1
|
Grotewold N, Albin RL. Update: Protective and risk factors for Parkinson disease. Parkinsonism Relat Disord 2024; 125:107026. [PMID: 38879999 DOI: 10.1016/j.parkreldis.2024.107026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
We review the epidemiologic literature on potential protective and risk factors in Parkinson's Disease (PD). Prior research identified numerous possible protective and risk factors. Potential protective factors include tobacco abuse, physical activity, urate levels, NSAID use, calcium channel blocker use, statin use, and use of some α1-adrenergic antagonists. Some potential protective factors could be products of reverse causation, including increased serum urate, tobacco abuse, and coffee-tea-caffeine consumption. Potential risk factors include traumatic brain injury, pesticide exposure, organic solvent exposure, lead exposure, air pollution, Type 2 Diabetes, some dairy products, cardiovascular disease, and some infections including Hepatitis C, H. pylori, and COVID-19. Potential non-environmental risk factors include bipolar disorder, essential tremor, bullous pemphigoid, and inflammatory bowel disease. There is an inverse relationship with PD and risk of most cancers. Though many potential protective and risk factors for PD were identified, research has not yet led to unique, rigorous prevention trials or successful disease-modifying interventions. While efforts to reduce exposure to some industrial toxicants are well justified, PD incidence might be most effectively reduced by mitigation of risks, such as Type 2 Diabetes, air pollution, traumatic brain injury, or physical inactivity, that are general public health intervention targets.
Collapse
Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC & Neurology Service, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
| |
Collapse
|
2
|
Mo N, Yang Y, Wang W, Zhou P, Liu F, Zhang Y, Zhang J, Han L, Lu C. Causal associations between psoriasis, eczema, urticaria, and mental illness: A bidirectional Mendelian randomization study of the European population. Medicine (Baltimore) 2024; 103:e38586. [PMID: 38941419 DOI: 10.1097/md.0000000000038586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Observational studies have reported a relationship between multiple common dermatoses and mental illness. To assess the potential bidirectional causality between 3 skin disorders (psoriasis, eczema, and urticaria) and 4 psychiatric disorders (bipolar disorder, schizophrenia, major depressive disorder, and anxiety) in the European population, we used Mendelian randomization (MR) analysis, which provides definitive evidence for causal inference. Eligible single nucleotide polymorphisms were screened for dermatological and psychiatric disorders using a genome-wide association study database. We conducted bidirectional, 2-sample MR analysis using instrumental variables related to psoriasis, eczema, and urticaria as exposure factors, and bipolar disorder, schizophrenia, major depression, and anxiety as outcomes. Reverse MR analysis with bipolar disorder, schizophrenia, major depression, and anxiety as exposure and psoriasis, eczema, and urticaria as outcomes were also performed, and the causality was analyzed using inverse-variance weighting (IVW), MR-Egger, and weighted median methods. To thoroughly assess causality, sensitivity analyses were conducted using the IVW, MR-PRESSO, and MR-Egger methods. The results showed that bipolar disorder increased the incidence of psoriasis (odds ratio = 1.271, 95% confidence interval = 1.003-1.612, P = .047), heterogeneity test with Cochran Q test in the IVW showed P value > .05, (P = .302), the MR-Pleiotropy and MR-PRESSO (outlier methods) in the multiplicity test showed P value > .05, (P = .694; P = .441), and MR-Pleiotropy evidence showed no apparent intercept (intercept = -0.060; SE = 0.139; P = .694). Major depression increased the risk of eczema (odds ratio = 1.002, 95% confidence interval = 1.000-1.004, P = .024), heterogeneity test showed P value > .05, (P = .328), multiplicity detection showed P value > .05, (P = .572; P = .340), and MR-Pleiotropy evidence showed no apparent intercept (intercept = -0.099; SE = 0.162; P = .572). Sensitivity analyses of the above results were reliable, and no heterogeneity or multiplicity was found. This study demonstrated a statistically significant causality between bipolar disorder and psoriasis, major depression, and eczema in a European population, which could provide important information for physicians in the clinical management of common skin conditions.
