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Mazzini L, Gelati M, Profico DC, Sorarù G, Ferrari D, Copetti M, Muzi G, Ricciolini C, Carletti S, Giorgi C, Spera C, Frondizi D, Masiero S, Stecco A, Cisari C, Bersano E, De Marchi F, Sarnelli MF, Querin G, Cantello R, Petruzzelli F, Maglione A, Zalfa C, Binda E, Visioli A, Trombetta D, Torres B, Bernardini L, Gaiani A, Massara M, Paolucci S, Boulis NM, Vescovi AL. Results from Phase I Clinical Trial with Intraspinal Injection of Neural Stem Cells in Amyotrophic Lateral Sclerosis: A Long-Term Outcome. Stem Cells Transl Med 2019; 8:887-897. [PMID: 31104357 PMCID: PMC6708070 DOI: 10.1002/sctm.18-0154] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/19/2019] [Indexed: 12/13/2022] Open
Abstract
The main objective of this phase I trial was to assess the feasibility and safety of microtransplanting human neural stem cell (hNSC) lines into the spinal cord of patients with amyotrophic lateral sclerosis (ALS). Eighteen patients with a definite diagnosis of ALS received microinjections of hNSCs into the gray matter tracts of the lumbar or cervical spinal cord. Patients were monitored before and after transplantation by clinical, psychological, neuroradiological, and neurophysiological assessment. For up to 60 months after surgery, none of the patients manifested severe adverse effects or increased disease progression because of the treatment. Eleven patients died, and two underwent tracheotomy as a result of the natural history of the disease. We detected a transitory decrease in progression of ALS Functional Rating Scale Revised, starting within the first month after surgery and up to 4 months after transplantation. Our results show that transplantation of hNSC is a safe procedure that causes no major deleterious effects over the short or long term. This study is the first example of medical transplantation of a highly standardized cell drug product, which can be reproducibly and stably expanded ex vivo, comprising hNSC that are not immortalized, and are derived from the forebrain of the same two donors throughout this entire study as well as across future trials. Our experimental design provides benefits in terms of enhancing both intra‐ and interstudy reproducibility and homogeneity. Given the potential therapeutic effects of the hNSCs, our observations support undertaking future phase II clinical studies in which increased cell dosages are studied in larger cohorts of patients. stem cells translational medicine2019;8:887&897
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Affiliation(s)
- Letizia Mazzini
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Maurizio Gelati
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy.,Fondazione IRCCS Casa Sollievo della Sofferenza, Advanced Therapies Production Unit, San Giovanni Rotondo, Foggia, Italy
| | - Daniela Celeste Profico
- Fondazione IRCCS Casa Sollievo della Sofferenza, Advanced Therapies Production Unit, San Giovanni Rotondo, Foggia, Italy
| | - Gianni Sorarù
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Ferrari
- Biotechnology and Bioscience Department Bicocca University, Milan, Italy
| | - Massimiliano Copetti
- Fondazione IRCCS Casa Sollievo della Sofferenza, Biostatistic Unit, San Giovanni Rotondo, Foggia, Italy
| | - Gianmarco Muzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy
| | - Claudia Ricciolini
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy
| | - Sandro Carletti
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Cesare Giorgi
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Cristina Spera
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Domenico Frondizi
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Stefano Masiero
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandro Stecco
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Novara
| | - Carlo Cisari
- Department of Physical Therapy, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Novara
| | - Enrica Bersano
