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Salabasidou E, Binder T, Volkmann J, Kuzkina A, Üçeyler N. Pain in Parkinson disease: a deep phenotyping study. Pain 2024:00006396-990000000-00517. [PMID: 38314763 DOI: 10.1097/j.pain.0000000000003173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
ABSTRACT In our prospective cross-sectional study, we comprehensively characterized Parkinson disease (PD)-related pain in monocentrically recruited patients with PD using standardized tools of pain assessment and categorization. One hundred fifty patients were systematically interviewed and filled in questionnaires for pain, depression, motor, and nonmotor symptoms. Patients with PD-related pain (PD pain), patients without PD-related pain (no PD pain), and patients without pain (no pain) were compared. Pain was present in 108/150 (72%) patients with PD, and 90/150 (60%) patients were classified as having PD-related pain. Most of the patients with PD (67/90, 74%) reported nociceptive pain, which was episodic (64/90, 71%), primarily nocturnal (56/90, 62%), and manifested as cramps (32/90, 36%). Parkinson disease-related pain was most frequently located in the feet (51/90, 57%), mainly at the toe joints (22/51, 43%). 38/90 (42%) patients with PD-related pain received analgesic medication with nonsteroidal anti-inflammatory drugs being the most frequently used (31/42, 82%) and opioids most effective (70% pain reduction of individual maximum pain intensities, range 22%-100%, confidence interval 50%-90%). All patients received oral PD treatment; however, levodopa equivalent dose showed no correlation with mean pain intensities (Spearman ρ = 0.027, P > 0.05). Our data provide a comprehensive analysis of PD-related pain, giving evidence for mainly non-neuropathic podalgia, which bears the potential to rethink assessment and analgesic treatment of pain in PD in clinical practice.
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Affiliation(s)
- Elena Salabasidou
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Kuzkina is now with the Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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2
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Gilboa T, Swank Z, Thakur R, Gould RA, Ooi KH, Norman M, Flynn EA, Deveney BT, Chen A, Borberg E, Kuzkina A, Ndayisaba A, Khurana V, Weitz DA, Walt DR. Toward the quantification of α-synuclein aggregates with digital seed amplification assays. Proc Natl Acad Sci U S A 2024; 121:e2312031121. [PMID: 38194461 PMCID: PMC10801878 DOI: 10.1073/pnas.2312031121] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024] Open
Abstract
The quantification and characterization of aggregated α-synuclein in clinical samples offer immense potential toward diagnosing, treating, and better understanding neurodegenerative synucleinopathies. Here, we developed digital seed amplification assays to detect single α-synuclein aggregates by partitioning the reaction into microcompartments. Using pre-formed α-synuclein fibrils as reaction seeds, we measured aggregate concentrations as low as 4 pg/mL. To improve our sensitivity, we captured aggregates on antibody-coated magnetic beads before running the amplification reaction. By first characterizing the pre-formed fibrils with transmission electron microscopy and size exclusion chromatography, we determined the specific aggregates targeted by each assay platform. Using brain tissue and cerebrospinal fluid samples collected from patients with Parkinson's Disease and multiple system atrophy, we demonstrated that the assay can detect endogenous pathological α-synuclein aggregates. Furthermore, as another application for these assays, we studied the inhibition of α-synuclein aggregation in the presence of small-molecule inhibitors and used a custom image analysis pipeline to quantify changes in aggregate growth and filament morphology.
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Affiliation(s)
- Tal Gilboa
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA02115
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
- Harvard Medical School, Boston, MA02115
| | - Zoe Swank
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA02115
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
- Harvard Medical School, Boston, MA02115
| | - Rohan Thakur
- John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA02138
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA02139
| | - Russell A. Gould
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
| | - Kean Hean Ooi
- Department of Medical Sciences, Harvard Medical School, Boston, MA02115
| | - Maia Norman
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA02115
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
- Harvard Medical School, Boston, MA02115
- Physician Scientist Training Program, Massachusetts General Hospital/McLean Residency in Adult Psychiatry, Boston, MA02114
| | - Elizabeth A. Flynn
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA02115
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
| | - Brendan T. Deveney
- John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA02138
| | - Anqi Chen
- John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA02138
| | - Ella Borberg
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA02115
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
- Harvard Medical School, Boston, MA02115
| | - Anastasia Kuzkina
- Harvard Medical School, Boston, MA02115
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA02115
| | - Alain Ndayisaba
- Harvard Medical School, Boston, MA02115
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA02115
| | - Vikram Khurana
- Harvard Medical School, Boston, MA02115
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA02115
- Harvard Stem Cell Institute, Cambridge, MA02138
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA02142
| | - David A. Weitz
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
- John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA02138
- Department of Physics, Harvard University, Cambridge, MA02138
| | - David R. Walt
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA02115
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115
- Harvard Medical School, Boston, MA02115
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3
