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Carstens L, Popp M, Keicher C, Hertrampf R, Weigner D, Meiering MS, Luippold G, Süssmuth SD, Beckmann CF, Wunder A, Grimm S. Effects of a single dose of amisulpride on functional brain changes during reward- and motivation-related processing using task-based fMRI in healthy subjects and patients with major depressive disorder - study protocol for a randomized clinical trial. Trials 2023; 24:761. [PMID: 38012795 PMCID: PMC10683198 DOI: 10.1186/s13063-023-07788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Anhedonia and other deficits in reward- and motivation-related processing in psychiatric patients, including patients with major depressive disorder (MDD), represent a high unmet medical need. Neurobiologically, these deficits in MDD patients are mainly associated with low dopamine function in a frontostriatal network. In this study, alterations in brain activation changes during reward processing and at rest in MDD patients compared with healthy subjects are explored and the effects of a single low dose of the dopamine D2 receptor antagonist amisulpride are investigated. METHODS This is a randomized, controlled, double-blind, single-dose, single-center parallel-group clinical trial to assess the effects of a single dose of amisulpride (100 mg) on blood-oxygenation-level-dependent (BOLD) responses during reward- and motivation-related processing in healthy subjects (n = 60) and MDD patients (n = 60). Using functional magnetic resonance imaging (fMRI), BOLD responses are assessed during the monetary incentive delay (MID) task (primary outcome). Exploratory outcomes include BOLD responses and behavioral measures during the MID task, instrumental learning task, effort-based decision-making task, social incentive delay task, and probabilistic reward task as well as changes in resting state functional connectivity and cerebral blood flow. DISCUSSION This study broadly covers all aspects of reward- and motivation-related processing as categorized by the National Institute of Mental Health Research Domain Criteria and is thereby an important step towards precision psychiatry. Results regarding the immediate effects of a dopaminergic drug on deficits in reward- and motivation-related processing not only have the potential to significantly broaden our understanding of underlying neurobiological processes but might eventually also pave the way for new treatment options. TRIAL REGISTRATION ClinicalTrials.gov NCT05347199. April 12, 2022.
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Affiliation(s)
| | - Margot Popp
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | | | | | | | | | - Gerd Luippold
- Clinical Development and Operations, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Sigurd D Süssmuth
- Medicine Therapeutic Area CNS-Retinopathies-Emerging Areas, Boehringer Ingelheim International GmbH, Biberach an Der Riss, Germany
| | - Christian F Beckmann
- Donders Institute, Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
- Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- SBGneuro Ltd, Littlemore, Oxford, UK
| | - Andreas Wunder
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
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Michal M, Schulz A, Wild PS, Koeck T, Münzel T, Schuster AK, Strauch K, Lackner K, Süssmuth SD, Niessen HG, Borta A, Allers KA, Zahn D, Beutel ME. Tryptophan catabolites and depression in the general population: results from the Gutenberg Health Study. BMC Psychiatry 2023; 23:27. [PMID: 36631760 PMCID: PMC9835277 DOI: 10.1186/s12888-023-04520-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Previous studies reported significantly altered tryptophan catabolite concentrations in major depression. Thus, tryptophan catabolites were considered as potential biomarkers of depression and their modulators as potential targets for psychopharmacotherapy. However, the results were based mainly on studies with small sample sizes limiting their generalizability. Against this background, we investigated the relationship of peripheral tryptophan catabolites with depression in a population-based sample with n = 3,389 participants (with fasting status ≥ 8 h and C-reactive protein < 10 mg/L). N = 248 had clinically significant depression according to a PHQ-9 score of ≥ 10, n = 1,101 subjects had mild depressive symptoms with PHQ-9 scores between 5 and 9, and n = 2,040 had no depression. After multivariable adjustment, clinically significant depression was associated with lower kynurenine and kynurenic acid. Spearman correlation coefficients of the tryptophan catabolites with the severity of depression were very small (rho ≤ 0.080, p ≤ 0.015). None of the tryptophan catabolites could diagnostically separate depressed from not depressed persons. Concerning linear associations, kynurenine and kynurenic acid were associated only with the severity and the cognitive dimension of depression but not its somatic dimension. Tryptophan catabolites were not associated with persistence or recurrence of depression at the 5 year follow-up. The results replicated the association between kynurenine and kynurenic acid with depression. However, the associations were small raising doubts about their clinical utility. Findings underline the complexity of the relationships between depression and tryptophan catabolites. The search for subgroups of depression with a potentially higher impact of depression might be warranted.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg University, 55131, Langenbeckstr. 1, Mainz, Germany.
| | - Andreas Schulz
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S. Wild
- grid.410607.4German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg University, 55131, Langenbeckstr. 1, Mainz, Germany ,grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Koeck
- grid.410607.4German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg University, 55131, Langenbeckstr. 1, Mainz, Germany ,grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- grid.410607.4Center for Cardiology – Cardiology I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander K. Schuster
- grid.410607.4Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Konstantin Strauch
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Karl Lackner
- grid.410607.4Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sigurd D. Süssmuth
- Clinical Development, uniQure NV, Allschwil, Switzerland ,grid.410712.10000 0004 0473 882XDepartment of Neurology, Univeristy Hospital of Ulm University, Ulm, Germany
| | - Heiko G. Niessen
- grid.420061.10000 0001 2171 7500Department of Translational Medicine & Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Strasse 65, 88397 Biberach an Der Riss, Germany
| | - Andreas Borta
- Clinical Development, uniQure NV, Allschwil, Switzerland
| | - Kelly A. Allers
- grid.420061.10000 0001 2171 7500CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Strasse 65, 88397 Biberach an Der Riss, Germany
| | - Daniela Zahn
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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3
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Milaneschi Y, Allers KA, Beekman ATF, Giltay EJ, Keller S, Schoevers RA, Süssmuth SD, Niessen HG, Penninx BWJH. The association between plasma tryptophan catabolites and depression: The role of symptom profiles and inflammation. Brain Behav Immun 2021; 97:167-175. [PMID: 34252568 DOI: 10.1016/j.bbi.2021.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/28/2021] [Accepted: 07/04/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Tryptophan catabolites ("TRYCATs") produced by the kynurenine pathway (KP) may play a role in depression pathophysiology. Studies comparing TRYCATs levels in depressed subjects and controls provided mixed findings. We examined the association of TRYCATs levels with 1) the presence of Major Depressive Disorder (MDD), 2) depressive symptom profiles and 3) inflammatory markers. METHODS The sample from the Netherlands Study of Depression and Anxiety included participants with current (n = 1100) or remitted (n = 753) MDD DSM-IV diagnosis and healthy controls (n = 642). Plasma levels of tryptophan (TRP), kynurenine (KYN), kynurenic acid (KynA), quinolinic acid (QA), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor (TNF) were measured. Atypical/energy-related symptom (AES), melancholic symptom (MS) and anxious-distress symptom (ADS) profiles were derived from questionnaires. RESULTS After adjustment for age, sex, education, smoking status, alcohol consumption and chronic diseases, no significant differences in TRYCATs were found comparing MDD cases versus controls. The MS profile was associated (q < 0.05) with lower KynA (β = -0.05), while AES was associated with higher KYN (β = 0.05), QA (β = 0.06) and TRP (β = 0.06). Inflammatory markers were associated with higher KYN (CRP β = 0.12, IL-6 β = 0.08, TNF β = 0.10) and QA (CRP β = 0.21, IL-6 β = 0.12, TNF β = 0.18). Significant differences against controls emerged after selecting MDD cases with high (top 30%) CRP (KYN d = 0.20, QA d = 0.33) and high TNF (KYN d = 0.24; QA d = 0.39). CONCLUSIONS TRYCATs levels were related to specific clinical and biological features, such as atypical symptoms or a proinflammatory status. Modulation of KP may potentially benefit a specific subset of depressed patients. Clinical studies should focus on patients with clear evidence of KP dysregulations.
