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van der Burg JMM, Weydt P, Landwehrmeyer GB, Aziz NA. Effect of Body Weight on Age at Onset in Huntington Disease: A Mendelian Randomization Study. Neurol Genet 2021; 7:e603. [PMID: 34250226 PMCID: PMC8265577 DOI: 10.1212/nxg.0000000000000603] [Citation(s) in RCA: 4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
Objective Weight loss is associated with clinical progression in Huntington disease (HD), but whether body weight causally affects disease onset or progression is unknown. Therefore, we aimed to assess whether genetically determined variations in body weight are causally related to age at onset in HD. Methods Using data from different recent genome-wide association studies, we performed a 2-sample mendelian randomization (MR) analysis to assess whether genetic markers of body mass index (BMI) are causally related to residual age at onset in HD, i.e., the difference between observed and expected age at onset based on mutation size. Our study had a statistical power of 90% to detect a causal effect of ≥3.8 months per BMI unit change at a type I error rate of 0.05. Results Inverse-variance weighted MR estimates showed that a higher genetically determined BMI was not causally related to residual age at onset in HD (β = -0.44 years per unit increase in BMI, confidence interval: -1.33 to 0.46, p = 0.34). All other complementary (nonparametric) MR regression methods yielded similar results. Conclusions Although maintaining a healthy and stable body weight remains important in patients with HD, promoting weight gain with the aim of delaying disease onset or slowing down disease progression should be discouraged. Our findings point toward the existence of underlying pathologic processes that dictate both the rate of clinical progression and weight loss in HD, which need further elucidation as targeting these pathways, rather than body weight per se, could be of therapeutic value.
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Affiliation(s)
- Jorien M M van der Burg
- Department of Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Neurodegenerative Diseases and Gerontopsychiatry (P.W.), University of Bonn; Department of Neurology (G.B.L.), Ulm University Hospital; Department of Neurology (N.A.A.), University Hospital Bonn; and Population Health Sciences (N.A.A.), German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Patrick Weydt
- Department of Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Neurodegenerative Diseases and Gerontopsychiatry (P.W.), University of Bonn; Department of Neurology (G.B.L.), Ulm University Hospital; Department of Neurology (N.A.A.), University Hospital Bonn; and Population Health Sciences (N.A.A.), German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Georg Bernhard Landwehrmeyer
- Department of Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Neurodegenerative Diseases and Gerontopsychiatry (P.W.), University of Bonn; Department of Neurology (G.B.L.), Ulm University Hospital; Department of Neurology (N.A.A.), University Hospital Bonn; and Population Health Sciences (N.A.A.), German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - N Ahmad Aziz
- Department of Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Neurodegenerative Diseases and Gerontopsychiatry (P.W.), University of Bonn; Department of Neurology (G.B.L.), Ulm University Hospital; Department of Neurology (N.A.A.), University Hospital Bonn; and Population Health Sciences (N.A.A.), German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Aziz NA, van der Burg JMM, Tabrizi SJ, Landwehrmeyer GB. Overlap between age-at-onset and disease-progression determinants in Huntington disease. Neurology 2018; 90:e2099-e2106. [PMID: 29743208 PMCID: PMC5996832 DOI: 10.1212/wnl.0000000000005690] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/14/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A fundamental but still unresolved issue regarding Huntington disease (HD) pathogenesis is whether the factors that determine age at onset are the same as those that govern disease progression. Because elucidation of this issue is crucial for the development as well as optimal timing of administration of novel disease-modifying therapies, we aimed to assess the extent of overlap between age-at-onset and disease-progression determinants in HD. METHODS Using observational data from Enroll-HD, the largest cohort of patients with HD worldwide, in this study we present, validate, and apply an intuitive method based on linear mixed-effect models to quantify the variability in the rate of disease progression in HD. RESULTS A total of 3,411 patients with HD met inclusion criteria. We found that (1) about two-thirds of the rate of functional, motor, and cognitive progression in HD is determined by the same factors that also determine age at onset, with CAG repeat-dependent mechanisms having by far the largest effect; (2) although expanded HTT CAG repeat size had a large influence on average body weight, the rate of weight loss was largely independent of factors that determine age at onset in HD; and (3) about one-third of the factors that determine the rate of functional, motor, and cognitive progression are different from those that govern age at onset and need further elucidation. CONCLUSION Our findings imply that targeting of CAG repeat-dependent mechanisms, for example through gene-silencing approaches, is likely to affect the rate of functional, motor, and cognitive impairment, but not weight loss, in manifest HD mutation carriers.
