The real-life effect of catechol-O-methyltransferase inhibition on non-motor symptoms in levodopa-treated Parkinson's disease: opicapone versus entacapone

OBJECTIVE

To evaluate the long-term, real-life effects on non-motor symptoms (NMS) of opicapone compared to entacapone in levodopa-treated people with Parkinson's disease (PwP).

METHODS

A retrospective data analysis, with pre- and post-opicapone initiation data of 17 PwP with motor fluctuations compared to a comparable group of 18 PwP introduced on entacapone. The primary outcome was changes in the NMS Scale (NMSS) total score after 1-year follow-up. Secondary outcomes included changes in the NMSS domains, and Parkinson's Disease Sleep Scale (PDSS) total and item scores after the same time span.

RESULTS

Groups were comparable for baseline demographics and Parkinson's-related features (p ≥ 0.314) as well as duration of follow-up (1.33 ± 0.66 years for PwP on opicapone and 1.23 ± 0.49 years for those on entacapone; p = 0.858). PwP who were introduced on opicapone showed no changes in NMSS and PDSS total scores after 1 year (p = 0.605 and p = 0.507, respectively), whereas PwP who were introduced on entacapone showed significant worsening of NMSS and PDSS total scores at follow-up (p = 0.005 and p = 0.001, respectively). In neither group changes in individual NMSS domains from baseline to follow-up were observed (p ≥ 0.288 for entacapone and p ≥ 0.816 for opicapone, respectively). In PwP on entacapone significant worsening was seen in the distressing dreams, hallucinations, and limb numbness items of the PDSS (p ≤ 0.05).

CONCLUSIONS

Introduction of opicapone in real-life PwP with motor fluctuations seems to stabilise NMS burden and aspects of sleep dysfunction, in contrast to entacapone where there was a worsening of NMS burden and PDSS scores over 1 year follow-up.

Gastrointestinal barriers to levodopa transport and absorption in Parkinson's disease

Levodopa is the gold standard for the symptomatic treatment of Parkinson's disease (PD). There are well documented motor and non-motor fluctuations, however, that occur almost inevitably once levodopa is started after a variable period in people with PD. Whilst brain neurodegenerative processes play a part in the pathogenesis of these fluctuations, a range of barriers across the gastrointestinal (GI) tract can alter levodopa pharmacokinetics, ultimately contributing to non-optimal levodopa response and symptoms fluctuations. GI barriers to levodopa transport and absorption include dysphagia, delayed gastric emptying, constipation, Helicobacter pylori infection, small intestinal bacterial overgrowth and gut dysbiosis. In addition, a protein-rich diet and concomitant medication intake can further alter levodopa pharmacokinetics. This can result in unpredictable or sub-optimal levodopa response, 'delayed on' or 'no on' phenomena. In this narrative review, we provided an overview on the plethora of GI obstacles to levodopa transport and absorption in PD and their implications on levodopa pharmacokinetics and development of motor fluctuations. In addition, management strategies to address GI dysfunction in PD are highlighted, including use of non-oral therapies to bypass the GI tract.

Assessing human exposure to inorganic arsenic in high-arsenic areas of Latium: a biomonitoring study integrated with indicators of dietary intake

BACKGROUND

In Latium (central Italy), arsenic concentrations exceeding the regulatory limit of 10 μg/L for drinking water are present in groundwater from a large area of volcanic origin. At least in part of the area, high arsenic concentrations have been detected also in soil and phytoavailable geogenic arsenic enters the food chain. As a result, local population may be exposed to inorganic arsenic via water and also through consumption of food with higher than background arsenic concentrations.

METHODS

A cross sectional study was conducted to assess inorganic arsenic exposure and metabolism in 269 residents of 27 municipalities in the provinces of Viterbo, Rome and Latina. Total arsenic in toenails and the sum of inorganic arsenic and methylated metabolites in urine, the latter determined by HPLC-ICP-MS, were used as biomarkers of inorganic arsenic exposure. All the subjects involved in the study provided samples of the water(s) used for drinking and cooking as well as detailed information on water use. To get an insight into dietary intake from locally-processed food, inorganic arsenic in bread samples collected in affected municipalities of the three provinces was determined and compared to background levels of samples from reference areas.

