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Jacob SM, Lee S, Kim SH, Sharkey KA, Pfeffer G, Nguyen MD. Brain-body mechanisms contribute to sexual dimorphism in amyotrophic lateral sclerosis. Nat Rev Neurol 2024; 20:475-494. [PMID: 38965379 DOI: 10.1038/s41582-024-00991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/06/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common form of human motor neuron disease. It is characterized by the progressive degeneration of upper and lower motor neurons, leading to generalized motor weakness and, ultimately, respiratory paralysis and death within 3-5 years. The disease is shaped by genetics, age, sex and environmental stressors, but no cure or routine biomarkers exist for the disease. Male individuals have a higher propensity to develop ALS, and a different manifestation of the disease phenotype, than female individuals. However, the mechanisms underlying these sex differences remain a mystery. In this Review, we summarize the epidemiology of ALS, examine the sexually dimorphic presentation of the disease and highlight the genetic variants and molecular pathways that might contribute to sex differences in humans and animal models of ALS. We advance the idea that sexual dimorphism in ALS arises from the interactions between the CNS and peripheral organs, involving vascular, metabolic, endocrine, musculoskeletal and immune systems, which are strikingly different between male and female individuals. Finally, we review the response to treatments in ALS and discuss the potential to implement future personalized therapeutic strategies for the disease.
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Affiliation(s)
- Sarah M Jacob
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sukyoung Lee
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University Hospital, Seoul, South Korea
| | - Keith A Sharkey
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gerald Pfeffer
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Minh Dang Nguyen
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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2
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Bradford D, Rodgers KE. Advancements and challenges in amyotrophic lateral sclerosis. Front Neurosci 2024; 18:1401706. [PMID: 38846716 PMCID: PMC11155303 DOI: 10.3389/fnins.2024.1401706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) continues to pose a significant challenge due to the disease complexity and heterogeneous manifestations. Despite recent drug approvals, there remains a critical need for the development of more effective therapies. This review explores the underlying mechanisms involved; including neuroinflammation, glutamate mediated excitotoxicity, mitochondrial dysfunction, and hypermetabolism, and how researchers are trying to develop novel drugs to target these pathways. While progress has been made, the unmet need of ALS patients highlights the urgency for continued research and resource allocation in the pursuit of effective treatments.
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Affiliation(s)
| | - Kathleen E. Rodgers
- Department of Medical Pharmacology, Center for Innovation in Brain Science, University of Arizona College of Medicine, Tucson, AZ, United States
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3
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Laucius O, Drūteika J, Balnytė R, Petrikonis K, Ališauskienė M, Vaitkus A. Sonographic Phrenic Nerve Changes in Amyotrophic Lateral Sclerosis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1745. [PMID: 37893463 PMCID: PMC10608041 DOI: 10.3390/medicina59101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects both the upper and lower motor neurons in the nervous system, causing muscle weakness and severe disability. The progressive course of the disease reduces the functional capacity of the affected patients, limits daily activities, and leads to complete dependence on caregivers, ultimately resulting in a fatal outcome. Respiratory dysfunction mostly occurs later in the disease and is associated with a worse prognosis. Forty-six participants were included in our study, with 23 patients in the ALS group and 23 individuals in the control group. The ultrasound examination of the phrenic nerve (PN) was performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine with a linear 4-18 MHz transducer. Our study revealed that the phrenic nerve is significantly smaller on both sides in ALS patients compared to the control group (p < 0.001). Only one significant study on PN ultrasound in ALS, conducted in Japan, also showed significant results (p < 0.00001). These small studies are particularly promising, as they suggest that ultrasound findings could serve as an additional diagnostic tool for ALS.
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Affiliation(s)
- Ovidijus Laucius
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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4
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Mead RJ, Shan N, Reiser HJ, Marshall F, Shaw PJ. Amyotrophic lateral sclerosis: a neurodegenerative disorder poised for successful therapeutic translation. Nat Rev Drug Discov 2023; 22:185-212. [PMID: 36543887 PMCID: PMC9768794 DOI: 10.1038/s41573-022-00612-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating disease caused by degeneration of motor neurons. As with all major neurodegenerative disorders, development of disease-modifying therapies has proven challenging for multiple reasons. Nevertheless, ALS is one of the few neurodegenerative diseases for which disease-modifying therapies are approved. Significant discoveries and advances have been made in ALS preclinical models, genetics, pathology, biomarkers, imaging and clinical readouts over the last 10-15 years. At the same time, novel therapeutic paradigms are being applied in areas of high unmet medical need, including neurodegenerative disorders. These developments have evolved our knowledge base, allowing identification of targeted candidate therapies for ALS with diverse mechanisms of action. In this Review, we discuss how this advanced knowledge, aligned with new approaches, can enable effective translation of therapeutic agents from preclinical studies through to clinical benefit for patients with ALS. We anticipate that this approach in ALS will also positively impact the field of drug discovery for neurodegenerative disorders more broadly.
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Affiliation(s)
- Richard J Mead
- Sheffield Institute for Translational Neuroscience, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
- Neuroscience Institute, University of Sheffield, Sheffield, UK
- Keapstone Therapeutics, The Innovation Centre, Broomhall, Sheffield, UK
| | - Ning Shan
- Aclipse Therapeutics, Radnor, PA, US
| | | | - Fiona Marshall
- MSD UK Discovery Centre, Merck, Sharp and Dohme (UK) Limited, London, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.
- Neuroscience Institute, University of Sheffield, Sheffield, UK.
- Keapstone Therapeutics, The Innovation Centre, Broomhall, Sheffield, UK.
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Spencer PS, Palmer VS, Kisby GE, Lagrange E, Horowitz BZ, Valdes Angues R, Reis J, Vernoux JP, Raoul C, Camu W. Early-onset, conjugal, twin-discordant, and clusters of sporadic ALS: Pathway to discovery of etiology via lifetime exposome research. Front Neurosci 2023; 17:1005096. [PMID: 36860617 PMCID: PMC9969898 DOI: 10.3389/fnins.2023.1005096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
The identity and role of environmental factors in the etiology of sporadic amyotrophic lateral sclerosis (sALS) is poorly understood outside of three former high-incidence foci of Western Pacific ALS and a hotspot of sALS in the French Alps. In both instances, there is a strong association with exposure to DNA-damaging (genotoxic) chemicals years or decades prior to clinical onset of motor neuron disease. In light of this recent understanding, we discuss published geographic clusters of ALS, conjugal cases, single-affected twins, and young-onset cases in relation to their demographic, geographic and environmental associations but also whether, in theory, there was the possibility of exposure to genotoxic chemicals of natural or synthetic origin. Special opportunities to test for such exposures in sALS exist in southeast France, northwest Italy, Finland, the U.S. East North Central States, and in the U.S. Air Force and Space Force. Given the degree and timing of exposure to an environmental trigger of ALS may be related to the age at which the disease is expressed, research should focus on the lifetime exposome (from conception to clinical onset) of young sALS cases. Multidisciplinary research of this type may lead to the identification of ALS causation, mechanism, and primary prevention, as well as to early detection of impending ALS and pre-clinical treatment to slow development of this fatal neurological disease.
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Affiliation(s)
- Peter S. Spencer
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States,*Correspondence: Peter S. Spencer,
| | - Valerie S. Palmer
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Glen E. Kisby
- College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, OR, United States
| | - Emmeline Lagrange
- Department of Neurology, Reference Center of Neuromuscular Disease and ALS Consultations, Grenoble University Hospital, Grenoble, France
| | - B. Zane Horowitz
- Department of Emergency Medicine, Oregon-Alaska Poison Center, Oregon Health and Science University, Portland, OR, United States
| | - Raquel Valdes Angues
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Jacques Reis
- University of Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Jean-Paul Vernoux
- Normandie Université, UNICAEN, Unité de Recherche Aliments Bioprocédés Toxicologie Environnements, Caen, France
| | - Cédric Raoul
- INM, University of Montpellier, INSERM, Montpellier, France
| | - William Camu
- ALS Reference Center, Montpellier University Hospital and University of Montpellier, INSERM, Montpellier, France
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6
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Julian TH, Boddy S, Islam M, Kurz J, Whittaker KJ, Moll T, Harvey C, Zhang S, Snyder MP, McDermott C, Cooper-Knock J, Shaw PJ. A review of Mendelian randomization in amyotrophic lateral sclerosis. Brain 2022; 145:832-842. [PMID: 34791088 PMCID: PMC9050546 DOI: 10.1093/brain/awab420] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/02/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Amyotrophic lateral sclerosis is a relatively common and rapidly progressive neurodegenerative disease that, in the majority of cases, is thought to be determined by a complex gene-environment interaction. Exponential growth in the number of performed genome-wide association studies combined with the advent of Mendelian randomization is opening significant new opportunities to identify environmental exposures that increase or decrease the risk of amyotrophic lateral sclerosis. Each of these discoveries has the potential to shape new therapeutic interventions. However, to do so, rigorous methodological standards must be applied in the performance of Mendelian randomization. We have reviewed Mendelian randomization studies performed in amyotrophic lateral sclerosis to date. We identified 20 Mendelian randomization studies, including evaluation of physical exercise, adiposity, cognitive performance, immune function, blood lipids, sleep behaviours, educational attainment, alcohol consumption, smoking and type 2 diabetes mellitus. We have evaluated each study using gold standard methodology supported by the Mendelian randomization literature and the STROBE-Mendelian randomization checklist. Where discrepancies exist between Mendelian randomization studies, we suggest the underlying reasons. A number of studies conclude that there is a causal link between blood lipids and risk of amyotrophic lateral sclerosis; replication across different datasets and even different populations adds confidence. For other putative risk factors, such as smoking and immune function, Mendelian randomization studies have provided cause for doubt. We highlight the use of positive control analyses in choosing exposure single nucleotide polymorphisms (SNPs) to make up the Mendelian randomization instrument, use of SNP clumping to avoid false positive results due to SNPs in linkage and the importance of multiple testing correction. We discuss the implications of survival bias for study of late age of onset diseases such as amyotrophic lateral sclerosis and make recommendations to mitigate this potentially important confounder. For Mendelian randomization to be useful to the amyotrophic lateral sclerosis field, high methodological standards must be applied to ensure reproducibility. Mendelian randomization is already an impactful tool, but poor-quality studies will lead to incorrect interpretations by a field that includes non-statisticians, wasted resources and missed opportunities.
