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Ludolph AC, Corcia P, Desnuelle C, Heiman-Patterson T, Mora JS, Mansfield CD, Couratier P. Categorization of the amyotrophic lateral sclerosis population via the clinical determinant of post-onset ΔFS for study design and medical practice. Muscle Nerve 2024; 70:36-41. [PMID: 38712849 DOI: 10.1002/mus.28101] [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: 11/21/2023] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024]
Abstract
The amyotrophic lateral sclerosis (ALS) functional rating scale-revised (ALSFRS-R) has become the most widely utilized measure of disease severity in patients with ALS, with change in ALSFRS-R from baseline being a trusted primary outcome measure in ALS clinical trials. This is despite the scale having several established limitations, and although alternative scales have been proposed, it is unlikely that these will displace ALSFRS-R in the foreseeable future. Here, we discuss the merits of delta FS (ΔFS), the slope or rate of ALSFRS-R decline over time, as a relevant tool for innovative ALS study design, with an as yet untapped potential for optimization of drug effectiveness and patient management. In our view, categorization of the ALS population via the clinical determinant of post-onset ΔFS is an important study design consideration. It serves not only as a critical stratification factor and basis for patient enrichment but also as a tool to explore differences in treatment response across the overall population; thereby, facilitating identification of responder subgroups. Moreover, because post-onset ΔFS is derived from information routinely collected as part of standard patient care and monitoring, it provides a suitable patient selection tool for treating physicians. Overall, post-onset ΔFS is a very attractive enrichment tool that is, can and should be regularly incorporated into ALS trial design.
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Affiliation(s)
- Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases, Ulm, Germany
| | - Philippe Corcia
- Le Centre de Référence pour les Maladies Rares SLA, CHRU Bretonneau, Tours, France
- UMR 1253 iBrain, Tours, France
| | - Claude Desnuelle
- Centre de Référence Maladies Neuromusculaires/SLA, Neurosciences Department, CHU Nice-University Nice-Côte d'Azur, Nice, France
| | - Terry Heiman-Patterson
- Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | | | - Philippe Couratier
- Centre de Référence SLA et Autres Maladies du Motoneurone, CHU Dupuytren, Limoges, France
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Pavey NA, Menon P, Peterchev AV, Kiernan MC, Vucic S. Abnormalities of cortical stimulation strength-duration time constant in amyotrophic lateral sclerosis. Clin Neurophysiol 2024; 164:161-167. [PMID: 38901111 DOI: 10.1016/j.clinph.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/23/2024] [Accepted: 05/26/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES Strength-duration time constant (SDTC) may now be determined for cortical motor neurones, with activity mediated by transient Na+ conductances. The present study determined whether cortical SDTC is abnormal and linked to the pathogenesis of amyotrophic lateral sclerosis. METHODS Cortical SDTC and rheobase were estimated from 17 ALS patients using a controllable pulse parameter transcranial magnetic stimulation (cTMS) device. Resting motor thresholds (RMTs) were determined at pulse widths (PW) of 30, 45, 60, 90 and 120 µs and M-ratio of 0.1, using a figure-of-eight coil applied to the primary motor cortex. RESULTS SDTC was significantly reduced in ALS patients (150.58 ± 9.98 µs; controls 205.94 ± 13.7 µs, P < 0.01). The reduced SDTC correlated with a rate of disease progression (Rho = -0.440, P < 0.05), ALS functional rating score (ALSFRS-R) score (Rho = 0.446, P < 0.05), and disease duration (R = 0.428, P < 0.05). The degree of change in SDTC was greater in patients with cognitive abnormalities as manifested by an abnormal total Edinburgh Cognitive ALS Screen score (140.5 ± 28.7 µs, P < 0.001) and ALS-specific subscore (141.7 ± 33.2 µs, P = 0.003). CONCLUSIONS Cortical SDTC reduction was associated with a more aggressive ALS phenotype, or with more prominent cognitive impairment. SIGNIFICANCE An increase in transient Na+ conductances may account for the reduction in SDTC, linked to the pathogenesis of ALS.
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Affiliation(s)
- Nathan A Pavey
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, Australia
| | - Angel V Peterchev
- Department of Biological Sciences, Dartmouth College, Hanover, NH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA
| | | | - Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, Australia.
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Khanna RK, Catanese S, Blasco H, Pisella PJ, Corcia P. Corneal nerves and amyotrophic lateral sclerosis: an in vivo corneal confocal imaging study. J Neurol 2024; 271:3370-3377. [PMID: 38498118 DOI: 10.1007/s00415-024-12282-8] [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: 11/27/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a severe motor neuron disorder. Diagnosis is challenging due to its clinical heterogeneity and the absence of definitive diagnostic tools, leading to delays averaging between 9.1 and 27 months. In vivo corneal confocal microscopy, assessing the sub-basal nerve plexus of the cornea, has been proposed as a potential biomarker for ALS. We aimed to determine whether the assessment of corneal nerves using in vivo confocal microscopy can serve as an imaging biomarker for ALS. METHODS A single-centre prospective case-control study was conducted in France from September 2021 to March 2023 including patients with ALS according to the revised EI Escorial criteria. The corneal sub-basal nerve plexus was analysed using in vivo confocal microscopy. An automated algorithm (ACCMetrics) was used to evaluate corneal parameters: nerve fibre density, nerve branch density, nerve fibre length, nerve fibre area, nerve total branch density, nerve fibre width, and nerve fractal dimension. RESULTS Twenty-two patients with ALS and 30 controls were included. No significant differences were found between ALS and control groups for all corneal parameters (p > 0.05). Corneal sensitivity did not differ between groups, and no correlation was identified between corneal nerve parameters and ALS disease duration, severity and rate of progression (p > 0.05). CONCLUSIONS The present study does not support the use of in vivo corneal confocal microscopy as an early diagnostic or prognostic tool for ALS. Further research, especially longitudinal investigations, is needed to understand any potential corneal innervation changes as ALS progresses.
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Affiliation(s)
- Raoul K Khanna
- Department of Ophthalmology, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France.
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France.
| | - Sophie Catanese
- Department of Ophthalmology, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
| | - Hélène Blasco
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
- Biochemistry and Molecular Biology Department, Bretonneau University Hospital of Tours, Tours, France
| | - Pierre-Jean Pisella
- Department of Ophthalmology, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Philippe Corcia
- Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, 37032, Tours, France
- Amyotrophic Lateral Sclerosis Centre, Department of Neurology, Bretonneau University Hospital of Tours, Tours, France
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Wendebourg MJ, Weigel M, Weidensteiner C, Sander L, Kesenheimer E, Naumann N, Haas T, Madoerin P, Braun N, Neuwirth C, Weber M, Jahn K, Kappos L, Granziera C, Schweikert K, Sinnreich M, Bieri O, Schlaeger R. Cervical and thoracic spinal cord gray matter atrophy is associated with disability in patients with amyotrophic lateral sclerosis. Eur J Neurol 2024; 31:e16268. [PMID: 38465478 DOI: 10.1111/ene.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND PURPOSE In amyotrophic lateral sclerosis (ALS), there is an unmet need for more precise patient characterization through quantitative, ideally operator-independent, assessments of disease extent and severity. Radially sampled averaged magnetization inversion recovery acquisitions (rAMIRA) magnetic resonance imaging enables gray matter (GM) and white matter (WM) area quantitation in the cervical and thoracic spinal cord (SC) with optimized contrast. We aimed to investigate rAMIRA-derived SC GM and SC WM areas and their association with clinical phenotype and disability in ALS. METHODS A total of 36 patients with ALS (mean [SD] age 61.7 [12.6] years, 14 women) and 36 healthy, age- and sex-matched controls (HCs; mean [SD] age 63.1 [12.1] years, 14 women) underwent two-dimensional axial rAMIRA imaging at the inter-vertebral disc levels C2/3-C5/C6 and the lumbar enlargement level Tmax. ALS Functional Rating Scale-revised (ALSFRS-R) score, muscle strength, and sniff nasal inspiratory pressure (SNIP) were assessed. RESULTS Compared to HCs, GM and WM areas were reduced in patients at all cervical levels (p < 0.0001). GM area (p = 0.0001), but not WM area, was reduced at Tmax. Patients with King's Stage 3 showed significant GM atrophy at all levels, while patients with King's Stage 1 showed significant GM atrophy selectively at Tmax. SC GM area was significantly associated with muscle force at corresponding myotomes. GM area at C3/C4 was associated with ALSFRS-R (p < 0.001) and SNIP (p = 0.0016). CONCLUSION Patients with ALS assessed by rAMIRA imaging show significant cervical and thoracic SC GM and SC WM atrophy. SC GM area correlates with muscle strength and clinical disability. GM area reduction at Tmax may be an early disease sign. Longitudinal studies are warranted.
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Affiliation(s)
- Maria Janina Wendebourg
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Claudia Weidensteiner
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Laura Sander
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Eva Kesenheimer
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Nicole Naumann
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Philipp Madoerin
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Nathalie Braun
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital Sankt Gallen, St. Gallen, Switzerland
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital Sankt Gallen, St. Gallen, Switzerland
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital Sankt Gallen, St. Gallen, Switzerland
| | - Kathleen Jahn
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Kathi Schweikert
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Sinnreich
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Biomedicine (DBE), University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Regina Schlaeger
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
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Kim HS, Woo H, Choi SJ, Baek JG, Ryu JS, Shin HI, Park KS, Beom J. Factors associated with adherence to noninvasive positive pressure ventilation in amyotrophic lateral sclerosis. PLoS One 2024; 19:e0302515. [PMID: 38748695 PMCID: PMC11095767 DOI: 10.1371/journal.pone.0302515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/05/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION This cohort study aimed to investigate the factors associated with noninvasive positive pressure ventilation adherence and assess the long-term effects of noninvasive positive pressure ventilation adherence in patients with amyotrophic lateral sclerosis (ALS). METHODS The medical records of patients with ALS admitted to a tertiary hospital for noninvasive positive pressure ventilation initiation were retrospectively reviewed. Pulmonary function parameters, variables of blood gas analysis, the site of symptom onset, the time from onset and diagnosis to noninvasive positive pressure ventilation application, ALS Functional Rating Scale-Revised, neurophysiological index, and the length of hospital stay were evaluated. The adherence to noninvasive positive pressure ventilation was defined as the use of noninvasive positive pressure ventilation for ≥ 2 h/day or ≥ 4 h/day. The correlations between noninvasive positive pressure ventilation adherence or length of hospital stay and other clinical parameters were analyzed. RESULTS Fifty-one patients with ALS were included in the study. The time from onset and diagnosis to NIPPV application was reduced by 16 months in the adherent group than that in the non-adherent group; however, the parameters of blood gas analysis and pulmonary function tests did not differ significantly between the groups. Furthermore, the neurophysiological index of the abductor digiti minimi muscle was higher by 4.05 in the adherent group than that in the non-adherent group. The adherence to noninvasive positive pressure ventilation prolonged tracheostomy-free survival compared to that of non-adherence. Desaturation events, lower forced vital capacity, last pCO2, bicarbonate, and base excess, and higher differences in pCO2, were associated with an increase in the length of hospital stay. CONCLUSIONS Noninvasive positive pressure ventilation application shortly after symptom onset and ALS diagnosis in patients with CO2 retention and reduced forced vital capacity can be considered for successful adherence. Adherence to noninvasive positive pressure ventilation may result in reduced tracheostomy conversion rates and prolonged tracheostomy-free survival.
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Affiliation(s)
- Hee Soo Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyeonseong Woo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong-Gyu Baek
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Moțățăianu A, Mănescu IB, Șerban G, Bărcuțean L, Ion V, Bălașa R, Andone S. Exploring the Role of Metabolic Hormones in Amyotrophic Lateral Sclerosis. Int J Mol Sci 2024; 25:5059. [PMID: 38791099 PMCID: PMC11121721 DOI: 10.3390/ijms25105059] [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: 03/26/2024] [Revised: 04/27/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease characterized by progressive loss of motor neurons. Emerging evidence suggests a potential link between metabolic dysregulation and ALS pathogenesis. This study aimed to investigate the relationship between metabolic hormones and disease progression in ALS patients. A cross-sectional study was conducted involving 44 ALS patients recruited from a tertiary care center. Serum levels of insulin, total amylin, C-peptide, active ghrelin, GIP (gastric inhibitory peptide), GLP-1 active (glucagon-like peptide-1), glucagon, PYY (peptide YY), PP (pancreatic polypeptide), leptin, interleukin-6, MCP-1 (monocyte chemoattractant protein-1), and TNFα (tumor necrosis factor alpha) were measured, and correlations with ALSFRS-R, evolution scores, and biomarkers were analyzed using Spearman correlation coefficients. Subgroup analyses based on ALS subtypes, progression pattern of disease, and disease progression rate patterns were performed. Significant correlations were observed between metabolic hormones and ALS evolution scores. Insulin and amylin exhibited strong correlations with disease progression and clinical functional outcomes, with insulin showing particularly robust associations. Other hormones such as C-peptide, leptin, and GLP-1 also showed correlations with ALS progression and functional status. Subgroup analyses revealed differences in hormone levels based on sex and disease evolution patterns, with male patients showing higher amylin and glucagon levels. ALS patients with slower disease progression exhibited elevated levels of amylin and insulin. Our findings suggest a potential role for metabolic hormones in modulating ALS progression and functional outcomes. Further research is needed to elucidate the underlying mechanisms and explore the therapeutic implications of targeting metabolic pathways in ALS management.
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Affiliation(s)
- Anca Moțățăianu
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Târgu Mureș, Romania
| | - Ion Bogdan Mănescu
- Department of Laboratory Medicine, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
| | - Georgiana Șerban
- Doctoral School, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
| | - Laura Bărcuțean
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Târgu Mureș, Romania
| | - Valentin Ion
- Faculty of Pharmacy, Department of Analytical Chemistry and Drug Analysis, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
- Drug Testing Laboratory, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
| | - Rodica Bălașa
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Târgu Mureș, Romania
| | - Sebastian Andone
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș ‘George Emil Palade’, 540142 Târgu Mureș, Romania
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Târgu Mureș, Romania
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Rhodes E, Alfa S, Jin HA, Massimo L, Elman L, Amado D, Baer M, Quinn C, McMillan CT. Cognitive reserve in ALS: the role of occupational skills and requirements. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-10. [PMID: 38591193 DOI: 10.1080/21678421.2024.2336113] [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: 12/18/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative condition featuring variable degrees of motor and cognitive impairment. We assessed the impact of specific, empirically derived occupational skills and requirements on cognitive and motor functioning in ALS. METHODS Individuals with ALS (n = 150) were recruited from the University of Pennsylvania's Comprehensive ALS Clinic. The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) measured cognition, and the Penn Upper Motor Neuron (PUMNS) and ALS Functional Rating Scales (ALSFRS-R) measured motor symptoms. We derived 17 factors representing distinct occupational skills and requirements from the Occupational Information Network (O*NET), which were related to cognitive and motor scores using multiple linear regression. RESULTS Occupational roles involving greater reasoning ability (β = 2.12, p < .05), social ability (β = 1.73, p < .05), analytic skills, (β = 3.12, p < .01) and humanities knowledge (β = 1.83, p<.01) were associated with better performance on the ECAS, while jobs involving more exposure to environmental hazards (β=-2.57, p < .01) and technical skills (β=-2.16, p<.01) were associated with lower ECAS scores. Jobs requiring more precision skills (β = 1.91, p < .05) were associated with greater motor dysfunction on the PUMNS. CONCLUSIONS Occupational histories involving more cognitively complex skills and activities were related to preserved cognitive functioning in ALS consistent with the cognitive reserve hypothesis, while jobs with greater exposure to environmental hazards and technical demands were linked to poorer cognitive functioning. Jobs involving more repetitive movements were associated with worse motor functioning, possibly due to overuse. Occupational history provides insight into protective and risk factors for variable degrees of cognitive and motor dysfunction in ALS.
