1
|
Sturchio A, Rocha EM, Kauffman MA, Marsili L, Mahajan A, Saraf AA, Vizcarra JA, Guo Z, Espay AJ. Recalibrating the Why and Whom of Animal Models in Parkinson Disease: A Clinician's Perspective. Brain Sci 2024; 14:151. [PMID: 38391726 PMCID: PMC10887152 DOI: 10.3390/brainsci14020151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
Animal models have been used to gain pathophysiologic insights into Parkinson's disease (PD) and aid in the translational efforts of interventions with therapeutic potential in human clinical trials. However, no disease-modifying therapy for PD has successfully emerged from model predictions. These translational disappointments warrant a reappraisal of the types of preclinical questions asked of animal models. Besides the limitations of experimental designs, the one-size convergence and oversimplification yielded by a model cannot recapitulate the molecular diversity within and between PD patients. Here, we compare the strengths and pitfalls of different models, review the discrepancies between animal and human data on similar pathologic and molecular mechanisms, assess the potential of organoids as novel modeling tools, and evaluate the types of questions for which models can guide and misguide. We propose that animal models may be of greatest utility in the evaluation of molecular mechanisms, neural pathways, drug toxicity, and safety but can be unreliable or misleading when used to generate pathophysiologic hypotheses or predict therapeutic efficacy for compounds with potential neuroprotective effects in humans. To enhance the translational disease-modification potential, the modeling must reflect the biology not of a diseased population but of subtypes of diseased humans to distinguish What data are relevant and to Whom.
Collapse
Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Emily M Rocha
- Pittsburgh Institute for Neurodegenerative Diseases, Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marcelo A Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires C1221ADC, Argentina
| | - Luca Marsili
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Ameya A Saraf
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Joaquin A Vizcarra
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 15213, USA
| | - Ziyuan Guo
- Center for Stem Cell and Organoid Medicine (CuSTOM), Division of Developmental Biology, Cincinnati Children's Hospital, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| |
Collapse
|
2
|
Sturchio A, Duker AP, Muñoz-Sanjuan I, Espay AJ. Subtyping monogenic disorders: Huntington disease. Handb Clin Neurol 2023; 193:171-184. [PMID: 36803810 DOI: 10.1016/b978-0-323-85555-6.00003-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Huntington disease is a highly disabling neurodegenerative disease characterized by psychiatric, cognitive, and motor deficits. The causal genetic mutation in huntingtin (Htt, also known as IT15), located on chromosome 4p16.3, leads to an expansion of a triplet coding for polyglutamine. The expansion is invariably associated with the disease when >39 repeats. Htt encodes for the protein huntingtin (HTT), which carries out many essential biological functions in the cell, in particular in the nervous system. The precise mechanism of toxicity is not known. Based on a one-gene-one-disease framework, the prevailing hypothesis ascribes toxicity to the universal aggregation of HTT. However, the aggregation process into mutant huntingtin (mHTT) is associated with a reduction of the levels of wild-type HTT. A loss of wild-type HTT may plausibly be pathogenic, contributing to the disease onset and progressive neurodegeneration. Moreover, many other biological pathways are altered in Huntington disease, such as in the autophagic system, mitochondria, and essential proteins beyond HTT, potentially explaining biological and clinical differences among affected individuals. As one gene does not mean one disease, future efforts at identifying specific Huntington subtypes are important to design biologically tailored therapeutic approaches that correct the corresponding biological pathways-rather than continuing to exclusively target the common denominator of HTT aggregation for elimination.
Collapse
Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden.
| | - Andrew P Duker
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
| |
Collapse
|
3
|
Ezzat K, Sturchio A, Espay AJ. The shift to a proteinopenia paradigm in neurodegeneration. Handb Clin Neurol 2023; 193:23-32. [PMID: 36803814 DOI: 10.1016/b978-0-323-85555-6.00001-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The toxic proteinopathy paradigm has defined neurodegenerative disorders for over a century. This gain-of-function (GOF) framework posited that proteins become toxic when turned into amyloids (pathology), predicting that lowering its levels would translate into clinical benefits. Genetic observations used to support a GOF framework are equally compatible with a loss-of-function (LOF) framework, as the soluble pool of proteins rendered unstable by these mutations (e.g., APP in Alzheimer's disease, SNCA in Parkinson's disease) aggregate, becoming depleted. In this review, we highlight misconceptions that have prevented LOF from gaining currency. Some of these misconceptions include no phenotype in knock-out animals (there is neurodegenerative phenotype in knock-out animals) and high levels of proteins in patients (patients have lower levels of the proteins involved in neurodegeneration than healthy age-matched controls). We also expose the internal contradictions within the GOF framework, namely that (1) pathology can have both pathogenic and protective roles; (2) the neuropathology gold standard for diagnosis can be present in normal individuals and absent in those affected; (3) oligomers are the toxic species even if they are ephemeral and decrease over time. We therefore advocate for a paradigm shift from proteinopathy (GOF) to proteinopenia (LOF) based on the universal depletion of soluble functional proteins in neurodegenerative diseases (low amyloid-β 42 in Alzheimer's disease, low α-synuclein in Parkinson's disease, and low tau in progressive supranuclear palsy) and supported by the confluence of biologic, thermodynamic, and evolutionary principles with proteins having evolved to perform a function, not to become toxic, and where protein depletion is consequential. Such shift to a Proteinopenia paradigm is necessary to examining the safety and efficacy of protein replacement strategies instead of perpetuating a therapeutic paradigm with further antiprotein permutations.
Collapse
Affiliation(s)
- Kariem Ezzat
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Andrea Sturchio
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
4
|
Sturchio A, Espay AJ. The theoretical problems of "prodrome" and "phenoconversion" in neurodegeneration. Handb Clin Neurol 2023; 192:155-167. [PMID: 36796940 DOI: 10.1016/b978-0-323-85538-9.00002-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The recognition of and approach to prodromal symptoms, those which manifest before a diagnosis can be ascertained at the bedside, are of increasing interest in neurodegenerative research. A prodrome is conceived of as an early window into a disease, a critical time when putative disease-modifying interventions may be best suited for examination. Several challenges affect research in this area. Prodromal symptoms are highly prevalent in the population, can be nonprogressive for years or decades, and exhibit limited specificity in predicting conversion versus nonconversion into a neurodegenerative category within a time window feasible for most longitudinal clinical studies. In addition, there is a large range of biological alterations subsumed within each prodromal syndrome, forced to converge into the unifying nosology of each neurodegenerative disorder. Initial prodromal subtyping efforts have been developed but given the scarcity of prodrome-to-disease longitudinal studies, it is not yet clear whether any prodromal subtype can be predicted to evolve into the corresponding subtype of manifesting disease - a form of construct validity. As current subtypes generated from one clinical population are not faithfully replicated to others, it is likely that, lacking biological or molecular anchors, prodromal subtypes may only be applicable to the cohorts within which they were developed. Furthermore, as clinical subtypes have not aligned with a consistent pattern of pathology or biology, such might also be the fate of prodromal subtypes. Finally, the threshold defining the change from prodrome to disease for most neurodegenerative disorders remains clinical (e.g., a motor change in gait becoming noticeable to a clinician or measurable with portable technologies), not biological. As such, a prodrome can be viewed as a disease state not yet overt to a clinician. Efforts into identifying biological subtypes of disease, regardless of clinical phenotype or disease stage, may best serve future disease-modifying therapeutic strategies deployed not for a prodromal symptom but for a defined biological derangement as soon as it can be determined to lead to clinical changes, prodromal or not.
Collapse
Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden.
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
| |
Collapse
|
5
|
Donadio V, Sturchio A, Rizzo G, Abu Rumeileh S, Liguori R, Espay AJ. Pathology vs pathogenesis: Rationale and pitfalls in the clinicopathology model of neurodegeneration. Handb Clin Neurol 2023; 192:35-55. [PMID: 36796947 DOI: 10.1016/b978-0-323-85538-9.00001-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In neurodegenerative disorders, the term pathology is often implicitly referred to as pathogenesis. Pathology has been conceived as a window into the pathogenesis of neurodegenerative disorders. This clinicopathologic framework posits that what can be identified and quantified in postmortem brain tissue can explain both premortem clinical manifestations and the cause of death, a forensic approach to understanding neurodegeneration. As the century-old clinicopathology framework has yielded little correlation between pathology and clinical features or neuronal loss, the relationship between proteins and degeneration is ripe for revisitation. There are indeed two synchronous consequences of protein aggregation in neurodegeneration: the loss of the soluble/normal proteins on one; the accrual of the insoluble/abnormal fraction of these proteins on the other. The omission of the first part in the protein aggregation process is an artifact of the early autopsy studies: soluble, normal proteins have disappeared, with only the remaining insoluble fraction amenable to quantification. We here review the collective evidence from human data suggesting that protein aggregates, known collectively as pathology, are the consequence of many biological, toxic, and infectious exposures, but may not explain alone the cause or pathogenesis of neurodegenerative disorders.
