The Quebec Parkinson Network: A Researcher-Patient Matching Platform and Multimodal Biorepository

BACKGROUND

Genetic, biologic and clinical data suggest that Parkinson's disease (PD) is an umbrella for multiple disorders with clinical and pathological overlap, yet with different underlying mechanisms. To better understand these and to move towards neuroprotective treatment, we have established the Quebec Parkinson Network (QPN), an open-access patient registry, and data and bio-samples repository.

OBJECTIVE

To present the QPN and to perform preliminary analysis of the QPN data.

METHODS

A total of 1,070 consecutively recruited PD patients were included in the analysis. Demographic and clinical data were analyzed, including comparisons between males and females, PD patients with and without RBD, and stratified analyses comparing early and late-onset PD and different age groups.

RESULTS

QPN patients exhibit a male:female ratio of 1.8:1, an average age-at-onset of 58.6 years, an age-at-diagnosis of 60.4 years, and average disease duration of 8.9 years. REM-sleep behavior disorder (RBD) was more common among men, and RBD was associated with other motor and non-motor symptoms including dyskinesia, fluctuations, postural hypotension and hallucinations. Older patients had significantly higher rates of constipation and cognitive impairment, and longer disease duration was associated with higher rates of dyskinesia, fluctuations, freezing of gait, falls, hallucinations and cognitive impairment. Since QPN's creation, over 60 studies and 30 publications have included patients and data from the QPN.

CONCLUSIONS

The QPN cohort displays typical PD demographics and clinical features. These data are open-access upon application (http://rpq-qpn.ca/en/), and will soon include genetic, imaging and bio-samples. We encourage clinicians and researchers to perform studies using these resources.

Spectroscopy of human plasma for diagnosis of idiopathic Parkinson’s disease

Background: No established chemical biomarkers of idiopathic Parkinson’s disease (PD) currently exist. Augmented oxidative stress (OS) has been implicated in both neural and peripheral PD tissues. Methods: In this study, Raman scattering and near-infrared spectroscopy were used to detect and quantify oxidative substrate modifications in blood plasma samples from PD and normal elderly control (NEC) subjects. Results:Hypothesis-driven preselection of OS-sensitive bandwidths distinguished PD from NEC subjects with approximately 75% sensitivity and specificity using both complementary spectroscopic techniques. Conclusion: Biospectroscopy of plasma may provide a rapid, minimally invasive and inexpensive chemical biomarker of idiopathic PD.

The error negativity in nonmedicated and medicated patients with Parkinson’s disease

OBJECTIVE

It has been hypothesized that the error negativity (Ne or ERN) is modulated by the midbrain dopaminergic system. Thus, in a depleted dopaminergic system as seen in patients with Parkinson's disease (PD) one would expect an attenuated Ne. However, studies investigating the error negativities in medicated patients with PD have produced contradictory results and the present study was designed to explore this relationship further.

METHODS

Using the event-related potential technique and an Eriksen flanker paradigm, we examined error negativities in nonmedicated (drug naive) and medicated PD patients and compared them to those of healthy controls.

RESULTS

(a) The error negativities of the nonmedicated and medicated PD patients were attenuated compared to those of healthy elderly controls at frontocentral scalp sites; and (b) nonmedicated and medicated PD patients produced error negativities similar to each other.

CONCLUSIONS

PD results in diminished error negativities both in the early stage nonmedicated patients and in the later stage medicated patients.

SIGNIFICANCE

Because both patient groups have reduced dopaminergic functioning compared to healthy controls, these findings are consistent with Ne amplitude being sensitive to modulations in that system.

