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Schulz I, Kruse N, Gera RG, Kremer T, Cedarbaum J, Barbour R, Zago W, Schade S, Otte B, Bartl M, Hutten SJ, Trenkwalder C, Mollenhauer B. Systematic Assessment of 10 Biomarker Candidates Focusing on α-Synuclein-Related Disorders. Mov Disord 2021; 36:2874-2887. [PMID: 34363416 DOI: 10.1002/mds.28738] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 03/31/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Objective diagnostic biomarkers are needed to support a clinical diagnosis. OBJECTIVES To analyze markers in various neurodegenerative disorders to identify diagnostic biomarker candidates for mainly α-synuclein (aSyn)-related disorders (ASRD) in serum and/or cerebrospinal fluid (CSF). METHODS Upon initial testing of commercially available kits or published protocols for the quantification of the candidate markers, assays for the following were selected: total and phosphorylated aSyn (pS129aSyn), neurofilament light chain (NfL), phosphorylated neurofilament heavy chain (pNfH), tau protein (tau), ubiquitin C-terminal hydrolase L1 (UCHL-1), glial fibrillary acidic protein (GFAP), calcium-binding protein B (S100B), soluble triggering receptor expressed on myeloid cells 2 (sTREM-2), and chitinase-3-like protein 1 (YKL-40). The cohort comprised participants with Parkinson's disease (PD, n = 151), multiple system atrophy (MSA, n = 17), dementia with Lewy bodies (DLB, n = 45), tau protein-related neurodegenerative disorders (n = 80, comprising patients with progressive supranuclear palsy (PSP, n = 38), corticobasal syndrome (CBS, n = 16), Alzheimer's disease (AD, n = 11), and frontotemporal degeneration/amyotrophic lateral sclerosis (FTD/ALS, n = 15), as well as healthy controls (HC, n = 20). Receiver operating curves (ROC) with area under the curves (AUC) are given for each marker. RESULTS CSF total aSyn was decreased. NfL, pNfH, UCHL-1, GFAP, S100B, and sTREM-2 were increased in patients with neurodegenerative disease versus HC (P < 0.05). As expected, some of the markers were highest in AD (i.e., UCHL-1, GFAP, S100B, sTREM-2, YKL-40). Within ASRD, CSF NfL levels were higher in MSA than PD and DLB (P < 0.05). Comparing PD to HC, interesting serum markers were S100B (AUC: 0.86), sTREM2 (AUC: 0.87), and NfL (AUC: 0.78). CSF S100B and serum GFAP were highest in DLB. CONCLUSIONS Levels of most marker candidates tested in serum and CSF significantly differed between disease groups and HC. In the stratification of PD versus other tau- or aSyn-related conditions, CSF NfL levels best discriminated PD and MSA. CSF S100B and serum GFAP best discriminated PD and DLB. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Affiliation(s)
| | - Niels Kruse
- Department of Neuropathology, University Medical Centre Goettingen, Goettingen, Germany
| | - Roland G Gera
- Department of Medical Statistics, University Medical Centre Goettingen, Goettingen, Germany
| | - Thomas Kremer
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Disease, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jesse Cedarbaum
- Coeruleus Clinical Sciences LLC, Woodbidge, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robin Barbour
- Prothena Biosciences Inc., San Francisco, California, USA
| | - Wagner Zago
- Prothena Biosciences Inc., San Francisco, California, USA
| | - Sebastian Schade
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Birgit Otte
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Michael Bartl
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurosurgery, University Medical Centre Goettingen, Goettingen, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
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2
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Romero K, Conrado D, Burton J, Nicholas T, Sinha V, Macha S, Ahamadi M, Cedarbaum J, Seibyl J, Marek K, Basseches P, Hill D, Somer E, Gallagher J, Dexter DT, Roach A, Stephenson D. Molecular Neuroimaging of the Dopamine Transporter as a Patient Enrichment Biomarker for Clinical Trials for Early Parkinson's Disease. Clin Transl Sci 2019; 12:240-246. [PMID: 30706986 PMCID: PMC6510371 DOI: 10.1111/cts.12619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/09/2018] [Accepted: 12/21/2018] [Indexed: 01/28/2023] Open
Abstract
The Critical Path for Parkinson's (CPP) Imaging Biomarker and Modeling and Simulation working groups aimed to achieve qualification opinion by the European Medicines Agency (EMA) Committee for Medical Products for Human Use (CHMP) for the use of baseline dopamine transporter neuroimaging for patient selection in early Parkinson's disease clinical trials. This paper describes the regulatory science strategy to achieve this goal. CPP is an international consortium of three Parkinson's charities and nine pharmaceutical partners, coordinated by the Critical Path Institute.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John Seibyl