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Affiliation(s)
- Thomas H Julian
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Sarah Boddy
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Mahjabin Islam
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Julian Kurz
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Katherine J Whittaker
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Tobias Moll
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Calum Harvey
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Sai Zhang
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher McDermott
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Johnathan Cooper-Knock
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
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D’Antona S, Caramenti M, Porro D, Castiglioni I, Cava C. Amyotrophic Lateral Sclerosis: A Diet Review. Foods 2021; 10:foods10123128. [PMID: 34945679 PMCID: PMC8702143 DOI: 10.3390/foods10123128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal disease related to upper and lower motor neurons degeneration. Although the environmental and genetic causes of this disease are still unclear, some factors involved in ALS onset such as oxidative stress may be influenced by diet. A higher risk of ALS has been correlated with a high fat and glutamate intake and β-methylamino-L-alanine. On the contrary, a diet based on antioxidant and anti-inflammatory compounds, such as curcumin, creatine, coenzyme Q10, vitamin E, vitamin A, vitamin C, and phytochemicals could reduce the risk of ALS. However, data are controversial as there is a discrepancy among different studies due to a limited number of samples and the many variables that are involved. In addition, an improper diet could lead to an altered microbiota and consequently to an altered metabolism that could predispose to the ALS onset. In this review we summarized some research that involve aspects related to ALS such as the epidemiology, the diet, the eating behaviour, the microbiota, and the metabolic diseases. Further research is needed to better comprehend the role of diet and the metabolic diseases in the mechanisms leading to ALS onset and progression.
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Affiliation(s)
- Salvatore D’Antona
- Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Via F.lli Cervi 93, 20054 Milan, Italy; (S.D.); (M.C.); (D.P.)
| | - Martina Caramenti
- Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Via F.lli Cervi 93, 20054 Milan, Italy; (S.D.); (M.C.); (D.P.)
| | - Danilo Porro
- Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Via F.lli Cervi 93, 20054 Milan, Italy; (S.D.); (M.C.); (D.P.)
| | - Isabella Castiglioni
- Department of Physics “G. Occhialini”, University of Milan-Bicocca, Piazza della Scienza 3, 20126 Milan, Italy;
| | - Claudia Cava
- Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Via F.lli Cervi 93, 20054 Milan, Italy; (S.D.); (M.C.); (D.P.)
- Correspondence:
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Abstract
Cigarette smoke (CS) has been consistently demonstrated to be an environmental risk factor for amyotrophic lateral sclerosis (ALS), although the molecular pathogenic mechanisms involved are yet to be elucidated. Here, we propose different mechanisms by which CS exposure can cause sporadic ALS pathogenesis. Oxidative stress and neuroinflammation are widely implicated in ALS pathogenesis, with blood–spinal cord barrier disruption also recognised to be involved in the disease process. In addition, immunometabolic, epigenetic and microbiome alterations have been implicated in ALS recently. Identification of the underlying pathophysiological mechanisms that underpin CS-associated ALS will drive future research to be conducted into new targets for treatment.
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McKay KA, Smith KA, Smertinaite L, Fang F, Ingre C, Taube F. Military service and related risk factors for amyotrophic lateral sclerosis. Acta Neurol Scand 2021; 143:39-50. [PMID: 32905613 PMCID: PMC7756624 DOI: 10.1111/ane.13345] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence. METHODS Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS. RESULTS A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel. CONCLUSIONS There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.
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Affiliation(s)
- Kyla A. McKay
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska Institutet Stockholm Sweden
| | - Kelsi A. Smith
- Clinical Epidemiology Division Department of Medicine Solna, Karolinska Institutet Stockholm Sweden
| | - Lidija Smertinaite
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology Insitute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fabian Taube
- School of Public Health and Community Medicine Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Swedish Armed Forces Center for Defence Medicine Gothenburg Sweden
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10
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Pereira M, Gromicho M, Henriques A, Pronto-Laborinho AC, Grosskreutz J, Kuźma-Kozakiewicz M, Petri S, Uysal H, Swash M, de Carvalho M. Cardiovascular comorbidities in amyotrophic lateral sclerosis. J Neurol Sci 2020; 421:117292. [PMID: 33423011 DOI: 10.1016/j.jns.2020.117292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The role of cardiovascular risk factors in amyotrophic lateral sclerosis (ALS) is controversial. A favourable profile has been found in ALS patients, but previous studies have not specifically considered the profile in different disease phenotypes. METHODS Demographic data, smoking habits, lifetime exercise, and medical history including diabetes mellitus, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, stroke, and cardiac events, were analysed in ALS patients and in controls with other neurological disorders, utilising a standardized questionnaire applied by the same neurologist. In ALS patients the results were analysed according to their different phenotypes. Univariate analyses and multinomial logistic models were applied to estimate the odds ratios (ORs) and confidence intervals (CIs) for covariates, to test potential modifiers and their effects. RESULTS 500 consecutively assessed adult ALS patients (mean age 65.6, 47% women, and 136 bulbar-onset) and 327 age and gender-matched controls were studied. Patients with spinal-onset ALS took more exercise (p = 0.012), reported less hypertension (p = 0.002) and had fewer cardiac events (p = 0.012). Multinomial regression analysis showed that men without hypertension have a higher risk of having spinal-onset ALS (p < 0.001) while female with hypertension have a higher risk of having bulbar-onset ALS (p = 0.033). CONCLUSIONS Risk-factors in ALS can be influenced by gender and phenotype. This study suggests that men with spinal ALS are healthier, exercise more and have lower rate of hypertension, but females with bulbar-onset ALS are more prone to hypertension. The complex interplay between exercise, diet and comorbidities with ALS phenotype requires further investigation.
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Affiliation(s)
- Mariana Pereira
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Gromicho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Ana Henriques
- Departamento de Estatística e Investigação Operacional, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Pronto-Laborinho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | | | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hilmi Uysal
- Department of Neurology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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11
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He J, Fu JY, Chen L, He J, Dang J, Zou Z, Ma S, Li N, Fan D. Multicentre, prospective registry study of amyotrophic lateral sclerosis in mainland China (CHALSR): study protocol. BMJ Open 2020; 10:e042603. [PMID: 33277290 PMCID: PMC7722390 DOI: 10.1136/bmjopen-2020-042603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a representative rare disease characterised by progressive, fatal motor neuron degeneration. Due to the unknown aetiology and variability of the phenotypes, there are no accurate reports concerning the epidemiology or clinical characteristics of the disease. The low prevalence, as previously reported, makes it difficult to carry out studies with large samples. The aim of this study was to explore the natural history and clinical features of ALS in mainland China through a multicentre, prospective cohort study. The findings will both offer a better understanding of ALS and also support the development of a model to study other rare diseases. METHODS AND ANALYSIS Patients from 88 representative hospitals in different parts of mainland China will be recruited through a specially designed online data system (http://www.chalsr.net/). We aim to recruit 4752 ALS patients over a 3-year period. Baseline data will be recorded, and follow-up data will be collected every 3 months. The primary outcome is effective survival. Overall survival and indices of disease progression will be measured as the secondary outcomes. ETHICS AND DISSEMINATION Ethical approval has been obtained from the ethics committee of Peking University Third Hospital (M2019388). Informed written consent will be obtained from each participant. Dissemination of the study protocol and data will take place primarily through a specially designed online data system (http://www.chalsr.net/). The collective results of the study will be published in peer-reviewed journals and shared in scientific presentations. TRIAL REGISTRATION NUMBER NCT04328675.