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Affiliation(s)
- Emma Rhodes
- University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia, PA, USA and
| | - Sebleh Alfa
- University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia, PA, USA and
| | - Hannah A Jin
- University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia, PA, USA and
| | - Lauren Massimo
- University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia, PA, USA and
| | - Lauren Elman
- University of Pennsylvania Comprehensive ALS Center, Philadelphia, PA, USA
| | - Defne Amado
- University of Pennsylvania Comprehensive ALS Center, Philadelphia, PA, USA
| | - Michael Baer
- University of Pennsylvania Comprehensive ALS Center, Philadelphia, PA, USA
| | - Colin Quinn
- University of Pennsylvania Comprehensive ALS Center, Philadelphia, PA, USA
| | - Corey T McMillan
- University of Pennsylvania Frontotemporal Degeneration Center, Philadelphia, PA, USA and
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Moțățăianu A, Andone S, Stoian A, Bălașa R, Huțanu A, Sărmășan E. A Potential Role of Interleukin-5 in the Pathogenesis and Progression of Amyotrophic Lateral Sclerosis: A New Molecular Perspective. Int J Mol Sci 2024; 25:3782. [PMID: 38612591 PMCID: PMC11011909 DOI: 10.3390/ijms25073782] [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: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Cumulative data suggest that neuroinflammation plays a prominent role in amyotrophic lateral sclerosis (ALS) pathogenesis. The purpose of this work was to assess if patients with ALS present a specific peripheral cytokine profile and if it correlates with neurological disability assessed by ALSFRS-R, the rate of disease progression, and the pattern of disease progression (horizontal spreading [HSP] versus vertical spreading [VSP]). We determined the levels of 15 cytokines in the blood of 59 patients with ALS and 40 controls. We identified a positive correlation between levels of pro-inflammatory cytokines (interleukin [IL]-17F, IL-33, IL-31) and the age of ALS patients, as well as a positive correlation between IL-12p/70 and survival from ALS onset and ALS diagnosis. Additionally, there was a positive correlation between the ALSFRS-R score in the upper limb and respiratory domain and IL-5 levels. In our ALS cohort, the spreading pattern was 42% horizontal and 58% vertical, with patients with VSP showing a faster rate of ALS progression. Furthermore, we identified a negative correlation between IL-5 levels and the rate of disease progression, as well as a positive correlation between IL-5 and HSP of ALS. To the best of our knowledge, this is the first study reporting a "protective" role of IL-5 in ALS.
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Affiliation(s)
- Anca Moțățăianu
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Sebastian Andone
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Stoian
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Rodica Bălașa
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Huțanu
- Department of Laboratory Medicine, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emanuela Sărmășan
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
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9
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Hu N, Li Y, Liu J, Cui L, Liu M. Split Phenomenon of Fasciculation between Antagonistic Muscles in Amyotrophic Lateral Sclerosis: An Ultrasound Study. Can J Neurol Sci 2024; 51:187-195. [PMID: 37183728 DOI: 10.1017/cjn.2023.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Paresis of muscle groups in patients with amyotrophic lateral sclerosis (ALS) tends to present split phenomena. We explored the split phenomenon of fasciculation in multiple antagonistic muscle groups in ALS patients. METHODS One hundred and forty ALS patients and 66 non-ALS patients were included from a single ALS center. Muscle ultrasonography (MUS) was performed to detect fasciculation in elbow flexor-extensor, wrist flexor-extensor, knee flexor-extensor, and ankle flexor-extensor. Split phenomena of fasciculation between different antagonistic muscle groups were summarized, and the possible influence factors were analyzed through stratified analysis. RESULTS The frequency of split phenomenon of fasciculation intensity was significantly higher than those of muscle strength (26.1% vs. 7.1% for elbow flexor-extensor, 38.3% vs. 5.7% for wrist flexor-extensor, 37.9% vs. 3.0% for knee extensor-flexor, and 33.6% vs. 14.4% for ankle flexor-extensor) (P < 0.01). For muscles with 0-1 level of muscle strength (the Medical Research Council, MRC, score), significance difference in mean fasciculation intensity was observed only in ankle flexor-extensor. For muscles with 2-5 level of muscle strength, significant dissociation of fasciculation grade was common, especially among patients with slow rapid progression rate and both upper and lower motor neuron (UMN and LMN) involvement. As for non-ALS patients, no significant difference was observed in fasciculation intensity between antagonistic muscles. CONCLUSION Split phenomenon of fasciculation between antagonistic muscles was common and relatively specific in ALS patients. Muscle strength, progression rate, and UMN involvement were influence factors of the split phenomenon of fasciculation intensity.
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Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yi Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
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10
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Zamani A, Thomas E, Wright DK. Sex biology in amyotrophic lateral sclerosis. Ageing Res Rev 2024; 95:102228. [PMID: 38354985 DOI: 10.1016/j.arr.2024.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
Although sex differences in amyotrophic lateral sclerosis (ALS) have not been studied systematically, numerous clinical and preclinical studies have shown sex to be influential in disease prognosis. Moreover, with the development of advanced imaging tools, the difference between male and female brain in structure and function and their response to neurodegeneration are more definitive. As discussed in this review, ALS patients exhibit a sex bias pertaining to the features of the disease, and their clinical, pathological, (and pathophysiological) phenotypes. Several epidemiological studies have indicated that this sex disparity stems from various aetiologies, including sex-specific brain structure and neural functioning, genetic predisposition, age, gonadal hormones, susceptibility to traumatic brain injury (TBI)/head trauma and lifestyle factors.
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Affiliation(s)
- Akram Zamani
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
| | - Emma Thomas
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
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11
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Pavey N, Hannaford A, Higashihara M, van den Bos M, Kiernan MC, Menon P, Vucic S. Utility of split hand index with different motor unit number estimation techniques in ALS. Clin Neurophysiol 2023; 156:175-182. [PMID: 37967511 DOI: 10.1016/j.clinph.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Utility of the split hand index (SI) in amyotrophic lateral sclerosis (ALS) has been reported when using the compound muscle action potential (CMAP) amplitude method (SICMAP amp). A motor unit number index (MUNIX) based SI method (SIMUNIX) was purported to exhibit higher sensitivity. The present study assessed the clinical utility of SI, derived by CMAP amplitude, MUNIX and MScan-MUNE (SIMScanFit-MUNE) methods, in ALS. METHODS Sixty-two consecutive patients with neuromuscular symptoms (36 ALS and 26 ALS-mimics) were prospectively recruited. The SI was derived by dividing the product of the CMAP amplitude, MUNIX and MScan-MUNE values recorded over first dorsal interosseous and abductor pollicis brevis by values recorded over abductor digit minimi. RESULTS SICMAP amp, SIMUNIX and SIMScanFit-MUNE were significantly reduced in ALS, with SICMAP amp (area under curve (AUC) = 0.801) and SIMScanFit-MUNE (AUC = 0.805) exhibiting greater diagnostic utility than SIMUNIX (AUC = 0.713). SICMAP amp and SIMScanFit-MUNE exhibited significant correlations with clinical measures of functional disability and weakness of intrinsic hand muscles. CONCLUSIONS SI differentiated ALS from mimic disorders, with SICMAP amp and SIMScanFit-MUNE exhibiting greater utility. SIGNIFICANCE The split hand index represents could serve as a potential diagnostic biomarker in ALS.
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Affiliation(s)
- Nathan Pavey
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Andrew Hannaford
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mehdi van den Bos
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia.
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12
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Zucchi E, Musazzi UM, Fedele G, Martinelli I, Gianferrari G, Simonini C, Fini N, Ghezzi A, Caputo M, Sette E, Vacchiano V, Zinno L, Anceschi P, Canali E, Vinceti M, Ferro S, Mandrioli J. Effect of tauroursodeoxycholic acid on survival and safety in amyotrophic lateral sclerosis: a retrospective population-based cohort study. EClinicalMedicine 2023; 65:102256. [PMID: 37842553 PMCID: PMC10570688 DOI: 10.1016/j.eclinm.2023.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Background Oral tauroursodeoxycholic acid (TUDCA) is a commercial drug currently tested in patients with amyotrophic lateral sclerosis (ALS) both singly and combined with sodium phenylbutyrate. This retrospective study aimed to investigate, in a real-world setting, whether TUDCA had an impact on the overall survival of patients with ALS who were treated with this drug compared to those patients who received standard care only. Methods This propensity score-matched study was conducted in the Emilia Romagna Region (Italy), which has had an ALS regional registry since 2009. Out of 627 patients with ALS diagnosed from January 1st, 2015 to June 30th, 2021 and recorded in the registry with available information on death/tracheostomy, 86 patients took TUDCA and were matched in a 1:2 ratio with patients who received only usual care according to age at onset, sex, phenotype, diagnostic latency, ALS Functional Rating Scale-Revised (ALSFRS-R) at first visit, disease progression rate at first visit, and BMI at diagnosis. The primary outcome was survival difference (time from onset of symptoms to tracheostomy/death) between TUDCA exposed and unexposed patients. Findings A total of 86 patients treated with TUDCA were matched to 172 patients who did not receive treatment. TUDCA-exposed patients were stratified based on dosage (less than or equal to 1000 mg/day or greater) and duration (less than or equal to 12 months or longer) of treatment. The median overall survival was 49.6 months (95% CI 41.7-93.5) among those treated with TUDCA and 36.2 months (95% CI 32.7-41.6) in the control group, with a reduced risk of death observed in patients exposed to a higher dosage (defined as ≥ 1000 mg/day) of TUDCA (HR 0.56; 95% CI 0.38-0.83; p = 0.0042) compared to both the control group and those with lower TUDCA dosages (defined as < 1000 mg/day). TUDCA was generally well-tolerated, except for a minority of patients (n = 7, 8.1%) who discontinued treatment due to side effects, primarily gastrointestinal and mild in severity; only 2 adverse events required hospital access but resolved without sequelae. Interpretation In this population-based exploratory study, patients with ALS who were treated with TUDCA may have prolonged survival compared to patients receiving standard care only. Additional prospective randomized studies are needed to confirm the efficacy and safety of this drug. Funding Emilia-Romagna Region.
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Affiliation(s)
- Elisabetta Zucchi
- Neuroscience PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Umberto Maria Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, via G. Colombo 71, 20133, Milan, Italy
| | - Guido Fedele
- Associazione Farmaceutici dell'Industria (AFI), Viale Ranzoni 1, 20149, Milano, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Gianferrari
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Andrea Ghezzi
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Caputo
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lucia Zinno
- Neurology Unit, Department of Neuroscience, University of Parma, Parma, Italy
| | - Pietro Anceschi
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Canali
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia Medical School, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, Bologna, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Yang J, Xin C, Huo J, Li X, Dong H, Liu Q, Li R, Liu Y. Rab Geranylgeranyltransferase Subunit Beta as a Potential Indicator to Assess the Progression of Amyotrophic Lateral Sclerosis. Brain Sci 2023; 13:1531. [PMID: 38002490 PMCID: PMC10670085 DOI: 10.3390/brainsci13111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/11/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Currently, there is no effective treatment for amyotrophic lateral sclerosis (ALS), a devastating neurodegenerative disorder. Many biomarkers have been proposed, but because ALS is a clinically heterogeneous disease with an unclear etiology, biomarker discovery for ALS has been challenging due to the lack of specificity of these biomarkers. In recent years, the role of autophagy in the development and treatment of ALS has become a research hotspot. In our previous studies, we found that the expression of RabGGTase (low RABGGTB expression and no change in RABGGTA) is lower in the lumbar and thoracic regions of spinal cord motoneurons in SOD1G93A mice compared with WT (wild-type) mice groups, and upregulation of RABGGTB promoted prenylation modification of Rab7, which promoted autophagy to protect neurons by degrading SOD1. Given that RabGGTase is associated with autophagy and autophagy is associated with inflammation, and based on the above findings, since peripheral blood mononuclear cells are readily available from patients with ALS, we proposed to investigate the expression of RabGGTase in peripheral inflammatory cells. METHODS Information and venous blood were collected from 86 patients diagnosed with ALS between January 2021 and August 2023. Flow cytometry was used to detect the expression of RABGGTB in monocytes from peripheral blood samples collected from patients with ALS and healthy controls. Extracted peripheral blood mononuclear cells (PBMCs) were differentiated in vitro into macrophages, and then the expression of RABGGTB was detected by immunofluorescence. RABGGTB levels in patients with ALS were analyzed to determine their impact on disease progression. RESULTS Using flow cytometry in monocytes and immunofluorescence in macrophages, we found that RABGGTB expression in the ALS group was significantly higher than in the control group. Age, sex, original location, disease course, C-reactive protein (CRP), and interleukin-6 (IL-6) did not correlate with the ALS functional rating scale-revised (ALSFRS-R), whereas the RABGGTB level was significantly correlated with the ALSFRS-R. In addition, multivariate analysis revealed a significant correlation between RABGGTB and ALSFRS-R score. Further analysis revealed a significant correlation between RABGGTB expression levels and disease progression levels (ΔFS). CONCLUSIONS The RABGGTB level was significantly increased in patients with ALS compared with healthy controls. An elevated RABGGTB level in patients with ALS is associated with the rate of progression in ALS, suggesting that elevated RABGGTB levels in patients with ALS may serve as an indicator for tracking ALS progression.
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Affiliation(s)
- Jing Yang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Cheng Xin
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Jia Huo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Hui Dong
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Qi Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Rui Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
| | - Yaling Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; (J.Y.); (C.X.); (J.H.); (X.L.); (H.D.); (Q.L.); (R.L.)
