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Lin J, Ou R, Li C, Hou Y, Zhang L, Wei Q, Liu K, Jiang Q, Yang T, Xiao Y, Pang D, Zhao B, Chen X, Yang J, Shang H. Evolution and Predictive Role of Plasma Alzheimer's Disease-related Pathological Biomarkers in Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2023; 78:2203-2213. [PMID: 37560912 DOI: 10.1093/gerona/glad189] [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: 03/24/2023] [Indexed: 08/11/2023] Open
Abstract
Plasma Alzheimer's disease-related pathological biomarkers' role in Parkinson's disease (PD) remains unknown. We aimed to determine whether plasma Alzheimer's disease-related biomarkers can predict PD progression. A total of 184 PD patients and 86 healthy controls were included and followed up for 5 years. Plasma phosphorylated tau181 (p-tau181), Aβ40, and Aβ42 were measured at baseline and the 1- and 2-year follow-ups using the Quanterix-single-molecule array. Global cognitive function and motor symptoms were assessed using the Montreal Cognitive Assessment and Unified Parkinson's Disease Rating Scale part III. Genetic analyses were conducted to identify APOE and MAPT genotypes. Plasma p-tau181 levels were higher in PD than healthy controls. APOE-ε4 carriers had lower plasma Aβ42 levels and Aβ42/Aβ40 ratio. The linear mixed-effects models showed that Montreal Cognitive Assessment scores were associated with plasma p-tau181/Aβ42 ratio (β -1.719 [-3.398 to -0.040], p = .045). Higher baseline plasma p-tau181 correlated with faster cognitive decline and motor symptoms deterioration in total patients (β -0.170 [-0.322 to -0.018], p = .029; β 0.329 [0.032 to 0.626], p = .030) and APOE-ε4 carriers (β -0.318 [-0.602 to -0.034], p = .030; β 0.632 [0.017 to 1.246], p = .046), but not in the noncarriers. Higher baseline plasma Aβ40 correlated with faster cognitive decline in total patients (β -0.007 [-0.015 to -0.0001], p = .047) and faster motor symptoms deterioration in total patients (β 0.026 [0.010 to 0.041], p = .001) and APOE-ε4 carriers (β 0.044 [-0.026 to 0.049], p = .020), but not in the noncarriers. The plasma p-tau181/Aβ2 ratio monitors the cognitive status of PD. Higher baseline plasma p-tau181 and Aβ40 predict faster cognitive decline and motor symptoms deterioration in PD, especially in APOE-ε4 carriers.
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Affiliation(s)
- Junyu Lin
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunyu Li
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingyu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kuncheng Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qirui Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianmi Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Xiao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dejiang Pang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueping Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Zenuni H, Bovenzi R, Bissacco J, Grillo P, Simonetta C, Mascioli D, Pieri M, Bernardini S, Sancesario GM, Stefani A, Mercuri NB, Schirinzi T. Clinical and neurochemical correlates of the APOE genotype in early-stage Parkinson's disease. Neurobiol Aging 2023; 131:24-28. [PMID: 37572524 DOI: 10.1016/j.neurobiolaging.2023.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/14/2023]
Abstract
Emerging evidence indicates that apolipoprotein E (APOE) genotype may influence Parkinson's disease (PD) course, although clinical and neurochemical correlates have not been completely established. This study aimed to determine the associations of APOE genotypes (ε4 vs. non-ε4) with cerebrospinal fluid (CSF) neurodegeneration biomarkers and clinical parameters in early-stage PD patients. One hundred and seventy-five PD patients and 89 non-neurodegenerative controls grouped in APOE-ε4 carriers (28 PD; 12 controls) and non-APOE-ε4 carriers (147 PD; 78 controls) were enrolled. CSF levels of amyloid-β-42, amyloid-β-40, total and 181-phosphorylated tau, and clinical scores were compared among groups adjusting for main covariates. APOE genotypes prevalence was similar in PD and controls. PD APOE-ε4 carriers had lower amyloid-β-42 CSF levels than PD non-APOE-ε4 carriers and controls, independently from age. PD APOE-ε4 carriers also had higher total and "item 5" (attention and memory) non-motor symptoms scale scores than PD non-APOE-ε4 carriers, independently from confounding factors. APOE-ε4 genotype might thus account for a more vulnerable PD subtype characterized by prominent amyloidopathy and a greater burden of non-motor symptoms in the early disease stages. DATA AVAILABILITY: Data are available upon reasonable request.
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Affiliation(s)
- Henri Zenuni
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Roberta Bovenzi
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Jacopo Bissacco
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Piergiorgio Grillo
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Clara Simonetta
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Davide Mascioli
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Massimo Pieri
- Clinical Biochemistry Unit, Department of Experimental Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Segio Bernardini
- Clinical Biochemistry Unit, Department of Experimental Medicine, University of Roma Tor Vergata, Rome, Italy
| | | | - Alessandro Stefani
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Tommaso Schirinzi
- Unit of Neurology, Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy.
