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Courtman M, Kim D, Wit H, Wang H, Sun L, Ifeachor E, Mullin S, Thurston M. Deep Learning Detection of Aneurysm Clips for Magnetic Resonance Imaging Safety. J Imaging Inform Med 2024; 37:72-80. [PMID: 38343241 DOI: 10.1007/s10278-023-00932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 03/02/2024]
Abstract
Flagging the presence of metal devices before a head MRI scan is essential to allow appropriate safety checks. There is an unmet need for an automated system which can flag aneurysm clips prior to MRI appointments. We assess the accuracy with which a machine learning model can classify the presence or absence of an aneurysm clip on CT images. A total of 280 CT head scans were collected, 140 with aneurysm clips visible and 140 without. The data were used to retrain a pre-trained image classification neural network to classify CT localizer images. Models were developed using fivefold cross-validation and then tested on a holdout test set. A mean sensitivity of 100% and a mean accuracy of 82% were achieved. Predictions were explained using SHapley Additive exPlanations (SHAP), which highlighted that appropriate regions of interest were informing the models. Models were also trained from scratch to classify three-dimensional CT head scans. These did not exceed the sensitivity of the localizer models. This work illustrates an application of computer vision image classification to enhance current processes and improve patient safety.
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Affiliation(s)
- Megan Courtman
- Faculty of Science and Engineering, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Daniel Kim
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LJ, UK
| | - Huub Wit
- Department of Radiology, Torbay and South Devon NHS Trust, Torquay, TQ2 7AA, UK
| | - Hongrui Wang
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
| | - Lingfen Sun
- Faculty of Science and Engineering, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Emmanuel Ifeachor
- Faculty of Science and Engineering, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Stephen Mullin
- Plymouth Institute of Health and Care Research, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Mark Thurston
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
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Chapman R, Zeissler ML, Meinert E, Mullin S, Whipps S, Whipps J, Hockey K, Hockey P, Carroll CB. Incorporating usability evaluation into iterative development of an online platform to support research participation in Parkinson's disease: a mixed methods protocol. BMJ Open 2023; 13:e078638. [PMID: 38114283 DOI: 10.1136/bmjopen-2023-078638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Many people with Parkinson's (PwP) are not given the opportunity or do not have adequate access to participate in clinical research. To address this, we have codeveloped with users an online platform that connects PwP to clinical studies in their local area. It enables site staff to communicate with potential participants and aims to increase the participation of the Parkinson's community in research. This protocol outlines the mixed methods study protocol for the usability testing of the platform. METHODS AND ANALYSIS We will seek user input to finalise the platform's design, which will then be deployed in a limited launch for beta testing. The beta version will be used as a recruitment tool for up to three studies with multiple UK sites. Usability data will be collected from the three intended user groups: PwP, care partners acting on their behalf and site study coordinators. Usability questionnaires and website analytics will be used to capture user experience quantitatively, and a purposive sample of users will be invited to provide further feedback via semistructured interviews. Quantitative data will be analysed using descriptive statistics, and a thematic analysis undertaken for interview data. Data from this study will inform future platform iterations. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Plymouth (3291; 3 May 2022). We will share our findings via a 'Latest News' section within the platform, presentations, conference meetings and national PwP networks.
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Affiliation(s)
- Rebecca Chapman
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Marie-Louise Zeissler
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Edward Meinert
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Mullin
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sue Whipps
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - John Whipps
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - Kate Hockey
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - Philip Hockey
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - Camille B Carroll
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Toffoli M, Chohan H, Mullin S, Jesuthasan A, Yalkic S, Koletsi S, Menozzi E, Rahall S, Limbachiya N, Loefflad N, Higgins A, Bestwick J, Lucas-Del-Pozo S, Fierli F, Farbos A, Mezabrovschi R, Lee-Yin C, Schrag A, Moreno-Martinez D, Hughes D, Noyce A, Colclough K, Jeffries AR, Proukakis C, Schapira AHV. Phenotypic effect of GBA1 variants in individuals with and without Parkinson's disease: The RAPSODI study. Neurobiol Dis 2023; 188:106343. [PMID: 37926171 DOI: 10.1016/j.nbd.2023.106343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/08/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Variants in the GBA1 gene cause the lysosomal storage disorder Gaucher disease (GD). They are also risk factors for Parkinson's disease (PD), and modify the expression of the PD phenotype. The penetrance of GBA1 variants in PD is incomplete, and the ability to determine who among GBA1 variant carriers are at higher risk of developing PD, would represent an advantage for prognostic and trial design purposes. OBJECTIVES To compare the motor and non-motor phenotype of GBA1 carriers and non-carriers. METHODS We present the cross-sectional results of the baseline assessment from the RAPSODI study, an online assessment tool for PD patients and GBA1 variant carriers. The assessment includes clinically validated questionnaires, a tap-test, the University of Pennsyllvania Smell Identification Test and cognitive tests. Additional, homogeneous data from the PREDICT-PD cohort were included. RESULTS A total of 379 participants completed all parts of the RAPSODI assessment (89 GBA1-negative controls, 169 GBA1-negative PD, 47 GBA1-positive PD, 47 non-affected GBA1 carriers, 27 GD). Eighty-six participants were recruited through PREDICT-PD (43 non-affected GBA1 carriers and 43 GBA1-negative controls). GBA1-positive PD patients showed worse performance in visual cognitive tasks and olfaction compared to GBA1-negative PD patients. No differences were detected between non-affected GBA1 carriers carriers and GBA1-negative controls. No phenotypic differences were observed between any of the non-PD groups. CONCLUSIONS Our results support previous evidence that GBA1-positive PD has a specific phenotype with more severe non-motor symptoms. However, we did not reproduce previous findings of more frequent prodromal PD signs in non-affected GBA1 carriers.
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Affiliation(s)
- Marco Toffoli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Harneek Chohan
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Stephen Mullin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | | | - Selen Yalkic
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Sofia Koletsi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Soraya Rahall
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Naomi Limbachiya
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Nadine Loefflad
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Abigail Higgins
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Sara Lucas-Del-Pozo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Federico Fierli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Audrey Farbos
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Roxana Mezabrovschi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Chiao Lee-Yin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - David Moreno-Martinez
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust and University College London, London, UK
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust and University College London, London, UK
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Kevin Colclough
- Exeter Genomics Laboratory, Royal Devon University Healthcare NHS Trust, Exeter, UK
| | - Aaron R Jeffries
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Christos Proukakis
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA
| | - Anthony H V Schapira
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, USA.
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Foltynie T, Gandhi S, Gonzalez-Robles C, Zeissler ML, Mills G, Barker R, Carpenter J, Schrag A, Schapira A, Bandmann O, Mullin S, Duffen J, McFarthing K, Chataway J, Parmar M, Carroll C. Towards a multi-arm multi-stage platform trial of disease modifying approaches in Parkinson's disease. Brain 2023; 146:2717-2722. [PMID: 36856727 PMCID: PMC10316775 DOI: 10.1093/brain/awad063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/20/2022] [Accepted: 01/08/2023] [Indexed: 03/02/2023] Open
Abstract
An increase in the efficiency of clinical trial conduct has been successfully demonstrated in the oncology field, by the use of multi-arm, multi-stage trials allowing the evaluation of multiple therapeutic candidates simultaneously, and seamless recruitment to phase 3 for those candidates passing an interim signal of efficacy. Replicating this complex innovative trial design in diseases such as Parkinson's disease is appealing, but in addition to the challenges associated with any trial assessing a single potentially disease modifying intervention in Parkinson's disease, a multi-arm platform trial must also specifically consider the heterogeneous nature of the disease, alongside the desire to potentially test multiple treatments with different mechanisms of action. In a multi-arm trial, there is a need to appropriately stratify treatment arms to ensure each are comparable with a shared placebo/standard of care arm; however, in Parkinson's disease there may be a preference to enrich an arm with a subgroup of patients that may be most likely to respond to a specific treatment approach. The solution to this conundrum lies in having clearly defined criteria for inclusion in each treatment arm as well as an analysis plan that takes account of predefined subgroups of interest, alongside evaluating the impact of each treatment on the broader population of Parkinson's disease patients. Beyond this, there must be robust processes of treatment selection, and consensus derived measures to confirm target engagement and interim assessments of efficacy, as well as consideration of the infrastructure needed to support recruitment, and the long-term funding and sustainability of the platform. This has to incorporate the diverse priorities of clinicians, triallists, regulatory authorities and above all the views of people with Parkinson's disease.