Treatment of essential tremor with the barbiturate t2000 (1,3-dimethoxymethyl-5,5-diphenyl-barbituric acid)

The effect of the barbiturate T2000 (1,3-dimethoxymethyl-5,5-diphenyl-barbituric acid; DMMDPB) on essential tremor, given in twice daily doses of 400 and 300 mg, was assessed in two brief, randomized, placebo-controlled, parallel-group, double-blinded, single-center trials in 12 and 22 patients, respectively. These trials represent the first clinical use of T2000 for a specific indication. The primary endpoint was the change in the mean scores of the treated and control groups based on the Fahn-Tolosa-Marin tremor scale. In the first study of 12 patients treated with 400 mg or placebo twice daily for 14 days, the mean change from baseline at day 14 was 19.3 (P < 0.0001) in the treated group and 9.0 (P = 0.0121) in the control group. Using a two-factor mixed ANOVA model to evaluate within group and between group changes, the effect of T2000 was significantly different from that of the placebo group (P = 0.03). In the second study of 22 patients treated with 300 mg of T2000 or placebo twice daily for 20 days, statistically significant changes were seen in treated patients compared to baseline, but the ANOVA model did not demonstrate a significant treatment effect of T2000 compared to placebo. When the treated groups from each study are compared, the 800-mg daily group is significantly different from the 600-mg daily group (P = 0.02). Some treated patients in each study, but no placebo patients, experienced marked improvement. These results support further evaluation of T2000 in the treatment of essential tremor.

Characterization of α1-antitrypsin as a heme oxygenase-1 suppressor in Alzheimer plasma

Heme oxygenase-1 (HO-1) mRNA and protein levels are diminished in Alzheimer disease (AD) blood, cerebrospinal fluid (CSF) and choroid plexus. Herein, the presence of a heme oxygenase-1 suppressor (HOS) factor was ascertained by astroglial bioassay, biochemical techniques and immunofluorescence confocal microscopy. We report significantly augmented plasma HOS activity in AD patients relative to healthy elderly and neurological controls. The HOS factor was determined to be a 50-100 kDa heat-labile, heparin-binding glycoprotein that is unrelated to antioxidant ingestion, plasma total antioxidant capacity, circulating cortisol levels or apolipoprotein E epsilon4 carrier status. HOS bioactivity was recapitulated by exogenous alpha(1)-antitrypsin. alpha(1)-antitrypsin levels were significantly increased in AD plasma and correlated with HOS activity and MMSE scores. alpha(1)-antitrypsin immunodepletion attenuated HOS activity of AD plasma. In AD brain, alpha(1)-antitrypsin immunoreactivity was augmented and co-distributed with HO-1. HOS activity of alpha(1)-antitrypsin may curtail HO-1-dependent derangement of cerebral iron homeostasis and account for diminished HO-1 expression in AD peripheral tissues.

An atypical case of Trypanosoma cruzi infection in a young English Mastiff

A case of Trypanosoma cruzi infection in a young English Mastiff from Texas is presented. Clinical signs and laboratory findings included subcutaneous edema, lymphadenopathy, weight loss, and hypoalbuminemia. Cytology of a lymph node revealed numerous amastigotes. No trypomastigotes were observed in buffy coat preparation of peripheral blood, and on histologic evaluation, most organs contained numerous interstitial pseudocysts. Initial serology was positive for both T. cruzi and Leishmania, and immunohistochemistry supported a diagnosis of Leishmania. However, additional serology supported a T. cruzi infection, and cultivation of organisms isolated from a lymph node revealed morphology consistent with T. cruzi. In addition, PCR analysis resulted in a 504 bp fragment with 99% homology to a flagellar protein of T. cruzi. Although uncommon, autochthonous cases of both T. cruzi and Leishmania have been reported in the United States. Clinical signs observed with both diseases can show many similarities, cytology may be indistinguishable, as in this case, and serological cross-reactivity is common. This case demonstrates an unusual presentation of T. cruzi and the use of multiple testing strategies to support its diagnosis.

Evaluation of heme oxygenase-1 as a systemic biological marker of sporadic AD

BACKGROUND

Heme oxygenase-1 (HO-1) is a 32-kDa stress protein that catalyzes the degradation of heme to biliverdin. HO-1 immunoreactivity is greatly increased in neurons and astrocytes of the hippocampus and cerebral cortex of individuals with AD and colocalizes to senile plaques and neurofibrillary tangles.

