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Mollalo A, Hamidi B, Lenert L, Alekseyenko AV. Application of Spatial Analysis for Electronic Health Records: Characterizing Patient Phenotypes and Emerging Trends. RESEARCH SQUARE 2024:rs.3.rs-3443865. [PMID: 37886509 PMCID: PMC10602163 DOI: 10.21203/rs.3.rs-3443865/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Electronic health records (EHR) commonly contain patient addresses that provide valuable data for geocoding and spatial analysis, enabling more comprehensive descriptions of individual patients for clinical purposes. Despite the widespread use of EHR in clinical decision support and interventions, no systematic review has examined the extent to which spatial analysis is used to characterize patient phenotypes. Objective This study reviews advanced spatial analyses that employed individual-level health data from EHR within the US to characterize patient phenotypes. Methods We systematically evaluated English-language peer-reviewed articles from PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases from inception to August 20, 2023, without imposing constraints on time, study design, or specific health domains. Results Only 49 articles met the eligibility criteria. These articles utilized diverse spatial methods, with a predominant focus on clustering techniques, while spatiotemporal analysis (frequentist and Bayesian) and modeling were relatively underexplored. A noteworthy surge (n = 42, 85.7%) in publications was observed post-2017. The publications investigated a variety of adult and pediatric clinical areas, including infectious disease, endocrinology, and cardiology, using phenotypes defined over a range of data domains, such as demographics, diagnoses, and visits. The primary health outcomes investigated were asthma, hypertension, and diabetes. Notably, patient phenotypes involving genomics, imaging, and notes were rarely utilized. Conclusions This review underscores the growing interest in spatial analysis of EHR-derived data and highlights knowledge gaps in clinical health, phenotype domains, and spatial methodologies. Additionally, this review proposes guidelines for harnessing the potential of spatial analysis to enhance the context of individual patients for future clinical decision support.
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Barney RE, Huang G, Gallagher TL, Tischbein M, DeWitt J, Martindale R, LaRochelle EMP, Tsongalis GJ, Stommel EW. Validation of a Droplet Digital PCR (ddPCR) Assay to Detect Cyanobacterial 16S rDNA in Human Lung Tissue. TOXICS 2023; 11:531. [PMID: 37368631 DOI: 10.3390/toxics11060531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Cyanobacteria produce a variety of secondary metabolites, including toxins that may contribute to the development of disease. Previous work was able to detect the presence of a cyanobacterial marker in human nasal and broncoalveolar lavage samples; however, it was not able to determine the quantification of the marker. To further research the relationship between cyanobacteria and human health, we validated a droplet digital polymerase chain reaction (ddPCR) assay to simultaneously detect the cyanobacterial 16S marker and a human housekeeping gene in human lung tissue samples. The ability to detect cyanobacteria in human samples will allow further research into the role cyanobacteria plays in human health and disease.
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Affiliation(s)
- Rachael E Barney
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Guohong Huang
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Torrey L Gallagher
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Maeve Tischbein
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - John DeWitt
- Department of Pathology, University of Vermont, Burlington, VT 05405, USA
| | - Rachel Martindale
- Department of Pathology, University of Vermont, Burlington, VT 05405, USA
| | - Ethan M P LaRochelle
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Gregory J Tsongalis
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Elijah W Stommel
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
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Nugumanova G, Ponomarev ED, Askarova S, Fasler-Kan E, Barteneva NS. Freshwater Cyanobacterial Toxins, Cyanopeptides and Neurodegenerative Diseases. Toxins (Basel) 2023; 15:toxins15030233. [PMID: 36977124 PMCID: PMC10057253 DOI: 10.3390/toxins15030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Cyanobacteria produce a wide range of structurally diverse cyanotoxins and bioactive cyanopeptides in freshwater, marine, and terrestrial ecosystems. The health significance of these metabolites, which include genotoxic- and neurotoxic agents, is confirmed by continued associations between the occurrence of animal and human acute toxic events and, in the long term, by associations between cyanobacteria and neurodegenerative diseases. Major mechanisms related to the neurotoxicity of cyanobacteria compounds include (1) blocking of key proteins and channels; (2) inhibition of essential enzymes in mammalian cells such as protein phosphatases and phosphoprotein phosphatases as well as new molecular targets such as toll-like receptors 4 and 8. One of the widely discussed implicated mechanisms includes a misincorporation of cyanobacterial non-proteogenic amino acids. Recent research provides evidence that non-proteinogenic amino acid BMAA produced by cyanobacteria have multiple effects on translation process and bypasses the proof-reading ability of the aminoacyl-tRNA-synthetase. Aberrant proteins generated by non-canonical translation may be a factor in neuronal death and neurodegeneration. We hypothesize that the production of cyanopeptides and non-canonical amino acids is a more general mechanism, leading to mistranslation, affecting protein homeostasis, and targeting mitochondria in eukaryotic cells. It can be evolutionarily ancient and initially developed to control phytoplankton communities during algal blooms. Outcompeting gut symbiotic microorganisms may lead to dysbiosis, increased gut permeability, a shift in blood-brain-barrier functionality, and eventually, mitochondrial dysfunction in high-energy demanding neurons. A better understanding of the interaction between cyanopeptides metabolism and the nervous system will be crucial to target or to prevent neurodegenerative diseases.