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Affiliation(s)
- Tom Foltynie
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Sonia Gandhi
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Cristina Gonzalez-Robles
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | | | - Georgia Mills
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Roger Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0PY, UK
| | | | - Anette Schrag
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Anthony Schapira
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Oliver Bandmann
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield S10 2HQ, UK
| | - Stephen Mullin
- Faculty of Health, University of Plymouth, Plymouth PL4 9AA, UK
| | - Joy Duffen
- MRC Clinical Trials Unit at UCL, London WC1V 6LJ, UK
| | | | - Jeremy Chataway
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, London WC1V 6LJ, UK
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth PL4 9AA, UK
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Courtman M, Thurston M, McGavin L, Caroll C, Sun L, Ifeachor E, Mullin S. 095 Artificial Intelligence based detection of Parkinson’s disease in magnetic resonance imaging brain scans. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere is a need for diagnostic tests of early PD diagnosis. A subset of AI known as deep learning (DL) has shown great promise in diagnostic medical imaging, sometimes outperforming radiolo- gists by detecting patterns invisible to the human eye. Using DL, we explored whether such changes are detectable on routine PD MRI scans.MethodsWe trained a convolutional neural network to classify 138 PD and 60 control brain MRI images acquired from the Parkinson’s Progression Marker Initiative (PPMI) database. Models were assessed using k-fold cross-validation. We used Deep SHapley Additive exPlanations (DeepSHAP) to visualise the contri- bution of individual pixels to the model’s prediction.ResultsA combined dataset of axial T2 and proton density MRI images was classified with 79% accuracy and an area under the curve (AUC) of 0.86. Respectively T2 and proton density models classified cases with 81/84% accuracy and AUC of 0.83/0.88. DeepSHAP heat maps demonstrated predominant interest in midbrain slices.ConclusionOur models exhibited good diagnostic performance and demonstrated interest in PD relevant brain regions. We will validate this model in a large dataset of routinely collected NHS MRI scans, many of which predate onset of motor symptoms.
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Toffoli M, Chen X, Sedlazeck FJ, Lee CY, Mullin S, Higgins A, Koletsi S, Garcia-Segura ME, Sammler E, Scholz SW, Schapira AHV, Eberle MA, Proukakis C. Comprehensive short and long read sequencing analysis for the Gaucher and Parkinson's disease-associated GBA gene. Commun Biol 2022; 5:670. [PMID: 35794204 PMCID: PMC9259685 DOI: 10.1038/s42003-022-03610-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 12/28/2021] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
GBA variants carriers are at increased risk of Parkinson’s disease (PD) and Lewy body dementia (LBD). The presence of pseudogene GBAP1 predisposes to structural variants, complicating genetic analysis. We present two methods to resolve recombinant alleles and other variants in GBA: Gauchian, a tool for short-read, whole-genome sequencing data analysis, and Oxford Nanopore sequencing after PCR enrichment. Both methods were concordant for 42 samples carrying a range of recombinants and GBAP1-related mutations, and Gauchian outperformed the GATK Best Practices pipeline. Applying Gauchian to sequencing of over 10,000 individuals shows that copy number variants (CNVs) spanning GBAP1 are relatively common in Africans. CNV frequencies in PD and LBD are similar to controls. Gains may coexist with other mutations in patients, and a modifying effect cannot be excluded. Gauchian detects more GBA variants in LBD than PD, especially severe ones. These findings highlight the importance of accurate GBA analysis in these patients. Two methods fully resolve the GBA gene: Gauchian, a tool for short-read, whole-genome sequencing data analysis, and Oxford Nanopore sequencing after PCR enrichment. The approach improves our understanding of the relationship between GBA, Gaucher disease and Parkinson disease.
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Affiliation(s)
- Marco Toffoli
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom
| | - Xiao Chen
- Illumina Inc., San Diego, CA, USA.,Pacific Biosciences, 1305 O'Brien Dr., Menlo Park, CA, 94025, USA
| | - Fritz J Sedlazeck
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Chiao-Yin Lee
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom
| | - Stephen Mullin
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom.,Institute of Translational and Stratified Medicine, University of Plymouth School of Medicine, Plymouth, United Kingdom
| | - Abigail Higgins
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom
| | - Sofia Koletsi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom
| | - Monica Emili Garcia-Segura
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom
| | - Esther Sammler
- MRC Protein Phosphorylation and Ubiquitylation Unit, School of Life Sciences, University of Dundee, Dundee, United Kingdom.,Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, 20892, USA.,Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, 21287, USA
| | - Anthony H V Schapira
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom
| | - Michael A Eberle
- Illumina Inc., San Diego, CA, USA. .,Pacific Biosciences, 1305 O'Brien Dr., Menlo Park, CA, 94025, USA.
| | - Christos Proukakis
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, NW3 2PF, United Kingdom.
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Higgins AL, Toffoli M, Mullin S, Lee CY, Koletsi S, Avenali M, Blandini F, Schapira AH. The remote assessment of parkinsonism supporting ongoing development of interventions in Gaucher disease. Neurodegener Dis Manag 2021; 11:451-458. [PMID: 34666501 DOI: 10.2217/nmt-2021-0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Mutations in GBA which are causative of Gaucher disease in their biallelic form, are the most common genetic risk factor for Parkinson's disease (PD). The diagnosis of PD relies upon clinically defined motor features which appear after irreversible neurodegeneration. Prodromal symptoms of PD may provide a means to predict latent pathology, years before the onset of motor features. Previous work has reported prodromal features of PD in GBA mutation carriers, however this has been insufficiently sensitive to identify those that will develop PD. The Remote Assessment of Parkinsonism Supporting Ongoing Development of Interventions in Gaucher Disease (RAPSODI GD) study assesses a large cohort of GBA mutation carriers, to aid development of procedures for earlier diagnosis of PD.
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Affiliation(s)
- Abigail Louise Higgins
- Department of Clinical & Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Marco Toffoli
- Department of Clinical & Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Stephen Mullin
- Institute of Translational and Stratified Medicine, University of Plymouth Peninsula School of Medicine, Plymouth, UK
| | - Chiao-Yin Lee
- Department of Clinical & Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Sofia Koletsi
- Department of Clinical & Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Micol Avenali
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Fabio Blandini
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Cellular and Molecular Neurobiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anthony Hv Schapira
- Department of Clinical & Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
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Avenali M, Cerri S, Cerami C, Crespi C, Gegg M, Mullin S, Toffoli M, Hughes D, Valente E, Tassorelli C, Schapira A, Blandini F. Combined GCASE/ALPHA-synuclein pattern may identify specific prodomal PD patterns in GBA carriers: A cluster analysis study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119455] [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: 11/16/2022]
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Day JO, Mullin S. The Genetics of Parkinson's Disease and Implications for Clinical Practice. Genes (Basel) 2021; 12:genes12071006. [PMID: 34208795 PMCID: PMC8304082 DOI: 10.3390/genes12071006] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 12/17/2022] Open
Abstract
The genetic landscape of Parkinson’s disease (PD) is characterised by rare high penetrance pathogenic variants causing familial disease, genetic risk factor variants driving PD risk in a significant minority in PD cases and high frequency, low penetrance variants, which contribute a small increase of the risk of developing sporadic PD. This knowledge has the potential to have a major impact in the clinical care of people with PD. We summarise these genetic influences and discuss the implications for therapeutics and clinical trial design.
