (Z.C., L.S., J.L., B.T., H.J.), Center for Medical Genetics School of Life Sciences (K.X., J.L., C.C.), Hunan Key Laboratory of Medical Genetics (K.X., J.L., C.C.), School of Computer Science and Engineering (R.Q.), and School of Basic Medical Science (H.J.), Central South University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany.
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Kim DH, Kim R, Lee JY, Lee KM. Clinical, Imaging, and Laboratory Markers of Premanifest Spinocerebellar Ataxia 1, 2, 3, and 6: A Systematic Review. J Clin Neurol 2021; 17:187-199. [PMID: 33835738 PMCID: PMC8053554 DOI: 10.3988/jcn.2021.17.2.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background and Purpose Premanifest mutation carriers with spinocerebellar ataxia (SCA) can exhibit subtle abnormalities before developing ataxia. We summarized the preataxic manifestations of SCA1, -2, -3, and -6, and their associations with ataxia onset. Methods We included studies of the premanifest carriers of SCA published between January 1998 and December 2019 identified in Scopus and PubMed by searching for terms including ‘spinocerebellar ataxia’ and several synonyms of ‘preataxic manifestation’. We systematically reviewed the results obtained in studies categorized based on clinical, imaging, and laboratory markers. Results We finally performed a qualitative analysis of 48 papers. Common preataxic manifestations appearing in multiple SCA subtypes were muscle cramps, abnormal muscle reflexes, instability in gait and posture, lower Composite Cerebellar Functional Severity scores, abnormalities in video-oculography and transcranial magnetic stimulation, and gray-matter loss and volume reduction in the brainstem and cerebellar structures. Also, decreased sensory amplitudes in nerve conduction studies were observed in SCA2. Eotaxin and neurofilament light-chain levels were revealed as sensitive blood biomarkers in SCA3. Concerning potential predictive markers, hyporeflexia and abnormalities of somatosensory evoked potentials showed correlations with the time to ataxia onset in SCA2 carriers. However, no longitudinal data were found for the other SCA gene carriers. Conclusions Our results suggest that preataxic manifestations vary among SCA1, -2, -3, and -6, with some subtypes sharing specific features. Combining various markers into a standardized index for premanifest carriers may be useful for early screening and assessing the risk of disease progression in SCA carriers.
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Affiliation(s)
- Dong Hoi Kim
- Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ryul Kim
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Jee Young Lee
- Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Kyoung Min Lee
- Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Coarelli G, Darios F, Petit E, Dorgham K, Adanyeguh I, Petit E, Brice A, Mochel F, Durr A. Plasma neurofilament light chain predicts cerebellar atrophy and clinical progression in spinocerebellar ataxia. Neurobiol Dis 2021; 153:105311. [PMID: 33636389 DOI: 10.1016/j.nbd.2021.105311] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Neurofilament light chain (NfL) is a marker of brain atrophy and predictor of disease progression in rare diseases such as Huntington Disease, but also in more common neurological disorders such as Alzheimer's disease. The aim of this study was to measure NfL longitudinally in autosomal dominant spinocerebellar ataxias (SCAs) and establish correlation with clinical and imaging parameters. We enrolled 62 pathological expansions carriers (17 SCA1, 13 SCA2, 19 SCA3, and 13 SCA7) and 19 age-matched controls in a prospective biomarker study between 2011 and 2015 and followed for 24 months at the Paris Brain Institute. We performed neurological examination, brain 3 T MRI and plasma NfL measurements using an ultrasensitive single-molecule array at baseline and at the two-year follow-up visit. We evaluated NfL correlations with ages, CAG repeat sizes, clinical scores and volumetric brain MRIs. NfL levels were significantly higher in SCAs than controls at both time points (p < 0.001). Age-adjusted NfL levels were significantly correlated at baseline with clinical scores (p < 0.01). We identified optimal NfL cut-off concentrations to differentiate controls from carriers for each genotype (SCA1 16.87 pg/mL, SCA2, 19.1 pg/mL, SCA3 16.04 pg/mL, SCA7 16.67 pg/mL). For all SCAs, NfL concentration was stable over two years (p = 0.95) despite a clinical progression (p < 0.0001). Clinical progression between baseline and follow-up was associated with higher NfL concentrations at baseline (p = 0.04). Of note, all premanifest carriers with NfL levels close to cut off concentrations had signs of the disease at follow-up. For all SCAs, the higher the observed NfL, the lower the pons volume at baseline (p < 0.01) and follow-up (p = 0.02). Higher NfL levels at baseline in all SCAs predicted a decrease in cerebellar volume (p = 0.03). This result remained significant for SCA2 only among all genotypes (p = 0.02). Overall, plasma NfL levels at baseline in SCA expansion carriers predict cerebellar volume change and clinical score progression. NfL levels might help refine inclusion criteria for clinical trials in carriers with very subtle signs.