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Affiliation(s)
- Galina Nugumanova
- Department of Biology, School of Sciences and Humanities, Nazarbayev University, Astana 010000, Kazakhstan
| | - Eugene D Ponomarev
- Department of Biology, School of Sciences and Humanities, Nazarbayev University, Astana 010000, Kazakhstan
| | - Sholpan Askarova
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan
| | - Elizaveta Fasler-Kan
- Department of Pediatric Surgery, Children's Hospital, Inselspital Bern, University of Bern, 3010 Bern, Switzerland
| | - Natasha S Barteneva
- Department of Biology, School of Sciences and Humanities, Nazarbayev University, Astana 010000, Kazakhstan
- The Environment & Resource Efficiency Cluster (EREC), Nazarbayev University, Astana 010000, Kazakhstan
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Spencer PS, Palmer VS, Kisby GE, Lagrange E, Horowitz BZ, Valdes Angues R, Reis J, Vernoux JP, Raoul C, Camu W. Early-onset, conjugal, twin-discordant, and clusters of sporadic ALS: Pathway to discovery of etiology via lifetime exposome research. Front Neurosci 2023; 17:1005096. [PMID: 36860617 PMCID: PMC9969898 DOI: 10.3389/fnins.2023.1005096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
The identity and role of environmental factors in the etiology of sporadic amyotrophic lateral sclerosis (sALS) is poorly understood outside of three former high-incidence foci of Western Pacific ALS and a hotspot of sALS in the French Alps. In both instances, there is a strong association with exposure to DNA-damaging (genotoxic) chemicals years or decades prior to clinical onset of motor neuron disease. In light of this recent understanding, we discuss published geographic clusters of ALS, conjugal cases, single-affected twins, and young-onset cases in relation to their demographic, geographic and environmental associations but also whether, in theory, there was the possibility of exposure to genotoxic chemicals of natural or synthetic origin. Special opportunities to test for such exposures in sALS exist in southeast France, northwest Italy, Finland, the U.S. East North Central States, and in the U.S. Air Force and Space Force. Given the degree and timing of exposure to an environmental trigger of ALS may be related to the age at which the disease is expressed, research should focus on the lifetime exposome (from conception to clinical onset) of young sALS cases. Multidisciplinary research of this type may lead to the identification of ALS causation, mechanism, and primary prevention, as well as to early detection of impending ALS and pre-clinical treatment to slow development of this fatal neurological disease.
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Affiliation(s)
- Peter S. Spencer
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States,*Correspondence: Peter S. Spencer,
| | - Valerie S. Palmer
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Glen E. Kisby
- College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, OR, United States
| | - Emmeline Lagrange
- Department of Neurology, Reference Center of Neuromuscular Disease and ALS Consultations, Grenoble University Hospital, Grenoble, France
| | - B. Zane Horowitz
- Department of Emergency Medicine, Oregon-Alaska Poison Center, Oregon Health and Science University, Portland, OR, United States
| | - Raquel Valdes Angues
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Jacques Reis
- University of Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Jean-Paul Vernoux
- Normandie Université, UNICAEN, Unité de Recherche Aliments Bioprocédés Toxicologie Environnements, Caen, France
| | - Cédric Raoul
- INM, University of Montpellier, INSERM, Montpellier, France
| | - William Camu
- ALS Reference Center, Montpellier University Hospital and University of Montpellier, INSERM, Montpellier, France
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Boumédiene F, Marin B, Luna J, Bonneterre V, Camu W, Lagrange E, Besson G, Esselin F, De La Cruz E, Lautrette G, Preux PM, Couratier P. Spatio-temporal clustering of amyotrophic lateral sclerosis in France: A population-based study. Eur J Epidemiol 2022; 37:1181-1193. [PMID: 36098945 DOI: 10.1007/s10654-022-00904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess spatial aggregates of amyotrophic lateral sclerosis (ALS) incident cases, using a solid geo-epidemiological statistical method, in France. METHODS This population-based study (2003-2011) investigated 47.1 million person-years of follow-up (PYFU). Case ascertainment of incident ALS cases was based on multiple sources (ALS referral centers, hospital centres and health insurance data). Neurologists confirmed all ALS diagnoses. Exhaustiveness was estimated through capture-recapture. Aggregates were investigated in four steps: (a) geographical modelling (standardized incidence ratio (SIR) calculation), (b) analysis of the spatial distribution of incidence (Phothoff-Winttinghill's test, Global Moran's Index, Kulldorf's spatial scan statistic, Local Moran's Index), (c) classification of the level of certainty of spatial aggregates (i.e. definite cluster; probable over-incidence area; possible over-incidence area) and (d) evaluation of the robustness of the results. RESULTS The standardized incidence of ALS was 2.46/100,000 PYFU (95% CI 2.31-2.63, European population as reference) based on 1199 incident cases. We identified 13 areas of spatial aggregates: one cluster (stable in robustness analysis), five probable over-incidence areas (2 stable in robustness analysis) and seven possible over-incidence areas (including 4 stable areas in robustness analysis). A cluster was identified in the Rhône-Alpes region: 100 observed vs 54.07 expected cases for 2,411,514 PYFU, SIR: 1.85 (95% CI 1.50-2.25). CONCLUSION We report here one of the largest investigations of incidence and spatial aggregation of ALS ever performed in a western country. Using a solid methodology framework for case ascertainment and cluster analysis, we identified 13 areas that warrant further investigation.
