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Parvizi T, Klotz S, Keritam O, Caliskan H, Imhof S, König T, Haider L, Traub-Weidinger T, Wagner M, Brunet T, Brugger M, Zimprich A, Rath J, Stögmann E, Gelpi E, Cetin H. Clinical heterogeneity within the ALS-FTD spectrum in a family with a homozygous optineurin mutation. Ann Clin Transl Neurol 2024. [PMID: 38689506 DOI: 10.1002/acn3.52075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Mutations in the gene encoding for optineurin (OPTN) have been reported in the context of different neurodegenerative diseases including the amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) spectrum. Based on single case reports, neuropathological data in OPTN mutation carriers have revealed transactive response DNA-binding protein 43 kDa (TDP-43) pathology, in addition to accumulations of tau and alpha-synuclein. Herein, we present two siblings from a consanguineous family with a homozygous frameshift mutation in the OPTN gene and different clinical presentations. METHODS Both affected siblings underwent (i) clinical, (ii) neurophysiological, (iii) neuropsychological, (iv) radiological, and (v) laboratory examinations, and (vi) whole-exome sequencing (WES). Postmortem histopathological examination was conducted in the index patient, who deceased at the age of 41. RESULTS The index patient developed rapidly progressing clinical features of upper and lower motor neuron dysfunction as well as apathy and cognitive deterioration at the age of 41. Autopsy revealed an ALS-FTLD pattern associated with prominent neuronal and oligodendroglial TDP-43 pathology, and an atypical limbic 4-repeat tau pathology reminiscent of argyrophilic grain disease. The brother of the index patient exhibited behavioral changes and mnestic deficits at the age of 38 and was diagnosed with behavioral FTD 5 years later, without any evidence of motor neuron dysfunction. WES revealed a homozygous frameshift mutation in the OPTN gene in both siblings (NM_001008212.2: c.1078_1079del; p.Lys360ValfsTer18). INTERPRETATION OPTN mutations can be associated with extensive TDP-43 pathology and limbic-predominant tauopathy and present with a heterogeneous clinical phenotype within the ALS-FTD spectrum within the same family.
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Affiliation(s)
- Tandis Parvizi
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Sigrid Klotz
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Haluk Caliskan
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sophie Imhof
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Theresa König
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Matias Wagner
- Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany
- Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - Theresa Brunet
- Institute of Human Genetics, Technical University Munich, Munich, Germany
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr. von Hauner's Children's Hospital, University of Munich, Munich, Germany
| | - Melanie Brugger
- Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - Alexander Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Stögmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ellen Gelpi
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Krenn M, Wagner M, Zulehner G, Weng R, Jäger F, Keritam O, Sener M, Brücke C, Milenkovic I, Langer A, Buchinger D, Habersam R, Mayerhanser K, Brugger M, Brunet T, Jacob M, Graf E, Berutti R, Cetin H, Hoefele J, Winkelmann J, Zimprich F, Rath J. Next-generation sequencing and comprehensive data reassessment in 263 adult patients with neuromuscular disorders: insights into the gray zone of molecular diagnoses. J Neurol 2024; 271:1937-1946. [PMID: 38127101 DOI: 10.1007/s00415-023-12101-6] [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: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Neuromuscular disorders (NMDs) are heterogeneous conditions with a considerable fraction attributed to monogenic defects. Despite the advancements in genomic medicine, many patients remain without a diagnosis. Here, we investigate whether a comprehensive reassessment strategy improves the diagnostic outcomes. METHODS We analyzed 263 patients with NMD phenotypes that underwent diagnostic exome or genome sequencing at our tertiary referral center between 2015 and 2023. We applied a comprehensive reassessment encompassing variant reclassification, re-phenotyping and NGS data reanalysis. Multivariable logistic regression was performed to identify predictive factors associated with a molecular diagnosis. RESULTS Initially, a molecular diagnosis was identified in 53 cases (20%), while an additional 23 (9%) had findings of uncertain significance. Following comprehensive reassessment, the diagnostic yield increased to 23%, revealing 44 distinct monogenic etiologies. Reasons for newly obtained molecular diagnoses were variant reclassifications in 7 and NGS data reanalysis in 3 cases including one recently described disease-gene association (DNAJB4). Male sex reduced the odds of receiving a molecular diagnosis (OR 0.42; 95%CI 0.21-0.82), while a positive family history (OR 5.46; 95%CI 2.60-11.76) and a myopathy phenotype (OR 2.72; 95%CI 1.11-7.14) increased the likelihood. 7% were resolved through targeted genetic testing or classified as acquired etiologies. CONCLUSION Our findings reinforce the use of NGS in NMDs of suspected monogenic origin. We show that a comprehensive reassessment enhances diagnostic accuracy. However, one needs to be aware that genetic diagnoses are often made with uncertainty and can even be downgraded based on new evidence.
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Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Matias Wagner
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Rosa Weng
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Fiona Jäger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Merve Sener
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ivan Milenkovic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Agnes Langer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Dominic Buchinger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Richard Habersam
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Katharina Mayerhanser
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Melanie Brugger
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Theresa Brunet
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr. Von Hauner's Children's Hospital, University of Munich, Munich, Germany
| | - Maureen Jacob
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Elisabeth Graf
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Riccardo Berutti
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Juliane Winkelmann
- Institute of Human Genetics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
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Emre TY, Cetin H, Selcuk H, Kilic KK, Aykanat F, Sarikcioglu L, Kose O. Comparison of five different fluoroscopic methods for identifying the MPFL femoral footprint. Arch Orthop Trauma Surg 2024; 144:1675-1684. [PMID: 38400901 PMCID: PMC10965741 DOI: 10.1007/s00402-024-05213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/24/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE The success of medial patellofemoral ligament (MPFL) reconstruction is closely linked to the precise positioning of the femoral tunnel. Intraoperative fluoroscopy is commonly utilized to identify the MPFL footprint. This study aimed to ascertain the most accurate fluoroscopic method among the five previously described methods used to determine the MPFL femoral footprint. MATERIALS AND METHODS Using 44 well-preserved dry femur bones, the MPFL femoral insertion site was demarcated using anatomical bony landmarks, namely the center of the saddle sulcus between the medial epicondyle, adductor tubercle and gastrocnemius tubercle. Fluoroscopic true lateral knee images were acquired and measurements taken, referencing established methods by Schottle et al., Redfern et al., Wijdicks et al., Barnett et al., and Kaipel et al. The distance between anatomic and fluoroscopic MPFL footprints was then measured on digital fluoroscopic images. The accuracy of the locations was compared using a margin of error of 5 and 7 mm. RESULTS The Schottle method consistently emerged superior, showcasing the smallest mean distance (3.2 ± 1.2 mm) between the anatomic and radiographic MPFL footprints and a high in-point detection rate of 90.9% under 5 mm criteria. While the Redfern method displayed perfect accuracy (100%) within the 7 mm criteria, the Schottle method also performed 97.7% accuracy. CONCLUSIONS For intraoperative identification of the MPFL footprint using fluoroscopy, the Schottle method is the most consistent and accurate among the assessed methods. Thus, its accuracy in detecting the MPFL footprint makes it recommended for MPFLR to ensure optimal outcomes. LEVEL OF EVIDENCE Level IV, cadaveric study.
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Affiliation(s)
- Tuluhan Yunus Emre
- Department of Orthopaedics and Traumatology, Kadikoy Hospital, Acıbadem University, Istanbul, Turkey
| | - Hakan Cetin
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd., Muratpasa, 07100, Antalya, Turkey
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd., Muratpasa, 07100, Antalya, Turkey
| | - Koray Kaya Kilic
- Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Faruk Aykanat
- Medical Faculty Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, Turkey
| | - Levent Sarikcioglu
- Department of Anatomy, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd., Muratpasa, 07100, Antalya, Turkey.
- Department of Anatomy, Medical Faculty, Akdeniz University, Antalya, Turkey.
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Kastrati K, Nakhost Lotfi N, Tawfik MG, Gelpi E, Hametner S, Höftberger R, Zimprich F, Cetin H, Lindeck-Pozza E, Heil PM, Kiener HP, Heinz LX, Mrak D, Aletaha D, Bonelli M, Radner H. Impact of muscle biopsy on the clinical decision-making process in patients with suspected idiopathic inflammatory myopathy. J Autoimmun 2024; 144:103185. [PMID: 38428109 DOI: 10.1016/j.jaut.2024.103185] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The significance of muscle biopsy as a diagnostic tool in idiopathic inflammatory myopathies (IIM) remains elusive. We aimed to determine the diagnostic weight that has been given to muscle biopsy in patients with suspected IIM, particularly in terms of clinical diagnosis and therapeutic decisions. MATERIAL AND METHODS In this retrospective multicentric study, we analyzed muscle biopsy results of adult patients with suspected IIM referred to a tertiary center between January 1, 2007, and October 31, 2021. Information regarding referral department, suspected diagnosis, biopsy site, demographic, clinical, laboratory data, and imaging results were extracted. Statistical analyses included the level of agreement between suspected and histological diagnosis and calculation of diagnostic performance (positive and negative predictive values, positive and negative likelihood ratios, sensitivity, and specificity of muscle biopsy in relation to clinical diagnosis and/or treatment initiation). Performance was tested in different strata based on clinical pre-test probability. RESULTS Among 758 muscle biopsies, IIM was histologically compatible in 357/758 (47.1%) cases. Proportion of IIM was higher if there was a solid clinical pre-test probability (64.3% vs. 42.4% vs. 48% for high, medium and low pre-test probability). Sensitivity and specificity of muscle biopsy were highest (82%) when the diagnosis by the clinician was used as outcome scenario. Negative predictive value was only moderate (between 63% and 80%) and lowest if autoantibodies were positive (35%). CONCLUSION In patients with clinically suspected IIM, approximately 50% of biopsies revealed features indicative of IIM. Diagnostic performance of muscle biopsy was moderate to high depending on clinical pre-test probability.
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Affiliation(s)
- Kastriot Kastrati
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Nasim Nakhost Lotfi
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marwa G Tawfik
- Department of Rheumatology and Rehabilitation, Suez Canal University, Ismailia, Egypt
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | | | | | - Hans P Kiener
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Leonhard X Heinz
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniel Mrak
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Bonelli
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Helga Radner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Kleinveld VEA, Keritam O, Horlings CGC, Cetin H, Wanschitz J, Hotter A, Zirch LS, Zimprich F, Topakian R, Müller P, Oel D, Quasthoff S, Erdler M, Rauschka H, Grinzinger S, Jecel J, Gaulhofer P, Castek B, Stadler K, Löscher WN. Multifocal motor neuropathy as a mimic of amyotrophic lateral sclerosis: Serum neurofilament light chain as a reliable diagnostic biomarker. Muscle Nerve 2024; 69:422-427. [PMID: 38334356 DOI: 10.1002/mus.28054] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION/AIMS The clinical presentation of multifocal motor neuropathy (MMN) may mimic early amyotrophic lateral sclerosis (ALS) with predominant lower motor neuron (LMN) involvement, posing a diagnostic challenge. Both diseases have specific treatments and prognoses, highlighting the importance of early diagnosis. The aim of this study was to assess the diagnostic value of serum neurofilament light chain (NfL) in differentiating MMN from LMN dominant ALS. METHODS NfL was measured in serum in n = 37 patients with MMN and n = 37 age- and sex-matched patients with LMN dominant ALS, to determine the diagnostic accuracy. Clinical and demographic data were obtained at the time of NfL sampling. RESULTS Serum NfL concentration was significantly lower in MMN patients compared to ALS patients (mean 20.7 pg/mL vs. 59.4 pg/mL, p < .01). NfL demonstrated good diagnostic value in discriminating the two groups (AUC 0.985 [95% CI 0.963-1.000], sensitivity 94.6%, specificity 100%, cut-off 44.00 pg/mL). DISCUSSION NfL could be a helpful tool in differentiating MMN from LMN dominant ALS in those patients in whom electrophysiological and clinical examinations remain inconclusive early in the diagnostic process.