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Affiliation(s)
- Jacob Oliver Day
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK;
| | - Stephen Mullin
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK;
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London WC1N 3BG, UK
- Correspondence:
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Toffoli M, Higgins A, Lee C, Koletsi S, Chen X, Eberle M, Sedlazeck FJ, Mullin S, Proukakis C, Schapira AH. Intronic Haplotypes in the GBA Gene Do Not Predict Age at Diagnosis of Parkinson's Disease. Mov Disord 2021; 36:1456-1460. [PMID: 34008887 PMCID: PMC8436748 DOI: 10.1002/mds.28616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND GBA mutations are a common risk factor for Parkinson's disease (PD). A recent study has suggested that GBA haplotypes, identified by intronic variants, can affect age at diagnosis of PD. OBJECTIVES In this study, we assess this hypothesis using long reads across a large cohort and the publicly available Accelerating Medicines Partnership-Parkinson's Disease (AMP-PD) cohort. METHODS We recruited a PD cohort through the Remote Assessment of Parkinsonism Supporting Ongoing Development of Interventions in Gaucher Disease study (RAPSODI) and sequenced GBA using Oxford Nanopore technology. Genetic and clinical data on the full AMP-PD cohort were obtained from the online portal of the consortium. RESULTS A total of 1417 participants were analyzed. There was no significant difference in age at PD diagnosis between the two main haplotypes of the GBA gene. CONCLUSIONS GBA haplotypes do not affect age at diagnosis of PD in the two independent cohorts studied. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marco Toffoli
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Abigail Higgins
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Chiao Lee
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Sofia Koletsi
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Xiao Chen
- Research and Technology DevelopmentIllumina Inc.San DiegoCaliforniaUSA
| | - Michael Eberle
- Research and Technology DevelopmentIllumina Inc.San DiegoCaliforniaUSA
| | | | - Stephen Mullin
- Institute of Translational and Stratified MedicineUniversity of Plymouth Peninsula School of MedicinePlymouthUnited Kingdom
| | - Christos Proukakis
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Anthony H.V. Schapira
- Department of Clinical and Movement NeurosciencesUniversity College London Queen Square Institute of NeurologyLondonUnited Kingdom
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Mullin S, Stokholm MG, Hughes D, Mehta A, Parbo P, Hinz R, Pavese N, Brooks DJ, Schapira AH. Brain Microglial Activation Increased in Glucocerebrosidase (GBA) Mutation Carriers without Parkinson's disease. Mov Disord 2021; 36:774-779. [PMID: 33278043 PMCID: PMC8048428 DOI: 10.1002/mds.28375] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/11/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Glucocerebrosidase gene mutations are a common genetic risk factor for Parkinson's disease. They exhibit incomplete penetrance. The objective of the present study was to measure microglial activation and dopamine integrity in glucocerebrosidase gene mutation carriers without Parkinson's disease compared to controls. METHODS We performed PET scans on 9 glucocerebrosidase gene mutation carriers without Parkinson's disease and 29 age-matched controls. We measured microglial activation as 11 C-(R)-PK11195 binding potentials, and dopamine terminal integrity with 18 F-dopa influx constants. RESULTS The 11 C-(R)-PK11195 binding potential was increased in the substantia nigra of glucocerebrosidase gene carriers compared with controls (Student t test; right, t = -4.45, P = 0.0001). Statistical parametric mapping also localized significantly increased 11 C-(R)-PK11195 binding potential in the occipital and temporal lobes, cerebellum, hippocampus, and mesencephalon. The degree of hyposmia correlated with nigral 11 C-(R)-PK11195 regional binding potentials (Spearman's rank, P = 0.0066). Mean striatal 18 F-dopa uptake was similar to healthy controls. CONCLUSIONS In vivo 11 C-(R)-PK11195 PET imaging detects neuroinflammation in brain regions susceptible to Lewy pathology in glucocerebrosidase gene mutation carriers without Parkinson's. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stephen Mullin
- Department of Clinical and Movement Neurosciences, Institute of NeurologyUCLLondonUK
- Institute of Health and Care ResearchUniversity of Plymouth Peninsula School of MedicinePlymouthUK
| | | | - Derralyn Hughes
- Department of Haematology, Institute of Immunity and TransplantationUCLLondonUK
| | - Atul Mehta
- Department of Haematology, Institute of Immunity and TransplantationUCLLondonUK
| | - Peter Parbo
- Department of Nuclear Medicine & PET CentreAarhus University HospitalAarhusDenmark
| | - Rainer Hinz
- Wolfson Molecular Imaging CentreUniversity of ManchesterManchesterUK
| | - Nicola Pavese
- Department of Nuclear Medicine & PET CentreAarhus University HospitalAarhusDenmark
- Institute of Translational and Clinical ResearchNewcastle UniversityNewcastleUK
| | - David J. Brooks
- Department of Nuclear Medicine & PET CentreAarhus University HospitalAarhusDenmark
- Institute of Translational and Clinical ResearchNewcastle UniversityNewcastleUK
| | - Anthony H.V. Schapira
- Department of Clinical and Movement Neurosciences, Institute of NeurologyUCLLondonUK
- Lysosomal storage disease unitRoyal Free HospitalLondonUK
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Talbot J, Stuckey R, Crawford L, Weatherby S, Mullin S. Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment - real world outcomes. J Headache Pain 2021; 22:5. [PMID: 33421995 PMCID: PMC7797151 DOI: 10.1186/s10194-020-01214-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. Methods We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for ‘resistant migraine’. Outcome measures (recorded monthly) included days with headache limiting activities of daily living (“red”), not limiting (“amber”), headache free (“green”), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. Results Mean number of red days improved by − 6.4 days (SE 0.67, 95%CI − 7.7 to − 5.1, p=0.001) at 3 months; − 6.8 days (SE 0.96, 95%CI − 8.80 to − 4.9, p=0.001) at 6 months and − 6.5 days (SE 0.86, 95%CI − 8.3 to − 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. Conclusion We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-020-01214-2.
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Affiliation(s)
- J Talbot
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK.