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Affiliation(s)
- Farid Boumédiene
- Inserm U1094, IRD U270, USC1501 INRAE, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Benoît Marin
- Inserm U1094, IRD U270, USC1501 INRAE, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Jaime Luna
- Inserm U1094, IRD U270, USC1501 INRAE, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.,Department of Neurology, Centre de Reference SLA et Autres Maladies du Neurone Moteur, CHU Limoges, Limoges, France
| | - Vincent Bonneterre
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC, 38000, Grenoble, France
| | - William Camu
- Explorations Neurologiques et Centre SLA, CHU et Université de Montpellier, INSERM, Montpellier, France
| | - Emmeline Lagrange
- Department of Neurology, CHU Grenoble-Alpes (Grenoble Teaching Hospital), Grenoble, France
| | - Gérard Besson
- Department of Neurology, CHU Grenoble-Alpes (Grenoble Teaching Hospital), Grenoble, France
| | - Florence Esselin
- Explorations Neurologiques et Centre SLA, CHU et Université de Montpellier, INSERM, Montpellier, France
| | - Elisa De La Cruz
- Explorations Neurologiques et Centre SLA, CHU et Université de Montpellier, INSERM, Montpellier, France
| | - Géraldine Lautrette
- Department of Neurology, Centre de Reference SLA et Autres Maladies du Neurone Moteur, CHU Limoges, Limoges, France
| | - Pierre Marie Preux
- Inserm U1094, IRD U270, USC1501 INRAE, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.,CEBIMER, Centre d'Epidémiologie, de Biostatistique et de Méthodologie de la Recherche, CHU Limoges, Limoges, France
| | - Philippe Couratier
- Inserm U1094, IRD U270, USC1501 INRAE, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France. .,Department of Neurology, Centre de Reference SLA et Autres Maladies du Neurone Moteur, CHU Limoges, Limoges, France.
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Longinetti E, Pupillo E, Belometti C, Bianchi E, Poloni M, Fang F, Beghi E. Geographical clusters of amyotrophic lateral sclerosis and the Bradford Hill criteria. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:329-343. [PMID: 34565247 DOI: 10.1080/21678421.2021.1980891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With the aim of shedding further light on the role of environmental factors in amyotrophic lateral sclerosis (ALS) etiology, we hereby conducted a historical narrative review to critically appraise the published reports on ALS geographical clusters using the modern interpretation of the Bradford Hill criteria for causation. Our research hypothesis was that the more criteria were met, the greater was the evidence supporting a causal association. We found that cluster studies that met the greatest number of Bradford's Hill criteria regarded the non-protein amino acid β-N-methylamino-L-alanine (L-BMAA) and exposure to metals and minerals, but the evidence for causation was at best moderate and was poor for other environmental factors. This defective picture might be attributed not only to the methodological approach adopted by published studies, but also to the inherent difficulties in the application of Bradford Hill criteria, due to the complexity of the disease phenotype and the underlying pathogenic mechanisms.
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Affiliation(s)
- Elisa Longinetti
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisabetta Pupillo
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy, and
| | - Chiara Belometti
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy, and
| | - Elisa Bianchi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy, and
| | - Marco Poloni
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy, and
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy, and
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Andrew AS, Pioro EP, Li M, Shi X, Gui J, Stommel EW, Butt TH, Peipert D, Henegan P, Tischbein M, Cazzolli P, Novak J, Quick A, Pugar KD, Sawlani K, Katirji B, Hayes TA, Horton DK, Mehta P, Bradley WG. The Incidence of Amyotrophic Lateral Sclerosis in Ohio 2016-2018: The Ohio Population-Based ALS Registry. Neuroepidemiology 2021; 55:196-205. [PMID: 33902051 DOI: 10.1159/000515103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/05/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a fatal, neuromuscular disease with no cure. ALS incidence rates have not been assessed specifically in Ohio, yet the state contains both metropolitan and rural areas with a variety of environmental factors that could contribute to disease etiology. We report the incidence of ALS in Ohio residents diagnosed from October 2016 through September 2018. METHODS We engaged practitioners from 9 Ohio sites to identify newly diagnosed ALS patients and to complete case report forms with demographic and clinical information. ALS was diagnosed according to the Awaji criteria and classified as either definite, probable, or possible. We developed a method to estimate missing cases using a Poisson regression model to impute cases in counties with evidence of undercounting. RESULTS We identified 333 newly diagnosed ALS patients residing in Ohio during the 2-year index period and found incidence rates varied in the 88 state counties. After incorporating the estimated 27% of missing cases, the corrected crude annual incidence was 1.96/100,000 person-years, and the age- and gender-standardized incidence was 1.71/100,000 person-years (standardized to the 2010 US census). DISCUSSION/CONCLUSION The estimated Ohio incidence of ALS is overall similar to that reported in other states in the USA. This study reveals a geospatial variation in incidence within the state, and areas with higher rates warrant future investigation.