Collapse
Affiliation(s)
- Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.
| | - Andrea Sturchio
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Samir Abu Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
6
|
Te Vruchte D, Sturchio A, Priestman DA, Tsitsi P, Hertz E, Andréasson M, Markaki I, Wallom KL, Platt F, Svenningsson P. Glycosphingolipid Changes in Plasma in Parkinson's Disease Independent of Glucosylceramide Levels. Mov Disord 2022; 37:2129-2134. [PMID: 35876461 DOI: 10.1002/mds.29163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/27/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Alteration in glycosphingolipids (GSLs) in Parkinson's disease (PD) still needs to be determined. OBJECTIVES We evaluated if PD subjects show abnormal GSLs levels compared to healthy controls (HC) and if GSLs correlate with clinical features. METHODS We analyzed GSLs and glucosylceramide (GlcCer) in plasma using two normal-phase high-performance liquid chromatography assays; clinico-demographic data were extracted. RESULTS Eighty PD subjects and 25 HCs were analyzed. Levels of GlcCer, GD1b, Gb4, GalNAcGA1, and b-series were higher in PD patients than in HCs; total GSLs, GT1b, GM1a, GM3, GM2, and a-series levels were lower in PD patients than in HCs. Changes in GSLs were present in PD subjects, with GlcCer levels similar to those in HCs. The results were similar after excluding certain GBA1 mutation carriers. Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III, correlated with Gb4 and Montreal Cognitive Assessment with GD1b levels. CONCLUSIONS Multiple GSL abnormalities in plasma were detected in patients with and without GlcCer changes, indicating a broader shift in lipid homeostasis. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
Collapse
Affiliation(s)
| | - Andrea Sturchio
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden.,James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - David A Priestman
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Panagiota Tsitsi
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden
| | - Ellen Hertz
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden
| | - Mattias Andréasson
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden
| | - Ioanna Markaki
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden
| | - Kerri-Lee Wallom
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Frances Platt
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Per Svenningsson
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden.,Department of Basic and Clinical Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
7
|
Marsili L, Duque KR, Sturchio A, Sobrero G, Premoli I, Dwivedi AK, Espay AJ, Merola A. Droxidopa reduces postural sway in Parkinson disease patients with orthostatic hypotension. Parkinsonism Relat Disord 2022; 99:62-64. [PMID: 35605513 DOI: 10.1016/j.parkreldis.2022.05.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/30/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
Abstract
We evaluate the effect of droxidopa on gait and balance measures in nine patients with Parkinson's disease and neurogenic orthostatic hypotension. Computerized gait/balance analysis showed a significant effect of droxidopa in reducing postural sway. Future studies may determine if such effect translates into improvement in postural reflexes and falls.
Collapse
Affiliation(s)
- Luca Marsili
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Kevin R Duque
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, 171 76, Stockholm, Sweden.
| | - Gabriele Sobrero
- Autonomic and Orthostatic Hypotension Unit, Department of Medical Sciences; AOU Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Isabella Premoli
- Biomarker Department, Division of Experimental Medicine, H. Lundbeck A/S, 2500, Copenhagen, Denmark; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK.
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA.
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
| |
Collapse
|
8
|
Ezzat K, Sturchio A, Espay AJ. Proteins Do Not Replicate, They Precipitate: Phase Transition and Loss of Function Toxicity in Amyloid Pathologies. Biology (Basel) 2022; 11:biology11040535. [PMID: 35453734 PMCID: PMC9031251 DOI: 10.3390/biology11040535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/11/2022]
Abstract
Protein aggregation into amyloid fibrils affects many proteins in a variety of diseases, including neurodegenerative disorders, diabetes, and cancer. Physicochemically, amyloid formation is a phase transition process, where soluble proteins are transformed into solid fibrils with the characteristic cross-β conformation responsible for their fibrillar morphology. This phase transition proceeds via an initial, rate-limiting nucleation step followed by rapid growth. Several well-defined nucleation pathways exist, including homogenous nucleation (HON), which proceeds spontaneously; heterogeneous nucleation (HEN), which is catalyzed by surfaces; and seeding via preformed nuclei. It has been hypothesized that amyloid aggregation represents a protein-only (nucleic-acid free) replication mechanism that involves transmission of structural information via conformational templating (the prion hypothesis). While the prion hypothesis still lacks mechanistic support, it is also incompatible with the fact that proteins can be induced to form amyloids in the absence of a proteinaceous species acting as a conformational template as in the case of HEN, which can be induced by lipid membranes (including viral envelopes) or polysaccharides. Additionally, while amyloids can be formed from any protein sequence and via different nucleation pathways, they invariably adopt the universal cross-β conformation; suggesting that such conformational change is a spontaneous folding event that is thermodynamically favorable under the conditions of supersaturation and phase transition and not a templated replication process. Finally, as the high stability of amyloids renders them relatively inert, toxicity in some amyloid pathologies might be more dependent on the loss of function from protein sequestration in the amyloid state rather than direct toxicity from the amyloid plaques themselves.
Collapse
Affiliation(s)
- Kariem Ezzat
- Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, 141 57 Stockholm, Sweden
- Correspondence:
| | - Andrea Sturchio
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, 171 76 Stockholm, Sweden;
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45221, USA;
| |
Collapse
|
9
|
Sturchio A, Dwivedi AK, Malm T, Wood MJ, Cilia R, Sharma JS, Hill EJ, Schneider LS, Graff-Radford NR, Mori H, Nübling G, El Andaloussi S, Svenningsson P, Ezzat K, Espay AJ. High Soluble Amyloid-β42 Predicts Normal Cognition in Amyloid-Positive Individuals with Alzheimer's Disease-Causing Mutations. J Alzheimers Dis 2022; 90:333-348. [PMID: 36120786 PMCID: PMC9661329 DOI: 10.3233/jad-220808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 08/15/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND In amyloid-positive individuals at risk for Alzheimer's disease (AD), high soluble 42-amino acid amyloid-β (Aβ42) levels are associated with normal cognition. It is unknown if this relationship applies longitudinally in a genetic cohort. OBJECTIVE To test the hypothesis that high Aβ42 preserves normal cognition in amyloid-positive individuals with Alzheimer's disease (AD)-causing mutations (APP, PSEN1, or PSEN2) to a greater extent than lower levels of brain amyloid, cerebrospinal fluid (CSF) phosphorylated tau (p-tau), or total tau (t-tau). METHODS Cognitive progression was defined as any increase in Clinical Dementia Rating (CDR = 0, normal cognition; 0.5, very mild dementia; 1, mild dementia) over 3 years. Amyloid-positivity was defined as a standard uptake value ratio (SUVR) ≥1.42 by Pittsburgh compound-B positron emission tomography (PiB-PET). We used modified Poisson regression models to estimate relative risk (RR), adjusted for age at onset, sex, education, APOE4 status, and duration of follow-up. The results were confirmed with multiple sensitivity analyses, including Cox regression. RESULTS Of 232 mutation carriers, 108 were PiB-PET-positive at baseline, with 43 (39.8%) meeting criteria for progression after 3.3±2.0 years. Soluble Aβ42 levels were higher among CDR non-progressors than CDR progressors. Higher Aβ42 predicted a lower risk of progression (adjusted RR, 0.36; 95% confidence interval [CI], 0.19-0.67; p = 0.002) better than lower SUVR (RR, 0.81; 95% CI, 0.68-0.96; p = 0.018). CSF Aβ42 levels predicting lower risk of progression increased with higher SUVR levels. CONCLUSION High CSF Aβ42 levels predict normal cognition in amyloid-positive individuals with AD-causing genetic mutations.
Collapse
Affiliation(s)
- Andrea Sturchio
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden
| | - Alok K. Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Matthew J.A. Wood
- Department of Paediatrics, University of Oxford, Oxford, UK
- MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, UK
| | - Roberto Cilia
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Jennifer S. Sharma
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Emily J. Hill
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Lon S. Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Hiroshi Mori
- Department of Clinical Neuroscience, Medical School, Osaka City University, Sutoku University, Abenoku, Osaka, Nagaoka, Japan
| | - Georg Nübling
- German Center for Neurodegenerative Diseases, Site Munich, Germany
- Department of Neurology, Ludwig-Maximilians University Munich, Germany
| | - Samir El Andaloussi
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden
| | - Kariem Ezzat
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alberto J. Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | | |
Collapse
|
10
|
Espay AJ, Ezzat K, Sturchio A. Does the Anti-Tau Strategy in Progressive Supranuclear Palsy Need to Be Reconsidered? Yes. Mov Disord Clin Pract 2021; 8:1034-1037. [PMID: 34631938 DOI: 10.1002/mdc3.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology University of Cincinnati Cincinnati Ohio USA
| | - Kariem Ezzat
- Department of Laboratory Medicine, Clinical Research Center Karolinska Institutet Stockholm Sweden
| | - Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology University of Cincinnati Cincinnati Ohio USA
- Department of Clinical Neuroscience Neuro Svenningsson, Karolinska Institute Stockholm Sweden
| |
Collapse
|
11
|
van de Wetering-van Dongen VA, Espay AJ, Marsili L, Sturchio A, Holter ST, Bloem BR, Nijkrake MJ. Biphasic (Subtherapeutic) Levodopa-Induced Respiratory Dysfunction in Parkinson Disease. Neurol Clin Pract 2021; 11:e402-e406. [PMID: 34484937 DOI: 10.1212/cpj.0000000000001043] [Citation(s) in RCA: 2] [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] [Received: 09/02/2020] [Accepted: 11/19/2020] [Indexed: 11/15/2022]
Abstract
Objective To evaluate 3 cases illustrating a rarely recognized phenotype of Parkinson disease (PD), namely, biphasic levodopa-induced respiratory dysfunction manifesting as dyspnea. Methods To appreciate the nature of the fluctuations of respiratory function in response to levodopa, we measured changes in respiratory muscle control before and after the best therapeutic response to levodopa in 3 PD patients with fluctuating dyspnea. Results Episodes of breathlessness were accompanied by shallow tachypnea and reduced respiratory muscle control, as measured by maximal expiratory pressure, peak cough flow, and forced expiratory volume in 1 second. Conclusions The spectrum of respiratory dysfunction in PD includes a biphasic reduced respiratory muscle control accompanying periods when the effect of levodopa is subtherapeutic. This biphasic levodopa-related complication represents a rarely recognized nonmotor phenomenon in PD. Management requires increasing the levodopa dose, shortening the interdose interval, or implementing a program of continuous dopaminergic stimulation.