METHODS

We investigated whether systemic HO-1 regulation is also deranged in AD patients and whether blood HO-1 measurements provide a peripheral biomarker of the disease. Plasma HO-1 protein levels were measured by competitive ELISA and lymphocyte HO-1 mRNA levels were determined by Northern analysis in patients with early probable sporadic AD, normal elderly controls (NEC), normal younger controls, individuals with age-associated cognitive decline (AACD) not meeting AD criteria, and patients with non-Alzheimer dementia, nondementing neurologic illness, and chronic medical disorders. CSF HO-1 protein concentrations were also determined by ELISA in pathologically confirmed AD and control cases.

RESULTS

Mean plasma HO-1 protein concentrations were significantly lower in AD patients (0.85 +/- 0.14 microg/mL) compared with NEC (1.77 +/- 0.34 microg/mL; p < 0.05) and control patients. The AACD group exhibited plasma HO-1 concentrations (1.06 +/- 0.33 microg/mL) intermediate between, but not different from, those of the AD patients and NEC. Lymphocyte HO-1 mRNA levels were lower in the AD cohort relative to NEC (p < 0.001) and individuals with AACD, non-Alzheimer dementia, nondementing neurologic illness, and chronic medical conditions. Lymphocyte HO-1 mRNA levels were also lower in the AACD group relative to NEC (p < 0.05). In comparison with all groups excluding AACD, the sensitivity and specificity of lymphocyte HO-1 mRNA measurement for diagnosis of early sporadic AD are 88% and 75%. Mean CSF HO-1 protein concentrations were lower (p < 0.01) in AD cases (19.07 ng/mL) relative to control values (32.48 ng/mL).

CONCLUSIONS

Plasma and CSF HO-1 protein and lymphocyte HO-1 mRNA levels are decreased in subjects with sporadic AD. Quantitative assay for lymphocyte HO-1 mRNA expression may serve as a useful biologic marker in early sporadic AD.

Progressive myoclonus epilepsy in young adults with neuropathologic features of Alzheimer's disease

Progressive myoclonus epilepsy (PME) may develop in adult life. We present two patients with PME appearing around the age of 30 years in whom the disorder represented a manifestation of Alzheimer's disease. This diagnosis must be considered in addition to possible Kufs' disease or myoclonic epilepsy with ragged red fibers (MERRF) when PME develops in young adults.

Symmetry and synkinesis during rehabilitation of unilateral facial paralysis

We evaluated biofeedback rehabilitation in patients with severe chronic unilateral facial paralysis, who had intact facial-motor innervation (House grades 3 to 5). Recovery of facial function was characterized (1) by grading facial movement symmetry, and (2) by counting the number of muscles exhibiting synkinesis during maximal execution of selected facial movements (e.g., smiling). Facial function in 21 patients typically improved by one House grade. Facial symmetry recovered rapidly during the first 5 months of treatment, and then improved more slowly. However, during this latter period, examination of the relationship between symmetry and synkinesis (visualized by a graph plotting symmetry grades on the x-axis, against the number of synkinetic muscles on the y-axis) indicated that overall facial control was improving even when House grading suggested that it was not. Such information should aid facial retraining and may clarify understanding of underlying rehabilitation mechanisms.

Mitochondrial dysfunction in multiple symmetrical lipomatosis

Multiple symmetrical lipomatosis is a striking clinical finding associated with a variety of peripheral and central nervous system abnormalities. We describe 4 unrelated patients with evidence of mitochondrial dysfunction in skeletal muscle. Multiple symmetrical lipomatosis is an additional, albeit unusual, manifestation of the expanding clinical spectrum of mitochondrial diseases.