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Affiliation(s)
- Giulia Coarelli
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Frederic Darios
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Emilien Petit
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Karim Dorgham
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), F-75013 Paris, France
| | - Isaac Adanyeguh
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Elodie Petit
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexis Brice
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Fanny Mochel
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexandra Durr
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.
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45
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de Oliveira CM, Leotti VB, Bolzan G, Cappelli AH, Rocha AG, Ecco G, Kersting N, Rieck M, Martins AC, Sena LS, Saraiva-Pereira ML, Jardim LB. Pre-ataxic Changes of Clinical Scales and Eye Movement in Machado-Joseph Disease: BIGPRO Study. Mov Disord 2021; 36:985-994. [PMID: 33438269 DOI: 10.1002/mds.28466] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The pathological burden of spinocerebellar ataxia type 3, also known as Machado-Joseph disease (SCA3/MJD), accumulates before the beginning of symptoms. Our study aims at validating biomarkers for disease progression since pre-ataxic periods. We report on baseline findings of clinical scales and oculomotor neurophysiology. METHODS Ataxic (Scale for the Assessment and Rating of Ataxia > 2.5) and at 50% risk subjects were included. The latter were subdivided into noncarriers, pre-ataxic carriers near (PAN), or pre-ataxic carriers far from (PAFF) ataxia onset (AO), with 4 years from the predicted age at onset being the cutoff. The subjects were assessed by Neurological Examination Score for Spinocerebellar Ataxia (NESSCA), International Cooperative Ataxia Rating Scale (ICARS), Inventory of Non-Ataxic Signs (INAScount), Composite Cerebellar Functions Score and SCA Functional Index, and video-oculography, including the regression slope of vestibulo-ocular reflex gain (VORr), main sequence of volitional and reflexive vertical saccades, slow-phase velocity of central and gaze-evoked (SPV-GE) nystagmus, and vertical pursuit gain. Correction for multiple comparisons was performed; the threshold for statistical significance was P < 0.05. RESULTS A total of 35 ataxic, 14 PAN, 24 PAFF, and 22 noncarriers were included. All variables showed significant differences between groups and correlated to time to onset or time after onset, among all 73 SCA3/MJD carriers; none significantly changed with age in controls. NESSCA, ICARS, INAScount, VORr, main sequence of volitional saccades, and SPV-GE not only distinguished PAN from controls but also correlated with time left to AO. CONCLUSIONS Clinical scales and video-oculography variables were already altered in pre-ataxic SCA3/MJD carriers and worsened with time. NESSCA, ICARS, INAScount, VORr, main sequence of vertical volitional saccades, and SPV-GE are good candidates to measure preclinical changes in SCA3/MJD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Camila Maria de Oliveira
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Bolzan
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda Henz Cappelli
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriela Ecco
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nathalia Kersting
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mariana Rieck
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Carolina Martins
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Schenatto Sena
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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46
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Donaldson J, Powell S, Rickards N, Holmans P, Jones L. What is the Pathogenic CAG Expansion Length in Huntington's Disease? J Huntingtons Dis 2021; 10:175-202. [PMID: 33579866 PMCID: PMC7990448 DOI: 10.3233/jhd-200445] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Huntington's disease (HD) (OMIM 143100) is caused by an expanded CAG repeat tract in the HTT gene. The inherited CAG length is known to expand further in somatic and germline cells in HD subjects. Age at onset of the disease is inversely correlated with the inherited CAG length, but is further modulated by a series of genetic modifiers which are most likely to act on the CAG repeat in HTT that permit it to further expand. Longer repeats are more prone to expansions, and this expansion is age dependent and tissue-specific. Given that the inherited tract expands through life and most subjects develop disease in mid-life, this implies that in cells that degenerate, the CAG length is likely to be longer than the inherited length. These findings suggest two thresholds- the inherited CAG length which permits further expansion, and the intracellular pathogenic threshold, above which cells become dysfunctional and die. This two-step mechanism has been previously proposed and modelled mathematically to give an intracellular pathogenic threshold at a tract length of 115 CAG (95% confidence intervals 70- 165 CAG). Empirically, the intracellular pathogenic threshold is difficult to determine. Clues from studies of people and models of HD, and from other diseases caused by expanded repeat tracts, place this threshold between 60- 100 CAG, most likely towards the upper part of that range. We assess this evidence and discuss how the intracellular pathogenic threshold in manifest disease might be better determined. Knowing the cellular pathogenic threshold would be informative for both understanding the mechanism in HD and deploying treatments.