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Affiliation(s)
- N Ahmad Aziz
- From the Department of Neurodegenerative Disease (N.A.A., S.J.T.), UCL Huntington's Disease Centre, University College London Institute of Neurology, UK; Departments of Neurology (N.A.A.) and Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Population Health Sciences (N.A.A.), German Center for Neurodegenerative Diseases (DZNE), Bonn; and Department of Neurology (G.B.L.), Ulm University Hospital, Germany.
| | - Jorien M M van der Burg
- From the Department of Neurodegenerative Disease (N.A.A., S.J.T.), UCL Huntington's Disease Centre, University College London Institute of Neurology, UK; Departments of Neurology (N.A.A.) and Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Population Health Sciences (N.A.A.), German Center for Neurodegenerative Diseases (DZNE), Bonn; and Department of Neurology (G.B.L.), Ulm University Hospital, Germany
| | - Sarah J Tabrizi
- From the Department of Neurodegenerative Disease (N.A.A., S.J.T.), UCL Huntington's Disease Centre, University College London Institute of Neurology, UK; Departments of Neurology (N.A.A.) and Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Population Health Sciences (N.A.A.), German Center for Neurodegenerative Diseases (DZNE), Bonn; and Department of Neurology (G.B.L.), Ulm University Hospital, Germany
| | - G Bernhard Landwehrmeyer
- From the Department of Neurodegenerative Disease (N.A.A., S.J.T.), UCL Huntington's Disease Centre, University College London Institute of Neurology, UK; Departments of Neurology (N.A.A.) and Public Health and Primary Care (J.M.M.v.d.B.), Leiden University Medical Centre, the Netherlands; Department of Population Health Sciences (N.A.A.), German Center for Neurodegenerative Diseases (DZNE), Bonn; and Department of Neurology (G.B.L.), Ulm University Hospital, Germany
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van der Burg JMM, Gardiner SL, Ludolph AC, Landwehrmeyer GB, Roos RAC, Aziz NA. Body weight is a robust predictor of clinical progression in Huntington disease. Ann Neurol 2017; 82:479-483. [PMID: 28779551 DOI: 10.1002/ana.25007] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 11/09/2022]
Abstract
Unintended weight loss is a hallmark of Huntington disease (HD), but it is unknown to what extent weight loss impacts the rate of disease progression. Therefore, using longitudinal data from the Enroll-HD study, we assessed the association between baseline body mass index (BMI) and the rate of clinical progression in 5,821 HD mutation carriers. We found that high baseline BMI was associated with a significantly slower rate of functional, motor, and cognitive deterioration (all p < 0.001), independent of mutant HTT CAG repeat size. Our findings provide strong rationale for exploration of systemic metabolism as a therapeutic target in HD. Ann Neurol 2017;82:479-483.
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Affiliation(s)
- Jorien M M van der Burg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Sarah L Gardiner
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - N Ahmad Aziz
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurodegenerative Disease, University College London Huntington's Disease Centre, University College London Institute of Neurology, London, United Kingdom
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van der Burg JMM, Tordoir RL, Smithuis RHM. [A man who is not able to straighten his knee]. Ned Tijdschr Geneeskd 2016; 160:A9856. [PMID: 27096479] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An 86-year-old man presented at the Emergency Department with pain in his right leg and the inability to extend his knee after a fall. An ultrasound of the leg revealed a quadriceps tendon rupture. Surgical repair was performed and we expect complete recovery.
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van der Burg JMM, Pijl H, Campman YJM, Roos RAC, Aziz NA. Does midlife obesity really lower dementia risk? Lancet Diabetes Endocrinol 2015; 3:499-500. [PMID: 26138163 DOI: 10.1016/s2213-8587(15)00217-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jorien M M van der Burg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2300, Netherlands
| | - Hanno Pijl
- Department of Endocrinology & Metabolism, Leiden University Medical Centre, Leiden, 2300, Netherlands
| | - Yvonne J M Campman
- Department of Neurology, Leiden University Medical Centre, Leiden, 2300, Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, 2300, Netherlands
| | - N Ahmad Aziz
- Department of Neurology, Leiden University Medical Centre, Leiden, 2300, Netherlands.