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Affiliation(s)
- Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC/Vrije Universiteit, Amsterdam, The Netherlands.
| | - Kelly A Allers
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC/Vrije Universiteit, Amsterdam, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Sascha Keller
- Drug Metabolism & Pharmacokinetics, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Sigurd D Süssmuth
- Therapeutic Area CNS-Retinopathies-Emerging Areas, Boehringer Ingelheim International GmbH, Biberach an der Riss, Germany
| | - Heiko G Niessen
- Department of Translational Medicine & Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC/Vrije Universiteit, Amsterdam, The Netherlands
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Schradt F, Geitner C, Lindner-Pfleghar B, Rea D, Hamilton A, Lang C, Süssmuth SD, Weydt P, Schumann B, Werner C. H2 Dysphagia in huntington’s disease (HD): a longitudinal, observational study. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.160] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brettschneider J, Maier M, Arda S, Claus A, Süssmuth SD, Kassubek J, Tumani H. Tau protein level in cerebrospinal fluid is increased in patients with early multiple sclerosis. Mult Scler 2016; 11:261-5. [PMID: 15957504 DOI: 10.1191/1352458505ms1159oa] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 11/05/2022]
Abstract
Axonal damage has been proposed as the major substrate of permanent clinical disability in multiple sclerosis. Tau protein, a microtubule-associated protein localised in neuronal axons, may serve as a biochemical surrogate marker to evaluate axonal damage in vivo.We intended to determine the extent of axonal damage in different stages and clinical subtypes of MS by investigating cerebrospinal fluid tau concentrations. Tau was measured using an immunoassay in 35 patients with relapsing—remitting MS, eight patients with secondary progressive MS, nine patients with primary progressive MS, 50 patients with clinically isolated syndrome suggestive of early MS and 46 normal controls. Cerebrospinal fluid tau was significantly elevated in MS compared with normal controls (median 206.0 pg/mL versus152.0 pg/mL;P=0.002). No significant difference among different subtypes of MS could be detected, although highest levels were found in very early disease stages. There was a significant elevation of CSF tau among patients with gadolinium-enhancing brain lesions in magnetic resonance imaging (P=0.02) and a tendency towards higher CSF tau levels in patients with pronounced intrathecal IgG synthesis, supporting the notion that axonal damage is influenced by inflammatory activity.
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Affiliation(s)
- J Brettschneider
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Süssmuth SD, Müller VM, Geitner C, Landwehrmeyer GB, Iff S, Gemperli A, Orth M. Fat-free mass and its predictors in Huntington's disease. J Neurol 2015; 262:1533-40. [PMID: 25904208 DOI: 10.1007/s00415-015-7753-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/18/2022]
Abstract
The causes of weight loss in Huntington's disease (HD) are not entirely clear. The aim was to identify risk factors that are associated with a loss of metabolically active tissues, i.e. fat-free mass. A consecutive cohort of non-diabetic HD participants (manifest HD, n = 43; CAG: mean 43.6.0 ± 3.6; preHD, n = 10; CAG: mean 41.4 ± 1.4) and 36 healthy controls was recruited. Twenty-five HD participants were early-stage HD (UHDRS Total Functional Capacity [TFC] stages I and II), 12 mid-stage HD (TFC stage III), and 6 participants were in late-stage HD (TFC stages IV and V). Food intake, basic metabolic rate and glucose homeostasis were assessed. In addition, fat-free mass was determined using bioelectric impedance analysis, and leptin, insulin and ghrelin as key metabolic regulators. Sex ratio and age were similar in HD participants (71 % women; age 50.6 ± 10.9) and controls (66 % women; age 46.4 ± 14.5). Body mass index (BMI) was lower in HD participants than controls (median 24.1 vs. 25.9, p = 0.04). However, fat-free mass and basic metabolic rate were not statistically different between groups and showed no association with disease burden. In controls and HD participants, leptin was the most important predictor of fat-free mass. While BMI was lower in HD participants, fat-free mass was similar to controls with leptin as its most important predictor. Leptin levels and fat-free mass measurements using bioelectric impedance analysis may be good screening tools to identify HD patients at risk for weight loss.