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang 050000, China
- Neurological Laboratory of Hebei Province, Shijiazhuang 050000, China
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14
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Dubbioso R, Provitera V, Pacella D, Santoro L, Manganelli F, Nolano M. Autonomic dysfunction is associated with disease progression and survival in amyotrophic lateral sclerosis: a prospective longitudinal cohort study. J Neurol 2023; 270:4968-4977. [PMID: 37358634 PMCID: PMC10511550 DOI: 10.1007/s00415-023-11832-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Among non-motor symptoms, autonomic disturbances have been described in amyotrophic lateral sclerosis (ALS) and reported as mild to moderate in up to 75% of patients. However, no study has systematically investigated autonomic symptoms as prognostic factors. OBJECTIVES The main aim of this longitudinal study was to examine the association of autonomic dysfunction with disease progression and survival in ALS. METHODS We enrolled newly diagnosed ALS patients and a healthy control group (HC). Time from disease onset to disease milestone (King's stage 4) and death were calculated to assess disease progression and survival. Autonomic symptoms were assessed by a dedicated questionnaire. Longitudinal evaluation of parasympathetic cardiovascular activity was performed by the heart rate variability (HRV). Multivariable Cox proportional hazards regression models on the risk of the disease milestone and death were used. A mixed-effect linear regression model was used to compare autonomic dysfunction with a HC group as well as its impairment over time. RESULTS A total of 102 patients and 41 HC were studied. ALS patients, compared with HC, complained of more autonomic symptoms, especially in bulbar onset patients. Autonomic symptoms occurred in 69 (68%) patients at diagnosis and progressed over time (post-6: p = 0.015 and post-12: p < 0.001). A higher autonomic symptom burden was an independent marker of faster development of King's stage 4 (HR 1.05; 95% CI 1.00-1.11; p = 0.022); whereas, urinary complaints were independent factors of a shorter survival (HR 3.12; 95% CI 1.22-7.97; p = 0.018). Moreover, HRV in ALS patients was lower than in HC (p = 0.018) and further decreased over time (p = 0.003), implying a parasympathetic hypofunction that progressed over time. CONCLUSION Autonomic symptoms occur in most of the ALS patients at diagnosis and progress over time, implying that autonomic dysfunction represents an intrinsic non-motor feature of the disease. A higher autonomic burden is a poor prognostic factor, associated with a more rapid development of disease milestones and shorter survival.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Vincenzo Provitera
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037, Telese Terme, Benevento, Italy
| | - Daniela Pacella
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037, Telese Terme, Benevento, Italy
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15
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Noh MY, Kwon MS, Oh KW, Nahm M, Park J, Kim YE, Ki CS, Jin HK, Bae JS, Kim SH. Role of NCKAP1 in the Defective Phagocytic Function of Microglia-Like Cells Derived from Rapidly Progressing Sporadic ALS. Mol Neurobiol 2023; 60:4761-4777. [PMID: 37154887 PMCID: PMC10293423 DOI: 10.1007/s12035-023-03339-2] [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: 10/21/2022] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
Microglia plays a key role in determining the progression of amyotrophic lateral sclerosis (ALS), yet their precise role in ALS has not been identified in humans. This study aimed to identify a key factor related to the functional characteristics of microglia in rapidly progressing sporadic ALS patients using the induced microglia model, although it is not identical to brain resident microglia. After confirming that microglia-like cells (iMGs) induced by human monocytes could recapitulate the main signatures of brain microglia, step-by-step comparative studies were conducted to delineate functional differences using iMGs from patients with slowly progressive ALS [ALS(S), n = 14] versus rapidly progressive ALS [ALS(R), n = 15]. Despite an absence of significant differences in the expression of microglial homeostatic genes, ALS(R)-iMGs preferentially showed defective phagocytosis and an exaggerated pro-inflammatory response to LPS stimuli compared to ALS(S)-iMGs. Transcriptome analysis revealed that the perturbed phagocytosis seen in ALS(R)-iMGs was closely associated with decreased NCKAP1 (NCK-associated protein 1)-mediated abnormal actin polymerization. NCKAP1 overexpression was sufficient to rescue impaired phagocytosis in ALS(R)-iMGs. Post-hoc analysis indicated that decreased NCKAP1 expression in iMGs was correlated with the progression of ALS. Our data suggest that microglial NCKAP1 may be an alternative therapeutic target in rapidly progressive sporadic ALS.
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Affiliation(s)
- Min-Young Noh
- Department of Neurology, College of Medicine, Hanyang University, Wangsimniro 222-1, Seoul, 04763 Republic of Korea
| | - Min-Soo Kwon
- Department of Pharmacology, Research Institute of Basic Medical Science, School of Medicine, CHA University, CHA Bio Complex, 335 Pangyo, Gyeonggi-Do 13488 Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Wangsimniro 222-1, Seoul, 04763 Republic of Korea
| | - Minyeop Nahm
- Dementia Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Wangsimniro 222-1, Seoul, 04763 Republic of Korea
| | - Young-Eun Kim
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Wangsimniro 222-1, Seoul, 04763 Republic of Korea
| | - Chang-Seok Ki
- GC Genome Corporation, Yongin, 16924 Republic of Korea
| | - Hee Kyung Jin
- KNU Alzheimer’s Disease Research Institute, Kyungpook National University, Daegu, 41566 Republic of Korea
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, 41566 Republic of Korea
| | - Jae-sung Bae
- KNU Alzheimer’s Disease Research Institute, Kyungpook National University, Daegu, 41566 Republic of Korea
- Department of Physiology, Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, 41944 Republic of Korea
- Department of Biomedical Science, BK21 Plus KNU Biomedical Convergence Program, Kyungpook National University, Wangsimniro 222-1, Daegu, 41944 Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Wangsimniro 222-1, Seoul, 04763 Republic of Korea
- Cell Therapy Center, Hanyang University Hospital, Wangsimniro 222-1, Seoul, 04763 Republic of Korea
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16
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Khosla R, Bhagat H, Lal P, Anand A. ALS plasma reduces the viability of NSC34 cells via altering mRNA expression of VEGF: A short report. Heliyon 2023; 9:e18287. [PMID: 37519724 PMCID: PMC10372388 DOI: 10.1016/j.heliyon.2023.e18287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Amyotrophic Lateral Sclerosis (ALS) is a devastating neurodegenerative disorder that progressively leads to motor neuron degeneration at the neuromuscular junctions, resulting in paralysis in the patients. The clinical diagnosis of ALS is time taking and further delays the therapeutics that can be helpful if the disease is diagnosed at an early stage. Changes in plasma composition can be reflected upon CSF composition and hence, can be used to study the diagnosis and prognosis markers for the disease. Aim To develop a simple model system using motor neuron like cell line after plasma induction. Method Neuroblastoma × Spinal Cord hybridoma cell line (NSC34) was cultured under appropriate conditions. 10% ALS patients' plasma was added to the media, and cells were conditioned for 12 h. Cell survival analysis and differential gene expression of a panel of molecules (published previously, VEGF, VEGFR2, ANG, OPTN, TDP43, and MCP-1) were done. Results ALS patients' plasma impacted the life of the cells and reduced survival to nearly 50% after induction. VEGF was found to be significantly down-regulated in the cells, which can be explained as a reason for reduced cell survival. Conclusion ALS plasma altered the expression of an essential neuroprotective and growth factor VEGF in NSC34 cells leading to reduced viability.
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Affiliation(s)
| | - Hemant Bhagat
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Parth Lal
- Advanced Paediatric Centre, PGIMER, Chandigarh, India
| | - Akshay Anand
- Neuroscience Research Lab, PGIMER, Chandigarh, India
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17
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Vucic S, Menon P, Huynh W, Mahoney C, Ho KS, Hartford A, Rynders A, Evan J, Evan J, Ligozio S, Glanzman R, Hotchkin MT, Kiernan MC. Efficacy and safety of CNM-Au8 in amyotrophic lateral sclerosis (RESCUE-ALS study): a phase 2, randomised, double-blind, placebo-controlled trial and open label extension. EClinicalMedicine 2023; 60:102036. [PMID: 37396808 PMCID: PMC10314176 DOI: 10.1016/j.eclinm.2023.102036] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Background CNM-Au8® is a catalytically-active gold nanocrystal neuroprotective agent that enhances intracellular energy metabolism and reduces oxidative stress. The phase 2, randomised, double-blind, placebo-controlled trial and open label extension RESCUE-ALS trial evaluated the efficacy and safety of CNM-Au8 for treatment of amyotrophic lateral sclerosis (ALS). Methods RESCUE-ALS and its long-term open label extension (OLE) were conducted at two multidisciplinary ALS clinics located in Sydney, Australia: (i) the Brain and Mind Centre and (ii) Westmead Hospital. The double-blind portion of RESCUE-ALS was conducted from January 16, 2020 (baseline visit, first-patient first-visit (FPFV)) through July 13, 2021 (double-blind period, last-patient last-visit (LPLV)). Participants (N = 45) were randomised 1:1 to receive 30 mg of CNM-Au8 or matching placebo daily over 36 weeks in addition to background standard of care, riluzole. The primary outcome was mean percent change in summed motor unit number index (MUNIX), a sensitive neurophysiological biomarker of lower motor neuron function. Change in total (or summated) MUNIX score and change in forced vital capacity (FVC) were secondary outcome measures. ALS disease progression events, ALS Functional Rating Scale (ALSFRS-R) change, change in quality of life (ALSSQOL-SF) were assessed as exploratory outcome measures. Long-term survival evaluated vital status of original active versus placebo randomisation for all participants through at least 12 months following last-patient last-visit (LPLV) of the double-blind period. RESCUE-ALS and the open label study are registered in clinicaltrials.gov with registration numbers NCT04098406 and NCT05299658, respectively. Findings In the intention-to-treat (ITT) population, there was no significant difference in the summated MUNIX score percent change (LS mean difference: 7.7%, 95% CI: -11.9 to 27.3%, p = 0.43), total MUNIX score change (18.8, 95% CI: -56.4 to 94.0), or FVC change (LS mean difference: 3.6, 95% CI: -12.4 to 19.7) between the active and placebo treated groups at week 36. In contrast, survival analyses through 12-month LPLV demonstrated a 60% reduction in all-cause mortality with CNM-Au8 treatment [hazard ratio = 0.408 (95% Wald CI: 0.166 to 1.001, log-rank p = 0.0429). 36 participants entered the open label extension (OLE), and those initially randomised to CNM-Au8 exhibited a slower rate of disease progression, as measured by time to the occurrence of death, tracheostomy, initiation of non-invasive ventilatory support, or gastrostomy tube placement. CNM-Au8 was well-tolerated, and no safety signals were observed. Interpretation CNM-Au8, in combination with riluzole, was well-tolerated in ALS with no identified safety signals. While the primary and secondary outcomes of this trial were not significant, the clinically meaningful exploratory results support further investigation of CNM-Au8 in ALS. Funding The RESCUE-ALS was substantially funded by a grant from FightMND. Additional funding was provided by Clene Australia Pty Ltd.
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Affiliation(s)
- Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School and Department of Neurology, Concord Repatriation General Hospital, The University of Sydney, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School and Department of Neurology, Concord Repatriation General Hospital, The University of Sydney, Sydney, Australia
| | - William Huynh
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Colin Mahoney
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Karen S. Ho
- Clene Nanomedicine, Inc., Salt Lake City, UT, USA
| | | | | | - Jacob Evan
- Clene Nanomedicine, Inc., Salt Lake City, UT, USA
| | - Jeremy Evan
- Clene Nanomedicine, Inc., Salt Lake City, UT, USA
| | | | | | | | - Matthew C. Kiernan
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
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Gotkine M, Caraco Y, Lerner Y, Blotnick S, Wanounou M, Slutsky SG, Chebath J, Kuperstein G, Estrin E, Ben-Hur T, Hasson A, Molakandov K, Sonnenfeld T, Stark Y, Revel A, Revel M, Izrael M. Safety and efficacy of first-in-man intrathecal injection of human astrocytes (AstroRx®) in ALS patients: phase I/IIa clinical trial results. J Transl Med 2023; 21:122. [PMID: 36788520 PMCID: PMC9927047 DOI: 10.1186/s12967-023-03903-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Malfunction of astrocytes is implicated as one of the pathological factors of ALS. Thus, intrathecal injection of healthy astrocytes in ALS can potentially compensate for the diseased astrocytes. AstroRx® is an allogeneic cell-based product, composed of healthy and functional human astrocytes derived from embryonic stem cells. AstroRx® was shown to clear excessive glutamate, reduce oxidative stress, secrete various neuroprotective factors, and act as an immunomodulator. Intrathecal injection of AstroRx® to animal models of ALS slowed disease progression and extended survival. Here we report the result of a first-in-human clinical study evaluating intrathecal injection of AstroRx® in ALS patients. METHODS We conducted a phase I/IIa, open-label, dose-escalating clinical trial to evaluate the safety, tolerability, and therapeutic effects of intrathecal injection of AstroRx® in patients with ALS. Five patients were injected intrathecally with a single dose of 100 × 106 AstroRx® cells and 5 patients with 250 × 106 cells (low and high dose, respectively). Safety and efficacy assessments were recorded for 3 months pre-treatment (run-in period) and 12 months post-treatment (follow-up period). RESULTS A single administration of AstroRx® at either low or high doses was safe and well tolerated. No adverse events (AEs) related to AstroRx® itself were reported. Transient AEs related to the Intrathecal (IT) procedure were all mild to moderate. The study demonstrated a clinically meaningful effect that was maintained over the first 3 months after treatment, as measured by the pre-post slope change in ALSFRS-R. In the 100 × 106 AstroRx® arm, the ALSFRS-R rate of deterioration was attenuated from - 0.88/month pre-treatment to - 0.30/month in the first 3 months post-treatment (p = 0.039). In the 250 × 106 AstroRx® arm, the ALSFRS-R slope decreased from - 1.43/month to - 0.78/month (p = 0.0023). The effect was even more profound in a rapid progressor subgroup of 5 patients. No statistically significant change was measured in muscle strength using hand-held dynamometry and slow vital capacity continued to deteriorate during the study. CONCLUSIONS Overall, these findings suggest that a single IT administration of AstroRx® to ALS patients at a dose of 100 × 106 or 250 × 106 cells is safe. A signal of beneficial clinical effect was observed for the first 3 months following cell injection. These results support further investigation of repeated intrathecal administrations of AstroRx®, e.g., every 3 months. TRIAL REGISTRATION NCT03482050.
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Affiliation(s)
- Marc Gotkine
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoseph Caraco
- Hadassah Clinical Research Center (HCRC), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yossef Lerner
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Blotnick
- Hadassah Clinical Research Center (HCRC), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maor Wanounou
- Hadassah Clinical Research Center (HCRC), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shalom Guy Slutsky
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Judith Chebath
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Graciela Kuperstein
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Elena Estrin
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Tamir Ben-Hur
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Arik Hasson
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Kfir Molakandov
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Tehila Sonnenfeld
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Yafit Stark
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Ariel Revel
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
| | - Michel Revel
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel
- Department of Molecular Genetics, Weizmann Institute of Science, 76100, Rehovot, Israel
| | - Michal Izrael
- Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel.