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Affiliation(s)
- Ji He
- Neurology, Peking University Third Hospital, Beijing, China
| | - Jia Yu Fu
- Neurology, Peking University Third Hospital, Beijing, China
| | - Lu Chen
- Neurology, Peking University Third Hospital, Beijing, China
| | - Jing He
- Neurology, Beijing Hospital, Beijing, Beijing, China
| | - Jingxia Dang
- Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhangyu Zou
- Neurology, Fujian Medical University Union Hospital, Xiamen, Fujian, China
| | - Sha Ma
- Neurology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Neurology, Peking University Third Hospital, Beijing, China
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12
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Western Pacific ALS-PDC: Evidence implicating cycad genotoxins. J Neurol Sci 2020; 419:117185. [PMID: 33190068 DOI: 10.1016/j.jns.2020.117185] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
Amyotrophic Lateral Sclerosis and Parkinsonism-Dementia Complex (ALS-PDC) is a disappearing neurodegenerative disorder of apparent environmental origin formerly hyperendemic among Chamorros of Guam-USA, Japanese residents of the Kii Peninsula, Honshu Island, Japan and Auyu-Jakai linguistic groups of Papua-Indonesia on the island of New Guinea. The most plausible etiology is exposure to genotoxins in seed of neurotoxic cycad plants formerly used for food and/or medicine. Primary suspicion falls on methylazoxymethanol (MAM), the aglycone of cycasin and on the non-protein amino acid β-N-methylamino-L-alanine, both of which are metabolized to formaldehyde. Human and animal studies suggest: (a) exposures occurred early in life and sometimes during late fetal brain development, (b) clinical expression of neurodegenerative disease appeared years or decades later, and (c) pathological changes in various tissues indicate the disease was not confined to the CNS. Experimental evidence points to toxic molecular mechanisms involving DNA damage, epigenetic changes, transcriptional mutagenesis, neuronal cell-cycle reactivation and perturbation of the ubiquitin-proteasome system that led to polyproteinopathy and culminated in neuronal degeneration. Lessons learned from research on ALS-PDC include: (a) familial disease may reflect common toxic exposures across generations, (b) primary disease prevention follows cessation of exposure to culpable environmental triggers; and (c) disease latency provides a prolonged period during which to intervene therapeutically. Exposure to genotoxic chemicals ("slow toxins") in the early stages of life should be considered in the search for the etiology of ALS-PDC-related neurodegenerative disorders, including sporadic forms of ALS, progressive supranuclear palsy and Alzheimer's disease.
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13
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Quinn C, Elman L. Amyotrophic Lateral Sclerosis and Other Motor Neuron Diseases. Continuum (Minneap Minn) 2020; 26:1323-1347. [DOI: 10.1212/con.0000000000000911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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14
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Wannarong T, Ungprasert P. Diabetes mellitus is associated with a lower risk of amyotrophic lateral sclerosis: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 199:106248. [PMID: 33031990 DOI: 10.1016/j.clineuro.2020.106248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Previous studies have suggested that diabetes mellitus (DM) could be a protective factor against amyotrophic lateral sclerosis (ALS) although the results are inconsistent. This study aimed to comprehensively investigate this relationship by identifying all available studies and summarizing their results. METHODS A systematic review was conducted in MEDLINE and EMBASE database from inception to January 1st, 2020 to identify cohort studies and case-control studies that investigated the risk of development of ALS among patients with DM versus individuals without DM. Point estimates and standard errors from eligible studies were pooled together using the generic inverse variance method, as described by DerSimonian and Laird. Visualization of the funnel plot was used to assess for the presence of publication bias. RESULTS A total of 1683 articles were identified by the search strategy. After two rounds of review, three cohort studies and eight case-control studies fulfilled the inclusion criteria and were included in the meta-analysis. The risk of developing ALS was significantly lower among patients with DM than individuals without DM with the pooled relative risk of 0.68 (95 % CI, 0.55 - 0.84; I2 81 %). The funnel plot was relatively symmetric and was not suggestive of the presence of publication bias. CONCLUSION A significantly decreased risk of ALS among patients with DM was observed in this meta-analysis.
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Affiliation(s)
- Thapat Wannarong
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44118, USA
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195 USA.
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The Relationship between Selected Demographic Factors and Speech Organ Dysfunction in Sporadic ALS Patients. ACTA ACUST UNITED AC 2020; 56:medicina56080390. [PMID: 32764342 PMCID: PMC7466202 DOI: 10.3390/medicina56080390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
Background and objectives: Speech disorders are observed in 30% of newly diagnosed sporadic amyotrophic lateral sclerosis (ALS) patients. Characterized by a dynamic course, dysfunction of articulation has not so far been well understood. The aim of this study was to analyze the influence of demographic factors (sex, age, duration of the disease) and concomitant diseases (degenerative spine disease, depression, hypertension, hypothyroidism, hyperthyroidism, and allergy) on the functioning of speech organs in ALS patients. Materials and Methods: The study group consisted of 65 patients with sporadic ALS. Patients were examined for articulatory functions by means of the Frenchay Dysarthria Assessment (FDA). Results: 68% of the study sample had spinal disorders. Logistic regression analysis showed that a decline in the functioning of lips, soft palate, length of phonation, and voice loudness was more common among men. Patients diagnosed with degenerative spine disease more often suffered from respiratory disorders, while younger patients (<60 years of age) significantly more often had the impairment of the sentence and spontaneous speech functions. Conclusions: The male gender in patients with ALS is associated with an increased risk of deterioration of the phonation length function. Patients under 60 years of age are associated with more often pronouncing sentences disorders and spontaneous speech disorders.
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Juntas-Morales R, Pageot N, Marin G, Dupuy AM, Alphandery S, Labar L, Esselin F, Picot MC, Camu W. Low 25OH Vitamin D Blood Levels Are Independently Associated With Higher Amyotrophic Lateral Sclerosis Severity Scores: Results From a Prospective Study. Front Neurol 2020; 11:363. [PMID: 32547467 PMCID: PMC7272711 DOI: 10.3389/fneur.2020.00363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive degeneration of upper and lower motor neurons. Prognosis is highly variable, ranging from few months to more than 30 years. 25OH vitamin D (25OH VD) blood levels have been associated with worse prognosis of ALS, but these results remain in dispute. We addressed this controversy with a prospective study and multivariate analysis to study the influence of known clinical prognostic factors of the disease and 25OH VD levels on Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) severity score (ALS-SS), as defined by the monthly rate of decline of ALSFRS-R score, to identify the factors most closely linked to the risk of worsening of the disease. Results:This prospective cohort of ALS patients recruited 127 individuals, and 105 of them met inclusion criteria. Mean age of onset was 62.2 ± 12.1 years, 32% of subjects had bulbar onset, and gender ratio was 1.44 (male/female). Mean 25OH VD level was 26.8 ± 10.8 ng/ml and was similar between males and females. Patients with 25OH VD levels <15 ng/ml had significantly higher ALS-SS at inclusion (ALS-SSi) than those with normal levels (>30 ng/ml), p = 0.011. The study of ALS-SS as calculated at the end of follow-up (ALS-SSe) was not found correlated to initial 25OH VD levels (r = −0.19; p = 0.084). Univariate analysis showed that ALS-SSe correlated with 25OH VD levels, ALS duration at inclusion, slow vital capacity (SVC) at inclusion, and SVC loss. Multivariate model showed that 25OH VD levels were independently associated with ALS-SSe: r = −0.0125, p = 0.033. Log rank test with Kaplan–Meier curves did not show significant differences of survival between the groups defined by 25OH VD levels: <15, >15 and <30, and > 30 ng/ml, p = 0.88. Conclusions: This prospective study in ALS patients confirmed previous retrospective results: ALS-SSi is significantly higher in patients with severe VD deficiency. For the first time, multivariate analysis showed that 25OH VD level was an independent prognostic factor correlated to ALS-SSe, suggesting that discrepancies between previous works could be due to confounders. It would be important that the present work be replicated in larger samples to confirm the present findings.
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Affiliation(s)
- Raul Juntas-Morales
- Clinique du Motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | - Nicolas Pageot
- Clinique du Motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | - Gregory Marin
- Département d'Information Médicale, CHU de la Colombière, Montpellier, France
| | - Anne-Marie Dupuy
- Laboratoire de Biochimie et Hormonologie, CHU Lapeyronie, Montpellier, France
| | - Sébastien Alphandery
- Clinique du Motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | - Laura Labar
- Clinique du Motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | - Florence Esselin
- Clinique du Motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | | | - William Camu
- Clinique du Motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
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Opie-Martin S, Jones A, Iacoangeli A, Al-Khleifat A, Oumar M, Shaw PJ, Shaw CE, Morrison KE, Wootton RE, Davey-Smith G, Pearce N, Al-Chalabi A. UK case control study of smoking and risk of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:222-227. [PMID: 32301340 PMCID: PMC7261396 DOI: 10.1080/21678421.2019.1706580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Susceptibility to amyotrophic lateral sclerosis (ALS) is associated with smoking in some studies, but it is not clear which aspect of smoking behavior is related. Using detailed records of lifetime smoking we investigated the relationship between smoking and ALS in a UK population. Methods: In this retrospective case-control study, smoking status was collected using environmental questionnaires from people diagnosed with ALS between 2008 and 2013 and from age, sex and geographically matched controls. Categorical measures of smoking behavior were: smoking at the time of survey and smoking initiation; continuous measures were intensity (cigarettes per day), duration (years from starting to stopping or time of survey), cigarette pack years, and comprehensive smoking index (CSI), a measure of lifetime smoking. We used logistic regression to assess the risk of ALS with different combinations of smoking variables adjusted for age at survey, gender, level of education, smoking status and alcohol initiation, selecting the best model using the Akaike Information Criterion. Results: There were 388 records with full smoking history. The best-fitting model used CSI and smoking status at the time of survey. We found a weak association between current smoking and risk of ALS, OR 3.63 (95% CI 1.02-13.9) p value 0.05. Increase in CSI score did not increase risk of ALS: OR 0.81 (95% CI 0.58-1.11) p value 0.2.Conclusion: There is weak evidence of a positive effect of current smoking on the risk of ALS which does not show dose-dependence with higher levels of lifetime smoking and maybe a false positive result.
