Weight change and body composition in patients with Parkinson's disease

OBJECTIVE

To compare reports of weight loss and actual measures of body composition to predict nutritional risk in patients with Parkinson's disease and matched control subjects.

DESIGN

Patients and control subjects were asked to record prior changes in weight and activity. Body composition was then compared in both groups using percentage ideal body weight (IBW), body mass index (BMI), triceps skinfold (TSF) thickness, midarm muscle circumference, and percentage body fat (BF) as determined by bioelectrical impedance.

SUBJECTS

Fifty-one free-living patients with Parkinson's disease and 49 matched control subjects were recruited from the neurology clinic and the surrounding area.

MAIN OUTCOME MEASURES

We anticipated that reported weight loss would be greater and actual measures of body composition would show greater nutritional risk in the patients with Parkinson's disease.

STATISTICAL ANALYSES PERFORMED

chi 2 Analysis was used to determine differences in the ratio of patients and control subjects who lost weight. Paired t tests were used to compare amount of weight change and measures of body composition. Correlations were performed among measures of weight change, body composition, and associated disease factors.

RESULTS

Patients with Parkinson's disease were four times more likely to report weight loss greater than 10 lb than the matched control subjects (odds ratio > 4.2). Patients reported a mean (+/- standard deviation) weight loss of 7.2 +/- 2.9 lb and control subjects reported a mean weight gain of 2.1 +/- 1.6 lb (P < .01). Percentage IBW (P < .02), BMI (P < .009), TSF thickness (P < .005), and percentage BF (P < .022) were lower in patients. Significant correlations (P < .01) were found between reported weight change and percentage IBW, BMI, TSF, percentage BF, and stage of the disease. CONCLUSIONS/APPLICATION: Patients with Parkinson's disease appear to be at greater nutritional risk than a matched population. Simple screening and assessment tools can be used to detect nutritional risk.

Motor complications of chronic levodopa therapy in Parkinson's disease

We report on motor complications of chronic levodopa therapy among 811 levodopa-responsive patients with idiopathic Parkinson's disease (PD), stratified by duration after diagnosis. Predictable "offs" were noted in 20.2% of patients in the first 5 years, in 58.3% after 15 years. Unpredictable or sudden offs and early morning dystonia were less common. Longer duration was associated with greater percentages of patients with off periods or dyskinesias (up to 70% after 15 years), although patients with 6-15 years' duration saw relatively little increase in frequency of those complications, and a minority of patients (approximately 30%) with duration into the second decade did not experience off periods or dyskinesia. Across groups, mean Hoehn and Yahr stage and daily levodopa dosage progressively increase (and mean Schwab and England disability ratings decrease), but more conservatively than in prior reports in the postlevodopa era. We note that with advancing PD duration, levodopa complications are more common, but in many cases there appear to be relatively stable periods in terms of levodopa dosage and disease severity, and a minority of patients will be relatively free of motor complications into the second decade of their disease.

Clinical experience with controlled-release carbidopa/levodopa in Parkinson's disease

We converted 158 Parkinson's disease (PD) patients on stable doses of standard carbidopa/levodopa (Std-L) to controlled-release carbidopa/levodopa (L-CR). Of the 141 patients who completed the study, 103 (73%) preferred L-CR, 26 (18.5%) preferred Std-L, and 12 (8.5%) had no preference. One hundred fourteen patients elected to continue L-CR, and we performed the primary data analysis on this group. Following conversion to L-CR, patients reported an increase in length of benefit from each dose and an increased "kick-in" time. There was a decrease in the total number of doses, "off" periods, sleep interruptions per night, dose failures, and sleep disturbances. Conversion to L-CR resulted in a significant increase in total levodopa dose. There was no significant change in the dyskinesias. However, early-morning dystonia resolved in eight of 14 patients. Our findings suggest that L-CR is particularly effective in decreasing motor fluctuations, reducing nocturnal problems, and minimizing levodopa dose failures in PD.