- Molecular Neuroimaging, New Haven, Connecticut, USA
| | | | | | - Derek Hill
- Panoramic Digital Health, Saint Pierre de Chartreuse, France
| | - Ed Somer
- General Electric, Little Chalfont, UK
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3
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Chen-Plotkin AS, Albin R, Alcalay R, Babcock D, Bajaj V, Bowman D, Buko A, Cedarbaum J, Chelsky D, Cookson MR, Dawson TM, Dewey R, Foroud T, Frasier M, German D, Gwinn K, Huang X, Kopil C, Kremer T, Lasch S, Marek K, Marto JA, Merchant K, Mollenhauer B, Naito A, Potashkin J, Reimer A, Rosenthal LS, Saunders-Pullman R, Scherzer CR, Sherer T, Singleton A, Sutherland M, Thiele I, van der Brug M, Van Keuren-Jensen K, Vaillancourt D, Walt D, West A, Zhang J. Finding useful biomarkers for Parkinson's disease. Sci Transl Med 2018; 10:eaam6003. [PMID: 30111645 PMCID: PMC6097233 DOI: 10.1126/scitranslmed.aam6003] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
The recent advent of an "ecosystem" of shared biofluid sample biorepositories and data sets will focus biomarker efforts in Parkinson's disease, boosting the therapeutic development pipeline and enabling translation with real-world impact.
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Affiliation(s)
- Alice S Chen-Plotkin
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Roger Albin
- Neurology Service and GRECC, VAAHS, Ann Arbor, MI 48105, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Roy Alcalay
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA
| | - Debra Babcock
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20824, USA
| | - Vikram Bajaj
- Verily/Google Life Sciences, South San Francisco, CA 94080, USA
| | - Dubois Bowman
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Alex Buko
- Human Metabolome Technology-America, Boston, MA 02134, USA
| | | | | | - Mark R Cookson
- Cell Biology and Gene Expression Section, Laboratory of Neurogenetics, National Institute of Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ted M Dawson
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Richard Dewey
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY 10163, USA
| | - Dwight German
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Katrina Gwinn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20824, USA
| | - Xuemei Huang
- Department of Neurology, Penn State University-Hershey Medical Center, Hershey, PA 17033, USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY 10163, USA
| | - Thomas Kremer
- Pharmaceutical Research and Early Development, NORD Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Shirley Lasch
- Institute for Neurodegenerative Disorders, New Haven, CT 06510, USA
| | - Ken Marek
- Institute for Neurodegenerative Disorders, New Haven, CT 06510, USA
| | - Jarrod A Marto
- Departments of Cancer Biology and Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
- Blais Proteomics Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | | | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, 34128 Kassel, Germany
- University Medical Center, 37075 Goettingen, Germany
| | - Anna Naito
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY 10163, USA
| | - Judith Potashkin
- Department of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL 60064, USA
| | - Alyssa Reimer
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY 10163, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY 10003, USA
| | - Clemens R Scherzer
- Center for Advanced Parkinson's Disease Research and Precision Neurology Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Todd Sherer
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY 10163, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - Margaret Sutherland
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20824, USA
| | - Ines Thiele
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Luxembourg, Luxembourg
| | | | | | - David Vaillancourt
- Department of Applied Physiology, Biomedical Engineering, and Neurology, University of Florida, Gainesville, FL 32611, USA
| | - David Walt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Andrew West
- Department of Neurology, University of Alabama, Birmingham, AL 35233, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
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4