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Affiliation(s)
- Angeline S Andrew
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Erik P Pioro
- Section of ALS and Related Disorders, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meifang Li
- Department of Geography, Dartmouth College, Hanover, New Hampshire, USA
| | - Xun Shi
- Department of Geography, Dartmouth College, Hanover, New Hampshire, USA
| | - Jiang Gui
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Elijah W Stommel
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tanya H Butt
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Daniel Peipert
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Patricia Henegan
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Maeve Tischbein
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - John Novak
- Ohio Health Physician Group, Westerville, Ohio, USA
| | - Adam Quick
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - K Doug Pugar
- Dayton Center for Neurological Disorders, Dayton, Ohio, USA
| | - Komal Sawlani
- Department of Neurology, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Bashar Katirji
- Department of Neurology, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - D Kevin Horton
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
| | - Walter G Bradley
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Stipa G, Ancidoni A, Mazzola M, Testai E, Funari E, Spera C, Fanelli C, Mancini A, Vanacore N. Is Chronic Exposure to Raw Water a Possible Risk Factor for Amyotrophic Lateral Sclerosis? A Pilot Case-Control Study. Brain Sci 2021; 11:brainsci11020193. [PMID: 33562464 PMCID: PMC7914845 DOI: 10.3390/brainsci11020193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The etiopathogenesis of amyotrophic lateral sclerosis (ALS) is still largely unknown. Methods: We performed a case-control study (33 cases and 35 controls) in Umbria, Italy. We investigated associations between common lifestyle, clinical factors, as well as environmental exposures potentially implicated with ALS onset. Face-to-face interviews were carried out. All cases were recruited and diagnosed according to El Escorial criteria. Case-control comparisons were made for educational and residential status, occupational exposures, and clinical and lifestyle factors prior to cases’ dates of diagnosis. Results: Our results showed an increased risk of ALS for subjects chronically exposed to raw water use (odds ratio (OR) = 6.55, 95% confidence interval (CI): 2.24–19.12). Garden activities showed a tight association with ALS as well, very likely as a consequence of chronic raw water exposure. Indeed, we could exclude an impact for pesticides, as no significant differences were observed in pesticide exposure in the two groups interviewed. However, cases were more often exposed to fertilizers. After adjustment for age, sex, and heavy physical activities, exposure to raw water was still associated with increased ALS risk (OR = 4.74, 95% CI: 1.33–16.85). Discussion: These findings suggest an association between ALS and exposure to raw water, which should be further investigated for the presence of chemicals interfering with nervous system functionality.
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Affiliation(s)
- Giuseppe Stipa
- Clinical Neurophysiology Division, Neuroscience Department, S. Maria University Hospital, 05100 Terni, Italy; (C.F.); (A.M.)
- Correspondence:
| | - Antonio Ancidoni
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), 34, 00162 Roma, Italy; (A.A.); (M.M.); (N.V.)
| | - Monica Mazzola
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), 34, 00162 Roma, Italy; (A.A.); (M.M.); (N.V.)
| | - Emanuela Testai
- Department of Environment and Health, National Institute of Health (ISS), 299, 00161 Roma, Italy; (E.T.); (E.F.)
| | - Enzo Funari
- Department of Environment and Health, National Institute of Health (ISS), 299, 00161 Roma, Italy; (E.T.); (E.F.)
| | - Cristina Spera
- Neurology Division, Neuroscience Department, S. Maria University Hospital, 05100 Terni, Italy;
| | - Cinzia Fanelli
- Clinical Neurophysiology Division, Neuroscience Department, S. Maria University Hospital, 05100 Terni, Italy; (C.F.); (A.M.)
| | - Alessia Mancini
- Clinical Neurophysiology Division, Neuroscience Department, S. Maria University Hospital, 05100 Terni, Italy; (C.F.); (A.M.)
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), 34, 00162 Roma, Italy; (A.A.); (M.M.); (N.V.)
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Facciponte DN, Bough MW, Seidler D, Carroll JL, Ashare A, Andrew AS, Tsongalis GJ, Vaickus LJ, Henegan PL, Butt TH, Stommel EW. Identifying aerosolized cyanobacteria in the human respiratory tract: A proposed mechanism for cyanotoxin-associated diseases. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 645:1003-1013. [PMID: 30248825 PMCID: PMC6159226 DOI: 10.1016/j.scitotenv.2018.07.226] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 05/10/2023]
Abstract
Cyanobacteria produce harmful toxins that have been associated with several acute conditions and chronic human diseases, like gastroenteritis, non-alcoholic liver disease, and amyotrophic lateral sclerosis. Aerosol from waterbodies appears to be a likely mechanism for exposure. We conducted a study of human biospecimens focused on the cyanobacterial aerosilization process by evaluating the extent to which cyanobacteria can invade the human respiratory tract. Our study suggests that humans routinely inhale aerosolized cyanobacteria, which can be harbored in the nostrils and the lungs. Using PCR, cyanobacteria were found at high frequencies in the upper respiratory tract (92.20%) and central airway (79.31%) of our study subjects. Nasal swabs were not predictive of bronchoalveolar lavage (BAL) when detecting inhaled cyanobacteria. Interestingly, we found no evidence that time of year was a significant factor for cyanobacteria positivity (BAL cytology p = 1.0 and PCR p = 1.0); (nasal swab cytology p = 0.051 and PCR p = 0.65). Additionally, we found that proximity to a waterbody was not a significant factor for cyanobacteria positivity in BAL and nasal swabs collected during cyanobacteria bloom season [May-October] (p = 0.46 and p = 0.38). These data suggest that cyanobacteria exposure may be a prevalent and chronic phenomenon not necessarily restricted to waterbodies alone. Sources of indoor exposure warrant future investigation. Given the widespread prevalence of cyanobacterial exposure in the airway, investigation of the aerosol spread of cyanotoxins, more specifically, is warranted. Our findings are consistent with the hypothesis that aerosol is a significant route for cyanobacteria exposure, and thus a likely route of transmission for cyanotoxin-associated human diseases.