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Abakumova T, Kuzkina A, Koshkin P, Pozdeeva D, Abakumov M, Melnikov P, Ionova K, Gubskii I, Gurina O, Nukolova N, Chekhonin V. Localized Increased Permeability of Blood-Brain Barrier for Antibody Conjugates in the Cuprizone Model of Demyelination. Int J Mol Sci 2023; 24:12688. [PMID: 37628867 PMCID: PMC10454543 DOI: 10.3390/ijms241612688] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
The development of new neurotherapeutics depends on appropriate animal models being chosen in preclinical studies. The cuprizone model is an effective tool for studying demyelination and remyelination processes in the brain, but blood-brain barrier (BBB) integrity in the cuprizone model is still a topic for debate. Several publications claim that the BBB remains intact during cuprizone-induced demyelination; others demonstrate results that could explain the increased BBB permeability. In this study, we aim to analyze the permeability of the BBB for different macromolecules, particularly antibody conjugates, in a cuprizone-induced model of demyelination. We compared the traditional approach using Evans blue injection with subsequent dye extraction and detection of antibody conjugates using magnetic resonance imaging (MRI) and confocal microscopy to analyze BBB permeability in the cuprizone model. First, we validated our model of demyelination by performing T2-weighted MRI, diffusion tensor imaging, quantitative rt-PCR to detect changes in mRNA expression of myelin basic protein and proteolipid protein, and Luxol fast blue histological staining of myelin. Intraperitoneal injection of Evans blue did not result in any differences between the fluorescent signal in the brain of healthy and cuprizone-treated mice (IVIS analysis with subsequent dye extraction). In contrast, intravenous injection of antibody conjugates (anti-GFAP or non-specific IgG) after 4 weeks of a cuprizone diet demonstrated accumulation in the corpus callosum of cuprizone-treated mice both by contrast-enhanced MRI (for gadolinium-labeled antibodies) and by fluorescence microscopy (for Alexa488-labeled antibodies). Our results suggest that the methods with better sensitivity could detect the accumulation of macromolecules (such as fluorescent-labeled or gadolinium-labeled antibody conjugates) in the brain, suggesting a local BBB disruption in the demyelinating area. These findings support previous investigations that questioned BBB integrity in the cuprizone model and demonstrate the possibility of delivering antibody conjugates to the corpus callosum of cuprizone-treated mice.
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Affiliation(s)
- Tatiana Abakumova
- Department of Synthetic Neurotechnology, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Anastasia Kuzkina
- Faculty of Medicine, Sechenov First Medical University, Moscow 119991, Russia
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
| | - Philipp Koshkin
- Department of Medicine and Biology, Chair of Medical Nanotechnology, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Daria Pozdeeva
- Faculty of Medicine, Sechenov First Medical University, Moscow 119991, Russia
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
| | - Maxim Abakumov
- Department of Medicine and Biology, Chair of Medical Nanotechnology, Pirogov Russian National Research Medical University, Moscow 117997, Russia
- Laboratory of Biomedical Nanomaterials, National University of Science and Technology MISIS, Moscow 119049, Russia
| | - Pavel Melnikov
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
| | - Klavdia Ionova
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
| | - Ilia Gubskii
- Department of Medicine and Biology, Chair of Medical Nanotechnology, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Olga Gurina
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
| | - Natalia Nukolova
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
- Massachusetts Institute of Technology, Koch Institute for Integrative Cancer Research, Cambridge, MA 02139, USA
| | - Vladimir Chekhonin
- Department of Immunochemistry, V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow 119034, Russia
- Department of Medicine and Biology, Chair of Medical Nanotechnology, Pirogov Russian National Research Medical University, Moscow 117997, Russia
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4
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Haake M, Haack B, Schäfer T, Harter PN, Mattavelli G, Eiring P, Vashist N, Wedekink F, Genssler S, Fischer B, Dahlhoff J, Mokhtari F, Kuzkina A, Welters MJP, Benz TM, Sorger L, Thiemann V, Almanzar G, Selle M, Thein K, Späth J, Gonzalez MC, Reitinger C, Ipsen-Escobedo A, Wistuba-Hamprecht K, Eichler K, Filipski K, Zeiner PS, Beschorner R, Goedemans R, Gogolla FH, Hackl H, Rooswinkel RW, Thiem A, Roche PR, Joshi H, Pühringer D, Wöckel A, Diessner JE, Rüdiger M, Leo E, Cheng PF, Levesque MP, Goebeler M, Sauer M, Nimmerjahn F, Schuberth-Wagner C, von Felten S, Mittelbronn M, Mehling M, Beilhack A, van der Burg SH, Riedel A, Weide B, Dummer R, Wischhusen J. Tumor-derived GDF-15 blocks LFA-1 dependent T cell recruitment and suppresses responses to anti-PD-1 treatment. Nat Commun 2023; 14:4253. [PMID: 37474523 PMCID: PMC10359308 DOI: 10.1038/s41467-023-39817-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
Immune checkpoint blockade therapy is beneficial and even curative for some cancer patients. However, the majority don't respond to immune therapy. Across different tumor types, pre-existing T cell infiltrates predict response to checkpoint-based immunotherapy. Based on in vitro pharmacological studies, mouse models and analyses of human melanoma patients, we show that the cytokine GDF-15 impairs LFA-1/β2-integrin-mediated adhesion of T cells to activated endothelial cells, which is a pre-requisite of T cell extravasation. In melanoma patients, GDF-15 serum levels strongly correlate with failure of PD-1-based immune checkpoint blockade therapy. Neutralization of GDF-15 improves both T cell trafficking and therapy efficiency in murine tumor models. Thus GDF-15, beside its known role in cancer-related anorexia and cachexia, emerges as a regulator of T cell extravasation into the tumor microenvironment, which provides an even stronger rationale for therapeutic anti-GDF-15 antibody development.