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Affiliation(s)
- S D Süssmuth
- Department of Neurology, Ulm University, Oberer Eselsberg 45/1, 89081, Ulm, Germany
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7
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Süssmuth SD, Haider S, Landwehrmeyer GB, Farmer R, Frost C, Tripepi G, Andersen CA, Di Bacco M, Lamanna C, Diodato E, Massai L, Diamanti D, Mori E, Magnoni L, Dreyhaupt J, Schiefele K, Craufurd D, Saft C, Rudzinska M, Ryglewicz D, Orth M, Brzozy S, Baran A, Pollio G, Andre R, Tabrizi SJ, Darpo B, Westerberg G. An exploratory double-blind, randomized clinical trial with selisistat, a SirT1 inhibitor, in patients with Huntington's disease. Br J Clin Pharmacol 2015; 79:465-76. [PMID: 25223731 PMCID: PMC4345957 DOI: 10.1111/bcp.12512] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [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: 03/27/2014] [Accepted: 09/06/2014] [Indexed: 12/22/2022] Open
Abstract
AIMS Selisistat, a selective SirT1 inhibitor is being developed as a potentially disease-modifying therapeutic for Huntington's disease (HD). This was the first study of selisistat in HD patients and was primarily aimed at development of pharmacodynamic biomarkers. METHODS This was a randomized, double-blind, placebo-controlled, multicentre exploratory study. Fifty-five male and female patients in early stage HD were randomized to receive 10 mg or 100 mg of selisistat or placebo once daily for 14 days. Blood sampling, clinical and safety assessments were conducted throughout the study. Candidate pharmacodynamic markers included circulating soluble huntingtin and innate immune markers. RESULTS Selisistat was found to be safe and well tolerated, and systemic exposure parameters showed that the average steady-state plasma concentration achieved at the 10 mg dose level (125 nm) was comparable with the IC50 for SirT1 inhibition. No adverse effects on motor, cognitive or functional readouts were recorded. While circulating levels of soluble huntingtin were not affected by selisistat in this study, the biological samples collected have allowed development of assay technology for use in future studies. No effects on innate immune markers were seen. CONCLUSIONS Selisistat was found to be safe and well tolerated in early stage HD patients at plasma concentrations within the anticipated therapeutic concentration range.
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Affiliation(s)
| | - Salman Haider
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
| | | | - Ruth Farmer
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | | | | | | | - Claudia Lamanna
- Siena Biotech SpASiena, Italy
- European Huntington's Disease Network (EHDN)Chieti, Italy
| | | | | | | | | | | | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm UniversityUlm, Germany
| | - Karin Schiefele
- Institute of Epidemiology and Medical Biometry, Ulm UniversityUlm, Germany
| | - David Craufurd
- Institute of Human Development, Faculty of Medical and Human Sciences, University of ManchesterManchester, United Kingdom
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science CentreManchester, United Kingdom
| | - Carsten Saft
- Department of Neurology, Huntington-Center NRW, St. Josef-Hospital, Ruhr-UniversityBochum, Germany
| | - Monika Rudzinska
- Department of Neurology, Medical University of SilesiaKatowice, Poland
| | - Danuta Ryglewicz
- Department of Neurology, Institute of Psychiatry and NeurologyWarsaw, Poland
| | - Michael Orth
- Department of Neurology, Ulm University HospitalUlm, Germany
| | | | | | | | - Ralph Andre
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
| | - Borje Darpo
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd HospitalStockholm, Sweden
- iCardiac TechnologiesRochester, NY, USA
| | - Goran Westerberg
- Siena Biotech SpASiena, Italy
- La Crocina Pharmaceutical Consultants D.I.San Giovanni d'Asso (S), Italy
| | - Paddington Consortium
- Department of Neurology, Ulm University HospitalUlm, Germany
- Department of Neurodegenerative Disease, University College London Institute of NeurologyLondon, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondon, United Kingdom
- Siena Biotech SpASiena, Italy
- European Huntington's Disease Network (EHDN)Chieti, Italy
- Institute of Epidemiology and Medical Biometry, Ulm UniversityUlm, Germany
- Institute of Human Development, Faculty of Medical and Human Sciences, University of ManchesterManchester, United Kingdom
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science CentreManchester, United Kingdom
- Department of Neurology, Huntington-Center NRW, St. Josef-Hospital, Ruhr-UniversityBochum, Germany
- Department of Neurology, Medical University of SilesiaKatowice, Poland
- Department of Neurology, Institute of Psychiatry and NeurologyWarsaw, Poland
- KCR.S.A.Warsaw, Poland
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd HospitalStockholm, Sweden
- iCardiac TechnologiesRochester, NY, USA
- La Crocina Pharmaceutical Consultants D.I.San Giovanni d'Asso (S), Italy
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Reilmann R, Rouzade‐Dominguez M, Saft C, Süssmuth SD, Priller J, Rosser A, Rickards H, Schöls L, Pezous N, Gasparini F, Johns D, Landwehrmeyer GB, Gomez‐Mancilla B. A randomized, placebo‐controlled trial of AFQ056 for the treatment of chorea in Huntington's disease. Mov Disord 2015; 30:427-31. [DOI: 10.1002/mds.26174] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ralf Reilmann
- George‐Huntington‐InstituteMünster Germany
- Institute for Clinical Radiology, University of MünsterMünster Germany
- Department of Neurodegenerative Diseases and Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingen Germany
| | | | - Carsten Saft
- Department of NeurologyHuntington Center NRW, Ruhr‐University Bochum, St. Josef‐HospitalBochum Germany
| | | | - Josef Priller
- Department of NeuropsychiatryCharité‐Universitätsmedizin BerlinBerlin Germany
| | - Anne Rosser
- Cardiff University Schools of Medicine and Biosciences, Neuroscience and Mental Health Research InstituteCardiff United Kingdom
| | - Hugh Rickards
- Department of NeuropsychiatryThe Barberry Birmingham United Kingdom
| | - Ludger Schöls
- Clinical Neurogenetics Unit, Center of Neurology and Hertie‐Institute for Clinical Brain ResearchTübingen Germany
- German Center for Neurodegenerative Diseases (DZNE)Tübingen Germany
| | - Nicole Pezous
- IIS Translational Sciences–Early Development Statistical Research, Novartis Pharma AGBasel Switzerland
| | - Fabrizio Gasparini
- Novartis Institutes for Biomedical Research, Novartis Pharma AGBasel Switzerland
| | - Donald Johns
- Neuroscience Translational Medicine, Novartis Institutes for Biomedical Research Inc.Cambridge Massachusetts USA
| | | | - Baltazar Gomez‐Mancilla
- Novartis Institutes for Biomedical Research, Novartis Pharma AGBasel Switzerland
- Department of Neurology and NeurosurgeryMcGill UniversityMontréal Québec Canada
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Wolf RC, Sambataro F, Vasic N, Depping MS, Thomann PA, Landwehrmeyer GB, Süssmuth SD, Orth M. Abnormal resting-state connectivity of motor and cognitive networks in early manifest Huntington's disease. Psychol Med 2014; 44:3341-3356. [PMID: 25066491 DOI: 10.1017/s0033291714000579] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) of multiple neural networks during the brain's 'resting state' could facilitate biomarker development in patients with Huntington's disease (HD) and may provide new insights into the relationship between neural dysfunction and clinical symptoms. To date, however, very few studies have examined the functional integrity of multiple resting state networks (RSNs) in manifest HD, and even less is known about whether concomitant brain atrophy affects neural activity in patients. METHOD Using MRI, we investigated brain structure and RSN function in patients with early HD (n = 20) and healthy controls (n = 20). For resting-state fMRI data a group-independent component analysis identified spatiotemporally distinct patterns of motor and prefrontal RSNs of interest. We used voxel-based morphometry to assess regional brain atrophy, and 'biological parametric mapping' analyses to investigate the impact of atrophy on neural activity. RESULTS Compared with controls, patients showed connectivity changes within distinct neural systems including lateral prefrontal, supplementary motor, thalamic, cingulate, temporal and parietal regions. In patients, supplementary motor area and cingulate cortex connectivity indices were associated with measures of motor function, whereas lateral prefrontal connectivity was associated with cognition. CONCLUSIONS This study provides evidence for aberrant connectivity of RSNs associated with motor function and cognition in early manifest HD when controlling for brain atrophy. This suggests clinically relevant changes of RSN activity in the presence of HD-associated cortical and subcortical structural abnormalities.