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Cedarbaum J, Donohue MC, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Saykin AJ, Shaw L, Thompson PM, Toga AW, Trojanowski JQ. Impact of the Alzheimer's Disease Neuroimaging Initiative, 2004 to 2014. Alzheimers Dement 2016; 11:865-84. [PMID: 26194320 DOI: 10.1016/j.jalz.2015.04.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [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: 12/12/2014] [Revised: 03/04/2015] [Accepted: 04/23/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) was established in 2004 to facilitate the development of effective treatments for Alzheimer's disease (AD) by validating biomarkers for AD clinical trials. METHODS We searched for ADNI publications using established methods. RESULTS ADNI has (1) developed standardized biomarkers for use in clinical trial subject selection and as surrogate outcome measures; (2) standardized protocols for use across multiple centers; (3) initiated worldwide ADNI; (4) inspired initiatives investigating traumatic brain injury and post-traumatic stress disorder in military populations, and depression, respectively, as an AD risk factor; (5) acted as a data-sharing model; (6) generated data used in over 600 publications, leading to the identification of novel AD risk alleles, and an understanding of the relationship between biomarkers and AD progression; and (7) inspired other public-private partnerships developing biomarkers for Parkinson's disease and multiple sclerosis. DISCUSSION ADNI has made myriad impacts in its first decade. A competitive renewal of the project in 2015 would see the use of newly developed tau imaging ligands, and the continued development of recruitment strategies and outcome measures for clinical trials.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California- San Diego, La Jolla, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Nigel J Cairns
- Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jesse Cedarbaum
- Neurology Early Clinical Development, Biogen Idec, Cambridge, MA, USA
| | - Michael C Donohue
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute and the School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Andrew J Saykin
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, University of Southern California, Marina Del Rey, CA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California Los Angeles, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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5
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Cedarbaum J, Green RC, Harvey D, Jack CR, Jagust W, Luthman J, Morris JC, Petersen RC, Saykin AJ, Shaw L, Shen L, Schwarz A, Toga AW, Trojanowski JQ. 2014 Update of the Alzheimer's Disease Neuroimaging Initiative: A review of papers published since its inception. Alzheimers Dement 2016; 11:e1-120. [PMID: 26073027 DOI: 10.1016/j.jalz.2014.11.001] [Citation(s) in RCA: 203] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/18/2013] [Indexed: 01/18/2023]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) is an ongoing, longitudinal, multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer's disease (AD). The initial study, ADNI-1, enrolled 400 subjects with early mild cognitive impairment (MCI), 200 with early AD, and 200 cognitively normal elderly controls. ADNI-1 was extended by a 2-year Grand Opportunities grant in 2009 and by a competitive renewal, ADNI-2, which enrolled an additional 550 participants and will run until 2015. This article reviews all papers published since the inception of the initiative and summarizes the results to the end of 2013. The major accomplishments of ADNI have been as follows: (1) the development of standardized methods for clinical tests, magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebrospinal fluid (CSF) biomarkers in a multicenter setting; (2) elucidation of the patterns and rates of change of imaging and CSF biomarker measurements in control subjects, MCI patients, and AD patients. CSF biomarkers are largely consistent with disease trajectories predicted by β-amyloid cascade (Hardy, J Alzheimer's Dis 2006;9(Suppl 3):151-3) and tau-mediated neurodegeneration hypotheses for AD, whereas brain atrophy and hypometabolism levels show predicted patterns but exhibit differing rates of change depending on region and disease severity; (3) the assessment of alternative methods of diagnostic categorization. Currently, the best classifiers select and combine optimum features from multiple modalities, including MRI, [(18)F]-fluorodeoxyglucose-PET, amyloid PET, CSF biomarkers, and clinical tests; (4) the development of blood biomarkers for AD as potentially noninvasive and low-cost alternatives to CSF biomarkers for AD diagnosis and the assessment of α-syn as an additional biomarker; (5) the development of methods for the early