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Affiliation(s)
- Dominic N Facciponte
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA.
| | - Matthew W Bough
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA; Dartmouth College, Hanover, NH 03755, USA
| | - Darius Seidler
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - James L Carroll
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Alix Ashare
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Angeline S Andrew
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Gregory J Tsongalis
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Louis J Vaickus
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Patricia L Henegan
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA
| | - Tanya H Butt
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA
| | - Elijah W Stommel
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA.
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10
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Theme 5 Epidemiology and informatics. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:178-197. [DOI: 10.1080/21678421.2018.1510572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Riancho J, Bosque-Varela P, Perez-Pereda S, Povedano M, de Munaín AL, Santurtun A. The increasing importance of environmental conditions in amyotrophic lateral sclerosis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1361-1374. [PMID: 29713861 DOI: 10.1007/s00484-018-1550-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common neurodegenerative disease affecting motor neurons (MNs). Although a small percentage of ALS has a familial origin, the vast majority of cases are sporadic in which genetic factors and environment interact with each other leading to disease onset in genetically predisposed individuals. In the current model of the disease, each individual has a determined genetic load, some degree of cell degeneration related to age and several risky environmental exposures. In this scenario, MN degeneration would occur when the sum of these factors reach a certain threshold. To date, an extensive list of environmental factors has been associated to ALS, including different categories, such as exposure to heavy metals and other toxicants, cyanotoxins or infectious agents. In addition, in recent years, lifestyle and other demographic parameters are gaining relevance in the genesis of the disease. Among them, physical activity, nutrition, body mass index, cardiovascular risk factors, autoimmune diseases and cancer are some of the conditions which have been related to the disease. In this review, we will discuss the potential mechanisms of environmental conditions in motor neuron degeneration. Understanding the role of each one of these factors as well as their interactions appears as a crucial step in order to develop new preventive, diagnostic and therapeutic approaches for ALS patients.
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Affiliation(s)
- Javier Riancho
- Service of Neurology, Hospital Sierrallana, Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain.
- Department of Medicine, University of Cantabria, Santander, Spain.
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Instituto Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain.
| | - Pilar Bosque-Varela
- Service of Neurology, University Hospital Marques de Valdecilla, Santander, Spain
| | - Sara Perez-Pereda
- Service of Neurology, University Hospital Marques de Valdecilla, Santander, Spain
| | - Mónica Povedano
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Instituto Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain
- Service of Neurology-Motor Neuron Unit, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Adolfo López de Munaín
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Instituto Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain
- ALS Multidisciplinary Unit, Hospital Donostia- Neuroscience Area, Donostia Health Research Institute, San Sebastián, Spain
| | - Ana Santurtun
- Toxicology Unit, Physiology and Farmacology Department, University of Cantabria-IDIVAL, Santander, Spain
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12
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Povedano M, Saez M, Martínez-Matos JA, Barceló MA. Spatial Assessment of the Association between Long-Term Exposure to Environmental Factors and the Occurrence of Amyotrophic Lateral Sclerosis in Catalonia, Spain: A Population-Based Nested Case-Control Study. Neuroepidemiology 2018; 51:33-49. [PMID: 29852480 DOI: 10.1159/000489664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/27/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It is believed that an interaction between genetic and non-genetic factors may be involved in the development of amyotrophic lateral sclerosis (ALS). With the exception of exposure to agricultural chemicals like pesticides, evidence of an association between environmental risk factors and ALS is inconsistent. Our objective here was to investigate the association between long-term exposure to environmental factors and the occurrence of ALS in Catalonia, Spain, and to provide evidence that spatial clusters of ALS related to these environmental factors exist. METHODS We carried out a nested case-control study constructed from a retrospective population-based cohort, covering the entire region. Environmental variables were the explanatory variables of interest. We controlled for both observed and unobserved confounders. RESULTS We have found some spatial clusters of ALS. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables, in particular agricultural chemicals. In addition, in high-risk clusters, besides corresponding to agricultural areas, key road infrastructures with a high density of traffic are also located. CONCLUSION Our results indicate that some environmental factors, in particular those associated with exposure to pesticides and air pollutants as a result of urban traffic, could be associated with the occurrence of ALS.
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Affiliation(s)
- Mònica Povedano
- Functional Motoneurona Unit (UFMNA), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Juan-Antonio Martínez-Matos
- Functional Motoneurona Unit (UFMNA), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Antònia Barceló
- Functional Motoneurona Unit (UFMNA), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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13
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Castanedo-Vazquez D, Bosque-Varela P, Sainz-Pelayo A, Riancho J. Infectious agents and amyotrophic lateral sclerosis: another piece of the puzzle of motor neuron degeneration. J Neurol 2018; 266:27-36. [PMID: 29845377 DOI: 10.1007/s00415-018-8919-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common neurodegenerative disease affecting motor neurons (MN). This fatal disease is characterized by progressive muscle wasting and lacks an effective treatment. ALS pathogenesis has not been elucidated yet. In a small proportion of ALS patients, the disease has a familial origin, related to mutations in specific genes, which directly result in MN degeneration. By contrast, the vast majority of cases are though to be sporadic, in which genes and environment interact leading to disease in genetically predisposed individuals. Lately, the role of the environment has gained relevance in this field and an extensive list of environmental conditions have been postulated to be involved in ALS. Among them, infectious agents, particularly viruses, have been suggested to play an important role in the pathogenesis of the disease. These agents could act by interacting with some crucial pathways in MN degeneration, such as gene processing, oxidative stress or neuroinflammation. In this article, we will review the main studies about the involvement of microorganisms in ALS, subsequently discussing their potential pathogenic effect and integrating them as another piece in the puzzle of ALS pathogenesis.