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Huber RG, Pandey S, Chhangani D, Rincon-Limas DE, Staff NP, Yeo CJJ. Identification of potential pathways and biomarkers linked to progression in ALS. Ann Clin Transl Neurol 2023; 10:150-165. [PMID: 36533811 PMCID: PMC9930436 DOI: 10.1002/acn3.51697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify potential diagnostic and prognostic biomarkers for clinical management and clinical trials in amyotrophic lateral sclerosis. METHODS We analysed proteomics data of ALS patient-induced pluripotent stem cell-derived motor neurons available through the AnswerALS consortium. After stratifying patients using clinical ALSFRS-R and ALS-CBS scales, we identified differentially expressed proteins indicative of ALS disease severity and progression rate as candidate ALS-related and prognostic biomarkers. Pathway analysis for identified proteins was performed using STITCH. Protein sets were correlated with the effects of drugs using the Connectivity Map tool to identify compounds likely to affect similar pathways. RNAi screening was performed in a Drosophila TDP-43 ALS model to validate pathological relevance. A statistical classification machine learning model was constructed using ridge regression that uses proteomics data to differentiate ALS patients from controls. RESULTS We identified 76, 21, 71 and 1 candidate ALS-related biomarkers and 22, 41, 27 and 64 candidate prognostic biomarkers from patients stratified by ALSFRS-R baseline, ALSFRS-R progression slope, ALS-CBS baseline and ALS-CBS progression slope, respectively. Nineteen proteins enhanced or suppressed pathogenic eye phenotypes in the ALS fly model. Nutraceuticals, dopamine pathway modulators, statins, anti-inflammatories and antimicrobials were predicted starting points for drug repurposing using the connectivity map tool. Ten diagnostic biomarker proteins were predicted by machine learning to identify ALS patients with high accuracy and sensitivity. INTERPRETATION This study showcases the powerful approach of iPSC-motor neuron proteomics combined with machine learning and biological confirmation in the prediction of novel mechanisms and diagnostic and predictive biomarkers in ALS.
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Affiliation(s)
- Roland G Huber
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Matrix #07-01, 30 Biopolis Street, Singapore, 138671, Singapore
| | - Swapnil Pandey
- Department of Neurology, McKnight Brain Institute, and Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, 32611, USA
| | - Deepak Chhangani
- Department of Neurology, McKnight Brain Institute, and Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, 32611, USA
| | - Diego E Rincon-Limas
- Department of Neurology, McKnight Brain Institute, and Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, 32611, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Crystal Jing Jing Yeo
- Agency for Science, Technology and Research (A*STAR), IMCB, 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
- Lee Kong Chian School of Medicine, Imperial College London and NTU Singapore, Singapore, 308232, Singapore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, AB243FX, Scotland, UK
- National Neuroscience Institute, TTSH Campus, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore
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20
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Nigri A, Dalla Bella E, Ferraro S, Medina Carrion JP, Demichelis G, Bersano E, Consonni M, Bischof A, Stanziano M, Palermo S, Lauria G, Bruzzone MG, Papinutto N. Cervical spinal cord atrophy in amyotrophic lateral sclerosis across disease stages. Ann Clin Transl Neurol 2023; 10:213-224. [PMID: 36599092 PMCID: PMC9930423 DOI: 10.1002/acn3.51712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Spinal cord degeneration is a hallmark of amyotrophic lateral sclerosis. The assessment of gray matter and white matter cervical spinal cord atrophy across clinical stages defined using the King's staging system could advance the understanding of amyotrophic lateral sclerosis progression. METHODS We assessed the in vivo spatial pattern of gray and white matter atrophy along cervical spinal cord (C2 to C6 segments) using 2D phase-sensitive inversion recovery imaging in a cohort of 44 amyotrophic lateral sclerosis patients, evaluating its change across the King's stages and the correlation with disability scored by the amyotrophic lateral sclerosis functional rating scale revised (ALSFRS-R) and disease duration. A mathematical model inferring the potential onset of cervical gray matter atrophy was developed. RESULTS In amyotrophic lateral sclerosis patients at King's stage 1, significant cervical spinal cord alterations were mainly identified in gray matter, whereas they involved both gray and white matter in patients at King's stage ≥ 2. Gray and white matter areas correlated with clinical disability at all cervical segments. C3-C4 level was the segment showing early gray matter atrophy starting about 7 to 20 months before symptom onset according to our model. INTERPRETATION Our findings suggest that cervical spinal cord atrophy spreads from gray to white matter across King's stages in amyotrophic lateral sclerosis, making spinal cord magnetic resonance imaging an in vivo assessment tool to measure the progression of the disease.
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Affiliation(s)
- Anna Nigri
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Stefania Ferraro
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,School of Life Science and Technology, MOE Key Laboratory for NeuroinformationUniversity of Electronic Science and Technology of ChinaChengduChina
| | | | - Greta Demichelis
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Enrica Bersano
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,Department of Medical Biotechnology and Translational MedicineUniversity of MilanMilanItaly
| | - Monica Consonni
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Antje Bischof
- Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Neurology with Institute for Translational NeurologyUniversity Hospital MünsterMünsterGermany
| | - Mario Stanziano
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,ALS Centre, “Rita Levi Montalcini” Department of NeuroscienceUniversity of TurinTurinItaly
| | - Sara Palermo
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,Department of Medical Biotechnology and Translational MedicineUniversity of MilanMilanItaly
| | | | - Nico Papinutto
- Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
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21
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Chen X, Zhou L, Cui C, Sun J. Evolving markers in amyotrophic lateral sclerosis. Adv Clin Chem 2023. [DOI: 10.1016/bs.acc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
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22
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Hannaford A, Byth K, Pavey N, Henderson RD, Mathers S, Needham M, Schultz D, Menon P, Kiernan MC, Vucic S. Clinical and neurophysiological biomarkers of disease progression in amyotrophic lateral sclerosis. Muscle Nerve 2023; 67:17-24. [PMID: 36214183 DOI: 10.1002/mus.27736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Rate of disease progression (ΔFS), measured as change in the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and body mass index (BMI), are predictors of survival in amyotrophic lateral sclerosis (ALS). Our aim in this study was to assess the utility of these clinical biomarkers along with neurophysiological measures, such as the split hand index (SI), in monitoring disease progression. METHODS Clinical trial data were collected from 107 patients recruited into the Tecfidera in ALS trial. The prognostic utility of clinical and neurophysiological measures, including ΔFS, BMI, SI, and neurophysiological index (NPI), were assessed cross-sectionally and longitudinally (40 weeks). The outcome measures of disease severity and progression included: (i) ALSFRS-R score; (ii) Medical Research Council (MRC) score; and (iii) forced vital capacity and sniff nasal inspiratory pressure. RESULTS Fast-progressor ALS patients (ΔFS ≥1.1) exhibited significantly lower ALSFRS-R and total MRC scores at baseline. A baseline ΔFS score ≥1.1 was associated with a greater reduction in ALSFRS-R (P = .002) and MRC (P = .002) scores over 40 weeks. Baseline BMI <25 was also associated with faster reduction of ALSFRS-R and MRC scores. SI and NPI were associated with disease severity at baseline, but not with subsequent rate of disease progression. DISCUSSION Implementation of the assessed clinical and neurophysiological biomarkers may assist in patient management and stratification into clinical trials.
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Affiliation(s)
- Andrew Hannaford
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Byth
- NHMRC Clinica Trials Center, Westmead Hospital, Research and Education Network, Westmead, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nathan Pavey
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Robert D Henderson
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Susan Mathers
- Department of Neurology, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Merrilee Needham
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Australia.,Centre for Molecular Medicine, Murdoch University, Perth, Western Australia, Australia.,Department of Neurology, Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia.,Department of Neurology, University of Notre Dame, Fremantle, Western Australia, Australia
| | - David Schultz
- Department of Neurology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Department of Neurology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
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23
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de Luna N, Carbayo Á, Dols-Icardo O, Turon-Sans J, Reyes-Leiva D, Illan-Gala I, Jericó I, Pagola-Lorz I, Lleixà C, Querol L, Rubio-Guerra S, Alcolea D, Fortea J, Lleó A, Cortés-Vicente E, Rojas-Garcia R. Neuroinflammation-Related Proteins NOD2 and Spp1 Are Abnormally Upregulated in Amyotrophic Lateral Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/2/e200072. [PMID: 36460480 PMCID: PMC9720732 DOI: 10.1212/nxi.0000000000200072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of unknown etiology and poorly understood pathophysiology. There is no specific biomarker either for diagnosis or prognosis. The aim of our study was to investigate differentially expressed proteins in the CSF and serum from patients with ALS to determine their role in the disease process and evaluate their utility as diagnostic or prognostic biomarkers. METHODS We performed mass spectrometry in the CSF from 3 patients with ALS and 3 healthy controls (HCs). The results were compared with motor cortex dysregulated transcripts obtained from 11patients with sporadic ALS and 8 HCs. Candidate proteins were tested using ELISA in the serum of 123 patients with ALS, 30 patients with Alzheimer disease (AD), 28 patients with frontotemporal dementia (FTD), and 102 HCs. Patients with ALS, AD, and FTD were prospectively recruited from January 2003 to December 2020. A group of age-matched HCs was randomly selected from the Sant Pau Initiative on Neurodegeneration cohort of the Sant Pau Memory Unit. RESULTS Nucleotide-binding oligomerization domain-containing protein 2 (NOD2) and osteopontin (Spp1) were differentially expressed in the CSF and the motor cortex transcriptome of patients with ALS compared with that in HCs (p < 0.05). NOD2 and Spp1 levels were significantly higher in sera from patients with ALS than in HCs (p < 0.001). Receiver operating characteristic analysis showed an area under the curve of 0.63 for NOD2 and 0.81 for Spp1. NOD2 levels were significantly lower in patients with AD and FTD than in patients with ALS (p < 0.0001), but we found no significant differences in Spp1 levels between patients with ALS, AD (p = 0.51), and FTD (p = 0.42). We found a negative correlation between Spp1 levels and ALS functional rating scale (r = -0.24, p = 0.009). DISCUSSION Our discovery-based approach identified NOD2 as a novel biomarker in ALS and adds evidence to the contribution of Spp1 in the disease process. Both proteins are involved in innate immunity and autophagy and are increased in the serum from patients with ALS. Our data support a relevant role of neuroinflammation in the pathophysiology of the disease and may identify targets for disease-modifying treatments in ALS. Further longitudinal studies should investigate the diagnostic and prognostic value of NOD2 and Spp1 in clinical practice.
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Affiliation(s)
- Noemí de Luna
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Álvaro Carbayo
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Oriol Dols-Icardo
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Janina Turon-Sans
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - David Reyes-Leiva
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Ignacio Illan-Gala
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Ivonne Jericó
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Inma Pagola-Lorz
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Cinta Lleixà
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Luis Querol
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Sara Rubio-Guerra
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Daniel Alcolea
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Juan Fortea
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Alberto Lleó
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Elena Cortés-Vicente
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.)
| | - Ricardo Rojas-Garcia
- From the Neuromuscular Diseases Laboratory (N.d.C., A.C., D.R.-L., C.L., L.Q., E.C.-V., R.R.-G.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB Sant-Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (N.d.C., A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Madrid; Motor Neuron Diseases Clinic (A.C., J.T.-S., D.R.-L., L.Q., E.C.-V., R.R.-G.), Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona; Sant Pau Memory Unit (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) (O.D.-I., I.I.-G., S.R.-G., D.A., J.F., A.L.), Madrid, Spain; and Neuromuscular and Motor Neuron Diseases Research Group-Health Research Institute of Navarra (IdisNA) (I.J., I.P.-L.).
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Song Y, Cheng H, Liu J, Kazuo S, Feng L, Wei Y, Zhang C, Gao Y. Effectiveness of herbal medicine on patients with amyotrophic lateral sclerosis: Analysis of the PRO-ACT data using propensity score matching. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 107:154461. [PMID: 36198223 DOI: 10.1016/j.phymed.2022.154461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) have restricted pharmacotherapy options and thus resort to herbal medicines (HMs), despite limited and conflicting evidence. Therefore, use of HMs needs to be assessed in patients with ALS. PURPOSE This study aimed to evaluate the benefits of HMs in ALS and to describe the characteristics of HM users. STUDY DESIGN The correlation between HMs and prognosis was determined based on data obtained from the largest ALS database with high-quality clinical trials. Propensity score (PS) matching was used to address confounding and selection bias. METHODS In total, 321 and 231 HM users with at least a 4-week HM prescription were identified and PS-matched with non-HM users at a 1:1 ratio based on predefined confounders. Time-to-event models with censoring at 12 or 18 months were established for survival analyses. For evaluating activity limitation and respiratory function, 320 and 376 HM users were included, respectively, and analyzed using multivariate analysis of variance (MANOVA). RESULTS The profiles of 321 HM users indicated a better condition compared with that of non-HM users before PS-matching, including higher weight (median [IQR], 77.90 [21.8] kg vs. 74.00 [21.2] kg, p < 0.01), higher body mass index (26.00 [5.4] vs. 25.20 [5.8], p < 0.01), more percentage of limb onset (261 [81.3%] vs. 2366 [67.2%], p < 0.01), and slower progression (0.47 [0.5] vs. 0.51 [0.5], p = 0.03). HM did not significantly affect survival at 12 months (adjusted hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.49-1.03; log-rank p = 0.069), but it significantly prolonged survival at 18 months (adjusted HR 0.74, 95% CI 0.56-0.98; log-rank p = 0.038). After imputation of missing data, MANOVA revealed significant effectiveness of HMs in improving activity limitation (Pillai trace, 0.0195; p = 0.03). CONCLUSION PS-based methods eliminated baseline differences between HM and non-HM users. Overall, the use of HM to treat patients with ALS is favored based on their association with prolonged overall survival within 18 months and improved activity limitation.
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Affiliation(s)
- Yuebo Song
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Hao Cheng
- National Academy of Innovation Strategy, China Association for Science and Technology, Beijing 100038, China
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Sugimoto Kazuo
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China; Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100010, China
| | - Luda Feng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yufei Wei
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530022, China
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
| | - Ying Gao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China.