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Affiliation(s)
- Sarah Opie-Martin
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Ashley Jones
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Alfredo Iacoangeli
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Ahmad Al-Khleifat
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Mohamed Oumar
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Chris E Shaw
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Karen E Morrison
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Robyn E Wootton
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom.,NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - George Davey-Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, United Kingdom
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ammar Al-Chalabi
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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18
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Armon C. Smoking is a cause of amyotrophic lateral sclerosis. High low-density lipoprotein cholesterol levels? Unsure. Ann Neurol 2020; 85:465-469. [PMID: 30875450 DOI: 10.1002/ana.25468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Carmel Armon
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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19
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Juntas-Morales R, Pageot N, Bendarraz A, Alphandéry S, Sedel F, Seigle S, Camu W. High-dose pharmaceutical grade biotin (MD1003) in amyotrophic lateral sclerosis: A pilot study. EClinicalMedicine 2020; 19:100254. [PMID: 32140672 PMCID: PMC7046518 DOI: 10.1016/j.eclinm.2019.100254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oligodendrocytes (OGs) provide metabolic support to motor neurons (MNs) and are implicated in the pathophysiology of amyotrophic lateral sclerosis (ALS). MD1003, or high-dose Pharmaceutical grade Biotin (hdPB), may improve disability in progressive multiple sclerosis patients via augmentation of OG or MN energy levels. Here, we assessed the safety and efficacy of MD1003 in ALS patients. METHODS This single centre, randomised, double-blind, placebo-controlled trial included patients aged 25-80 years with probable or definite ALS. Patients were assigned (2:1), using a computer-generated randomisation list, to receive oral MD1003 (300 mg/day) or placebo treatment for 24 weeks. The primary outcome, safety, was analysed in all patients who received at least one dose of study drug. This study, registered with ClinicalTrials.gov, NCT03114215, has been completed. FINDINGS Between June and December 2016, 30 patients were enrolled (MD1003, n = 20; placebo, n = 10). Baseline characteristics were representative of the ALS population. MD1003 and placebo groups were not well balanced at screening, with the MD1003-treated group having a higher rate of ALSFRS-R decline prior to screening versus placebo (-6·0 IQR [-8·5, -5·0] vs. -5·0 IQR [-5·0, -3·0]) and a predominance of ALS with upper limb onset compared to placebo (35% vs. 10%). MD1003 had a favourable safety profile and was well tolerated. The occurrence of adverse events was similar in both groups (60%). Two deaths occurred in the MD1003 group versus 1 in the placebo group. ALSFRS-R median change from baseline to month 6 was not significantly different between the two groups (p = 0·49); the mean difference between groups was -1·6 (SEM=3·3). INTERPRETATION MD1003 treatment was safe and well tolerated. It was not possible to establish MD1003 efficacy in this relatively small study. Given the favourable safety profile of MD1003 and an imbalance between treatment groups favouring placebo, additional, larger studies in ALS are warranted. FUNDING MedDay Pharmaceuticals.
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Affiliation(s)
- Raul Juntas-Morales
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | - Nicolas Pageot
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | | | - Sébastien Alphandéry
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | | | | | - William Camu
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
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20
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Filippini T, Fiore M, Tesauro M, Malagoli C, Consonni M, Violi F, Arcolin E, Iacuzio L, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030857. [PMID: 32019087 PMCID: PMC7037077 DOI: 10.3390/ijerph17030857] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results: We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19–5.72), electric shock (OR = 2.09, 95% CI 0.62–7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73–2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88–2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12–0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions: Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk.
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Affiliation(s)
- Tommaso Filippini
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Carlotta Malagoli
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Federica Violi
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Elisa Arcolin
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
| | - Laura Iacuzio
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Department of Public Health, Local Health Unit, 41121 Modena, Italy
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Antonio Cristaldi
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Elisabetta Zucchi
- Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Letizia Mazzini
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Fabrizio Pisano
- Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy;
| | - Ileana Gagliardi
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marco Vinceti
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Correspondence:
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21
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Peters S, Visser AE, D'Ovidio F, Vlaanderen J, Portengen L, Beghi E, Chio A, Logroscino G, Hardiman O, Pupillo E, Veldink JH, Vermeulen R, van den Berg LH. Effect modification of the association between total cigarette smoking and ALS risk by intensity, duration and time-since-quitting: Euro-MOTOR. J Neurol Neurosurg Psychiatry 2020; 91:33-39. [PMID: 31434759 DOI: 10.1136/jnnp-2019-320986] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 08/05/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the association between cigarette smoking and risk of amyotrophic lateral sclerosis (ALS) in a pooled analysis of population-based case-control studies and explored the independent effects of intensity, duration and time-since-quitting. METHODS ALS cases and controls, matched by age, sex and region, were recruited in the Netherlands, Italy and Ireland (*Euro-MOTOR project). Demographics and detailed lifetime smoking histories were collected through questionnaires. Effects of smoking status, intensity (cigarettes/day), duration (years), pack-years and time-since-quitting (years) on ALS risk were estimated using logistic regression models, adjusting for age, sex, alcohol, education and centre. We further investigated effect modification of the linear effects of pack-years by intensity, duration and time-since-quitting using excess OR (eOR) models. RESULTS Analyses were performed on 1410 cases and 2616 controls. Pack-years were positively associated with ALS risk; OR=1.26 (95% CI: 1.03 to 1.54) for the highest quartile compared with never smokers. This association appeared to be predominantly driven by smoking duration (ptrend=0.001) rather than intensity (ptrend=0.86), although the trend for duration disappeared after adjustment for time-since-quitting. Time-since-quitting was inversely related to ALS (ptrend<0.0001). The eOR decreased with time-since-quitting smoking, until about 10 years prior to disease onset. High intensity smoking with shorter duration appeared more deleterious than lower intensity for a longer duration. CONCLUSIONS Our findings provide further support for the association between smoking and ALS. Pack-years alone may be insufficient to capture effects of different smoking patterns. Time-since-quitting appeared to be an important factor, suggesting that smoking may be an early disease trigger.
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Affiliation(s)
- Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands .,Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne E Visser
- Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fabrizio D'Ovidio
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Torino, Italy
| | - Jelle Vlaanderen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ettore Beghi
- Department of Neuroscience, Istituto Mario Negri, Milan, Italy
| | - Adriano Chio
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Torino, Italy
| | - Giancarlo Logroscino
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | | | - Jan H Veldink
- Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.,University Medical Centre Utrecht, Julius Centre for Public Health Sciences and Primary Care, Utrecht, The Netherlands
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Kacem I, Sghaier I, Bougatef S, Nasri A, Gargouri A, Ajroud-Driss S, Gouider R. Epidemiological and clinical features of amyotrophic lateral sclerosis in a Tunisian cohort. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:131-139. [DOI: 10.1080/21678421.2019.1704012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Imen Kacem
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | - Ikram Sghaier
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
| | - Sabrine Bougatef
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | - Amina Nasri
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | - Amina Gargouri
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | | | - Riadh Gouider
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
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Lian L, Liu M, Cui L, Guan Y, Liu T, Cui B, Zhang K, Tai H, Shen D. Environmental risk factors and amyotrophic lateral sclerosis (ALS): A case-control study of ALS in China. J Clin Neurosci 2019; 66:12-18. [DOI: 10.1016/j.jocn.2019.05.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 01/08/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
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Affiliation(s)
- Carmel Armon
- From the Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine; Shamir (Assaf Harofeh) Medical Center (C.A.), Israel; Neuromuscular Diseases Research Section (B.J.T.), Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda; and Neurology Department (B.J.T.), Johns Hopkins University, Baltimore, MD.
| | - Bryan J Traynor
- From the Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine; Shamir (Assaf Harofeh) Medical Center (C.A.), Israel; Neuromuscular Diseases Research Section (B.J.T.), Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda; and Neurology Department (B.J.T.), Johns Hopkins University, Baltimore, MD
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Bandres-Ciga S, Noyce AJ, Hemani G, Nicolas A, Calvo A, Mora G, Tienari PJ, Stone DJ, Nalls MA, Singleton AB, Chiò A, Traynor BJ. Shared polygenic risk and causal inferences in amyotrophic lateral sclerosis. Ann Neurol 2019; 85:470-481. [PMID: 30723964 PMCID: PMC6450729 DOI: 10.1002/ana.25431] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify shared polygenic risk and causal associations in amyotrophic lateral sclerosis (ALS). METHODS Linkage disequilibrium score regression and Mendelian randomization were applied in a large-scale, data-driven manner to explore genetic correlations and causal relationships between >700 phenotypic traits and ALS. Exposures consisted of publicly available genome-wide association studies (GWASes) summary statistics from MR Base and LD-hub. The outcome data came from the recently published ALS GWAS involving 20,806 cases and 59,804 controls. Multivariate analyses, genetic risk profiling, and Bayesian colocalization analyses were also performed. RESULTS We have shown, by linkage disequilibrium score regression, that ALS shares polygenic risk genetic factors with a number of traits and conditions, including positive correlations with smoking status and moderate levels of physical activity, and negative correlations with higher cognitive performance, higher educational attainment, and light levels of physical activity. Using Mendelian randomization, we found evidence that hyperlipidemia is a causal risk factor for ALS and localized putative functional signals within loci of interest. INTERPRETATION Here, we have developed a public resource (https://lng-nia.shinyapps.io/mrshiny) which we hope will become a valuable tool for the ALS community, and that will be expanded and updated as new data become available. Shared polygenic risk exists between ALS and educational attainment, physical activity, smoking, and tenseness/restlessness. We also found evidence that elevated low-desnity lipoprotein cholesterol is a causal risk factor for ALS. Future randomized controlled trials should be considered as a proof of causality. Ann Neurol 2019;85:470-481.
