1
|
Schootemeijer S, de Vries NM, Macklin EA, Roes KCB, Joosten H, Omberg L, Ascherio A, Schwarzschild MA, Bloem BR. The STEPWISE study: study protocol for a smartphone-based exercise solution for people with Parkinson's Disease (randomized controlled trial). BMC Neurol 2023; 23:323. [PMID: 37700241 PMCID: PMC10496249 DOI: 10.1186/s12883-023-03355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Exercise has various health benefits for people with Parkinson's disease (PD). However, implementing exercise into daily life and long-term adherence remain challenging. To increase a sustainable engagement with physical activity of people with PD, interventions that are motivating, accessible, and scalable are needed. We primarily aim to investigate whether a smartphone app (STEPWISE app) can increase physical activity (i.e., step count) in people with PD over one year. Our second aim is to investigate the potential effects of the intervention on physical fitness, and motor- and non-motor function. Our third aim is to explore whether there is a dose-response relationship between volume of physical activity and our secondary endpoints. METHODS STEPWISE is a double-blind, randomized controlled trial. We aim to include 452 Dutch people with PD who can walk independently (Hoehn & Yahr stages 1-3) and who do not take more than 7,000 steps per day prior to inclusion. Physical activity levels are measured as step counts on the participant's own smartphone and scaled as percentage of each participant's baseline. Participants are randomly assigned to an active control group with an increase of 5-20% (active controls) or any of the three intervention arms with increases of 25-100% (intermediate dose), 50-200% (large dose), or 100-400% (very large dose). The primary endpoint is change in step count as measured by the STEPWISE smartphone app from baseline to 52 weeks. For our primary aim, we will evaluate the between-group difference in average daily step count change from baseline to 52 weeks. For our second aim, measures of physical fitness, and motor- and non-motor function are included. For our third aim, we will associate 52-week changes in step count with 52-week changes in secondary outcomes. DISCUSSION This trial evaluates the potential of a smartphone-based intervention to increase activity levels in people with PD. We envision that motivational apps will increase adherence to physical activity recommendations and could permit conduct of remote clinical trials of exercise for people with PD or those at risk of PD. TRIAL REGISTRATION ClinicalTrials.gov; NCT04848077; 19/04/2021. CLINICALTRIALS gov/ct2/show/NCT04848077.
Collapse
Affiliation(s)
- Sabine Schootemeijer
- DisordersDonders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nienke M de Vries
- DisordersDonders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kit C B Roes
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, the Netherlands
| | - Hilde Joosten
- Department of Sports Medicine, Canisius Wilhelmina Hospital, Burgemeester Daleslaan 27, Nijmegen, 6532 CL, the Netherlands
| | | | - Alberto Ascherio
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael A Schwarzschild
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Mass General Institute for Neurodegenerative Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Bastiaan R Bloem
- DisordersDonders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
2
|
Bohnen JLB, Albin RL, Bohnen NI. Ketogenic interventions in mild cognitive impairment, Alzheimer's disease, and Parkinson's disease: A systematic review and critical appraisal. Front Neurol 2023; 14:1123290. [PMID: 36846143 PMCID: PMC9947355 DOI: 10.3389/fneur.2023.1123290] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Background There is increasing interest in therapeutic ketosis as a potential therapy for neurodegenerative disorders-in particular, mild cognitive impairment (MCI), Alzheimer's disease (AD), and Parkinson's disease (PD)-following a proof-of-concept study in Parkinson's disease published in 2005. Methods To provide an objective assessment of emerging clinical evidence and targeted recommendations for future research, we reviewed clinical trials involving ketogenic interventions in mild cognitive impairment, Alzheimer's disease, and Parkinson's disease reported since 2005. Levels of clinical evidence were systematically reviewed using the American Academy of Neurology criteria for rating therapeutic trials. Results 10 AD, 3 MCI, and 5 PD therapeutic ketogenic trials were identified. Respective grades of clinical evidence were objectively assessed using the American Academy of Neurology criteria for rating therapeutic trials. We found class "B" evidence (probably effective) for cognitive improvement in subjects with mild cognitive impairment and subjects with mild-to-moderate Alzheimer's disease negative for the apolipoprotein ε4 allele (APOε4-). We found class "U" evidence (unproven) for cognitive stabilization in individuals with mild-to-moderate Alzheimer's disease positive for the apolipoprotein ε4 allele (APOε4+). We found class "C" evidence (possibly effective) for improvement of non-motor features and class "U" evidence (unproven) for motor features in individuals with Parkinson's disease. The number of trials in Parkinson's disease is very small with best evidence that acute supplementation holds promise for improving exercise endurance. Conclusions Limitations of the literature to date include the range of ketogenic interventions currently assessed in the literature (i.e., primarily diet or medium-chain triglyceride interventions), with fewer studies using more potent formulations (e.g., exogenous ketone esters). Collectively, the strongest evidence to date exists for cognitive improvement in individuals with mild cognitive impairment and in individuals with mild-to-moderate Alzheimer's disease negative for the apolipoprotein ε4 allele. Larger-scale, pivotal trials are justified in these populations. Further research is required to optimize the utilization of ketogenic interventions in differing clinical contexts and to better characterize the response to therapeutic ketosis in patients who are positive for the apolipoprotein ε4 allele, as modified interventions may be necessary.