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Affiliation(s)
- Vera E A Kleinveld
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Hotter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura S Zirch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
- Klinisches Forschungsinstitut Neurowissenschaften, Johannes Kepler UniversitätLinz, Linz, Austria
| | - Petra Müller
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Dierk Oel
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Marcus Erdler
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Helmut Rauschka
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Susanne Grinzinger
- Department of Neurology, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
| | - Julia Jecel
- Department of Neurology, KH Hietzing, Vienna, Austria
| | | | | | | | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Esteller D, Schiava M, Verdú-Díaz J, Villar-Quiles RN, Dibowski B, Venturelli N, Laforet P, Alonso-Pérez J, Olive M, Domínguez-González C, Paradas C, Vélez B, Kostera-Pruszczyk A, Kierdaszuk B, Rodolico C, Claeys K, Pál E, Malfatti E, Souvannanorath S, Alonso-Jiménez A, de Ridder W, De Smet E, Papadimas G, Papadopoulos C, Xirou S, Luo S, Muelas N, Vilchez JJ, Ramos-Fransi A, Monforte M, Tasca G, Udd B, Palmio J, Sri S, Krause S, Schoser B, Fernández-Torrón R, López de Munain A, Pegoraro E, Farrugia ME, Vorgerd M, Manousakis G, Chanson JB, Nadaj-Pakleza A, Cetin H, Badrising U, Warman-Chardon J, Bevilacqua J, Earle N, Campero M, Díaz J, Ikenaga C, Lloyd TE, Nishino I, Nishimori Y, Saito Y, Oya Y, Takahashi Y, Nishikawa A, Sasaki R, Marini-Bettolo C, Guglieri M, Straub V, Stojkovic T, Carlier RY, Díaz-Manera J. Correction to: Analysis of muscle magnetic resonance imaging of a large cohort of patient with VCP‑mediated disease reveals characteristic features useful for diagnosis. J Neurol 2024; 271:2147-2148. [PMID: 38349561 DOI: 10.1007/s00415-023-12178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Diana Esteller
- Neurology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - José Verdú-Díaz
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Rocío-Nur Villar-Quiles
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Boris Dibowski
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Nadia Venturelli
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Pascal Laforet
- Département de Neurologie Hôpital Raymond-Poincaré Garches France Inserm U1179, Garches, France
| | - Jorge Alonso-Pérez
- Servicio de Neurología. Hospital Virgen de la Candelaria, Tenerife, Spain
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montse Olive
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Domínguez-González
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Instituto de Investigación imas12, Hospital 12 de Octubre, Madrid, Spain
| | - Carmen Paradas
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Beatriz Vélez
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Carmelo Rodolico
- UOC di Neurologia e Malattie Neuromuscolari, AOU Policlinico "G. Martino", Rome, Italy
| | - Kristl Claeys
- Neurologie, Neuromusculair Referentiecentrum, Universitaire Ziekenhuizen, Leuven, Belgium
| | - Endre Pál
- Neurology Department, University of Pécs, Pécs, Hungary
| | - Edoardo Malfatti
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | - Sarah Souvannanorath
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | | | - Willem de Ridder
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - Eline De Smet
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - George Papadimas
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | | | - Sofia Xirou
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | - Sushan Luo
- Neurology Department, Huashan Hospital, Fudan University, Shangai, China
| | - Nuria Muelas
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Juan J Vilchez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Alba Ramos-Fransi
- Unitat de Malalties Neuromusculars, Servei de Neurologia, Hospital Germans Tries I Pujol, Badalona, Spain
| | - Mauro Monforte
- UOC di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Bjarne Udd
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Johanna Palmio
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Srtuhi Sri
- Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sabine Krause
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Roberto Fernández-Torrón
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Adolfo López de Munain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Mathias Vorgerd
- Heimer Institut for Muscle Research, Klinikum Bergmannsheil Ruhr, University Bochum, Bochum, Germany
| | | | - Jean Baptiste Chanson
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aleksandra Nadaj-Pakleza
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hakan Cetin
- Neurology Department, Medical University of Vienna, Vienna, Austria
| | | | | | - Jorge Bevilacqua
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Nicholas Earle
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Mario Campero
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Jorge Díaz
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Chiseko Ikenaga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yukako Nishimori
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, NCNP, Tokyo, Japan
| | - Yoshiaki Takahashi
- Department of Neurology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | | | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Tanya Stojkovic
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Robert Y Carlier
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Jordi Díaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom.
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
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7
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Yagdiran B, Cakir BT, Cetin H. Diagnostic Contribution of Additional Sequences to the Evaluation of Cord Lesions in Patients with Cervical Spinal Multiple Sclerosis in Turkey: A Retrospective Study. Niger J Clin Pract 2024; 27:272-279. [PMID: 38409158 DOI: 10.4103/njcp.njcp_333_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in young adults. Spinal cord involvement is observed in 55-75% of patients with MS. AIM To identify the strengths and shortcomings of sagittal phase-sensitive inversion recovery (PSIR), sagittal proton density/T2-weighted (PD/T2W), and axial turbo inversion recovery magnitude (TIRM) sequences in the detection of cervical MS plaques by comparing with routine sequences (axial and sagittal T2W, sagittal T1W, sagittal TIRM, fat-suppressed contrast T1W) and therefore determine their diagnostic contributions. MATERIALS AND METHODS A total of 48 patients in whom additional magnetic resonance imaging (MRI) sequences were obtained for the diagnosis of cervical MS were retrospectively identified and included in the study. A total of 111 MS plaques were analyzed in terms of visibility, number, size, border sharpness, and intensity ratio based on the routine and additional MRI sequences. The evaluation of the images was independently undertaken by two radiologists. RESULTS The highest visibility was provided by sagittal PSIR, sagittal TIRM, and axial TIRM sequences (P < 0.05 for all additional sequences). Seven lesions in PD/T2W and four lesions in axial T2W sequences were unable to be detected. Lesions seen in sagittal and axial TIRM sequences were larger than the others. The sharpest borders were determined in the axial TIRM sequence, and the most diffuse borders in the PD/T2W sequence. In intensity ratio, the sagittal PSIR sequence revealed the most significant contrast difference. CONCLUSION The sagittal PSIR sequence may improve the detection of cervical MS plaques due to the improved visibility and intensity ratios. The axial TIRM sequence may be more useful than routine axial T2W in the evaluation of visibility, border sharpness, and size measurement of MS plaques.
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Affiliation(s)
- B Yagdiran
- Department of Radiology, Başkent University, Faculty of Medicine, Fevzi Çakmak Cd. 10. Sk. No: 45 Bahçelievler/ANKARA, Turkey
| | - B T Cakir
- Department of Radiology, Gülhane Training and Research Hospital, General Dr. Tevfik Sağlam Cd. No: 1 Etlik/Ankara, Turkey
| | - H Cetin
- Department of Radiology, Yildirim Beyazit University, Üniversiteler Mahallesi Bilkent Caddesi No: 1, Çankaya, Ankara, Turkey
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8
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Esteller D, Schiava M, Verdú-Díaz J, Villar-Quiles RN, Dibowski B, Venturelli N, Laforet P, Alonso-Pérez J, Olive M, Domínguez-González C, Paradas C, Vélez B, Kostera-Pruszczyk A, Kierdaszuk B, Rodolico C, Claeys K, Pál E, Malfatti E, Souvannanorath S, Alonso-Jiménez A, de Ridder W, De Smet E, Papadimas G, Papadopoulos C, Xirou S, Luo S, Muelas N, Vilchez JJ, Ramos-Fransi A, Monforte M, Tasca G, Udd B, Palmio J, Sri S, Krause S, Schoser B, Fernández-Torrón R, López de Munain A, Pegoraro E, Farrugia ME, Vorgerd M, Manousakis G, Chanson JB, Nadaj-Pakleza A, Cetin H, Badrising U, Warman-Chardon J, Bevilacqua J, Earle N, Campero M, Díaz J, Ikenaga C, Lloyd TE, Nishino I, Nishimori Y, Saito Y, Oya Y, Takahashi Y, Nishikawa A, Sasaki R, Marini-Bettolo C, Guglieri M, Straub V, Stojkovic T, Carlier RY, Díaz-Manera J. Analysis of muscle magnetic resonance imaging of a large cohort of patient with VCP-mediated disease reveals characteristic features useful for diagnosis. J Neurol 2023; 270:5849-5865. [PMID: 37603075 PMCID: PMC10632218 DOI: 10.1007/s00415-023-11862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The diagnosis of patients with mutations in the VCP gene can be complicated due to their broad phenotypic spectrum including myopathy, motor neuron disease and peripheral neuropathy. Muscle MRI guides the diagnosis in neuromuscular diseases (NMDs); however, comprehensive muscle MRI features for VCP patients have not been reported so far. METHODS We collected muscle MRIs of 80 of the 255 patients who participated in the "VCP International Study" and reviewed the T1-weighted (T1w) and short tau inversion recovery (STIR) sequences. We identified a series of potential diagnostic MRI based characteristics useful for the diagnosis of VCP disease and validated them in 1089 MRIs from patients with other genetically confirmed NMDs. RESULTS Fat replacement of at least one muscle was identified in all symptomatic patients. The most common finding was the existence of patchy areas of fat replacement. Although there was a wide variability of muscles affected, we observed a common pattern characterized by the involvement of periscapular, paraspinal, gluteal and quadriceps muscles. STIR signal was enhanced in 67% of the patients, either in the muscle itself or in the surrounding fascia. We identified 10 diagnostic characteristics based on the pattern identified that allowed us to distinguish VCP disease from other neuromuscular diseases with high accuracy. CONCLUSIONS Patients with mutations in the VCP gene had common features on muscle MRI that are helpful for diagnosis purposes, including the presence of patchy fat replacement and a prominent involvement of the periscapular, paraspinal, abdominal and thigh muscles.
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Affiliation(s)
- Diana Esteller
- Neurology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - José Verdú-Díaz
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Rocío-Nur Villar-Quiles
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Boris Dibowski
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Nadia Venturelli
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Pascal Laforet
- Département de Neurologie Hôpital Raymond-Poincaré Garches France Inserm U1179, Garches, France
| | - Jorge Alonso-Pérez
- Servicio de Neurología. Hospital Virgen de la Candelaria, Tenerife, Spain
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montse Olive
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Domínguez-González
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Instituto de Investigación imas12, Hospital 12 de Octubre, Madrid, Spain
| | - Carmen Paradas
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Beatriz Vélez
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Carmelo Rodolico
- UOC di Neurologia e Malattie Neuromuscolari, AOU Policlinico "G. Martino", Rome, Italy
| | - Kristl Claeys
- Neurologie, Neuromusculair Referentiecentrum, Universitaire Ziekenhuizen, Leuven, Belgium
| | - Endre Pál
- Neurology Department, University of Pécs, Pécs, Hungary
| | - Edoardo Malfatti
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | - Sarah Souvannanorath
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | | | - Willem de Ridder
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - Eline De Smet
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - George Papadimas
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | | | - Sofia Xirou
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | - Sushan Luo
- Neurology Department, Huashan Hospital, Fudan University, Shangai, China
| | - Nuria Muelas
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Juan J Vilchez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Alba Ramos-Fransi
- Unitat de Malalties Neuromusculars, Servei de Neurologia, Hospital Germans Tries I Pujol, Badalona, Spain
| | - Mauro Monforte
- UOC di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Bjarne Udd
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Johanna Palmio
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Srtuhi Sri
- Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sabine Krause
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Roberto Fernández-Torrón
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Adolfo López de Munain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Mathias Vorgerd
- Heimer Institut for Muscle Research, Klinikum Bergmannsheil Ruhr, University Bochum, Bochum, Germany
| | | | - Jean Baptiste Chanson
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aleksandra Nadaj-Pakleza
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hakan Cetin
- Neurology Department, Medical University of Vienna, Vienna, Austria
| | | | | | - Jorge Bevilacqua
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Nicholas Earle
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Mario Campero
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Jorge Díaz
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Chiseko Ikenaga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yukako Nishimori
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, NCNP, Tokyo, Japan
| | - Yoshiaki Takahashi
- Department of Neurology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | | | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Tanya Stojkovic
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Robert Y Carlier
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Jordi Díaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom.
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
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9
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Frohne A, Koenighofer M, Cetin H, Nieratschker M, Liu DT, Laccone F, Neesen J, Nemec SF, Schwarz-Nemec U, Schoefer C, Avraham KB, Frei K, Grabmeier-Pfistershammer K, Kratzer B, Schmetterer K, Pickl WF, Parzefall T. A homozygous AP3D1 missense variant in patients with sensorineural hearing loss as the leading manifestation. Hum Genet 2023; 142:1077-1089. [PMID: 36445457 PMCID: PMC10449960 DOI: 10.1007/s00439-022-02506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
Loss-of-function variants in AP3D1 have been linked to Hermansky-Pudlak syndrome (HPS) 10, a severe multisystem disorder characterized by oculocutaneous albinism, immunodeficiency, neurodevelopmental delay, hearing loss (HL), and neurological abnormalities, fatal in early childhood. Here, we report a consanguineous family who presented with presumably isolated autosomal recessive (AR) HL. Whole-exome sequencing was performed on all core family members, and selected patients were screened using array-based copy-number analysis and karyotyping. Candidate variants were validated by Sanger sequencing and assessed in silico. A homozygous, likely pathogenic p.V711I missense variant in AP3D1 segregated with the HL. The family was characterized by thorough medical and laboratory examination. The HL was consistent across patients and accompanied by neurological manifestations in two brothers. The sole female patient was diagnosed with premature ovarian failure. Further findings, including mild neutropenia and reduced NK-cell cytotoxicity in some as well as brain alterations in all homozygous patients, were reminiscent of HPS10, though milder and lacking the characteristic albinism. Previously unrecognized, milder, isolated HL was identified in all heterozygous carriers. A protein model indicates that the variant interferes with protein-protein interactions. These results suggest that a missense variant alters inner-ear-specific functions leading to HL with mild HPS10-like symptoms of variable penetrance. Milder HL in heterozygous carriers may point towards semi-dominant inheritance of this trait. Since all previously reported HPS10 cases were pediatric, it is unknown whether the observed primary ovarian insufficiency recapitulates the subfertility in Ap3d1-deficient mice.