Collapse
Affiliation(s)
- Nian Mo
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Yujie Yang
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Wen Wang
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Panyu Zhou
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Fanlu Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Yating Zhang
- Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Junhong Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Ling Han
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
- State Key Laboratory of TCM Moisture Syndrome at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory of TCM and Immune Disease Research in Guangzhou, Guangzhou, China
- Guangdong Province Hospital of Chinese Medicine in Guangzhou, Guangzhou, China
| | - Chuanjian Lu
- The Second Clinical College of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
- State Key Laboratory of TCM Moisture Syndrome at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangzhou, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint Laboratory of TCM and Immune Disease Research in Guangzhou, Guangzhou, China
- Guangdong Province Hospital of Chinese Medicine in Guangzhou, Guangzhou, China
| |
Collapse
|
3
|
Gabbert C, Blöbaum L, Lüth T, König IR, Caliebe A, Sendel S, Laabs BH, Klein C, Trinh J. The combined effect of lifestyle factors and polygenic scores on age at onset in Parkinson's disease. Sci Rep 2024; 14:14670. [PMID: 38918550 PMCID: PMC11199580 DOI: 10.1038/s41598-024-65640-x] [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: 02/08/2024] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
The objective of this study was to investigate the association between a Parkinson's disease (PD)-specific polygenic score (PGS) and protective lifestyle factors on age at onset (AAO) in PD. We included data from 4367 patients with idiopathic PD, 159 patients with GBA1-PD, and 3090 healthy controls of European ancestry from AMP-PD, PPMI, and Fox Insight cohorts. The association between PGS and lifestyle factors on AAO was assessed with linear and Cox proportional hazards models. The PGS showed a negative association with AAO (β = - 1.07, p = 6 × 10-7) in patients with idiopathic PD. The use of one, two, or three of the protective lifestyle factors showed a reduction in the hazard ratio by 21% (p = 0.0001), 44% (p < 2 × 10-16), and 55% (p < 2 × 10-16), compared to no use. An additive effect of aspirin (β = 7.62, p = 9 × 10-7) and PGS (β = - 1.58, p = 0.0149) was found for AAO without an interaction (p = 0.9993) in the linear regressions, and similar effects were seen for tobacco. In contrast, no association between aspirin intake and AAO was found in GBA1-PD (p > 0.05). In our cohort, coffee, tobacco, aspirin, and PGS are independent predictors of PD AAO. Additionally, lifestyle factors seem to have a greater influence on AAO than common genetic risk variants with aspirin presenting the largest effect.
Collapse
Affiliation(s)
- Carolin Gabbert
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Leonie Blöbaum
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Theresa Lüth
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian Sendel
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Björn-Hergen Laabs
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Joanne Trinh
- Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| |
Collapse
|
4
|
Park KW, Woo HT, Hwang YS, Lee SH, Chung SJ. Appendectomy and the Risk of Parkinson's Disease: A Korean Nationwide Study. Mov Disord Clin Pract 2024; 11:704-707. [PMID: 38696328 PMCID: PMC11145134 DOI: 10.1002/mdc3.14031] [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: 10/10/2023] [Revised: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The vermiform appendix is considered a potential reservoir for the abnormal α-synuclein aggregate in Parkinson's disease (PD). Previous epidemiologic evidence on the association between appendectomy and PD risk remains inconclusive, especially outside the Western world. OBJECTIVES To investigate the association between appendectomy and PD risk in Korea. METHODS Among 703,831 eligible adult subjects in the National Health Insurance Service sample cohort, we identified 16,122 patients who underwent appendectomy. The rest formed the control group. PD risk was assessed using time-dependent Cox regression analyses. RESULTS The appendectomy group did not have altered risk of PD compared with the control group in either unadjusted [hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.97-1.80, P = 0.08] or adjusted model (HR 1.42, CI 0.88-2.30, P = 0.15). No further statistical difference appeared when stratified by sex. CONCLUSIONS Appendectomy is not associated with altered risk of PD in the Korean population.