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Long Z, Irish M, Hodges JR, Piguet O, Burrell JR. Distinct disease trajectories in frontotemporal dementia-motor neuron disease and behavioural variant frontotemporal dementia: A longitudinal study. Eur J Neurol 2022; 29:3158-3169. [PMID: 35921225 PMCID: PMC9804178 DOI: 10.1111/ene.15518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE The heterogeneity of cognitive and behavioural disturbances in frontotemporal dementia-motor neuron disease (FTD-MND), and clinical differences between FTD-MND and FTD subtypes, have been illustrated cross-sectionally. This study aimed to examine the FTD-MND disease trajectory by comparing clinical features of FTD-MND and the behavioural variant FTD (bvFTD) longitudinally. METHODS Neuropsychological and disease severity assessments were conducted in a cohort of FTD-MND (baseline, n = 42; follow-up, n = 18) and bvFTD (baseline, n = 116; follow-up, n = 111) using a longitudinal, case-control design. Age-, sex-, and education-matched controls (n = 52) were recruited. Predictors of clinical progression were analyzed. Voxel-based morphometry analysis was undertaken to investigate the progression of brain atrophy. RESULTS At baseline, FTD-MND was characterized by semantic and general cognition deficits, whereas bvFTD had greater behavioural disturbances. General cognition and language deteriorated in FTD-MND when followed longitudinally. Language deficits at baseline predicted cognitive deterioration and disease progression and correlated with progressive atrophy of language regions. Further deterioration in behaviour was evident in bvFTD over time. The rate of disease progression (i.e., general cognition, semantic association, and disease severity) was significantly faster in FTD-MND than in bvFTD. CONCLUSIONS FTD-MND and bvFTD appear to have distinct disease trajectories, with more rapid progression in FTD-MND. Language impairments should be closely monitored in FTD-MND as potential predictors of cognitive deterioration and disease progression.
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Affiliation(s)
- Zhe Long
- Department of NeurologyThe Second Xiangya Hospital of Central South UniversityChangshaChina,Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Muireann Irish
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia,School of PsychologyUniversity of SydneySydneyNew South WalesAustralia,Australian Research Council Centre of Excellence in Cognition and Its DisordersSydneyNew South WalesAustralia
| | - John R. Hodges
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia,Australian Research Council Centre of Excellence in Cognition and Its DisordersSydneyNew South WalesAustralia
| | - Olivier Piguet
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia,School of PsychologyUniversity of SydneySydneyNew South WalesAustralia,Australian Research Council Centre of Excellence in Cognition and Its DisordersSydneyNew South WalesAustralia
| | - James R. Burrell
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Australian Research Council Centre of Excellence in Cognition and Its DisordersSydneyNew South WalesAustralia,Concord Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Faculty of Health SciencesUniversity of SydneySydneyNew South WalesAustralia
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Ramamoorthy D, Severson K, Ghosh S, Sachs K, Glass JD, Fournier CN, Herrington TM, Berry JD, Ng K, Fraenkel E. Identifying patterns in amyotrophic lateral sclerosis progression from sparse longitudinal data. NATURE COMPUTATIONAL SCIENCE 2022; 2:605-616. [PMID: 38177466 PMCID: PMC10766562 DOI: 10.1038/s43588-022-00299-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 07/14/2022] [Indexed: 01/06/2024]
Abstract
The clinical presentation of amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease, varies widely across patients, making it challenging to determine if potential therapeutics slow progression. We sought to determine whether there were common patterns of disease progression that could aid in the design and analysis of clinical trials. We developed an approach based on a mixture of Gaussian processes to identify clusters of patients sharing similar disease progression patterns, modeling their average trajectories and the variability in each cluster. We show that ALS progression is frequently nonlinear, with periods of stable disease preceded or followed by rapid decline. We also show that our approach can be extended to Alzheimer's and Parkinson's diseases. Our results advance the characterization of disease progression of ALS and provide a flexible modeling approach that can be applied to other progressive diseases.
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Affiliation(s)
| | - Kristen Severson
- Center for Computational Health and MIT-IBM Watson AI Lab, IBM Research, Cambridge, MA, USA
| | - Soumya Ghosh
- Center for Computational Health and MIT-IBM Watson AI Lab, IBM Research, Cambridge, MA, USA
| | - Karen Sachs
- Department of Biological Engineering, MIT, Cambridge, MA, USA
- Next Generation Analytics, Palo Alto, CA, USA
| | - Jonathan D Glass
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kenney Ng
- Center for Computational Health and MIT-IBM Watson AI Lab, IBM Research, Cambridge, MA, USA
| | - Ernest Fraenkel
- Department of Biological Engineering, MIT, Cambridge, MA, USA.
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Sanfilippo MJ, Layshock ME, Keniston L. Exploring the association between outcome measures to guide clinical management in patients with amyotrophic lateral sclerosis. J Phys Ther Sci 2022; 34:532-539. [PMID: 35937622 PMCID: PMC9345750 DOI: 10.1589/jpts.34.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The usefulness and limitations of outcome measures changes throughout
functional decline of patients with Amyotrophic Lateral Sclerosis (ALS). This study aims
to describe associations between outcome measures in patients with ALS over time.
[Participants and Methods] Participant data was collected at a multidisciplinary ALS
clinic during regular clinic visits, including gait velocity, Timed Up and Go, the ALS
Functional Rating Scale-Revised, and it’s Gross Motor Subscale. [Results] All gait
velocity measures were <1.2 m/sec; average Timed Up and Go was >13.5 sec. There was
strong internal consistency between ALS Functional Rating Scale-Revised and its functional
mobility components and a strong, significant correlation between the Timed Up and Go and
the Gross Motor Subscale. [Conclusion] Patients with ALS are not community ambulators and
demonstrate risk for falls. We found concurrent validity between objective and
self-reported measures. The strong association between the Gross Motor Subscale and the
Timed Up and Go may allow PTs to utilize the self-reported Gross Motor Subscale to predict
fall risk. Clinically, when the Timed Up and Go and gait velocity are no longer
appropriate due to disease progression, the Gross Motor Subscale can provide insight into
functional decline.
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Affiliation(s)
- Michelle J Sanfilippo
- Department of Physical Therapy, University of Maryland Eastern Shore: 1 College Backbone Road, Princess Anne, MD 21853, USA
| | - Mary E Layshock
- Department of Physical Therapy, University of Maryland Eastern Shore: 1 College Backbone Road, Princess Anne, MD 21853, USA
| | - Leslie Keniston
- Department of Physical Therapy, University of Maryland Eastern Shore: 1 College Backbone Road, Princess Anne, MD 21853, USA
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El Mendili MM, Grapperon AM, Dintrich R, Stellmann JP, Ranjeva JP, Guye M, Verschueren A, Attarian S, Zaaraoui W. Alterations of Microstructure and Sodium Homeostasis in Fast Amyotrophic Lateral Sclerosis Progressors: A Brain DTI and Sodium MRI Study. AJNR Am J Neuroradiol 2022; 43:984-990. [PMID: 35772800 DOI: 10.3174/ajnr.a7559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE While conventional MR imaging has limited value in amyotrophic lateral sclerosis, nonconventional MR imaging has shown alterations of microstructure using diffusion MR imaging and recently sodium homeostasis with sodium MR imaging. We aimed to investigate the topography of brain regions showing combined microstructural and sodium homeostasis alterations in amyotrophic lateral sclerosis subgroups according to their disease-progression rates. MATERIALS AND METHODS Twenty-nine patients with amyotrophic lateral sclerosis and 24 age-matched healthy controls were recruited. Clinical assessments included disease duration and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale. Patients were clinically differentiated into fast (n = 13) and slow (n = 16) progressors according to the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale progression rate. 3T MR imaging brain protocol included 1H T1-weighted and diffusion sequences and a 23Na density-adapted radial sequence. Quantitative maps of diffusion with fractional anisotropy, mean diffusivity, and total sodium concentration were measured. The topography of diffusion and sodium abnormalities was assessed by voxelwise analyses. RESULTS Patients with amyotrophic lateral sclerosis showed significantly higher sodium concentrations and lower fractional anisotropy, along with higher sodium concentrations and higher mean diffusivity compared with healthy controls, primarily within the corticospinal tracts, corona radiata, and body and genu of the corpus callosum. Fast progressors showed wider-spread abnormalities mainly in the frontal areas. In slow progressors, only fractional anisotropy measures showed abnormalities compared with healthy controls, localized in focal regions of the corticospinal tracts, the body of corpus callosum, corona radiata, and thalamic radiation. CONCLUSIONS The present study evidenced widespread combined microstructural and sodium homeostasis brain alterations in fast amyotrophic lateral sclerosis progressors.
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Affiliation(s)
- M M El Mendili
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France .,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - A-M Grapperon
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France.,APHM, Hôpital de la Timone (A.-M.G., R.D., S.A.), Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - R Dintrich
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France.,APHM, Hôpital de la Timone (A.-M.G., R.D., S.A.), Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - J-P Stellmann
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - J-P Ranjeva
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - M Guye
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - A Verschueren
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - S Attarian
- APHM, Hôpital de la Timone (A.-M.G., R.D., S.A.), Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - W Zaaraoui
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
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Malhotra HS, Singh BP, Kumar N, Garg RK, Kirubakaran R, Emsley HCA, Chhetri SK, Mulvaney CA, Villanueva G. Immunomodulatory treatment for amyotrophic lateral sclerosis/motor neuron disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd013945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Hardeep S Malhotra
- Department of Neurology; King George's Medical University; Lucknow India
- Cochrane India-King George's Medical University, Lucknow affiliate; Lucknow India
| | - Balendra P Singh
- Cochrane India-King George's Medical University, Lucknow affiliate; Lucknow India
- Department of Prosthodontics; King George's Medical University; Lucknow India
| | - Neeraj Kumar
- Department of Neurology; King George's Medical University; Lucknow India
- Cochrane India-King George's Medical University, Lucknow affiliate; Lucknow India
| | - Ravindra K Garg
- Department of Neurology; King George's Medical University; Lucknow India
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy; Christian Medical College; Vellore India
| | - Hedley CA Emsley
- Department of Neurology; Lancashire Teaching Hospitals NHS Foundation Trust; Preston UK
- Lancaster Medical School; Lancaster University; Lancaster UK
| | - Suresh Kumar Chhetri
- Department of Neurology; Lancashire Teaching Hospitals NHS Foundation Trust; Preston UK
- Lancaster Medical School; Lancaster University; Lancaster UK
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Shaabi A. Modeling Amyotrophic Lateral Sclerosis Progression: Logic in the Logit. Cureus 2022; 14:e24887. [PMID: 35698688 PMCID: PMC9183745 DOI: 10.7759/cureus.24887] [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] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) has emerged as a clinical prognostic marker for clinical and research purposes in amyotrophic lateral sclerosis (ALS). However, tools for predicting disease progression are still underdeveloped. The aim of this study was to mathematically model ALS progression to provide a reliable and personalized approach to the prognosis for ALS patients. Also, it aimed to provide a reliable prediction tool for the current and newly diagnosed patients. Methods Twenty patients from the South-East England Amyotrophic Lateral Sclerosis register (SEALS) database were included in the analysis. A non-linear logistic regression model was used to describe disease progression from baseline health to the theoretical maximum disease. The reliability of predicted variables and correlation between model parameters were assessed separately for each subject. Results The logistic regression model best described the disease progression in patients with a high progression rate. Most notably, the model fitted better when a patient has progressed enough to approximately the midpoint of the functional rating scale. The model failed to characterize the disease course in patients defined as slow progressors. Furthermore, the linear relationship between the rate of progression and time since onset at ALFRS-R score of 24 was evident in 65% of patients. Conclusion These results indicate that the rate of disease progression and time when ALSFRS-R declines to half the maximum score are correlated with functional outcomes. Nonetheless, the logistic model failed to describe disease course in patients with slow progression rates. Different rates of progression can be attributed to the genetic heterogeneity of ALS. Thus, clinicians and patients can benefit from adding a gene factor to the equation. With the outlined limitations, the model can provide a good prognostic tool.
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A SUMO4 initiator codon variant in amyotrophic lateral sclerosis reduces SUMO4 expression and alters stress granule dynamics. J Neurol 2022; 269:4863-4871. [PMID: 35503374 PMCID: PMC9363285 DOI: 10.1007/s00415-022-11126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recent evidence points toward a role of the small ubiquitin-like modifier (SUMO) system, including SUMO4, in protecting from stress insults and neurodegeneration, such as the progressive motor neuron disease amyotrophic lateral sclerosis (ALS), e.g., by regulating stress granule (SG) dynamics. Here, we investigated whether SUMO4 variants play a role in ALS pathogenesis. METHODS Whole-exome or targeted SUMO4 sequencing was done in 222 unrelated European ALS patients. The consequences of the identified initiator codon variant were analyzed at the mRNA, protein and cellular level. SUMO4 expression was quantified in human tissues. All patients were subjected to clinical, electrophysiological, and neuroradiological characterization. RESULTS A rare heterozygous SUMO4 variant, i.e., SUMO4:c.2T>C p.Met1?, was detected in four of 222 (1.8%) ALS patients, significantly more frequently than in two control cohorts (0.3% each). SUMO4 mRNA and protein expression was diminished in whole blood or fibroblasts of a SUMO4 variant carrier versus controls. Pertinent stress factors, i.e., head trauma or cancer (treated by radiochemotherapy), were significantly more frequent in SUMO4 variant carrier versus non-carrier ALS patients. The mean number of SGs per cell was significantly higher in fibroblasts of a SUMO4 variant carrier compared to controls at baseline, upon oxidative stress, and after recovery, and SUMOylation of ALS-associated valosin-containing protein by SUMO4 was decreased. SUMO4 mRNA expression was highest in brain of all human tissues analyzed. CONCLUSIONS Our results are consistent with SUMO4 haploinsufficiency as a contributor to ALS pathogenesis impacting SG dynamics and possibly acting in conjunction with environmental oxidative stress-related factors.
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Cui C, Ingre C, Yin L, Li X, Andersson J, Seitz C, Ruffin N, Pawitan Y, Piehl F, Fang F. Correlation between leukocyte phenotypes and prognosis of amyotrophic lateral sclerosis. eLife 2022; 11:74065. [PMID: 35287794 PMCID: PMC8923665 DOI: 10.7554/elife.74065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
The prognostic role of immune cells in amyotrophic lateral sclerosis (ALS) remains undetermined. Therefore, we conducted a longitudinal cohort study including 288 ALS patients with up to 5-year follow-up during 2015–2020 recruited at the only tertiary referral center for ALS in Stockholm, Sweden, and measured the levels of differential leukocytes and lymphocyte subpopulations. The primary outcome was risk of death after diagnosis of ALS and the secondary outcomes included functional status and disease progression rate. Cox model was used to evaluate the associations between leukocytes and risk of death. Generalized estimating equation model was used to assess the correlation between leukocytes and functional status and disease progression rate. We found that leukocytes, neutrophils, and monocytes increased gradually over time since diagnosis and were negatively correlated with functional status, but not associated with risk of death or disease progression rate. For lymphocyte subpopulations, NK cells (HR= 0.61, 95% CI = [0.42–0.88] per SD increase) and Th2-diffrentiated CD4+ central memory T cells (HR= 0.64, 95% CI = [0.48–0.85] per SD increase) were negatively associated with risk of death, while CD4+ effector memory cells re-expressing CD45RA (EMRA) T cells (HR= 1.39, 95% CI = [1.01–1.92] per SD increase) and CD8+ T cells (HR= 1.38, 95% CI = [1.03–1.86] per SD increase) were positively associated with risk of death. None of the lymphocyte subpopulations was correlated with functional status or disease progression rate. Our findings suggest a dual role of immune cells in ALS prognosis, where neutrophils and monocytes primarily reflect functional status whereas NK cells and different T lymphocyte populations act as prognostic markers for survival.