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Affiliation(s)
- Sara Bandres-Ciga
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.,Department of Clinical and Movement Neurosciences, University College London, Institute of Neurology, London, United Kingdom
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Aude Nicolas
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri, IRCCS, Milan, Italy
| | | | | | - Pentti J Tienari
- Department of Neurology, Helsinki University Hospital and Molecular Neurology Programme, Biomedicum, University of Helsinki, Helsinki, Finland
| | - David J Stone
- Genetics and Pharmacogenomics, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Mike A Nalls
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD.,Data Tecnica International, Glen Echo, MD
| | - Andrew B Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Institute of Cognitive Sciences and Technologies, C.N.R, Rome, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD.,Department of Neurology, Johns Hopkins University, Baltimore, MD
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Myung W, Lee H, Kim H. Short-term air pollution exposure and emergency department visits for amyotrophic lateral sclerosis: A time-stratified case-crossover analysis. ENVIRONMENT INTERNATIONAL 2019; 123:467-475. [PMID: 30622072 DOI: 10.1016/j.envint.2018.12.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive and devastating neurodegenerative disease, eventually leading to respiratory failure. Although the only currently available therapeutic interventions merely slow the disease progression, few studies have examined risk factors associated with ALS exacerbation and progression. OBJECTIVE To investigate the association between exposure to short-term air pollution and acute exacerbation of ALS requiring emergency department (ED) visit. METHODS We identified from the national emergency database of Korea 617 patients who visited EDs in Seoul with ALS as a primary cause during the period 2008-2014. We estimated short-term exposure to particles <2.5 μm (PM2.5), particles <10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO). We conducted a conditional logistic regression with a time-stratified case-crossover design to examine the association between ED visits for ALS and short-term exposure to interquartile range (IQR) increase and upper quartile levels of air pollutants on the day of the ED visit, compared to the control days matched to day of the week, month, and year. RESULTS The risk of ED visits for ALS was significantly associated with an IQR increase of PM2.5 [Odds ratio (OR) = 1.21; 95% confidence interval (CI): 1.08, 1.35], PM10 [OR = 1.13; 95% CI: 1.02, 1.25], SO2 [OR = 1.19; 95% CI: 1.01, 1.41], and CO [OR = 1.19; 95% CI: 1.03, 1.36]. Exposure to the highest quartiles of PM2.5 and PM10 showed higher associations with ED visits for ALS [OR = 1.40; 95% CI: 1.06, 1.85 and OR = 1.33; 95% CI: 1.00, 1.77]. DISCUSSION We provide new evidence that exposure to short-term air pollution may increase the risk of acute exacerbation of ALS. Further studies are warranted to understand the underlying mechanisms.
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Affiliation(s)
- Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyewon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea; Institute of Health and Environment, Seoul National University, Seoul, South Korea.
| | - Ho Kim
- Institute of Health and Environment, Seoul National University, Seoul, South Korea; Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
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Tang L, Ma Y, Liu XL, Chen L, Fan DS. Better survival in female SOD1-mutant patients with ALS: a study of SOD1-related natural history. Transl Neurodegener 2019; 8:2. [PMID: 30637102 PMCID: PMC6325854 DOI: 10.1186/s40035-018-0142-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022] Open
Abstract
Background SOD1 mutations are the most common cause of amyotrophic lateral sclerosis (ALS) in non-Caucasian patients. Detailed natural history profiles of SOD1-mutant patients will be beneficial for the strategy and interpretation of future SOD1-targeted clinical practice. Methods Mutational distribution, age at onset (AAO), site of onset, diagnostic delay, disease progression (rate of ALSFRS-R decrease, ΔFS) and survival were analysed. Further comparisons between heredity of disease, gender, and mutations were performed. Results Sixty-six cases with 43 SOD1 mutations were included and analysed, with p.His47Arg as the leading mutation and seven novel variants identified. The mean (SD) AAO was 43.92 years (9.24) for all subjects, with a significant difference between patients carrying mutations in exon 2 (n = 24,46.83, 8.31) and exon 4 (n = 18, 37.75, 7.67) (p = 0.002). The median (IQR) diagnostic delay from symptom onset was 14.50 (6.00–36.50) months for all SOD1-mutant patients, 9.50 (4.75–24.25) months for males and 24.00 (9.50–47.50) months for females, revealing a gender difference (p = 0.009). Similar advantages in median (IQR) ΔFS [male: female, 0.55 (0.24–0.94) vs 0.19 (0.06–0.90), p = 0.041] and mean (95% CI) survival [57.4 (38.90–75.90) months vs 125.6 (99.80–151.50) months, p = 0.006] were also observed in females, both of which existed in sporadic ALS only when stratified by familiar or sporadic ALS. Conclusions The results highlight a distinct mutational distribution and natural history spectrum in ALS patients carrying SOD1 mutations in China. A prominent mild disease progression was observed in female patients, which had rarely been reported in the previous literature. This finding, together with the detailed analysis of natural history among each mutation, can have important implications for future genetic counselling and SOD1-targeted clinical trials.
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Affiliation(s)
- Lu Tang
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People's Republic of China
| | - Yan Ma
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People's Republic of China
| | - Xiao-Lu Liu
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People's Republic of China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People's Republic of China
| | - Dong-Sheng Fan
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People's Republic of China
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Theme 5 Epidemiology and informatics. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:178-197. [DOI: 10.1080/21678421.2018.1510572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Parkin Kullmann JA, Hayes S, Pamphlett R. Are people with amyotrophic lateral sclerosis (ALS) particularly nice? An international online case-control study of the Big Five personality factors. Brain Behav 2018; 8:e01119. [PMID: 30239176 PMCID: PMC6192405 DOI: 10.1002/brb3.1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/01/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many people with ALS have been suggested to have a "nice" personality, but most ALS personality studies to date have had limited numbers of participants and have not taken into account personality differences between genders. We used Big Five Inventory data obtained from an online questionnaire looking for risk factors for ALS to investigate personality traits in large numbers of people with ALS and controls. METHODS A total of 741 questionnaire respondents aged 40 years and over indicated the extent to which they agreed with each of the 44 Big Five Inventory statements. Respondents were 339 with ALS (212 male, 127 female) who responded to the statements as they applied to them before their diagnosis and 402 controls (120 male, 282 female). Unpaired t tests with 95% confidence intervals were used to compare mean values of Big Five-factor scores. RESULTS Female respondents taken together had higher mean scores for Agreeableness and Neuroticism than all male respondents. Male ALS respondents had higher mean scores than male controls for Conscientiousness and Extraversion. Female ALS respondents had higher mean scores than female controls for Agreeableness, Conscientiousness, and Extraversion, and a lower score for Neuroticism. CONCLUSIONS Many people with ALS have personality traits that are likely to underlie the perception they are particularly "nice." This raises the possibility that genetic polymorphisms that influence personality could play a role in ALS. Furthermore, different personality traits could underlie lifestyle choices that are currently thought to be risk factors for ALS.
