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Grolez G, Moreau C, Sablonnière B, Garçon G, Devedjian JC, Meguig S, Gelé P, Delmaire C, Bordet R, Defebvre L, Cabantchik IZ, Devos D. Ceruloplasmin activity and iron chelation treatment of patients with Parkinson's disease. BMC Neurol 2015; 15:74. [PMID: 25943368 PMCID: PMC4429376 DOI: 10.1186/s12883-015-0331-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/24/2015] [Indexed: 01/06/2023] Open
Abstract
Background Growing body of evidence suggests that Parkinson’s disease (PD) is associated with oxidative damage via iron accumulation in the substantia nigra (SN). Low ceruloplasmin (CP)-ferroxidase activity has been identified in the SN and the cerebrospinal fluid (CSF) of patients with PD. The iron chelator, deferiprone, reduces the abnormally high levels of iron in the SN. In order to determine CP’s involvement in iron accumulation in SN and PD progression, we aim to compare the ability of iron chelation treatment to reducing both SN iron levels and motor handicap in PD patients according to the level of ceruloplasmin activity. Methods We used a moderate chelation protocol with deferiprone (DFP) based on a, 6-month delayed-start paradigm, randomized placebo controlled clinical trial in 40 PD patients. CP-ferroxidase activity was determined in blood and CSF together with the D544E gene polymorphism (rs701753). Iron levels were determined by R2* MRI sequence and the motor handicap by the UPDRS motor score. Results After 6 to 12 months of DFP treatment, greater reductions in SN iron levels and UPDRS motor scores were obtained in patients with higher serum and CSF levels of CP-ferroxidase activity. After 6 months of DFP treatment, the AT genotype group displayed greater reduction of iron level in the SN with greater CSF and serum levels of CP activity than the AA genotype group. Conclusion Although most of the DFP-treated patients displayed clinical and radiological improvements, those with the lower CP activity appeared to respond better to iron chelation. Larger RCTs are now needed to establish whether pharmacological modulation of CP activity could be an innovative neuroprotective strategy in PD. Trial registration FAIR-PARK study (ClinicalTrials.gov reference: NCT00943748; French national reference number: 2008−006842−25). This study was approved by the French Drug Agency (ANSM) and the local institutional review board (“Comité de Protection des Personnes of Lille”). Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0331-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guillaume Grolez
- Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. .,INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France.
| | - Caroline Moreau
- Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. .,INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France.
| | - Bernard Sablonnière
- Department of Molecular Biology and Pathology Centre, Unit 837, Team 1, INSERM Lille Faculty of Medicine, Lille University Hospital, Lille Nord de France University, Lille, France.
| | - Guillaume Garçon
- Department of Toxicology, Public Health and Environment, EA 4483, Faculty of Pharmaceutic and Biological Sciences, Lille Nord de France University, Lille, France.
| | - Jean-Christophe Devedjian
- Department of Medical Pharmacology, Lille Nord de France University, Lille, France. .,INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France.
| | - Sayah Meguig
- Department of Medical Pharmacology, Lille Nord de France University, Lille, France.
| | - Patrick Gelé
- Biological Resources Centre, Lille University Hospital, Lille, France.
| | - Christine Delmaire
- INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. .,Department of Neuroradiology, Lille University Hospital, Lille, France.
| | - Regis Bordet
- Department of Medical Pharmacology, Lille Nord de France University, Lille, France. .,INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France.
| | - Luc Defebvre
- Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. .,INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France.
| | - Ioav Z Cabantchik
- Della Pergola Chair, Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel.
| | - David Devos
- Department of Medical Pharmacology, Lille Nord de France University, Lille, France. .,Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. .,INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. .,Department of Toxicology, Public Health and Environment, EA 4483, Faculty of Pharmaceutic and Biological Sciences, Lille Nord de France University, Lille, France.