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Fabiola De Marchi
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Maria Francesca Sarnelli
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Giorgia Querin
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Roberto Cantello
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Francesco Petruzzelli
- Fondazione IRCCS Casa Sollievo della Sofferenza, Obstetrics and Gynaecology Department, San Giovanni Rotondo, Foggia, Italy
| | - Annamaria Maglione
- Fondazione IRCCS Casa Sollievo della Sofferenza, Obstetrics and Gynaecology Department, San Giovanni Rotondo, Foggia, Italy
| | - Cristina Zalfa
- Biotechnology and Bioscience Department Bicocca University, Milan, Italy
| | - Elena Binda
- Fondazione IRCCS Casa Sollievo della Sofferenza, Cancer Stem Cells Unit, San Giovanni Rotondo, Foggia, Italy
| | | | - Domenico Trombetta
- Fondazione IRCCS Casa Sollievo della Sofferenza, Department of Oncology, San Giovanni Rotondo, Foggia, Italy
| | - Barbara Torres
- Fondazione IRCCS Casa Sollievo della Sofferenza, Cytogenetics Unit, San Giovanni Rotondo, Foggia, Italy
| | - Laura Bernardini
- Fondazione IRCCS Casa Sollievo della Sofferenza, Cytogenetics Unit, San Giovanni Rotondo, Foggia, Italy
| | | | - Maurilio Massara
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Silvia Paolucci
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | | | - Angelo L Vescovi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy.,Fondazione IRCCS Casa Sollievo della Sofferenza, Advanced Therapies Production Unit, San Giovanni Rotondo, Foggia, Italy.,Biotechnology and Bioscience Department Bicocca University, Milan, Italy
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Tiziano FD, Lomastro R, Abiusi E, Pasanisi MB, Di Pietro L, Fiori S, Baranello G, Angelini C, Sorarù G, Gaiani A, Mongini T, Vercelli L, Mercuri E, Vasco G, Pane M, Vita G, Vita G, Messina S, Petillo R, Passamano L, Politano L, Campanella A, Mantegazza R, Morandi L. Longitudinal evaluation of SMN levels as biomarker for spinal muscular atrophy: results of a phase IIb double-blind study of salbutamol. J Med Genet 2018; 56:293-300. [DOI: 10.1136/jmedgenet-2018-105482] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/10/2018] [Accepted: 11/30/2018] [Indexed: 11/04/2022]
Abstract
BackgroundSpinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder, due to the loss of function of the survival motor neuron (SMN1) gene. The first treatment for the condition, recently approved, is based on the reduction of exon 7 skipping in mRNAs produced by a highly homologous gene (SMN2). The primary objective of the present study was to evaluate the applicability of the dosage of SMN gene produts in blood, as biomarker for SMA, and the safety of oral salbutamol, a beta2-adrenergic agonist modulating SMN2 levels.MethodsWe have performed a 1-year multicentre, double-blind, placebo-controlled study with salbutamol in 45 adult patients with SMA. Patients assumed 4 mg of salbutamol or placebo/three times a day. Molecular tests were SMN2 copy number, SMN transcript and protein levels. We have also explored the clinical effect, by the outcome measures available at the time of study design.ResultsThirty-six patients completed the study. Salbutamol was safe and well tolerated. We observed a significant and progressive increase in SMN2 full-length levels in peripheral blood of the salbutamol-treated patients (p<0.00001). The exploratory analysis of motor function showed an improvement in most patients.ConclusionsOur data demonstrate safety and molecular efficacy of salbutamol. We provide the first longitudinal evaluation of SMN levels (both transcripts and protein) in placebo and in response to a compound modulating the gene expression: SMN transcript dosage in peripheral blood is reliable and may be used as pharmacodynamic marker in clinical trials with systemic compounds modifying SMN2levels.Trial registration numberEudraCT no. 2007-001088-32.