| | - R Stuckey
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - L Crawford
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - S Weatherby
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - S Mullin
- Peninsula Medical School, University of Plymouth, Plymouth, UK.,UCL Queen Square Institute of Neurology, University College London, London, UK
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13
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Mullin S, Smith L, Lee K, D'Souza G, Woodgate P, Elflein J, Hällqvist J, Toffoli M, Streeter A, Hosking J, Heywood WE, Khengar R, Campbell P, Hehir J, Cable S, Mills K, Zetterberg H, Limousin P, Libri V, Foltynie T, Schapira AHV. Ambroxol for the Treatment of Patients With Parkinson Disease With and Without Glucocerebrosidase Gene Mutations: A Nonrandomized, Noncontrolled Trial. JAMA Neurol 2020; 77:427-434. [PMID: 31930374 PMCID: PMC6990847 DOI: 10.1001/jamaneurol.2019.4611] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Question Does ambroxol cross the blood-brain barrier, and what are the biochemical changes associated with ambroxol therapy in patients with Parkinson disease with and without glucocerebrosidase gene mutations? Findings In this open-label clinical trial of 17 patients with Parkinson disease, ambroxol crossed the blood-brain barrier and bound to the β-glucocerebrosidase enzyme, and it increased β-glucocerebrosidase enzyme protein levels and cerebrospinal fluid α-synuclein levels in patients both with and without glucocerebrosidase gene mutations. Meaning Ambroxol therapy has potential for study as a neuroprotective compound for the treatment of patients with Parkinson disease both with and without glucocerebrosidase gene mutations. Importance Mutations of the glucocerebrosidase gene, GBA1 (OMIM 606463), are the most important risk factor for Parkinson disease (PD). In vitro and in vivo studies have reported that ambroxol increases β-glucocerebrosidase (GCase) enzyme activity and reduces α-synuclein levels. These observations support a potential role for ambroxol therapy in modifying a relevant pathogenetic pathway in PD. Objective To assess safety, tolerability, cerebrospinal fluid (CSF) penetration, and target engagement of ambroxol therapy with GCase in patients with PD with and without GBA1 mutations. Interventions An escalating dose of oral ambroxol to 1.26 g per day. Design, Setting, and Participants This single-center open-label noncontrolled clinical trial was conducted between January 11, 2017, and April 25, 2018, at the Leonard Wolfson Experimental Neuroscience Centre, a dedicated clinical research facility and part of the University College London Queen Square Institute of Neurology in London, United Kingdom. Participants were recruited from established databases at the Royal Free London Hospital and National Hospital for Neurology and Neurosurgery in London. Twenty-four patients with moderate PD were evaluated for eligibility, and 23 entered the study. Of those, 18 patients completed the study; 1 patient was excluded (failed lumbar puncture), and 4 patients withdrew (predominantly lumbar puncture–related complications). All data analyses were performed from November 1 to December 14, 2018. Main Outcomes and Measures Primary outcomes at 186 days were the detection of ambroxol in the CSF and a change in CSF GCase activity. Results Of the 18 participants (15 men [83.3%]; mean [SD] age, 60.2 [9.7] years) who completed the study, 17 (8 with GBA1 mutations and 9 without GBA1 mutations) were included in the primary analysis. Between days 0 and 186, a 156-ng/mL increase in the level of ambroxol in CSF (lower 95% confidence limit, 129 ng/mL; P < .001) was observed. The CSF GCase activity decreased by 19% (0.059 nmol/mL per hour; 95% CI, –0.115 to –0.002; P = .04). The ambroxol therapy was well tolerated, with no serious adverse events. An increase of 50 pg/mL (13%) in the CSF α-synuclein concentration (95% CI, 14-87; P = .01) and an increase of 88 ng/mol (35%) in the CSF GCase protein levels (95% CI, 40-137; P = .002) were observed. Mean (SD) scores on part 3 of the Movement Disorders Society Unified Parkinson Disease Rating Scale decreased (ie, improved) by 6.8 (7.1) points (95% CI, –10.4 to –3.1; P = .001). These changes were observed in patients with and without GBA1 mutations. Conclusions and Relevance The study results suggest that ambroxol therapy was safe and well tolerated; CSF penetration and target engagement of ambroxol were achieved, and CSF α-synuclein levels were increased. Placebo-controlled clinical trials are needed to examine whether ambroxol therapy is associated with changes in the natural progression of PD. Trial Registration ClinicalTrials.gov identifier: NCT02941822; EudraCT identifier: 2015-002571-24
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Affiliation(s)
- Stephen Mullin
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom.,Institute of Translational and Stratified Medicine, University of Plymouth School of Medicine, Plymouth, United Kingdom
| | - Laura Smith
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Katherine Lee
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Gayle D'Souza
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Philip Woodgate
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Josh Elflein
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jenny Hällqvist
- Translational Mass Spectrometry Research Group, University College London Institute of Child Health, London, United Kingdom
| | - Marco Toffoli
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Adam Streeter
- Department of Medical Statistics, University of Plymouth School of Medicine, Plymouth, United Kingdom
| | - Joanne Hosking
- Department of Medical Statistics, University of Plymouth School of Medicine, Plymouth, United Kingdom
| | - Wendy E Heywood
- Translational Mass Spectrometry Research Group, University College London Institute of Child Health, London, United Kingdom
| | - Rajeshree Khengar
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Philip Campbell
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Jason Hehir
- Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Sarah Cable
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Kevin Mills
- Translational Mass Spectrometry Research Group, University College London Institute of Child Health, London, United Kingdom
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom.,UK Dementia Research Institute at University College London, London, United Kingdom.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Molndal, Sweden.,Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Molndal, Sweden
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
| | - Anthony H V Schapira
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom
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Abstract
PURPOSE To explore contemporary clincial case management of patients with Ebola virus disease. METHODS A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. RESULTS Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. CONCLUSION With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - S Mullin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Lane, North York, ON, M3K 0A1, Canada
| | - N K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - R A Fowler
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
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15
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Avenali M, Toffoli M, Mullin S, McNeil A, Hughes DA, Mehta A, Blandini F, Schapira AHV. Evolution of prodromal parkinsonian features in a cohort of GBA mutation-positive individuals: a 6-year longitudinal study. J Neurol Neurosurg Psychiatry 2019; 90:1091-1097. [PMID: 31221723 DOI: 10.1136/jnnp-2019-320394] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES GBA1 mutations are a frequent risk factor for Parkinson disease (PD). The aim of this study is to evaluate clinical features in a group of GBA1 mutation-positive individuals over a 6-year follow-up. METHODS This is a longitudinal study on a cohort of GBA1-positive carriers. We enrolled 31 patients with Gaucher disease type 1 (GD), 29 GBA1 heterozygous carriers (Het GBA group) and 30 controls (HC) at baseline and followed them for 6 years. We assessed baseline motor and non-motor signs of PD in all subjects using clinical questionnaires and scales (reduced Unified Multiple System Atrophy Rating Scale (UMSARS), Montreal Cognitive assessment (MoCA), University of Pennsylvania Smell Identification Test (UPSIT), REM Sleep Behavior Disorder screening questionnaire (RBDsq), Movement Disorders Society Unified Parkinson's Disease Rating Scale motor subscale (MDS-UPDRS III) and Beck Depression Inventory (BDI). We repeated these at the 6-year follow-up alongside venous blood sampling for measurement of glucocerebrosidase enzymatic activity (GCase). We explored whether the GCase activity level was altered in leucocytes of these subjects and how it was related to development of PD. RESULTS We observed a significant worsening in UMSARS, RBDsq, MDS-UPDRS III and BDI scores at the 6-year follow-up compared with baseline in both the GD and Het GBA groups. Intergroup comparisons showed that GD subjects had significantly worse scores in UPSIT, UMSARS, MoCA and MDS-UPDRS III than HC, while Het GBA displayed worse outcomes in UPSIT and MDS-UPDRS III compared with HC. In GBA1 mutation-positive individuals (Het GBA and GD), an UPSIT score of 23 at baseline was correlated with worse outcome at 6 years in UPSIT, MoCA, MDS-UPDRS III and BDI. CONCLUSION In this 6-year-long longitudinal study, GBA1 mutation-positive subjects showed a worsening in motor and non-motor prodromal PD features.