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Moreau C, Meguig S, Corvol JC, Labreuche J, Vasseur F, Duhamel A, Delval A, Bardyn T, Devedjian JC, Rouaix N, Petyt G, Brefel-Courbon C, Ory-Magne F, Guehl D, Eusebio A, Fraix V, Saulnier PJ, Lagha-Boukbiza O, Durif F, Faighel M, Giordana C, Drapier S, Maltête D, Tranchant C, Houeto JL, Debû B, Azulay JP, Tison F, Destée A, Vidailhet M, Rascol O, Dujardin K, Defebvre L, Bordet R, Sablonnière B, Devos D. Polymorphism of the dopamine transporter type 1 gene modifies the treatment response in Parkinson's disease. Brain 2015; 138:1271-83. [PMID: 25805645 DOI: 10.1093/brain/awv063] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/17/2015] [Indexed: 11/14/2022] Open
Abstract
After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guidelines on setting the optimal dose for a given patient. The dopamine transporter type 1, now known as solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3) is the most powerful determinant of dopamine neurotransmission and might therefore influence the treatment response. We recently demonstrated that methylphenidate (a dopamine transporter inhibitor) is effective in patients with Parkinson's disease with motor and gait disorders. The objective of the present study was to determine whether genetic variants of the dopamine transporter type 1-encoding gene (SLC6A3) are associated with differences in the response to treatment of motor symptoms and gait disorders with l-DOPA and methylphenidate (with respect to the demographic, the disease and the treatment parameters and the other genes involved in the dopaminergic neurotransmission). This analysis was part of a multicentre, parallel-group, double-blind, placebo-controlled, randomized clinical trial of methylphenidate in Parkinson's disease (Protocol ID:2008-005801-20; ClinicalTrials.gov:NCT00914095). We scored the motor Unified Parkinson's Disease Rating Scale and the Stand-Walk-Sit Test before and after a standardized acute l-DOPA challenge before randomization and then after 3 months of methylphenidate treatment. Patients were screened for variants of genes involved in dopamine metabolism: rs28363170 and rs3836790 polymorphisms in the SLC6A3 gene, rs921451 and rs3837091 in the DDC gene (encoding the aromatic L-amino acid decarboxylase involved in the synthesis of dopamine from l-DOPA), rs1799836 in the MAOB gene (coding for monoamine oxidase B) and rs4680 in the COMT gene (coding for catechol-O-methyltransferase). Investigators and patients were blinded to the genotyping data throughout the study. Eighty-one subjects were genotyped and 61 were analysed for their acute motor response to l-DOPA. The SLC6A3 variants were significantly associated with greater efficacy of l-DOPA for motor symptoms. The SLC6A3 variants were also associated with greater efficacy of methylphenidate for motor symptoms and gait disorders in the ON l-DOPA condition. The difference between motor Unified Parkinson's Disease Rating Scale scores for patients with different SLC6A3 genotypes was statistically significant in a multivariate analysis that took account of other disease-related, treatment-related and pharmacogenetic parameters. Our preliminary results suggest that variants of SLC6A3 are genetic modifiers of the treatment response to l-DOPA and methylphenidate in Parkinson's disease. Further studies are required to assess the possible value of these genotypes for (i) guiding l-DOPA dose adaptations over the long term; and (ii) establishing the risk/benefit balance associated with methylphenidate treatment for gait disorders.