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Gaiani A, Martinelli I, Bello L, Querin G, Puthenparampil M, Ruggero S, Toffanin E, Cagnin A, Briani C, Pegoraro E, Sorarù G. Diagnostic and Prognostic Biomarkers in Amyotrophic Lateral Sclerosis: Neurofilament Light Chain Levels in Definite Subtypes of Disease. JAMA Neurol 2017; 74:525-532. [PMID: 28264096 PMCID: PMC5822207 DOI: 10.1001/jamaneurol.2016.5398] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/10/2016] [Indexed: 01/14/2023]
Abstract
Importance A clearer definition of the role of neurofilament light chain (NFL) as a biomarker in amyotrophic lateral sclerosis (ALS) is needed. Objectives To assess the ability of NFL to serve as a diagnostic biomarker in ALS and the prognostic value of cerebrospinal fluid NFL in patients with ALS. Design, Setting, and Participants In this single-center, retrospective, longitudinal study, disease progression was assessed by the ALS Functional Rating Score-Revised and the ALS Milano-Torino Staging system at baseline and 6, 12, 24, and 36 months. Cerebrospinal fluid samples were obtained from 176 patients admitted to the Department of Neurosciences of the University of Padua, Padova, Italy, from January 1, 2010, through February 29, 2016. Patients with ALS underwent ambulatory follow-up at the same department. Main Outcomes and Measures Levels of NFL. Results The study included 94 patients with ALS (64 men [36.4%] and 30 women [17.0%]; median age, 62.5 years), 20 patients with frontotemporal dementia (FTD) (8 men [4.5%] and 12 women [6.8%]; median age, 65 years), 18 patients with motor neuropathies (14 men [8.0%] and 4 women [2.3%]; median age, 63 years), and 44 controls (24 men [13.6%] and 20 women [11.4%]; median age, 54 years). Log-transformed NFL (log[NFL]) concentrations were higher in the ALS and FTD groups compared with the motor neuropathies and control groups (hazard ratio [HR], 2.45; 95% CI, 1.66-3.61; P < .001). Patients with typical ALS (HR, 1.0 [reference]), progressive bulbar palsy (HR, 1.48; 95% CI, 0.58-3.75; P = .41), and upper motor neuron dominant ALS (HR, 0.12; 95% CI, 0.02-0.61; P = .01) had higher levels of NFL than did those with flail arm or leg syndrome (HR, 0.28; 95% CI, 0.08-0.10; P = .049) and progressive muscular atrophy (HR, 0.17; 95% CI, 0.22-1.36; P = .10). There was an inverse correlation between log[NFL] concentration and overall survival (HR, 2.45; 95% CI, 1.66-3.61; P < .001). There was no evidence of different log[NFL] concentrations and survival in genetic ALS. Conclusions and Relevance This study confirms the role of NFL as a biomarker in ALS. Elevation in NFL levels in patients with upper motor neuron involvement and FTD might reflect the corticospinal tract degeneration. Low NFL levels in patients with lower motor neuron signs might be a prognostic indicator of milder phenotypes of disease.
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Affiliation(s)
| | | | - Luca Bello
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Giorgia Querin
- Department of Neurosciences, University of Padua, Padova, Italy
| | | | - Susanna Ruggero
- Department of Neurosciences, General Hospital of Padua, Padova, Italy
| | | | | | - Chiara Briani
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padua, Padova, Italy
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Politano L, Scutifero M, Patalano M, Sagliocchi A, Zaccaro A, Civati F, Brighina E, Vita G, Messina S, Sframeli M, Elena Lombardo M, Scalise R, Colia G, Catteruccia M, Berardinelli A, Motta MC, Gaiani A, Semplicini C, Bello L, Astrea G, Ricci G, Grazia D'Angelo M, Vita G, Pane M, D'Amico A, Balottin U, Angelini C, Battini R, Magliano L. Integrated care of muscular dystrophies in Italy. Part 1. Pharmacological treatment and rehabilitative interventions. Acta Myol 2017; 36:19-24. [PMID: 28690390 PMCID: PMC5479104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes the pharmacological therapies and rehabilitative interventions received by 502 patients with Muscular Dystrophies, evaluated in relation to patient's socio-demographic and clinical variables, and geographical areas. Data were collected by the MD-Socio-Demographic and Clinical Schedule (MD-SC-CS) and by the Family Problems Questionnaire (FPQ). The most part of the enrolled patients were in drug treatment. The number of the medications increased in relation to patient's age, disability degree and duration of illness and was higher among patients with Duchenne Muscular Dystrophy (DMD) compared with Becker (BMD) or Limb-Girdle Muscular Dystrophies (LGMD). Steroids (deflazacort or prednisone) were the drug most frequently used, followed by cardiologic and bone metabolism drugs. In general, patients using steroids were younger and had a shorter duration of illness; patients using cardiac drugs and dietary supplements were older and had a longer duration of illness. Rehabilitative interventions were provided to about 70% (351/502) of patients, mainly DMD. Of these, physiotherapy was the more frequent treatment (96.6%) and was prevalently performed in rehabilitative centres (about 70% of patients) and at home in only 30%. Hydrokinetic-therapy was practiced by 6.8% of patients. Respiratory rehabilitation was provided to 47.0% of patients (165/351) and assisted mechanical ventilaventilation to 13.1% (46). The amount of rehabilitative interventions increased in relation to the patient's age, level of disability and duration of illness. Compared to Central and Northern Italy, in Southern Italy there was a higher attention to cardiological impairment as shown by a higher number of patients receiving heart drugs. No statistically significant differences concerning the possibility to have access to rehabilitative interventions were noted among the three geographical areas. However, patient living in Southern Italy tend to receive rehabilitation more often at home.