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Affiliation(s)
- Markus Haake
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- CatalYm GmbH, Am Klopferspitz 19, 82152, Munich, Germany
| | - Beatrice Haack
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Tina Schäfer
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurological Institute (Edinger Institute), University Hospital, Goethe University, Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- Center for Neuropathology and Prion Research, Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Greta Mattavelli
- Mildred Scheel Early Career Center, University Hospital of Würzburg, Würzburg, Germany
| | - Patrick Eiring
- Department of Biotechnology and Biophysics, Julius Maximilians University Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Neha Vashist
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- CatalYm GmbH, Am Klopferspitz 19, 82152, Munich, Germany
| | - Florian Wedekink
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | | | - Birgitt Fischer
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- CatalYm GmbH, Am Klopferspitz 19, 82152, Munich, Germany
| | - Julia Dahlhoff
- Department of Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Fatemeh Mokhtari
- Department of Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Anastasia Kuzkina
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Marij J P Welters
- Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Tamara M Benz
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Lena Sorger
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Vincent Thiemann
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Giovanni Almanzar
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Martina Selle
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Klara Thein
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Jacob Späth
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | | | - Carmen Reitinger
- Division of Genetics, Department of Biology, University of Erlangen, 91058, Erlangen, Germany
| | - Andrea Ipsen-Escobedo
- Division of Genetics, Department of Biology, University of Erlangen, 91058, Erlangen, Germany
| | - Kilian Wistuba-Hamprecht
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Section for Clinical Bioinformatics, Department of Internal Medicine I, University Medical Center Tübingen, Tübingen, Germany
| | - Kristin Eichler
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- CatalYm GmbH, Am Klopferspitz 19, 82152, Munich, Germany
| | - Katharina Filipski
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurological Institute (Edinger Institute), University Hospital, Goethe University, Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
| | - Pia S Zeiner
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurological Institute (Edinger Institute), University Hospital, Goethe University, Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Rudi Beschorner
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Renske Goedemans
- Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Falk Hagen Gogolla
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innrain 80, 6020, Innsbruck, Austria
| | - Hubert Hackl
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innrain 80, 6020, Innsbruck, Austria
| | | | - Alexander Thiem
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
- Clinic for Dermatology and Venereology, Rostock University Medical Center, Rostock, Germany
| | - Paula Romer Roche
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- CatalYm GmbH, Am Klopferspitz 19, 82152, Munich, Germany
| | - Hemant Joshi
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63130, USA
| | - Dirk Pühringer
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Achim Wöckel
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Joachim E Diessner
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | | | - Eugen Leo
- CatalYm GmbH, Am Klopferspitz 19, 82152, Munich, Germany
| | - Phil F Cheng
- Department of Dermatology, University of Zurich, University of Zurich Hospital, Wagistrasse 18, 8952, Zürich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University of Zurich, University of Zurich Hospital, Wagistrasse 18, 8952, Zürich, Switzerland
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Markus Sauer
- Department of Biotechnology and Biophysics, Julius Maximilians University Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Falk Nimmerjahn
- Division of Genetics, Department of Biology, University of Erlangen, 91058, Erlangen, Germany
| | | | - Stefanie von Felten
- oikostat GmbH, Statistical Analyses and Consulting, Lucerne, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zürich, Switzerland
| | - Michel Mittelbronn
- Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
- Luxembourg Centre of Neuropathology (LCNP), Luxembourg, Luxembourg
- National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Dudelange, Luxembourg
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Life Sciences and Medicine (DLSM), University of Luxembourg, Luxembourg, Luxembourg
- Faculty of Science, Technology and Medicine (FSTM), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Matthias Mehling
- Department of Biomedicine and Neurology Department, University Hospital Basel, 4031, Basel, Switzerland
| | - Andreas Beilhack
- Department of Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Sjoerd H van der Burg
- Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Angela Riedel
- Mildred Scheel Early Career Center, University Hospital of Würzburg, Würzburg, Germany
| | - Benjamin Weide
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | | | - Jörg Wischhusen
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany.