RESULTS

30% of the sample used bottled water or resorted to water treatment in order to lower the arsenic content <10 μg/L (Group 1), 51% of the sample drank bottled water and used tap water with an arsenic content exceeding 10 μg/L for cooking only (Group 2), 19% of the sample used tap water with an arsenic content exceeding 10 μg/L for both drinking and cooking (Group 3). Nail arsenic was higher for Group 2 and 3 compared to Group 1, whereas all groups had higher nail arsenic than the reference group. The sum of inorganic arsenic and related metabolites in urine was higher in Group 3 than in the other two groups, and higher in Group 2 compared to Group 1. White bread from the study area showed significantly higher inorganic arsenic levels compared to samples from reference areas.

CONCLUSIONS

Use of toenail arsenic as biomarker of long-term exposure allowed to retrospectively reconstruct exposure irrespective of recent modifications due to changes in water use. In Group 3, urinary concentration of inorganic arsenic and metabolites exceeded the upper limit of the reference concentration range for the Italian population. Inter-individual variability of the efficiency of arsenic metabolism in the study population was substantial indicating that a subgroup of the population is more susceptible to the toxic effects of inorganic arsenic owing to a lower methylation capability.

[The Italian Registry for Therapeutic Apheresis: fifteen years of activity]

There is currently no consensus about the indications for therapeutic apheresis, also due to the lack of large clinical trials. A registry where all the data can be organized and analyzed therefore becomes a priority for all professionals involved in apheresis. The Apheresis Study Group of the Italian Society of Nephrology has instituted a registry for data collection. This report describes data collected from 1994 to 2008 by 68 units of different specialties in 15 Italian regions. Data about 29,260 treatments on 2,503 patients were recorded. Plasma exchange accounted for 43.4% of the procedures; 37% of these were performed by filtration. Plasma treatment was used in 48% of procedures, in particular with protein A immunoadsorption (11%), LDL-cholesterol apheresis by dextran sulfate adsorption (13%), and semiselective cascade or double filtration (12.5%). Cell apheresis, limited to photopheresis and leukocytapheresis, was used in 3.6% of cases, and whole blood treatment, with different techniques, in 5% of cases for the treatment of dyslipidemia, liver failure and sepsis. These procedures account for about 20% of the estimated therapeutic apheresis performed in Italy according to the national survey performed for the year 2005 by the Italian Apheresis and Cell Manipulation Society. The data collected are sufficiently informative to show a definite trend to use plasma/whole blood treatments as often as possible. The registry not only is a tool for consultation and information, but also a platform to plan and realize interdisciplinary and multicenter clinical trials.

Effects of cognitive challenge on self-directed behaviors by chimpanzees (Pan troglodytes)

In primates, including humans, scratching and other self-directed behaviors (SDBs) have recently been reported to be differentially displayed as a function of social interactions, anxiety-related drugs, and response outcomes during learning tasks. Yet few studies have focused on the factors influencing SDBs in our closest living relatives, the chimpanzees (Pan troglodytes). Furthermore, no previous experimental study has examined handedness of SDBs as a function of changes in task difficulty. Using matching-to-sample tasks of varying difficulty, the present study examines the effect of manipulations of task difficulty on rates, handedness, and type of SDBs in an experimental study of eight chimpanzees. SDBs were categorized as rubs, gentle scratches, and rough scratches. SDBs increased during difficult discriminations, but only for subjects who started the experiment on an easy discrimination; subjects who started on a difficult discrimination exhibited no differential rates of SDBs as a function of task difficulty. There was a tendency to exhibit relatively more SDBs with the right hand in the more difficult task. Rates of SDBs decreased after auditory feedback signals, suggesting a link between SDBs and uncertainty. Rubs were directed more to the face (trigeminal), and gentle and rough scratches more to the body (spinothalamic), suggesting that face-directed SDBs may index a different motivational basis than scratches. Taken together, these results extend previous research on SDBs to the domain of cognitive stress in nonsocial contexts, demonstrating that SDBs are sensitive to manipulations of task difficulty in chimpanzees.