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Affiliation(s)
- Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli" (former denomination: Second University of Naples), Italy;,Address for correspondence: Luisa Politano, Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli", Primo Policlinico, piazza Miraglia, 80138 Naples, Italy. E-mail:
| | - Marianna Scutifero
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli" (former denomination: Second University of Naples), Italy
| | - Melania Patalano
- Department of Psychology, Campania University "Luigi Vanvitelli", Italy
| | | | - Antonella Zaccaro
- Department of Psychology, Campania University "Luigi Vanvitelli", Italy
| | - Federica Civati
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | - Erika Brighina
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | | | | | | | | | - Roberta Scalise
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Giulia Colia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Maria Catteruccia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Angela Berardinelli
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Maria Chiara Motta
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Luca Bello
- Department of Neurosciences, University of Padova, Italy
| | - Guja Astrea
- Developmental Neuroscience, IRCCS Stella Maris, Pisa Italy
| | - Giulia Ricci
- Developmental Neuroscience, IRCCS Stella Maris, Pisa Italy
| | - Maria Grazia D'Angelo
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | | | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Umberto Balottin
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Lorenza Magliano
- Department of Psychology, Campania University "Luigi Vanvitelli", Italy
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5
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Querin G, Bertolin C, Da Re E, Volpe M, Zara G, Pegoraro E, Caretta N, Foresta C, Silvano M, Corrado D, Iafrate M, Angelini L, Sartori L, Pennuto M, Gaiani A, Bello L, Semplicini C, Pareyson D, Silani V, Ermani M, Ferlin A, Sorarù G. Non-neural phenotype of spinal and bulbar muscular atrophy: results from a large cohort of Italian patients. J Neurol Neurosurg Psychiatry 2016; 87:810-6. [PMID: 26503015 PMCID: PMC4975824 DOI: 10.1136/jnnp-2015-311305] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/02/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To carry out a deep characterisation of the main androgen-responsive tissues involved in spinal and bulbar muscular atrophy (SBMA). METHODS 73 consecutive Italian patients underwent a full clinical protocol including biochemical and hormonal analyses, genitourinary examination, bone metabolism and densitometry, cardiological evaluation and muscle pathology. RESULTS Creatine kinase levels were slightly to markedly elevated in almost all cases (68 of the 73; 94%). 30 (41%) patients had fasting glucose above the reference limit, and many patients had total cholesterol (40; 54.7%), low-density lipoproteins cholesterol (29; 39.7%) and triglyceride (35; 48%) levels above the recommended values. Although testosterone, luteinising hormone and follicle-stimulating hormone values were generally normal, in one-third of cases we calculated an increased Androgen Sensitivity Index reflecting the presence of androgen resistance in these patients. According to the International Prostate Symptom Score (IPSS), 7/70 (10%) patients reported severe lower urinal tract symptoms (IPSS score >19), and 21/73 (30%) patients were moderately symptomatic (IPSS score from 8 to 19). In addition, 3 patients were carriers of an indwelling bladder catheter. Videourodynamic evaluation indicated that 4 of the 7 patients reporting severe urinary symptoms had an overt prostate-unrelated bladder outlet obstruction. Dual-energy X-ray absorptiometry scan data were consistent with low bone mass in 25/61 (41%) patients. Low bone mass was more frequent at the femoral than at the lumbar level. Skeletal muscle biopsy was carried out in 20 patients and myogenic changes in addition to the neurogenic atrophy were mostly observed. CONCLUSIONS Our study provides evidence of a wide non-neural clinical phenotype in SBMA, suggesting the need for comprehensive multidisciplinary protocols for these patients.