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Affiliation(s)
- Alexandra Frohne
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Center of Anatomy and Cell Biology, Department for Cell and Developmental Biology, Medical University of Vienna, Vienna, Austria
| | - Martin Koenighofer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Nieratschker
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Franco Laccone
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Juergen Neesen
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Stefan F Nemec
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Schoefer
- Center of Anatomy and Cell Biology, Department for Cell and Developmental Biology, Medical University of Vienna, Vienna, Austria
| | - Karen B Avraham
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Klemens Frei
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Bernhard Kratzer
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Klaus Schmetterer
- Center of Translational Research, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Winfried F Pickl
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Parzefall
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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10
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Wurm R, Parvizi T, Goeschl S, Untersteiner H, Silvaieh S, Stamm T, Cetin H, Reichardt B, Stögmann E. Analysis of co-medication in people with dementia. Eur J Neurol 2023; 30:823-830. [PMID: 36632031 DOI: 10.1111/ene.15675] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Dementia prevalence is increasing, with numbers projected to double by 2050. Risk factors for its development include age and cardiovascular comorbidities, which are found more often in patients with dementia and should be treated properly to improve outcomes. In this case-control study, we analysed a large population-based prescription database to explore the patterns of co-medication in patients with dementia. METHODS Prescription claims covering >99% of the Austrian population from 2005 to 2016 were obtained. Patients who were treated with an approved antidementia drug (ADD) were included and co-medication exposure was recorded. A group of people not taking ADDs was matched for age, sex and follow-up duration as a control. RESULTS We included 70,799 patients on ADDs who were exposed to a mean of 5.3 co-medications while control patients were treated with a total of 5.2 co-medications (p < 0.001). We found that patients on ADDs received less somatic (4.1 vs. 4.5) but more psychiatric medication (1.1 vs. 0.6; p < 0.001 for both). Patients on ADDs were less likely to be treated for pain, cardiovascular conditions or hyperlipidemia. More than 50% of patients on ADDs were treated with antidepressants or antipsychotics. Greater number of co-medications was associated with markers of more intensive antidementia treatment. CONCLUSION Patients on ADDs received more medications overall but were less frequently treated for somatic conditions known to be more prevalent in this group. Together, our data suggest that management of comorbidities in dementia could be improved to optimize outcome and quality of life.
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Affiliation(s)
- Raphael Wurm
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Tandis Parvizi
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Stella Goeschl
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | | | - Sara Silvaieh
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Tanja Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Wien, Austria
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11
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Krenn M, Sener M, Rath J, Zulehner G, Keritam O, Wagner M, Laccone F, Iglseder S, Marte S, Baumgartner M, Eisenkölbl A, Liechtenstein C, Rudnik S, Quasthoff S, Grinzinger S, Spenger J, Wortmann SB, Löscher WN, Zimprich F, Kellersmann A, Rappold M, Bernert G, Freilinger M, Cetin H. The clinical and molecular landscape of congenital myasthenic syndromes in Austria: a nationwide study. J Neurol 2023; 270:909-916. [PMID: 36308527 PMCID: PMC9886627 DOI: 10.1007/s00415-022-11440-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Congenital myasthenic syndromes (CMS) are a heterogeneous group of disorders caused by genetic defects resulting in impaired neuromuscular transmission. Although effective treatments are available, CMS is probably underdiagnosed, and systematic clinico-genetic investigations are warranted. METHODS We used a nationwide approach to collect Austrian patients with genetically confirmed CMS. We provide a clinical and molecular characterization of this cohort and aimed to ascertain the current frequency of CMS in Austria. RESULTS Twenty-eight cases with genetically confirmed CMS were identified, corresponding to an overall prevalence of 3.1 per million (95% CI 2.0-4.3) in Austria. The most frequent genetic etiology was CHRNE (n = 13), accounting for 46.4% of the cohort. Within this subgroup, the variant c.1327del, p.(Glu443Lysfs*64) was detected in nine individuals. Moreover, causative variants were found in DOK7 (n = 4), RAPSN (n = 3), COLQ (n = 2), GMPPB (n = 2), CHAT (n = 1), COL13A1 (n = 1), MUSK (n = 1) and AGRN (n = 1). Clinical onset within the first year of life was reported in one half of the patients. Across all subtypes, the most common symptoms were ptosis (85.7%), lower limb (67.9%), upper limb (60.7%) and facial weakness (60.7%). The majority of patients (96.4%) received specific treatment, including acetylcholinesterase inhibitors in 20, adrenergic agonists in 11 and 3,4-diaminopyridine in nine patients. CONCLUSIONS Our study presents the first systematic characterization of individuals with CMS in Austria, providing prevalence estimates and genotype-phenotype correlations that may help to improve the diagnostic approach and patient management.
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Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Merve Sener
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matias Wagner
- Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Institute for Neurogenomics, Helmholtz Center Munich, Munich, Germany
| | - Franco Laccone
- Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Stephan Iglseder
- Department of Neurology, Krankenhaus Barmherzige Brüder, Linz, Austria
| | | | - Manuela Baumgartner
- Department of Neuropaediatrics, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - Astrid Eisenkölbl
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Christian Liechtenstein
- Department of Paediatrics and Adolescent Medicine, Villach Regional Hospital, Villach, Austria
| | - Sabine Rudnik
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Susanne Grinzinger
- Department of Neurology, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
| | - Johannes Spenger
- University Children's Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Saskia B Wortmann
- University Children's Hospital, Paracelsus Medical University, Salzburg, Austria.,Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Mika Rappold
- Department of Pediatrics, Klinik Favoriten, Vienna, Austria
| | | | - Michael Freilinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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12
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Hametner S, Silvaieh S, Thurnher M, Dal-Bianco A, Cetin H, Ponleitner M, Zebenholzer K, Pemp B, Trattnig S, Rössler K, Berger T, Lassmann H, Hainfellner JA, Bsteh G. A case of primary optic pathway demyelination caused by oncocytic oligodendrogliopathy of unknown origin. Acta Neuropathol Commun 2022; 10:160. [DOI: 10.1186/s40478-022-01462-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
AbstractWe report the case of a 22-year-old woman presenting with an acute onset of dizziness, gait dysbalance and blurred vision. Magnetic resonance imaging included 3 Tesla and 7 Tesla imaging and revealed a T2-hyperintense, T1-hypointense, non-contrast-enhancing lesion strictly confined to the white matter affecting the right optic radiation. An extensive ophthalmologic examination yielded mild quadrantanopia but no signs of optic neuropathy. The lesion was biopsied. The neuropathological evaluation revealed a demyelinating lesion with marked tissue vacuolization and granular myelin disintegration accompanied by mild T cell infiltration and a notable absence of myelin uptake by macrophages. Oligodendrocytes were strikingly enlarged, displaying oncocytic characteristics and showed cytoplasmic accumulation of mitochondria, which had mildly abnormal morphology on electron microscopy. The diagnosis of multiple sclerosis was excluded. Harding's disease, a variant of Leber's hereditary optic neuropathy, was then suspected. However, neither PCR for relevant mutations nor whole exome sequencing yielded known pathogenetic mutations in the patient's genome. We present a pattern of demyelinating tissue injury of unknown etiology with an oncocytic change of oligodendrocytes and a lack of adequate phagocytic response by macrophages, which to the best of our knowledge, has not been described before.
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13
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König T, Wurm R, Parvizi T, Silvaieh S, Hotzy C, Cetin H, Klotz S, Gelpi E, Bancher C, Benke T, Dal-Bianco P, Defrancesco M, Fischer P, Marksteiner J, Sutterlüty H, Ransmayr G, Schmidt R, Zimprich A, Stögmann E. C9orf72 repeat length might influence clinical sub-phenotypes in dementia patients. Neurobiol Dis 2022; 175:105927. [DOI: 10.1016/j.nbd.2022.105927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/27/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
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14
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Krenn M, Gelpi E, Simonitsch-Klupp I, Kasprian G, Zulehner G, Grisold A, Zimprich F, Cetin H, Hülsmann M, Wohlfarth P. Muscle involvement in T-cell large granular lymphocytic leukemia presenting with asymmetric limb-girdle weakness and scapular winging. Muscle Nerve 2022; 66:E18-E21. [PMID: 35906958 DOI: 10.1002/mus.27690] [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: 02/03/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gudun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Philipp Wohlfarth
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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15
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Schiava M, Ikenaga C, Villar-Quiles RN, Caballero-Ávila M, Topf A, Nishino I, Kimonis V, Udd B, Schoser B, Zanoteli E, Souza PVS, Tasca G, Lloyd T, Lopez-de Munain A, Paradas C, Pegoraro E, Nadaj-Pakleza A, De Bleecker J, Badrising U, Alonso-Jiménez A, Kostera-Pruszczyk A, Miralles F, Shin JH, Bevilacqua JA, Olivé M, Vorgerd M, Kley R, Brady S, Williams T, Domínguez-González C, Papadimas GK, Warman-Chardon J, Claeys KG, de Visser M, Muelas N, LaForet P, Malfatti E, Alfano LN, Nair SS, Manousakis G, Kushlaf HA, Harms MB, Nance C, Ramos-Fransi A, Rodolico C, Hewamadduma C, Cetin H, García-García J, Pál E, Farrugia ME, Lamont PJ, Quinn C, Nedkova-Hristova V, Peric S, Luo S, Oldfors A, Taylor K, Ralston S, Stojkovic T, Weihl C, Diaz-Manera J. Genotype-phenotype correlations in valosin-containing protein disease: a retrospective muticentre study. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-328921. [PMID: 35896379 PMCID: PMC9880250 DOI: 10.1136/jnnp-2022-328921] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Valosin-containing protein (VCP) disease, caused by mutations in the VCP gene, results in myopathy, Paget's disease of bone (PBD) and frontotemporal dementia (FTD). Natural history and genotype-phenotype correlation data are limited. This study characterises patients with mutations in VCP gene and investigates genotype-phenotype correlations. METHODS Descriptive retrospective international study collecting clinical and genetic data of patients with mutations in the VCP gene. RESULTS Two hundred and fifty-five patients (70.0% males) were included in the study. Mean age was 56.8±9.6 years and mean age of onset 45.6±9.3 years. Mean diagnostic delay was 7.7±6 years. Symmetric lower limb weakness was reported in 50% at onset progressing to generalised muscle weakness. Other common symptoms were ventilatory insufficiency 40.3%, PDB 28.2%, dysautonomia 21.4% and FTD 14.3%. Fifty-seven genetic variants were identified, 18 of these no previously reported. c.464G>A (p.Arg155His) was the most frequent variant, identified in the 28%. Full time wheelchair users accounted for 19.1% with a median time from disease onset to been wheelchair user of 8.5 years. Variant c.463C>T (p.Arg155Cys) showed an earlier onset (37.8±7.6 year) and a higher frequency of axial and upper limb weakness, scapular winging and cognitive impairment. Forced vital capacity (FVC) below 50% was as risk factor for being full-time wheelchair user, while FVC <70% and being a full-time wheelchair user were associated with death. CONCLUSION This study expands the knowledge on the phenotypic presentation, natural history, genotype-phenotype correlations and risk factors for disease progression of VCP disease and is useful to improve the care provided to patient with this complex disease.