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Affiliation(s)
- Caroline Moreau
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Sayah Meguig
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | - Jean-Christophe Corvol
- 4 Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, Département des Maladies du Système Nerveux, Paris, France
| | - Julien Labreuche
- 5 Department of Biostatistics, Lille University, CHU Lille, Lille, France
| | - Francis Vasseur
- 5 Department of Biostatistics, Lille University, CHU Lille, Lille, France
| | - Alain Duhamel
- 5 Department of Biostatistics, Lille University, CHU Lille, Lille, France
| | - Arnaud Delval
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Thomas Bardyn
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | | | - Nathalie Rouaix
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | - Gregory Petyt
- 6 Department of Nuclear Medicine, Lille University, CHU Lille, Lille, France
| | - Christine Brefel-Courbon
- 7 Departments of Clinical Pharmacology and Neurosciences, CIC9302, University Hospital and Paul Sabatier University, Toulouse, France
| | - Fabienne Ory-Magne
- 7 Departments of Clinical Pharmacology and Neurosciences, CIC9302, University Hospital and Paul Sabatier University, Toulouse, France
| | - Dominique Guehl
- 8 Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR CNRS 5293 and CHU de Bordeaux, Bordeaux, France
| | - Alexandre Eusebio
- 9 Department of Neurology and Movement Disorders - APHM Timone University Hospital and Institut de Neurosciences de la Timone, AMU-CNRS UMR 7289, Marseille, France
| | - Valérie Fraix
- 10 Department of Psychiatry and Neurology, CHU Grenoble, Grenoble, France
| | - Pierre-Jean Saulnier
- 11 Department of Movement Disorders and Neurology, Centre d'Investigation Clinique, INSERM CIC 0802, INSERM U1084, Laboratoire de Neurosciences Expérimentales et Cliniques, CHU de Poitiers, Poitiers, France
| | - Ouhaid Lagha-Boukbiza
- 12 Department of Movement Disorders and Neurology, CHU Strasbourg, Strasbourg, France
| | - Frank Durif
- 13 Department of Movement Disorders and Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mirela Faighel
- 14 Department of Movement Disorders and Neurology, INSERM, CIC04, CHU Nantes, Nantes, France
| | - Caroline Giordana
- 15 Department of Movement Disorders and Neurology, CHU Nice, Nice, France
| | - Sophie Drapier
- 16 Department of Neurology, EA- 425 Université Rennes 1 et CHU Pontchaillou, CHU Rennes, Rennes, France
| | - David Maltête
- 17 Department of Neurology and INSERM CIC-CRB 0204, Rouen University Hospital, CHU Rouen Rouen, France
| | - Christine Tranchant
- 12 Department of Movement Disorders and Neurology, CHU Strasbourg, Strasbourg, France
| | - Jean-Luc Houeto
- 11 Department of Movement Disorders and Neurology, Centre d'Investigation Clinique, INSERM CIC 0802, INSERM U1084, Laboratoire de Neurosciences Expérimentales et Cliniques, CHU de Poitiers, Poitiers, France
| | - Bettina Debû
- 10 Department of Psychiatry and Neurology, CHU Grenoble, Grenoble, France
| | - Jean-Philippe Azulay
- 9 Department of Neurology and Movement Disorders - APHM Timone University Hospital and Institut de Neurosciences de la Timone, AMU-CNRS UMR 7289, Marseille, France
| | - François Tison
- 8 Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR CNRS 5293 and CHU de Bordeaux, Bordeaux, France
| | - Alain Destée
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 18 INSERM U837/6 Lille JPARC, France
| | - Marie Vidailhet
- 6 Department of Nuclear Medicine, Lille University, CHU Lille, Lille, France
| | - Olivier Rascol
- 7 Departments of Clinical Pharmacology and Neurosciences, CIC9302, University Hospital and Paul Sabatier University, Toulouse, France 19 INSERM NS-PARK National Network, France
| | - Kathy Dujardin
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Luc Defebvre
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France
| | - Régis Bordet
- 2 INSERM U1171, Lille University, Lille, France 18 INSERM U837/6 Lille JPARC, France
| | - Bernard Sablonnière
- 3 Department of Molecular Biology and Pathology Centre, Lille University, CHU Lille, Lille, France
| | - David Devos
- 1 Department of Movement Disorders and Neurology, Lille University, CHU Lille, Lille, France 2 INSERM U1171, Lille University, Lille, France 20 Department of Medical Pharmacology, Lille University, CHU Lille, Lille, France
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