Response of fecal cortisol to stress in captive chimpanzees (Pan troglodytes)

This study examined whether fecal cortisol could be used as an index of stress responses. The stress responsiveness of fecal cortisol was tested with a stressor known to stimulate adrenal activity, the stress of anesthesia. Daily fecal and urine samples were collected from four captive chimpanzees (Pan troglodytes) before and after anesthetizations with Telazol/Ketasat. Tests of assay validity indicated that cortisol was measurable in chimpanzee fecal extracts. Fecal cortisol concentrations were significantly elevated 2 days after anesthetization, with elevations in seven of the eight treatments. The posttreatment peak was significantly greater than baseline values in three of the four subjects. Both fecal concentrations and proportionate increases in responses to stress were significantly correlated with the corresponding values in urinary cortisol, confirming the stressfulness of these procedures and the stress responsiveness of fecal cortisol. These findings provide evidence for the application of fecal cortisol as a noninvasive index of physiologic stress in nonhuman primates.

Inhibition of social behavior in chimpanzees under high-density conditions

This is the first study to investigate the short-term effects of high population density on captive chimpanzees (Pan troglodytes). Subjects of the study were 45 chimpanzees living in five different groups at the Yerkes Regional Primate Research Center. The groups were observed under two conditions: 1) when they had access to both the indoor and outdoor sections of their enclosures; 2) during cold days when they were locked into the indoor runs, which reduced the available space by more than half. Under the high-density condition, allogrooming and submissive greetings decreased, but juvenile play increased. Remarkably, the rate of various forms of agonistic behavior, such as aggression, bluff charge, bluff display, and hooting, occurred less frequently under the high-density condition. This general decrease in adult social activity, including agonistic behavior, can be interpreted as an inhibition strategy to reduce opportunities for conflict when interindividual distances are reduced. This strategy is probably effective only in the short run, however. Behavioral indicators of anxiety, such as rough scratching and yawning, showed elevated rates, suggesting increased social tension under the high-density condition.

Injury risks among chimpanzees in three housing conditions

Meeting the psychological needs of chimpanzees (Pan troglodytes) can be a challenge given their aggressiveness on the one hand and the complexity of their social lives on the other. It is unclear how to balance the need to provide opportunities for species-appropriate behavior against potential risks of injury chimpanzees may inflict on each other. This study evaluates the suggestion that simpler social environments protect chimpanzees from wounding. Over a two-year period all visible injuries to 46 adult males, 64 adult females, and 25 immature chimpanzees were recorded at the Yerkes Regional Primate Research Center. Approximately half of the subjects were mother-reared, and the rest were nursery-reared. Housing included compounds containing about 20 chimpanzees, interconnected indoor-outdoor runs for groups of up to 12 individuals, and smaller indoor-outdoor runs for pairs and trios. Annual wounding rates were calculated for serious wounds (extensive injuries and all those requiring veterinary intervention) as well as for minor wounds. Compound-housed chimpanzees incurred the highest level of minor wounding, but serious wounding levels were not affected by housing condition. Even with a period of dominance instability and elevated levels of wounding in one compound, compound chimpanzees were not injured more than those in smaller social groups over the long term. Nursery-reared females in moderate-sized groups were wounded more than mother-reared females. Also, nursery-reared males and females were wounded less often when paired with mother-reared companions. Overall, this study indicates that maintaining chimpanzees in pairs and trios would not be an effective means for reducing injuries. The management of wounding in chimpanzee colonies is influenced more by the sex and rearing composition of a colony.