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Affiliation(s)
- Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University, and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Chiseko Ikenaga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rocío Nur Villar-Quiles
- APHP, Centre de référence des maladies neuromusculaires, Institut de Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marta Caballero-Ávila
- Neuromuscular Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Topf
- Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle University, Newcastle upon Tyne, UK
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Virginia Kimonis
- Department of Pediatrics Division of Genetics and Genomic Medicine, University of California-Irvine Medical Center Children’s Hospital of Orange County, Orange, California, USA
| | - Bjarne Udd
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute Ludwig Maximilian University Clinics, Munich, Germany
| | - Edmar Zanoteli
- Department of Neurology, School of Medicine, Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Thomas Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adolfo Lopez-de Munain
- Biodonostia Neurosciences Area Group of Neuromuscular Diseases Biodonostia-Osakidetza Basque Health Service, San Sebastian, Spain
| | - Carmen Paradas
- Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Center for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Aleksandra Nadaj-Pakleza
- Department of Neurology, Centre de Reference des Maldies Neuromusculaires Nord-Est-Ile de France, University Hospital of Strasbourg, Strasbourg, France
| | - Jan De Bleecker
- Department of Neurology and Neuromuscular Reference Center, Ghent University Hospital, Ghent, Belgium
| | - Umesh Badrising
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alicia Alonso-Jiménez
- Department of Neurology, Neuromuscular Reference Centre, Antwerp University Hospital, Universiteit Antwerpen, Instituut Born Bunge, Antwerpen, Belgium
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, European Reference Network ERN-NMD, Warsaw, Poland
| | - Francesc Miralles
- Department of Neurology, Unitat de Patologia Neuromuscular i Gabinet d’electrodiagnòstic, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jin-Hong Shin
- Laboratory of Molecular Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jorge Alfredo Bevilacqua
- Unidad Neuromuscular, Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
- Departamento de Neurología y Neurocirugía Clínica, Clínica Dávila, Santiago Chile, Chile
| | - Montse Olivé
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Deaprtment of Neurology, Neuromuscular Disorders Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Matthias Vorgerd
- Heimer Institut for Muscle Research, Klinikum Bergmannsheil, Ruhr University, Bochum, Germany
| | - Rudi Kley
- Department of Neurology and Clinical Neurophysiology, St Marien-Hospital Borken, Borken, Germany
| | - Stefen Brady
- Neurology Department, John Radcliffe Hospital, Oxford, UK
| | - Timothy Williams
- Newcastle Motor Neurone Disease Care Centre, Royal Victoria Infirmary, Newcastle, UK
| | - Cristina Domínguez-González
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
- Neurology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - George K Papadimas
- First Department of Neurology, Medical School, Eginition Hospital and National and Kapodistrian University of Athens, Athens, Greece
| | - Jodi Warman-Chardon
- Department of Medicine, Ottawa Neuromuscular Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Laboratory for Muscle Diseases and Neuropathies, Leuven, Belgium
| | - Marianne de Visser
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nuria Muelas
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
- Neuromuscular Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pascal LaForet
- Neurology department, Raymond-Poincaré hospital, APHP, UVSQ, Paris-Saclay University, Paris, France
| | - Edoardo Malfatti
- APHP, Neuromuscular Reference Center Nord-Est-Ile-de-France, Henri Mondor Hospital, Université Paris Est, U955, INSERM, Créteil, IMRB, Paris, France
| | - Lindsay N Alfano
- Center for Gene Therapy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota Hospital, Minneapolis, Minnesota, USA
| | - Hani A Kushlaf
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matthew B Harms
- NewYork Presbyterian Columbia University Irving Medical Centre, New York, New York, USA
| | - Christopher Nance
- Department of Neurology, Carver College of Medicine at the University of Iowa, Iowa, Iowa, USA
| | - Alba Ramos-Fransi
- Neuromuscular Unit, Neurology Department, Hospital Germas Trias i Pujol, Badalona, Spain
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Channa Hewamadduma
- Sheffield Institute for translational neurosciences (SITRAN), Neuroscience Institute, University of Sheffield, Sheffield, UK
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jorge García-García
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Endre Pál
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Maria Elena Farrugia
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Phillipa J Lamont
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Colin Quinn
- Neuromuscular Division, Neurology Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Stojan Peric
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sushan Luo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Anders Oldfors
- Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Stuart Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Tanya Stojkovic
- APHP, Centre de référence des maladies neuromusculaires, Institut de Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Conrad Weihl
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University, and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Panhuber A, Lamorte G, Bruno V, Cetin H, Bauer W, Höftberger R, Erber AC, Frommlet F, Koneczny I. A systematic review and meta-analysis of HLA class II associations in patients with IgG4 autoimmunity. Sci Rep 2022; 12:9229. [PMID: 35654912 PMCID: PMC9163138 DOI: 10.1038/s41598-022-13042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Autoimmune diseases caused by pathogenic IgG4 subclass autoantibodies (IgG4-AID) include diseases like MuSK myasthenia gravis, pemphigus vulgaris or thrombotic thrombocytopenic purpura. Their etiology is still unknown. Polymorphisms in the human leukocyte antigen (HLA) gene locus, particularly in HLA-DRB1, are known genetic susceptibility factors for autoimmune diseases. We hypothesized a similar role for HLA polymorphisms in IgG4-AID and conducted a systematic review and meta-analysis with case-control studies on IgG4-AID based on MOOSE/ HuGENet guidelines. Genotype (G) and allele (A) frequencies of HLA-DQB1*05 (G: OR 3.8; 95% CI 2.44-5.9; p < 0.00001; A: OR 2.54; 95% CI 1.82-3.55; p < 0.00001) and HLA-DRB1*14 (G: OR 4.31; 95% CI 2.82-6.59; p < 0.00001; A: OR 4.78; 95% CI 3.52-6.49; p < 0.00001) and the HLA-DRB1*14-DQB1*05 haplotype (OR 6.3; 95% CI 3.28-12.09; p < 0.00001/OR 4.98; 95% CI 3.8-6.53; p < 0.00001) were increased while HLA-DRB1*13 (G: OR 0.48; 95% CI 0.34-0.68; p < 0.0001; A: OR 0.46; 95% CI 0.34-0.62; p < 0.00001) was decreased in IgG4-AID patients. In conclusion, the HLA-DQB1*05, HLA-DRB1*14 alleles and the HLA-DQB1*05-DRB1*14 haplotype could be genetic risk factors that predispose for the production of pathogenic IgG4 autoantibodies and the HLA-DRB1*13 allele may protect from IgG4 autoimmunity.
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Affiliation(s)
- Anja Panhuber
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Giovanni Lamorte
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Veronica Bruno
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Bauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Astrid C Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Florian Frommlet
- Center for Medical Statistics Informatics and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Borch JDS, Krag T, Holm-Yildiz SD, Cetin H, Solheim TA, Fornander F, Straub V, Duno M, Vissing J. Three novel FHL1 Variants cause a mild Phenotype of Emery-Dreifuss Muscular Dystrophy. Hum Mutat 2022; 43:1234-1238. [PMID: 35607917 PMCID: PMC9545859 DOI: 10.1002/humu.24415] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/14/2022] [Accepted: 05/22/2022] [Indexed: 11/11/2022]
Abstract
Emery-Dreifuss muscular dystrophy (EDMD) is a hereditary muscle disease, characterized by the clinical triade of early-onset joint contractures, progressive muscle weakness and cardiac involvement. Pathogenic variants in FHL1 can cause a rare X-linked recessive form of EDMD, type 6. We report three men with novel variants in FHL1 leading to EDMD6. Onset of muscle symptoms was in late adulthood and muscle weakness was not prominent in either of the patients. All patients had hypertrophic cardiomyopathy and one of them also had cardiac arrhythmias. Western blot performed on muscle biopsies from two of the patients showed no FHL1 protein expression. We predict that the variant in the third patient also leads to absence of FHL1 protein. Complete loss of all FHL1 isoforms combined with mild muscle involvement supports the hypothesis that loss of all FHL1 isoforms is more benign than the cytotoxic effects of expressed FHL1 protein with pathogenic missense variants. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Josefine D S Borch
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Thomas Krag
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Sonja D Holm-Yildiz
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Austria
| | - Tuva A Solheim
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Freja Fornander
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 3BZ, UK
| | - Morten Duno
- Department of Clinical Genetics, section 4062, Rigshospitalet, University of Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
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18
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Rath J, Taborsky M, Moser B, Zulehner G, Weng R, Krenn M, Cetin H, Matilla JRR, Müllauer L, Zimprich F. Short-term and sustained clinical response following thymectomy in patients with myasthenia gravis. Eur J Neurol 2022; 29:2453-2462. [PMID: 35435305 PMCID: PMC9541265 DOI: 10.1111/ene.15362] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate short- and long-term outcome following thymectomy in patients with acetylcholine-receptor-antibody (AchR-Ab) positive myasthenia gravis (MG). METHODS Rates of clinical response (defined as minimal manifestation, pharmacological or complete stable remission) lasting for at least one year were retrospectively analyzed using Cox proportional hazard models. The occurrence of relapses was recorded during follow-up. Clinical factors associated with achieving an initial or a sustained response were analyzed. RESULTS 94 patients with a median age of 33 years (IQR 22-51), 68% with non-thymomatous MG and 32% with thymoma-associated MG were included. An initial clinical response was reached in 72% (68/94). Neither sex, age at onset, thymus histology, delay to surgery after disease onset, surgical approach, corticosteroid treatment nor clinical severity before thymectomy were significantly associated with achieving this endpoint. During long-term follow-up (median 89.5 months; IQR 46-189.5) only half of the patients with an initial response (34/68) had a sustained response without relapses. No clinical factors predicted if the response would become sustained. In patients without immunosuppressive treatment before thymectomy (n=24), a high AChR-Ab levels reduction rate after thymectomy was associated with a higher likelihood of achieving an initial response (p=0.03). CONCLUSION Sustained long-term clinical response of MG patients after thymectomy is significantly lower than the initial response rates would suggest. The observation that none of the evaluated clinical factors was associated with a worse outcome supports the current clinical practice of patient selection for thymectomy. The relative decline of AchR-antibodies after surgery appears to be a promising prognostic marker.
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Affiliation(s)
- Jakob Rath
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Manuela Taborsky
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rosa Weng
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - José Ramon R Matilla
- Department of Thoracic Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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19
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Aghakhani A, Pena-Francesch A, Bozuyuk U, Cetin H, Wrede P, Sitti M. High shear rate propulsion of acoustic microrobots in complex biological fluids. Sci Adv 2022; 8:eabm5126. [PMID: 35275716 PMCID: PMC8916727 DOI: 10.1126/sciadv.abm5126] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/20/2022] [Indexed: 05/28/2023]
Abstract
Untethered microrobots offer a great promise for localized targeted therapy in hard-to-access spaces in our body. Despite recent advancements, most microrobot propulsion capabilities have been limited to homogenous Newtonian fluids. However, the biological fluids present in our body are heterogeneous and have shear rate-dependent rheological properties, which limit the propulsion of microrobots using conventional designs and actuation methods. We propose an acoustically powered microrobotic system, consisting of a three-dimensionally printed 30-micrometer-diameter hollow body with an oscillatory microbubble, to generate high shear rate fluidic flow for propulsion in complex biofluids. The acoustically induced microstreaming flow leads to distinct surface-slipping and puller-type propulsion modes in Newtonian and non-Newtonian fluids, respectively. We demonstrate efficient propulsion of the microrobots in diverse biological fluids, including in vitro navigation through mucus layers on biologically relevant three-dimensional surfaces. The microrobot design and high shear rate propulsion mechanism discussed herein could open new possibilities to deploy microrobots in complex biofluids toward minimally invasive targeted therapy.
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Affiliation(s)
- Amirreza Aghakhani
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Abdon Pena-Francesch
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
- Department of Materials Science and Engineering, Macromolecular Science and Engineering, Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ugur Bozuyuk
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
- Institute for Biomedical Engineering, ETH Zürich,, 8092 Zürich, Switzerland
| | - Hakan Cetin
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
- Electrical and Electronics Engineering Department, Özyegin University, 34794 Istanbul, Turkey
| | - Paul Wrede
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Metin Sitti
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
- Institute for Biomedical Engineering, ETH Zürich,, 8092 Zürich, Switzerland
- School of Medicine and College of Engineering, Koç University, 34450 Istanbul, Turkey
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20
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Krenn M, Tomschik M, Wagner M, Zulehner G, Weng R, Rath J, Klotz S, Gelpi E, Bsteh G, Keritam O, Colonna I, Paternostro C, Jäger F, Lindeck-Pozza E, Iglseder S, Grinzinger S, Schönfelder M, Hohenwarter C, Freimüller M, Embacher N, Wanschitz J, Topakian R, Töpf A, Straub V, Quasthoff S, Zimprich F, Löscher WN, Cetin H. Clinico-genetic spectrum of limb-girdle muscular weakness in Austria: a multi-centre cohort study. Eur J Neurol 2022; 29:1815-1824. [PMID: 35239206 PMCID: PMC9314602 DOI: 10.1111/ene.15306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Abstract
Background and purpose Hereditary myopathies with limb‐girdle muscular weakness (LGW) are a genetically heterogeneous group of disorders, in which molecular diagnosis remains challenging. Our aim was to present a detailed clinical and genetic characterization of a large cohort of patients with LGW. Methods This nationwide cohort study included patients with LGW suspected to be associated with hereditary myopathies. Parameters associated with specific genetic aetiologies were evaluated, and we further assessed how they predicted the detection of causative variants by conducting genetic analyses. Results Molecular diagnoses were identified in 62.0% (75/121) of the cohort, with a higher proportion of patients diagnosed by next‐generation sequencing (NGS) than by single‐gene testing (77.3% vs. 22.7% of solved cases). The median (interquartile range) time from onset to genetic diagnosis was 8.9 (3.7–19.9) and 17.8 (7.9–27.8) years for single‐gene testing and NGS, respectively. The most common diagnoses were myopathies associated with variants in CAPN3 (n = 9), FKRP (n = 9), ANO5 (n = 8), DYSF (n = 8) and SGCA (n = 5), which together accounted for 32.2% of the cohort. Younger age at disease onset (p = 0.043), >10× elevated creatine kinase activity levels (p = 0.024) and myopathic electromyography findings (p = 0.007) were significantly associated with the detection of causative variants. Conclusions Our findings suggest that an earlier use of NGS in patients with LGW is needed to avoid long diagnostic delays. We further present parameters predictive of a molecular diagnosis that may help to select patients for genetic analyses, especially in centres with limited access to sequencing.
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Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matias Wagner
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute for Neurogenomics, Helmholtz Center Munich, Neuherberg, Germany.,LMU University Hospital, Department of Pediatrics, Dr. von Hauner Children's Hospital, Division of Pediatric Neurology, LMU Center for Development and Children with Medical Complexity, Ludwig-Maximilians-University, Munich, Germany
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Rosa Weng
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sigrid Klotz
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Isabella Colonna
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Fiona Jäger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Stephan Iglseder
- Department of Neurology, KH der Barmherzigen Brüder, Linz, Austria
| | - Susanne Grinzinger
- Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Martina Schönfelder
- Department of Neurology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | | | | | - Norbert Embacher
- Department of Neurology, University Hospital St, Pölten, St. Pölten, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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21
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Kliest T, Van Eijk RPA, Al-Chalabi A, Albanese A, Andersen PM, Amador MDM, BrÅthen G, Brunaud-Danel V, Brylev L, Camu W, De Carvalho M, Cereda C, Cetin H, Chaverri D, Chiò A, Corcia P, Couratier P, De Marchi F, Desnuelle C, Van Es MA, Esteban J, Filosto M, GarcÍa Redondo A, Grosskreutz J, Hanemann CO, HolmØy T, HØyer H, Ingre C, Koritnik B, Kuzma-Kozakiewicz M, Lambert T, Leigh PN, Lunetta C, Mandrioli J, Mcdermott CJ, Meyer T, Mora JS, Petri S, Povedano MÓ, Reviers E, Riva N, Roes KCB, Rubio MÁ, Salachas F, Sarafov S, SorarÙ G, Stevic Z, Svenstrup K, MØller AT, Turner MR, Van Damme P, Van Leeuwen LAG, Varona L, VÁzquez Costa JF, Weber M, Hardiman O, Van Den Berg LH. Clinical trials in pediatric ALS: a TRICALS feasibility study. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:481-488. [PMID: 35172656 PMCID: PMC9662181 DOI: 10.1080/21678421.2021.2024856] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Pediatric investigation plans (PIPs) describe how adult drugs can be studied in children. In 2015, PIPs for Amyotrophic Lateral Sclerosis (ALS) became mandatory for European marketing-authorization of adult treatments, unless a waiver is granted by the European Medicines Agency (EMA). Objective: To assess the feasibility of clinical studies on the effect of therapy in children (<18 years) with ALS in Europe. Methods: The EMA database was searched for submitted PIPs in ALS. A questionnaire was sent to 58 European ALS centers to collect the prevalence of pediatric ALS during the past ten years, the recruitment potential for future pediatric trials, and opinions of ALS experts concerning a waiver for ALS. Results: Four PIPs were identified; two were waived and two are planned for the future. In total, 49 (84.5%) centers responded to the questionnaire. The diagnosis of 44,858 patients with ALS was reported by 46 sites; 39 of the patients had an onset < 18 years (prevalence of 0.008 cases per 100,000 or 0.087% of all diagnosed patients). The estimated recruitment potential (47 sites) was 26 pediatric patients within five years. A majority of ALS experts (75.5%) recommend a waiver should apply for ALS due to the low prevalence of pediatric ALS. Conclusions: ALS with an onset before 18 years is extremely rare and may be a distinct entity from adult ALS. Conducting studies on the effect of disease-modifying therapy in pediatric ALS may involve lengthy recruitment periods, high costs, ethical/legal implications, challenges in trial design and limited information.