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Affiliation(s)
- R C Wolf
- Center for Psychosocial Medicine,Department of General Psychiatry,University of Heidelberg,Heidelberg,Germany
| | - F Sambataro
- Center for Neuroscience and Cognitive Systems@UniTN,Rovereto,Italy
| | - N Vasic
- Department of Psychiatry and Psychotherapy III,Ulm University,Ulm,Germany
| | - M S Depping
- Center for Psychosocial Medicine,Department of General Psychiatry,University of Heidelberg,Heidelberg,Germany
| | - P A Thomann
- Center for Psychosocial Medicine,Department of General Psychiatry,University of Heidelberg,Heidelberg,Germany
| | | | - S D Süssmuth
- Department of Neurology,Ulm University,Ulm,Germany
| | - M Orth
- Department of Neurology,Ulm University,Ulm,Germany
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10
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Müller HP, Kassubek J, Grön G, Sprengelmeyer R, Ludolph AC, Klöppel S, Hobbs NZ, Roos RAC, Duerr A, Tabrizi SJ, Orth M, Süssmuth SD, Landwehrmeyer GB. Impact of the control for corrupted diffusion tensor imaging data in comparisons at the group level: an application in Huntington disease. Biomed Eng Online 2014; 13:128. [PMID: 25178314 PMCID: PMC4162922 DOI: 10.1186/1475-925x-13-128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 05/15/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022] Open
Abstract
Background Corrupted gradient directions (GD) in diffusion weighted images may seriously affect reliability of diffusion tensor imaging (DTI)-based comparisons at the group level. In the present study we employed a quality control (QC) algorithm to eliminate corrupted gradient directions from DTI data. We then assessed effects of this procedure on comparisons between Huntington disease (HD) subjects and controls at the group level. Methods Sixty-one HD patients in early stages and forty matched healthy controls were studied in a longitudinal design (baseline and two follow-ups at three time points over 15 months), in a multicenter setting with similar acquisition protocols on four different MR scanners at four European study sites. A QC algorithm was used to identify corrupted GD in DTI data sets. Differences in fractional anisotropy (FA) maps at the group level with and without elimination of corrupted GD were analyzed. Results The elimination of corrupted GD had an impact on individual FA maps as well as on cross-sectional group comparisons between HD subjects and controls. Following application of the QC algorithm, less small clusters of FA changes were observed, compared to the analysis without QC. However, the main pattern of regional reductions and increases in FA values with and without QC-based elimination of corrupted GD was unchanged. Conclusion An impact on the result patterns of the comparison of FA maps between HD subjects and controls was observed depending on whether QC-based elimination of corrupted GD was performed. QC-based elimination of corrupted GD in DTI scans reduces the risk of type I and type II errors in cross-sectional group comparison of FA maps contributing to an increase in reliability and stability of group comparisons.
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Sprengelmeyer R, Orth M, Müller HP, Wolf RC, Grön G, Depping MS, Kassubek J, Justo D, Rees EM, Haider S, Cole JH, Hobbs NZ, Roos RAC, Dürr A, Tabrizi SJ, Süssmuth SD, Landwehrmeyer GB. The neuroanatomy of subthreshold depressive symptoms in Huntington's disease: a combined diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) study. Psychol Med 2014; 44:1867-1878. [PMID: 24093462 DOI: 10.1017/s003329171300247x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depressive symptoms are prominent psychopathological features of Huntington's disease (HD), making a negative impact on social functioning and well-being. METHOD We compared the frequencies of a history of depression, previous suicide attempts and current subthreshold depression between 61 early-stage HD participants and 40 matched controls. The HD group was then split based on the overall HD group's median Hospital Anxiety and Depression Scale-depression score into a group of 30 non-depressed participants (mean 0.8, s.d. = 0.7) and a group of 31 participants with subthreshold depressive symptoms (mean 7.3, s.d. = 3.5) to explore the neuroanatomy underlying subthreshold depressive symptoms in HD using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). RESULTS Frequencies of history of depression, previous suicide attempts or current subthreshold depressive symptoms were higher in HD than in controls. The severity of current depressive symptoms was also higher in HD, but not associated with the severity of HD motor signs or disease burden. Compared with the non-depressed HD group DTI revealed lower fractional anisotropy (FA) values in the frontal cortex, anterior cingulate cortex, insula and cerebellum of the HD group with subthreshold depressive symptoms. In contrast, VBM measures were similar in both HD groups. A history of depression, the severity of HD motor signs or disease burden did not correlate with FA values of these regions. CONCLUSIONS Current subthreshold depressive symptoms in early HD are associated with microstructural changes - without concomitant brain volume loss - in brain regions known to be involved in major depressive disorder, but not those typically associated with HD pathology.