Injury risks among chimpanzees in three housing conditions

Meeting the psychological needs of chimpanzees (Pan troglodytes) can be a challenge given their aggressiveness on the one hand and the complexity of their social lives on the other. It is unclear how to balance the need to provide opportunities for species-appropriate behavior against potential risks of injury chimpanzees may inflict on each other. This study evaluates the suggestion that simpler social environments protect chimpanzees from wounding. Over a two-year period all visible injuries to 46 adult males, 64 adult females, and 25 immature chimpanzees were recorded at the Yerkes Regional Primate Research Center. Approximately half of the subjects were mother-reared, and the rest were nursery-reared. Housing included compounds containing about 20 chimpanzees, interconnected indoor-outdoor runs for groups of up to 12 individuals, and smaller indoor-outdoor runs for pairs and trios. Annual wounding rates were calculated for serious wounds (extensive injuries and all those requiring veterinary intervention) as well as for minor wounds. Compound-housed chimpanzees incurred the highest level of minor wounding, but serious wounding levels were not affected by housing condition. Even with a period of dominance instability and elevated levels of wounding in one compound, compound chimpanzees were not injured more than those in smaller social groups over the long term. Nursery-reared females in moderate-sized groups were wounded more than mother-reared females. Also, nursery-reared males and females were wounded less often when paired with mother-reared companions. Overall, this study indicates that maintaining chimpanzees in pairs and trios would not be an effective means for reducing injuries. The management of wounding in chimpanzee colonies is influenced more by the sex and rearing composition of a colony.

Social anxiety, relationships and self-directed behaviour among wild female olive baboons

Self-directed behaviour (SDB) can be used as a behavioural indicator of stress and anxiety in nonhuman primates (Maestripieri et al. 1992, Animal Behaviour, 44, 967-979). We investigated the effect of nearest neighbours' relative dominance status on the SDB of sexually mature female olive baboons, Papio anubis. When the animal nearest to (within 5 m of) a female was a dominant individual, SDB rates (a combined measure of self-scratching, self-grooming, self-touching, body shaking and yawning) increased by ca. 40% over those observed when the nearest neighbour was a subordinate. The results indicate that (1) SDB can be used as a measure of uncertainty during the social interactions of cercopithecine primates and (2) as there was considerable variation in SDB response according to the nature of the dominant individual, SDB can be used to assess relationship security (i.e. the perceived predictability of a relationship for one partner). Finally, in combination with measures of affiliation rate, SDB may provide insight into relationship value. Copyright 1999 The Association for the Study of Animal Behaviour.

Reconciliation patterns among stumptailed macaques: a multivariate approach

This study focused on two aspects of the dynamics of reconciliation in stumptailed macaques, Macaca arctoides. First, we investigated the combined effects of multiple variables (i.e. sex, age, rank, conflict intensity, outcome, or number of participants, interopponent distance, kinship and friendship) on the occurrence of reconciliation. Second, we investigated whether opponents used different behaviour patterns in their postconflict reunions depending on the characteristics of their conflicts or their relationship with their opponents. We studied a multimale, multifemale group of 38 stumptailed macaques housed in a large outdoor compound. Three types of data were collected: (1) instantaneous scan sampling of contact sitting to infer 'friendship'; (2) ad libitum data on bared-teeth and teeth-chattering displays to infer dominance rank; (3) 10-min focal observations during postconflict (PC) and matched control (MC) periods in which we recorded interopponent distance at the beginning of the observation and all aggressive and affiliative behaviours between former opponents. Our study confirmed the high conciliatory tendency of stumptailed macaques previously reported for other groups. A stepwise logistic regression revealed that initial interopponent distance in PC, friendship and kinship were the only factors that independently contributed to explain the occurrence of reconciliation. Two main clusters of postconflict behavioural patterns emerged: allogrooming+contact sitting and sociosexual behaviours (e.g. hold-bottom). It is hypothesized that postconflict allogrooming and contact sitting may be used for the maintenance of valuable relationships, whereas sociosexual behaviours may be used more indiscriminately by any pair of opponents as a buffering mechanism to prevent immediate recurrence of aggression. Copyright 1999 The Association for the Study of Animal Behaviour.