detection of AD. CSF biomarkers, β-amyloid 42 and tau, as well as amyloid PET may reflect the earliest steps in AD pathology in mildly symptomatic or even nonsymptomatic subjects and are leading candidates for the detection of AD in its preclinical stages; (6) the improvement of clinical trial efficiency through the identification of subjects most likely to undergo imminent future clinical decline and the use of more sensitive outcome measures to reduce sample sizes. Multimodal methods incorporating APOE status and longitudinal MRI proved most highly predictive of future decline. Refinements of clinical tests used as outcome measures such as clinical dementia rating-sum of boxes further reduced sample sizes; (7) the pioneering of genome-wide association studies that leverage quantitative imaging and biomarker phenotypes, including longitudinal data, to confirm recently identified loci, CR1, CLU, and PICALM and to identify novel AD risk loci; (8) worldwide impact through the establishment of ADNI-like programs in Japan, Australia, Argentina, Taiwan, China, Korea, Europe, and Italy; (9) understanding the biology and pathobiology of normal aging, MCI, and AD through integration of ADNI biomarker and clinical data to stimulate research that will resolve controversies about competing hypotheses on the etiopathogenesis of AD, thereby advancing efforts to find disease-modifying drugs for AD; and (10) the establishment of infrastructure to allow sharing of all raw and processed data without embargo to interested scientific investigators throughout the world.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jesse Cedarbaum
- Neurology Early Clinical Development, Biogen Idec, Cambridge, MA, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Johan Luthman
- Neuroscience Clinical Development, Neuroscience & General Medicine Product Creation Unit, Eisai Inc., Philadelphia, PA, USA
| | - John C Morris
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Li Shen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam Schwarz
- Tailored Therapeutics, Eli Lilly and Company, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Istace A, Bracoud L, Berman RM, Luo F, Roche F, Salloway S, Dyck C, Dubois B, Andreasen N, Brody M, Curtis C, Soininen H, Thein S, Shiovitz T, Ferris SH, Grill JD, Gouttard S, Schaerer J, Hayes W, Kaplita S, Belaroussi B, Yu HJ, Cedarbaum J, Feldman H, Pachai C, Coric V. P2‐202: VOLUMETRIC MRI RESULTS OF BMS AVAGACESTAT IN A PRODROMAL AD POPULATION. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - Feng Luo
- Bristol Myers SquibbPrincetonNew JerseyUnited States
| | | | - Stephen Salloway
- Brown Medical School, Butler HospitalProvidenceRhode IslandUnited States
| | - Christopher Dyck
- Yale, Alzheimer's Disease Research UnitNew HavenConnecticutUnited States
| | | | | | - Mark Brody
- Brain Matters Research, Inc.Delray BeachFloridaUnited States
| | - Craig Curtis
- Compass Research, LLCOrlandoFloridaUnited States
| | | | - Stephen Thein
- Pacific Research Network IncSan DiegoCaliforniaUnited States
| | - Thomas Shiovitz
- California Neuroscience Research Medical Group, IncSherman OaksCaliforniaUnited States
| | | | - Joshua D. Grill
- UCLA Easton Alzheimer's Disease Research CenterLos AngelesCaliforniaUnited States
| | | | | | - Wendy Hayes
- Bristol‐Myers SquibbPrincetonNew JerseyUnited States
| | | | | | | | | | - Howard Feldman
- University of British Columbia HospitalVancouverBritish ColumbiaCanada
| | | | - Vlad Coric
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
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7
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Istace A, Bracoud L, Berman RM, Luo F, Roche F, Salloway S, Dyck C, Dubois B, Andreasen N, Brody M, Curtis C, Soininen H, Thein S, Shiovitz T, Ferris SH, Grill JD, Gouttard S, Schaerer J, Hayes W, Kaplita S, Belaroussi B, Yu HJ, Cedarbaum J, Feldman H, Pachai C, Coric V. IC‐P‐108: VOLUMETRIC MRI RESULTS OF BMS AVAGACESTAT IN A PRODROMAL AD POPULATION. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - Feng Luo
- Bristol Myers SquibbPrincetonNew JerseyUnited States
| | | | - Stephen Salloway
- Brown Medical School, Butler HospitalProvidenceRhode IslandUnited States
| | - Christopher Dyck
- Yale University School of MedicineNew HavenConnecticutUnited States
| | | | | | - Mark Brody
- Brain Matters Research, Inc.Delray BeachFloridaUnited States
| | - Craig Curtis
- Compass Research, LLCOrlandoFloridaUnited States
| | | | - Stephen Thein
- Pacific Research Network IncSan DiegoCaliforniaUnited States
| | - Thomas Shiovitz
- California Neuroscience Research Medical Group, IncSherman OaksCaliforniaUnited States
| | - Steven H. Ferris