Collapse
Affiliation(s)
- Veerle A van de Wetering-van Dongen
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| | - Alberto J Espay
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| | - Luca Marsili
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| | - Andrea Sturchio
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| | - Susanne Ten Holter
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| | - Maarten J Nijkrake
- Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands
| |
Collapse
|
12
|
Abstract
Brain proteins function in their soluble, native conformation and cease to function when transformed into insoluble aggregates, also known as amyloids. Biophysically, the soluble-to-insoluble phase transformation represents a process of polymerization, similar to crystallization, dependent on such extrinsic factors as concentration, pH, and a nucleation surface. The resulting cross-β conformation of the insoluble amyloid is markedly stable, making it an unlikely source of toxicity. The spread of brain amyloidosis can be fully explained by mechanisms of spontaneous or catalyzed polymerization and phase transformation instead of active replication, which is an enzyme- and energy-requiring process dependent on a specific nucleic acid code for the transfer of biological information with high fidelity. Early neuronal toxicity in Alzheimer's disease may therefore be mediated to a greater extent by a reduction in the pool of soluble, normal-functioning protein than its accumulation in the polymerized state. This alternative loss-of-function hypothesis of pathogenicity can be examined by assessing the clinical and neuroimaging effects of administering non-aggregating peptide analogs to replace soluble amyloid-β levels above the threshold below which neuronal toxicity may occur. Correcting the depletion of soluble amyloid-β, however, would only exemplify 'rescue medicine.' Precision medicine will necessitate identifying the pathogenic factors catalyzing the protein aggregation in each affected individual. Only then can we stratify patients for etiology-specific treatments and launch precision medicine for Alzheimer's disease and other neurodegenerative disorders.
Collapse
Affiliation(s)
- Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, 171 76 Stockholm, Sweden
| | - Lon S Schneider
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kariem Ezzat
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
13
|
Agliardi C, Guerini FR, Zanzottera M, Bolognesi E, Meloni M, Riboldazzi G, Zangaglia R, Sturchio A, Casali C, Di Lorenzo C, Minafra B, Clerici M. The VDR FokI (rs2228570) polymorphism is involved in Parkinson's disease. J Neurol Sci 2021; 428:117606. [PMID: 34365149 DOI: 10.1016/j.jns.2021.117606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/12/2021] [Revised: 07/15/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022]
Abstract
The etiology of Parkinson's disease (PD) is presumably multifactorial and likely involves interactions between genetic and environmental factors, as well as mitochondrial dysfunction, oxidative stress and inflammation. Among environmental factors, Vitamin D was reported to associate with the risk of PD. Vitamin D activity is mediated by its binding to the vitamin D Receptor (VDR), a transcriptional factor for almost 3% of human genes. We genotyped for ApaI, BsmI, TaqI, FokI and rs1989969 VDR single nucleotide polymorphisms (SNPs) a cohort of 406 PD and 800 healthy controls (HC) and found a strong association between the FokI (rs2228570) VDR SNP and PD. Thus, the TT genotype and the T allele resulted associated with PD in the overall analyzed PD population. Gender-based stratification of data indicated that results were maintained for FokI TT genotype and T allele in male PD patients, whereas the FokI T allele alone was confirmed as a risk factor for PD in females. Co-segregation analyses indicated the TaqI ApaI FokI rs1989969 GCTG as a "risk" haplotype for PD. In a subgroup of patients and controls neural Vitamin D and VDR concentration was analyzed in extravesicles (NDEVs) isolated from peripheral blood: no differences emerged between PD and HC. NDEVs results will need to be validated in ampler cohort but we can speculate that, if at neuronal level the amounts of Vitamin D and of VDR are comparable, than the bioavailability of vitamin D and the efficacy of the vitamin D/VDR axis is differentially modulated in PD by VDR SNPs.
Collapse
Affiliation(s)
| | | | | | | | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milano, Italy
| | - Giulio Riboldazzi
- Center for Parkinson's Disease and Movement Disorders, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Roberta Zangaglia
- Parkinson's disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Sturchio
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, Stockholm, Sweden
| | - Carlo Casali
- Department of Medical-Surgical Sciences and Biotechnologies, University of Rome, Roma, Italy
| | - Cherubino Di Lorenzo
- Department of Medical-Surgical Sciences and Biotechnologies, University of Rome, Roma, Italy
| | - Brigida Minafra
- Parkinson's disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| |
Collapse
|
14
|
Sturchio A, Dwivedi AK, Young CB, Malm T, Marsili L, Sharma JS, Mahajan A, Hill EJ, Andaloussi SEL, Poston KL, Manfredsson FP, Schneider LS, Ezzat K, Espay AJ. High cerebrospinal amyloid-β 42 is associated with normal cognition in individuals with brain amyloidosis. EClinicalMedicine 2021; 38:100988. [PMID: 34505023 PMCID: PMC8413261 DOI: 10.1016/j.eclinm.2021.100988] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Brain amyloidosis does not invariably predict dementia. We hypothesized that high soluble 42-amino acid β amyloid (Aβ42) peptide levels are associated with normal cognition and hippocampal volume despite increasing brain amyloidosis. METHODS This cross-sectional study of 598 amyloid-positive participants in the Alzheimer's Disease Neuroimaging Initiative cohort examined whether levels of soluble Aβ42 are higher in amyloid-positive normal cognition (NC) individuals compared to mild cognitive impairment (MCI) and Alzheimer's disease (AD) and whether this relationship applies to neuropsychological assessments and hippocampal volume measured within the same year. All subjects were evaluated between June 2010 and February 2019. Brain amyloid positivity was defined as positron emission tomography-based standard uptake value ratio (SUVR) ≥1.08 for [18] F-florbetaben or 1.11 for [18]F-florbetapir, with higher SUVR indicating more brain amyloidosis. Analyses were adjusted for age, sex, education, APOE4, p-tau, t-tau, and centiloids levels. FINDINGS Higher soluble Aβ42 levels were observed in NC (864.00 pg/ml) than in MCI (768.60 pg/ml) or AD (617.46 pg/ml), with the relationship between NC, MCI, and AD maintained across all amyloid tertiles. In adjusted analysis, there was a larger absolute effect size of soluble Aβ42 than SUVR for NC (0.82 vs. 0.40) and MCI (0.60 vs. 0.26) versus AD. Each standard deviation increase in Aβ42 was associated with greater odds of NC than AD (adjusted odds ratio, 6.26; p < 0.001) or MCI (1.42; p = 0.006). Higher soluble Aβ42 levels were also associated with better neuropsychological function and larger hippocampal volume. INTERPRETATION Normal cognition and hippocampal volume are associated with preservation of high soluble Aβ42 levels despite increasing brain amyloidosis. FUNDING Please refer to the Funding section at the end of the article.
Collapse
Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
- Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, 171 76 Stockholm, Sweden
| | - Alok K. Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Christina B. Young
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Luca Marsili
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer S. Sharma
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Emily J. Hill
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Samir EL Andaloussi
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Kathleen L. Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Lon S. Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kariem Ezzat
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
15
|
Marsili L, Sharma J, Espay AJ, Migazzi A, Abdelghany E, Hill EJ, Duque KR, Hagen MC, Stephen CD, Kovacs GG, Lang AE, Hadjivassiliou M, Basso M, Kauffman MA, Sturchio A. Neither a Novel Tau Proteinopathy nor an Expansion of a Phenotype: Reappraising Clinicopathology-Based Nosology. Int J Mol Sci 2021; 22:ijms22147292. [PMID: 34298918 PMCID: PMC8329925 DOI: 10.3390/ijms22147292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023] Open
Abstract
The gold standard for classification of neurodegenerative diseases is postmortem histopathology; however, the diagnostic odyssey of this case challenges such a clinicopathologic model. We evaluated a 60-year-old woman with a 7-year history of a progressive dystonia–ataxia syndrome with supranuclear gaze palsy, suspected to represent Niemann–Pick disease Type C. Postmortem evaluation unexpectedly demonstrated neurodegeneration with 4-repeat tau deposition in a distribution diagnostic of progressive supranuclear palsy (PSP). Whole-exome sequencing revealed a new heterozygous variant in TGM6, associated with spinocerebellar ataxia type 35 (SCA35). This novel TGM6 variant reduced transglutaminase activity in vitro, suggesting it was pathogenic. This case could be interpreted as expanding: (1) the PSP phenotype to include a spinocerebellar variant; (2) SCA35 as a tau proteinopathy; or (3) TGM6 as a novel genetic variant underlying a SCA35 phenotype with PSP pathology. None of these interpretations seem adequate. We instead hypothesize that impairment in the crosslinking of tau by the TGM6-encoded transglutaminase enzyme may compromise tau functionally and structurally, leading to its aggregation in a pattern currently classified as PSP. The lessons from this case study encourage a reassessment of our clinicopathology-based nosology.