Heart rate responses to social interactions in free-moving rhesus macaques (Macaca mulatta): a pilot study

Heart rate telemetry was explored as a means to access animal emotion during social interactions under naturalistic conditions. Heart rates of 2 middle-ranking adult females living in a large group of rhesus macaques (Macaca mulatta) were recorded along with their behavior. Heart rate changes during 2 types of interactions were investigated, while controlling for the effects of posture and activity. The risk of aggression associated with the approach of a dominant individual was expected to provoke anxiety in the approachee. This prediction was supported by the heart rate increase after such an approach. No increase was found when the approacher was a kin or a subordinate individual. The tension-reduction function of allogrooming was also supported. Heart rate decelerated faster during the receipt of grooming than in matched control periods.

Differential kinship effect on reconciliation in three species of macaques (Macaca fascicularis, M. fuscata, and M. sylvanus)

Macaque societies are typically characterized by despotic dominance styles and strong bonds between related individuals. Interspecies variation in dominance style, however, has been recently documented. This study investigated whether kinship effects on social interactions vary depending on the species dominance style. Reconciliation was chosen as as a measure of relationship quality between group members. Groups of Japanese (Macaca fuscata) and long-tailed (M. fascicularis) macaques were selected for their highly despotic style, and Barbary (M. sylvanus) macaques were chosen for their lower level of despotism. The findings confirmed the hypothesis that kinship effects on reconciliation are stronger the more despotic the species is. Barbary macaque nonkin reconciled more often than nonkin of the other 2 species. In addition, the differences in reconciliation frequency between kin and nonkin were less pronounced among the less despotic Barbary macaques.

Conflict resolution and distress alleviation in monkeys and apes

Research on nonhuman primates has produced compelling evidence for reconciliation and consolation, that is, postconflict contacts that serve to respectively repair social relationships and reassure distressed individuals, such as victims of attack. This has led to a view of conflict and conflict resolution as an integrated part of social relationships, hence determined by social factors and modifiable by the social environment. Implications of this new model of social conflict are discussed along with evidence for behavioral flexibility, the value of cooperation, and the possibility that distress alleviation rests on empathy, a capacity that may be present in chimpanzees and humans but not in most other animals.

Scratching as a behavioral index of anxiety in macaque mothers

The aim of this study was to assess the validity of the notion that anxiety influences maternal style in monkeys. To this end, we investigated the correlations between measures of the quality of mother-infant relationship and scratching, a behavior pattern that reflects a state of anxiety. The subjects were seven group-living macaque mothers and their infants observed during the first 12 weeks postpartum. Postpartum scratching by the mothers was positively correlated with both maternal possessiveness and maternal warmth, two composite measures of the quality of mother-infant relationship that reflect a possessive and attentive maternal style. Evaluation of the correlations between maternal rank and scratching before and after parturition indicated that interactions with their infants, not those with other group companions, were the main source of anxiety for the mothers. These results support the notion that anxiety influences maternal style in monkeys and suggest that studies aimed at investigating physiological and social correlates of maternal emotionality in nonhuman primates could use scratching as a useful and simple behavioral measure.

Severity of early separation and later abusive mothering in monkeys: what is the pathogenic threshold?

This study reports on a nonexperimentally induced case of infant abuse by a macaque mother living in a stable social group. The case is of particular interest because of the early experience of the abusive mother: she had been abandoned right after birth by her biological mother, adopted and reared by an adoptive mother who provided adequate maternal care. The abusive mother alternated violent abuse and attentive maternal care and was shown to have a very possessive relationship with her infant. This study raises questions about etiology of primate infant abuse and supports the view that maternal anxiety may play a role in precipitating abuse.