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Affiliation(s)
| | - M Orth
- Department of Neurology,University of Ulm,Ulm,Germany
| | - H-P Müller
- Department of Neurology,University of Ulm,Ulm,Germany
| | - R C Wolf
- Centre for Psychosocial Medicine, Department of General Psychiatry,University of Heidelberg,Heidelberg,Germany
| | - G Grön
- Department of Psychiatry,University of Ulm,Ulm,Germany
| | - M S Depping
- Centre for Psychosocial Medicine, Department of General Psychiatry,University of Heidelberg,Heidelberg,Germany
| | - J Kassubek
- Department of Neurology,University of Ulm,Ulm,Germany
| | - D Justo
- Institut du Cerveau et de la Moelle épinière, Pitié-Salpêtrière Hospital,Pierre and Marie Curie University (UPMC),Paris,France
| | - E M Rees
- Department of Neurodegenerative Disease, Institute of Neurology,University College London,London,UK
| | - S Haider
- Department of Neurodegenerative Disease, Institute of Neurology,University College London,London,UK
| | - J H Cole
- Department of Neurodegenerative Disease, Institute of Neurology,University College London,London,UK
| | - N Z Hobbs
- Department of Neurodegenerative Disease, Institute of Neurology,University College London,London,UK
| | - R A C Roos
- Department of Neurology,Leiden University Medical Centre,Leiden,The Netherlands
| | - A Dürr
- Institut du Cerveau et de la Moelle épinière, Pitié-Salpêtrière Hospital,Pierre and Marie Curie University (UPMC),Paris,France
| | - S J Tabrizi
- Department of Neurodegenerative Disease, Institute of Neurology,University College London,London,UK
| | - S D Süssmuth
- Department of Neurology,University of Ulm,Ulm,Germany
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Wolf RC, Sambataro F, Vasic N, Baldas EM, Ratheiser I, Bernhard Landwehrmeyer G, Depping MS, Thomann PA, Sprengelmeyer R, Süssmuth SD, Orth M. Visual system integrity and cognition in early Huntington's disease. Eur J Neurosci 2014; 40:2417-26. [PMID: 24698429 DOI: 10.1111/ejn.12575] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/17/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
Posterior cortical volume changes and abnormal visuomotor performance are present in patients with Huntington's disease (HD). However, it is unclear whether posterior cortical volume loss contributes to abnormal neural activity, and whether activity changes predict cognitive dysfunction. Using magnetic resonance imaging (MRI), we investigated brain structure and visual network activity at rest in patients with early HD (n = 20) and healthy controls (n = 20). The symbol digit modalities test (SDMT) and subtests of the Visual Object and Space Perception Battery were completed offline. For functional MRI data, a group independent component analysis was used. Voxel-based morphometry was employed to assess regional brain atrophy, and 'biological parametric mapping' analyses were included to investigate the impact of atrophy on neural activity. Patients showed significantly worse visuomotor and visual object performance than controls. Structural analyses confirmed occipitotemporal atrophy. In patients and controls, two spatiotemporally distinct visual systems were identified. Patients showed decreased activity in the left fusiform cortex, and increased left cerebellar activity. These findings remained stable after correction for brain atrophy. Lower fusiform cortex activity was associated with lower SDMT performance and with higher disease burden scores. These associations were absent when cerebellar function was related to task performance and disease burden. The results of this study suggest that regionally specific functional abnormalities of the visual system can account for the worse visuomotor cognition in HD patients. However, occipital volume changes cannot sufficiently explain abnormal neural function in these patients.
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Affiliation(s)
- Robert C Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, Heidelberg, 69115, Germany
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Rosenbohm A, Süssmuth SD, Kassubek J, Müller HP, Pontes C, Abicht A, Bulst S, Ludolph AC, Pinkhardt E. Novel ETFDH mutation and imaging findings in an adult with glutaric aciduria type II. Muscle Nerve 2014; 49:446-50. [PMID: 23893693 DOI: 10.1002/mus.23979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Glutaric aciduria type II (GAII) is a rare autosomal recessive disorder with variable clinical course. The disorder is caused by a defect in the mitochondrial electron transfer flavoprotein or the electron transfer flavoprotein dehydrogenase (ETFDH). METHODS We performed clinical characterization, brain and whole body MRI, muscle histopathology, and genetic analysis of the ETFDH gene in a young woman. RESULTS She presented with rhabdomyolysis and severe quadriparesis. We identified a novel homozygous missense mutation in ETFDH (c.1544G>T, p.Ser515Ile). Body fat MRI revealed a large amount of subcutaneous fat but no increase in visceral fat despite steatosis of liver and muscle. Diffusion tensor imaging (DTI) of cerebral MRI revealed reduced directionality of the white matter tracts. Histopathological findings showed lipid storage myopathy. CONCLUSIONS In this study, we highlight diagnostic clues and body fat MRI in this rare metabolic disorder.
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Affiliation(s)
- Angela Rosenbohm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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14
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Massai L, Petricca L, Magnoni L, Rovetini L, Haider S, Andre R, Tabrizi SJ, Süssmuth SD, Landwehrmeyer BG, Caricasole A, Pollio G, Bernocco S. Development of an ELISA assay for the quantification of soluble huntingtin in human blood cells. BMC Biochem 2013; 14:34. [PMID: 24274906 PMCID: PMC4221641 DOI: 10.1186/1471-2091-14-34] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/19/2013] [Indexed: 11/10/2022]
Abstract
Background Huntington’s disease (HD) is a monogenic disorder caused by an aberrant expansion of CAG repeats in the huntingtin gene (HTT). Pathogenesis is associated with expression of the mutant (mHTT) protein in the CNS, with its levels most likely related to disease progression and symptom severity. Since non-invasive methods to quantify HTT in the CNS do not exist, measuring amount of soluble HTT in peripheral cells represents an important step in development of disease-modifying interventions in HD. Results An ELISA assay using commercially available antibodies was developed to quantify HTT levels in complex matrices like mammalian cell cultures lysates and human samples. The immunoassay was optimized using a recombinant full-length HTT protein, and validated both on wild-type and mutant HTT species. The ability of the assay to detect significant variations of soluble HTT levels was evaluated using an HSP90 inhibitor that is known to enhance HTT degradation. Once optimized, the bioassay was applied to peripheral blood mononuclear cells (PBMCs) from HD patients, demonstrating good potential in tracking the disease course. Conclusions The method described here represents a validated, simple and rapid bio-molecular assay to evaluate soluble HTT levels in blood cells as useful tool in disease and pharmacodynamic marker identification for observational and clinical trials.
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Affiliation(s)
- Luisa Massai
- Pharmacology Department, Siena Biotech SpA, Strada del Petriccio e Belriguardo, 35, 53100 Siena, Italy.