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Affiliation(s)
- Tessa Kliest
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ruben P A Van Eijk
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.,Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | | | - Peter M Andersen
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Maria Del Mar Amador
- Département de Neurologie, Centre de référence SLA Ile de France.,Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Geir BrÅthen
- Department of Neurology, University Hospital of Trondheim, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, Moscow, Russian Federation.,Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russian Federation
| | - William Camu
- ALS Centre CHU Gui de Chauliac, University of Montpellier, Montpellier, France
| | - Mamede De Carvalho
- Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurosciences and Mental Health, H Santa Maria-CHLN, Lisbon, Portugal
| | - Cristina Cereda
- Regional Newborn Screening Laboratory, Vittore Buzzi Children's Hospital-University of Milan, Italy
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Delia Chaverri
- Neurology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy.,Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Philippe Corcia
- Centre Constitutif SLA, CHRU de Tours - Fédération des centres SLA Tours-Limoges, LitORALS, Tours, France
| | - Philippe Couratier
- Centre Constitutif de reference SLA-Fédération Tours-Limoges, CHU de Limoges, Limoges, France
| | | | | | - Michael A Van Es
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - JesÚs Esteban
- ALS Research Lab - ALS Unit, Instituto de Investigación Sanitaria Hospital 12 de Octubre "i + 12", CIBERER, Madrid, Spain
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Alberto GarcÍa Redondo
- ALS Research Lab - ALS Unit, Instituto de Investigación Sanitaria Hospital 12 de Octubre "i + 12", CIBERER, Madrid, Spain
| | - Julian Grosskreutz
- Precision Neurology, Dept. of Neurology, Lübeck University Hospital, Lübeck, Germany
| | - Clemens O Hanemann
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Trygve HolmØy
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helle HØyer
- Department of Medical Genetics, Telemark Hospital, Skien, Norway
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Blaz Koritnik
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Thomas Lambert
- Department of Neurology, Royal Stoke University Hospital, Stoke, United Kingdom
| | - Peter N Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Brighton, UK
| | - Christian Lunetta
- NEMO Clinical Center, Serena Onlus Foundation, Milan, Italy.,NEMO LAB, Milan, Italy
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Neuroscience, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Christopher J Mcdermott
- Department of Neuroscience, University of Sheffield, Sheffield Institute for Translational Neuroscience, Sheffield, United Kingdom
| | - Thomas Meyer
- ALS Outpatient Department, Charité - Universitatsmedizin Berlin, Berlin, Germany
| | - Jesus S Mora
- ALS Unit/Neurology, Hospital San Rafael, Madrid, Spain
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - MÓnica Povedano
- Functional Unit of Amyotrophic Lateral Sclerosis (UFELA), Service of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Evy Reviers
- European Organization for Professionals and Patients with ALS (EUpALS) & ALS Liga Belgium, Leuven, Belgium
| | - Nilo Riva
- Department of Neurology, Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Kit C B Roes
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Miguel Á Rubio
- Neuromuscular Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investivaciones Médicas (IMIM), Barcelona, Spain
| | - FranÇois Salachas
- Département de Neurologie, Centre de référence SLA Ile de France.,Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France
| | - Stayko Sarafov
- Clinic of General Neurology, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Gianni SorarÙ
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Zorica Stevic
- Clinic of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kirsten Svenstrup
- Department of Neurology, Bispebjerg-Frederiksberg Hospital and Rigshospitalet, University Hospital of Copenhagen, Denmark
| | | | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Philip Van Damme
- Department of Neurosciences, Laboratory for Neurobiology, KU Leuven and Centre for Brain & Disease Research, VIB, Leuven Brain Institute, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Lucie A G Van Leeuwen
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Luis Varona
- Department of Neurology, Basurto University Hospital, Vizcaya, Spain
| | - Juan F VÁzquez Costa
- ALS Unit and Neuromuscular Disease Unit, Department of Neurology, Hospital La Fe, Valencia, Spain
| | - Markus Weber
- Neuromoscular Disease Unit/ALS Clinic, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Orla Hardiman
- Academic Unit of Neurology Trinity College Dublin Ireland, Dublin, Ireland
| | - Leonard H Van Den Berg
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
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22
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Paternostro C, Gopp L, Tomschik M, Krenn M, Weng R, Bointner K, Jäger F, Zulehner G, Rath J, Berger T, Zimprich F, Cetin H. Incidence and clinical spectrum of rhabdomyolysis in general neurology: a retrospective cohort study. Neuromuscul Disord 2021; 31:1227-1234. [PMID: 34711480 DOI: 10.1016/j.nmd.2021.09.012] [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: 06/21/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023]
Abstract
The objective of this retrospective cohort study was to evaluate demographic, clinical and laboratory characteristics of patients with rhabdomyolysis as defined by a serum creatine kinase (sCK) activity > 950 U/L. A total of 248 patients were recruited from the Department of Neurology, Medical University of Vienna, between 01/2000 and 12/2017, with a median sCK activity of 2,160 U/l (IQR 1,342-4,786). Seizures (31.9%), illicit drugs/alcohol (9.7%) and exercise (8.5%) were the most common trigger factors. Rhabdomyolysis incidence rates in specific neurological diseases as estimated by the ratio between rhabdomyolysis cases and the total number of cases with the corresponding disease were highest in myopathies (49.8/1,000 person-years, 95% CI 32.3-67.4), followed by epilepsy (16.4/1,000 person-years, 95% CI 12.8-20.0) and stroke (11.9/1,000 person-years, 95% CI 8.4-15.4). The half-life of sCK activity was 1.5 days in the total cohort. In myopathies, sCK activity was significantly higher as compared to other disease entities 7 days after the peak measurement (p = 0.0023). Acute kidney injury (AKI) developed in 18 patients (7.3%) with no AKI-related deaths during the study period. In conclusion, rhabdomyolysis occurred in a broad range of neurological entities but was associated with a favorable prognosis in most cases rarely resulting in AKI and death.
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Affiliation(s)
- Chiara Paternostro
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Lorina Gopp
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Rosa Weng
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Karl Bointner
- IT-Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Fiona Jäger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
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Rath J, Zulehner G, Schober B, Grisold A, Krenn M, Cetin H, Zimprich F. Cerebrospinal fluid analysis in Guillain-Barré syndrome: value of albumin quotients. J Neurol 2021; 268:3294-3300. [PMID: 33651153 PMCID: PMC8357680 DOI: 10.1007/s00415-021-10479-9] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
Abstract
Background Albuminocytologic dissociation in cerebrospinal fluid (CSF) is a diagnostic hallmark of Guillain–Barré syndrome (GBS). Compared to CSF total protein (TP), the CSF/serum albumin quotient (Qalb) has the advantage of method-independent reference ranges. Whether the diagnostic yield differs between Qalb and CSF-TP is currently unknown. Methods We retrospectively analyzed the diagnostic yield (i.e., a value above the URL indicating blood–nerve barrier dysfunction) of Qalb and CSF-TP levels in patients with GBS. We evaluated two different equations (Reiber’s and Hegen’s) for age-adjusted URLs of Qalb and compared results to CSF-TP using the standard URL of 0.45 g/L as well as age-adjusted URLs (by decade of age). Additionally, multivariable logistic regression analysis was used to assess the effect of clinical factors on the diagnostic yield. Results We analyzed 110 patients [62% males; median age 48 (IQR 35–58)] with sensorimotor (68), motor (16), sensory (12) and localized (8) GBS as well as Miller Fisher syndrome (6). Qalb and CSF-TP were highly correlated (r = 0.95, p < 0.001). The diagnostic yield of Qalb was 65% with Reiber’s and 47% with Hegen’s age-adjusted URLs compared to 66% with the fixed CSF-TP URL of 0.45 g/L and 49% with age-adjusted CSF-TP URLs. A longer duration from clinical onset to lumbar puncture was associated with a higher diagnostic yield. Conclusion Qalb strongly correlates with CSF-TP in patients with GBS with a similar diagnostic yield for the detection of a blood–nerve barrier dysfunction. However, the diagnostic yield of both values is lower when using more recent age-adjusted URLs and at earlier timepoints.
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Affiliation(s)
- Jakob Rath
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernadette Schober
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Abstract
Acoustic manipulation of microparticles and cells, called acoustophoresis, inside microfluidic systems has significant potential in biomedical applications. In particular, using acoustic radiation force to push microscopic objects toward the wall surfaces has an important role in enhancing immunoassays, particle sensors, and recently microrobotics. In this paper, we report a flexural-wave based acoustofluidic system for trapping micron-sized particles and cells at the soft wall boundaries. By exciting a standard microscope glass slide (1 mm thick) at its resonance frequencies <200 kHz, we show the wall-trapping action in sub-millimeter-size rectangular and circular cross-sectional channels. For such low-frequency excitation, the acoustic wavelength can range from 10-150 times the microchannel width, enabling a wide design space for choosing the channel width and position on the substrate. Using the system-level acousto-structural simulations, we confirm the acoustophoretic motion of particles near the walls, which is governed by the competing acoustic radiation and streaming forces. Finally, we investigate the performance of the wall-trapping acoustofluidic setup in attracting the motile cells, such as Chlamydomonas reinhardtii microalgae, toward the soft boundaries. Furthermore, the rotation of microalgae at the sidewalls and trap-escape events under pulsed ultrasound are demonstrated. The flexural-wave driven acoustofluidic system described here provides a biocompatible, versatile, and label-free approach to attract particles and cells toward the soft walls.
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Affiliation(s)
- Amirreza Aghakhani
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany.
| | - Hakan Cetin
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany. and Electrical and Electronics Engineering Department, Özyeğin University, 34794 Istanbul, Turkey
| | - Pelin Erkoc
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany. and Faculty of Engineering and Natural Sciences, Bahcesehir University, 34353 Istanbul, Turkey
| | - Guney Isik Tombak
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany. and Electrical and Electronics Engineering Department, Boğaziçi University, 34342 Istanbul, Turkey
| | - Metin Sitti
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany. and Institute for Biomedical Engineering, ETH Zurich, 8092 Zurich, Switzerland and School of Medicine and School of Engineering, Koç University, 34450 Istanbul, Turkey
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Rath J, Schober B, Zulehner G, Grisold A, Krenn M, Cetin H, Zimprich F. Nerve conduction studies in Guillain-Barré syndrome: Influence of timing and value of repeated measurements. J Neurol Sci 2020; 420:117267. [PMID: 33352506 DOI: 10.1016/j.jns.2020.117267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/08/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Nerve conduction studies (NCS) are essential to differentiate between demyelinating and axonal subtypes in Guillain-Barré syndrome (GBS). However, it is debated to which extent the delay of NCS after symptom onset and repeated measurements during the disease course influence the diagnostic accuracy. METHODS We evaluated NCS in 93 patients with a classical GBS applying two widely used criteria (Hadden's and Rajabally's). The initial measurements after symptom onset were compared to follow-up studies where available (n = 43). We analyzed the influence of NCS timing after symptom onset and clinical severity on fulfilling the electrophysiological criteria for axonal or demyelinating subtypes and evaluated the impact of repeated measurements. We further evaluated the presence of reversible conduction failure. RESULTS A higher GBS disability scale at nadir correlated with a successful subclassification whereas the delay of the first NCS after symptom onset did not influence the diagnostic yield (75% for Hadden's and 68% for Rajabally's criteria for the first assessment). A second measurement allowed the additional successful classification in 19% and 14% of patients, respectively. On the other hand, a repeated measurement in patients with an initial successful classification resulted in a different subtype in 5% and 7%, respectively. Reversible conduction failure was found in 7% of patients. CONCLUSION Clinical severity but not timing of NCS influenced the fulfilment of electrophysiological criteria for either the axonal or demyelinating subtype. Repeated electrophysiological measurements led to a further specification or a change in subtype classification in a relevant proportion of patients.