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Affiliation(s)
- Jane A Parkin Kullmann
- The Stacey Motor Neuron Disease Laboratory, Discipline of Pathology, The University of Sydney, Sydney, New South Wales, Australia
| | - Susan Hayes
- Forensic Psychology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Roger Pamphlett
- The Stacey Motor Neuron Disease Laboratory, Discipline of Pathology, The University of Sydney, Sydney, New South Wales, Australia.,Department of Neuropathology, Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia
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Pamphlett R, Bishop DP, Kum Jew S, Doble PA. Age-related accumulation of toxic metals in the human locus ceruleus. PLoS One 2018; 13:e0203627. [PMID: 30231068 PMCID: PMC6145836 DOI: 10.1371/journal.pone.0203627] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/23/2018] [Indexed: 12/28/2022] Open
Abstract
Damage to the locus ceruleus has been implicated in the pathogenesis of a number of neurological conditions. Locus ceruleus neurons accumulate toxic metals such as mercury selectively, however, the presence of toxic metals in locus ceruleus neurons of people of different ages, and with a variety of disorders, is not known. To demonstrate at what age toxic metals are first detectable in the locus ceruleus, and to evaluate whether their presence is more common in certain clinicopathological conditions, we looked for these metals in 228 locus ceruleus samples. Samples were taken at coronial autopsies from individuals with a wide range of ages, pre-existing conditions and causes of death. Paraffin sections of pons containing the locus ceruleus were stained with silver nitrate autometallography, which indicates inorganic mercury, silver and bismuth within cells (termed autometallography-detected toxic metals, or AMG™). No locus ceruleus AMG neurons were seen in 38 individuals aged under 20 years. 47% of the 190 adults (ie, aged 20 years and over) had AMG locus ceruleus neurons. The proportion of adults with locus ceruleus AMG neurons increased during aging, except for a decreased proportion in the 90-plus years age group. No differences were found in the proportions of locus ceruleus AMG neurons between groups with different neurological, psychiatric, or other clinicopathological conditions, or among various causes of death. Elemental analysis with laser ablation-inductively coupled plasma-mass spectrometry was used to cross-validate the metals detected by AMG, by looking for silver, gold, bismuth, cadmium, chromium, iron, mercury, nickel, and lead in the locus ceruleus of ten individuals. This confirmed the presence of mercury in locus ceruleus samples containing AMG neurons, and showed cadmium, silver, lead, iron, and nickel in the locus ceruleus of some individuals. In conclusion, toxic metals stained by AMG (most likely inorganic mercury) appear in locus ceruleus neurons in early adult life. About half of adults in this study had locus ceruleus neurons containing inorganic mercury, and elemental analysis found a range of other toxic metals in the locus ceruleus. Locus ceruleus inorganic mercury increased during aging, except for a decrease in advanced age, but was not found more often in any single clinicopathological condition or cause of death.
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Affiliation(s)
- Roger Pamphlett
- Discipline of Pathology, Sydney Medical School, Brain and Mind Centre, The University of Sydney, New South Wales, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David P. Bishop
- Elemental Bio-imaging Facility, University of Technology, Sydney, New South Wales, Australia
| | - Stephen Kum Jew
- Discipline of Pathology, Sydney Medical School, Brain and Mind Centre, The University of Sydney, New South Wales, Australia
| | - Philip A. Doble
- Elemental Bio-imaging Facility, University of Technology, Sydney, New South Wales, Australia
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Armon C. From Snow to Hill to ALS: An epidemiological odyssey in search of ALS causation. J Neurol Sci 2018; 391:134-140. [DOI: 10.1016/j.jns.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/19/2018] [Accepted: 05/19/2018] [Indexed: 12/11/2022]
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Chiò A, Mazzini L, D'Alfonso S, Corrado L, Canosa A, Moglia C, Manera U, Bersano E, Brunetti M, Barberis M, Veldink JH, van den Berg LH, Pearce N, Sproviero W, McLaughlin R, Vajda A, Hardiman O, Rooney J, Mora G, Calvo A, Al-Chalabi A. The multistep hypothesis of ALS revisited: The role of genetic mutations. Neurology 2018; 91:e635-e642. [PMID: 30045958 PMCID: PMC6105040 DOI: 10.1212/wnl.0000000000005996] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 05/16/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) incidence rates are consistent with the hypothesis that ALS is a multistep process. We tested the hypothesis that carrying a large effect mutation might account for ≥1 steps through the effect of the mutation, thus leaving fewer remaining steps before ALS begins. METHODS We generated incidence data from an ALS population register in Italy (2007-2015) for which genetic analysis for C9orf72, SOD1, TARDBP, and FUS genes was performed in 82% of incident cases. As confirmation, we used data from ALS cases diagnosed in the Republic of Ireland (2006-2014). We regressed the log of age-specific incidence against the log of age with least-squares regression for the subpopulation carrying disease-associated variation in each separate gene. RESULTS Of the 1,077 genetically tested cases, 74 (6.9%) carried C9orf72 mutations, 20 (1.9%) had SOD1 mutations, 15 (1.4%) had TARDBP mutations, and 3 (0.3%) carried FUS mutations. In the whole population, there was a linear relationship between log incidence and log age (r2 = 0.98) with a slope estimate of 4.65 (4.37-4.95), consistent with a 6-step process. The analysis for C9orf72-mutated patients confirmed a linear relationship (r2 = 0.94) with a slope estimate of 2.22 (1.74-2.29), suggesting a 3-step process. This estimate was confirmed by data from the Irish ALS register. The slope estimate was consistent with a 2-step process for SOD1 and with a 4-step process for TARDBP. CONCLUSION The identification of a reduced number of steps in patients with ALS with genetic mutations compared to those without mutations supports the idea of ALS as a multistep process and is an important advance for dissecting the pathogenic process in ALS.
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Affiliation(s)
- Adriano Chiò
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK.
| | - Letizia Mazzini
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Sandra D'Alfonso
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Lucia Corrado
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Antonio Canosa
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Cristina Moglia
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Umberto Manera
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Enrica Bersano
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Maura Brunetti
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Marco Barberis
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Jan H Veldink
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Leonard H van den Berg
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Neil Pearce
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - William Sproviero
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Russell McLaughlin
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Alice Vajda
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Orla Hardiman
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - James Rooney
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Gabriele Mora
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Andrea Calvo
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Ammar Al-Chalabi
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
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Seltenrich N. Another Potential Risk Factor for ALS: Exposure to Traffic-Related Air Pollutants. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:024004. [PMID: 29483062 PMCID: PMC6066352 DOI: 10.1289/ehp2882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 06/08/2023]
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Hamzeiy H, Savaş D, Tunca C, Şen NE, Gündoğdu Eken A, Şahbaz I, Calini D, Tiloca C, Ticozzi N, Ratti A, Silani V, Başak AN. Elevated Global DNA Methylation Is Not Exclusive to Amyotrophic Lateral Sclerosis and Is Also Observed in Spinocerebellar Ataxia Types 1 and 2. NEURODEGENER DIS 2018; 18:38-48. [PMID: 29428949 DOI: 10.1159/000486201] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022] Open
Abstract
Adult-onset neurological disorders are caused and influenced by a multitude of different factors, including epigenetic modifications. Here, using an ELISA kit selected upon careful testing, we investigated global 5-methylcytosine (5-mC) levels in sporadic and familial amyotrophic lateral sclerosis (sALS and fALS), spinocerebellar ataxia types 1 and 2 (SCA1 and SCA2), Huntington's disease, Friedreich's ataxia, and myotonic dystrophy type 1. We report a significant elevation in global 5-mC levels of about 2-7% on average for sALS (p < 0.01 [F(1, 243) = 9.159, p = 0.0027]) and various forms of fALS along with SCA1 (p < 0.01 [F(1, 83) = 11.285], p = 0.0012) and SCA2 (p < 0.001 [F(1, 122) = 29.996, p = 0.0001]) when compared to age- and sex-matched healthy controls. C9orf72 expansion carrier ALS patients exhibit the highest global 5-mC levels along with C9orf72 promoter hypermethylation. We failed to measure global 5-hydroxymethylcytosine (5-hmC) levels in blood, probably due to the very low levels of 5-hmC and the limitations of the commercially available ELISA kits. Our results point towards a role for epigenetics modification in ALS, SCA1, and SCA2, and help conclude a dispute on the global 5-mC levels in sALS blood.
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Affiliation(s)
- Hamid Hamzeiy
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
| | - Doruk Savaş
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
| | - Ceren Tunca
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
| | - Nesli Ece Şen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
| | - Aslı Gündoğdu Eken
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
| | - Irmak Şahbaz
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
| | - Daniela Calini
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Cinzia Tiloca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - A Nazlı Başak
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Molecular Biology and Genetics Department, Boğaziçi University, Istanbul, Turkey
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Battaglia G, Bruno V. Metabotropic glutamate receptor involvement in the pathophysiology of amyotrophic lateral sclerosis: new potential drug targets for therapeutic applications. Curr Opin Pharmacol 2018. [DOI: 10.1016/j.coph.2018.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Åberg M, Nyberg J, Robertson J, Kuhn G, Schiöler L, Nissbrandt H, Waern M, Torén K. Risk factors in Swedish young men for amyotrophic lateral sclerosis in adulthood. J Neurol 2017; 265:460-470. [PMID: 29285652 PMCID: PMC5834569 DOI: 10.1007/s00415-017-8719-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
Recent research suggests that the incidence of amyotrophic lateral sclerosis (ALS) may be on the rise. Since ALS becomes predominant in later life, most studies on causal factors are conducted in middle-aged or older populations where potentially important influences from early life can usually not be adequately captured. We aimed to investigate predictors in young Swedish men for ALS in adulthood. Therefore, we performed a prospective cohort study of young men (aged 16-25, n = 1,819,817) who enlisted 1968-2005 and took part in comprehensive conscription examinations. Incident cases of ALS (n = 526) during up to 46 years of follow-up were identified in the National Hospital Register and Swedish Cause of Death Register. Those who developed ALS had lower BMI (body mass index) at conscription than their peers (p = 0.03). The risk of ALS during follow-up was calculated with Cox proportional hazards models. No associations were found with physical fitness, erythrocyte sedimentation rate, or non-psychotic mental disorders. Low overall muscle strength compared to high overall muscle strength [hazard ratio (HR) 1.36; 95% confidence interval (CI) 1.01-1.83] and low BMI (a one-unit increase HR 0.96; 95% CI 0.93-0.99) and lower erythrocyte volume fraction (a one-unit increase HR 0.96; 95% CI 0.92-0.998) were the statistically significant predictors for ALS in adjusted models. These findings provide novel epidemiologic evidence of a prospective association between low overall muscle strength and erythrocyte volume fraction in young men and ALS risk.