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Affiliation(s)
- Jasmine Donaldson
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Sophie Powell
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Nadia Rickards
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Holmans
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Lesley Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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47
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Nigri A, Sarro L, Mongelli A, Pinardi C, Porcu L, Castaldo A, Ferraro S, Grisoli M, Bruzzone MG, Gellera C, Taroni F, Mariotti C, Nanetti L. Progression of Cerebellar Atrophy in Spinocerebellar Ataxia Type 2 Gene Carriers: A Longitudinal MRI Study in Preclinical and Early Disease Stages. Front Neurol 2020; 11:616419. [PMID: 33384659 PMCID: PMC7770103 DOI: 10.3389/fneur.2020.616419] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Spinocerebellar ataxias type 2 (SCA2) is an autosomal dominant inherited disease caused by expanded trinucleotide repeats (≥32 CAG) within the coding region of ATXN2 gene. Age of disease onset primarily depends on the length of the expanded region. The majority of subjects carrying the mutation remain free of clinical signs for few decades (“pre-symptomatic” stage), but in proximity of disease onset subtle neurophysiological, cognitive, and structural brain imaging changes may occur. Aims of the present study are to determine the time-window in which early clinical and neurodegenerative MRI changes may be identified, and to evaluate the rate of the disease progression in both preclinical and early disease phases. We performed a 1-year longitudinal study in 42 subjects: 14 SCA2 patients (mean age 39 years, disease duration 7 years, SARA score 9 points), 13 presymptomatic SCA2 subjects (preSCA2, mean age 39 years, expected time to disease onset 16 years), and 15 gene-negative healthy controls (mean age 33 years). All participants underwent genetic test, neurological examination, cognitive tests, and brain MRI. Evaluations were repeated at 1-year interval. Baseline MRI evaluations in SCA2 patients showed significant atrophy in cerebellum, brainstem, basal ganglia and cortex compared to controls, while preSCA2 subjects had isolated volume loss in the pons, and cortical thinning in specific frontal and parietal areas, namely rostral-middle-frontal and precuneus. One-year longitudinal follow-up demonstrated, in SCA2 patients, volume reduction in cerebellum, pons, superior cerebellar peduncles, and midbrain, and only in the cerebellum in preSCA2 subjects. No progression in clinical or cognitive measures was observed in preSCA2 subjects. The rate of volume loss in the cerebellum and subcortical regions greatly differed between patients and preSCA2. In conclusion, our pilot study demonstrated that MRI measures are highly sensitive to identify longitudinal structural changes in SCA2 patients, and in preSCA2 up to a decade before expected disease onset. These findings may contribute in the understanding of early neurodegenerative processes and may be useful in future therapeutical trials.