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Affiliation(s)
- Jakob Rath
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Bernadette Schober
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Wurm R, Stamm T, Reichardt B, Parvizi T, Silvaieh S, König T, Cetin H, Stögmann E. Frequency of comedication in patients with dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.039493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cetin H, Beeson D, Vincent A, Webster R. The Structure, Function, and Physiology of the Fetal and Adult Acetylcholine Receptor in Muscle. Front Mol Neurosci 2020; 13:581097. [PMID: 33013323 PMCID: PMC7506097 DOI: 10.3389/fnmol.2020.581097] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/13/2020] [Indexed: 12/31/2022] Open
Abstract
The neuromuscular junction (NMJ) is a highly developed synapse linking motor neuron activity with muscle contraction. A complex of molecular cascades together with the specialized NMJ architecture ensures that each action potential arriving at the motor nerve terminal is translated into an action potential in the muscle fiber. The muscle-type nicotinic acetylcholine receptor (AChR) is a key molecular component located at the postsynaptic muscle membrane responsible for the generation of the endplate potential (EPP), which usually exceeds the threshold potential necessary to activate voltage-gated sodium channels and triggers a muscle action potential. Two AChR isoforms are found in mammalian muscle. The fetal isoform is present in prenatal stages and is involved in the development of the neuromuscular system whereas the adult isoform prevails thereafter, except after denervation when the fetal form is re-expressed throughout the muscle. This review will summarize the structural and functional differences between the two isoforms and outline congenital and autoimmune myasthenic syndromes that involve the isoform specific AChR subunits.
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Affiliation(s)
- Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - David Beeson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Richard Webster
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Krenn M, Grisold A, Wohlfarth P, Rath J, Cetin H, Koneczny I, Zimprich F. Pathomechanisms and Clinical Implications of Myasthenic Syndromes Exacerbated and Induced by Medical Treatments. Front Mol Neurosci 2020; 13:156. [PMID: 32922263 PMCID: PMC7457047 DOI: 10.3389/fnmol.2020.00156] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/31/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
Myasthenic syndromes are typically characterized by muscle weakness and increased fatigability due to an impaired transmission at the neuromuscular junction (NMJ). Most cases are caused by acquired autoimmune conditions such as myasthenia gravis (MG), typically with antibodies against the acetylcholine receptor (AChR). Different drugs are among the major factors that may complicate pre-existing autoimmune myasthenic conditions by further impairing transmission at the NMJ. Some clinical observations are substantiated by experimental data, indicating that presynaptic, postsynaptic or more complex pathomechanisms at the NMJ may be involved, depending on the individual compound. Most robust data exist for the risks associated with some antibiotics (e.g., aminoglycosides, ketolides, fluoroquinolones) and cardiovascular medications (e.g., class Ia antiarrhythmics, beta blockers). Apart from primarily autoimmune-mediated disorders of the NMJ, de novo myasthenic manifestations may also be triggered by medical treatments that induce an autoimmune reaction. Most notably, there is growing evidence that the immune checkpoint inhibitors (ICI), a modern class of drugs to treat various malignancies, represent a relevant risk factor to develop severe and progressive medication-induced myasthenia via an immune-mediated mechanism. From a clinical perspective, it is of utmost importance for the treating physicians to be aware of such adverse treatment effects and their consequences. In this article, we aim to summarize existing evidence regarding the key molecular and immunological mechanisms as well as the clinical implications of medication-aggravated and medication-induced myasthenic syndromes.
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Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Philipp Wohlfarth
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Inga Koneczny
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Cetin H, Sun J, Almqvist C, Reichardt B, Tomschik M, Zimprich F, Fang F, Ingre C. No association between proton pump inhibitor use and ALS risk: a nationwide nested case-control study. Sci Rep 2020; 10:13371. [PMID: 32770128 PMCID: PMC7414209 DOI: 10.1038/s41598-020-70373-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022] Open
Abstract
The use of proton pump inhibitors (PPIs) has been proposed as a potential risk factor for neurodegenerative diseases, but little is known regarding its role in amyotrophic lateral sclerosis (ALS). We therefore aimed to assess the association of PPI use with the subsequent risk of ALS, and performed a register-based nationwide nested case–control study, including 2,484 ALS cases diagnosed during July 2006–December 2013 in Sweden and 10 population controls per case that were individually matched to the case by sex, age, and area of residence. Dispenses and cumulative defined daily doses (cDDDs) of PPIs were extracted from the Swedish Prescribed Drug Register. The association of PPI use with the risk of ALS was assessed using conditional logistic regression, after applying different lag windows to avoid reverse causation. ALS patients were more likely to be dispensed with PPIs before diagnosis than controls. However, previous PPI use was not associated with an increased risk of ALS (OR = 1.08, 95% CI 0.97–1.19), and there was no dose–response relationship between cDDDs of PPIs and ALS risk (p = 0.0874), after excluding dispenses during the year before ALS diagnosis. The results were similar after excluding dispenses during the 2 or 3 years before ALS diagnosis.
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Affiliation(s)
- Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden.
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Tomschik M, Hilger E, Rath J, Mayer EM, Fahrner M, Cetin H, Löscher WN, Zimprich F. Subgroup stratification and outcome in recently diagnosed generalized myasthenia gravis. Neurology 2020; 95:e1426-e1436. [PMID: 32641537 DOI: 10.1212/wnl.0000000000010209] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 03/16/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To describe disease outcomes of myasthenia gravis (MG) subgroups and which factors influence outcomes by reviewing individual patient records of a representative cohort. METHODS We performed a retrospective analysis of 199 patients with generalized MG and disease onset after the year 2000 who were treated at 2 tertiary referral centers in Austria. We stratified patients as early- and late-onset acetylcholine receptor antibody-positive, muscle-specific tyrosine kinase (MuSK) antibody-positive, and seronegative patients and patients with thymoma regardless of antibody status. We evaluated patients' symptom severity and treatment regimens and the occurrence of life-threatening events at yearly time points for up to 10 years. RESULTS Minimal manifestation status or better was eventually achieved and sustained for >1 year by 125 (63%) patients. Forty percent (66 of 165 patients) showed an early response to treatment, which predicted a benign disease course later on. In contrast, 19% of patients, who remained symptomatic for 2 years after disease onset despite immunosuppressive therapy, were more treatment resistant in the following years. The strongest predictor of outcome was the diagnostic subgroup. Patients with MuSK-MG had a much better outcome than previously reported. CONCLUSION Our data give an update on the disease course of generalized MG in the new century. Diagnostic subgroups and response to treatment within the first 2 years help to predict the long term outcome.
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Affiliation(s)
- Matthias Tomschik
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Hilger
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Rath
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Eva-Maria Mayer
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Fahrner
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Hakan Cetin
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang N Löscher
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Zimprich
- From the Department of Neurology (M.T., E.H., J.R., M.F., H.C., F.Z.), Medical University of Vienna; and Department of Neurology (E.-M.M., W.N.L.), Medical University of Innsbruck, Innsbruck, Austria.
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Vanhaesebrouck AE, Webster R, Maxwell S, Rodriguez Cruz PM, Cossins J, Wickens J, Liu WW, Cetin H, Cheung J, Ramjattan H, Palace J, Beeson D. β2-Adrenergic receptor agonists ameliorate the adverse effect of long-term pyridostigmine on neuromuscular junction structure. Brain 2020; 142:3713-3727. [PMID: 31633155 PMCID: PMC6892641 DOI: 10.1093/brain/awz322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/18/2019] [Revised: 07/04/2019] [Accepted: 08/26/2019] [Indexed: 01/07/2023] Open
Abstract
Acetylcholine receptor deficiency is the most common form of the congenital myasthenic syndromes, a heterogeneous collection of genetic disorders of neuromuscular transmission characterized by fatiguable muscle weakness. Most patients with acetylcholine receptor deficiency respond well to acetylcholinesterase inhibitors; however, in some cases the efficacy of acetylcholinesterase inhibitors diminishes over time. Patients with acetylcholine receptor deficiency can also benefit from the addition of a β2-adrenergic receptor agonist to their medication. The working mechanism of β2-adrenergic agonists in myasthenic patients is not fully understood. Here, we report the long-term follow-up for the addition of β2-adrenergic agonists for a cohort of patients with acetylcholine receptor deficiency on anticholinesterase medication that demonstrates a sustained quantitative improvement. Coincidently we used a disease model to mirror the treatment of acetylcholine receptor deficiency, and demonstrate improved muscle fatigue, improved neuromuscular transmission and improved synaptic structure resulting from the addition of the β2-adrenergic agonist salbutamol to the anticholinesterase medication pyridostigmine. Following an initial improvement in muscle fatiguability, a gradual decline in the effect of pyridostigmine was observed in mice treated with pyridostigmine alone (P < 0.001). Combination therapy with pyridostigmine and salbutamol counteracted this decline (P < 0.001). Studies of compound muscle action potential decrement at high nerve stimulation frequencies (P < 0.05) and miniature end-plate potential amplitude analysis (P < 0.01) showed an improvement in mice following combination therapy, compared to pyridostigmine monotherapy. Pyridostigmine alone reduced postsynaptic areas (P < 0.001) and postsynaptic folding (P < 0.01). Combination therapy increased postsynaptic area (P < 0.001) and promoted the formation of postsynaptic junctional folds (P < 0.001), in particular in fast-twitch muscles. In conclusion, we demonstrate for the first time how the improvement seen in patients from adding salbutamol to their medication can be explained in an experimental model of acetylcholine receptor deficiency, the most common form of congenital myasthenic syndrome. Salbutamol enhances neuromuscular junction synaptic structure by counteracting the detrimental effects of long-term acetylcholinesterase inhibitors on the postsynaptic neuromuscular junction. The results have implications for both autoimmune and genetic myasthenias where anticholinesterase medication is a standard treatment.
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Affiliation(s)
- An E Vanhaesebrouck
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - Richard Webster
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - Susan Maxwell
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - Pedro M Rodriguez Cruz
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK.,Department of Clinical Neurology, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Judith Cossins
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - James Wickens
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, Oxford, OX1 3TA, UK
| | - Wei-Wei Liu
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - Hakan Cetin
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - Jonathan Cheung
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
| | - Hayley Ramjattan
- Paediatric Neurology, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - David Beeson
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DS, UK
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Cetin H, Wurm R, Reichardt B, Tomschik M, Silvaieh S, Parvizi T, König T, Erber A, Schernhammer E, Stamm T, Stögmann E. Increased risk of death associated with the use of proton-pump inhibitors in patients with dementia and controls - a pharmacoepidemiological claims data analysis. Eur J Neurol 2020; 27:1422-1428. [PMID: 32281706 PMCID: PMC7496707 DOI: 10.1111/ene.14252] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
Abstract
Background and purpose The use of proton‐pump inhibitors (PPIs) was reported to be associated with increased mortality risk and has been proposed as a potential risk factor for neurodegenerative diseases. We aimed to assess the impact of PPI use on survival in patients with dementia as compared with controls. Methods This register‐based control‐matched cohort study included 28 428 patients with dementia ascertained by the prescription of antidementia drugs and two control individuals matched by sex, age and area of residence for each patient with dementia during the study period from 1 January 2005 to 30 June 2016. Cumulative defined daily doses (DDDs) of PPIs were extracted from the health insurance prescription registries. A multivariate Cox regression model for non‐proportional hazards was used to analyse mortality risk in dependence of PPI exposure, which was limited to 1 year preceding the date of cohort entry (index date) in order to avoid immortal time bias. Results The PPI exposure of 100 DDDs in the year before the index date was associated with an increased mortality risk in patients with dementia (adjusted hazard ratio, 1.07; 95% confidence intervals, 1.03–1.12), but also in controls (adjusted hazard ratio, 1.47; 95% confidence intervals, 1.31–1.64). The mortality risk in relation to PPI use was significantly lower in patients with dementia as compared with controls (P < 0.0001) and highest in the first 2 years after the index date in both cohorts. Conclusions Our findings promote more stringent pharmacovigilance strategies to avoid PPI use in cases lacking a clear indication for therapy or where potential risks outweigh the benefits.
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Affiliation(s)
- H Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - R Wurm
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - B Reichardt
- Unit for Healthcare Economics, Regional Sickness Fund of the County Burgenland (BGKK), Eisenstadt, Austria
| | - M Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - S Silvaieh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - T Parvizi
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - T König
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - A Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - E Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA
| | - T Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - E Stögmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Cetin H, Webster R, Liu WW, Nagaishi A, Koneczny I, Zimprich F, Maxwell S, Cossins J, Beeson D, Vincent A. Myasthenia gravis AChR antibodies inhibit function of rapsyn-clustered AChRs. J Neurol Neurosurg Psychiatry 2020; 91:526-532. [PMID: 32165373 PMCID: PMC7231439 DOI: 10.1136/jnnp-2019-322640] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Direct inhibition of acetylcholine receptor (AChR) function by autoantibodies (Abs) is considered a rare pathogenic mechanism in myasthenia gravis (MG), but is usually studied on AChRs expressed in cell lines, rather than tightly clustered by the intracellular scaffolding protein, rapsyn, as at the intact neuromuscular junction. We hypothesised that clustered AChRs would provide a better target for investigating the functional effects of AChR-Abs. METHODS Acetylcholine-induced currents were measured using whole-cell patch clamping and a fast perfusion system to assess fast (<2 min) functional effects of the serum samples. The sensitivity, specificity and rapidity of the system were first demonstrated by applying maternal AChR-Ab positive plasmas known to inhibit fetal AChR function in TE671 cells. Eleven previously untested AChR-Ab positive MG sera, 10 AChR-Ab negative MG sera and 5 healthy control sera were then applied to unclustered and rapsyn-clustered human adult AChRs in CN21 cells. RESULTS The maternal AChR-Ab positive plasmas reduced fetal AChR currents, but not adult AChR currents, by >80% within 100 s. Only 2/11 AChR-Ab positive sera inhibited AChR currents in unclustered AChRs, but 6/11 AChR-Ab positive sera compared with none of the 10 AChR-Ab negative sera (p=0.0020) inhibited rapsyn-clustered AChR currents, and current inhibition by the AChR-Ab positive sera was greater when the AChRs were clustered (p=0.0385). None of the sera had detectable effects on desensitisation or recovery from desensitisation. CONCLUSION These results show that antibodies can inhibit AChR function rapidly and demonstrate the importance of clustering in exploring pathogenic disease mechanisms of MG Abs.