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Affiliation(s)
- Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, 405 30, Gothenburg, Sweden.
| | - Jenny Nyberg
- Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, 405 30, Gothenburg, Sweden
| | - Georg Kuhn
- Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Nissbrandt
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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van Es MA, Hardiman O, Chio A, Al-Chalabi A, Pasterkamp RJ, Veldink JH, van den Berg LH. Amyotrophic lateral sclerosis. Lancet 2017; 390:2084-2098. [PMID: 28552366 DOI: 10.1016/s0140-6736(17)31287-4] [Citation(s) in RCA: 774] [Impact Index Per Article: 110.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis is characterised by the progressive loss of motor neurons in the brain and spinal cord. This neurodegenerative syndrome shares pathobiological features with frontotemporal dementia and, indeed, many patients show features of both diseases. Many different genes and pathophysiological processes contribute to the disease, and it will be necessary to understand this heterogeneity to find effective treatments. In this Seminar, we discuss clinical and diagnostic approaches as well as scientific advances in the research fields of genetics, disease modelling, biomarkers, and therapeutic strategies.
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Affiliation(s)
- Michael A van Es
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Beaumont, Ireland
| | - Adriano Chio
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK; NIHR Dementia Biomedical Research Unit, King's College London, London, UK
| | - R Jeroen Pasterkamp
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
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D'Ovidio F, d'Errico A, Carnà P, Calvo A, Costa G, Chiò A. The role of pre-morbid diabetes on developing amyotrophic lateral sclerosis. Eur J Neurol 2017; 25:164-170. [PMID: 28921834 DOI: 10.1111/ene.13465] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The literature on the association between diabetes and amyotrophic lateral sclerosis (ALS) consists of a limited number of studies. This cohort study was developed in order to assess the role of diabetes on the risk of developing ALS. METHODS The study population was represented by all residents in Turin (Italy) at the beginning of 1996 who participated in the 1991 census, over 14 years of age (n = 727 977) and followed up for ALS occurrence from 1998 to 2014. Presence of diabetes at baseline or during follow-up was ascertained through two Piedmont regional sources: the Diabetes Registry and the Anatomical Therapeutic Chemical Drug Prescription Archive. The risk of ALS was estimated using the Piedmont and Valle d'Aosta ALS Registry (PARALS). The association of diabetes, treated as a time-dependent variable, with ALS onset was estimated through Cox proportional hazard regression models adjusted for age, gender, education and marital status. RESULTS During follow-up, 397 subjects developed ALS, 24 of whom were already diabetic before ALS onset. Diabetes was associated with a significantly decreased risk of ALS [hazard ratio, 0.30 (95% confidence interval, 0.19-0.45)] without differences in risk by gender, age class or ALS phenotype. CONCLUSION The results support the protective role of diabetes toward ALS.
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Affiliation(s)
- F D'Ovidio
- 'Rita Levi Montalcini' Department of Neurosciences, University of Turin, Turin
| | - A d'Errico
- Epidemiology Department ASL TO3 - Piedmont Region, Grugliasco, Turin, Italy
| | - P Carnà
- Epidemiology Department ASL TO3 - Piedmont Region, Grugliasco, Turin, Italy
| | - A Calvo
- 'Rita Levi Montalcini' Department of Neurosciences, University of Turin, Turin
| | - G Costa
- Epidemiology Department ASL TO3 - Piedmont Region, Grugliasco, Turin, Italy
| | - A Chiò
- 'Rita Levi Montalcini' Department of Neurosciences, University of Turin, Turin
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Torbick N, Ziniti B, Stommel E, Linder E, Andrew A, Caller T, Haney J, Bradley W, Henegan PL, Shi X. Assessing Cyanobacterial Harmful Algal Blooms as Risk Factors for Amyotrophic Lateral Sclerosis. Neurotox Res 2017; 33:199-212. [PMID: 28470570 PMCID: PMC5727154 DOI: 10.1007/s12640-017-9740-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/16/2017] [Accepted: 04/21/2017] [Indexed: 12/14/2022]
Abstract
Reoccurring seasonal cyanobacterial harmful algal blooms (CHABs) persist in many waters, and recent work has shown links between CHAB and elevated risk of amyotrophic lateral sclerosis (ALS). Quantifying the exposure levels of CHAB as a potential risk factor for ALS is complicated by human mobility, potential pathways, and data availability. In this work, we develop phycocyanin concentration (i.e., CHAB exposure) maps using satellite remote sensing across northern New England to assess relationships with ALS cases using a spatial epidemiological approach. Strategic semi-analytical regression models integrated Landsat and in situ observations to map phycocyanin concentration (PC) for all lakes greater than 8 ha (n = 4117) across the region. Then, systematic versions of a Bayesian Poisson Log-linear model were fit to assess the mapped PC as a risk factor for ALS while accounting for model uncertainty and modifiable area unit problems. The satellite remote sensing of PC had strong overall ability to map conditions (adj. R2, 0.86; RMSE, 11.92) and spatial variability across the region. PC tended to be positively associated with ALS risk with the level of significance depending on fixed model components. Meta-analysis shows that when average PC exposure is 100 μg/L, an all model average odds ratio is 1.48, meaning there is about a 48% increase in average ALS risk. This research generated the first regionally comprehensive map of PC for thousands of lakes and integrated robust spatial uncertainty. The outcomes support the hypothesis that cyanotoxins increase the risk of ALS, which helps our understanding of the etiology of ALS.
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Affiliation(s)
- Nathan Torbick
- Applied Geosolutions, 55 Main St, Suite 125, Newmarket, NH, 03857, USA. .,Department of Neurology, Dartmouth College, Hanover, NH, USA.
| | - Beth Ziniti
- Applied Geosolutions, 55 Main St, Suite 125, Newmarket, NH, 03857, USA
| | - Elijah Stommel
- Department of Neurology, Dartmouth College, Hanover, NH, USA
| | - Ernst Linder
- Department of Mathematics and Statistics, University of New Hampshire, Durham, NH, USA
| | | | - Tracie Caller
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jim Haney
- Department of Biological Sciences, University of New Hampshire, Durham, NH, USA
| | - Walter Bradley
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Xun Shi
- Department of Geography, Dartmouth College, Hanover, NH, USA
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Seelen M, Toro Campos RA, Veldink JH, Visser AE, Hoek G, Brunekreef B, van der Kooi AJ, de Visser M, Raaphorst J, van den Berg LH, Vermeulen RCH. Long-Term Air Pollution Exposure and Amyotrophic Lateral Sclerosis in Netherlands: A Population-based Case-control Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:097023. [PMID: 29989551 PMCID: PMC5915195 DOI: 10.1289/ehp1115] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 05/11/2023]
Abstract
BACKGROUND Recently, there has been increasing evidence that exposure to air pollution is linked to neurodegenerative diseases, but little is known about the association with amyotrophic lateral sclerosis (ALS). OBJECTIVES We investigated the association between long-term exposure to air pollution and risk of developing ALS. METHODS A population-based case-control study was conducted in Netherlands from 1 January 2006 to 1 January 2013. Data from 917 ALS patients and 2,662 controls were analyzed. Annual mean air pollution concentrations were assessed by land use regression (LUR) models developed as part of the European Study of Cohorts for Air Pollution Effects (ESCAPE). Exposure estimates included nitrogen oxides (NO2, NOx), particulate matter (PM) with diameters of <2.5 μm (PM2.5), <10 μm (PM10), between 10 μm and 2.5 μm (PMcoarse), and PM2.5 absorbance. We performed conditional logistic regression analysis using two different multivariate models (model 1 adjusted for age, gender, education, smoking status, alcohol use, body mass index, and socioeconomic status; model 2 additionally adjusted for urbanization degree). RESULTS Risk of ALS was significantly increased for individuals in the upper exposure quartile of PM2.5 absorbance [OR=1.67; 95% confidence interval (CI): 1.27, 2.18], NO2 (OR=1.74; 95% CI: 1.32, 2.30), and NOx concentrations (OR=1.38; 95% CI: 1.07, 1.77). These results, except for NOx, remained significant after adjusting additionally for urbanization degree. CONCLUSIONS Based on a large population-based case-control study, we report evidence for the association between long-term exposure to traffic-related air pollution and increased susceptibility to ALS. Our findings further support the necessity for regulatory public health interventions to combat air pollution levels and provide additional insight into the potential pathophysiology of ALS. https://doi.org/10.1289/EHP1115.