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Affiliation(s)
- Anna Nigri
- Department of Neuroradiology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lidia Sarro
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Ospedale Martini, Turin, Italy
| | - Alessia Mongelli
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pinardi
- Department of Neuroradiology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Anna Castaldo
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefania Ferraro
- Department of Neuroradiology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Department of Neuroradiology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cinzia Gellera
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Franco Taroni
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Nanetti
- Department of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
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48
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Peng L, Chen Z, Chen T, Lei L, Long Z, Liu M, Deng Q, Yuan H, Zou G, Wan L, Wang C, Peng H, Shi Y, Wang P, Peng Y, Wang S, He L, Xie Y, Tang Z, Wan N, Gong Y, Hou X, Shen L, Xia K, Li J, Chen C, Zhang Z, Qiu R, Tang B, Jiang H. Prediction of the Age at Onset of Spinocerebellar Ataxia Type 3 with Machine Learning. Mov Disord 2020; 36:216-224. [PMID: 32991004 DOI: 10.1002/mds.28311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In polyglutamine (polyQ) disease, the investigation of the prediction of a patient's age at onset (AAO) facilitates the development of disease-modifying intervention and underpins the delay of disease onset and progression. Few polyQ disease studies have evaluated AAO predicted by machine-learning algorithms and linear regression methods. OBJECTIVE The objective of this study was to develop a machine-learning model for AAO prediction in the largest spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) population from mainland China. METHODS In this observational study, we introduced an innovative approach by systematically comparing the performance of 7 machine-learning algorithms with linear regression to explore AAO prediction in SCA3/MJD using CAG expansions of 10 polyQ-related genes, sex, and parental origin. RESULTS Similar prediction performance of testing set and training set in each models were identified and few overfitting of training data was observed. Overall, the machine-learning-based XGBoost model exhibited the most favorable performance in AAO prediction over the traditional linear regression method and other 6 machine-learning algorithms for the training set and testing set. The optimal XGBoost model achieved mean absolute error, root mean square error, and median absolute error of 5.56, 7.13, 4.15 years, respectively, in testing set 1, with mean absolute error (4.78 years), root mean square error (6.31 years), and median absolute error (3.59 years) in testing set 2. CONCLUSION Machine-learning algorithms can be used to predict AAO in patients with SCA3/MJD. The optimal XGBoost algorithm can provide a good reference for the establishment and optimization of prediction models for SCA3/MJD or other polyQ diseases. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Linliu Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhao Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Tiankai Chen
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Lijing Lei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhe Long
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mingjie Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qi Deng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyu Yuan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Guangdong Zou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Linlin Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Chunrong Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Huirong Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuting Shi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Puzhi Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Shang Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lang He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yue Xie
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhichao Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Na Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yiqing Gong
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Hou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Kun Xia
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Jinchen Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Chao Chen