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Affiliation(s)
- Can Cui
- Institute of Environmental Medicine, Karolinska Institutet
| | | | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Xia Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - John Andersson
- Institute of Environmental Medicine, Karolinska Institutet
| | | | - Nicolas Ruffin
- Department of Clinical Neuroscience, Karolinska Institutet
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | | | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet
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Huang S, Zheng M, Lin J, Huang P, Chen W, He R, Yao X. Natural history and remarkable psychiatric state of late-onset amyotrophic lateral sclerosis in China. Acta Neurol Scand 2022; 146:24-33. [PMID: 35187661 DOI: 10.1111/ane.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease affecting motor neurons. The proportion of late-onset ALS in China were low and may have distinct clinical and genetic manifestations. We aimed to investigate the natural history and remarkable psychiatric state of ALS with age at onset over 60 years in China. MATERIALS AND METHODS We collected all ALS cases from 2017 to 2020 in our center and focused on late-onset ALS patients particularly, by analyzing the clinical data, including the ALS onset and disease progression. Anxiety, depression, cognitive function, and sleep quality were assessed to reflect the psychiatric state. RESULTS A total of 193 late-onset ALS patients were included in this study. The median age at onset of late-onset ALS was 65 years with the quartile from 62 to 68 years. When compared with 446 non-late-onset ALS, late-onset ALS showed distinct clinical presentation, with lower ALS Functional Rating Scale-Revised at diagnosis and faster rate of progression. Remarkably, late-onset ALS were suffering from worse psychiatric state, including serious anxiety and depression, as well as worse cognitive function with sleep quality. The abnormal psychiatric state was more pronounced in female patients of late-onset. CONCLUSIONS In the current study, ALS patients with late-onset showed unique clinical features. Severe psychiatric conditions and faster progression in the early stage of the disease of late-onset ALS indicated the need for more social and psychiatric support in this population.
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Affiliation(s)
- Sen Huang
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Minying Zheng
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Jianing Lin
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Pian Huang
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Weineng Chen
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Ruojie He
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Xiaoli Yao
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
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Song Y, Li M, Sugimoto K, Han Y, Liu J, Ma B, Song H, Zhang C, Gao Y. China amyotrophic lateral sclerosis registry of patients with Traditional Chinese Medicine (CARE-TCM): Rationale and design. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114774. [PMID: 34699945 DOI: 10.1016/j.jep.2021.114774] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese medicine (TCM) has become popular interventional treatment for amyotrophic lateral sclerosis (ALS). However, lack of knowledge about the general characteristics and long-term clinical outcomes hampers the development of herbal drugs for ALS. AIM OF THE STUDY The China Amyotrophic Lateral Sclerosis Registry of Patients with Traditional Chinese Medicine (CARE-TCM) provides an opportunity to better understand which TCM interventions patients with ALS are receiving, what the characteristics of patients with ALS are, and how these interventions impact clinical measures. MATERIALS AND METHODS This study includes a voluntary nationwide registry, and data will be collected prospectively using an electronic data system. Detailed data collection will be performed every 3 months for 5 years. Baseline characteristics and 5-year survival will be collected. This registry was initiated in March 2021. The number of participating medical centers will be about 30 hospitals, and the target procedure number will be 2000. We will also compare the results with those of other registries in China and other countries. DISCUSSION The CARE-TCM registry will first provide real-world data regarding TCM and ALS in China, focusing on the clinical characteristics of ALS patients with TCM, disease phenotypes that respond best to TCM, and correlating clinical response with other parameters. The CARE-TCM can be very helpful to improve the efficiency and quality of TCM clinical trial design. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04885374 (registered on May 8, 2021).
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Affiliation(s)
- Yuebo Song
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Mingxuan Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Kazuo Sugimoto
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Yi Han
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China.
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Bin Ma
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China.
| | - Hujie Song
- Xi'an Encephalopathy Hospital of Traditional Chinese Medicine, China.
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Ying Gao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
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Resting state functional brain networks associated with emotion processing in frontotemporal lobar degeneration. Mol Psychiatry 2022; 27:4809-4821. [PMID: 35595978 PMCID: PMC9734056 DOI: 10.1038/s41380-022-01612-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 12/14/2022]
Abstract
This study investigated the relationship between emotion processing and resting-state functional connectivity (rs-FC) of the brain networks in frontotemporal lobar degeneration (FTLD). Eighty FTLD patients (including cases with behavioral variant of frontotemporal dementia, primary progressive aphasia, progressive supranuclear palsy syndrome, motor neuron disease) and 65 healthy controls underwent rs-functional MRI. Emotion processing was tested using the Comprehensive Affect Testing System (CATS). In patients and controls, correlations were investigated between each emotion construct and rs-FC changes within critical networks. Mean rs-FC of the clusters significantly associated with CATS scoring were compared among FTLD groups. FTLD patients had pathological CATS scores compared with controls. In controls, increased rs-FC of the cerebellar and visuo-associative networks correlated with better scores in emotion-matching and discrimination tasks, respectively; while decreased rs-FC of the visuo-spatial network was related with better performance in the affect-matching and naming. In FTLD, the associations between rs-FC and CATS scores involved more brain regions, such as orbitofrontal and middle frontal gyri within anterior networks (i.e., salience and default-mode), parietal and somatosensory regions within visuo-spatial and sensorimotor networks, caudate and thalamus within basal-ganglia network. Rs-FC changes associated with CATS were similar among all FTLD groups. In FTLD compared to controls, the pattern of rs-FC associated with emotional processing involves a larger number of brain regions, likely due to functional specificity loss and compensatory attempts. These associations were similar across all FTLD groups, suggesting a common physiopathological mechanism of emotion processing breakdown, regardless the clinical presentation and pattern of atrophy.
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Osmanovic A, Gogol I, Martens H, Widjaja M, Müller K, Schreiber-Katz O, Feuerhake F, Langhans CD, Schmidt G, Andersen PM, Ludolph AC, Weishaupt JH, Brand F, Petri S, Weber RG. Heterozygous DHTKD1 Variants in Two European Cohorts of Amyotrophic Lateral Sclerosis Patients. Genes (Basel) 2021; 13:genes13010084. [PMID: 35052424 PMCID: PMC8774751 DOI: 10.3390/genes13010084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/26/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive upper and lower motor neuron (LMN) loss. As ALS and other neurodegenerative diseases share genetic risk factors, we performed whole-exome sequencing in ALS patients focusing our analysis on genes implicated in neurodegeneration. Thus, variants in the DHTKD1 gene encoding dehydrogenase E1 and transketolase domain containing 1 previously linked to 2-aminoadipic and 2-oxoadipic aciduria, Charcot-Marie-Tooth (CMT) disease type 2, and spinal muscular atrophy (SMA) were identified. In two independent European ALS cohorts (n = 643 cases), 10 sporadic cases of 225 (4.4%) predominantly sporadic patients of cohort 1, and 12 familial ALS patients of 418 (2.9%) ALS families of cohort 2 harbored 14 different rare heterozygous DHTKD1 variants predicted to be deleterious. Four DHTKD1 variants were previously described pathogenic variants, seven were recurrent, and eight were located in the E1_dh dehydrogenase domain. Nonsense variants located in the E1_dh domain were significantly more prevalent in ALS patients versus controls. The phenotype of ALS patients carrying DHTKD1 variants partially overlapped with CMT and SMA by presence of sensory impairment and a higher frequency of LMN-predominant cases. Our results argue towards rare heterozygous DHTKD1 variants as potential contributors to ALS phenotype and, possibly, pathogenesis.
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Affiliation(s)
- Alma Osmanovic
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
- Essen Center for Rare Diseases (EZSE), University Hospital Essen, 45147 Essen, Germany
| | - Isabel Gogol
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Helge Martens
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
| | - Maylin Widjaja
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Kathrin Müller
- Department of Neurology, University of Ulm, 89070 Ulm, Germany; (K.M.); (A.C.L.); (J.H.W.)
| | | | - Friedrich Feuerhake
- Department of Neuropathology, Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany;
| | - Claus-Dieter Langhans
- GCMS Laboratory, Dietmar Hopp Metabolic Center, University Children’s Hospital, 69120 Heidelberg, Germany;
| | - Gunnar Schmidt
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
| | - Peter M. Andersen
- Department of Clinical Sciences, Neurosciences, Umeå University, 90185 Umeå, Sweden;
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89070 Ulm, Germany; (K.M.); (A.C.L.); (J.H.W.)
| | - Jochen H. Weishaupt
- Department of Neurology, University of Ulm, 89070 Ulm, Germany; (K.M.); (A.C.L.); (J.H.W.)
- Division for Neurodegenerative Diseases, Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Frank Brand
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
- Correspondence: (S.P.); (R.G.W.)
| | - Ruthild G. Weber
- Department of Human Genetics, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (I.G.); (H.M.); (M.W.); (G.S.); (F.B.)
- Correspondence: (S.P.); (R.G.W.)
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Introna A, Milella G, Morea A, Ucci M, Fraddosio A, Zoccolella S, D'Errico E, Simone IL. King's college progression rate at first clinical evaluation: A new measure of disease progression in amyotrophic lateral sclerosis. J Neurol Sci 2021; 431:120041. [PMID: 34736124 DOI: 10.1016/j.jns.2021.120041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND To estimate King's college clinical stage progression rate (ΔKC) at first clinical evaluation in order to define its predictive and prognostic role on survival in a large cohort of Amyotrophic Lateral Sclerosis (ALS) patients. METHODS The ΔKC was calculated with the following formula: 0 - KC clinical stage at first clinical evaluation/disease duration from onset to first evaluation, and each result was reported as absolute value. All the evaluations were performed in two cohorts: one from our tertiary centre for motor neuron disease and the other one from a pooled resource open-access ALS clinical trials (PRO-ACT) database. C-statistic was used to evaluate the model discrimination of survival at different time points (1-3 years). Cox proportional hazard model was used to identify factors associated with survival. RESULTS ΔKC predicted survival at three years in our centre and in the PRO-ACT cohort (C-statistic 0.83, 95% CI 0.8-0.86, p < 0.0001; 0.7, 95% CI 0.68-0.73, p < 0.0001, respectively). At multivariate analysis, ΔKC was independently associated with survival both in our cohort (HR 3.62 95% CI 2.71-4.83 p = 0.001) and in the PRO-ACT cohort (HR 2.75 95% CI 2.1-3.6 p = 0.001). CONCLUSIONS Based on our results, ΔKC could be used as a novel measure of disease progression, hence as an accurate predictor of survival in ALS patients. Indeed, greater values of ΔKC were associated with a 3.5-fold higher risk to experience the event, confirming its robust prognostic value.
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Affiliation(s)
- Alessandro Introna
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Giammarco Milella
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Antonella Morea
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Maria Ucci
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Angela Fraddosio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | | | - Eustachio D'Errico
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Isabella Laura Simone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", piazza Giulio Cesare 11, 70100 Bari, Italy.
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38
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Pavey N, Higashihara M, van den Bos MA, Menon P, Vucic S. The split-elbow index: A biomarker of the split elbow sign in ALS. Clin Neurophysiol Pract 2021; 7:16-20. [PMID: 35024511 PMCID: PMC8733259 DOI: 10.1016/j.cnp.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The split elbow sign is a clinical feature of amyotrophic lateral sclerosis (ALS), characterised by preferential weakness of biceps brachii muscle compared to triceps. A novel neurophysiological index, termed the split elbow index (SEI), was developed to quantify the split-elbow sign, and assess its utility in ALS. METHODS Clinical and neurophysiological assessment was prospectively undertaken on 34 ALS patients and 32 ALS mimics. Compound muscle action potential (CMAP) amplitude was recorded from biceps brachii and triceps muscles from which the SEI was calculated using the following formula: SEI = CMAPamplitudeBICEPSBRACHII CMAPamplitudeTRICEPSBRACHII . RESULTS The split elbow sign was significantly more common in ALS patients when compared to ALS mimic patients (P < 0.05). The SEI was significantly reduced in ALS patients when compared to ALS mimics (P < 0.01). This reduction was evident in spinal and bulbar onset ALS. A SEI cut-off value of ≤0.62 exhibited a sensitivity of 71% and specificity of 61%. CONCLUSIONS The split elbow sign is significantly more common in ALS patients, and was supported by a reduction in the SEI. SIGNIFICANCE The SEI may be utilised as a surrogate biomarker of the split elbow sign in future ALS studies.
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Affiliation(s)
- Nathan Pavey
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Mehdi A.J. van den Bos
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Steve Vucic
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
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39
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Su WM, Cheng YF, Jiang Z, Duan QQ, Yang TM, Shang HF, Chen YP. Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis. EBioMedicine 2021; 74:103732. [PMID: 34864363 PMCID: PMC8646173 DOI: 10.1016/j.ebiom.2021.103732] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background The survival time of amyotrophic lateral sclerosis (ALS) is greatly variable and protective or risk effects of the potential survival predictors are controversial. Thus, we aim to undertake a comprehensive meta-analysis of studies investigating non-genetic prognostic and survival factors in patients with ALS. Methods A search of relevant literature from PubMed, Embase, Cochrane library and other citations from 1st January 1966 to 1st December 020 was conducted. Random-effects models were conducted to pool the multivariable or adjusted hazard ratios (HR) by Stata MP 16.0. PROSPERO registration number: CRD42021256923. Findings A total of 5717 reports were identified, with 115 studies meeting pre-designed inclusion criteria involving 55,169 ALS patients. Five dimensions, including demographic, environmental or lifestyle, clinical manifestations, biochemical index, therapeutic factors or comorbidities were investigated. Twenty-five prediction factors, including twenty non-intervenable and five intervenable factors, were associated with ALS survival. Among them, NFL (HR:3.70, 6.80, in serum and CSF, respectively), FTD (HR:2.98), ALSFRS-R change (HR:2.37), respiratory subtype (HR:2.20), executive dysfunction (HR:2.10) and age of onset (HR:1.03) were superior predictors for poor prognosis, but pLMN or pUMN (HR:0.32), baseline ALSFRS-R score (HR:0.95), duration (HR:0.96), diagnostic delay (HR:0.97) were superior predictors for a good prognosis. Our results did not support the involvement of gender, education level, diabetes, hypertension, NIV, gastrostomy, and statins in ALS survival. Interpretation Our study provided a comprehensive and quantitative index for assessing the prognosis for ALS patients, and the identified non-intervenable or intervenable factors will facilitate the development of treatment strategies for ALS. Funding This study was supported by the National Natural Science Fund of China (Grant No. 81971188), the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant No. 2019HXFH046), and the Science and Technology Bureau Fund of Sichuan Province (No. 2019YFS0216).