Collapse
Affiliation(s)
| | - Roger L. Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, United States
| | - Nicolaas I. Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, United States
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
3
|
Gordevicius J, Li P, Marshall LL, Killinger BA, Lang S, Ensink E, Kuhn NC, Cui W, Maroof N, Lauria R, Rueb C, Siebourg-Polster J, Maliver P, Lamp J, Vega I, Manfredsson FP, Britschgi M, Labrie V. Epigenetic inactivation of the autophagy-lysosomal system in appendix in Parkinson's disease. Nat Commun 2021; 12:5134. [PMID: 34446734 PMCID: PMC8390554 DOI: 10.1038/s41467-021-25474-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/04/2021] [Indexed: 12/13/2022] Open
Abstract
The gastrointestinal tract may be a site of origin for α-synuclein pathology in idiopathic Parkinson's disease (PD). Disruption of the autophagy-lysosome pathway (ALP) may contribute to α-synuclein aggregation. Here we examined epigenetic alterations in the ALP in the appendix by deep sequencing DNA methylation at 521 ALP genes. We identified aberrant methylation at 928 cytosines affecting 326 ALP genes in the appendix of individuals with PD and widespread hypermethylation that is also seen in the brain of individuals with PD. In mice, we find that DNA methylation changes at ALP genes induced by chronic gut inflammation are greatly exacerbated by α-synuclein pathology. DNA methylation changes at ALP genes induced by synucleinopathy are associated with the ALP abnormalities observed in the appendix of individuals with PD specifically involving lysosomal genes. Our work identifies epigenetic dysregulation of the ALP which may suggest a potential mechanism for accumulation of α-synuclein pathology in idiopathic PD.
Collapse
Affiliation(s)
- Juozas Gordevicius
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA.
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania.
| | - Peipei Li
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Lee L Marshall
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Bryan A Killinger
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
- Graduate College, Rush University Medical Center, Chicago, IL, USA
| | - Sean Lang
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Elizabeth Ensink
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Nathan C Kuhn
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Wei Cui
- Center for Epigenetics, Van Andel Institute, Grand Rapids, MI, USA
| | - Nazia Maroof
- Roche Pharma Research and Early Development, Neuroscience Discovery, Roche Innovation Center, Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Roberta Lauria
- Roche Pharma Research and Early Development, Neuroscience Discovery, Roche Innovation Center, Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Christina Rueb
- Roche Pharma Research and Early Development, Neuroscience Discovery, Roche Innovation Center, Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Juliane Siebourg-Polster
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Pierre Maliver
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jared Lamp
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Integrated Mass Spectrometry Unit, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Irving Vega
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Integrated Mass Spectrometry Unit, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Fredric P Manfredsson
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Parkinson's Disease Research Unit, Department of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Markus Britschgi
- Roche Pharma Research and Early Development, Neuroscience Discovery, Roche Innovation Center, Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Viviane Labrie
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
- Division of Psychiatry and Behavioral Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| |
Collapse
|