- California Neuroscience Research Medical Group, IncSherman OaksCaliforniaUnited States
| | - Joshua D. Grill
- UCLA Easton Alzheimer's Disease Research CenterLos AngelesCaliforniaUnited States
| | | | | | - Wendy Hayes
- Bristol‐Myers SquibbPrincetonNew JerseyUnited States
| | | | | | | | | | - Howard Feldman
- University of British Columbia HospitalVancouverBritish ColumbiaCanada
| | | | - Vlad Coric
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
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8
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Vellas B, Carrillo MC, Sampaio C, Brashear HR, Siemers E, Hampel H, Schneider LS, Weiner M, Doody R, Khachaturian Z, Cedarbaum J, Grundman M, Broich K, Giacobini E, Dubois B, Sperling R, Wilcock GK, Fox N, Scheltens P, Touchon J, Hendrix S, Andrieu S, Aisen P. Designing drug trials for Alzheimer's disease: What we have learned from the release of the phase III antibody trials: A report from the EU/US/CTAD Task Force. Alzheimers Dement 2013; 9:438-44. [DOI: 10.1016/j.jalz.2013.03.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/28/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Bruno Vellas
- UMR1027 InsermToulouseFrance
- University of Toulouse IIIToulouseFrance
- Gerontopole ToulouseToulouse University HospitalToulouseFrance
| | | | | | | | | | - Harald Hampel
- Department of PsychiatryGoethe UniversityFrankfurtGermany
| | - Lon S. Schneider
- University of Southern California Keck School of MedicineLos AngelesCAUSA
| | - Michael Weiner
- Center for Imaging of Neurodegenerative DiseaseVA Medical Center, University of California San FranciscoSan FranciscoCAUSA
| | - Rachelle Doody
- Alzheimer's Disease and Memory Disorders CenterBaylor College of MedicineHoustonTXUSA
| | | | | | | | - Karl Broich
- Federal Institute of Drugs and Medical DevicesBonnGermany
| | - Ezio Giacobini
- Department of Internal Medicine, Rehabilitation and GeriatricsUniversity of GenevaGenevaSwitzerland
| | - Bruno Dubois
- Institute for Memory and Alzheimer's DiseaseUMR‐S975, Salpêtrière Hospital, Pierre & Marie Curie UniversityParisFrance
| | - Reisa Sperling
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | | | - Nick Fox
- Dementia Research CentreUCL Institute of NeurologyLondonUK
| | - Philip Scheltens
- Department of Neurology and Alzheimer CenterVU University Medical CentreAmsterdamNetherlands
| | | | | | - Sandrine Andrieu
- UMR1027 InsermToulouseFrance
- University of Toulouse IIIToulouseFrance
- Gerontopole ToulouseToulouse University HospitalToulouseFrance
| | - Paul Aisen
- Department of NeurosciencesUniversity of California, San DiegoSan DiegoCAUSA
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9
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Abstract
Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. Once thought to emerge primarily in people with late-stage disease, these symptoms are currently known to manifest commonly in very early disease and in prodromal phases, such as mild cognitive impairment. Despite decades of research, reliable treatments for dementia-associated NPS have not been found, and those that are in widespread use present notable risks for people using these medications. An Alzheimer's Association Research Roundtable was convened in the spring of 2010 to review what is known about NPS in Alzheimer's disease, to discuss classification and underlying neuropathogenesis and vulnerabilities, and to formulate recommendations for new approaches to tailored therapeutics.
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10
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Lyketsos CG, Carrillo MC, Ryan JM, Khachaturian AS, Trzepacz P, Amatniek J, Cedarbaum J, Brashear R, Miller DS. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimers Dement 2012; 7:532-9. [PMID: 21889116 DOI: 10.1016/j.jalz.2011.05.2410] [Citation(s) in RCA: 599] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 05/16/2011] [Indexed: 10/17/2022]
Abstract
Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. Once thought to emerge primarily in people with late-stage disease, these symptoms are currently known to manifest commonly in very early disease and in prodromal phases, such as mild cognitive impairment. Despite decades of research, reliable treatments for dementia-associated NPS have not been found, and those that are in widespread use present notable risks for people using these medications. An Alzheimer's Association Research Roundtable was convened in the spring of 2010 to review what is known about NPS in Alzheimer's disease, to discuss classification and underlying neuropathogenesis and vulnerabilities, and to formulate recommendations for new approaches to tailored therapeutics.