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Affiliation(s)
| | - Pilar Bosque-Varela
- Service of Neurology, University Hospital Marques de Valdecilla, Santander, Spain
| | | | - Javier Riancho
- Service of Neurology, Hospital Sierrallana-IDIVAL, Torrelavega, Spain. .,CIBERNED, Madrid, Spain.
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14
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Vasta R, Calvo A, Moglia C, Cammarosano S, Manera U, Canosa A, D'Ovidio F, Mazzini L, Chiò A. Spatial epidemiology of amyotrophic lateral sclerosis in Piedmont and Aosta Valley, Italy: a population-based cluster analysis. Eur J Neurol 2018; 25:756-761. [PMID: 29377594 DOI: 10.1111/ene.13586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/19/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The analysis of the spatial distribution of cases could give important cues on putative environmental causes of a disease. Our aim was to perform a spatial analysis of an amyotrophic lateral sclerosis (ALS) cohort from the Piedmont and Aosta Valley ALS register (PARALS) over a 20-year period. METHODS The address at the moment of diagnosis was considered for each ALS case. Municipalities' and census divisions' resident populations during the 1995-2014 period were obtained. A cluster analysis was performed adopting both Moran's index and the Kulldorff spatial scan statistic. RESULTS A total of 2702 ALS patients were identified. An address was retrieved for 2671 (99%) patients. Moran's index was -0.01 (P value 0.83), thus revealing no clusters. SaTScan identified no statistically significant clusters. When census divisions were considered, Moran's index was 0.13 (P value 0.45); SaTScan revealed one statistically significant small cluster in the province of Alessandria. Here, 0.0099 cases were expected and three cases were observed (relative risk 304.60; 95% confidence interval 109.83-845.88, P value 0.03). DISCUSSION Our study showed a substantial homogeneous distribution of ALS cases in Piedmont and Aosta Valley. The population-based setting and the adoption of proper statistical analyses strengthen the validity of our results. Such a finding further suggests the involvement of multiple environmental and genetic factors in ALS pathogenesis.
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Affiliation(s)
- R Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Calvo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - C Moglia
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - S Cammarosano
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - U Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Canosa
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - F D'Ovidio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - L Mazzini
- ALS Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - A Chiò
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
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15
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Torbick N, Ziniti B, Stommel E, Linder E, Andrew A, Caller T, Haney J, Bradley W, Henegan PL, Shi X. Assessing Cyanobacterial Harmful Algal Blooms as Risk Factors for Amyotrophic Lateral Sclerosis. Neurotox Res 2017; 33:199-212. [PMID: 28470570 PMCID: PMC5727154 DOI: 10.1007/s12640-017-9740-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/16/2017] [Accepted: 04/21/2017] [Indexed: 12/14/2022]
Abstract
Reoccurring seasonal cyanobacterial harmful algal blooms (CHABs) persist in many waters, and recent work has shown links between CHAB and elevated risk of amyotrophic lateral sclerosis (ALS). Quantifying the exposure levels of CHAB as a potential risk factor for ALS is complicated by human mobility, potential pathways, and data availability. In this work, we develop phycocyanin concentration (i.e., CHAB exposure) maps using satellite remote sensing across northern New England to assess relationships with ALS cases using a spatial epidemiological approach. Strategic semi-analytical regression models integrated Landsat and in situ observations to map phycocyanin concentration (PC) for all lakes greater than 8 ha (n = 4117) across the region. Then, systematic versions of a Bayesian Poisson Log-linear model were fit to assess the mapped PC as a risk factor for ALS while accounting for model uncertainty and modifiable area unit problems. The satellite remote sensing of PC had strong overall ability to map conditions (adj. R2, 0.86; RMSE, 11.92) and spatial variability across the region. PC tended to be positively associated with ALS risk with the level of significance depending on fixed model components. Meta-analysis shows that when average PC exposure is 100 μg/L, an all model average odds ratio is 1.48, meaning there is about a 48% increase in average ALS risk. This research generated the first regionally comprehensive map of PC for thousands of lakes and integrated robust spatial uncertainty. The outcomes support the hypothesis that cyanotoxins increase the risk of ALS, which helps our understanding of the etiology of ALS.
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Affiliation(s)
- Nathan Torbick
- Applied Geosolutions, 55 Main St, Suite 125, Newmarket, NH, 03857, USA. .,Department of Neurology, Dartmouth College, Hanover, NH, USA.
| | - Beth Ziniti
- Applied Geosolutions, 55 Main St, Suite 125, Newmarket, NH, 03857, USA
| | - Elijah Stommel
- Department of Neurology, Dartmouth College, Hanover, NH, USA
| | - Ernst Linder
- Department of Mathematics and Statistics, University of New Hampshire, Durham, NH, USA
| | | | - Tracie Caller
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jim Haney
- Department of Biological Sciences, University of New Hampshire, Durham, NH, USA
| | - Walter Bradley
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Xun Shi
- Department of Geography, Dartmouth College, Hanover, NH, USA
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16
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Michaelson N, Facciponte D, Bradley W, Stommel E. Cytokine expression levels in ALS: A potential link between inflammation and BMAA-triggered protein misfolding. Cytokine Growth Factor Rev 2017; 37:81-88. [PMID: 28532674 DOI: 10.1016/j.cytogfr.2017.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 01/13/2023]
Abstract
Recently, it has been shown that proinflammatory cytokines play a complex and important role in the pathogenesis of many neurological disorders, including amyotrophic lateral sclerosis (ALS). To help facilitate future discoveries and more effective treatment strategies, we highlight the role that both innate and adaptive immune systems play in ALS and summarize the main observations that relate to cytokine expression levels in this disease. Furthermore, we propose a mechanism by which a known neurotoxin, β-N-methylamino-l-alanine (BMAA), may trigger this cytokine expression profile through motor neuron protein misfolding and subsequent NLRP3 (nucleotide-binding domain (NOD)-like receptor protein 3) inflammasome activation.