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Affiliation(s)
- Giorgia Querin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Cinzia Bertolin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Elisa Da Re
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Marco Volpe
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Gabriella Zara
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Elena Pegoraro
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Nicola Caretta
- Department of Medicine, Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | - Carlo Foresta
- Department of Medicine, Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | - Maria Silvano
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Massimo Iafrate
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy
| | - Lorenzo Angelini
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy
| | - Leonardo Sartori
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
| | - Maria Pennuto
- Dulbecco Telethon Institute Lab of Neurodegenerative Diseases, Centre for Integrative Biology (CIBIO), University of Trento, Trento, Italy
| | - Alessandra Gaiani
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Luca Bello
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Claudio Semplicini
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Davide Pareyson
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences-IRCCS Foundation, "C. Besta" Neurological Institute, Milan, Italy
| | - Vincenzo Silani
- Departments of Neurology and Laboratory of Neuroscience, and Pathophysiology and Transplantation, IRCCS Istituto Auxologico Italiano, "Dino Ferrari" Centre, Universita' degli Studi di Milano, Milan, Italy
| | - Mario Ermani
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Alberto Ferlin
- Department of Medicine, Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
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Magliano L, Patalano M, Sagliocchi A, Scutifero M, Zaccaro A, D'angelo MG, Civati F, Brighina E, Vita G, Vita GL, Messina S, Sframeli M, Pane M, Lombardo ME, Scalise R, D'amico A, Colia G, Catteruccia M, Balottin U, Berardinelli A, Chiara Motta M, Angelini C, Gaiani A, Semplicini C, Bello L, Battini R, Astrea G, Politano L. Burden, professional support, and social network in families of children and young adults with muscular dystrophies. Muscle Nerve 2015; 52:13-21. [PMID: 25363165 PMCID: PMC5029774 DOI: 10.1002/mus.24503] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/11/2022]
Abstract
Introduction: This study explores burden and social and professional support in families of young patients with muscular dystrophies (MDs) in Italy. Methods: The study was carried out on 502 key relatives of 4‐ to 25‐year‐old patients suffering from Duchenne, Becker, or Limb‐Girdle MD who were living with at least 1 adult relative. Results: A total of 77.1% of relatives reported feelings of loss, 74.0% had feelings of sadness, and 59.1% had constraints in leisure activities. Burden was higher among relatives of patients with higher disability and who spent more daily hours in caregiving. Practical difficulties were higher among relatives who perceived lower help in patient emergencies and less practical support by their social network. Psychological burden was higher in those relatives who were unemployed, those with poorer support in emergencies, and those with lower social contacts. Conclusions: Caring for patients with MDs may be demanding for relatives even in the early stages of these disorders, especially when social support is poor and the patient's disability increases. Muscle Nerve52: 13–21, 2015
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Melania Patalano
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Alessandra Sagliocchi
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Marianna Scutifero
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
| | - Antonella Zaccaro
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
| | - Maria Grazia D'angelo
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Federica Civati
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Erika Brighina
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Gian Luca Vita
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Sonia Messina
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Maria Sframeli
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | | | - Roberta Scalise
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Adele D'amico
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Giulia Colia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Umberto Balottin
- Department of Brain and Behavioural Sciences - Child Neuropsychiatry Unit, University of Pavia, Italy
| | | | | | | | | | | | - Luca Bello
- Department of Neurosciences, University of Padova, Italy
| | | | - Guja Astrea
- Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
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Mazzini L, Gelati M, Profico DC, Sgaravizzi G, Projetti Pensi M, Muzi G, Ricciolini C, Rota Nodari L, Carletti S, Giorgi C, Spera C, Domenico F, Bersano E, Petruzzelli F, Cisari C, Maglione A, Sarnelli MF, Stecco A, Querin G, Masiero S, Cantello R, Ferrari D, Zalfa C, Binda E, Visioli A, Trombetta D, Novelli A, Torres B, Bernardini L, Carriero A, Prandi P, Servo S, Cerino A, Cima V, Gaiani A, Nasuelli N, Massara M, Glass J, Sorarù G, Boulis NM, Vescovi AL. Human neural stem cell transplantation in ALS: initial results from a phase I trial. J Transl Med 2015; 13:17. [PMID: 25889343 PMCID: PMC4359401 DOI: 10.1186/s12967-014-0371-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023] Open
Abstract