Collapse
Affiliation(s)
- Kye Won Park
- Pacific Parkinson Research CentreUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Hyeong Taek Woo
- Department of Preventive MedicineKeimyung University School of MedicineDaeguKorea
| | - Yun Su Hwang
- Department of NeurologyJeonbuk National University Medical School and HospitalJeonjuKorea
| | | | - Sun Ju Chung
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| |
Collapse
|
5
|
Rose KN, Schwarzschild MA, Gomperts SN. Clearing the Smoke: What Protects Smokers from Parkinson's Disease? Mov Disord 2024; 39:267-272. [PMID: 38226487 PMCID: PMC10923097 DOI: 10.1002/mds.29707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/22/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
The link between smoking and a lower risk of Parkinson's disease (PD) is one of the strongest environmental or lifestyle associations in neuroepidemiology. Growing evidence supports the hypothesis that the association is based on a neuroprotective effect of smoking on PD, despite the plausible alternative that smoking serves as a marker for a proximal protective influence without itself conferring benefit. But how smoking could protect against neurodegeneration in PD is not well understood. Of several candidate molecules and mechanisms that have been nominated, nicotine has received the most attention. However, randomized controlled clinical trials of nicotine in PD have failed to demonstrate benefit on motor endpoints, including the NIC-PD study in which recently diagnosed participants were randomly assigned to placebo or nicotine treatment for 1 year. Given these results, the time is right to evaluate the neuroprotective potential of other molecules and biochemical cascades triggered by smoking. Here, we review the evidence supporting smoking's possible protective effect on PD, compounds in tobacco and smoke that might mediate such benefit, and non-causal classes of explanation, including reverse causation and the prospect of shared genetic determinants of smoking and PD resistance. The therapeutic potential of non-nicotine components of smoke is suggested by studies supporting multiple alternative mechanisms ranging from monoamine oxidase inhibitors to gut microbiome disruption to antioxidant response induction by chronic exposure to low levels of carbon monoxide. Rigorous investigation is warranted to evaluate this molecule and others for disease-preventing and disease-modifying activity in PD models and, if warranted, in clinical trials. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Kenneth N. Rose
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Stephen N. Gomperts
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Neilson LE, Quinn JF, Lim MM. Screening and Targeting Risk Factors for Prodromal Synucleinopathy: Taking Steps toward a Prescriptive Multi-modal Framework. Aging Dis 2023; 14:1243-1263. [PMID: 37307836 PMCID: PMC10389816 DOI: 10.14336/ad.2022.1024] [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: 09/24/2022] [Accepted: 10/24/2022] [Indexed: 06/14/2023] Open
Abstract
As the prevalence of Parkinson's disease (PD) grows, so too does the population at-risk of developing PD, those in the so-called prodromal period. This period can span from those experiencing subtle motor deficits yet not meeting full diagnostic criteria or those with physiologic markers of disease alone. Several disease-modifying therapies have failed to show a neuroprotective effect. A common criticism is that neurodegeneration, even in the early motor stages, has advanced too far for neuro-restoration-based interventions to be effective. Therefore, identifying this early population is essential. Once identified, these patients could then potentially benefit from sweeping lifestyle modifications to alter their disease trajectory. Herein, we review the literature on risk factors for, and prodromal symptoms of, PD with an emphasis on ones which may be modifiable in the earliest possible stages. We propose a process for identifying this population and speculate on some strategies which may modulate disease trajectory. Ultimately, this proposal warrants prospective studies.
Collapse
Affiliation(s)
- Lee E Neilson
- Department of Neurology, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA.
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Joseph F Quinn
- Department of Neurology, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA.
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Miranda M Lim
- Department of Neurology, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA.
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA.
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR 97239, USA.