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Affiliation(s)
- Nara Michaelson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | | | - Walter Bradley
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elijah Stommel
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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17
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Sher RB. The interaction of genetics and environmental toxicants in amyotrophic lateral sclerosis: results from animal models. Neural Regen Res 2017; 12:902-905. [PMID: 28761418 PMCID: PMC5514860 DOI: 10.4103/1673-5374.208564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that results in the progressive death of motor neurons, leading to paralysis and eventual death. There is presently no cure for ALS, and only two drugs are available, neither of which provide significant extension of life. The wide variation in onset and progression of the disease, both in sporadic and even in strongly penetrant monogenic familial forms of ALS, indicate that in addition to background genetic variation impacting the disease process, environmental exposures are likely contributors. Epidemiological evidence worldwide implicates exposures to bacterial toxins, heavy metals, pesticides, and trauma as probable environmental factors. Here, we review current advances in gene-environment interactions in ALS animal models. We report our recent discoveries in a zebrafish model of ALS in relation to exposure to the cyanobacterial toxin BMAA, and discuss several results from mouse models that show interactions with exposure to mercury and statin drugs, both leading to acceleration of the disease process. The increasing research into this combinatorial gene-environment process is just starting, but shows early promise to uncover the underlying biochemical pathways that instigate the initial motor neuron defects and lead to their rapidly progressive dysfunction.
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Affiliation(s)
- Roger B Sher
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, USA
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18
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Abstract
The causes of amyotrophic lateral sclerosis (ALS) are largely unknown, and may always be multiple, including environmental factors. Monogenetic determinants of ALS are involved in roughly 20% of all cases (including 10% familial cases). Less well understood multigenetic causes may contribute to another 20% to 80%. Environmental factors likely play a role in the development of ALS in susceptible individuals, but proved causation remains elusive. This article discusses the possible factors of male gender (males are selectively exposed to different influences, or genetically predisposed to be susceptible), smoking, military service, exercise, electrical exposure, heavy metals, agricultural chemicals, and geographic clusters.
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Affiliation(s)
- Björn Oskarsson
- UC Davis Multidisciplinary ALS Clinic, An ALS Association Certified Center of Excellence, University of California Davis Medical Center, 4860 Y Street, Suite 3700, Sacramento, CA 95817, USA.
| | - D Kevin Horton
- Division of Toxicology and Human Health Sciences, ATSDR/CDC, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA
| | - Hiroshi Mitsumoto
- The Eleanor and Lou Gehrig MDA/ALS Research Center, The Neurological Institute, Columbia University Medical Center, 710 West 168th Street, Floor 9, New York, NY 10032, USA
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19
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Zufiría M, Gil-Bea FJ, Fernández-Torrón R, Poza JJ, Muñoz-Blanco JL, Rojas-García R, Riancho J, López de Munain A. ALS: A bucket of genes, environment, metabolism and unknown ingredients. Prog Neurobiol 2016; 142:104-129. [DOI: 10.1016/j.pneurobio.2016.05.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/22/2016] [Accepted: 05/09/2016] [Indexed: 12/11/2022]
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20
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Bradley WG, Stommel EW, Shi X, Torbick NM, Caller TA, Sabel CE, Rooney JP, Staines A, Hardiman O. Spatial cluster analysis of population amyotrophic lateral sclerosis risk in Ireland. Neurology 2016; 85:1822-3. [PMID: 26574539 DOI: 10.1212/01.wnl.0000473800.89178.a9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Theme 8 Epidemiology. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16 Suppl 1:146-59. [DOI: 10.3109/21678421.2015.1098813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Henry KA, Fagliano J, Jordan HM, Rechtman L, Kaye WE. Geographic Variation of Amyotrophic Lateral Sclerosis Incidence in New Jersey, 2009-2011. Am J Epidemiol 2015; 182:512-9. [PMID: 26041711 PMCID: PMC4564938 DOI: 10.1093/aje/kwv095] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/03/2015] [Indexed: 01/03/2023] Open
Abstract
Few analyses in the United States have examined geographic variation and socioeconomic disparities in amyotrophic lateral sclerosis (ALS) incidence, because of lack of population-based incidence data. In this analysis, we used population-based ALS data to identify whether ALS incidence clusters geographically and to determine whether ALS risk varies by area-based socioeconomic status (SES). This study included 493 incident ALS cases diagnosed (via El Escorial criteria) in New Jersey between 2009 and 2011. Geographic variation and clustering of ALS incidence was assessed using a spatial scan statistic and Bayesian geoadditive models. Poisson regression was used to estimate the associations between ALS risk and SES based on census-tract median income while controlling for age, sex, and race. ALS incidence varied across and within counties, but there were no statistically significant geographic clusters. SES was associated with ALS incidence. After adjustment for age, sex, and race, the relative risk of ALS was significantly higher (relative risk (RR) = 1.37, 95% confidence interval (CI): 1.02, 1.82) in the highest income quartile than in the lowest. The relative risk of ALS was significantly lower among blacks (RR = 0.57, 95% CI: 0.39, 0.83) and Asians (RR = 0.63, 95% CI: 0.41, 0.97) than among whites. Our findings suggest that ALS incidence in New Jersey appears to be associated with SES and race.