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Affiliation(s)
- Micol Avenali
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Toffoli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Stephen Mullin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Alisdair McNeil
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London, UK
| | - A Mehta
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London, UK
| | - Fabio Blandini
- Laboratory of Cellular and Molecular Neurobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Anthony H V Schapira
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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Mullin S, Beavan M, Bestwick J, McNeill A, Proukakis C, Cox T, Hughes D, Mehta A, Zetterberg H, Schapira AHV. Evolution and clustering of prodromal parkinsonian features in GBA1 carriers. Mov Disord 2019; 34:1365-1373. [PMID: 31251436 PMCID: PMC6790937 DOI: 10.1002/mds.27775] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background Five to 25% of patients with PD carry glucocerebrosidase gene mutations, and 10% to 30% of glucocerebrosidase carriers will develop PD by age 80. Stratification of PD risk in glucocerebrosidase carriers provides an opportunity to target disease‐modifying therapies. Objective Cross‐sectional and longitudinal survey of prodromal PD signs among glucocerebrosidase carriers. Design Prospective assessment of 82 glucocerebrosidase mutation carriers and 35 controls over 4 to 5 years for prodromal clinical PD features. Results At all time points, olfactory (measured using University of Pennsylvania Smell Identification Test) and cognitive (Montreal Cognitive Assessment) function and the International Parkinson and Movement Disorder Society UPDRS parts II and III scores were significantly worse amongst glucocerebrosidase mutation carriers. Progression to microsmia (odds ratio: 8.5; 95% confidence interval: 2.6–28.2; P < 0.05) and mild cognitive impairment (odds ratio: 4.2; 95% confidence interval: 1.1–16.6; P < 0.05) were more rapid compared to controls. Those with worse olfaction also had worse cognition (OR, 1.5; 95% CI: 0.0–2.8; P < 0.05) and depression (OR, 1.3; 95% CI: 0.6–2.8; P < 0.05). No participants reached the MDS prodromal PD diagnostic criteria before PD diagnosis. One participant developed PD. He did not fulfill the International Parkinson and Movement Disorder Society prodromal PD criteria before diagnosis. Conclusion Assessment of individual and clustered PD prodromal features may serve as a useful tool to identify high‐risk subjects for conversion to PD. As a result of the low conversion rate in our glucocerebrosidase mutation carriers to date, prospective validation is needed in larger cohorts to establish the profile of these features in PD convertors. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stephen Mullin
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom.,Institute of Translational and Stratified medicine, Plymouth University Peninsular School of Medicine, Plymouth, United Kingdom
| | - Michelle Beavan
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Jonathan Bestwick
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Alisdair McNeill
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Cambridge, United Kingdom
| | - Christos Proukakis
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Timothy Cox
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, and Department of Haematology, University College London, London, United Kingdom
| | - Atul Mehta
- Lysosomal Storage Disorders Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, and Department of Haematology, University College London, London, United Kingdom
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Molecular Neuroscience, University College London Institute of Neurology, London, United Kingdom
| | - Anthony H V Schapira
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom
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Leija‐Salazar M, Sedlazeck FJ, Toffoli M, Mullin S, Mokretar K, Athanasopoulou M, Donald A, Sharma R, Hughes D, Schapira AH, Proukakis C. Evaluation of the detection of GBA missense mutations and other variants using the Oxford Nanopore MinION. Mol Genet Genomic Med 2019; 7:e564. [PMID: 30637984 PMCID: PMC6418358 DOI: 10.1002/mgg3.564] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/23/2018] [Accepted: 12/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Mutations in GBA cause Gaucher disease when biallelic and are strong risk factors for Parkinson's disease when heterozygous. GBA analysis is complicated by the nearby pseudogene. We aimed to design and validate a method for sequencing GBA using long reads. METHODS We sequenced GBA on the Oxford Nanopore MinION as an 8.9 kb amplicon from 102 individuals, including patients with Parkinson's and Gaucher diseases. We used NanoOK for quality metrics, NGMLR to align data (after comparing with GraphMap), Nanopolish and Sniffles to call variants, and WhatsHap for phasing. RESULTS We detected all known missense mutations in these samples, including the common p.N409S (N370S) and p.L483P (L444P) in multiple samples, and nine rarer ones, as well as a splicing and a truncating mutation, and intronic SNPs. We demonstrated the ability to phase mutations, confirm compound heterozygosity, and assign haplotypes. We also detected two known risk variants in some Parkinson's patients. Rare false positives were easily identified and filtered, with the Nanopolish quality score adjusted for the number of reads a very robust discriminator. In two individuals carrying a recombinant allele, we were able to detect and fully define it in one carrier, where it included a 55-base pair deletion, but not in another one, suggesting a limitation of the PCR enrichment method. Missense mutations were detected at the correct zygosity, except for the case where the RecNciI one was missed. CONCLUSION The Oxford Nanopore MinION can detect missense mutations and an exonic deletion in this difficult gene, with the added advantages of phasing and intronic analysis. It can be used as an efficient research tool, but additional work is required to exclude all recombinants.
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Affiliation(s)
- Melissa Leija‐Salazar
- Department of Clinical and Movement Neurosciences, Royal Free Campus, Institute of NeurologyUniversity College LondonLondonUK
| | | | - Marco Toffoli
- Department of Clinical and Movement Neurosciences, Royal Free Campus, Institute of NeurologyUniversity College LondonLondonUK
| | - Stephen Mullin
- Department of Clinical and Movement Neurosciences, Royal Free Campus, Institute of NeurologyUniversity College LondonLondonUK
- Institute of Translational and Stratified MedicinePlymouth University Peninsula School of MedicinePlymouthUK
| | - Katya Mokretar
- Department of Clinical and Movement Neurosciences, Royal Free Campus, Institute of NeurologyUniversity College LondonLondonUK
| | - Maria Athanasopoulou
- Department of Molecular Neuroscience, Institute of NeurologyUniversity College LondonLondonUK
| | - Aimee Donald
- Department of PaediatricsRoyal Manchester Children’s HospitalManchesterUK
| | - Reena Sharma
- The Mark Holland Metabolic Unit, Salford Royal Foundation NHS TrustSalfordUK
| | - Derralynn Hughes
- Institute of Immunity and TransplantationLysosomal Storage Disorders Unit, Royal Free HospitalLondonUK
| | - Anthony H.V. Schapira
- Department of Clinical and Movement Neurosciences, Royal Free Campus, Institute of NeurologyUniversity College LondonLondonUK
| | - Christos Proukakis
- Department of Clinical and Movement Neurosciences, Royal Free Campus, Institute of NeurologyUniversity College LondonLondonUK
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18
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Blandini F, Cilia R, Cerri S, Pezzoli G, Schapira AHV, Mullin S, Lanciego JL. Glucocerebrosidase mutations and synucleinopathies: Toward a model of precision medicine. Mov Disord 2018; 34:9-21. [PMID: 30589955 DOI: 10.1002/mds.27583] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 05/10/2018] [Revised: 10/24/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Glucocerebrosidase is a lysosomal enzyme. The characterization of a direct link between mutations in the gene coding for glucocerebrosidase (GBA1) with the development of Parkinson's disease and dementia with Lewy bodies has heightened interest in this enzyme. Although the mechanisms through which glucocerebrosidase regulates the homeostasis of α-synuclein remains poorly understood, the identification of reduced glucocerebrosidase activity in the brains of patients with PD and dementia with Lewy bodies has paved the way for the development of novel therapeutic strategies directed at enhancing glucocerebrosidase activity and reducing α-synuclein burden, thereby slowing down or even preventing neuronal death. Here we reviewed the current literature relating to the mechanisms underlying the cross talk between glucocerebrosidase and α-synuclein, the GBA1 mutation-associated clinical phenotypes, and ongoing therapeutic approaches targeting glucocerebrosidase. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Fabio Blandini
- Laboratory of Functional Neurochemistry, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Cilia
- Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - Silvia Cerri
- Laboratory of Functional Neurochemistry, IRCCS Mondino Foundation, Pavia, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - Anthony H V Schapira
- Department of Clinical Neurosciences, Institute of Neurology, University College London, Hampstead, UK
| | - Stephen Mullin
- Department of Clinical Neurosciences, Institute of Neurology, University College London, Hampstead, UK.,Institute of Translational and Stratified Medicine, Plymouth University Peninsula School of Medicine, Plymouth, UK
| | - José L Lanciego
- Programa de Neurociencias, Fundación para la Investigación Médica Aplicada (FIMA), Universidad de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CiberNed), Madrid, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Mullin S, Hughes D, Mehta A, Schapira AHV. Neurological effects of glucocerebrosidase gene mutations. Eur J Neurol 2018; 26:388-e29. [PMID: 30315684 PMCID: PMC6492454 DOI: 10.1111/ene.13837] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/09/2018] [Indexed: 01/08/2023]
Abstract
The association between Gaucher disease (GD) and Parkinson disease (PD) has been described for almost two decades. In the biallelic state (homozygous or compound heterozygous) mutations in the glucocerebrosidase gene (GBA) may cause GD, in which glucosylceramide, the sphingolipid substrate of the glucocerebrosidase enzyme (GCase), accumulates in visceral organs leading to a number of clinical phenotypes. In the biallelic or heterozygous state, GBA mutations increase the risk for PD. Mutations of the GBA allele are the most significant genetic risk factor for idiopathic PD, found in 5%–20% of idiopathic PD cases depending on ethnicity. The neurological consequences of GBA mutations are reviewed and the proposition that GBA mutations result in a disparate but connected range of clinically and pathologically related neurological features is discussed. The literature relating to the clinical, biochemical and genetic basis of GBA PD, type 1 GD and neuronopathic GD is considered highlighting commonalities and distinctions between them. The evidence for a unifying disease mechanism is considered.