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5
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Kuzkina A, Panzer C, Seger A, Schmitt D, Rößle J, Schreglmann SR, Knacke H, Salabasidou E, Kohl A, Sittig E, Barbe M, Berg D, Volkmann J, Sommer C, Oertel WH, Schaeffer E, Sommerauer M, Janzen A, Doppler K. Dermal Real-Time Quaking-Induced Conversion Is a Sensitive Marker to Confirm Isolated Rapid Eye Movement Sleep Behavior Disorder as an Early α-Synucleinopathy. Mov Disord 2023; 38:1077-1082. [PMID: 36750755 DOI: 10.1002/mds.29340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Skin biopsy is a potential tool for the premortem confirmation of an α-synucleinopathy. OBJECTIVE The aim was to assess the aggregation assay real-time quaking-induced conversion (RT-QuIC) of skin biopsy lysates to confirm isolated rapid eye movement sleep behavior disorder (iRBD) as an α-synucleinopathy. METHODS Skin biopsies of patients with iRBD, Parkinson's disease (PD), and controls were analyzed using RT-QuIC and immunohistochemical detection of phospho-α-synuclein. RESULTS α-Synuclein aggregation was detected in 97.4% of iRBD patients (78.4% of iRBD biopsies), 87.2% of PD patients (70% of PD biopsies), and 13% of controls (7.9% of control biopsies), with a higher seeding activity in iRBD compared to PD. RT-QuIC was more sensitive but less specific than immunohistochemistry. CONCLUSIONS Dermal RT-QuIC is a sensitive method to detect α-synuclein aggregation in iRBD, and high seeding activity may indicate a strong involvement of dermal nerve fibers in these patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anastasia Kuzkina
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Celine Panzer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Aline Seger
- Department of Neurology, University Hospital Cologne, University of Cologne, Köln, Germany
| | - Daniela Schmitt
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jonas Rößle
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Henrike Knacke
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elena Salabasidou
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Antonia Kohl
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Elisabeth Sittig
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Michael Barbe
- Department of Neurology, University Hospital Cologne, University of Cologne, Köln, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang H Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
- Helmholtz Center for Health and Environment, Institute for Neurogenomics, München-Neuherberg, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Sommerauer
- Department of Neurology, University Hospital Cologne, University of Cologne, Köln, Germany
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Annette Janzen
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
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6
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Kuzkina A, Rößle J, Seger A, Panzer C, Kohl A, Maltese V, Musacchio T, Blaschke SJ, Tamgüney G, Kaulitz S, Rak K, Scherzad A, Zimmermann PH, Klussmann JP, Hackenberg S, Volkmann J, Sommer C, Sommerauer M, Doppler K. Combining skin and olfactory α-synuclein seed amplification assays (SAA)-towards biomarker-driven phenotyping in synucleinopathies. NPJ Parkinsons Dis 2023; 9:79. [PMID: 37248217 DOI: 10.1038/s41531-023-00519-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Seed amplification assays (SAA) are becoming commonly used in synucleinopathies to detect α-synuclein aggregates. Studies in Parkinson's disease (PD) and isolated REM-sleep behavior disorder (iRBD) have shown a considerably lower sensitivity in the olfactory epithelium than in CSF or skin. To get an insight into α-synuclein (α-syn) distribution within the nervous system and reasons for low sensitivity, we compared SAA assessment of nasal brushings and skin biopsies in PD (n = 27) and iRBD patients (n = 18) and unaffected controls (n = 30). α-syn misfolding was overall found less commonly in the olfactory epithelium than in the skin, which could be partially explained by the nasal brushing matrix exerting an inhibitory effect on aggregation. Importantly, the α-syn distribution was not uniform: there was a higher deposition of misfolded α-syn across all sampled tissues in the iRBD cohort compared to PD (supporting the notion of RBD as a marker of a more malignant subtype of synucleinopathy) and in a subgroup of PD patients, misfolded α-syn was detectable only in the olfactory epithelium, suggestive of the recently proposed brain-first PD subtype. Assaying α-syn of diverse origins, such as olfactory (part of the central nervous system) and skin (peripheral nervous system), could increase diagnostic accuracy and allow better stratification of patients.