| |
Collapse
|
7
|
Domenighetti C, Douillard V, Sugier PE, Sreelatha AAK, Schulte C, Grover S, May P, Bobbili DR, Radivojkov-Blagojevic M, Lichtner P, Singleton AB, Hernandez DG, Edsall C, Gourraud PA, Mellick GD, Zimprich A, Pirker W, Rogaeva E, Lang AE, Koks S, Taba P, Lesage S, Brice A, Corvol JC, Chartier-Harlin MC, Mutez E, Brockmann K, Deutschländer AB, Hadjigeorgiou GM, Dardiotis E, Stefanis L, Simitsi AM, Valente EM, Petrucci S, Duga S, Straniero L, Zecchinelli A, Pezzoli G, Brighina L, Ferrarese C, Annesi G, Quattrone A, Gagliardi M, Matsuo H, Nakayama A, Hattori N, Nishioka K, Chung SJ, Kim YJ, Kolber P, van de Warrenburg BPC, Bloem BR, Aasly J, Toft M, Pihlstrøm L, Guedes LC, Ferreira JJ, Bardien S, Carr J, Tolosa E, Ezquerra M, Pastor P, Diez-Fairen M, Wirdefeldt K, Pedersen NL, Ran C, Belin AC, Puschmann A, Rödström EY, Clarke CE, Morrison KE, Tan M, Krainc D, Burbulla LF, Farrer MJ, Krüger R, Gasser T, Sharma M, Vince N, Elbaz A. The Interaction between HLA-DRB1 and Smoking in Parkinson's Disease Revisited. Mov Disord 2022; 37:1929-1937. [PMID: 35810454 PMCID: PMC9597672 DOI: 10.1002/mds.29133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Two studies that examined the interaction between HLA-DRB1 and smoking in Parkinson's disease (PD) yielded findings in opposite directions. OBJECTIVE To perform a large-scale independent replication of the HLA-DRB1 × smoking interaction. METHODS We genotyped 182 single nucleotide polymorphism (SNPs) associated with smoking initiation in 12 424 cases and 9480 controls to perform a Mendelian randomization (MR) analysis in strata defined by HLA-DRB1. RESULTS At the amino acid level, a valine at position 11 (V11) in HLA-DRB1 displayed the strongest association with PD. MR showed an inverse association between genetically predicted smoking initiation and PD only in absence of V11 (odds ratio, 0.74, 95% confidence interval, 0.59-0.93, PInteraction = 0.028). In silico predictions of the influence of V11 and smoking-induced modifications of α-synuclein on binding affinity showed findings consistent with this interaction pattern. CONCLUSIONS Despite being one of the most robust findings in PD research, the mechanisms underlying the inverse association between smoking and PD remain unknown. Our findings may help better understand this association. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Cloé Domenighetti
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Team “Exposome, heredity, cancer and health”, CESP, 94807, Villejuif, France
| | - Venceslas Douillard
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-4400 Nantes, France
| | - Pierre-Emmanuel Sugier
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Team “Exposome, heredity, cancer and health”, CESP, 94807, Villejuif, France
| | - Ashwin Ashok Kumar Sreelatha
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Germany
| | - Claudia Schulte
- Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tubingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tubingen, Germany
| | - Sandeep Grover
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Germany
| | - Patrick May
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Belval, Luxembourg
| | - Dheeraj R. Bobbili
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Belval, Luxembourg
| | | | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Andrew B. Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, NIA, NIH, Bethesda, MD 20892, USA
- Center For Alzheimer’s and Related Dementias, NIA, NIH, Bethesda, MD 20892, USA
| | - Dena G. Hernandez
- Molecular Genetics Section, Laboratory of Neurogenetics, NIA, NIH, Bethesda, MD 20892, USA
| | - Connor Edsall
- Molecular Genetics Section, Laboratory of Neurogenetics, NIA, NIH, Bethesda, MD 20892, USA
| | - Pierre-Antoine Gourraud
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-4400 Nantes, France
| | - George D. Mellick
- Griffith Institute for Drug Discovery, Griffith University, Don Young Road, Nathan, Queensland, Australia
| | | | - Walter Pirker
- Department of Neurology, Klinik Ottakring, Vienna, Austria
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E. Lang
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Sulev Koks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
- Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Suzanne Lesage
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Department of Neurologie, Paris, France
| | - Alexis Brice
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Department of Neurologie, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Department of Neurologie, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Paris, France
| | - Marie-Christine Chartier-Harlin
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - LilNCog- Centre de Recherche Lille Neurosciences & Cognition, F-59000 Lille, France
| | - Eugénie Mutez
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - LilNCog- Centre de Recherche Lille Neurosciences & Cognition, F-59000 Lille, France
| | - Kathrin Brockmann
- Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tubingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tubingen, Germany
| | - Angela B. Deutschländer
- Department of Neurology, Ludwig Maximilians University of Munich, Germany
- Department of Neurology, Max Planck Institute of Psychiatry, Munich, Germany
- Department of Neurology and Department of Clinical Genomics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Georges M. Hadjigeorgiou
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Efthimos Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Athina Maria Simitsi
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Simona Petrucci
- UOC Medical Genetics and Advanced Cell Diagnostics, S. Andrea University Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, University of Rome, Rome, Italy
| | - Stefano Duga
- Department of Biomedical Sciences - Humanitas University, Milan, Italy
- Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Letizia Straniero
- Department of Biomedical Sciences - Humanitas University, Milan, Italy
| | - Anna Zecchinelli
- Parkinson Institute, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini/CTO, Milano
| | - Gianni Pezzoli
- Parkinson Institute, Fontazione Grigioni - Via Zuretti, 35, Milan 20125 Italy
| | - Laura Brighina
- Department of Neurology, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano Bicocca, Milano, Italy
| | - Carlo Ferrarese
- Department of Neurology, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano Bicocca, Milano, Italy
| | - Grazia Annesi
- Institute for Biomedical Research and Innovation, National Research Council, Cosenza, Italy
| | - Andrea Quattrone
- Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Monica Gagliardi
- Institute of Molecular Bioimaging and Physiology National Research Council, Catanzaro, Italy
| | - Hirotaka Matsuo
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Akiyoshi Nakayama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Pierre Kolber
- Neurology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Bart PC van de Warrenburg
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Jan Aasly
- Department of Neurology, St Olav’s Hospital and Norwegian University of Science and Technology, Trondheim
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte (CHULN), Lisbon, Portugal
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Jonathan Carr
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Eduardo Tolosa
- Parkinson’s disease & Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII) Barcelona, Spain
| | - Mario Ezquerra
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Institut de Neurociències, Universitat de Barcelona, ES-08036 Barcelona, Catalonia
| | - Pau Pastor
- Fundació per la Recerca Biomèdica i Social Mútua Terrassa, Terrassa, Barcelona, Spain
- Movement Disorders Unit, Department of Neurology, Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Monica Diez-Fairen
- Fundació per la Recerca Biomèdica i Social Mútua Terrassa, Terrassa, Barcelona, Spain
- Movement Disorders Unit, Department of Neurology, Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Karin Wirdefeldt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andrea C. Belin
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Puschmann
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Getingevägen 4, 221 85, Lund, Sweden
| | - Emil Ygland Rödström
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Getingevägen 4, 221 85, Lund, Sweden
| | - Carl E. Clarke
- University of Birmingham and Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Karen E. Morrison
- Faculty of Medicine, Health and Life Sciences, Queens University, Belfast, United Kingdom
| | - Manuela Tan
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Dimitri Krainc
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Lena F. Burbulla
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Matt J. Farrer
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Rejko Krüger
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Belval, Luxembourg
- Neurology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Thomas Gasser
- Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tubingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tubingen, Germany
| | - Manu Sharma
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Germany
| | - Nicolas Vince
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-4400 Nantes, France
| | - Alexis Elbaz
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Team “Exposome, heredity, cancer and health”, CESP, 94807, Villejuif, France
| |
Collapse
|
8
|