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Weydt P, Dietzel M, Lang C, Landwehrmeyer GB, Süssmuth SD. I09 Optical motion sensing device (kinect) to assess motor function in HD—a pilot study. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Mueller HP, Sprengelmeyer R, Süssmuth SD, Groen G, Hobbs NZ, Roos RAC, Dürr A, Schoonderbeek A, 't Hart E, Valabrègue R, Landwehrmeyer GB, Kassubek J, Tabrizi SJ. G08 A multicentre approach for the detection of patterns of impairment in Huntington's disease by using diffusion tensor imaging. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.88] [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: 11/03/2022]
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Brecht I, Jenuwein J, Landwehrmeyer GB, Süssmuth SD. Q16 Exercises for self-perception as an alternative type of physiotherapeutic practice increase motivation for other therapeutic interventions in HD. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Sprengelmeyer R, Müller HP, Süssmuth SD, Groen G, Hobbs NZ, Cole J, Roos RAC, Dürr A, Tabrizi SJ, Landwehrmeyer GB. K02 The neuroanatomy of depression: evidence from Huntington's disease. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Süssmuth SD, Schradt F, Eschenbach C, Orth M, Weydt P, Lindner-Pfleghar B, Landwehrmeyer GB. L04 Assessing dysphagia in Huntington's disease using Fiberoptic Endoscopic Evaluation of Swallowing (FEES). J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Süssmuth SD, Landwehrmeyer GB, Tabrizi SJ, Andersen C, DiBacco M, Tripepi G, Westerberg G. Q02 A randomised, double-blind, placebo-controlled phase IB pharmacodynamic study with selisistat (SEN0014196) in HD patients. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Müller HP, Süssmuth SD, Landwehrmeyer GB, Ludolph A, Tabrizi SJ, Kloppel S, Kassubek J. Stability effects on results of diffusion tensor imaging analysis by reduction of the number of gradient directions due to motion artifacts: an application to presymptomatic Huntington's disease. PLoS Curr 2011; 3:RRN1292. [PMID: 22307262 PMCID: PMC3269342 DOI: 10.1371/currents.rrn1292] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2011] [Indexed: 12/11/2022]
Abstract
In diffusion tensor imaging (DTI), an improvement in the signal-to-noise ratio (SNR) of the fractional anisotropy (FA) maps can be obtained when the number of recorded gradient directions (GD) is increased. Vice versa, elimination of motion-corrupted or noisy GD leads to a more accurate characterization of the diffusion tensor. We previously suggest a slice-wise method for artifact detection in FA maps. This current study applies this approach to a cohort of 18 premanifest Huntington's disease (pHD) subjects and 23 controls. By 2-D voxelwise statistical comparison of original FA-maps and FA-maps with a reduced number of GD, the effect of eliminating GD that were affected by motion was demonstrated.We present an evaluation metric that allows to test if the computed FA-maps (with a reduced number of GD) still reflect a "true" FA-map, as defined by simulations in the control sample. Furthermore, we investigated if omitting data volumes affected by motion in the pHD cohort could lead to an increased SNR in the resulting FA-maps.A high agreement between original FA maps (with all GD) and corrected FA maps (i.e. without GD corrupted by motion) were observed even for numbers of eliminated GD up to 13. Even in one data set in which 46 GD had to be eliminated, the results showed a moderate agreement.
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Affiliation(s)
- Hans-Peter Müller
- Dept. of Neurology, University of Ulm, Ulm, Germany; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK and Freiburg Brain Imaging, Department of Psychiatry and Psychotherapy. University of Freiburg
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Süssmuth SD, Uttner I, Landwehrmeyer B, Pinkhardt EH, Brettschneider J, Petzold A, Kramer B, Schulz JB, Palm C, Otto M, Ludolph AC, Kassubek J, Tumani H. Differential pattern of brain-specific CSF proteins tau and amyloid-beta in Parkinsonian syndromes. Mov Disord 2010; 25:1284-8. [DOI: 10.1002/mds.22895] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Süssmuth SD, Sperfeld AD, Hinz A, Brettschneider J, Endruhn S, Ludolph AC, Tumani H. CSF glial markers correlate with survival in amyotrophic lateral sclerosis. Neurology 2010; 74:982-7. [PMID: 20308682 DOI: 10.1212/wnl.0b013e3181d5dc3b] [Citation(s) in RCA: 56] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), CSF biomarkers are increasingly studied to evaluate their relevance for differential diagnosis, disease progression, and understanding of pathophysiologic processes. OBJECTIVE To identify a biomarker profile of neuronal and glial CSF proteins to discriminate ALS from other motor neuron diseases (MND) and to assess whether baseline levels of CSF measures in ALS are associated with the course of the disease. METHODS A total of 122 consecutive subjects with MND were included in this cross-sectional study (ALS, n = 75; lower motor neuron syndrome, n = 39; upper motor neuron diseases, n = 8). Clinical follow-up included 76 patients. We determined baseline levels of protein tau and astroglial S100beta in CSF and microglial sCD14 in CSF and serum in relation to diagnosis, duration of disease, and survival. RESULTS CSF tau was significantly elevated in ALS and upper motor neuron diseases as compared to lower motor neuron diseases and controls. CSF S100beta levels were significantly lower in lower motor neuron diseases as compared to other MND. CSF concentrations of S100beta and sCD14 correlated with the survival time in patients with ALS. CONCLUSIONS In motor neuron diseases, CSF tau elevation indicates the degeneration of upper motor neurons, while S100 beta and sCD14 may indicate the activation of CNS glial cells. Because S100beta and sCD14 concentrations correlate with survival in amyotrophic lateral sclerosis (ALS), we suppose that the combination of both markers may be useful to obtain prognostic information in patients with ALS.
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Affiliation(s)
- S D Süssmuth
- Department of Neurology, University of Ulm, Ulm, Germany
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Süssmuth SD, Sperfeld AD, Ludolph AC, Tumani H. Hypercapnia is a possible determinant of the function of the blood-cerebrospinal fluid barrier in amyotrophic lateral sclerosis. Neurochem Res 2010; 35:1071-4. [PMID: 20333464 DOI: 10.1007/s11064-010-0156-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
Elevated cerebrospinal fluid (CSF)/serum quotients of albumin (Q(Alb)) may occur in motor neuron diseases (MND) including amyotrophic lateral sclerosis (ALS), but the pathophysiologic mechanisms underlying these alterations are unclear. Evidence from animal experiments suggests that the arterial carbon dioxide level might affect the Q(Alb), i.e. the function of the blood-CSF barrier (BCB). We therefore compared basic CSF parameters in different forms of MND (ALS, n = 105; lower motor neuron diseases, n = 12; and upper motor neuron diseases, n = 7) and investigated the relationship between elevated Q(Alb) and the arterial partial pressure of carbon dioxide (pCO(2)) in ALS where respiratory insufficiency leads to hypercapnia in the course of the disease. Pathologic elevations of Q(Alb) occurred in 32 of 124 MND patients. In ALS, Q(Alb) significantly correlated with the arterial pCO(2) (r = 0.454; P = 0.001; n = 45). These data indicate that BCB dysfunction is a frequent finding in different forms of MND and may reflect distinct pathophysiological mechanisms. In ALS, an important underlying mechanism might be the influence of the arterial pCO(2) which may alter the CSF flow.