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Affiliation(s)
- A Kuzkina
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - J Rößle
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Seger
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Panzer
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Kohl
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - V Maltese
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - T Musacchio
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - S J Blaschke
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - G Tamgüney
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany
- Institute of Biological Information Processing (Structural Biochemistry: IBI-7), Forschungszentrum Jülich, 52428, Jülich, Germany
| | - S Kaulitz
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - K Rak
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Scherzad
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - P H Zimmermann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Strasse 62, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University Hospital Cologne, Robert-Koch-Strasse 21, 50931, Cologne, Germany
| | - J P Klussmann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Strasse 62, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University Hospital Cologne, Robert-Koch-Strasse 21, 50931, Cologne, Germany
| | - S Hackenberg
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- RWTH Aachen University, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aachen, Germany
| | - J Volkmann
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - C Sommer
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - M Sommerauer
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - K Doppler
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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7
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Kuzkina A, Bargar C, Schmitt D, Rößle J, Wang W, Schubert AL, Tatsuoka C, Gunzler SA, Zou WQ, Volkmann J, Sommer C, Doppler K, Chen SG. Diagnostic value of skin RT-QuIC in Parkinson's disease: a two-laboratory study. NPJ Parkinsons Dis 2021; 7:99. [PMID: 34782640 PMCID: PMC8593128 DOI: 10.1038/s41531-021-00242-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022] Open
Abstract
Skin α-synuclein deposition is considered a potential biomarker for Parkinson's disease (PD). Real-time quaking-induced conversion (RT-QuIC) is a novel, ultrasensitive, and efficient seeding assay that enables the detection of minute amounts of α-synuclein aggregates. We aimed to determine the diagnostic accuracy, reliability, and reproducibility of α-synuclein RT-QuIC assay of skin biopsy for diagnosing PD and to explore its correlation with clinical markers of PD in a two-center inter-laboratory comparison study. Patients with clinically diagnosed PD (n = 34), as well as control subjects (n = 30), underwent skin punch biopsy at multiple sites (neck, lower back, thigh, and lower leg). The skin biopsy samples (198 in total) were divided in half to be analyzed by RT-QuIC assay in two independent laboratories. The α-synuclein RT-QuIC assay of multiple skin biopsies supported the clinical diagnosis of PD with a diagnostic accuracy of 88.9% and showed a high degree of inter-rater agreement between the two laboratories (92.2%). Higher α-synuclein seeding activity in RT-QuIC was shown in patients with longer disease duration and more advanced disease stage and correlated with the presence of REM sleep behavior disorder, cognitive impairment, and constipation. The α-synuclein RT-QuIC assay of minimally invasive skin punch biopsy is a reliable and reproducible biomarker for Parkinson's disease. Moreover, α-synuclein RT-QuIC seeding activity in the skin may serve as a potential indicator of progression as it correlates with the disease stage and certain non-motor symptoms.
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Affiliation(s)
- Anastasia Kuzkina
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Connor Bargar
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daniela Schmitt
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Jonas Rößle
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Wen Wang
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anna-Lena Schubert
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Steven A Gunzler
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Wen-Quan Zou
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Kathrin Doppler
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany.
| | - Shu G Chen
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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8
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Miglis MG, Adler CH, Antelmi E, Arnaldi D, Baldelli L, Boeve BF, Cesari M, Dall'Antonia I, Diederich NJ, Doppler K, Dušek P, Ferri R, Gagnon JF, Gan-Or Z, Hermann W, Högl B, Hu MT, Iranzo A, Janzen A, Kuzkina A, Lee JY, Leenders KL, Lewis SJG, Liguori C, Liu J, Lo C, Ehgoetz Martens KA, Nepozitek J, Plazzi G, Provini F, Puligheddu M, Rolinski M, Rusz J, Stefani A, Summers RLS, Yoo D, Zitser J, Oertel WH. Biomarkers of conversion to α-synucleinopathy in isolated rapid-eye-movement sleep behaviour disorder. Lancet Neurol 2021; 20:671-684. [PMID: 34302789 DOI: 10.1016/s1474-4422(21)00176-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/19/2022]
Abstract
Patients with isolated rapid-eye-movement sleep behaviour disorder (RBD) are commonly regarded as being in the early stages of a progressive neurodegenerative disease involving α-synuclein pathology, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy. Abnormal α-synuclein deposition occurs early in the neurodegenerative process across the central and peripheral nervous systems and might precede the appearance of motor symptoms and cognitive decline by several decades. These findings provide the rationale to develop reliable biomarkers that can better predict conversion to clinically manifest α-synucleinopathies. In addition, biomarkers of disease progression will be essential to monitor treatment response once disease-modifying therapies become available, and biomarkers of disease subtype will be essential to enable prediction of which subtype of α-synucleinopathy patients with isolated RBD might develop.
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Affiliation(s)
- Mitchell G Miglis
- Department of Neurology and Neurological Sciences and Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA.
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Bradley F Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irene Dall'Antonia
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Nico J Diederich
- Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | | | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal-Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Ziv Gan-Or
- The Neuro-Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, and Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE), Research Site Rostock, Rostock, Germany
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Annette Janzen
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany
| | | | - Jee-Young Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Klaus L Leenders
- Department of Nuclear Medicine and Biomedical Imaging, University Medical Center Groningen, Groningen, Netherlands
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Claudio Liguori
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Christine Lo
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kaylena A Ehgoetz Martens
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; UOC Clinica Neurologica Rete Metropolitana NEUROMET, Bellaria Hospital, Bologna, Italy
| | - Monica Puligheddu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Michal Rolinski
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jennifer Zitser
- Department of Neurology and Neurological Sciences, University of California, San Francisco, CA, USA; Department of Neurology, Tel Aviv Sourasky Medical Center, Affiliate of Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wolfgang H Oertel
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany; Institute for Neurogenomics, Helmholtz Center for Health and Environment, München-Neuherberg, Germany
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9
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Doppler K, Antelmi E, Kuzkina A, Donadio V, Incensi A, Plazzi G, Pizza F, Marelli S, Ferini-Strambi L, Tinazzi M, Mayer G, Sittig E, Booij J, Sedghi A, Oertel WH, Volkmann J, Sommer C, Janzen A, Liguori R. Consistent skin α-synuclein positivity in REM sleep behavior disorder - A two center two-to-four-year follow-up study. Parkinsonism Relat Disord 2021; 86:108-113. [PMID: 33895068 DOI: 10.1016/j.parkreldis.2021.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE/METHODS Phosphorylated alpha-synuclein (p-syn) in dermal nerves of patients with isolated REM sleep behavior disorder (iRBD) is detectable by immunofluorescence-labeling. Skin-biopsy-p-syn-positivity was recently postulated to be a prodromal marker of Parkinson's disease (PD) or related synucleinopathies. Here, we provide two-to four-year clinical and skin biopsy follow-up data of 33 iRBD patients, whose skin biopsy findings at baseline were reported in 2017. RESULTS Follow-up biopsies were available from 25 patients (18 positive at baseline) and showed consistent findings over time in 24 patients. One patient converted from skin-biopsy-negativity to -positivity. P-syn-positivity was observed in iRBD patients who still had a normal FP-CIT-SPECT two years later. Clinically, five of the 23 at baseline skin-biopsy-positive patients (21.7%) had converted to PD or dementia with Lewy bodies at follow-up, but none of the skin-biopsy-negative patients. CONCLUSIONS Dermal p-syn in iRBD is most probably an early consistent marker of synucleinopathy and may support other indicators of conversion to manifest disease state.