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11
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Shefner J, Andrews J, Bedlack R, Berry J, Goslin K, Jackson C, Kissel J, Lange D, Licht J, Mozaffar T, Pestronk A, Rosenfeld J, Wolff A, Lee J, Masonek J, Jones D, Meng L, Cedarbaum J. A Study To Evaluate Safety and Tolerability of CK-2017357 (CK-357) in Patients with Amyotrophic Lateral Sclerosis Using a Twice-Daily, Dose-Titration Regimen (P04.155). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.155] [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: 11/15/2022] Open
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12
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Shefner J, Barohn R, Boylan K, Bradshaw D, Brooks B, Heiman-Patterson T, Katz J, Maragakis N, Mitsumoto H, Pestronk A, Simmons Z, Wolff A, Lee J, Masonek J, Jones D, Meng L, Cedarbaum J. A Study To Evaluate Safety, and Tolerability of Repeated Doses of CK-2017357 (CK-357) in Patients with Amyotrophic Lateral Sclerosis (S25.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s25.005] [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: 11/15/2022] Open
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13
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Tariot P, Lyketsos C, Crans G, Cedarbaum J, Hernandez C, Abushakra S. The Effects of ELND005 (Scyllo-Inositol) on Emergence of Neuropsychiatric Symptoms (NPS) in Mild/Moderate Alzheimer's Disease: Results from a 78-Week Phase 2 Study (P04.215). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Vellas B, Pesce A, Robert PH, Aisen PS, Ancoli-Israel S, Andrieu S, Cedarbaum J, Dubois B, Siemers E, Spire JP, Weiner MW, May TS. AMPA workshop on challenges faced by investigators conducting Alzheimer's disease clinical trials. Alzheimers Dement 2011; 7:e109-17. [PMID: 21784343 DOI: 10.1016/j.jalz.2010.05.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 05/24/2010] [Indexed: 01/25/2023]
Abstract
The recruitment and retention of patients are among the greatest challenges currently being faced by researchers who conduct Alzheimer's disease (AD) clinical trials. To discuss these challenges and other major issues associated with clinical research in AD, an international workshop was organized by the Association Monégasque pour la recherche sur la Maladie d'Alzheimer at Monte Carlo, Monaco, in February 2010, with the participation of leading research experts in the field of Alzheimer's. Key topics discussed were as follows: (1) the selection, recruitment, and retention of clinical trial subjects; (2) international co-operation among researchers; and (3) patient rights and informed consent for participants in clinical trials. This article highlights some of the challenges faced by investigators when conducting clinical trials in AD, and it also offers some recommendations aimed at overcoming these challenges.
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Affiliation(s)
- Bruno Vellas
- Department of Geriatrics, INSERM U558, Toulouse University Hospital Center, Toulouse, France
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15
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Vellas B, Aisen PS, Sampaio C, Carrillo M, Scheltens P, Scherrer B, Frisoni GB, Weiner M, Schneider L, Gauthier S, Gispen-de Wied CC, Hendrix S, Feldman H, Cedarbaum J, Petersen R, Siemers E, Andrieu S, Prvulovic D, Touchon J, Hampel H. Prevention trials in Alzheimer's disease: an EU-US task force report. Prog Neurobiol 2011; 95:594-600. [PMID: 21925234 DOI: 10.1016/j.pneurobio.2011.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [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: 06/14/2011] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 11/20/2022]
Abstract
Despite enormous financial and scientific efforts, still no approved disease-modifying therapies exist for Alzheimer's disease (AD). During the last decade all Phase III clinical trials on disease modifiers in AD have failed. The dementia stage of AD being probably too late in order to allow for successful disease modification has been identified as a possible culprit that could explain the failure of so many clinical trials. In parallel, a major development in the diagnostic research field of AD was achieved by the recent proposal of new diagnostic criteria for AD, which also specifically incorporate the use of biomarkers as defining criteria for preclinical stages of AD, thus extending the traditional definition of disease to very early stages that may be a more feasible target for various disease modifying therapeutic interventions. This ongoing paradigm shift in AD definition and diagnosis represents a fundamental basis for redefinition of interventional trials in AD, allowing to specifically focus on preventative measures during very early pathophysiologically confirmed stages of disease. This consensus paper reflects the outcome from a European Union and North American Task Force meeting comprised of experts from academia, industry, private foundations, and regulatory agencies that was convened in Toulouse, France on November 5, 2010 and that focused on prevention trials in AD. This position paper thoroughly analyzes prerequisites for successful preventative trials in AD and concludes with concrete recommendations on biomarkers, statistical tools and other variables important for improved study designs suitable for preventative as well as for early therapeutic interventional trials in AD.