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Affiliation(s)
- Hakan Cetin
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Richard Webster
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Wei Wei Liu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Akiko Nagaishi
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Inga Koneczny
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Susan Maxwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Judith Cossins
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - David Beeson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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Wurm R, Stamm T, Reichardt B, Schwarz F, Parvizi T, Silvaieh S, König T, Cetin H, Stögmann E. Prescription patterns of antidementives in a high income country: A pharmacoepidemiologic study. Alzheimers Dement (N Y) 2020; 6:e12014. [PMID: 32355871 PMCID: PMC7189407 DOI: 10.1002/trc2.12014] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Dementia is a leading and growing cause of morbidity and mortality. The aim of this study was to investigate real-world prescription patterns of antidementive medication in one of the largest cohorts published thus far to optimize use in this growing population. METHODS Prescription claims from 2005 to 2016 were provided by Austrian sickness funds, covering 98% of the population of Austria. Patients treated with at least one of the four approved antidementive drugs (ADDs) were included. Prescription prevalence was calculated for 2014 and 2015, and prescription patterns were traced on an individual level during the entire study period. RESULTS A total of 127,896 patients were treated with an ADD between 2005 and 2016. The prevalence was 0.93% in 2014 and 1% in 2015. The median age at initiation of treatment was 82.3 years, and 65% were female. Initial therapy was a cholinesterase inhibitor (ChEI) in 80% and memantine in 20%. The median duration of therapy was 13.3 months. Eighteen percent of patients switched medication: two thirds to receive memantine, and one third to a different cholinesterase inhibitor. More than 26% discontinued treatment early. CONCLUSION We find that discontinuation of ADDs is more frequent than switching; memantine is a common starting drug and age at the start of treatment is rather high in this population. Interpretation should be cautious, but the data may suggest that treatment guidelines are followed inconsistently. Appropriate provision of the available options should be emphasized to optimize cognitive survival, comorbidity, quality of life, and health care expenditures.
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Affiliation(s)
- Raphael Wurm
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Tanja Stamm
- Center for Medical Statistics, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | | | - Felix Schwarz
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Tandis Parvizi
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Sara Silvaieh
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Theresa König
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Hakan Cetin
- Department of NeurologyMedical University of ViennaViennaAustria
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Erber AC, Cetin H, Berry D, Schernhammer ES. The role of gut microbiota, butyrate and proton pump inhibitors in amyotrophic lateral sclerosis: a systematic review. Int J Neurosci 2019; 130:727-735. [PMID: 31870202 DOI: 10.1080/00207454.2019.1702549] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/13/2022]
Abstract
Aim of the study: We conducted a systematic review on existing literature in humans and animals, linking the gut microbiome with amyotrophic lateral sclerosis (ALS). Additionally, we sought to explore the role of the bacterially produced metabolite butyrate as well as of proton pump inhibitors (PPIs) in these associations.Materials and methods: Following PRISMA guidelines for systematic literature reviews, four databases (Medline, Scopus, Embase and Web of Science) were searched and screened by two independent reviewers against defined inclusion criteria. Six studies in humans and six animal studies were identified, summarized and reviewed.Results: Overall, the evidence accrued to date is supportive of changes in the gut microbiome being associated with ALS risk, and potentially progression, though observational studies are small (describing a total of 145 patients with ALS across all published studies), and not entirely conclusive.Conclusions: With emerging studies beginning to apply metagenome sequencing, more clarity regarding the importance and promise of the gut microbiome in ALS can be expected. Future studies may also help establish the therapeutic potential of butyrate, and the role of PPIs in these associations.
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Affiliation(s)
- Astrid C Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Headington, Oxford, UK
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - David Berry
- Division of Microbial Ecology, Department of Microbiology and Ecosystem Function, Centre for Microbiology and Environmental Systems Science, University of Vienna, Vienna, Austria.,Joint Microbiome Facility of the Medical University of Vienna and the University of Vienna, Vienna, Austria
| | - Eva S Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA
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36
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Rath J, Brunner I, Tomschik M, Zulehner G, Hilger E, Krenn M, Paul A, Cetin H, Zimprich F. Frequency and clinical features of treatment-refractory myasthenia gravis. J Neurol 2019; 267:1004-1011. [PMID: 31828474 PMCID: PMC7109164 DOI: 10.1007/s00415-019-09667-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/06/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
Background To investigate the frequency and characterize the clinical features of treatment-refractory myasthenia gravis in an Austrian cohort. Methods Patient charts of 126 patients with generalized myasthenia gravis and onset between 2000 and 2016 were analyzed retrospectively. Patients were classified as treatment-refractory according to strict, predefined criteria. These mandated patients being at least moderately symptomatic (i.e., MGFA class III) or needing either maintenance immunoglobulins or plasma exchange therapy for at least 1 year in spite of two adequately dosed immunosuppressive drugs. Clinical features and outcome at last follow-up were compared to treatment-responsive patients. Results 14 out of 126 patients (11.1%) met these criteria of treatment-refractory myasthenia gravis. Treatment-refractory patients had more frequent clinical exacerbations and more often received rescue treatments or a further escalation of immunosuppressive therapies. They also remained more severely affected at last follow-up. An early onset of myasthenia gravis was associated with a higher risk for a refractory course. Conclusion A small subgroup of patients with generalized myasthenia gravis do not respond sufficiently to standard therapies. Refractory disease has considerable implications for both patients and health care providers and highlights an unmet need for new treatment options.
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Affiliation(s)
- Jakob Rath
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ines Brunner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Eva Hilger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Anna Paul
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Krenn M, Tomschik M, Rath J, Cetin H, Grisold A, Zulehner G, Milenkovic I, Stogmann E, Zimprich A, Strom TM, Meitinger T, Wagner M, Zimprich F. Genotype-guided diagnostic reassessment after exome sequencing in neuromuscular disorders: experiences with a two-step approach. Eur J Neurol 2019; 27:51-61. [PMID: 31407473 PMCID: PMC6916592 DOI: 10.1111/ene.14033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/11/2019] [Accepted: 07/05/2019] [Indexed: 01/03/2023]
Abstract
Background and purpose Next‐generation sequencing has greatly improved the diagnostic success rates for genetic neuromuscular disorders (NMDs). Nevertheless, most patients still remain undiagnosed, and there is a need to maximize the diagnostic yield. Methods A retrospective study was conducted on 72 patients with NMDs who underwent exome sequencing (ES), partly followed by genotype‐guided diagnostic reassessment and secondary investigations. The diagnostic yields that would have been achieved by appropriately chosen narrow and comprehensive gene panels were also analysed. Results The initial diagnostic yield of ES was 30.6% (n = 22/72 patients). In an additional 15.3% of patients (n = 11/72) ES results were of unknown clinical significance. After genotype‐guided diagnostic reassessment and complementary investigations, the yield was increased to 37.5% (n = 27/72). Compared to ES, targeted gene panels (<25 kilobases) reached a diagnostic yield of 22.2% (n = 16/72), whereas comprehensive gene panels achieved 34.7% (n = 25/72). Conclusion Exome sequencing allows the detection of pathogenic variants missed by (narrowly) targeted gene panel approaches. Diagnostic reassessment after genetic testing further enhances the diagnostic outcomes for NMDs.
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Affiliation(s)
- M Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - M Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - J Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - H Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - G Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - I Milenkovic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - E Stogmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - A Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - T M Strom
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - T Meitinger
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Wagner
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - F Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Cetin H, Liu W, Cheung J, Cossins J, Vanhaesebrouck A, Maxwell S, Vincent A, Beeson D, Webster R. Rapsyn facilitates recovery from desensitization in fetal and adult acetylcholine receptors expressed in a muscle cell line. J Physiol 2019; 597:3713-3725. [PMID: 31158924 PMCID: PMC6767687 DOI: 10.1113/jp277819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/03/2019] [Accepted: 06/03/2019] [Indexed: 01/29/2023] Open
Abstract
Key points The physiological significance of the developmental switch from fetal to adult acetylcholine receptors in muscle (AChRs) and the functional impact of AChR clustering by rapsyn are not well studied. Using patch clamp experiments, we show that recovery from desensitization is faster in the adult AChR isoform. Recovery from desensitization is determined by the AChR isoform‐specific cytoplasmic M3–M4 domain. The co‐expression of rapsyn in muscle cells induced AChR clustering and facilitated recovery from desensitization in both fetal and adult AChRs. In fetal AChRs, facilitation of recovery kinetics by rapsyn was independent of AChR clustering. These effects could be crucial adaptations to motor neuron firing rates, which, in rodents, have been shown to increase around the time of birth when AChRs cluster at the developing neuromuscular junctions.
Abstract The neuromuscular junction (NMJ) is the site of a number of autoimmune and genetic disorders, many involving the muscle‐type nicotinic acetylcholine receptor (AChR), although there are aspects of normal NMJ development and function that need to be better understood. In particular, there are still questions regarding the implications of the developmental switch from fetal to adult AChRs, as well as how their functions might be modified by rapsyn that clusters the AChRs. Desensitization of human muscle AChRs was investigated using the patch clamp technique to measure whole‐cell currents in muscle‐type (TE671/CN21) and non‐muscle (HEK293) cell lines expressing either fetal or adult AChRs. Desensitization time constants were similar with both AChR isoforms but recovery time constants were shorter in cells expressing adult compared to fetal AChRs (P < 0.0001). Chimeric experiments showed that recovery from desensitization was determined by the M3–M4 cytoplasmic loops of the γ‐ and ε‐subunits. Expression of rapsyn in TE671/CN21 cells induced AChR aggregation and also, surprisingly, shortened recovery time constants in both fetal and adult AChRs. However, this was not dependent on clustering because rapsyn also facilitated recovery from desensitization in HEK293 cells expressing a δ‐R375H AChR mutant that did not form clusters in C2C12 myotubes. Thus, rapsyn interactions with AChRs lead not only to clustering, but also to a clustering independent faster recovery from desensitization. Both effects of rapsyn could be a necessary adjustment to the motor neuron firing rates that increase around the time of birth. The physiological significance of the developmental switch from fetal to adult acetylcholine receptors in muscle (AChRs) and the functional impact of AChR clustering by rapsyn are not well studied. Using patch clamp experiments, we show that recovery from desensitization is faster in the adult AChR isoform. Recovery from desensitization is determined by the AChR isoform‐specific cytoplasmic M3–M4 domain. The co‐expression of rapsyn in muscle cells induced AChR clustering and facilitated recovery from desensitization in both fetal and adult AChRs. In fetal AChRs, facilitation of recovery kinetics by rapsyn was independent of AChR clustering. These effects could be crucial adaptations to motor neuron firing rates, which, in rodents, have been shown to increase around the time of birth when AChRs cluster at the developing neuromuscular junctions.
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Affiliation(s)
- Hakan Cetin
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wei Liu
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jonathan Cheung
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Judith Cossins
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - An Vanhaesebrouck
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Susan Maxwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - David Beeson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Richard Webster
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Löscher WN, Oberreiter EM, Erdler M, Quasthoff S, Culea V, Berek K, Embacher N, Grinzinger S, Hess I, Höger FS, Horlings CGC, Huemer M, Jecel J, Kleindienst W, Laich E, Müller P, Oel D, Örtl W, Lenzenweger E, Rath J, Stadler K, Stieglbauer K, Thaler-Wolf C, Wanschitz J, Zimprich F, Cetin H, Topakian R. Multifocal motor neuropathy in Austria: a nationwide survey of clinical features and response to treatment. J Neurol 2018; 265:2834-2840. [PMID: 30259176 PMCID: PMC6244652 DOI: 10.1007/s00415-018-9071-9] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Multifocal motor neuropathy (MMN) is a rare neuropathy and detailed descriptions of larger patient cohorts are scarce. The objective of this study was to evaluate epidemiological, clinical, and laboratory features of MMN patients and their response to treatment in Austria and to compare these data with those from the literature. METHODS Anonymized demographic and clinical data about MMN patients until 31.12.2017 were collected from registered Austrian neurologists. Exploratory statistics on clinical and laboratory features as well as treatment regimens and responses were performed. RESULTS 57 Patients with MMN were identified, resulting in a prevalence of 0.65/100.000. Mean age of onset was 44.1 ± 13.1 years, the diagnostic delay 5.5 ± 8.4 years. In 77% of patients, symptom onset was in the upper limbs, and in 92%, it occurred in distal muscles. Proximal onset was never observed in the lower limbs. At the final follow-up, the majority of patients had atrophy (88%) in affected regions. Definite motor conduction blocks (CB) were found in 54 patients. Anti-GM1-IgM antibodies were present in 43%. Treatment with intravenous immunoglobulins improved muscle strength and INCAT score initially, but at last follow-up, both scores deteriorated to values before treatment. DISCUSSION The findings of the present study corroborate the previous findings in MMN. Onset typically occurs in the upper limbs and mostly distal, CBs are found in the majority of cases, while anti-GM1-IgM antibodies are detected in only approximately 40%. Our study underlines that the initial good response to treatment fades over time.