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Affiliation(s)
- Meinie Seelen
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rosario A Toro Campos
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anne E Visser
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerard Hoek
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Bert Brunekreef
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Center for Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roel C H Vermeulen
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Wang MD, Little J, Gomes J, Cashman NR, Krewski D. Identification of risk factors associated with onset and progression of amyotrophic lateral sclerosis using systematic review and meta-analysis. Neurotoxicology 2017; 61:101-130. [DOI: 10.1016/j.neuro.2016.06.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
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Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterised by a rapid loss of lower and upper motor neurons. As a complex disease, the ageing process and complicated gene-environment interactions are involved in the majority of cases. Main body Significant advances have been made in unravelling the genetic susceptibility to ALS with massively parallel sequencing technologies, while environmental insults remain a suspected but largely unexplored source of risk. Several studies applying the strategy of Mendelian randomisation have strengthened the link between environmental insults and ALS, but none so far has proved conclusive. We propose a new ALS model which links the current knowledge of genetic factors, ageing and environmental insults. This model provides a mechanism as to how ALS is initiated, with environmental insults playing a critical role. Conclusion The available evidence has suggested that inherited defect(s) could cause mitochondrial dysfunction, which would establish the primary susceptibility to ALS. Further study of the underlying mechanism may shed light on ALS pathogenesis. Environmental insults are a critical trigger for ALS, particularly in the aged individuals with other toxicant susceptible genes. The identification of ALS triggers could lead to preventive strategies for those individuals at risk.
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Affiliation(s)
- Bing Yu
- Sydney Medical School (Central), The University of Sydney, Camperdown, NSW 2006 Australia.,Department of Medical Genomics, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, NSW 2050 Australia
| | - Roger Pamphlett
- Discipline of Pathology, Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050 Australia.,Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
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Abstract
Neuromuscular disorders as a group are linked by anatomy with significant differences in pathogenetic mechanisms, clinical expression, and time course of disease. Each neuromuscular disease is relatively uncommon, yet causes a significant burden of disease socioeconomically. Epidemiologic studies in different global regions have demonstrated certain neuromuscular diseases have increased incidence and prevalence rates over time. Understanding differences in global epidemiologic trends will aid clinical research and policies focused on prevention of disease. There is a critical need to understand the global impact of neuromuscular diseases using metrics currently established for communicable and noncommunicable diseases.
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Affiliation(s)
- Jaydeep M Bhatt
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.
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Michaelson N, Facciponte D, Bradley W, Stommel E. Cytokine expression levels in ALS: A potential link between inflammation and BMAA-triggered protein misfolding. Cytokine Growth Factor Rev 2017; 37:81-88. [PMID: 28532674 DOI: 10.1016/j.cytogfr.2017.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 01/13/2023]
Abstract
Recently, it has been shown that proinflammatory cytokines play a complex and important role in the pathogenesis of many neurological disorders, including amyotrophic lateral sclerosis (ALS). To help facilitate future discoveries and more effective treatment strategies, we highlight the role that both innate and adaptive immune systems play in ALS and summarize the main observations that relate to cytokine expression levels in this disease. Furthermore, we propose a mechanism by which a known neurotoxin, β-N-methylamino-l-alanine (BMAA), may trigger this cytokine expression profile through motor neuron protein misfolding and subsequent NLRP3 (nucleotide-binding domain (NOD)-like receptor protein 3) inflammasome activation.
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Affiliation(s)
- Nara Michaelson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | | | - Walter Bradley
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elijah Stommel
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Luna J, Logroscino G, Couratier P, Marin B. Current issues in ALS epidemiology: Variation of ALS occurrence between populations and physical activity as a risk factor. Rev Neurol (Paris) 2017; 173:244-253. [DOI: 10.1016/j.neurol.2017.03.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022]
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Timmins HC, Saw W, Cheah BC, Lin CSY, Vucic S, Ahmed RM, Kiernan MC, Park SB. Cardiometabolic health and risk of amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:721-725. [PMID: 28029705 DOI: 10.1002/mus.25547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/14/2016] [Accepted: 12/26/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Patients diagnosed with amyotrophic lateral sclerosis (ALS) generally have a limited medical history and a normal body mass index, raising the possibility of a premorbid ALS phenotype. METHODS The prevalence of cardiometabolic factors was analyzed in 58 ALS patients via comprehensive cardiovascular assessments and compared with Australian population norms. RESULTS ALS patients had good cardiac fitness and no reported cardiovascular events. Average blood pressure, heart rate, PR interval, and corrected QT interval were in the normal range. There were significantly fewer obese women in the ALS cohort (13.6%, P < 0.05) and more men with a normal body mass index than in the general population (47.2%, P < 0.001). The percentage of individuals who had never smoked was greater for the ALS cohort (55.8%, P ≤ 0.001), and the prevalence of dyslipidemia was lower (38.7%) compared with the general population (74.4%, P < 0.001). CONCLUSION ALS patients had good cardiometabolic health, with evidence of a reduced vascular risk profile. Muscle Nerve 56: 721-725, 2017.
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Affiliation(s)
- Hannah C Timmins
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Wilfred Saw
- Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Benjamin C Cheah
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Cindy S Y Lin
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Steve Vucic
- Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
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D’Ovidio F, d’Errico A, Calvo A, Costa G, Chiò A. Occupations and amyotrophic lateral sclerosis: are jobs exposed to the general public at higher risk? Eur J Public Health 2017; 27:643-647. [DOI: 10.1093/eurpub/ckx006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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D’Ovidio F, Rooney JPK, Visser AE, Vermeulen RCH, Veldink JH, Van Den Berg LH, Hardiman O, Logroscino G, Chiò A, Beghi E. Critical issues in ALS case-control studies: the case of the Euro-MOTOR study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:411-418. [DOI: 10.1080/21678421.2017.1285939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Fabrizio D’Ovidio
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy,
| | - James P. K. Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland,
| | - Anne E. Visser
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Roel C. H. Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands,
| | - Jan H. Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Leonard H. Van Den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland,
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy, and
| | - Adriano Chiò
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy,
| | - Ettore Beghi
- Neurological Diseases Laboratory, Department of Neurosciences, IRCCS Mario Negri, Milano, Italy
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Jimenez-Pacheco A, Franco JM, Lopez S, Gomez-Zumaquero JM, Magdalena Leal-Lasarte M, Caballero-Hernandez DE, Cejudo-Guillén M, Pozo D. Epigenetic Mechanisms of Gene Regulation in Amyotrophic Lateral Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 978:255-275. [DOI: 10.1007/978-3-319-53889-1_14] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Calvo A, Canosa A, Bertuzzo D, Cugnasco P, Solero L, Clerico M, De Mercanti S, Bersano E, Cammarosano S, Ilardi A, Manera U, Moglia C, Marinou K, Bottacchi E, Pisano F, Mora G, Mazzini L, Chiò A. Influence of cigarette smoking on ALS outcome: a population-based study. J Neurol Neurosurg Psychiatry 2016; 87:1229-1233. [PMID: 27656044 DOI: 10.1136/jnnp-2016-313793] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the prognostic influence of premorbid smoking habits and vascular risk profile on amyotrophic lateral sclerosis (ALS) phenotype and outcome in a population-based cohort of Italian patients. METHODS A total of 650 patients with ALS from the Piemonte/Valle d'Aosta Register for ALS, incident in the 2007-2011 period, were recruited. Information about premorbid cigarette smoking habits and chronic obstructive pulmonary disease (COPD) were collected at the time of diagnosis. RESULTS Current smokers had a significantly shorter median survival (1.9 years, IQR 1.2-3.4) compared with former (2.3 years, IQR 1.5-4.2) and never smokers (2.7 years, IQR 1.8-4.6) (p=0.001). Also COPD adversely influenced patients' prognosis. Both smoking habits and CODP were retained in Cox multivariable model. CONCLUSIONS This study has demonstrated in a large population-based cohort of patients with ALS that cigarette smoking is an independent negative prognostic factor for survival, with a dose-response gradient. Its effect is not related to the presence of COPD or to respiratory status at time of diagnosis. The understanding of the mechanisms, either genetic or epigenetic, through which exogenous factors influence disease phenotype is of major importance towards a more focused approach to cure ALS.
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Affiliation(s)
- Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Davide Bertuzzo
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Paolo Cugnasco
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Luca Solero
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Marinella Clerico
- Department of Biological and Clinical Science, University of Turin, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Stefania De Mercanti
- Department of Biological and Clinical Science, University of Turin, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Enrica Bersano
- Department of Neurology, ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy Eastern Piedmont University, Novara, Italy
| | - Stefania Cammarosano
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Antonio Ilardi
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Umberto Manera
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Kalliopi Marinou
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Milano, Milano, Italy
| | - Edo Bottacchi
- Department of Neurology, Azienda Ospedaliera Regionale di Aosta, Azienda USL Valle d'Aosta, Aosta, Italy
| | - Fabrizio Pisano
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Veruno (NO), Veruno, Italy
| | - Gabriele Mora
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Milano, Milano, Italy
| | - Letizia Mazzini
- Department of Neurology, ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy Neuroscience Institute of Torino (NIT), Turin, Italy
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