Background We report the initial results from a phase I clinical trial for ALS. We transplanted GMP-grade, fetal human neural stem cells from natural in utero death (hNSCs) into the anterior horns of the spinal cord to test for the safety of both cells and neurosurgical procedures in these patients. The trial was approved by the Istituto Superiore di Sanità and the competent Ethics Committees and was monitored by an external Safety Board. Methods Six non-ambulatory patients were treated. Three of them received 3 unilateral hNSCs microinjections into the lumbar cord tract, while the remaining ones received bilateral (n = 3 + 3) microinjections. None manifested severe adverse events related to the treatment, even though nearly 5 times more cells were injected in the patients receiving bilateral implants and a much milder immune-suppression regimen was used as compared to previous trials. Results No increase of disease progression due to the treatment was observed for up to18 months after surgery. Rather, two patients showed a transitory improvement of the subscore ambulation on the ALS-FRS-R scale (from 1 to 2). A third patient showed improvement of the MRC score for tibialis anterior, which persisted for as long as 7 months. The latter and two additional patients refused PEG and invasive ventilation and died 8 months after surgery due to the progression of respiratory failure. The autopsies confirmed that this was related to the evolution of the disease. Conclusions We describe a safe cell therapy approach that will allow for the treatment of larger pools of patients for later-phase ALS clinical trials, while warranting good reproducibility. These can now be carried out under more standardized conditions, based on a more homogenous repertoire of clinical grade hNSCs. The use of brain tissue from natural miscarriages eliminates the ethical concerns that may arise from the use of fetal material. Trial registration EudraCT:2009-014484-39.
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Affiliation(s)
- Letizia Mazzini
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Maurizio Gelati
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Daniela Celeste Profico
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Giada Sgaravizzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Massimo Projetti Pensi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Gianmarco Muzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Claudia Ricciolini
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Laura Rota Nodari
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Sandro Carletti
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Cesare Giorgi
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Cristina Spera
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Frondizi Domenico
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Enrica Bersano
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Francesco Petruzzelli
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Carlo Cisari
- Department of Physical Therapy, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Annamaria Maglione
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Maria Francesca Sarnelli
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Alessandro Stecco
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Giorgia Querin
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Stefano Masiero
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Roberto Cantello
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Daniela Ferrari
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Cristina Zalfa
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Elena Binda
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Alberto Visioli
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Domenico Trombetta
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Antonio Novelli
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Barbara Torres
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Laura Bernardini
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Alessandro Carriero
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Paolo Prandi
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Serena Servo
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Annalisa Cerino
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Valentina Cima
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Alessandra Gaiani
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Nicola Nasuelli
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Maurilio Massara
- Department of Physical Therapy, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Jonathan Glass
- Department of Neurology Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
| | - Gianni Sorarù
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Nicholas M Boulis
- Department of Neurosurgery Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
| | - Angelo L Vescovi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy. .,Fondazione Cellule Staminali di Terni, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
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Magliano L, Patalano M, Sagliocchi A, Scutifero M, Zaccaro A, D'Angelo MG, Civati F, Brighina E, Vita G, Vita GL, Messina S, Sframeli M, Pane M, Lombardo ME, Scalise R, D'Amico A, Colia G, Catteruccia M, Balottin U, Berardinelli A, Motta MC, Angelini C, Gaiani A, Semplicini C, Bello L, Battini R, Astrea G, Ricci G, Politano L. "I have got something positive out of this situation": psychological benefits of caregiving in relatives of young people with muscular dystrophy. J Neurol 2013; 261:188-95. [PMID: 24202786 PMCID: PMC3895206 DOI: 10.1007/s00415-013-7176-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/24/2013] [Indexed: 11/26/2022]
Abstract