Collapse
Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
- Correspondence: ; Tel.: +1-(513)558-4050
| | - Jennifer Sharma
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
| | - Alberto J. Espay
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
| | - Alice Migazzi
- Laboratory of Transcriptional Neurobiology, Department of Cellular, Computational and Integrative Biology—CIBIO, University of Trento, 38123 Trento, Italy; (A.M.); (M.B.)
| | - Elhusseini Abdelghany
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
| | - Emily J. Hill
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
| | - Kevin R. Duque
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
| | - Matthew C. Hagen
- Department of Pathology, University of Cincinnati, Cincinnati, OH 45219, USA;
| | - Christopher D. Stephen
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative Disease (CRND), Department of Laboratory Medicine and Pathobiology, University of Toronto, 60 Leonard Ave, Krembil Discovery Tower, Toronto, ON M5T 0S8, Canada;
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON M5T 1M8, Canada
- Edmond J. Safra Program in Parkinson’s Disease, Rossy Progressive Supranuclear Palsy Program and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada;
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson’s Disease, Rossy Progressive Supranuclear Palsy Program and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada;
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, UK;
| | - Manuela Basso
- Laboratory of Transcriptional Neurobiology, Department of Cellular, Computational and Integrative Biology—CIBIO, University of Trento, 38123 Trento, Italy; (A.M.); (M.B.)
| | - Marcelo A. Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires C1221ADC, Argentina;
| | - Andrea Sturchio
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA; (J.S.); (A.J.E.); (E.A.); (E.J.H.); (K.R.D.); (A.S.)
| |
Collapse
|
16
|
Pilotto A, Imarisio A, Conforti F, Scalvini A, Masciocchi S, Nocivelli S, Turrone R, Gipponi S, Cottini E, Borroni B, Rizzetti MC, Pizzi M, Bonanni L, Sturchio A, Espay AJ, Zetterberg H, Ashton NJ, Hye A, Padovani A. Plasma NfL, clinical subtypes and motor progression in Parkinson's disease. Parkinsonism Relat Disord 2021; 87:41-47. [PMID: 33964785 DOI: 10.1016/j.parkreldis.2021.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION neurofilament light chain (NfL) levels have been proposed as reliable biomarkers of neurodegeneration in Parkinson's disease (PD) but the relationship between plasma NfL, clinical subtypes of PD and motor progression is still debated. METHODS plasma NfL concentration was measured in 45 healthy controls and consecutive 92 PD patients who underwent an extensive motor and non-motor assessment at baseline and after 2 years of follow-up. PD malignant phenotype was defined as the combination of at least two out of cognitive impairment, orthostatic hypotension and REM sleep behavior disorder. PD patients were divided according to the age-adjusted cut-offs of plasma NfL levels into high and normal NfL (H-NfL and N-NfL, respectively). A multivariable linear regression model was used to assess the value of plasma NfL as predictor of 2-years progression in PD. RESULTS NfL was higher in PD patients than in controls (p = 0.037). H-NfL (n = 16) group exhibited more severe motor and non-motor symptoms, higher prevalence of malignant phenotype and worse motor progression (MDS-UPDRS-III 11.3 vs 0.7 points, p = 0.003) compared to N-NfL group (n = 76). In linear regression analyses plasma NfL emerged as the best predictor of 2-year motor progression compared to age, sex, disease duration, baseline motor/non-motor variables. CONCLUSION increased plasma NfL concentration is associated with malignant PD phenotype and faster motor progression. These findings support the role of NfL assessment as a useful measure for stratifying patients with different baseline slopes of decline in future clinical trials of putative disease-modifying treatments.
Collapse
Affiliation(s)
- Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy.
| | - Alberto Imarisio
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesca Conforti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Scalvini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Masciocchi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Nocivelli
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rosanna Turrone
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Gipponi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elisabetta Cottini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Marina Pizzi
- Division of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK; NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK
| | - Abdul Hye
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK; NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
17
|
Sturchio A, Gastaldi M, Cariddi LP, Biacchi D, Espay AJ, Franciotta D, Versino M, Mauri M. Levodopa-responsive progressive encephalomyelitis with rigidity and myoclonus associated with glycine receptor antibodies. Parkinsonism Relat Disord 2021; 82:7-9. [DOI: 10.1016/j.parkreldis.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
|
18
|
Sturchio A, Dwivedi AK, Vizcarra JA, Chirra M, Keeling EG, Mata IF, Kauffman MA, Pandey MK, Roviello G, Comi C, Versino M, Marsili L, Espay AJ. Genetic parkinsonisms and cancer: a systematic review and meta-analysis. Rev Neurosci 2020; 32:159-167. [PMID: 33151182 DOI: 10.1515/revneuro-2020-0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/30/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
Genes associated with parkinsonism may also be implicated in carcinogenesis, but their interplay remains unclear. We systematically reviewed studies (PubMed 1967-2019) reporting gene variants associated with both parkinsonism and cancer. Somatic variants were examined in cancer samples, whereas germline variants were examined in cancer patients with both symptomatic and asymptomatic (carriers) genetic parkinsonisms. Pooled proportions were calculated with random-effects meta-analyses. Out of 9,967 eligible articles, 60 were included. Of the 28 genetic variants associated with parkinsonism, six were also associated with cancer. In cancer samples, SNCA was predominantly associated with gastrointestinal cancers, UCHL1 with breast cancer, and PRKN with head-and-neck cancers. In asymptomatic carriers, LRRK2 was predominantly associated with gastrointestinal and prostate cancers, PRKN with prostate and genitourinary tract cancers, GBA with sarcoma, and 22q11.2 deletion with leukemia. In symptomatic genetic parkinsonism, LRRK2 was associated with nonmelanoma skin cancers and breast cancers, and PRKN with head-and-neck cancers. Cancer was more often manifested in genetic parkinsonisms compared to asymptomatic carriers. These results suggest that intraindividual genetic contributions may modify the co-occurrence of cancer and neurodegeneration.
Collapse
Affiliation(s)
- Andrea Sturchio
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| | - Alok K Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Joaquin A Vizcarra
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Martina Chirra
- Department of Oncology, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Elizabeth G Keeling
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| | - Ignacio F Mata
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marcelo A Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires, Argentina
| | - Manoj K Pandey
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, Interdisciplinary Research Centre of Autoimmune Diseases, Movement Disorders Centre, University of Piemonte Orientale, Novara, Italy
| | | | - Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| |
Collapse
|
19
|
Espay AJ, Marsili L, Mahajan A, Sturchio A, Pathan R, Pilotto A, Elango DS, Pezous N, Masellis M, Gomez-Mancilla B. Rivastigmine in Parkinson's Disease Dementia with Orthostatic Hypotension. Ann Neurol 2020; 89:91-98. [PMID: 33016374 DOI: 10.1002/ana.25923] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate if the cognitive benefit of rivastigmine is affected by the presence of orthostatic hypotension (OH) in patients with Parkinson's disease dementia (PDD). METHODS We conducted a post hoc analysis on 1,047 patients with PDD from 2 randomized controlled trials comparing rivastigmine versus placebo at week 24 (n = 501) and rivastigmine patch versus capsule at week 76 (n = 546). A drop ≥ 20 mm Hg in systolic blood pressure (SBP) or ≥ 10 in diastolic blood pressure (DBP) upon standing classified subjects as OH positive (OH+); otherwise, OH negative (OH-). The primary end point was the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) at week 24 and the Mattis Dementia Rating Scale (MDRS) at week 76, using intention-to-treat with retrieved dropout at week 24 and observed cases at week 76, consistent with the original analyses. RESULTS Overall safety was comparable between OH+ (n = 288, 27.5%) and OH- (n = 730, 69.7%), except for higher frequency of syncope (9.2%) in the OH+ placebo arm. The placebo-adjusted effect of rivastigmine on ADAS-Cog at week 24 was 5.6 ± 1.2 for OH+ and 1.9 ± 0.9 in OH- (p = 0.0165). Among subjects with OH, the MDRS change from baseline at week 76 was higher for rivastigmine capsules versus patch (10.6 ± 2.9 vs -1.5 ± 3.0, p = 0.031). The overall prevalence of OH was lower for rivastigmine than placebo at week 24 (28.3% vs 44.6%, p = 0.0476). INTERPRETATION The cognitive benefit from rivastigmine is larger in patients with PDD with OH, possibly mediated by a direct antihypotensive effect. ANN NEUROL 2021;89:91-98.