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Duque KR, Vizcarra JA, Hill EJ, Espay AJ. Disease-modifying vs symptomatic treatments: Splitting over lumping. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:187-209. [PMID: 36803811 DOI: 10.1016/b978-0-323-85555-6.00020-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Clinical trials of putative disease-modifying therapies in neurodegeneration have obeyed the century-old principle of convergence, or lumping, whereby any feature of a clinicopathologic disease entity is considered relevant to most of those affected. While this convergent approach has resulted in important successes in trials of symptomatic therapies, largely aimed at correcting common neurotransmitter deficiencies (e.g., cholinergic deficiency in Alzheimer's disease or dopaminergic deficiency in Parkinson's disease), it has been consistently futile in trials of neuroprotective or disease-modifying interventions. As individuals affected by the same neurodegenerative disorder do not share the same biological drivers, splitting such disease into small molecular/biological subtypes, to match people to therapies most likely to benefit them, is vital in the pursuit of disease modification. We here discuss three paths toward the splitting needed for future successes in precision medicine: (1) encourage the development of aging cohorts agnostic to phenotype in order to enact a biology-to-phenotype direction of biomarker development and validate divergence biomarkers (present in some, absent in most); (2) demand bioassay-based recruitment of subjects into disease-modifying trials of putative neuroprotective interventions in order to match the right therapies to the right recipients; and (3) evaluate promising epidemiologic leads of presumed pathogenetic potential using Mendelian randomization studies before designing the corresponding clinical trials. The reconfiguration of disease-modifying efforts for patients with neurodegenerative disorders will require a paradigm shift from lumping to splitting and from proteinopathy to proteinopenia.
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Affiliation(s)
- Kevin R Duque
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Joaquin A Vizcarra
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Emily J Hill
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
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Myers PS, O'Donnell JL, Jackson JJ, Lessov-Schlaggar CN, Miller RL, Foster ER, Cruchaga C, Benitez BA, Kotzbauer PT, Perlmutter JS, Campbell MC. Proteinopathy and Longitudinal Cognitive Decline in Parkinson Disease. Neurology 2022; 99:e66-e76. [PMID: 35418463 PMCID: PMC9259093 DOI: 10.1212/wnl.0000000000200344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES People with Parkinson disease (PD) commonly experience cognitive decline, which may relate to increased α-synuclein, tau, and β-amyloid accumulation. This study examines whether the different proteins predict longitudinal cognitive decline in PD. METHODS All participants (PD n = 152, controls n = 52) were part of a longitudinal study and completed a lumbar puncture for CSF protein analysis (α-synuclein, total tau [tau], and β-amyloid42 [β-amyloid]), a β-amyloid PET scan, and/or provided a blood sample for APOE genotype (ε4+, ε4-), which is a risk factor for β-amyloid accumulation. Participants also had comprehensive, longitudinal clinical assessments of overall cognitive function and dementia status, as well as cognitive testing of attention, language, memory, and visuospatial and executive function. We used hierarchical linear growth models to examine whether the different protein metrics predict cognitive change and multivariate Cox proportional hazard models to predict time to dementia conversion. Akaike information criterion was used to compare models for best fit. RESULTS Baseline measures of CSF β-amyloid predicted decline for memory (p = 0.04) and overall cognitive function (p = 0.01). APOE genotypes showed a significant group (ε4+, ε4-) effect such that ε4+ individuals declined faster than ε4- individuals in visuospatial function (p = 0.03). Baseline β-amyloid PET significantly predicted decline in all cognitive measures (all p ≤ 0.004). Neither baseline CSF α-synuclein nor tau predicted cognitive decline. All 3 β-amyloid--related metrics (CSF, PET, APOE) also predicted time to dementia. Models with β-amyloid PET as a predictor fit the data the best. DISCUSSION Presence or risk of β-amyloid accumulation consistently predicted cognitive decline and time to dementia in PD. This suggests that β-amyloid has high potential as a prognostic indicator and biomarker for cognitive changes in PD.
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Affiliation(s)
- Peter S Myers
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - John L O'Donnell
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Joshua J Jackson
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Christina N Lessov-Schlaggar
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Rebecca L Miller
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Erin R Foster
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Carlos Cruchaga
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Bruno A Benitez
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Paul T Kotzbauer
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Joel S Perlmutter
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO
| | - Meghan C Campbell
- From the Department of Neurology (P.S.M., J.L.O., R.L.M., E.R.F., C.C., P.T.K., J.S.P., M.C.C.), Department of Psychiatry (C.N.L.-S., E.R.F., C.C., B.A.B.), Program in Occupational Therapy (E.R.F., J.S.P.), Department of Genetics (C.C.), Department of Radiology (J.S.P., M.C.C.), Department of Neuroscience (J.S.P.), and Program in Physical Therapy (J.S.P.), Washington University School of Medicine; and Department of Psychological and Brain Sciences (J.J.J.), Washington University in St. Louis, MO.
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