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Affiliation(s)
- Sigurd D Süssmuth
- Department of Neurology, Neurologische Klinik der Universität Ulm, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Abstract
The onset of multiple sclerosis presents in 85% of cases as a subacute clinical event, the so-called clinically isolated syndrome. This event involves either focal or multifocal brain regions, most frequently the optic nerve, brainstem or spinal cord. The initial diagnosis of multiple sclerosis necessitates the demonstration of dissemination of pathology in time and space, as well as the exclusion of other alternative diagnoses, and can be challenging. Confirming a diagnosis of multiple sclerosis is a sensitive time for both patient and physician. The patient is faced with a difficult diagnosis and the physician must consider making difficult treatment decisions regarding therapy and follow-up care. This article presents a number of case studies that illustrate the diversity of presentation of clinically isolated syndrome and the challenges associated with confirming a diagnosis of multiple sclerosis.
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Süssmuth SD, Sperfeld AD, Ludolph AC, Tumani H. Erhöhung des Liquor/Serum-Albuminquotienten bei neurodegenerativen Erkrankungen: die Hyperkapnie als relevanter Einflussfaktor am Beispiel der Amyotrophen Lateralsklerose. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238340] [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: 10/20/2022]
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Abstract
Cerebrospinal fluid (CSF) proteins may provide important information about the pathomechanisms present in multiple sclerosis (MS). Although diagnostic criteria for early MS are available, there is still a need for biomarkers, predicting disease subtype and progression to improve individually tailored treatment. Using the two-dimensional difference gel electrophoresis (2-D-DIGE) technology for comparative analysis, we compared CSF samples from patients with MS of the relapse-remitting type (RRMS, n = 12) and from patients with clinically isolated syndrome (CIS, n = 12) suggestive of a first demyelinating attack with neurologically normal controls. Protein spots that showed more than two-fold difference between patients and controls were selected for further analysis with MALDI-TOF mass spectrometry. Immunoblot analysis was performed to confirm the validity of individual candidate proteins. In RRMS, we identified 1 up-regulated and 10 down-regulated proteins. In CIS, 2 up-regulated and 11 down-regulated proteins were identified. One of these proteins (Apolipoprotein A1) was confirmed by immunoblot. Though the pathophysiological role of these proteins still remains to be elucidated in detail and further validation is needed, these findings may have a relevant impact on the identification of disease-specific markers.
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Affiliation(s)
- V Lehmensiek
- Department of Neurology, University of Ulm, 89081, Ulm, Germany
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Lehmensiek V, Süssmuth SD, Brettschneider J, Tauscher G, Felk S, Gillardon F, Tumani H. Proteome analysis of cerebrospinal fluid in Guillain–Barré syndrome (GBS). J Neuroimmunol 2007; 185:190-4. [PMID: 17367871 DOI: 10.1016/j.jneuroim.2007.01.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 10/04/2006] [Revised: 01/24/2007] [Accepted: 01/29/2007] [Indexed: 11/16/2022]
Abstract
We used two-dimensional difference in-gel electrophoresis (2-D-DIGE) for proteome analysis of cerebrospinal fluid (CSF) in Guillain-Barré syndrome (GBS). Spots showing >2-fold difference between GBS and controls were analysed using MALDI-TOF mass spectrometry. Proteins that were up-regulated in GBS included haptoglobin, serine/threonine kinase 10, alpha-1-antitrypsin, SNC73, alpha II spectrin, IgG kappa chain and cathepsin D preprotein, while transferrin, caldesmon, GALT, human heat shock protein 70, amyloidosis patient HL-heart-peptide 127aa and transthyretin were down-regulated. Some of these proteins are reported in CSF of GBS for the first time. Accordingly, the 2-D-DIGE technology may be useful to identify disease-specific proteins in patients with GBS.
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Affiliation(s)
- V Lehmensiek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Palm C, Ecker D, Süssmuth SD, Unrath A, Brettschneider J, Uttner I, Tumani H, Kassubek J. Prospektive open-label Studie über 3 Jahre bei früher schubförmiger Multipler Sklerose unter einer Therapie mit Glatirameracetat: Evaluation klinischer Parameter und cerebraler Atrophie. Akt Neurol 2007. [DOI: 10.1055/s-2007-987986] [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: 10/21/2022]
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30
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Süssmuth SD, Lehmensiek V, Ahlert T, Brettschneider J, Mogel H, Palm C, Landwehrmeyer B, Otto M, Ludolph AC, Tumani H. Auf der Suche nach Biomarkern bei atypischen Parkinsonsyndromen: bekannte Marker und innovative Techniken. Akt Neurol 2007. [DOI: 10.1055/s-2007-987469] [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: 10/21/2022]
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Abstract
OBJECTIVE To test whether biomarkers for axonal degeneration correlated with clinical subtypes and were of use in predicting progression of ALS. METHODS Patients with ALS (n = 69), patients with Alzheimer disease (AD; n = 73), and age-matched controls (n = 33) were included in this prospective study. CSF levels of tau protein and neurofilaments (NfHSMI35) were measured using ELISA. In 49 patients with ALS, follow-up data were available (median follow-up 7 months). RESULTS CSF levels of NfHSMI35 were five times higher in patients with ALS (1.7 ng/mL) than in controls (0.3 ng/mL, p < 0.001) and 10 times higher than in patients with AD (0.14 ng/mL, p < 0.001). NfHSMI35 values were also higher in patients with upper motor neuron-dominant ALS than in patients with typical ALS (upper motor neuron + lower motor neuron) at p = 0.02. Values of NfHSMI35 were higher in ALS of more rapid progression. The values of NfH and tau did not correlate with CSF protein content. CONCLUSIONS The authors propose that axonal damage markers in CSF may discriminate between subtypes of ALS and that they could be used as markers for therapeutic trials. CSF NfH was superior to tau in these discriminations.