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Affiliation(s)
- K Doppler
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany.
| | - E Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | - A Kuzkina
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - V Donadio
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - A Incensi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - G Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - F Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Marelli
- Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Centre, Milan, Italy
| | - L Ferini-Strambi
- Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Centre, Milan, Italy
| | - M Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - G Mayer
- Department of Neurology, Philipps University Marburg, Germany
| | - E Sittig
- Department of Neurology, Philipps University Marburg, Germany
| | - J Booij
- Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, the Netherlands
| | - A Sedghi
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - W H Oertel
- Department of Neurology, Philipps University Marburg, Germany; Institute for Neurogenomics, Helmholtz Center for Health and Environment, München-Neuherberg, Germany
| | - J Volkmann
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - C Sommer
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - A Janzen
- Department of Neurology, Philipps University Marburg, Germany
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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10
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Brumberg J, Kuzkina A, Lapa C, Mammadova S, Buck A, Volkmann J, Sommer C, Isaias IU, Doppler K. Dermal and cardiac autonomic fiber involvement in Parkinson's disease and multiple system atrophy. Neurobiol Dis 2021; 153:105332. [PMID: 33722614 DOI: 10.1016/j.nbd.2021.105332] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/11/2020] [Revised: 02/17/2021] [Accepted: 03/09/2021] [Indexed: 12/01/2022] Open
Abstract
Pathological aggregates of alpha-synuclein in peripheral dermal nerve fibers can be detected in patients with idiopathic Parkinson's disease and multiple system atrophy. This study combines skin biopsy staining for p-alpha-synuclein depositions and radionuclide imaging of the heart with [123I]-metaiodobenzylguanidine to explore peripheral denervation in both diseases. To this purpose, 42 patients with a clinical diagnosis of Parkinson's disease or multiple system atrophy were enrolled. All patients underwent a standardized clinical work-up including neurological evaluation, neurography, and blood samples. Skin biopsies were obtained from the distal and proximal leg, back, and neck for immunofluorescence double labeling with anti-p-alpha-synuclein and anti-PGP9.5. All patients underwent myocardial [123I]-metaiodobenzylguanidine scintigraphy. Dermal p-alpha-synuclein was observed in 47.6% of Parkinson's disease patients and was mainly found in autonomic structures. 81.0% of multiple system atrophy patients had deposits with most of cases in somatosensory fibers. The [123I]-metaiodobenzylguanidine heart-to-mediastinum ratio was lower in Parkinson's disease than in multiple system atrophy patients (1.94 ± 0.63 vs. 2.91 ± 0.96; p < 0.0001). Irrespective of the diagnosis, uptake was lower in patients with than without p-alpha-synuclein in autonomic structures (1.42 ± 0.51 vs. 2.74 ± 0.83; p < 0.0001). Rare cases of Parkinson's disease with p-alpha-synuclein in somatosensory fibers and multiple system atrophy patients with deposits in autonomic structures or both fiber types presented with clinically overlapping features. In conclusion, this study suggests that alpha-synuclein contributes to peripheral neurodegeneration and mediates the impairment of cardiac sympathetic neurons in patients with synucleinopathies. Furthermore, it indicates that Parkinson's disease and multiple system atrophy share pathophysiologic mechanisms of peripheral nervous system dysfunction with a clinical overlap.