Collapse
Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | - Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | - Abhimanyu Mahajan
- Section of Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Andrea Sturchio
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB ONLUS - S. Isidoro Hospital, Trescore Balneario (BG), Italy
| | | | - Nicole Pezous
- Early Development Biostatistics, Novartis Pharma, Basel, Switzerland
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Baltazar Gomez-Mancilla
- Neuroscience Translational Medicine, Novartis Institutes for Biomedical Research, Neurology, and Neurosurgery, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
20
|
Salinas V, Vega P, Marsili L, Pérez‐Maturo J, Martínez N, Zavala L, González‐Morón D, Medina N, Rodriguez‐Quiroga SA, Amartino H, Maxit C, Sturchio A, Grimberg B, Duque K, Comas B, Silva W, Consalvo D, Sfaello I, Espay AJ, Kauffman MA. The odyssey of complex neurogenetic disorders: From undetermined to positive. Am J Med Genet 2020; 184:876-884. [DOI: 10.1002/ajmg.c.31848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Valeria Salinas
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
- Faculty of Biomedical Sciences, Precision Medicine and Clinical Genomics Group, Translational Medicine Research Institute‐CONICET Universidad Austral Buenos Aires Argentina
| | - Patricia Vega
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
| | - Luca Marsili
- UC Gardner Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's disease and Movement Disorders University of Cincinnati Ohio
| | - Josefina Pérez‐Maturo
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
- Faculty of Biomedical Sciences, Precision Medicine and Clinical Genomics Group, Translational Medicine Research Institute‐CONICET Universidad Austral Buenos Aires Argentina
| | - Nerina Martínez
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
| | - Lucia Zavala
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
| | | | - Nancy Medina
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
| | | | - Hernán Amartino
- Pediatric Neurology Unit Hospital Universitario Austral Buenos Aires Argentina
| | - Clarisa Maxit
- Pediatric Neurology Unit, Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Andrea Sturchio
- UC Gardner Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's disease and Movement Disorders University of Cincinnati Ohio
| | - Barbara Grimberg
- UC Gardner Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's disease and Movement Disorders University of Cincinnati Ohio
| | - Kevin Duque
- UC Gardner Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's disease and Movement Disorders University of Cincinnati Ohio
| | - Betiana Comas
- Neurology Unit, Hospital de la Baxada “Dra. Teresa Ratto” Paraná Entre Ríos Argentina
| | - Walter Silva
- Pediatric Neurology Unit, Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Damián Consalvo
- Neurology Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
| | - Ignacio Sfaello
- CETES, Instituto de Neurología Infanto‐Juvenil Córdoba Argentina
| | - Alberto J. Espay
- UC Gardner Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's disease and Movement Disorders University of Cincinnati Ohio
| | - Marcelo A. Kauffman
- Neurogenetics Unit, Hospital JM Ramos Mejía Buenos Aires Argentina
- Faculty of Biomedical Sciences, Precision Medicine and Clinical Genomics Group, Translational Medicine Research Institute‐CONICET Universidad Austral Buenos Aires Argentina
| |
Collapse
|
21
|
Sturchio A, Marsili L, Vizcarra JA, Dwivedi AK, Kauffman MA, Duker AP, Lu P, Pauciulo MW, Wissel BD, Hill EJ, Stecher B, Keeling EG, Vagal AS, Wang L, Haslam DB, Robson MJ, Tanner CM, Hagey DW, El Andaloussi S, Ezzat K, Fleming RMT, Lu LJ, Little MA, Espay AJ. Phenotype-Agnostic Molecular Subtyping of Neurodegenerative Disorders: The Cincinnati Cohort Biomarker Program (CCBP). Front Aging Neurosci 2020; 12:553635. [PMID: 33132895 PMCID: PMC7578373 DOI: 10.3389/fnagi.2020.553635] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 04/19/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022] Open
Abstract
Ongoing biomarker development programs have been designed to identify serologic or imaging signatures of clinico-pathologic entities, assuming distinct biological boundaries between them. Identified putative biomarkers have exhibited large variability and inconsistency between cohorts, and remain inadequate for selecting suitable recipients for potential disease-modifying interventions. We launched the Cincinnati Cohort Biomarker Program (CCBP) as a population-based, phenotype-agnostic longitudinal study. While patients affected by a wide range of neurodegenerative disorders will be deeply phenotyped using clinical, imaging, and mobile health technologies, analyses will not be anchored on phenotypic clusters but on bioassays of to-be-repurposed medications as well as on genomics, transcriptomics, proteomics, metabolomics, epigenomics, microbiomics, and pharmacogenomics analyses blinded to phenotypic data. Unique features of this cohort study include (1) a reverse biology-to-phenotype direction of biomarker development in which clinical, imaging, and mobile health technologies are subordinate to biological signals of interest; (2) hypothesis free, causally- and data driven-based analyses; (3) inclusive recruitment of patients with neurodegenerative disorders beyond clinical criteria-meeting patients with Parkinson's and Alzheimer's diseases, and (4) a large number of longitudinally followed participants. The parallel development of serum bioassays will be aimed at linking biologically suitable subjects to already available drugs with repurposing potential in future proof-of-concept adaptive clinical trials. Although many challenges are anticipated, including the unclear pathogenic relevance of identifiable biological signals and the possibility that some signals of importance may not yet be measurable with current technologies, this cohort study abandons the anchoring role of clinico-pathologic criteria in favor of biomarker-driven disease subtyping to facilitate future biosubtype-specific disease-modifying therapeutic efforts.
Collapse
Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Luca Marsili
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Joaquin A. Vizcarra
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Alok K. Dwivedi
- Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Marcelo A. Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología “José María Ramos Mejía” y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Programa de Medicina de Precision y Genomica Clinica, Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral– Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, Pilar, Argentina
| | - Andrew P. Duker
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Peixin Lu
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- School of Information Management, Wuhan University, Wuhan, China
| | - Michael W. Pauciulo
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Benjamin D. Wissel
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emily J. Hill
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Benjamin Stecher
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Elizabeth G. Keeling
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Achala S. Vagal
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Lily Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - David B. Haslam
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Matthew J. Robson
- Division of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Cincinnati, OH, United States
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for Neurosciences, Parkinson’s Disease Research Education and Clinical Center, San Francisco Veteran’s Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel W. Hagey
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Samir El Andaloussi
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Kariem Ezzat
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Ronan M. T. Fleming
- Analytical Biosciences, Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Long J. Lu
- Programa de Medicina de Precision y Genomica Clinica, Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral– Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, Pilar, Argentina
| | - Max A. Little
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson’s disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
22
|
Artusi CA, Imbalzano G, Sturchio A, Pilotto A, Montanaro E, Padovani A, Lopiano L, Maetzler W, Espay AJ. Implementation of Mobile Health Technologies in Clinical Trials of Movement Disorders: Underutilized Potential. Neurotherapeutics 2020; 17:1736-1746. [PMID: 32734442 PMCID: PMC7851293 DOI: 10.1007/s13311-020-00901-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Indexed: 02/07/2023] Open
Abstract
Mobile health technologies (mHealth) are patient-worn or portable devices aimed at increasing the granularity and relevance of clinical measurements. The implementation of mHealth has the potential to decrease sample size, duration, and cost of clinical trials. We performed a review of the ClinicalTrials.gov database using a standardized approach to identify adoption in and usefulness of mHealth in movement disorders interventional clinical trials. Trial phase, geographical area, availability of data captured, constructs of interest, and outcome priority were collected. Eligible trials underwent quality appraisal using an ad hoc 5-point checklist to assess mHealth feasibility, acceptability, correlation with patient-centered outcome measures, and clinical meaningfulness. A total of 29% (n = 54/184) registered trials were using mHealth, mainly in Parkinson's disease and essential tremor (59.3% and 27.8%). In most cases, mHealth were used in phase 2 trials (83.3%) as secondary outcome measures (59.3%). Only five phase 3 trials, representing 9.3% of the total, used mHealth (1 as primary outcome measure, 3 as secondary, and 1 as tertiary). Only 3.7% (n = 2/54) of all trials used mHealth for measuring both motor and non-motor symptoms, and 23.1% (n = 12/52) used mHealth for unsupervised, ecologic outcomes. Our findings suggest that mHealth remain underutilized and largely relegated to phase 2 trials for secondary or tertiary outcome measures. Efforts toward greater alignment of mHealth with patient-centered outcomes and development of a universal, common-language platform to synchronize data from one or more devices will assist future efforts toward the integration of mHealth into clinical trials.
Collapse
Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Andrea Sturchio
- Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati Academic Health Center, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Alberto J Espay
- Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati Academic Health Center, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA.
| |
Collapse
|
23
|
Sturchio A, Dwivedi AK, Marsili L, Hadley A, Sobrero G, Heldman D, Maule S, Lopiano L, Comi C, Versino M, Espay AJ, Merola A. Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension. J Neurol 2020; 268:1006-1015. [PMID: 32979099 DOI: 10.1007/s00415-020-10240-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/19/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that technology could predict the risk of falls in Parkinson's disease (PD) patients with orthostatic hypotension (OH) with greater accuracy than in-clinic assessment. METHODS Twenty-six consecutive PD patients with OH underwent clinical (including home-like assessments of activities of daily living) and kinematic evaluations of balance and gait as well as beat-to-beat blood pressure (BP) monitoring to estimate their association with the risk of falls. Fall frequency was captured by a diary collected prospectively over 6 months. When applicable, the sensitivity, specificity, and diagnostic accuracy were measured using the area under the receiver operating characteristics curve (AUC). Additional in-clinic assessments included the OH Symptom Assessment (OHSA), the OH Daily Activity Score (OHDAS), and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS The prevalence of falls was 53.8% over six months. There was no association between the risk of falls and test of gait and postural stability (p ≥ 0.22) or home-like activities of daily living (p > 0.08). Conversely, kinematic data (waist sway during time-up-and-go, jerkiness, and centroidal frequency during postural sway with eyes-opened) predicted the risk of falls with high sensitivity and specificity (> 80%; AUC ≥ 0.81). There was a trend for higher risk of falls in patients with orthostatic mean arterial pressure ≤ 75 mmHg. CONCLUSIONS Kinematic but not clinical measures predicted falls in PD patients with OH. Orthostatic mean arterial pressure ≤ 75 mmHg may represent a hemodynamic threshold below which falls become more prevalent, supporting the aggressive deployment of corrective measures.