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Brettschneider J, Petzold A, Süssmuth SD, Landwehrmeyer GB, Ludolph AC, Kassubek J, Tumani H. Neurofilament heavy-chain NfHSMI35 in cerebrospinal fluid supports the differential diagnosis of Parkinsonian syndromes. Mov Disord 2006; 21:2224-7. [PMID: 17013909 DOI: 10.1002/mds.21124] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [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: 11/10/2022] Open
Abstract
We aimed to evaluate the potential of the cerebrospinal fluid (CSF) axonal damage biomarker NfH(SMI35) in the laboratory-supported differential diagnosis of parkinsonian syndromes. Patients with idiopathic Parkinson's disease (PD; n = 22), multiple-system atrophy (MSA; n = 21), progressive supranuclear palsy (PSP; n = 21), corticobasal degeneration (CBD; n = 6), and age-matched controls (n = 45) were included. CSF levels of NfH(SMI35) were measured using ELISA. Levels of CSF NfH(SMI35) were elevated in PSP compared to PD and controls (P < 0.05 each). They were also significantly higher in MSA than in PD and controls (P < 0.05 each). NfH(SMI35) differentiated PD from PSP with a sensitivity of 76.5% and a specificity of 94.4%. Axonal damage as measured by CSF NfH(SMI35) is most prominent in the more rapidly progressive syndromes PSP and MSA as compared to PD or CBD. CSF NfH(SMI35) may therefore be of some value for the laboratory-supported differential diagnosis of atypical parkinsonian syndromes.
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Kaufmann E, Boehm BO, Süssmuth SD, Kientsch-Engel R, Sperfeld A, Ludolph AC, Tumani H. The advanced glycation end-product Nɛ-(carboxymethyl)lysine level is elevated in cerebrospinal fluid of patients with amyotrophic lateral sclerosis. Neurosci Lett 2004; 371:226-9. [PMID: 15519762 DOI: 10.1016/j.neulet.2004.08.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 08/11/2004] [Accepted: 08/31/2004] [Indexed: 11/16/2022]
Abstract
Oxidative stress is involved in the aetiopathogenesis of amyotrophic lateral sclerosis (ALS), a fatal degenerative disorder. To test whether oxidative stress in ALS is increased and confined to the central nervous system, we have measured the glycoxidation product N(epsilon)-(carboxymethyl)lysine (CML) in serum and cerebrospinal fluid (CSF) samples by means of a novel enzyme immunoassay. Significant increases of CSF/serum ratio of CML in ALS patients (n = 25) as compared to normal controls (n = 20, p = 0.001) and to Alzheimer disease patients (n = 9, p = 0.029) suggest intrathecal production of this glycoxidation product. Measurement of CML levels may provide a novel diagnostic tool and may supplement current monitoring strategies in interventional trials.
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Affiliation(s)
- E Kaufmann
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, D-89081 Ulm, Germany
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Süssmuth SD, Tumani H, Ecker D, Ludolph AC. Amyotrophic lateral sclerosis: disease stage related changes of tau protein and S100 beta in cerebrospinal fluid and creatine kinase in serum. Neurosci Lett 2004; 353:57-60. [PMID: 14642437 DOI: 10.1016/j.neulet.2003.09.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [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: 10/26/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease leading to progressive cell death of upper and lower motor neurons and reactive astrogliosis. Two proteins which may be relevant in this respect (tau and S100 beta) were studied in cerebrospinal fluid (CSF) next to routine parameters in 20 patients with sporadic ALS and 20 age-matched controls. Serum levels of creatine kinase (CK) were also determined to monitor the muscular involvement. S100 beta showed a significant decrease in CSF over the disease course (P=0.024). CSF tau as well as serum CK were elevated in 70% of the ALS patients. While highest CSF tau levels were found rather in the early disease stages, serum CK showed a shift of the peak values to several months later. Elevation of the CSF/serum albumin quotient occurred in 20% of the cases most likely representing a non-specific finding in ALS.
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Affiliation(s)
- Sigurd D Süssmuth
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Süssmuth SD, Reiber H, Tumani H. Tau protein in cerebrospinal fluid (CSF): a blood-CSF barrier related evaluation in patients with various neurological diseases. Neurosci Lett 2001; 300:95-8. [PMID: 11207383 DOI: 10.1016/s0304-3940(01)01556-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tau protein (tau) is primarily localised in neurons, and after brain parenchymal damage its release into cerebrospinal fluid (CSF) is increased. The particular influences of blood-CSF barrier function and of disease topography on CSF tau levels have not been studied yet. CSF tau concentrations determined by enzyme-immunoassay in various neurological diseases (n = 61) were not dependent upon blood-CSF barrier dysfunction. Significant elevation of tau levels in patients with meningoencephalitis and cerebral hemorrhage indicates brain parenchymal damage. In contrast, tau levels remained normal in patients with bacterial meningitis if encephalitic complications did not occur. In patients with Guillain-Barré syndrome tau levels were low. Increased tau levels in active multiple sclerosis compared to clinically nonactive states indicate axonal pathology in active disease.
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Affiliation(s)
- S D Süssmuth
- Department of Neurology, University of Ulm, Germany
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Süssmuth SD, Muscholl-Silberhorn A, Wirth R, Susa M, Marre R, Rozdzinski E. Aggregation substance promotes adherence, phagocytosis, and intracellular survival of Enterococcus faecalis within human macrophages and suppresses respiratory burst. Infect Immun 2000; 68:4900-6. [PMID: 10948103 PMCID: PMC101694 DOI: 10.1128/iai.68.9.4900-4906.2000] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aggregation substance (AS) of Enterococcus faecalis, encoded on sex pheromone plasmids, is a surface-bound glycoprotein that mediates aggregation between bacteria thereby facilitating plasmid transfer. Sequencing of the pAD1-encoded Asa1 revealed that this surface protein contains two RGD motifs which are known to ligate integrins. Therefore, we investigated the influence of AS on the interaction of E. faecalis with human monocyte-derived macrophages which constitutively express beta(2) integrins (e.g., CD18). AS was found to cause a greater-than-fivefold increase in enterococcal adherence to macrophages and a greater-than-sevenfold increase in phagocytosis. Adherence was mediated by an interaction between the RGD motif and the integrin CD11b/CD18 (complement receptor type 3) as demonstrated by inhibition studies with monoclonal antibodies and RGD peptide. AS-bearing enterococci were significantly more resistant to macrophage killing during the first 3 h postinfection, probably due to inhibition of the respiratory burst as indicated by reduced concentrations of superoxide anion.
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Affiliation(s)
- S D Süssmuth
- Department of Medical Microbiology and Hygiene, University of Ulm, D-89081 Ulm, Germany
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