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16
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Liang E, Liu WJ, Lohr L, Nguyen V, Lin H, Munson ML, Crans G, Cedarbaum J. P2‐476: A Phase 1, dose escalation study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple oral daily doses of ELND006 in healthy elderly subjects. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Earvin Liang
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
| | | | - Lisa Lohr
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
| | - Van Nguyen
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
| | - Holly Lin
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
| | - Marie Lou Munson
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
| | - Gerald Crans
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
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17
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Cedarbaum J. P2‐201: Predicting initial changes in brain volume with effective anti‐amyloid agents: Just ask alice. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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18
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Porsteinsson A, Sperling R, Salloway S, Keren R, Dyck C, Tariot P, Arnold D, Crans G, Hernandez R, Liang E, Bairu M, Cedarbaum J, Pastrak A, Abushakra S. O4‐06‐07: Imaging and cerebrospinal fluid biomarker results of a phase II dose‐ranging study of ELND005 (Scyllo‐inositol) in mild‐to‐moderate Alzheimer's disease. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Reisa Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women's HospitalBostonMassachusettsUnited States
| | - Stephen Salloway
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUnited States
| | - Ron Keren
- University Health Network Memory ClinicTorontoOntarioCanada
| | - Christopher Dyck
- Departments of Psychiatry and NeurobiologyYale University School of MedicineNew HavenConnecticutUnited States
| | - Pierre Tariot
- Banner Alzheimer's InstitutePhoenixArizonaUnited States
| | | | - Gerald Crans
- Elan Pharmaceuticals, Inc.South San FranciscoCaliforniaUnited States
| | - Ramon Hernandez
- Elan Pharmaceuticals, Inc.South San FranciscoCaliforniaUnited States
| | - Earvin Liang
- Elan Pharmaceuticals, Inc.South San FranciscoCaliforniaUnited States
| | - Menghis Bairu
- Elan Pharmaceuticals, Inc.South San FranciscoCaliforniaUnited States
| | - Jesse Cedarbaum
- Cytokinetics, Inc.South San FranciscoCaliforniaUnited States
| | | | - Susan Abushakra
- Elan Pharmaceuticals, Inc.South San FranciscoCaliforniaUnited States
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19
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Wagg J, Green M, Yan L, Liang E, Cedarbaum J, Abushakra S. P2‐509: Population pharmacokinetic analysis of plasma, cerebrospinal fluid and brain ELND005 in patients with mild to moderate Alzheimer's disease. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jonathan Wagg
- Pharsight CorporationSunnyvaleCaliforniaUnited States
| | | | - Li Yan
- Pharsight CorporationSunnyvaleCaliforniaUnited States
| | - Earvin Liang
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
| | | | - Susan Abushakra
- Elan Pharmaceuticals Inc.South San FranciscoCaliforniaUnited States
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20
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Affiliation(s)
- Jesse Cedarbaum
- Cytokinetics, Inc.South San FranciscoCaliforniaUnited States
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21
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Ward A, Michels SL, Cedarbaum J, Arrighi HM. P2‐082: Defining mild cognitive impairment: Disparity of incidence and prevalence estimates with variable operationalized definitions. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alex Ward
- United BioSource CorporationLexingtonMAUSA
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22
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Affiliation(s)
- J Cedarbaum
- Clinical Affaires, Regeneron Pharmaceuticals, Inc., New York, USA
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23
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Dupont J, Schwartz L, Koutcher J, Spriggs D, Gordon M, Mendelson D, Murren J, Lucarelli A, Cedarbaum J. Phase I and pharmacokinetic study of VEGF Trap administered subcutaneously (sc) to patients (pts) with advanced solid malignancies. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Dupont
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - L. Schwartz
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - J. Koutcher
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - D. Spriggs
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - M. Gordon
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - D. Mendelson
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - J. Murren
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - A. Lucarelli
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
| | - J. Cedarbaum
- Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Scottsdale, AZ; Yale University, New Haven, CT; Regeneron Pharmaceuticals Inc, Tarrytown, NY
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24
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25
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Abstract
OBJECTIVES This study investigates the cost of chronic constipation care. DESIGN AND PARTICIPANTS A consecutive sample of 31 chronically constipated elderly patients. SETTING A not-for-profit long-term care facility in New Hyde Park, New York. MEASUREMENTS Patient demographics and functional status, including activity of daily living scores, diagnosis, and medications were recorded. All constipation medication costs were obtained using the average wholesale price obtained from the Redbook (November 1999). All subjects were closely monitored for constipation care during two shifts a day (from 7:00 AM to 11:00 PM), over a 6-week period resulting in the collection of 1,860 shift reports. Each component of constipation treatment cost, namely drugs and staff time for drug administration, was identified and analyzed. RESULTS The average number of nursing interactions for constipation treatment was 23.3 per month. The average cost per day for care specifically for the treatment of constipation was 2.11 US dollars. Fleet Enema trade mark and milk of magnesia accounted for 49% of all treatments. Administration (staffing) costs accounted for 70% of total drug costs. CONCLUSIONS Although laxatives are the most frequently prescribed drugs used in long-term care settings, drug utilization patterns and associated costs in the treatment of chronic constipation have not been systematically reported. Our study identified staffing as the major cost factor in constipation care.