Collapse
Affiliation(s)
- Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- University of Pavia, Pavia, Italy
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aaron Hadley
- Great Lakes NeuroTechnologies, Cleveland, OH, USA
| | - Gabriele Sobrero
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Simona Maule
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurizio Versino
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
| |
Collapse
|
24
|
Duque KR, Marsili L, Sturchio A, Mahajan A, Merola A, Espay AJ, Kauffman MA. Progressive Ataxia with Hemiplegic Migraines: a Phenotype of CACNA1A Missense Mutations, Not CAG Repeat Expansions. Cerebellum 2020; 20:134-139. [PMID: 32888184 DOI: 10.1007/s12311-020-01185-9] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
We report a 52-year-old woman presenting with autosomal dominant progressive cerebellar ataxia and familial hemiplegic migraine type 1 whose genetic evaluation, negative for spinocerebellar ataxia (SCA) types 1, 2, 3, and 6, revealed instead a heterozygous pathogenic missense mutation in CACNA1A (NM_001127221:c.1748G > A:p.Arg583Gln). A systematic literature review showed that Arg583Gln is associated predominantly with progressive ataxia combined with episodic disorders (overwhelmingly hemiplegic migraine) whereas Thr666Met, the other most common CACNA1A missense mutation, with a combination of progressive ataxia and episodic disorders in half the cases and episodic disorders only in the other half. While uncertainties remain in the genotype-phenotype correlation of all CACNA1A mutations, the accumulated evidence suggests that that the co-occurrence of hemiplegic migraine and autosomal dominant progressive cerebellar ataxia should guide the clinician to test for CACNA1A missense mutation rather than CAG expansions or truncating mutations.
Collapse
Affiliation(s)
- Kevin R Duque
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA
| | - Luca Marsili
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA.
| | - Andrea Sturchio
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA
| | - Abhimanyu Mahajan
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA
| | - Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA
| | - Marcelo A Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires, Argentina
| |
Collapse
|
25
|
Sturchio A, Marsili L, Mahajan A, Grimberg MB, Kauffman MA, Espay AJ. How have advances in genetic technology modified movement disorder nosology? Eur J Neurol 2020; 27:1461-1470. [PMID: 32356310 DOI: 10.1111/ene.14294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/23/2020] [Accepted: 04/27/2020] [Indexed: 01/03/2023]
Abstract
The role of genetics and its technological development have been fundamental in advancing the field of movement disorders, opening the door to precision medicine. Starting from the revolutionary discovery of the locus of the Huntington's disease gene, we review the milestones of genetic discoveries in movement disorders and their impact on clinical practice and research efforts. Before the 1980s, early techniques did not allow the identification of genetic alteration in complex diseases. Further advances increasingly defined a large number of pathogenic genetic alterations. Moreover, these techniques allowed epigenomic, transcriptomic and microbiome analyses. In the 2020s, these new technologies are poised to displace phenotype-based classifications towards a nosology based on genetic/biological data. Advances in genetic technologies are engineering a reversal of the phenotype-to-genotype order of nosology development, replacing convergent clinicopathological disease models with the genotypic divergence required for future precision medicine applications.
Collapse
Affiliation(s)
- A Sturchio
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - L Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - A Mahajan
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - M B Grimberg
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - M A Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología 'José María Ramos Mejía' y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA and Programa de Medicina de Precision y Genomica Clinica, Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Pilar, Argentina
| | - A J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
26
|
Mahajan A, Chirra M, Dwivedi AK, Sturchio A, Keeling EG, Marsili L, Espay AJ. Skin Cancer May Delay Onset but Not Progression of Parkinson's Disease: A Nested Case-Control Study. Front Neurol 2020; 11:406. [PMID: 32547471 PMCID: PMC7270344 DOI: 10.3389/fneur.2020.00406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/11/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023] Open
Abstract
Objective: To evaluate the extent to which cancer, a biological opposite to neurodegenerative disorders, may affect the onset and progression of Parkinson's disease (PD). Methods: A nested case-control design in consecutive PD patients with (cases) vs. without (controls) cancer was used to compare time to clinical diagnosis and time to Hoehn & Yahr (H&Y) staging score ≥ 3 as a measure of progression. Further, we compared PD onset and progression between cases with cancer diagnosis before (cancer before PD group) and after (cancer after PD group) PD onset. Independent variables were age at PD onset, motor subscale of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, sex, cognitive impairment, falls, depression, anxiety, dementia, and autonomic symptoms. Time to H&Y ≥ 3 was determined using Cox proportional hazards, with adjusted results summarized as hazards ratio (HR). Group differences were evaluated using unpaired t-test or Fisher's exact test. Results: The clinical PD onset was later in cases vs. controls (median 67.2 vs. 59.8 years; p < 0.001), but the adjusted time to H&Y ≥ 3 was similar between groups (HR = 0.67; p = 0.13). Skin cancers constituted 75% of all cancers in cases. Amongst skin cancers, compared to controls, cases had an older age at PD onset (67.8 vs. 59.8 years; p < 0.001). There was no difference in risk of progression in PD patients with skin cancer compared to controls (HR = 0.54, p = 0.09). Conclusions: Cancer, in particular of the skin, may delay the onset but not the progression of PD. Future prospective observational studies are warranted to elucidate the complex interactions between these biologically divergent disorders.
Collapse
Affiliation(s)
- Abhimanyu Mahajan
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Martina Chirra
- Medical Oncology Unit, Department of Oncology, University of Siena, Siena, Italy.,Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Andrea Sturchio
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Elizabeth G Keeling
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Luca Marsili
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
27
|
Marsili L, Vizcarra JA, Sturchio A, Dwivedi AK, Keeling EG, Patel D, Mishra M, Farooqi A, Merola A, Fasano A, Mata IF, Kauffman MA, Espay AJ. When does postural instability appear in monogenic parkinsonisms? An individual-patient meta-analysis. J Neurol 2020; 268:3203-3211. [PMID: 32436106 DOI: 10.1007/s00415-020-09892-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/05/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postural instability is a disease milestone signaling advanced disease. OBJECTIVES To estimate the onset of postural instability in monogenic parkinsonisms. METHODS We systematically reviewed studies (PubMed 1996-2017) in SNCA, PRKN, PINK1, DJ-1, LRRK2, ATP13A2, FBXO7, VPS35, DNAJC6, or SYNJ1-related monogenic parkinsonisms, with documented postural instability. Genes with ≥ 15 patients were included in an individual-patient meta-analysis and compared with a retrospectively collected sporadic Parkinson's disease cohort from our center. The primary outcome measure was the progression-free survival from postural instability using Kaplan-Meier survival curves. Cox proportional hazards analyses were summarized using hazards ratio (HR). RESULTS Of 2085 eligible studies, 124 met full criteria (636 patients) for the systematic review, whereas a total of 871 subjects (270 from sporadic cohort, 601 monogenic parkinsonisms) were included in the individual-patient meta-analysis. Postural instability was reported in 80% of DJ-1, 40% of PRKN, 39% of PINK1, 34% of ATP13A2, 31% of LRRK2, and 29% of SNCA patients. Progression-free survival from postural instability at 10 years after disease onset was longest in ATP13A2 (97%) and shortest in SNCA (50%). Halfway between these two extremes were PRKN (88%), PINK1 (87%), and LRRK2 (81%), similar to sporadic Parkinson's disease (72%). Higher risk of postural instability was observed in SNCA (HR = 3.2, p = 0.007) and DJ-1 (HR = 3.96, p = 0.001) compared to sporadic Parkinson's disease. Young age at onset in PINK1 and female sex in LRRK2 were associated with a decreased risk of postural instability. CONCLUSIONS Monogenic parkinsonisms exhibit differential timelines to postural instability, informing prognostic counseling and interpretation of future genotype-specific treatment trials.
Collapse
Affiliation(s)
- Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Joaquin A Vizcarra
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Elizabeth G Keeling
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Dhiren Patel
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Murli Mishra
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
- St. George's University School of Medicine, St. George, Grenada
| | - Ashar Farooqi
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Wexner Medical Center Department of Neurology, Ohio State University, Columbus, Ohio, USA
| | - Alfonso Fasano
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- CenteR for Advancing Neurotechnological Innovation To Application (CRANIA), Toronto, ON, Canada
| | - Ignacio F Mata
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marcelo A Kauffman
- Consultorio Y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires, Argentina
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University 6 of Cincinnati, Cincinnati, OH, USA.
| |
Collapse
|
28
|
Malmberg M, Malm T, Gustafsson O, Sturchio A, Graff C, Espay AJ, Wright AP, El Andaloussi S, Lindén A, Ezzat K. Disentangling the Amyloid Pathways: A Mechanistic Approach to Etiology. Front Neurosci 2020; 14:256. [PMID: 32372895 PMCID: PMC7186396 DOI: 10.3389/fnins.2020.00256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/18/2019] [Accepted: 03/06/2020] [Indexed: 12/23/2022] Open
Abstract
Amyloids are fibrillar protein aggregates associated with diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), type II diabetes and Creutzfeldt-Jakob disease. The process of amyloid polymerization involves three pathological protein transformations; from natively folded conformation to the cross-β conformation, from biophysically soluble to insoluble, and from biologically functional to non-functional. While amyloids share a similar cross-β conformation, the biophysical transformation can either take place spontaneously via a homogeneous nucleation mechanism (HON) or catalytically on an exogenous surface via a heterogeneous nucleation mechanism (HEN). Here, we postulate that the different nucleation pathways can serve as a mechanistic basis for an etiological classification of amyloidopathies, where hereditary forms generally follow the HON pathway, while sporadic forms follow seed-induced (prions) or surface-induced (including microbially induced) HEN pathways. Critically, the conformational and biophysical amyloid transformation results in loss-of-function (LOF) of the original natively folded and soluble protein. This LOF can, at least initially, be the mechanism of amyloid toxicity even before amyloid accumulation reaches toxic levels. By highlighting the important role of non-protein species in amyloid formation and LOF mechanisms of toxicity, we propose a generalized mechanistic framework that could help better understand the diverse etiology of amyloid diseases and offer new opportunities for therapeutic interventions, including replacement therapies.