Multiomic analysis on human cell model of wolfram syndrome reveals changes in mitochondrial morphology and function

BACKGROUND

Wolfram syndrome (WFS) is a rare autosomal recessive syndrome in which diabetes mellitus and neurodegenerative disorders occur as a result of Wolframin deficiency and increased ER stress. In addition, WFS1 deficiency leads to calcium homeostasis disturbances and can change mitochondrial dynamics. The aim of this study was to evaluate protein levels and changes in gene transcription on human WFS cell model under experimental ER stress.

METHODS

We performed transcriptomic and proteomic analysis on WFS human cell model-skin fibroblasts reprogrammed into induced pluripotent stem (iPS) cells and then into neural stem cells (NSC) with subsequent ER stress induction using tunicamycin (TM). Results were cross-referenced with publicly available RNA sequencing data in hippocampi and hypothalami of mice with WFS1 deficiency.

RESULTS

Proteomic analysis identified specific signal pathways that differ in NSC WFS cells from healthy ones. Next, detailed analysis of the proteins involved in the mitochondrial function showed the down-regulation of subunits of the respiratory chain complexes in NSC WFS cells, as well as the up-regulation of proteins involved in Krebs cycle and glycolysis when compared to the control cells. Based on pathway enrichment analysis we concluded that in samples from mice hippocampi the mitochondrial protein import machinery and OXPHOS were significantly down-regulated.

CONCLUSIONS

Our results show the functional and morphological secondary mitochondrial damage in patients with WFS. Video Abstract.

Endogenous p53 inhibitor TIRR dissociates systemic metabolic health from oncogenic activity

It is unclear whether metabolic health corresponds to reduced oncogenesis or vice versa. We study Tudor-interacting repair regulator (TIRR), an inhibitor of p53 binding protein 1 (53BP1)-mediated p53 activation, and the physiological consequences of enhancing tumor suppressor activity. Deleting TIRR selectively activates p53, significantly protecting against cancer but leading to a systemic metabolic imbalance in mice. TIRR-deficient mice are overweight and insulin resistant, even under normal chow diet. Similarly, reduced TIRR expression in human adipose tissue correlates with higher BMI and insulin resistance. Despite the metabolic challenges, TIRR loss improves p53 heterozygous (p53HET) mouse survival and correlates with enhanced progression-free survival in patients with various p53HET carcinomas. Finally, TIRR's oncoprotective and metabolic effects are dependent on p53 and lost upon p53 deletion in TIRR-deficient mice, with glucose homeostasis and orexigenesis being primarily regulated by TIRR expression in the adipose tissue and the CNS, respectively, as evidenced by tissue-specific models. In summary, TIRR deletion provides a paradigm of metabolic deregulation accompanied by reduced oncogenesis.

RIPK3 cleavage is dispensable for necroptosis inhibition but restricts NLRP3 inflammasome activation

Caspase-8 activity is required to inhibit necroptosis during embryogenesis in mice. In vitro studies have suggested that caspase-8 directly cleaves RIPK1, CYLD and the key necroptotic effector kinase RIPK3 to repress necroptosis. However, recent studies have shown that mice expressing uncleavable RIPK1 die during embryogenesis due to excessive apoptosis, while uncleavable CYLD mice are viable. Therefore, these results raise important questions about the role of RIPK3 cleavage. To evaluate the physiological significance of RIPK3 cleavage, we generated Ripk3D333A/D333A mice harbouring a point mutation in the conserved caspase-8 cleavage site. These mice are viable, demonstrating that RIPK3 cleavage is not essential for blocking necroptosis during development. Furthermore, unlike RIPK1 cleavage-resistant cells, Ripk3D333A/D333A cells were not significantly more sensitive to necroptotic stimuli. Instead, we found that the cleavage of RIPK3 by caspase-8 restricts NLRP3 inflammasome activation-dependent pyroptosis and IL-1β secretion when Inhibitors of APoptosis (IAP) are limited. These results demonstrate that caspase-8 does not inhibit necroptosis by directly cleaving RIPK3 and further underscore a role for RIPK3 in regulating the NLRP3 inflammasome.