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Affiliation(s)
- Joachim Brumberg
- Department of Nuclear Medicine, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Oberdϋrrbacher Straβe 6, 97080 Würzburg, Germany.
| | - Anastasia Kuzkina
- Department of Neurology, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Josef-Schneider-Straβe 11, 97080 Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Oberdϋrrbacher Straβe 6, 97080 Würzburg, Germany; Nuclear Medicine, Medical Faculty, University of Augsburg, Stenglinstraβe 2, 86156 Augsburg, Germany
| | - Sona Mammadova
- Department of Neurology, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Josef-Schneider-Straβe 11, 97080 Würzburg, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Oberdϋrrbacher Straβe 6, 97080 Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Josef-Schneider-Straβe 11, 97080 Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Josef-Schneider-Straβe 11, 97080 Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Josef-Schneider-Straβe 11, 97080 Würzburg, Germany
| | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg and Julius-Maximilian-University Würzburg, Josef-Schneider-Straβe 11, 97080 Würzburg, Germany
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11
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Wang Z, Becker K, Donadio V, Siedlak S, Yuan J, Rezaee M, Incensi A, Kuzkina A, Orrú CD, Tatsuoka C, Liguori R, Gunzler SA, Caughey B, Jimenez-Capdeville ME, Zhu X, Doppler K, Cui L, Chen SG, Ma J, Zou WQ. Skin α-Synuclein Aggregation Seeding Activity as a Novel Biomarker for Parkinson Disease. JAMA Neurol 2020; 78:2771032. [PMID: 32986090 PMCID: PMC7522783 DOI: 10.1001/jamaneurol.2020.3311] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/06/2020] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Deposition of the pathological α-synuclein (αSynP) in the brain is the hallmark of synucleinopathies, including Parkinson disease (PD), Lewy body dementia (LBD), and multiple system atrophy (MSA). Whether real-time quaking-induced conversion (RT-QuIC) and protein misfolding cyclic amplification (PMCA) assays can sensitively detect skin biomarkers for PD and non-PD synucleinopathies remains unknown. OBJECTIVE To develop sensitive and specific skin biomarkers for antemortem diagnosis of PD and other synucleinopathies. DESIGN, SETTING, AND PARTICIPANTS This retrospective and prospective diagnostic study evaluated autopsy and biopsy skin samples from neuropathologically and clinically diagnosed patients with PD and controls without PD. Autopsy skin samples were obtained at 3 medical centers from August 2016 to September 2019, and biopsy samples were collected from 3 institutions from August 2018 to November 2019. Based on neuropathological and clinical diagnoses, 57 cadavers with synucleinopathies and 73 cadavers with nonsynucleinopathies as well as 20 living patients with PD and 21 living controls without PD were included. Specifically, cadavers and participants had PD, LBD, MSA, Alzheimer disease, progressive supranuclear palsy, or corticobasal degeneration or were nonneurodegenerative controls (NNCs). A total of 8 approached biopsy participants either refused to participate in or were excluded from this study due to uncertain clinical diagnosis. Data were analyzed from September 2019 to April 2020. MAIN OUTCOMES AND MEASURES Skin αSynP seeding activity was analyzed by RT-QuIC and PMCA assays. RESULTS A total of 160 autopsied skin specimens from 140 cadavers (85 male cadavers [60.7%]; mean [SD] age at death, 76.8 [10.1] years) and 41 antemortem skin biopsies (27 male participants [66%]; mean [SD] age at time of biopsy, 65.3 [9.2] years) were analyzed. RT-QuIC analysis of αSynP seeding activity in autopsy abdominal skin samples from 47 PD cadavers and 43 NNCs revealed 94% sensitivity (95% CI, 85-99) and 98% specificity (95% CI, 89-100). As groups, RT-QuIC also yielded 93% sensitivity (95% CI, 85-97) and 93% specificity (95% CI, 83-97) among 57 cadavers with synucleinopathies (PD, LBD, and MSA) and 73 cadavers without synucleinopathies (Alzheimer disease, progressive supranuclear palsy, corticobasal degeneration, and NNCs). PMCA showed 82% sensitivity (95% CI, 76-88) and 96% specificity (95% CI, 85-100) with autopsy abdominal skin samples from PD cadavers. From posterior cervical and leg skin biopsy tissues from patients with PD and controls without PD, the sensitivity and specificity were 95% (95% CI, 77-100) and 100% (95% CI, 84-100), respectively, for RT-QuIC and 80% (95% CI, 49-96) and 90% (95% CI, 60-100) for PMCA. CONCLUSIONS AND RELEVANCE This study provides proof-of-concept that skin αSynP seeding activity may serve as a novel biomarker for antemortem diagnoses of PD and other synucleinopathies.