Collapse
Affiliation(s)
- Maja Malmberg
- Section of Virology, Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
- SLU Global Bioinformatics Centre, Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Oskar Gustafsson
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Sturchio
- Department of Neurology and Rehabilitation Medicine, James J and Joan A Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Caroline Graff
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, James J and Joan A Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Anthony P. Wright
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Samir El Andaloussi
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Anders Lindén
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Kariem Ezzat
- Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
29
|
Artusi CA, Dwivedi A, Romagnolo A, Bortolani S, Marsili L, Imbalzano G, Sturchio A, Keeling EG, Zibetti M, Contarino MF, Fasano A, Tagliati M, Okun MS, Espay AJ, Lopiano L, Merola A. Differential response to pallidal deep brain stimulation among monogenic dystonias: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2020; 91:426-433. [PMID: 32079672 DOI: 10.1136/jnnp-2019-322169] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Genetic subtypes of dystonia may respond differentially to deep brain stimulation of the globus pallidus pars interna (GPi DBS). We sought to compare GPi DBS outcomes among the most common monogenic dystonias. METHODS This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. We searched PubMed for studies on genetically confirmed monogenic dystonia treated with GPi DBS documenting pre-surgical and post-surgical assessments using the Burke-Fahn-Marsden Dystonia Rating Scale Motor Score (BFMMS) and Burke-Fahn-Marsden Disability Score (BFMDS). We performed (i) meta-analysis for each gene mutation; (ii) weighted ordinary linear regression analyses to compare BFMMS and BFMDS outcomes between DYT-TOR1A and other monogenic dystonias, adjusting for age and disease duration and (iii) weighted linear regression analysis to estimate the effect of age, sex and disease duration on GPi DBS outcomes. Results were summarised with mean change and 95% CI. RESULTS DYT-TOR1A (68%, 38.4 points; p<0.001), DYT-THAP1 (37% 14.5 points; p<0.001) and NBIA/DYT-PANK2 (27%, 21.4 points; p<0.001) improved in BFMMS; only DYT-TOR1A improved in BFMDS (69%, 9.7 points; p<0.001). Improvement in DYT-TOR1A was significantly greater than in DYT-THAP1 (BFMMS -31%), NBIA/DYT-PANK2 (BFMMS -35%; BFMDS -53%) and CHOR/DYT-ADCY5 (BFMMS -36%; BFMDS -42%). Worse motor outcomes were associated with longer dystonia duration and older age at dystonia onset in DYT-TOR1A, longer dystonia duration in DYT/PARK-TAF1 and younger age at dystonia onset in DYT-SGCE. CONCLUSIONS GPi DBS outcomes vary across monogenic dystonias. These data serve to inform patient selection and prognostic counselling.
Collapse
Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Alok Dwivedi
- Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Sara Bortolani
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Luca Marsili
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Andrea Sturchio
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Maria Fiorella Contarino
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.,Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic. Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Michele Tagliati
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - M S Okun
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Aristide Merola
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
30
|
Mahajan A, Bader A, Wang LL, Rekhtman A, Espay AJ, Dwivedi AK, Sturchio A, Marsili L, Duker AP, Krishna V, Mandybur GT, Merola A. Thalamic Deep Brain Stimulation for tremor: The critical role of intraoperative testing. Parkinsonism Relat Disord 2020; 73:45-49. [PMID: 32247245 DOI: 10.1016/j.parkreldis.2020.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Optimal placement of Deep Brain Stimulation (DBS) lead is critical to ensure an adequate therapeutic benefit and minimize stimulation-induced side effects. METHODS We reviewed data from 2004 to 2018 of all cases of essential tremor treated with thalamic DBS at the University of Cincinnati. All procedures were performed with the patient awake. Change in parallel trajectory was classified as major repositioning, whereas a change in depth of electrode classified as minor repositioning. The following data were compared between groups (no vs. minor vs. major repositioning): age at surgery, sex, AC-PC length, third ventricle width, cerebral atrophy, small vessel disease burden, and intraoperative tremor control. Univariate and multivariate analyses were conducted to identify factors associated with intraoperative repositioning. RESULTS Of the 127 encounters with essential tremor, 71 required repositioning (33 major and 38 minor). Comparing procedures with major, minor, and no repositioning, mean number of changes per procedure (4 vs. 1.2 vs 0; p < 0.001) and AC-PC length (26 vs. 27 vs. 27.2 mm; p = 0.021) differed between the three groups. Older age at surgery (OR 1.04, p = 0.042), left side (OR 2.56, p = 0.04) and decrease in AC-PC length (OR 1.33, p = 0.026) were associated with greater odds of any (minor or major) repositioning. A decrease in AC-PC length was associated with greater odds of major repositioning (OR 1.37, p = 0.009). CONCLUSION Intraoperative functional testing may be critical to ensure the accuracy of thalamic DBS targeting based on neuroimaging data, particularly in patients with reduced AC-PC length.
Collapse
Affiliation(s)
- Abhimanyu Mahajan
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alexander Bader
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Lily L Wang
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Andrea Sturchio
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Luca Marsili
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Andrew P Duker
- James J. and Joan A. Gardner Center for Parkinson's disease and Movement disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Vibhor Krishna
- The Ohio State Wexner Medical Center, Department of Neurosurgery, Columbus, OH, USA
| | | | - Aristide Merola
- The Ohio State Wexner Medical Center, Department of Neurology, Columbus, OH, USA.
| |
Collapse
|
31
|
Agliardi C, Guerini FR, Zanzottera M, Riboldazzi G, Zangaglia R, Sturchio A, Casali C, Di Lorenzo C, Minafra B, Nemni R, Clerici M. SNAP25 Gene Polymorphisms Protect Against Parkinson's Disease and Modulate Disease Severity in Patients. Mol Neurobiol 2018; 56:4455-4463. [PMID: 30334187 DOI: 10.1007/s12035-018-1386-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/10/2018] [Accepted: 10/09/2018] [Indexed: 02/02/2023]
Abstract
Parkinson's disease (PD) is a α-synucleinopathy in which intracellular aggregates of α-synuclein (α-syn) result in neurodegeneration and in the impairment of the soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex-mediated release of neurotransmitters. SNAP25 is a SNARE complex component: its concentration is increased in the cerebrospinal fluid of PD patients and this is related to the severity of cognitive and motor symptoms. Five SNAP25 single-nucleotide polymorphisms (SNPs) that modulate gene expression and were described to play a role in neurologic conditions (rs363050, rs363039, rs363043, rs3746544, and rs1051312) were analyzed in a cohort of 412 sporadic Italian PD patients and 1103 healthy controls (HC) in order to identify possible correlation with the disease. The SNAP25 rs1051312 C allele and CC genotype confer protection against PD onset, in particular in males (p = 0.003, OR(95%CI) = 0.67(0.51-0.88)) (pc = 0.008, OR(95%CI) = 0.28(0.10-0.70)). Co-segregation analyses revealed that the rs1051312 effect was reinforced when present within the rs363043 C-rs3746544 T-rs1051312 C haplotype (p = 3.3 × 10-4, OR = 0.47, 95%CI = 0.31-0.72), once again in males. Finally, rs363039 influenced age at onset (p = 0.02) and MMSE (Mini-Mental State Examination) scores (p = 0.01). The SNAP25 SNPs analyzed herein modulate gene expression at different levels as they are involved in binding miRNA and transcription factors; this suggests a possible synergistic effect of SNAP25 SNPs in the pathogenesis of PD. A replication in a larger and independent sample will help to further explore this hypothesis.
Collapse
Affiliation(s)
| | | | | | - Giulio Riboldazzi
- Center for Parkinson's Disease and Movement Disorders, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Roberta Zangaglia
- Parkinson's disease and Movement Disorders Unit, IRCCS National Neurological Institute C. Mondino, Pavia, Italy
| | - Andrea Sturchio
- Neurology Unit-Varese, Insubria University Varese, Varese, Italy
| | - Carlo Casali
- Department of Medical-Surgical Sciences and Biotechnologies, University of Rome, Rome, Italy
| | | | - Brigida Minafra
- Parkinson's disease and Movement Disorders Unit, IRCCS National Neurological Institute C. Mondino, Pavia, Italy
| | - Raffaello Nemni
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy.,Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy.,Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
32
|
Merola A, Sturchio A, Hacker S, Serna S, Vizcarra JA, Marsili L, Fasano A, Espay AJ. Technology-based assessment of motor and nonmotor phenomena in Parkinson disease. Expert Rev Neurother 2018; 18:825-845. [PMID: 30269610 DOI: 10.1080/14737175.2018.1530593] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The increasing development and availability of portable and wearable technologies is rapidly expanding the field of technology-based objective measures (TOMs) in neurological disorders, including Parkinson disease (PD). Substantial challenges remain in the recognition of disease phenomena relevant to patients and clinicians, as well as in the identification of the most appropriate devices to carry out these measurements. Areas covered: The authors systematically reviewed PubMed for studies employing technology as outcome measures in the assessment of PD-associated motor and nonmotor abnormalities. Expert commentary: TOMs minimize intra- and inter-rater variability in clinical assessments of motor and nonmotor phenomena in PD, improving the accuracy of clinical endpoints. Critical unmet needs for the integration of TOMs into clinical and research practice are the identification and validation of relevant endpoints for individual patients, the capture of motor and nonmotor activities from an ecologically valid environment, the integration of various sensor data into an open-access, common-language platforms, and the definition of a regulatory pathway for approval of TOMs. The current lack of multidomain, multisensor, smart technologies to measure in real time a wide scope of relevant changes remain a significant limitation for the integration of technology into the assessment of PD motor and nonmotor functional disability.