Gao RC, Sang N, Jia CZ, Zhang MY, Li BH, Wei M, Wu GC. Association Between Sleep Traits and Rheumatoid Arthritis: A Mendelian Randomization Study. Front Public Health 2022; 10:940161. [PMID: 35844889 PMCID: PMC9280285 DOI: 10.3389/fpubh.2022.940161] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Currently, the causal association between sleep disorders and rheumatoid arthritis (RA) has been poorly understood. In this two-sample Mendelian randomization (TSMR) study, we tried to explore whether sleep disorders are causally associated with RA. Seven sleep-related traits were chosen from the published Genome-Wide Association Study (GWAS): short sleep duration, frequent insomnia, any insomnia, sleep duration, getting up, morningness (early-to-bed/up habit), and snoring, 27, 53, 57, 57, 70, 274, and 42 individual single-nucleotide polymorphisms (SNPs) (P < 5 × 10-8) were obtained as instrumental variables (IVs) for these sleep-related traits. Outcome variables were obtained from a public GWAS study that included 14,361 cases and 43,923 European Ancestry controls. The causal relationship between sleep disturbances and RA risk were evaluated by a two-sample Mendelian randomization (MR) analysis using inverse variance weighted (IVW), MR-Egger regression, weighted median, and weight mode methods. MR-Egger Regression and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) were used to test for horizontal pleomorphism and outliers. There was no evidence of a link between RA and frequent insomnia (IVW, odds ratio (OR): 0.99; 95% interval (CI): 0.84-1.16; P = 0.858), any insomnia (IVW, OR: 1.09; 95% CI: 0.85-1.42; P = 0.489), sleep duration (IVW, OR: 0.65, 95% CI: 0.38-1.10, P = 0.269), getting up (IVW, OR: 0.56, 95% CI: 0.13-2.46, P = 0.442), morningness (IVW, OR: 2.59; 95% CI: 0.73-9.16; P = 0.142), or snoring (IVW, OR: 0.95; 95% CI: 0.68-1.33; P = 0.757). Short sleep duration (6h) had a causal effect on RA, as supported by IVW and weighted median (OR: 1.47, 95% CI: 1.12-1.94, P = 0.006; OR: 1.43, 95%CI:1.01-2.05, P = 0.047). Sensitivity analysis showed that the results were stable. Our findings imply that short sleep duration is causally linked to an increased risk of RA. Therefore, sleep length should be considered in disease models, and physicians should advise people to avoid short sleep duration practices to lower the risk of RA.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, China
| |
Collapse
|
9
|
Kappen S, Bottigliengo D, Caliebe A, Del Greco M F, König IR. Systematic review of Mendelian randomization studies on Parkinson's disease. MED GENET-BERLIN 2022; 34:143-150. [PMID: 38835916 PMCID: PMC11006297 DOI: 10.1515/medgen-2022-2139] [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: 06/06/2024]
Abstract
Background Parkinson's disease (PD) is known to be associated with non-genetic factors. To infer causality, Mendelian randomization (MR) studies are increasingly used. Here, genetic variants are used as instrumental variables for the risk factor but have no direct effect on PD themselves. Methods We performed a systematic literature review on MR studies for PD. Studies were identified searching the PubMed database. Upon data extraction, we evaluated the methodological quality and summarized the evidence. Results Twelve articles were included. Most studies showed "good" methodological quality, but most did not report proper power estimations. Twelve analyses yielded nominally significant effects. Conclusions Our systematic review shows that most MR studies were well performed and allow to identify causal exposures, which may inform further studies on the prevention and early intervention of PD.
Collapse
Affiliation(s)
- Sophia Kappen
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | | | - Amke Caliebe
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
- Kiel University, Kiel, Germany
| | - Fabiola Del Greco M
- Institute for Biomedicine, Eurac Research, Via Galvani 31, 39100 Bolzano, Italy
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23562 Lübeck, Germany
| |
Collapse
|
10
|
Grover S, Sharma M. Sleep, Pain, and Neurodegeneration: A Mendelian Randomization Study. Front Neurol 2022; 13:765321. [PMID: 35585838 PMCID: PMC9108392 DOI: 10.3389/fneur.2022.765321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Our aim was to determine whether the genetic liability to sleep and pain-related traits have a causal effect on risk of neurodegeneration in individuals of predominantly European ancestry. We selected five neurodegenerative disorders, namely, age-related macular degeneration (AMD), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson's disease (PD). Sleep duration (SD), short sleep (SS), long sleep (LS), chronotype (CHR), morning person (MP), insomnia (INS), and multisite chronic pain (MCP) were considered as exposures. We conducted Mendelian randomization (MR) using an inverse-variance weighted (IVW) method to compute causal effect estimates using latest available GWAS data sets. The MP phenotype was observed as the strongest risk factor for genetic liability to AMD (ORIVW = 1.192; 95% CI 1.078, 1.318, P = 0.0007). We observed suggestive evidence of risky effects of CHR on AMD (P = 0.0034), SS on AD (P = 0.0044), and INS on ALS (P = 0.0123). However, we failed to observe any role of pain. The results were robust on sensitivity analyses. Our study highlighted the role of MP as a risk factor for AMD.