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Zuping Zhang
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Rong Qiu
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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49
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Jacobi H, du Montcel ST, Romanzetti S, Harmuth F, Mariotti C, Nanetti L, Rakowicz M, Makowicz G, Durr A, Monin ML, Filla A, Roca A, Schöls L, Hengel H, Infante J, Kang JS, Timmann D, Casali C, Masciullo M, Baliko L, Melegh B, Nachbauer W, Bürk-Gergs K, Schulz JB, Riess O, Reetz K, Klockgether T. Conversion of individuals at risk for spinocerebellar ataxia types 1, 2, 3, and 6 to manifest ataxia (RISCA): a longitudinal cohort study. Lancet Neurol 2020; 19:738-747. [PMID: 32822634 DOI: 10.1016/s1474-4422(20)30235-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/16/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Spinocerebellar ataxias (SCAs) are autosomal dominant neurodegenerative diseases. Our aim was to study the conversion to manifest ataxia among apparently healthy carriers of mutations associated with the most common SCAs (SCA1, SCA2, SCA3, and SCA6), and the sensitivity of clinical and functional measures to detect change in these individuals. METHODS In this prospective, longitudinal, observational cohort study, based at 14 referral centres in seven European countries, we enrolled children or siblings of patients with SCA1, SCA2, SCA3, or SCA6. Eligible individuals were those without ataxia, defined by a score on the Scale for the Assessment and Rating of Ataxia (SARA) of less than 3; participants had to be aged 18-50 years for children or siblings of patients with SCA1, SCA2, or SCA3, and 35-70 years for children or siblings of patients with SCA6. Study visits took place at recruitment and after 2, 4, and 6 years (plus or minus 3 months). We did genetic testing to identify mutation carriers, with results concealed to the participant and clinical investigator. We assessed patients with clinical scales, questionnaires of patient-reported outcome measures, a rating of the examiner's confidence of presence of ataxia, and performance-based coordination tests. Conversion to ataxia was defined by an SARA score of 3 or higher. We analysed the association of factors at baseline with conversion to ataxia and the evolution of outcome parameters on temporal scales (time from inclusion and time to predicted age at ataxia onset) in the context of mutation status and conversion status. This study is registered with ClinicalTrials.gov, NCT01037777. FINDINGS Between Sept 13, 2008, and Oct 28, 2015, 302 participants were enrolled. We analysed data for 252 participants with at least one follow-up visit. 83 (33%) participants were from families affected by SCA1, 99 (39%) by SCA2, 46 (18%) by SCA3, and 24 (10%) by SCA6. In participants who carried SCA mutations, 26 (52%) of 50 SCA1 carriers, 22 (59%) of 37 SCA2 carriers, 11 (42%) of 26 SCA3 carriers, and two (13%) of 15 SCA6 carriers converted to ataxia. One (3%) of 33 SCA1 non-carriers and one (2%) of 62 SCA2 non-carriers converted to ataxia. Owing to the small number of people who met our criteria for ataxia, subsequent analyses could not be done in carriers of the SCA6 mutation. Baseline factors associated with conversion were age (hazard ratio 1·13 [95% CI 1·03-1·24]; p=0·011), CAG repeat length (1·25 [1·11-1·41]; p=0·0002), and ataxia confidence rating (1·72 [1·23-2·41]; p=0·0015) for SCA1; age (1·08 [1·02-1·14]; p=0·0077) and CAG repeat length (1·65 [1·27-2·13]; p=0·0001) for SCA2; and age (1·27 [1·09-1·50]; p=0·0031), confidence rating (2·60 [1·23-5·47]; p=0·012), and double vision (14·83 [2·15-102·44]; p=0·0063) for SCA3. From the time of inclusion, the SARA scores of SCA1, SCA2, and SCA3 mutation carriers increased, whereas they remained stable in non-carriers. On a timescale defined by the predicted time of ataxia onset, SARA progression in SCA1, SCA2, and SCA3 mutation carriers was non-linear, with marginal progression before ataxia and increasing progression after ataxia onset. INTERPRETATION Our study provides quantitative data on the conversion of non-ataxic SCA1, SCA2, and SCA3 mutation carriers to manifest ataxia. Our data could prove useful for the design of preventive trials aimed at delaying the onset of ataxia by aiding sample size calculations and stratification of study participants. FUNDING European Research Area Network for Research Programmes on Rare Diseases, Polish Ministry of Science and Higher Education, Italian Ministry of Health, European Community's Seventh Framework Programme.