Collapse
Affiliation(s)
- Aristide Merola
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Andrea Sturchio
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Stephanie Hacker
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Santiago Serna
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Joaquin A Vizcarra
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Luca Marsili
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Alfonso Fasano
- b Edmond J. Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Clinic , Toronto Western Hospital, University of Toronto; Krembil Brain Institute , Toronto , ON , Canada
| | - Alberto J Espay
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| |
Collapse
|
33
|
Kustrimovic N, Comi C, Magistrelli L, Rasini E, Legnaro M, Bombelli R, Aleksic I, Blandini F, Minafra B, Riboldazzi G, Sturchio A, Mauri M, Bono G, Marino F, Cosentino M. Parkinson's disease patients have a complex phenotypic and functional Th1 bias: cross-sectional studies of CD4+ Th1/Th2/T17 and Treg in drug-naïve and drug-treated patients. J Neuroinflammation 2018; 15:205. [PMID: 30001736 PMCID: PMC6044047 DOI: 10.1186/s12974-018-1248-8] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [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: 02/06/2018] [Accepted: 07/02/2018] [Indexed: 12/24/2022] Open
Abstract
Background Parkinson’s disease (PD) affects an estimated 7 to 10 million people worldwide, and only symptomatic treatments are presently available to relieve the consequences of brain dopaminergic neurons loss. Neuronal degeneration in PD is the consequence of neuroinflammation in turn influenced by peripheral adaptive immunity, with CD4+ T lymphocytes playing a key role. CD4+ T cells may however acquire proinflammatory phenotypes, such as T helper (Th) 1 and Th17, as well as anti-inflammatory phenotypes, such as Th2 and the T regulatory (Treg) one, and to what extent the different CD4+ T cell subsets are imbalanced and their functions dysregulated in PD remains largely an unresolved issue. Methods We performed two cross-sectional studies in antiparkinson drug-treated and drug-naïve PD patients, and in age- and sex-matched healthy subjects. In the first one, we examined circulating Th1, Th2, Th17, and in the second one circulating Treg. Number and frequency of CD4+ T cell subsets in peripheral blood were assessed by flow cytometry and their functions were studied in ex vivo assays. In both studies, complete clinical assessment, blood count and lineage-specific transcription factors mRNA levels in CD4+ T cells were independently assessed and thereafter compared for their consistency. Results PD patients have reduced circulating CD4+ T lymphocytes, due to reduced Th2, Th17, and Treg. Naïve CD4+ T cells from peripheral blood of PD patients preferentially differentiate towards the Th1 lineage. Production of interferon-γ and tumor necrosis factor-α by CD4+ T cells from PD patients is increased and maintained in the presence of homologous Treg. This Th1-biased immune signature occurs in both drug-naïve patients and in patients on dopaminergic drugs, suggesting that current antiparkinson drugs do not affect peripheral adaptive immunity. Conclusions The complex phenotypic and functional profile of CD4+ T cell subsets in PD patients strengthen the evidence that peripheral adaptive immunity is involved in PD, and represents a target for the preclinical and clinical assessment of novel immunomodulating therapeutics. Electronic supplementary material The online version of this article (10.1186/s12974-018-1248-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Natasa Kustrimovic
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy
| | - Cristoforo Comi
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Emanuela Rasini
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy
| | - Massimiliano Legnaro
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy
| | - Raffaella Bombelli
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy
| | - Iva Aleksic
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy
| | - Fabio Blandini
- Center for Research in Neurodegenerative Diseases, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Brigida Minafra
- Center for Research in Neurodegenerative Diseases, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Giulio Riboldazzi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Andrea Sturchio
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Mauri
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Bono
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy
| | - Marco Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, VA, Italy.
| |
Collapse
|
34
|
Portaccio E, Ghezzi A, Hakiki B, Sturchio A, Martinelli V, Moiola L, Patti F, Mancardi GL, Solaro C, Tola MR, Pozzilli C, De Giglio L, Totaro R, Lugaresi A, De Luca G, Paolicelli D, Marrosu MG, Comi G, Trojano M, Amato MP. Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs. J Neurol Neurosurg Psychiatry 2014; 85:845-50. [PMID: 24403285 DOI: 10.1136/jnnp-2013-306054] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess relapses, disability progression and the role of disease modifying drugs (DMDs) in the year after delivery in women with multiple sclerosis (MS). METHODS We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centres. The risk of relapses and disability progression in the year after delivery was assessed using time-dependent Cox regression analysis. RESULTS 350 out of 423 pregnancies were assessed (pregnancies not resulting in live birth and with a postpartum follow-up period shorter than 1 year were excluded from the analysis). 148 patients (42.3%) had at least one relapse in the year after delivery. An Expanded Disability Status Scale (EDSS) score at conception ≥2.0 (HR=1.4; 95% CI 1.1 to 2.0; p=0.046) and a higher number of relapses before (HR=1.5; 95% CI 1.2 to 1.8; p<0.001) and during pregnancy (HR=2.3; 95% CI 1.6 to 3.4; p<0.001) were related to a higher risk of postpartum relapses. On the contrary, early DMD resumption after delivery marginally reduced the risk of postpartum relapses (HR=0.7, 95% CI 0.4 to 1.0; p=0.079). Moreover, 44/338 women progressed by at least one point on the EDSS. Disability progression was associated with a higher number of relapses before (HR=1.4, 95% CI 1.1 to 1.9; p=0.047) and after delivery (HR=2.7, 95% CI 1.4 to 5.2; p=0.002). CONCLUSIONS Our findings show an increased risk of postpartum relapses and disability accrual in women with higher disease activity before and during pregnancy. Since it may reduce the risk of postpartum relapses, early DMD resumption should be encouraged, particularly in patients with more active disease.
Collapse
Affiliation(s)
- Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Bahia Hakiki
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Andrea Sturchio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Lucia Moiola
- Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Patti
- Department of Neurology, University of Catania, Catania, Italy
| | | | | | | | - Carlo Pozzilli
- Department of Neurology and Psychiatry, "La Sapienza" University, Rome, Italy
| | - Laura De Giglio
- Department of Neurology and Psychiatry, "La Sapienza" University, Rome, Italy
| | - Rocco Totaro
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Lugaresi
- Department of Neuroscience and Imaging, University "G. d'Annunzio" of Chieti, Chieti, Italy
| | - Giovanna De Luca
- Department of Neuroscience and Imaging, University "G. d'Annunzio" of Chieti, Chieti, Italy
| | | | - Maria Giovanna Marrosu
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Giancarlo Comi
- Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Trojano
- Department of Neurology, University of Bari, Bari, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | | |
Collapse
|
35
|
Pecori C, Giannini M, Portaccio E, Ghezzi A, Hakiki B, Pastò L, Razzolini L, Sturchio A, De Giglio L, Pozzilli C, Paolicelli D, Trojano M, Marrosu MG, Patti F, Mancardi GL, Solaro C, Totaro R, Tola MR, De Luca G, Lugaresi A, Moiola L, Martinelli V, Comi G, Amato MP. Paternal therapy with disease modifying drugs in multiple sclerosis and pregnancy outcomes: a prospective observational multicentric study. BMC Neurol 2014; 14:114. [PMID: 24884599 PMCID: PMC4059028 DOI: 10.1186/1471-2377-14-114] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 03/11/2014] [Accepted: 05/20/2014] [Indexed: 01/05/2023] Open
Abstract
Background Most of Multiple Sclerosis (MS) patients undergo disease modifying drug (DMD) therapy at childbearing age. The objective of this prospective, collaborative study, was to assess outcomes of pregnancies fathered by MS patients undergoing DMD. Methods Structured interviews on pregnancies fathered by MS patients gathered in the Italian Pregnancy Dataset were collected; pregnancies were divided according to father exposure or unexposure to DMD at time of procreation. Treatment were compared with multivariable logistic and linear models. Results Seventy-eight pregnancies fathered by MS patients were tracked. Forty-five patients were taking DMD at time of conception (39 beta-interferons, 6 glatiramer acetate), while 33 pregnancies were unexposed to DMD. Seventy-five pregnancies ended in live-births, 44 in the exposed and 31 in the unexposed group. No significant differences between the two groups were found in the risk of spontaneous abortion or malformations (p > 0.454), mean gestational age (p = 0.513), frequency of cesarean delivery (p = 0.644), birth weight (p = 0.821) and birth length (p = 0.649). In comparison with data of the Italian general population, the proportion of spontaneous abortion and caesarean delivery in exposed pregnancies fell within the estimates, while the proportion of pre-term delivery in the exposed group was higher than expected. Conclusions Our data indicate no association between paternal DMD exposure at time of conception and risk of spontaneous abortion, adverse fetal outcomes and congenital malformations. Further studies clarifying the role of DMD fathers intake prior and during pregnancy are desirable, to supply guidelines for clinical practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Pia Amato
- Department of NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
| | | |
Collapse
|