This paper focuses on the psychological benefits of caregiving in key relatives of patients with muscular dystrophies (MD), a group of rare diseases characterized by progressive weakness and restriction of the patient's functional abilities. We describe whether relatives perceived caregiving to be a positive experience and test whether relatives' perceptions vary in relation to their view of the patient as a valued person, the degree of involvement in care, and the level of support provided by social network and professionals. The study sample included 502 key relatives of patients aged 4-25 years, suffering from Duchenne, Becker, or limb-girdle MD, in treatment for at least 6 months to one of the eight participating centers, living with at least one relative aged 18-80 years. Of key relatives, 88 % stated that they had gotten something positive out of the situation, 96 % considered their patients to be sensitive, and 94 % viewed their patients as talented. Positive aspects of caregiving were more recognized by key relatives who were more convinced that the patient was sensitive and who perceived that they received higher level of professional help and psychological social support. These results suggest that most key relatives consider that their caregiving experience has had a positive impact on their lives, despite the practical difficulties of caring for patients with MD. Professionals should help relatives to identify the benefits of caregiving without denying its difficulties. Clinicians themselves should develop positive attitudes towards family involvement in the care of patients with long-term diseases.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Second University of Naples (SUN), Viale Ellittico, 31, 81100, Naples, Caserta, Italy,
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9
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Bertolin C, D'Ascenzo C, Querin G, Gaiani A, Boaretto F, Salvoro C, Vazza G, Angelini C, Cagnin A, Pegoraro E, Sorarù G, Mostacciuolo ML. Improving the knowledge of amyotrophic lateral sclerosis genetics: novel SOD1 and FUS variants. Neurobiol Aging 2013; 35:1212.e7-1212.e10. [PMID: 24325798 DOI: 10.1016/j.neurobiolaging.2013.10.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/17/2013] [Accepted: 10/26/2013] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is as an adult-onset neurodegenerative disorder involving both upper and lower motor neurons. About 5% of all cases exhibit signs of frontotemporal degeneration (FTD). We established the mutation frequency of C9ORF72, SOD1, TARDBP, and FUS genes in 307 patients with sporadic ALS, 46 patients with familial ALS (FALS), and 73 patients affected with FTD, all originating from the northeastern part of Italy. C9ORF72 pathogenic expansion was found on 22% of familial ALS, 5% of sporadic ALS, and 14% of FTD patients, resulting the most frequently genetic determinant in our cohort. Sequence analysis of ALS cohort identified 2 novel variants on SOD1 (p.Glu41Gly) and FUS (p.Gly496Glyfs*31). Interestingly, the single base deletion on FUS was observed in an homozygous state, suggesting a recessive pattern of inheritance. No point mutations were identified on FTD cohort. Although useful to direct genetic testing, this study results expand the current knowledge of ALS genetics.
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Affiliation(s)
- Cinzia Bertolin
- Laboratory of Human Genetics, Department of Biology, University of Padova, Padova, Italy
| | - Carla D'Ascenzo
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Giorgia Querin
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Francesca Boaretto
- Laboratory of Human Genetics, Department of Biology, University of Padova, Padova, Italy
| | - Cecilia Salvoro
- Laboratory of Human Genetics, Department of Biology, University of Padova, Padova, Italy
| | - Giovanni Vazza
- Laboratory of Human Genetics, Department of Biology, University of Padova, Padova, Italy
| | - Corrado Angelini
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova, Padova, Italy.
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10
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Morandi L, Abiusi E, Pasanisi M, Lomastro R, Fiori S, Di Pietro L, Angelini C, Sorarù G, Gaiani A, Mongini T, Vercelli L, Vasco G, Vita G, Vita G, Messina S, Politano L, Passamano L, Gregorio GD, Tiziano F. P.6.4 Salbutamol tolerability and efficacy in adult type III SMA patients: Results of a multicentric, molecular and clinical, double-blind, placebo-controlled study. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Bruson A, Sambataro F, Querin G, D'Ascenzo C, Palmieri A, Agostini J, Gaiani A, Angelini C, Galbiati M, Poletti A, Pennuto M, Pegoraro E, Clementi M, Soraru G. CAG repeat length in androgen receptor gene is not associated with amyotrophic lateral sclerosis. Eur J Neurol 2012; 19:1373-5. [PMID: 22233359 DOI: 10.1111/j.1468-1331.2011.03646.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Epidemiological and clinical studies show higher prevalence of amyotrophic lateral sclerosis (ALS) in males than in females and more severe lesions in androgen receptor (AR)-expressing tissues. The AR gene contains a polymorphic CAG trinucleotide repeat, whose expansion over a certain threshold is toxic to motor neurons, causing spinal and bulbar muscular atrophy (SBMA). PURPOSE AND METHODS We tested the hypothesis that the AR CAG repeat linked to SBMA is a risk factor for ALS. We analyzed AR CAG expansions in 336 patients with ALS and 100 controls. RESULTS We found a negative association of AR CAG expansions with ALS susceptibility, clinical presentation, and survival. CONCLUSIONS Our findings do not support a role of the AR CAG repeat length in ALS.