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Affiliation(s)
- Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Eva-Maria Oberreiter
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | | | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Valeriu Culea
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Klaus Berek
- Department of Neurology, BKH Kufstein, Kufstein, Austria
| | - Norbert Embacher
- Department of Neurology, St. Pölten University, Sankt Pölten, Austria
| | - Susanne Grinzinger
- Department of Neurology, Paracelsus University of Salzburg, Salzburg, Austria
| | | | | | - Corinne G C Horlings
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Michael Huemer
- Department of Neurology, Kardinal Schwarzenberg Hospital, Schwarzach im Pongau, Austria
| | - Julia Jecel
- 2. Department of Neurology, KH Hietzing, Vienna, Austria
| | | | - Eva Laich
- Department of Neurology, LKH Steyr, Steyr, Austria
| | - Petra Müller
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
| | - Dierk Oel
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
| | - Wolfgang Örtl
- Department of Neurology, Johannes Kepler-University Linz, Linz, Austria
| | - Eva Lenzenweger
- Department of Neurology 2, Johannes Kepler-University Linz, Linz, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Klaus Stadler
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
| | | | | | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Raffi Topakian
- Department of Neurology, KH Wels-Grieskirchen, Wels, Austria
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Abstract
Autoimmune myasthenic syndromes are antibody-mediated disorders of the neuromuscular junction. Common antigenic targets are the acetylcholine receptor or muscle specific kinase (MuSK) in myasthenia gravis (MG) and the voltage-gated calcium channel in Lambert-Eaton myasthenic syndrome. There is evidence that antibodies directed against other antigens such as low-density lipoprotein receptor-related protein 4 (LRP4) are also involved in MG. The mechanisms by which various antibodies exert their pathogenic effect depend on the IgG subclass and also the epitope location on the antigens. These mechanisms are partly heterogeneous and include antigen degradation, complement activation, direct functional blocking, or disruption of protein-protein interactions. The neuromuscular junction is characterized by a structural and functional plasticity that is able to compensate for some of the neuromuscular junction defects. Here, we discuss the underlying pathogenic mechanisms of the different autoantibodies and correlate them with phenotypic features. The understanding of these elements should help guide the clinical management of patients with autoimmune myasthenic syndromes.
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Affiliation(s)
- Hakan Cetin
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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41
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Vanhaesebrouck A, Webster R, Maxwell S, Liu W, Cetin H, Cheung J, Wickens J, Beeson D. Beneficial effect of salbutamol added to pyridostigmine in myasthenic mice is directly related to neuromuscular junction structure changes. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Vincent A, Huda S, Cao M, Cetin H, Koneczny I, Rodriguez Cruz PM, Jacobson L, Viegas S, Jacob S, Woodhall M, Nagaishi A, Maniaol A, Damato V, Leite MI, Cossins J, Webster R, Palace J, Beeson D. Serological and experimental studies in different forms of myasthenia gravis. Ann N Y Acad Sci 2018; 1413:143-153. [PMID: 29377162 DOI: 10.1111/nyas.13592] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 10/02/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022]
Abstract
Antibodies to the acetylcholine receptor (AChR) have been recognized for over 40 years and have been important in the diagnosis of myasthenia gravis (MG), and its recognition in patients of different ages and thymic pathologies. The 10-20% of patients who do not have AChR antibodies are now known to comprise different subgroups, the most commonly reported of which is patients with antibodies to muscle-specific kinase (MuSK). The use of cell-based assays has extended the repertoire of antibody tests to clustered AChRs, low-density lipoprotein receptor-related protein 4, and agrin. Autoantibodies against intracellular targets, namely cortactin, titin, and ryanodine receptor (the latter two being associated with the presence of thymoma), may also be helpful as biomarkers in some patients. IgG4 MuSK antibodies are clearly pathogenic, but the coexisting IgG1, IgG2, and IgG3 antibodies, collectively, have effects that question the dominance of IgG4 as the sole pathologic factor in MuSK MG. After a brief historical review, we define the different subgroups and summarize the antibody characteristics. Experiments to demonstrate the in vitro and in vivo pathogenic roles of MuSK antibodies are discussed.
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Affiliation(s)
- Angela Vincent
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Saif Huda
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Michelangelo Cao
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Hakan Cetin
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Inga Koneczny
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Pedro M Rodriguez Cruz
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Leslie Jacobson
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Stuart Viegas
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Saiju Jacob
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Akiko Nagaishi
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Angelina Maniaol
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Valentina Damato
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Judith Cossins
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Richard Webster
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - David Beeson
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Salhofer-Polanyi S, Cetin H, Leutmezer F, Baumgartner A, Blechinger S, Dal-Bianco A, Altmann P, Bajer-Kornek B, Rommer P, Guger M, Leitner-Bohn D, Reichardt B, Alasti F, Temsch W, Stamm T. Epidemiology of Multiple Sclerosis in Austria. Neuroepidemiology 2017; 49:40-44. [PMID: 28848208 DOI: 10.1159/000479696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/09/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the incidence rate and prevalence ratio of multiple sclerosis (MS) in Austria. METHODS Hospital discharge diagnosis and MS-specific immunomodulatory treatment prescriptions from public health insurances, covering 98% of Austrian citizens with health insurance were used to extrapolate incidence and prevalence numbers based on the capture-recapture method. RESULTS A total of 1,392,629 medication prescriptions and 40,956 hospitalizations were extracted from 2 data sources, leading to a total of 13,205 patients. The incidence rate and prevalence ratio of MS in Austria based on the capture-recapture method were 19.5/100,000 person-years (95% CI 14.3-24.7) and 158.9/100,000 (95% CI 141.2-175.9), respectively. Female to male ratio was 1.6 for incidence and 2.2 for prevalence. CONCLUSIONS Incidence rates and prevalence ratios of MS in our study are within the upper range of comparable studies across many European countries as well as the United States.
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Ross JA, Webster RG, Lechertier T, Reynolds LE, Turmaine M, Bencze M, Jamshidi Y, Cetin H, Muntoni F, Beeson D, Hodilvala-Dilke K, Conti FJ. Multiple roles of integrin-α3 at the neuromuscular junction. Development 2017. [DOI: 10.1242/dev.154906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Rath J, Mauritz M, Zulehner G, Hilger E, Cetin H, Kasprian G, Auff E, Zimprich F. Iodinated contrast agents in patients with myasthenia gravis: a retrospective cohort study. J Neurol 2017; 264:1209-1217. [PMID: 28550477 PMCID: PMC5486553 DOI: 10.1007/s00415-017-8518-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/11/2017] [Revised: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Abstract
Currently, it has not been satisfactorily established, whether modern low-osmolality iodinated contrast agents (ICAs) used in computed tomography (CT) studies are a risk factor for exacerbation of myasthenic symptoms. The rate of acute adverse events as well as delayed clinical worsening up to 30 days were analyzed in 73 patients with confirmed myasthenia gravis (MG) who underwent contrast-enhanced CT studies and compared to 52 patients who underwent unenhanced CT studies. One acute adverse event was documented. 12.3% of MG patients experienced a delayed exacerbation of symptoms after ICA administration. The rate of delayed severe exacerbation was higher in the contrast-enhanced group. Alternative causes for the exacerbation of MG-related symptoms were more likely than ICA administration in all cases. ICA administration for CT studies in MG patients should not be withheld if indicated, but patients particularly those with concomitant acute diseases should be carefully monitored for exacerbation of symptoms.
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Affiliation(s)
- Jakob Rath
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Matthias Mauritz
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Eva Hilger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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46
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Ross JA, Webster RG, Lechertier T, Reynolds LE, Turmaine M, Bencze M, Jamshidi Y, Cetin H, Muntoni F, Beeson D, Hodilvala-Dilke K, Conti FJ. Multiple roles of integrin-α3 at the neuromuscular junction. J Cell Sci 2017; 130:1772-1784. [PMID: 28386022 DOI: 10.1242/jcs.201103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/30/2016] [Accepted: 03/31/2017] [Indexed: 12/22/2022] Open
Abstract
The neuromuscular junction (NMJ) is the synapse between motoneurons and skeletal muscle, and is responsible for eliciting muscle contraction. Neurotransmission at synapses depends on the release of synaptic vesicles at sites called active zones (AZs). Various proteins of the extracellular matrix are crucial for NMJ development; however, little is known about the identity and functions of the receptors that mediate their effects. Using genetically modified mice, we find that integrin-α3 (encoded by Itga3), an adhesion receptor at the presynaptic membrane, is involved in the localisation of AZ components and efficient synaptic vesicle release. Integrin-α3 also regulates integrity of the synapse - mutant NMJs present with progressive structural changes and upregulated autophagy, features commonly observed during ageing and in models of neurodegeneration. Unexpectedly, we find instances of nerve terminal detachment from the muscle fibre; to our knowledge, this is the first report of a receptor that is required for the physical anchorage of pre- and postsynaptic elements at the NMJ. These results demonstrate multiple roles of integrin-α3 at the NMJ, and suggest that alterations in its function could underlie defects that occur in neurodegeneration or ageing.
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Affiliation(s)
- Jacob A Ross
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Richard G Webster
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Tanguy Lechertier
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Louise E Reynolds
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Mark Turmaine
- Department of Cell and Developmental Biology, University College London, Gower Street, London WC1E 6BT, UK
| | - Maximilien Bencze
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Yalda Jamshidi
- Department of Genetics, Institute of Molecular and Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Hakan Cetin
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - David Beeson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Kairbaan Hodilvala-Dilke
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Francesco J Conti
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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Cetin H, Wöhrer A, Rittelmeyer I, Gencik M, Zulehner G, Zimprich F, Ströbel T, Zimprich A. The c.65-2A>G splice site mutation is associated with a mild phenotype in Danon disease due to the transcription of normal LAMP2 mRNA. Clin Genet 2016; 90:366-71. [DOI: 10.1111/cge.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
- H. Cetin
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - A. Wöhrer
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | | | - M. Gencik
- Center for Human Genetics; Vienna Austria
| | - G. Zulehner
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - F. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - T. Ströbel
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | - A. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
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Cetin H, Rath J, Füzi J, Reichardt B, Fülöp G, Koppi S, Erdler M, Ransmayr G, Weber J, Neumann K, Hagmann M, Löscher WN, Auff E, Zimprich F. Epidemiology of amyotrophic lateral sclerosis and effect of riluzole on disease course. Neuroepidemiology 2015; 44:6-15. [PMID: 25571962 DOI: 10.1159/000369813] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the epidemiology of ALS in Austria and to evaluate the long-term effect of riluzole treatment on survival. METHODS Hospital discharge and riluzole prescription databases were used to identify ALS cases from January 2008 to June 2012. Using the capture-recapture method we evaluated the incidence and prevalence of ALS and patients' survival in dependence of age, gender and riluzole treatment. RESULTS The corrected incidence and prevalence of ALS were 3.13/100,000 person-years (95% CI, 2.77 to 3.50) and 9.14/100,000 persons (95% CI, 8.53 to 9.79), respectively. Median survival from diagnosis was 676 days (95% CI, 591 to 761). A younger age at diagnosis was associated with a longer survival. Gender did not appear to affect survival time. Riluzole therapy was associated with a survival advantage only for the initial treatment period. The adjusted hazard ratio of mortality for using riluzole increased continually over time resulting in an apparent reversal of its beneficial effect after 6 months of therapy. CONCLUSIONS We report incidence and prevalence estimates that are on the upper end of the wide range discussed in literature. Riluzole seems to exert a beneficial effect only in the first 6 months of therapy.
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Affiliation(s)
- Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Löscher W, Cetin H, Schulte-Mattler W, Wanschitz J. Periphere Nervenübererregbarkeit – Krampf-Faszikulationssyndrom, Neuromyotonie und Morvan Syndrom. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1383563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- W. Löscher
- Univ-Klinik für Neurologie, Medizinische Universität Innsbruck, Österreich
| | - H. Cetin
- Univ-Klinik für Neurologie, Medizinische Universität Wien, Österreich
| | - W. Schulte-Mattler
- Neurologische Klinik und Poliklinik, Universität Regensburg, Deutschland
| | - J. Wanschitz
- Univ-Klinik für Neurologie, Medizinische Universität Innsbruck, Österreich
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50
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Sandal G, Cetin H. Electroconvulsive therapy during pregnancy as a possible cause of Möbius syndrome: additional clinical observation. Genet Couns 2014; 25:357-361. [PMID: 25804012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Möbius syndrome is a rare congenital disease with a prevalence of between 0.0002 and 0.002% of births. Minimum diagnostic criteria for this disease include congenital unilateral or bilateral facial and abducens nerve paresis. Occasionally, the cranial nerves V and VIII are affected. If cranial VIII is affected, the person experiences hearing loss. Other findings in these patients that are not part of the diagnostic criteria include the involvement of other cranial nerves, malformations of orofacial structures, reductive limb anomalies, and defects of the chest wall. We herein report a newborn case with Möbius syndrome.
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