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Affiliation(s)
- S Mullin
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK.,Institute of Translational and Stratified Medicine, University of Plymouth School of Medicine, Plymouth, UK
| | - D Hughes
- LSD Unit/Department of Haematology, Institute of Immunity and Transplantation, UCL, London, UK
| | - A Mehta
- LSD Unit/Department of Haematology, Institute of Immunity and Transplantation, UCL, London, UK
| | - A H V Schapira
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
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Pacei F, Quilici L, Mullin S, Innocenti A, Valvassori L, Nardone R, Bet L. Web of the carotid artery: An under-recognized cause of ischemic stroke. J Clin Neurosci 2018; 50:122-123. [DOI: 10.1016/j.jocn.2018.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
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Arkadir D, Dinur T, Mullin S, Mehta A, Baris HN, Alcalay RN, Zimran A. Trio approach reveals higher risk of PD in carriers of severe vs. mild GBA mutations. Blood Cells Mol Dis 2018; 68:115-116. [DOI: 10.1016/j.bcmd.2016.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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Smith L, Mullin S, Schapira AHV. Insights into the structural biology of Gaucher disease. Exp Neurol 2017; 298:180-190. [PMID: 28923368 DOI: 10.1016/j.expneurol.2017.09.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 06/08/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 01/08/2023]
Abstract
Gaucher disease, the most common lysosomal storage disorder, is caused by mutations in the gene encoding the acid-β-glucosidase lysosomal hydrolase enzyme that cleaves glucocerebroside into glucose and ceramide. Reduced enzyme activity and impaired structural stability arise due to >300 known disease-causing mutations. Several of these mutations have also been associated with an increased risk of Parkinson disease (PD). Since the discovery of the acid-β-glucosidase X-ray structure, there have been major advances in our understanding of the structural properties of the protein. Analysis of specific residues has provided insight into their functional and structural importance and provided insight into the pathogenesis of Gaucher disease and the contribution to PD. Disease-causing mutations are positioned throughout the acid-β-glucosidase structure, with many located far from the active site and thus retaining some enzymatic activity however, thus far no clear relationship between mutation location and disease severity has been established. Here, we review the crystal structure of acid-β-glucosidase, while highlighting important structural aspects of the protein in detail. This review discusses the structural stability of acid-β-glucosidase, which can be altered by pH and glycosylation, and explores the relationship between known Gaucher disease and PD mutations, structural stability and disease severity.
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Affiliation(s)
- Laura Smith
- Department of Clinical Neurosciences, Institute of Neurology, University College London, London, NW3 2PF, UK
| | - Stephen Mullin
- Department of Clinical Neurosciences, Institute of Neurology, University College London, London, NW3 2PF, UK
| | - Anthony H V Schapira
- Department of Clinical Neurosciences, Institute of Neurology, University College London, London, NW3 2PF, UK.
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Pakpoor J, Noyce A, Goldacre R, Selkihova M, Mullin S, Schrag A, Lees A, Goldacre M. Viral hepatitis and Parkinson disease. Neurology 2017; 88:1630-1633. [DOI: 10.1212/wnl.0000000000003848] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/25/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To study associations between viral hepatitis and Parkinson disease (PD).Methods:A retrospective cohort study was done by analyzing linked English National Hospital Episode Statistics and mortality data (1999–2011). Cohorts of individuals with hepatitis B, hepatitis C, autoimmune hepatitis, chronic active hepatitis, and HIV were constructed, and compared to a reference cohort for subsequent rates of PD.Results:The standardized rate ratio (RR) of PD following hepatitis B was 1.76 (95% confidence interval [CI] 1.28–2.37) (p < 0.001), based on 44 observed compared with 25 expected cases. The RR of PD following hepatitis C was 1.51 (95% CI, 1.18–1.9) (p < 0.001), based on 48.5 expected and 73 observed cases. There was no significant association between autoimmune hepatitis, chronic active hepatitis or HIV, and subsequent PD. When including only those episodes of care for PD that occurred first at least 1 year following each exposure condition, the RR for hepatitis B and hepatitis C were 1.82 (1.29–2.5) and 1.43 (1.09–1.84), respectively.Conclusions:We report strong evidence in favor of an elevation of rates of subsequent PD in patients with hepatitis B and hepatitis C. These findings may be explained by factors peculiar to viral hepatitis, but whether it reflects consequences of infection, shared disease mechanisms, or the result of antiviral treatment remains to be elucidated. Further work is needed to confirm this association and to investigate pathophysiologic pathways, potentially advancing etiologic understanding of PD more broadly.
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Murukutla N, Yan H, Kotov A, Mullin S, Hamill S. OC08_03 Cost-Effectiveness of a Smokeless Tobacco Campaign in India. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.035] [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: 10/21/2022] Open
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Brunsden C, Kiemle G, Mullin S. Male partner experiences of females with an acquired brain injury: An interpretative phenomenological analysis. Neuropsychol Rehabil 2015; 27:937-958. [DOI: 10.1080/09602011.2015.1109525] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Cara Brunsden
- Department of Clinical Psychology, University of Liverpool, Whelan Building, Liverpool L69 3GB, UK
| | - Gundi Kiemle
- Department of Clinical Psychology, University of Liverpool, Whelan Building, Liverpool L69 3GB, UK
| | - Stephen Mullin
- 5 Boroughs Partnership NHS Foundation Trust, Acquired Brain Injury Service, Specialist Psychological Therapy Services, Hazelmere Unit, Leigh Infirmary, Leigh, UK
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Abstract
The last 2 decades represent a period of unparalleled advancement in the understanding of the pathogenesis of Parkinson disease (PD). The discovery of several forms of familial parkinsonism with mendelian inheritance has elucidated insights into the mechanisms underlying the degeneration of dopaminergic neurons of the substantia nigra that histologically characterize PD. α-Synuclein, the principal component of Lewy bodies, remains the presumed pathogen at the heart of the current model; however, concurrently, a diverse range of other mechanisms have been implicated. The creation of a coherent disease model will be crucial to the development of effective disease modifying therapies for sporadic PD.
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Affiliation(s)
- Stephen Mullin
- Department of Clinical Neurosciences, UCL Institute of Neurology, Rowland Hill Street, Hampstead, London NW3 2PF, UK
| | - Anthony H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, Rowland Hill Street, Hampstead, London NW3 2PF, UK.