Collapse
Affiliation(s)
- Sandeep Grover
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Manu Sharma
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | | |
Collapse
|
11
|
Wang XL, Feng ST, Wang YT, Yuan YH, Li ZP, Chen NH, Wang ZZ, Zhang Y. Mitophagy, a Form of Selective Autophagy, Plays an Essential Role in Mitochondrial Dynamics of Parkinson's Disease. Cell Mol Neurobiol 2021; 42:1321-1339. [PMID: 33528716 DOI: 10.1007/s10571-021-01039-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a severe neurodegenerative disorder caused by the progressive loss of dopaminergic neurons in the substantia nigra and affects millions of people. Currently, mitochondrial dysfunction is considered as a central role in the pathogenesis of both sporadic and familial forms of PD. Mitophagy, a process that selectively targets damaged or redundant mitochondria to the lysosome for elimination via the autophagy devices, is crucial in preserving mitochondrial health. So far, aberrant mitophagy has been observed in the postmortem of PD patients and genetic or toxin-induced models of PD. Except for mitochondrial dysfunction, mitophagy is involved in regulating several other PD-related pathological mechanisms as well, e.g., oxidative stress and calcium imbalance. So far, the mitophagy mechanisms induced by PD-related proteins, PINK1 and Parkin, have been studied widely, and several other PD-associated genes, e.g., DJ-1, LRRK2, and alpha-synuclein, have been discovered to participate in the regulation of mitophagy as well, which further strengthens the link between mitophagy and PD. Thus, in this view, we reviewed mitophagy pathways in belief and discussed the interactions between mitophagy and several PD's pathological mechanisms and how PD-related genes modulate the mitophagy process.
Collapse
Affiliation(s)
- Xiao-Le Wang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Sunshine Southern Avenue, Fang-Shan District, Beijing, 102488, China
| | - Si-Tong Feng
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Sunshine Southern Avenue, Fang-Shan District, Beijing, 102488, China
| | - Ya-Ting Wang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Sunshine Southern Avenue, Fang-Shan District, Beijing, 102488, China
| | - Yu-He Yuan
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica and Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian-Nong-Tan Street, Xi-Cheng District, Beijing, 100050, China
| | - Zhi-Peng Li
- School of Pharmacy, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Nai-Hong Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica and Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian-Nong-Tan Street, Xi-Cheng District, Beijing, 100050, China
| | - Zhen-Zhen Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica and Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Xian-Nong-Tan Street, Xi-Cheng District, Beijing, 100050, China.
| | - Yi Zhang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Sunshine Southern Avenue, Fang-Shan District, Beijing, 102488, China.
| |
Collapse
|
12
|
Mappin-Kasirer B, Pan H, Lewington S, Kizza J, Gray R, Clarke R, Peto R. Tobacco smoking and the risk of Parkinson disease: A 65-year follow-up of 30,000 male British doctors. Neurology 2020; 94:e2132-e2138. [PMID: 32371450 PMCID: PMC7526668 DOI: 10.1212/wnl.0000000000009437] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the causal relevance of current tobacco smoking for the risk of Parkinson disease (PD). METHODS We compared the risks of death from PD with smoking habits in 30,000 male doctors in the British Doctors cohort study in 1951 and in survivors who had been resurveyed periodically for 5 decades. Cause-specific mortality was monitored for 65 years and included 283 deaths from PD. The relative risks (RRs) of PD (and 95% confidence intervals [CIs]) were estimated using Cox models for smoking habits (smoking status, amount smoked, and years since quitting) at baseline or updated habits at resurvey. RESULTS The prevalence of current smoking declined progressively during follow-up from 67% to 8% between 1951 and 1998. The crude rates of PD death were lower in current smokers than in never smokers at baseline (30 vs 46/100,000 persons-years). After adjustment for age at risk, current smokers at baseline had a 30% lower risk of PD (RR 0.71; 95% CI 0.60-0.84), and continuing smokers classified using updated smoking habits at resurvey had a 40% lower risk (RR 0.60; 95% CI 0.46-0.77) of PD compared with never smokers. The risks of PD were inversely associated with the amount of tobacco smoked. The protective effect of current smoking vs never smoking for PD was attenuated by increasing duration since quitting smoking. CONCLUSIONS In contrast to previous suggestions, the present report demonstrates a causally protective effect of current smoking on the risk of PD, which may provide insights into the etiology of PD.
Collapse
Affiliation(s)
- Benjamin Mappin-Kasirer
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Hongchao Pan
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sarah Lewington
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Jennifer Kizza
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Richard Gray
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Robert Clarke
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom.
| | - Richard Peto
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (B.M.-K., H.P., S.L., J.K., R.G., R.C., R.P.), Nuffield Department of Population Health, University of Oxford; and Medical Research Council Population Health Research Unit (H.P., S.L.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| |
Collapse
|
13
|
|