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van der Burg JMM, van Leeuwen RL. [A boy with a wart-like lesion of the toe]. Ned Tijdschr Geneeskd 2014; 158:A7417. [PMID: 24735812] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 10-year-old boy consulted a dermatologist with a painful, subungual tumour on one of his toes. X-ray showed an outgrowth of the distal phalanx and histopathological investigation showed osteochondromatous proliferation. The patient was diagnosed with exostosis. Subungual exostoses are benign osteocartilaginous tumours that occur beneath the nail bed. Excision was performed, the patient recovered well.
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Wood NI, Goodman AOG, van der Burg JMM, Gazeau V, Brundin P, Björkqvist M, Petersén A, Tabrizi SJ, Barker RA, Morton AJ. Increased thirst and drinking in Huntington's disease and the R6/2 mouse. Brain Res Bull 2008; 76:70-9. [PMID: 18395613 DOI: 10.1016/j.brainresbull.2007.12.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 11/16/2007] [Accepted: 12/06/2007] [Indexed: 11/16/2022]
Abstract
While Huntington's disease (HD) is a condition that primarily involves the basal ganglia, there is evidence to suggest that the hypothalamus is also affected. Because the osmoreceptors regulating thirst are situated in the circumventricular region of the hypothalamus, we were interested in whether altered thirst is a part of the HD phenotype. We used the LABORAS behavioural monitoring system and water consumption to show that drinking behaviour was abnormal in R6/2 mice. By 10 weeks of age, R6/2 mice spent significantly more time drinking and drank a greater volume than their wild-type (WT) littermates. The numbers of immunoreactive vasopressin neurons in the paraventricular nucleus (PVN) of the hypothalamus in R6/2 mice were significantly decreased from 8 weeks of age, suggesting that the change in drinking behaviour may be the result of hypothalamic dysfunction. We gave a xerostomia (dry mouth) questionnaire to HD patients and control subjects, and also measured their urine osmolality and serum vasopressin. The mean total xerostomia score was significantly higher in HD patients than in controls, indicating greater thirst in HD patients. Urine osmolality was unaffected in HD patients up to clinical stage III, and none of the patients had diabetes. However, serum vasopressin was increased, suggesting a dysregulation in the control of hypothalamic vasopressin release. A dry mouth can affect taste, mastication and swallowing, all of which may contribute to the significant weight loss seen in both HD patients and R6/2 mice, as can dehydration. We suggest that increased thirst may be an important and clinically relevant biomarker for the study of disease progression in HD.
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Affiliation(s)
- Nigel I Wood
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge CB2 1PD, United Kingdom
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Terpstra NJ, Bolhuis JJ, Riebel K, van der Burg JMM, den Boer-Visser AM. Localized brain activation specific to auditory memory in a female songbird. J Comp Neurol 2005; 494:784-91. [PMID: 16374807 DOI: 10.1002/cne.20831] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Song acquisition in songbird males is a prominent model system for the study of the brain mechanisms of memory. Male zebra finches (Taeniopygia guttata) learn their songs from an adult conspecific tutor early in life. Previous work has shown that exposure of males to their tutor song leads to increased expression of immediate early genes (IEGs) in the caudomedial nidopallium (NCM) and in the caudomedial mesopallium (CMM). In addition, IEG expression in the NCM correlates significantly with the strength of song learning. Interpretation of these findings is complicated, as males both learn the characteristics of tutor song and learn to produce a similar own song. Female zebra finches do not sing, but nevertheless they learn the characteristics of a song to which they were exposed when young, and form a preference for it. Here, adult zebra finch females reared with their fathers showed a significant preference for their father's song. Females that were later reexposed to their father's song showed significantly greater expression of Zenk, the protein product of the IEG ZENK, than controls that were exposed to a novel song, in the CMM, but not in the NCM or hippocampus. These results suggest that in female zebra finches the CMM may be (part of) the neural substrate for the representation of the memory of their father's song.
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Affiliation(s)
- Nienke J Terpstra
- Behavioural Biology, Institute of Biology Leiden, Leiden University, 2300 RA Leiden, The Netherlands
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