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Abstract
BACKGROUND Parkinson's disease (PD) was previously described as the prototypical sporadic disease; however, rapid advances in population and molecular genetics have revealed the existence of a significant number genetic risk factors, prompting its redefinition as a primarily genetic disorder. SOURCES OF DATA Data for this review have been gathered from the published literature. AREAS OF AGREEMENT Multiple haplotypes conveying variable but quantifiable genetic risk, acting concurrently and possibly interacting with one another, provide the basis for a new model of PD. The beginning of this revolution in our understanding came from the clinical observation of parkinsonism with a Mendelian pattern of inheritance in a number of families. The functional work that followed elucidated multiple disease pathways leading to the degeneration of the substantia nigra that characterizes PD. It is however only in recent years, with the emergence of large cohort genome-wide association studies (GWAS), that the relevance of these pathways to so-called sporadic PD has become apparent. AREAS OF CONTROVERSY A substantial portion of the presumed genetic inheritance of PD remains at present undefined. Although it is likely that so-called intermediate risk genetic risk factors are the principal component of this 'missing heritability', this is yet to be proved. GROWING POINTS Although the picture is by now means complete, the beginnings of rational basis for genetic screening of PD risk have begun to emerge. Equally, this enhanced understanding of the various genetic and in turn biochemical pathways shows promising signs of producing fruitful therapeutic strategies. Technological advances promise to reduce the costs associated with and further increase our capability to understand the complex influence of genetics on the pathogenesis of PD. AREAS TIMELY FOR DEVELOPING RESEARCH The coming years will require the enhancement of current techniques and the development of new ones to define PD's missing heritability. It will also require functional work to define better and in turn potentially reverse the mechanisms that contribute with large effect sizes to the risk of sporadic PD.
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Affiliation(s)
- Stephen Mullin
- Leonard Wolfson Clinical Research Fellow, UCL, Institute of Neurology, Rowland Hill Street, Hampstead, London NW3 2PF, UK
| | - Anthony Schapira
- Department of Clinical Neurosciences, UCL, Institute of Neurology, Hampstead, London, UK
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Porcari R, Proukakis C, Waudby CA, Bolognesi B, Mangione PP, Paton JFS, Mullin S, Cabrita LD, Penco A, Relini A, Verona G, Vendruscolo M, Stoppini M, Tartaglia GG, Camilloni C, Christodoulou J, Schapira AHV, Bellotti V. The H50Q mutation induces a 10-fold decrease in the solubility of α-synuclein. J Biol Chem 2014; 290:2395-404. [PMID: 25505181 PMCID: PMC4303689 DOI: 10.1074/jbc.m114.610527] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The conversion of α-synuclein from its intrinsically disordered monomeric state into the fibrillar cross-β aggregates characteristically present in Lewy bodies is largely unknown. The investigation of α-synuclein variants causative of familial forms of Parkinson disease can provide unique insights into the conditions that promote or inhibit aggregate formation. It has been shown recently that a newly identified pathogenic mutation of α-synuclein, H50Q, aggregates faster than the wild-type. We investigate here its aggregation propensity by using a sequence-based prediction algorithm, NMR chemical shift analysis of secondary structure populations in the monomeric state, and determination of thermodynamic stability of the fibrils. Our data show that the H50Q mutation induces only a small increment in polyproline II structure around the site of the mutation and a slight increase in the overall aggregation propensity. We also find, however, that the H50Q mutation strongly stabilizes α-synuclein fibrils by 5.0 ± 1.0 kJ mol−1, thus increasing the supersaturation of monomeric α-synuclein within the cell, and strongly favors its aggregation process. We further show that wild-type α-synuclein can decelerate the aggregation kinetics of the H50Q variant in a dose-dependent manner when coaggregating with it. These last findings suggest that the precise balance of α-synuclein synthesized from the wild-type and mutant alleles may influence the natural history and heterogeneous clinical phenotype of Parkinson disease.
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Affiliation(s)
- Riccardo Porcari
- From the Wolfson Drug Discovery Unit, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, and
| | - Christos Proukakis
- the Department of Clinical Neuroscience, Institute of Neurology, University College London, London NW3 2PF, United Kingdom
| | - Christopher A Waudby
- the Department of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
| | - Benedetta Bolognesi
- the Centre for Genomic Regulation and University Pompeu Fabra, 08003 Barcelona, Spain
| | - P Patrizia Mangione
- From the Wolfson Drug Discovery Unit, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, and the Department of Molecular Medicine, Institute of Biochemistry, University of Pavia, 27100 Pavia, Italy
| | - Jack F S Paton
- the Department of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
| | - Stephen Mullin
- the Department of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
| | - Lisa D Cabrita
- the Department of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
| | - Amanda Penco
- the Department of Physics, University of Genoa, 16146 Genoa, Italy
| | - Annalisa Relini
- the Department of Physics, University of Genoa, 16146 Genoa, Italy
| | - Guglielmo Verona
- From the Wolfson Drug Discovery Unit, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, and the Department of Molecular Medicine, Institute of Biochemistry, University of Pavia, 27100 Pavia, Italy
| | - Michele Vendruscolo
- the Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, United Kingdom, and
| | - Monica Stoppini
- the Department of Molecular Medicine, Institute of Biochemistry, University of Pavia, 27100 Pavia, Italy
| | | | - Carlo Camilloni
- the Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, United Kingdom, and
| | - John Christodoulou
- the Department of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom,
| | - Anthony H V Schapira
- the Department of Clinical Neuroscience, Institute of Neurology, University College London, London NW3 2PF, United Kingdom
| | - Vittorio Bellotti
- From the Wolfson Drug Discovery Unit, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, and the Department of Molecular Medicine, Institute of Biochemistry, University of Pavia, 27100 Pavia, Italy,
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Gill IJ, Mullin S, Simpson J. Are metacognitive processes associated with posttraumatic stress symptom severity following acquired brain injury? Disabil Rehabil 2014; 37:692-700. [DOI: 10.3109/09638288.2014.939774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gill IJ, Mullin S, Simpson J. Psychosocial and psychological factors associated with post-traumatic stress disorder following traumatic brain injury in adult civilian populations: A systematic review. Brain Inj 2013; 28:1-14. [DOI: 10.3109/02699052.2013.851416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chaudhuri A, Mullin S, Chawda S, Alkilani R. Angiographic thrombectomy in venous sinus thrombosis: Case review and series. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1044] [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: 10/26/2022]
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Nageshwaran S, Mullin S, Cowley P, Dorward N, Mort D, Weil RS. Subarachnoid haemorrhage as the presenting feature of lumbar spinal arteriovenous malformation. Pract Neurol 2013; 13:319-21. [PMID: 23533281 DOI: 10.1136/practneurol-2012-000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
α-Synuclein (SNCA) is a substantive component of Lewy bodies, the pathological hallmark of Parkinson's disease (PD). The discovery and subsequent derivation of its role in PD has led to a suprising but fruitful convergence of the fields of biochemistry and molecular genetics. In particular, the manipulation of the cell lines of a number of forms of familial PD has implicated SNCA in distinct and diverse biochemical pathways related to its pathogenesis. This current and rapidly evolving concept indicates PD is a disease in which interacting pathways of oxidative stress, mitochondrial dysfunction and impaired regulation of protein turnover interact to cause dopaminergic cell dysfunction and death. SNCA has a central role in these processes and manipulation of its expression, degradation and aggregation appear to be promising neuroprotective therapeutic targets.
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Affiliation(s)
- Stephen Mullin
- Department of Clinical Neurosciences, UCL, Institute of Neurology, Royal Free Campus, Pond Street, London NW3 2QG, UK.