Carotid-ophthalmic aneurysm: an uncommon cause of acute monocular blindness

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Peripheral neuropathy with IgM kappa monoclonal immunoglobulin directed against myelin-associated glycoprotein

Three patients with a monoclonal IgM kappa paraproteinemia had a slowly progressive segmental demyelinating peripheral neuropathy. Sural nerve biopsies showed predominantly large fiber loss, with widening of the intraperiod line of myelin associated with active demyelination. Immunoblot analysis showed reactivity of IgM to myelin-associated glycoprotein (MAG) of human myelin. An enzyme-linked immunosorbent assay (ELISA) was developed to provide a simple quantitative technique for detection of antibodies to MAG. Treatment with corticosteroids, immunosuppressive agents, and plasmapheresis produced no significant improvement.

Cylindrical spirals in human skeletal muscle

Muscle biopsies from two patients revealed that numerous type 2 fibers contained large abnormal areas filled with cylindrical spirals. The cytochemical profile of these cylindrical spirals was sufficiently characteristic that they could be distinguished from tubular aggregates. Their electron microscopic appearance was unmistakable. Their origin and significance are uncertain. The diverse nature of the patients' conditions (cramps and malignancy, and an unusual form of spinocerebellar degeneration) indicate that these abnormal structures are not disease specific.

The application of F-wave measurements in the differentiation of proximal and distal upper limb entrapments

Conduction velocities of the proximal segments of the median and ulnar nerves were measured by evoking F-wave responses. The results of these and conventional motor and sensory studies from 60 control subjects were compared with the results in 30 patients with carpal tunnel syndromes, 18 patients with cubital tunnel syndromes, and 23 patients with suspected proximal entrapments. Sixty-seven percent of patients with proximal lesions (confirmed by myelography in 60 percent of cases) had abnormalities in their F-wave studies. Conventional motor studies were normal. Twenty-three percent of the patients with carpal tunnel syndrome and 11 percent of the patients with cubital tunnel syndrome also had abnormal F-wave studies, indicating an additional element of proximal entrapment. This technique is felt bo be useful in differentiating between distal and proximal entrapments.

An electrophysiological method for examining lumbosacral root compression

The propagation velocities and conduction times of nerve impulses responsible for muscle F-waves were measured in the proximal segments of 60 normal posterior tibial nerves and of 41 normal peroneal nerves. The results were compared with those of 25 patients having confirmed lumbosacral root compression due to disc degeneration. Using the peroneal nerve, 65 per cent of patients had a prolonged proximal conduction time; a similar abnormality was found in 56 per cent of patients when the posterior tibial nerve was studied. The yield of positive results rose to 85 per cent and 76 per cent respectively when the M- and F-latencies in given individuals were compared. It was also shown that in normal subjects the F-response has a longer latency, and slower conduction velocity than the H-reflex when both are obtained using the same stimulating and recording sites. In patients in whom the ankle jerks and H-reflexes are absent, the F-waves may still be recorded indicating that the latter are mediated through motor fibers.

Experimental mitochondrial myopathy produced by in vivo uncoupling of oxidative phosphorylation

Two uncouplers of mitochondrial oxidative phosphorylation [2,4-dinitrophenol (DNP) and carbonylcyanide-m-chlorophenylhydrazone (CCCH)] were infused intra-arterially into a branch of the lower abdominal aorta of anesthetized rats over a 60-180 min period. An acute, severe, hypermetabolic state with systemic lactic acidosis and stiffness of the lower extremeities developed. In the plantaris muscles, by histochemistry, numerous "ragged red" fibers were present after the infusion. The "ragged red" areas presumably represented an absolute increase in mitochondrial mass in affected muscle fibers. By electron microscopy, linear inclusions were present in the intracristal space of many mitochondria. Simultaneous infusion of DNP and chloramphenicol, an inhibitor of mitochondrial protein synthesis, prevented the formation of ragged red fibers but not the intracristal inclusions. Infusion of relatively large amounts of oleic acid produced histochemical and electron-microscopic changes similar to those caused by the uncouplers. A possible pathogenesis of these reversible mitochondrial changes was discussed and their potential relevance to morphologic abnormalities of skeletal muscle mitochondria in human diseases was reviewed.