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Affiliation(s)
- Wei-Ming Su
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang-Fan Cheng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing-Qing Duan
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tian-Mi Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui-Fang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yong-Ping Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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40
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Jia R, Chen Q, Zhou Q, Zhang R, Jin J, Hu F, Liu X, Qin X, Kang L, Zhao S, Dang Y, Dang J. Characteristics of serum metabolites in sporadic amyotrophic lateral sclerosis patients based on gas chromatography-mass spectrometry. Sci Rep 2021; 11:20786. [PMID: 34675267 PMCID: PMC8531355 DOI: 10.1038/s41598-021-00312-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
To identify differential metabolites and metabolic pathways and provide guidance for the novel biomarkers for diagnosis and prognosis of amyotrophic lateral sclerosis (ALS). ALS patients and people without nervous diseases were recruited. Metabolomic analysis was performed using gas chromatography-mass spectrometry (GC/MS). The orthogonal projections to latent structures discriminant analysis (OPLS-DA) were used to identify differential metabolites. Kyoto Encyclopedia of Genes and Genomes and MetaboAnalyst were used to identify metabolic pathways. 75 metabolites were detected and aligned. The OPLS-DA showed the metabolomic profile of ALS patients and those in the fast-progression and slow-progression ALS groups differed from that of CTRL (p < 0.05). The levels of maltose, glyceric acid, lactic acid, beta-alanine, phosphoric acid, glutamic acid, ethanolamine and glycine in ALS were significantly higher, while 2,4,6-tri-tert-butylbenzenethiol was lower. Glycine, serine and threonine metabolism, D-glutamine and D-glutamate metabolism, alanine, aspartate, and glutamate metabolism, beta-alanine metabolism, and pyruvate metabolism were significantly altered metabolic pathways in ALS. ROC was used to discriminate ALS from CTRL with an AUC of 0.898 (p < 0.001) using 2,4,6-tri-tert-butylbenzenethiol, beta-alanine, glycine, and ethanolamine. The serum metabolites and metabolic pathways in ALS patients are significantly altered compared with CTRL. These findings may contribute to the early diagnosis of ALS.
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Affiliation(s)
- Rui Jia
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Qiaoyi Chen
- Department of Cell Biology and Genetics, Xian Jiaotong University Health Science Center, Xi'an, China
| | - Qingqing Zhou
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Ronghua Zhang
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Jiaoting Jin
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Fangfang Hu
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Xiao Liu
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Xing Qin
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Li Kang
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Songzhen Zhao
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China
| | - Yonghui Dang
- Key Laboratory of Environment and Genes Related to Diseases of the Education Ministry, Key Laboratory of the Health Ministry for Forensic Medicine, College of Medicine and Forensics, Xi'an Jiaotong University Health Science Center, Xi'an, China.
| | - Jingxia Dang
- Department of Neurology, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Western Yanta Rd, Xi'an, 710061, China.
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41
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Mora JS, Bradley WG, Chaverri D, Hernández-Barral M, Mascias J, Gamez J, Gargiulo-Monachelli GM, Moussy A, Mansfield CD, Hermine O, Ludolph AC. Long-term survival analysis of masitinib in amyotrophic lateral sclerosis. Ther Adv Neurol Disord 2021; 14:17562864211030365. [PMID: 34457038 PMCID: PMC8388186 DOI: 10.1177/17562864211030365] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: A randomized, placebo-controlled phase III study (AB10015) previously demonstrated that orally administered masitinib (4.5 mg/kg/day) slowed rate of functional decline, with acceptable safety, in amyotrophic lateral sclerosis (ALS) patients having an ALS Functional Rating Scale-revised (ALSFRS-R) progression rate from disease onset to baseline of <1.1 points/month. Here we assess long-term overall survival (OS) data of all participants from study AB10015 and test whether a signal in OS is evident in an enriched patient population similar to that prospectively defined for confirmatory study AB19001. Methods: Survival status of all patients originally randomized in AB10015 was collected from participating investigational sites. Survival analysis (using the multivariate log-rank test and Cox proportional hazards model, with stratification factors as covariates) was performed on the intention-to-treat population and enriched subgroups, which were defined according to initial randomization, baseline ALSFRS-R progression rate and baseline disease severity. Results: A significant survival benefit of 25 months (p = 0.037) and 47% reduced risk of death (p = 0.025) was observed for patients receiving 4.5 mg/kg/day masitinib (n = 45) versus placebo (n = 62) in an enriched cohort with ⩾2 on each baseline ALSFRS-R individual component score (i.e. prior to any complete loss or severe impairment of functionality) and post-onset ALSFRS-R progression rate <1.1 (i.e. exclusion of very fast progressors) [median OS of 69 versus 44 months, respectively; hazard ratio, 0.53 [95% CI (0.31–0.92)]]. This corresponds to the population enrolled in confirmatory phase III study, AB19001. Conclusions: Analysis of long-term OS (75 months average follow-up from diagnosis) indicates that oral masitinib (4.5 mg/kg/day) could prolong survival by over 2 years as compared with placebo, provided that treatment starts prior to severe impairment of functionality. This trial was registered at www.ClinicalTrials.gov under identifier NCT02588677 (28 October 2015).
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Affiliation(s)
| | - Walter G Bradley
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | - Delia Chaverri
- ALS Unit, Department of Neurology, University Hospital La Paz-Carlos III, Madrid, Spain
| | | | - Javier Mascias
- ALS Unit, Department of Neurology, University Hospital La Paz-Carlos III, Madrid, Spain
| | - Josep Gamez
- Neurology Department, GMA Clinic, Autonomous University of Barcelona, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Barcelona, Spain
| | | | | | | | - Olivier Hermine
- Department of Hematology, Necker Hospital, University of Paris, 149 Rue de Sèvres, Paris 75015, France
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
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42
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Rolfes L, Schulte-Mecklenbeck A, Schreiber S, Vielhaber S, Herty M, Marten A, Pfeuffer S, Ruck T, Wiendl H, Gross CC, Meuth SG, Boentert M, Pawlitzki M. Amyotrophic lateral sclerosis patients show increased peripheral and intrathecal T-cell activation. Brain Commun 2021; 3:fcab157. [PMID: 34405141 PMCID: PMC8363480 DOI: 10.1093/braincomms/fcab157] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Several studies suggest a role for the peripheral immune system in the pathophysiology of amyotrophic lateral sclerosis. However, comprehensive studies investigating the intrathecal immune system in amyotrophic lateral sclerosis are rare. To elucidate whether compartment-specific inflammation contributes to amyotrophic lateral sclerosis pathophysiology, we here investigated intrathecal and peripheral immune profiles in amyotrophic lateral sclerosis patients and compared them with controls free of neurological disorders (controls) and patients with dementia or primary progressive multiple sclerosis. Routine CSF parameters were examined in 308 patients, including 132 amyotrophic lateral sclerosis patients. In a subgroup of 41 amyotrophic lateral sclerosis patients, extensive flow-cytometric immune cell profiling in peripheral blood and CSF was performed and compared with data from 26 controls, 25 dementia and 21 multiple sclerosis patients. Amyotrophic lateral sclerosis patients presented with significantly altered proportions of monocyte subsets in peripheral blood and increased frequencies of CD4+ and CD8+ T cells expressing the activation marker HLA-DR in peripheral blood (CD8+) and CSF (CD4+ and CD8+) compared with controls. While dementia and multiple sclerosis patients exhibited a comparable increase in intrathecal CD8+ T-cell activation, CD8+ T-cell activation in the peripheral blood in amyotrophic lateral sclerosis was higher than in multiple sclerosis patients. Furthermore, intrathecal CD4+ T-cell activation in amyotrophic lateral sclerosis surpassed levels in dementia patients. Intrathecal T-cell activation resulted from in situ activation rather than transmigration of activated T cells from the blood. While T-cell activation did not correlate with amyotrophic lateral sclerosis progression, patients with rapid disease progression showed reduced intrathecal levels of immune-regulatory CD56bright natural killer cells. The integration of these parameters into a composite score facilitated the differentiation of amyotrophic lateral sclerosis patients from patients of all other cohorts. To conclude, alterations in peripheral monocyte subsets, as well as increased peripheral and intrathecal activation of CD4+ and CD8+ T cells concomitant with diminished immune regulation by CD56bright natural killer cells, suggest an involvement of these immune cells in amyotrophic lateral sclerosis pathophysiology.
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Affiliation(s)
- Leoni Rolfes
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany.,Department of Neurology, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf 40225, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg 39120, Germany.,German Center for Neurodegenerative Diseases, Magdeburg 39120, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg 39120, Germany.,German Center for Neurodegenerative Diseases, Magdeburg 39120, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany
| | - Michael Herty
- Institute of Geometry and Applied Mathematics, RWTH Aachen University, Aachen 52062, Germany
| | - Anika Marten
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
| | - Steffen Pfeuffer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
| | - Tobias Ruck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany.,Department of Neurology, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf 40225, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany.,Department of Neurology, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf 40225, Germany
| | - Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster 48149, Germany
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Cucovici A, Ivashynka A, Fontana A, Russo S, Mazzini L, Mandrioli J, Lisnic V, Muresanu DF, Leone MA. Coffee and Tea Consumption Impact on Amyotrophic Lateral Sclerosis Progression: A Multicenter Cross-Sectional Study. Front Neurol 2021; 12:637939. [PMID: 34393966 PMCID: PMC8356721 DOI: 10.3389/fneur.2021.637939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background/objectives: Amyotrophic lateral sclerosis (ALS) is a devastating and still untreatable motor neuron disease. The causes of ALS are unknown, but nutritional factors may impact the rate of disease progression. We aimed to ascertain the influence of coffee and tea consumption on ALS progression rate. Subjects/methods: In this multicenter cross-sectional study, we recruited 241 patients, 96 females, and 145 males; the mean age at onset was 59.9 ± 11.8 years. According to El Escorial criteria, 74 were definite ALS, 77 probable, 55 possible, and 35 suspected; 187 patients had spinal onset and 54 bulbar. Patients were categorized into three groups, according to their ΔFS (derived from ALS Functional Rating Scale-Revised score and disease duration from onset): slow (81), intermediate (80), and fast progressors (80). Results: Current coffee consumers were 179 (74.3%), 34 (14.1%) were non-consumers, and 22 (9.1%) were former consumers, whereas six (2.5%) consumed decaffeinated coffee only. The log-ΔFS was weakly correlated with the duration of coffee consumption (p = 0.034), but not with the number of cup-years, or the intensity of coffee consumption (cups/day). Current tea consumers were 101 (41.9%), 6 (2.5%) were former consumers, and 134 (55.6%) were non-consumers. Among current and former consumers, 27 (25.2%) consumed only green tea, 51 (47.7%) only black tea, and 29 (27.1%) both. The log-ΔFS was weakly correlated only with the consumption duration of black tea (p = 0.028) but not with the number of cup-years. Conclusions: Our study does not support the hypothesis that coffee or tea consumption is associated with the ALS progression rate.
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Affiliation(s)
- Aliona Cucovici
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Department of Neuromuscular Diseases, "Diomid Gherman" Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Andrei Ivashynka
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Rehabilitation and Functional Recovery, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Bari, Bari, Italy
| | - Andrea Fontana
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sergio Russo
- Innovation and Research Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Letizia Mazzini
- Department of Neurology, Amyotrophic Lateral Sclerosis (ALS) Center, Maggiore della Carità Hospital, Università del Piemonte Orientale, Novara, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, University Hospital of Modena, Modena, Italy
| | - Vitalie Lisnic
- Department of Neuromuscular Diseases, "Diomid Gherman" Institute of Neurology and Neurosurgery, Chisinau, Moldova.,Department of Neurology nr.1, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Dafin Fior Muresanu
- Department of Clinical Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maurizio Angelo Leone
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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44
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Toh TH, Abdul-Aziz NA, Yahya MA, Goh KJ, Loh EC, Capelle DP, Shahrizaila N. A model incorporating ultrasound to predict the probability of fast disease progression in amyotrophic lateral sclerosis. Clin Neurophysiol 2021; 132:2722-2728. [PMID: 34312065 DOI: 10.1016/j.clinph.2021.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to develop a model to predict amyotrophic lateral sclerosis (ALS) disease progression based on clinical and neuromuscular ultrasound (NMUS) parameters. METHODS ALS patients were prospectively recruited. Muscle fasciculation (≥2 over 30-seconds, examined in biceps brachii-brachialis (BB), brachioradialis, tibialis anterior and vastus medialis) and nerve cross-sectional area (CSA) (median, ulnar, tibial, fibular nerve) were evaluated through NMUS. Ultrasound parameters were correlated with clinical data, including revised ALS Functional Rating Scale (ALSFRS-R) progression at one year. A predictive model was constructed to differentiate fast progressors (ALSFRS-R decline ≥ 1/month) from non-fast progressors. RESULTS 40 ALS patients were recruited. Three parameters emerged as strong predictors of fast progressors: (i) ALSFRS-R slope at time of NMUS (p = 0.041), (ii) BB fasciculation count (p = 0.027) and (iii) proximal to distal median nerve CSA ratio < 1.22 (p = 0.026). A predictive model (scores 0-5) was built with excellent discrimination (area under curve: 0.915). Using a score of ≥ 3, the model demonstrated good sensitivity (81.3%) and specificity (91.0%) in differentiating fast from non-fast progressors. CONCLUSION The current model is simple and can predict the probability of fast disease progression. SIGNIFICANCE This model has potential as a surrogate biomarker of ALS disease progression.