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Affiliation(s)
- Kevin A. Henry
- Correspondence to Dr. Kevin A. Henry, Department of Geography and Urban Studies, College of Liberal Arts, Temple University, Gladfelter Hall, Room 313b, Philadelphia, PA 19122 (e-mail: )
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23
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Bradley WG. The John Walton Muscular Dystrophy Research Centre in the University of Newcastle and the BMAA Theory of Motor Neuron Disease. J Neuromuscul Dis 2015; 2:S77-S81. [PMID: 27858760 PMCID: PMC5271429 DOI: 10.3233/jnd-150090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Walter G. Bradley
- Correspondence to: Walter G. Bradley, Professor and Chairman Emeritus, Department of Neurology, Miller School of Medicine, University of Miami, USA. Tel.: +305 215 2144; Fax: +305 964 5336;
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24
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Uenal H, Rosenbohm A, Kufeldt J, Weydt P, Goder K, Ludolph A, Rothenbacher D, Nagel G. Incidence and geographical variation of amyotrophic lateral sclerosis (ALS) in Southern Germany--completeness of the ALS registry Swabia. PLoS One 2014; 9:e93932. [PMID: 24722455 PMCID: PMC3983245 DOI: 10.1371/journal.pone.0093932] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
Objective of this paper was to investigate the incidence, potential geographical clusters and the completeness of the amyotrophic lateral sclerosis (ALS) registry in Southern Germany (Swabia). Age-standardized incidence rates (ASR) and ratios (SIR) as well as 95% confidence intervals (CI) were estimated at county level. Capture-recapture (CARE) procedures were applied taking data source dependency into account to estimate the quality of case ascertainment in the ALS registry Swabia. We identified 438 ALS cases (53% men, 47% women) in the target population of about 8.4 Mio inhabitants. The gender ratio (men∶women) was 1.1∶1. The mean age at onset of ALS was 63.8 (SD = 11.9) years for men and 66.0 (12.2) for women. The age distribution peaked in the age group 70–74 years. The ASR of ALS was 2.5 per 100,000 person years (PY; 95% CI: 2.3–2.7). The mean SIR was 1.1 per 100,000 PY (95% CI: 1.0–1.2). High SIR suggesting geographical clusters were observed in two counties (Göppingen and Bodenseekreis), but the variation was not statistically significant (p-values = 0.2 and 0.5). The percentage of CARE estimated missing cases was 18.9% in the registry yielding an ASR of 3.1 per 100,000 PY. The high coverage of the CARE estimated completeness of the ALS registry Swabia indicates excellent quality for future projects. Regional variations have to be investigated further.
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Affiliation(s)
- Hatice Uenal
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Johannes Kufeldt
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Patrick Weydt
- Department of Neurology, Ulm University Clinic, Ulm, Germany
| | - Katharina Goder
- Department of Neurology, Ulm University Clinic, Ulm, Germany
| | - Albert Ludolph
- Department of Neurology, Ulm University Clinic, Ulm, Germany
| | | | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- * E-mail:
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25
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Mandrioli J, Biguzzi S, Guidi C, Venturini E, Sette E, Terlizzi E, Ravasio A, Casmiro M, Salvi F, Liguori R, Rizzi R, Pietrini V, Chierici E, Santangelo M, Granieri E, Mussuto V, Borghi A, Rinaldi R, Fini N, Georgoulopoulou E, De Pasqua S, Vinceti M, Bonvicini F, Ferro S, D'Alessandro R. Epidemiology of amyotrophic lateral sclerosis in Emilia Romagna Region (Italy): A population based study. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:262-8. [PMID: 24863640 DOI: 10.3109/21678421.2013.865752] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to describe incidence and clinical features of ALS from a prospective population-based study in Emilia Romagna Region (ERR). From 2009 onwards, a prospective registry recorded all incident cases of ALS among residents in the ERR (population, 4.4 million inhabitants), involving 17 neurological departments. For each patient, detailed demographic and clinical information was collected by caring physicians. Results showed that from 1 January 2009 to 31 December 2011, 347 patients received a new diagnosis of ALS with a crude incidence rate of 2.63/100,000/year. There was micro-geographic heterogeneity throughout ERR, with higher incidence rates in the low density population (3.27/100,000) (p < 0.01). ALS patients have been more frequently employed in agriculture than the general ERR population (8.64% vs. 4.6%, p < 0.01). Clinical features were similar to those described in previous population based studies. In conclusion, we report incidence rates similar to those reported by European registries, reflecting good accuracy of our prospective study. We confirmed previous studies reporting higher incidence rates in rural areas and among agricultural workers. Although genetics has been gaining increasing importance in ALS aetiology, some epidemiological data are still unexplained. Identifying geographical areas or populations with high incidence rates can be a starting point for identifying environmental risk factors. Further studies having this specific aim can shed light on these topics.
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