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Mullin S, Platts A, Randhawa K, Watts P. Cerebral vasospasm and anterior circulation stroke secondary to an exacerbation of hereditary corproporphyria. Pract Neurol 2012; 12:384-7. [DOI: 10.1136/practneurol-2012-000288] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Leeds JA, Sachdeva M, Mullin S, Dzink-Fox J, Lamarche MJ. Mechanism of action of and mechanism of reduced susceptibility to the novel anti-Clostridium difficile compound LFF571. Antimicrob Agents Chemother 2012; 56:4463-5. [PMID: 22644023 PMCID: PMC3421628 DOI: 10.1128/aac.06354-11] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [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: 12/12/2011] [Accepted: 03/06/2012] [Indexed: 01/07/2023] Open
Abstract
LFF571 is a novel semisynthetic thiopeptide and potent inhibitor of Gram-positive bacteria. We report that the antibacterial activity of LFF571 against Clostridium difficile is due to inhibition of translation. Single-step mutants of C. difficile with reduced susceptibility to LFF571 were selected at frequencies of <4.5 × 10(-11) to 1.2 × 10(-9). Sequencing revealed a G260E substitution in the thiopeptide-binding pocket of elongation factor Tu. Importantly, this mutation did not confer cross-resistance to clinically used antimicrobials. These results support the development of LFF571 as a treatment for C. difficile infection.
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Affiliation(s)
- J A Leeds
- Novartis Institutes for Biomedical Research, Infectious Disease Area, Emeryville, California, USA.
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Bargiela D, Mullin S, Kalluvya S, Manji H. 1218 HIV distal sensory polyneuropathy in Sub-Saharan Africa: an evolving epidemic. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mullin S, Temu A, Kalluvya S, Grant A, Manji H. High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania. Trop Med Int Health 2011; 16:1291-6. [PMID: 21707880 DOI: 10.1111/j.1365-3156.2011.02825.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. METHODS We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART-naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. RESULTS Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2-3.3) and older participants (aOR 2.7, 95% CI 1.1-6.2 for age 40 + vs. <30 years). CONCLUSION Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV-infected patients to an additional avoidable risk of DSP. Access to non-neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.
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Affiliation(s)
- S Mullin
- North Middlesex University Hospital NHS Trust, London, UK.
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Mullin S, Temu A, Kalluvya S, Grant A, Manji H. PAF63 High prevalence of distal sensory polyneuropathy in treated and untreated Tanzanians with HIV. A cross-sectional survey. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Although cryopreservation of pancreatic islets would add flexibility to transplantation, the recoveries are only 60% to 90% and function is decreased. Islets are multicellular structures approximately 50 to 250 microm in diameter organized into a network of cells and vascular channels. Due to this complexity, islets are more susceptible to damage during cryopreservation than an individual cell. This study investigated porcine small intestinal submucosa (SIS) as a matrix to support islets recovery and function post-thaw. Groups of frozen/thawed human islets (150 IE/condition; n = 4 preparations) were cultured for 5 weeks in plates containing noncoated Biopore membrane inserts alone or inserts covered with SIS. Islets were placed directly on the insert post-thaw (SIS(1)), or cultured overnight in standard plates, washed, and then transferred to the SIS (SIS(2)). Function was assessed by determining glucose-stimulated release of insulin, which was measured by radioimmunoassay. Analysis of basal insulin secretion showed time and treatment to be significantly different (P =.0043 and P =.0123, respectively) but without an interaction (P >.05). The two SIS treatments were not significantly different (P >.05); however, both SIS(1) and SIS(2) were significantly different from controls (P =.0108 and P =.0420, respectively). Similar results were obtained for stimulation indices; time and treatment were significantly different (P =.0161 and P =.0264, respectively) but not an interaction (P >.05). The two SIS treatments were not significantly different (P =.05); however, both SIS(1) and SIS(2) differed from controls (P =.0248 and P =.0407, respectively). The results indicate that SIS enables frozen-thawed islets to exhibit superior post-thaw function compared with a non-SIS-supported condition.
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Affiliation(s)
- E J Woods
- General BioTechnology LLC, Harlan Biotechnology Center, Indianapolis, Indiana 46202, USA.
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Cooper R, Mullin S. The foraging ecology of the gray rat snake (Elaphe obsoleta spiloides). II. Influence of habitat structural complexity when searching for arboreal avian prey. AMPHIBIA-REPTILIA 2000. [DOI: 10.1163/156853800507381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AbstractA predator's behavior and success when foraging can be compromised by a variety of environmental factors. We examined the effect of variation in habitat structural complexity on the predatory success of the semiarboreal gray rat snake (Elaphe obsoleta spiloides) foraging for arboreal bird nest contents. Individual snakes searched for nests in enclosures containing one of five levels of vegetation density that reflected the range of structural complexity measured at a field site where predator and prey species are common. Subjects were most proficient at locating prey in enclosures having low levels of structural complexity, and experienced decreased predatory success in barren or highly-complex habitats. Ten behaviors comprised over 95% of the trial durations, and four of these occurred more often than the other six regardless of variation in structural complexity within the enclosure. We suggest that low levels of structural complexity offer snakes concealment from predation while not obscuring their view of provisioning activity at the nest.
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Affiliation(s)
- Robert Cooper
- 1Daniel B. Warnell School of Forest Resources, University of Georgia, Athens, GA 30602, USA
| | - Stephen Mullin
- 2Department of Biological Sciences, Eastern Illinois University, Charleston, IL 61920
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Wright L, Mercer S, Mullin S, Thurston K, Harned AJ. Differences between American Indian and non-Indian children referred for psychological services. Am Indian Alsk Nativ Ment Health Res (1987) 1994; 5:45-51. [PMID: 7522587 DOI: 10.5820/aian.0503.1994.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The physical and social characteristics of 60 American Indian children referred for psychological services were compared to those of 60 matched, non-Indian controls. Data were obtained from detailed records available in a multidisciplinary, medical school-related child study clinic. Indian children exhibited more health and social risk factors, but were superior to non-Indians on a variety of motor variables. Interpretations are offered concerning better psychological services for American Indian children based on better understanding of their possible exposure to physical health and social risks which may be related to psychological development.
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Affiliation(s)
- L Wright
- University of Oklahoma, Department of Psychology, Norman 73019-0535
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Mock MB, Ringqvist I, Fisher LD, Davis KB, Chaitman BR, Kouchoukos NT, Kaiser GC, Alderman E, Ryan TJ, Russell RO, Mullin S, Fray D, Killip T. Survival of medically treated patients in the coronary artery surgery study (CASS) registry. Circulation 1982; 66:562-8. [PMID: 6980062 DOI: 10.1161/01.cir.66.3.562] [Citation(s) in RCA: 380] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study was to evaluate the impact on survival of the anatomic extent of obstructive coronary artery disease and of two measures of left ventricular (LV) performance. This study is based on 20,088 patients without previous coronary artery bypass graft surgery who were enrolled in the registry of the National Heart, Lung, and Blood Institute Coronary Artery Surgery Study from 1975 to 1979. The cumulative 4-year survival of medically managed patients was analyzed to determine the survival of specific subsets of patients with obstructive coronary disease. The vital status of 99.8% of the patients was known. The 4-year survival of medically treated patients with no significant obstructive disease was 97%, in contrast to 92%, 84% and 68% in patients with one-, two- and three-vessel disease, respectively. The presence of left main coronary artery disease decreased survival significantly. The 4-year survival decreased from 70% to 60% in patients with three-vessel disease when significant obstruction of the left main coronary artery was also present. Patients with significant coronary artery disease who had an ejection fraction of 50--100%, 35--49%, and 0--34% had a 4-year survival of 92%, 83% and 58%, respectively. The systolic contraction pattern was assessed in five selected segments and given a score of 1--6, with a score of 1 for normal function, increasing to 6 if an aneurysm was present. In a patient with normal LV contraction in all five segments of the LV ventricular angiogram, the LV score would equal 5. Patients with an LV score of 5--11, 12--16 and 17--30 had 4-year survivals of 90%, 71% and 53%, respectively. Patients with good LV function (a score of 5--11) had a 4-year survival of 94%, 91% and 79% for one-, two- and three-vessel disease, respectively. Patients with poor left ventricular function (score of 17--30) had a 4-year survival rate of 67%, 61% and 42% in one-, two- and three-vessel disease, respectively. Thus, LV function is a more important predictor of survival than the number of diseased vessels.
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