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Affiliation(s)
- A Bruson
- Department of Pediatrics, Clinical Genetics Unit, Università di Padova, Padova, Italy
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12
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Angelini C, Peterle E, Gaiani A, Bortolussi L, Borsato C. Dysferlinopathy course and sportive activity: clues for possible treatment. Acta Myol 2011; 30:127-32. [PMID: 22106716 PMCID: PMC3235880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
LGMD2B is a frequent proximo-distal myopathy with rapid evolution after age 20. Exacerbating factors may be physical exercise and inflammation. There is very little information about the effect of sportive activity in LGMD2B, since eccentric exercise frequently results in muscle damage. LGMD2B has often an onset with myalgia and MRI imaging (STIR-sequences) shows myoedema. In a prolonged observational study of a series of 18 MM/LGMD2B patients we have studied the pattern of clinical and radiological evolution. The disease has an abrupt onset in the second decade and most patients perform sports before definite disease onset. On the basis of Gardner-Medwin and Walton scale, grade 4 is reached two years faster in patients who performed sports (over 1000 hours). Other considerations regarding pathogenetic mechanism and response to treatment show a poor response to immunosuppressive treatment of muscle inflammation. Preventing a strenuous physical activity should be recommended in patients with high CK and diagnosed or suspected to have dysferlin deficiency.
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Affiliation(s)
- C. Angelini
- Address for correspondence: Prof. C. Angelini. Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128 Padova, Italy. E-mail:
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D'Ascenzo C, Cecchin D, Santelli L, Palmieri A, Gaiani A, Querin G, Cima V, Volpe M, Bello L, Bui F, Cagnin A, Angelini C, Pegoraro E, Sorarù G. Parkinson-like features in ALS with predominant upper motor neuron involvement. ACTA ACUST UNITED AC 2011; 13:137-43. [PMID: 21870999 DOI: 10.3109/17482968.2011.603732] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Owing to the frequent observation of poverty of movements, facial hypomimia and balance impairment, amyotrophic lateral sclerosis (ALS) variant with predominance of upper motor neuron involvement (UMN-ALS) is prone to be diagnosed with Parkinsonism. A clinical assessment, including the velocity-dependent stretch response test to differentiate between pyramidal and extrapyramidal stiffness; the Unified Parkinson's Disease Rating Scale and the Berg Balance Scale to assess degree of bradykinesia and postural instability; and (123)I-FP-CIT scintigraphy evaluation to investigate the nigrostriatal circuit involvement, were carried out to characterize Parkinson-like features in UMN-ALS patients. Sixteen UMN-ALS patients were included in the study. The velocity-dependent stretch response indicated spasticity in all the muscles tested. The degree of stiffness was found to be related to bradykinesia and postural instability. Eleven patients (70%) showed a reduction in striatal (123)I-FP-CIT uptake found to be related to disease duration and patients' ages but not to scores of the functional scales. Slowness of movements and postural instability noted in our patients could be mostly attributed to spasticity. The lack of any correlation between UPDRS or BBS scores and the degree of nigrostriatal impairment on DaTSCAN seems to disprove nigrostriatal circuit involvement in these extrapyramidal-like features.
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Affiliation(s)
- Carla D'Ascenzo
- Department of Neurosciences, University of Padova, via Giustiniani 5, Padova, Italy
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