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Affiliation(s)
- Zerui Wang
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Katelyn Becker
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, Michigan
| | - Vincenzo Donadio
- IRCCS Institute of Neurological Sciences of Bologna, Complex Operational Unit Clinica Neurologica, Bologna, Italy
| | - Sandra Siedlak
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jue Yuan
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Masih Rezaee
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Alex Incensi
- IRCCS Institute of Neurological Sciences of Bologna, Complex Operational Unit Clinica Neurologica, Bologna, Italy
| | - Anastasia Kuzkina
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Christina D. Orrú
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, Hamilton, Montana
| | - Curtis Tatsuoka
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences of Bologna, Complex Operational Unit Clinica Neurologica, Bologna, Italy
| | - Steven A. Gunzler
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, Hamilton, Montana
| | | | - Xiongwei Zhu
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kathrin Doppler
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Li Cui
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shu G. Chen
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jiyan Ma
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, Michigan
| | - Wen-Quan Zou
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- National Center for Regenerative Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Donadio V, Doppler K, Incensi A, Kuzkina A, Janzen A, Mayer G, Volkmann J, Rizzo G, Antelmi E, Plazzi G, Sommer C, Liguori R, Oertel WH. Abnormal α-synuclein deposits in skin nerves: intra- and inter-laboratory reproducibility. Eur J Neurol 2019; 26:1245-1251. [PMID: 30770596 DOI: 10.1111/ene.13939] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 06/15/2018] [Accepted: 02/07/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE Visualization of phosphorylated α-synuclein at serine 129 (p-syn) in skin nerves is a promising test for the in vivo diagnosis of synucleinopathies. Here the aim was to establish the intra- and inter-laboratory reproducibility of measurement of intraneural p-syn immunoreactivity in two laboratories with major expertise (Würzburg and Bologna). METHODS In total, 43 patients affected by Parkinson's disease (PD 21 patients), dementia with Lewy bodies (DLB 1), rapid eye movement sleep behaviour disorder (RBD 11), multiple system atrophy (MSA-P 4) and small fibre neuropathy (SFN 6) were enrolled. Skin biopsy was performed at the C7 paravertebral spine region and distal skin sites (thigh or leg). The analysis was standardized in both laboratories and carried out blinded on a single skin section double stained with antibodies to p-syn and the pan-axonal marker protein gene product 9.5. Fifty skin sections were randomly selected for the analysis: 25 from C7 and 25 from distal sites. Differently classified sections were re-evaluated to understand the reasons for the discrepancy. RESULTS The intra-laboratory analysis showed an excellent reproducibility both in Würzburg (concordance of classification 100% of sections; K = 1; P < 0.001) and Bologna (96% of sections; K = 0.92; P < 0.001). Inter-laboratory analysis showed reproducibility in 45 sections (90%; K = 0.8; P < 0.001) and a different classification in five sections, which was mainly due to fragmented skin samples or weak fluorescent signals. CONCLUSIONS Analysis of p-syn showed excellent inter- and intra-laboratory reproducibility supporting the reliability of this technique. The few ascertained discordances were important to further improve the standardization of this technique.
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Affiliation(s)
- V Donadio
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - K Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - A Incensi
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - A Kuzkina
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - A Janzen
- Philipps University, Marburg, Germany
| | - G Mayer
- Philipps University, Marburg, Germany
| | - J Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - G Rizzo
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - E Antelmi
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - G Plazzi
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - C Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - R Liguori
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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Kuzkina A, Schulmeyer L, Monoranu CM, Volkmann J, Sommer C, Doppler K. The aggregation state of α-synuclein deposits in dermal nerve fibers of patients with Parkinson's disease resembles that in the brain. Parkinsonism Relat Disord 2019; 64:66-72. [DOI: 10.1016/j.parkreldis.2019.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
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Weide B, Schäfer T, Martens A, Kuzkina A, Uder L, Noor S, Garbe C, Harter PN, Mittelbronn M, Wischhusen J. High GDF-15 Serum Levels Independently Correlate with Poorer Overall Survival of Patients with Tumor-Free Stage III and Unresectable Stage IV Melanoma. J Invest Dermatol 2016; 136:2444-2452. [PMID: 27705749 DOI: 10.1016/j.jid.2016.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/03/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 12/20/2022]
Abstract
Biomarkers are strongly needed for diagnostic surveillance of patients with metastatic melanoma. On the basis of its known association with tumor metastasis and its ability to induce cancer cachexia, we investigated serum levels of growth and differentiation factor 15 (sGDF-15) as a marker for overall survival (OS). sGDF-15 was retrospectively measured by ELISA in 761 samples obtained at distinct time points during routine clinical care of patients with stage III/IV melanoma. In the entire cohort, sGDF-15 ≥ 1.5 ng/ml was strongly associated with reduced OS after assessment. Subsequent analyses were performed separately for tumor-free stage III, tumor-free stage IV, and unresectable stage IV patients. For patients with unresectable distant metastasis (n = 206), sGDF-15 was independently associated with OS when considered together with the M-category and superior to serum level of lactate dehydrogenase. Analysis in tumor-free stage III patients during routine surveillance (n = 468) revealed sGDF-15 to be associated with OS and an independent factor when considered together with S100B and the pattern of locoregional metastasis. Only in tumor-free stage IV patients (n = 87) sGDF-15 was not associated with OS. sGDF-15 should thus be further validated as a marker for early detection of recurrence in stage III patients and as a prognostic or predictive marker particularly in the context newly available treatments in unresectable stage IV patients.
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Affiliation(s)
- Benjamin Weide
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany; Department of Immunology, University of Tübingen, Tübingen, Germany.
| | - Tina Schäfer
- Department of Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Alexander Martens
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Anastasia Kuzkina
- Department of Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Laura Uder
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Seema Noor
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Edinger Institute (Neurological Institute), Goethe University, Frankfurt/Main, Germany
| | - Michel Mittelbronn
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Edinger Institute (Neurological Institute), Goethe University, Frankfurt/Main, Germany
| | - Jörg Wischhusen
- Department of Gynecology, University of Würzburg Medical School, Würzburg, Germany
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