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Affiliation(s)
- Tsun-Haw Toh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Adilah Abdul-Aziz
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Azly Yahya
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean-Jin Goh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee-Chin Loh
- Palliative Care Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Palliative Care Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Sol J, Jové M, Povedano M, Sproviero W, Domínguez R, Piñol-Ripoll G, Romero-Guevara R, Hye A, Al-Chalabi A, Torres P, Andres-Benito P, Area-Gómez E, Pamplona R, Ferrer I, Ayala V, Portero-Otín M. Lipidomic traits of plasma and cerebrospinal fluid in amyotrophic lateral sclerosis correlate with disease progression. Brain Commun 2021; 3:fcab143. [PMID: 34396104 PMCID: PMC8361390 DOI: 10.1093/braincomms/fcab143] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 01/01/2023] Open
Abstract
Since amyotrophic lateral sclerosis cases exhibit significant heterogeneity, we aim to investigate the association of lipid composition of plasma and CSF with amyotrophic lateral sclerosis diagnosis, its progression and clinical characteristics. Lipidome analyses would help to stratify patients on a molecular basis. For this reason, we have analysed the lipid composition of paired plasma and CSF samples from amyotrophic lateral sclerosis cases and age-matched non-amyotrophic lateral sclerosis individuals (controls) by comprehensive liquid chromatography coupled to mass spectrometry. The concentrations of neurofilament light chain-an index of neuronal damage-were also quantified in CSF samples and plasma. Amyotrophic lateral sclerosis versus control comparison, in a moderate stringency mode, showed that plasma from cases contains more differential lipids (n = 122 for raw P < 0.05; n = 27 for P < 0.01) than CSF (n = 17 for raw P < 0.05; n = 4 for P < 0.01), with almost no overlapping differential species, mainly characterized by an increased content of triacylglyceride species in plasma and decreased in CSF. Of note, false discovery rate correction indicated that one of the CSF lipids (monoacylglycerol 18:0) had high statistic robustness (false discovery rate-P < 0.01). Plasma lipidomes also varied significantly with the main involvement at onset (bulbar, spinal or respiratory). Notably, faster progression cases showed particular lipidome fingerprints, featured by decreased triacylclycerides and specific phospholipids in plasma, with 11 lipids with false discovery rate-P < 0.1 (n = 56 lipids in plasma for raw P < 0.01). Lipid species associated with progression rate clustered in a relatively low number of metabolic pathways, mainly triacylglyceride metabolism and glycerophospholipid and sphingolipid biosynthesis. A specific triacylglyceride (68:12), correlated with neurofilament content (r = 0.8, P < 0.008). Thus, the present findings suggest that systemic hypermetabolism-potentially sustained by increased triacylglyceride content-and CNS alterations of specific lipid pathways could be associated as modifiers of disease progression. Furthermore, these results confirm biochemical lipid heterogeneity in amyotrophic lateral sclerosis with different presentations and progression, suggesting the use of specific lipid species as potential disease classifiers.
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Affiliation(s)
- Joaquim Sol
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
- Institut Català de la Salut, Atenció Primària, Lleida, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - Mariona Jové
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Monica Povedano
- Functional Unit of Amyotrophic Lateral Sclerosis (UFELA), Service of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - William Sproviero
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
| | - Raul Domínguez
- Functional Unit of Amyotrophic Lateral Sclerosis (UFELA), Service of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gerard Piñol-Ripoll
- Cognitive Disorders Unit, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria Lleida, Lleida, Spain
| | - Ricardo Romero-Guevara
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Abdul Hye
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
| | - Pascual Torres
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Pol Andres-Benito
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- CIBERNED (Network Centre of Biomedical Research of Neurodegenerative Diseases), Institute of Health Carlos III, Ministry of Economy and Competitiveness, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Estela Area-Gómez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Reinald Pamplona
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Isidro Ferrer
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- CIBERNED (Network Centre of Biomedical Research of Neurodegenerative Diseases), Institute of Health Carlos III, Ministry of Economy and Competitiveness, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Senior Consultant, Bellvitge University Hospital, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Victòria Ayala
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Manuel Portero-Otín
- Metabolic Physiopathology Research Group, Experimental Medicine Department, Lleida University-Lleida Biochemical Research Institute (UdL-IRBLleida), Lleida, Spain
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Peters N, Dal Bello-Haas V, Packham T, Chum M, O'Connell C, Johnston WS, MacDermid JC, Turnbull J, Van Damme J, Kuspinar A. Do Generic Preference-Based Measures Accurately Capture Areas of Health-Related Quality of Life Important to Individuals with Amyotrophic Lateral Sclerosis: A Content Validation Study. PATIENT-RELATED OUTCOME MEASURES 2021; 12:191-203. [PMID: 34211304 PMCID: PMC8242131 DOI: 10.2147/prom.s313512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
Abstract
Objective The objectives of this study were to 1) assess the content validity of generic preference-based measures (GPBMs), and (2) examine the convergent validity of the EuroQol 5 Dimension 5 Level (EQ-5D-5L), against the Patient Generated Index (PGI) in Amyotrophic Lateral Sclerosis (ALS). Methods Participants were recruited from 3 clinical sites across Canada. The PGI, EQ-5D-5L and Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) were administered through an online or hardcopy survey and scores compared for convergent validation. Domains nominated by participants as important to their health-related quality of life were generated using the PGI, classified using the International Classification of Functioning, Disability and Health (ICF) and mapped onto GPBMs to determine content coverage. Results Fifty-two participants (N=28 female; 61.3 ± 11.6 mean age ± standard deviation (SD); 3.5 ± 2.9 mean ± SD years since diagnosis) completed this study. The top three ICF domains identified by participants were recreation and leisure, lower limb mobility, and interpersonal relationships. The Quality of Well-Being Self-Administered (QWB-SA) scale had the highest content coverage (87%) and the Health Utilities Index 3 (HUI3) had the lowest (33%). Two domains were covered by all GPBMs and no GPBM included all domains identified as important by participants. A moderate correlation coefficient of 0.52 between the PGI and EQ-5D-5L was found. Conclusion The majority of GPBMs covered only approximately half of the domains important to individuals with ALS suggesting the need for an ALS specific preference-based measure to better reflect the health-related quality of life of this population.
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Affiliation(s)
- Nicole Peters
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Marvin Chum
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Wendy S Johnston
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, ON, Canada
| | - John Turnbull
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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47
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Hannaford A, Higashihara M, Pavey N, van den Bos M, Geevasinga N, Vucic S, Menon P. Split-hand index: A diagnostic and prognostic marker in amyotrophic lateral sclerosis across varying regions of onset. Clin Neurophysiol 2021; 132:2130-2135. [PMID: 34284248 DOI: 10.1016/j.clinph.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The split-hand index (SI), a reliable diagnostic marker of amyotrophic lateral sclerosis (ALS), was prospectively assessed for differences across ALS subtypes and between the onset side of clinical symptoms or the dominant and contralateral sides. In addition, the prognostic utility of the SI was longitudinally assessed. METHODS Two hundred and forty-five ALS patients underwent measurement of SI on both sides compared with 126 neuromuscular mimic disorders (NMD). A subset of patients (N = 45) underwent longitudinal assessment of SI. RESULTS The SI was significantly reduced (SI RIGHT ALS 5.47(4.2), SINMD 9.0 (5.0); P < 0.001; SILEFT ALS 5.5 (4.1), SI NMD 9.4 (5.0), P < 0.001) on both sides in all ALS patients with prominent reduction on the onset side in upper limb onset ALS (SI RIGHT P < 0.001; SI LEFT P < 0.05) and in Awaji definite/probable diagnostic category (SI RIGHT P < 0.05; SI LEFT P < 0.05). Longitudinal studies disclosed that the rate of SI decline correlated with the decline in ALSFRS-R (r = 0.21, P < 0.05). CONCLUSION The SI is reduced in all ALS subtypes most prominently in upper limb onset disease, on the side of clinical onset, and in patients with Awaji definite/probable diagnostic category. SIGNIFICANCE The split-hand index is a reliable diagnostic and outcome biomarker across ALS subtypes and may have potential utility in a clinical trial setting, although further multicenter studies are required to confirm this.
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Affiliation(s)
- Andrew Hannaford
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | - Mana Higashihara
- Westmead Hospital, Sydney, Australia; Tokyo Metropolitan Geriatric Hospital, Japan
| | - Nathan Pavey
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | - Mehdi van den Bos
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | | | - Steve Vucic
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | - Parvathi Menon
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia.
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48
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Milligan C, Atassi N, Babu S, Barohn RJ, Caress JB, Cudkowicz ME, Evora A, Hawkins GA, Wosiski-Kuhn M, Macklin EA, Shefner JM, Simmons Z, Bowser RP, Ladha SS. Tocilizumab is safe and tolerable and reduces C-reactive protein concentrations in the plasma and cerebrospinal fluid of ALS patients. Muscle Nerve 2021; 64:309-320. [PMID: 34075589 DOI: 10.1002/mus.27339] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION/AIMS We tested safety, tolerability, and target engagement of tocilizumab in amyotrophic lateral sclerosis (ALS) patients. METHODS Twenty-two participants, whose peripheral blood mononuclear cell (PBMC) gene expression profile reflected high messenger ribonucleic acid (mRNA) expression of inflammatory markers, were randomized 2:1 to three tocilizumab or placebo treatments (weeks 0, 4, and 8; 8 mg/kg intravenous). Participants were followed every 4 wk in a double-blind fashion for 16 wk and assessed for safety, tolerability, plasma inflammatory markers, and clinical measures. Cerebrospinal fluid (CSF) was collected at baseline and after the third treatment. Participants were genotyped for Asp358 Ala polymorphism of the interleukin 6 receptor (IL-6R) gene. RESULTS Baseline characteristics, safety, and tolerability were similar between treatment groups. One serious adverse event was reported in the placebo group; no deaths occurred. Mean plasma C-reactive protein (CRP) level decreased by 88% in the tocilizumab group and increased by 4% in the placebo group (-3.0-fold relative change, P < .001). CSF CRP reduction (-1.8-fold relative change, P = .01) was associated with IL-6R C allele count. No differences in PBMC gene expression or clinical measures were observed between groups. DISCUSSION Tocilizumab treatment was safe and well tolerated. PBMC gene expression profile was inadequate as a predictive or pharmacodynamic biomarker. Treatment reduced CRP levels in plasma and CSF, with CSF effects potentially dependent on IL-6R Asp358 Ala genotype. IL-6 trans-signaling may mediate a distinct central nervous system response in individuals inheriting the IL-6R C allele. These results warrant further study in ALS patients where IL-6R genotype and CRP levels may be useful enrichment biomarkers.
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Affiliation(s)
- Carol Milligan
- Department of Neurobiology and Anatomy, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Nazem Atassi
- Department of Neurology, Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Suma Babu
- Department of Neurology, Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard J Barohn
- Department of Neurology, Kansas University, Kansas City, Kansas, USA
| | - James B Caress
- Department of Neurology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Merit E Cudkowicz
- Department of Neurology, Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Armineuza Evora
- Department of Neurology, Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory A Hawkins
- Department of Biochemistry and Center for Precision Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Marlena Wosiski-Kuhn
- Department of Neurobiology and Anatomy, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Eric A Macklin
- Department of Medicine, Biostatistics Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy M Shefner
- Department of Neurology, Gregory W. Fulton ALS and Neuromuscular Disease Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robert P Bowser
- Departments of Neurology and Neurobiology, Gregory W. Fulton ALS and Neuromuscular Disease Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shafeeq S Ladha
- Department of Neurology, Gregory W. Fulton ALS and Neuromuscular Disease Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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49
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Sukockienė E, Ferfoglia RI, Poncet A, Janssens JP, Allali G. Longitudinal Timed Up and Go Assessment in Amyotrophic Lateral Sclerosis: A Pilot Study. Eur Neurol 2021; 84:375-379. [PMID: 34167113 DOI: 10.1159/000516772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
Progressive loss of walking ability in amyotrophic lateral sclerosis (ALS) has been scarcely studied as a potential predictive factor for survival in motor neuron disease. We aimed to assess the progression of gait decline and its association with mortality in ALS using the Timed Up and Go test (TUG). Patients were followed up prospectively at the Centre for ALS and Related Disorders in Geneva University Hospitals between 2012 and 2016. The TUG was performed at baseline and subsequent evaluations occurred every 3 months. At inclusion, patients were classified as unable to perform the TUG, "slow TUG" (>10.6 s), and "fast TUG" (≤10.6 s). In total, 68 patients with ALS (mean ± SD age: 68.6 ± 11.9 years; 50% female) were included. Baseline TUG was negatively correlated with the total ALSFRS-R score (r = -0.63, p < 0.001). At baseline, ALS patients with bulbar onset performed the TUG faster (9.9 ± 3.7 s) than the non-bulbar ones (17.3 ± 14.9 s, p = 0.008). Thirty of 68 (44%) patients died by the end of the follow-up period. The TUG performance at the first visit did not predict mortality. While we did not find any association with mortality in ALS and gait quantification, the TUG was feasible in a majority of ALS patients, was correlated with functional status, and could be of interest in the follow-up of non-bulbar ALS patients.
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Affiliation(s)
- Eglė Sukockienė
- Division of Neurology, Department of Clinical Neurosciences, Center for ALS and Related Disorders, Geneva University Hospitals, Geneva, Switzerland.,Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Ruxandra Iancu Ferfoglia
- Division of Neurology, Department of Clinical Neurosciences, Center for ALS and Related Disorders, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Poncet
- Center for Clinical Research & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.,Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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50
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Kläppe U, Chamoun S, Shen Q, Finn A, Evertsson B, Zetterberg H, Blennow K, Press R, Samuelsson K, Månberg A, Fang F, Ingre C. Cardiac troponin T is elevated and increases longitudinally in ALS patients. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:58-65. [PMID: 34151677 DOI: 10.1080/21678421.2021.1939384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To test whether high-sensitivity cardiac troponin T (hs-cTnT) could act as a diagnostic or prognostic biomarker in ALS, comparing hs-cTnT to neurofilament light (NfL). Methods: We performed a case-control study, including 150 ALS patients, 28 ALS mimics, and 108 healthy controls, and a follow-up study of the ALS patients, during 2014-2020 in Stockholm, Sweden. We compared concentrations of hs-cTnT in plasma and NfL in the cerebrospinal fluid between cases and controls. To evaluate the diagnostic performance, we calculated the area under the curve (AUC). Hazard ratios (HRs) were estimated from Cox models to assess associations between hs-cTnT and NfL at ALS diagnosis and risk of death. The longitudinal analysis measured changes of hs-cTnT and NfL since ALS diagnosis. Results: We noted higher levels of hs-cTnT in ALS patients (median: 16.5 ng/L) than in ALS mimics (11 ng/L) and healthy controls (6 ng/L). Both hs-cTnT and NfL could distinguish ALS patients from ALS mimics, with higher AUC noted for NfL (AUC 0.88; 95%CI 0.79-0.97). Disease progression correlated weakly with hs-cTnT (Pearson's r = 0.18, p = 0.04) and moderately with NfL (Pearson's r = 0.41, p < 0.001). Shorter survival was associated with higher levels of NfL at diagnosis (HR 1.08, 95%CI 1.04-1.11), but not hs-cTnT. hs-cTnT increased (12.61 ng/L per year, 95%CI 7.14-18.06) whereas NfL decreased longitudinally since ALS diagnosis. Conclusions: NfL is a stronger diagnostic and prognostic biomarker than hs-cTnT for ALS. However, hs-cTnT might constitute a disease progression biomarker as it increases longitudinally. The underlying causes for this increase need to be investigated.
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Affiliation(s)
- Ulf Kläppe
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Sanharib Chamoun
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Qing Shen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anja Finn
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Evertsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Psychology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Psychology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Rayomand Press
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristin Samuelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Månberg
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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