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Affiliation(s)
- Renée Pekmezaris
- Nerken Center for Research, New Hyde Park, New York 11040-1433, USA.
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26
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Gold R, Zielasek J, Schröder JM, Sellhaus B, Cedarbaum J, Hartung HP, Sendtner M, Toyka KV. Treatment with ciliary neurotrophic factor does not improve regeneration in experimental autoimmune neuritis of the Lewis rat. Muscle Nerve 1996; 19:1177-80. [PMID: 8761279 DOI: 10.1002/(sici)1097-4598(199609)19:9<1177::aid-mus17>3.0.co;2-s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R Gold
- Department of Neurology, Julius-Maximilians-Universität, Würzburg, Germany
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27
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28
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Eidelberg D, Moeller JR, Dhawan V, Sidtis JJ, Ginos JZ, Strother SC, Cedarbaum J, Greene P, Fahn S, Rottenberg DA. The metabolic anatomy of Parkinson's disease: complementary [18F]fluorodeoxyglucose and [18F]fluorodopa positron emission tomographic studies. Mov Disord 1990; 5:203-13. [PMID: 2117706 DOI: 10.1002/mds.870050304] [Citation(s) in RCA: 164] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We studied the metabolic anatomy of typical Parkinson's disease (PD) using [18F]fluorodeoxyglucose (FDG) and [18F]fluorodopa (FDOPA) and positron emission tomography (PET). Fourteen PD patients (mean age 49 years) had FDG/PET scans, of which 11 were scanned with both FDOPA and FDG. After the injection of FDOPA, brain uptake and arterial plasma radioactivity were monitored for 2 h. Striatal FDOPA uptake was analyzed with regard to a two-compartment model, and target-to-background ratios (TBRs) and TBR-versus-time slopes were also calculated. Regional patterns of metabolic covariation were extracted from FDG/PET data using the Scaled Subprofile Model (SSM). SSM pattern weights, FDOPA uptake constants (Ki), TBRs, and TBR slopes were correlated with clinical measures for bradykinesia, rigidity, tremor, gait disturbance, left-right asymmetry, dementia, and overall disease severity. In PD patients, rate constants for FDOPA uptake correlated with individual measures of bradykinesia (p = 0.001) and gait disability (p less than 0.05). SSM analysis revealed a distinct pattern of regional metabolic asymmetries, which correlated with motor asymmetries (p less than 0.001) and left-right differences in Ki (p less than 0.01). Our data suggest that in PD patients, FDG/PET and FDOPA/PET may provide unique and complementary information about underlying disease processes.
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Affiliation(s)
- D Eidelberg
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
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29
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Abstract
Overdose of carbamazepine (CBZ) can be fatal. We report the case of a patient with near-lethal toxicity due to delayed absorption of drug. A 36-year-old woman was admitted with coma, hypotension, and unusual movements. Carbamazepine (CBZ) level several hours later was 36 mg/L. Gastric lavage revealed no pill fragments, and activated charcoal was administered. CBZ level initially fell, reaching 28 mg/L 36 h after admission. Blood level then rose sharply, reaching 54 mg/L 64 h after admission. The pattern of rise suggested renewed absorption of drug. Vigorous cathartics were given, and further doses of charcoal were administered. Three hours after onset of diarrhea, roving eye movements occurred. Two hours later she grimaced to pain. Eight hours after the onset of diarrhea, she was awake. In CBZ overdose, activated charcoal therapy coupled with aggressive intestinal purging helps prevent continued absorption of drug, late exacerbation of symptoms, and potentially fatal outcome.
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Affiliation(s)
- M Sethna
- Department of Neurology, New York Hospital-Cornell University Medical College, New York
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30
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