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Affiliation(s)
- Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Sophie Tezenas du Montcel
- Sorbonne Université, Institut, Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, University Hospital Pitié-Salpêtrière, Paris, France
| | - Sandro Romanzetti
- Department of Neurology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Florian Harmuth
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Rakowicz
- First Neurological Department, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Grzegorz Makowicz
- Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, University Hospital Pitié-Salpêtrière, Paris, France
| | - Marie-Lorraine Monin
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, University Hospital Pitié-Salpêtrière, Paris, France
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Roca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Ludger Schöls
- Department of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Holger Hengel
- Department of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla-Instituto de Investigación Marqués de Valdecilla, University of Cantabria, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Santander, Spain
| | - Jun-Suk Kang
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | | | - Laszlo Baliko
- Department of Neurology, Magyar Imre Hospital, Ajka, Hungary
| | - Bela Melegh
- Department of Medical Genetics, University of Pécs and Szentagothai Research Centre, University of Pécs, Pécs, Hungary
| | - Wolfgang Nachbauer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Katrin Bürk-Gergs
- Department of Neurology, Philipps University of Marburg, Marburg, Germany; Kliniken Schmieder Stuttgart-Gerlingen, Gerlingen, Germany
| | - Jörg B Schulz
- Department of Neurology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany; Rare Disease Center Tübingen, University of Tübingen, Tübingen, Germany
| | - Kathrin Reetz
- Department of Neurology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurology, University Hospital of Bonn, Bonn, Germany
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Peng Y, Zhang Y, Chen Z, Peng H, Wan N, Zhang J, Tang J, Wang P, Xie Y, Cai Q, Liu S, Zhang X, Wang C, Yuan H, Li T, Wan L, Shi Y, Qiu R, Klockgether T, Tang B, Liao W, Jiang H. Association of serum neurofilament light and disease severity in patients with spinocerebellar ataxia type 3. Neurology 2020; 95:e2977-e2987. [PMID: 32817181 DOI: 10.1212/wnl.0000000000010671] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate serum neurofilament light protein (sNfL) levels in patients with spinocerebellar ataxia type 3 (SCA3) and to determine whether they are associated with disease severity. METHODS This cross-sectional study enrolled 185 healthy controls and 235 ATXN3 mutation carriers (17 asymptomatic stage, 20 preclinical stage, and 198 ataxic stage). We measured sNfL levels with the single molecule array (Simoa) platform. Clinical disease severity was assessed using the Scale of Assessment and Rating of Ataxia (SARA) and the Inventory of Nonataxia Signs (INAS). In a subgroup of 50 ataxic stage patients, we further evaluated the gray matter volume and the integrity of white matter fibers by MRI. RESULTS sNfL concentrations were elevated in asymptomatic, preclinical, and ataxic ATXN3 mutation carriers compared to controls (12.18 [10.20-13.92], 21.84 [18.37-23.45], 36.06 [30.04-45.90], and 8.24 [5.92-10.84] pg/mL, median [interquartile range], respectively, p < 0.001). sNfL correlated with SARA (r = 0.406, 95% confidence interval [CI] 0.284-0.515, p < 0.0001) and INAS (r = 0.375, 95% CI 0.250-0.487, p < 0.0001), and remained significant after adjustment for age and CAG repeats. In addition, we observed negative correlations of the sNfL with gray matter volume in the left precentral gyrus and the left paracentral lobule as well as with the mean diffusivity in widespread white matter tracts. CONCLUSION Our results demonstrate that sNfL levels are increased in SCA3 and are associated with clinical disease severity, which supports sNfL as a biomarker for disease severity in SCA3. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with SCA3, sNfL elevations are associated with clinical disease severity.
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Affiliation(s)
- Yun Peng
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Youming Zhang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Zhao Chen
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Huirong Peng
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Na Wan
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Jennifer Zhang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Jingyi Tang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Puzhi Wang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Yue Xie
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Qiyong Cai
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Shaohui Liu
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Xuewei Zhang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Chunrong Wang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Hongyu Yuan
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Tianjiao Li
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany.
| | - Linlin Wan
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Yuting Shi
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Rong Qiu
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Thomas Klockgether
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Beisha Tang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany
| | - Weihua Liao
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany.
| | - Hong Jiang
- From the Departments of Neurology (Y.P., Z.C., H.P., N.W., P.W., Y.X., H.Y., T.L., L.W., Y.S., B.T., H.J.), Radiology (Y.Z., J.T., W.L.), and Pathology (C.W.), Health Management Center (S.L., X.Z.), and National Clinical Research Center for Geriatric Diseases (B.T., W.L., H.J.), Xiangya Hospital, and School of Computer Science and Engineering (R.Q.), Laboratory of Medical Genetics (B.T., H.J.), and Key Laboratory of Hunan Province in Neurodegenerative Disorders (B.T., H.J.), Central South University, Changsha, Hunan, China; Department of Human Genetics (J.Z.), Emory University School of Medicine, Atlanta, GA; Institute of Chemical Biology and Nanomedicine (ICBN) (Q.C.), Hunan University, Changsha, Hunan, China; Department of Neurology (T.K.), University of Bonn; and German Center for Neurodegenerative Diseases (DZNE) (T.K.), Bonn, Germany.
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