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Baumer NT, Capone G. Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32069. [PMID: 37870763 DOI: 10.1002/ajmg.c.32069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.
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Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - George Capone
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
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2
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Bartesaghi R, Vicari S, Mobley WC. Prenatal and Postnatal Pharmacotherapy in Down Syndrome: The Search to Prevent or Ameliorate Neurodevelopmental and Neurodegenerative Disorders. Annu Rev Pharmacol Toxicol 2022; 62:211-233. [PMID: 34990205 PMCID: PMC9632639 DOI: 10.1146/annurev-pharmtox-041521-103641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Those with Down syndrome (DS)-trisomy for chromosome 21-are routinely impacted by cognitive dysfunction and behavioral challenges in children and adults and Alzheimer's disease in older adults. No proven treatments specifically address these cognitive or behavioral changes. However, advances in the establishment of rodent models and human cell models promise to support development of such treatments. A research agenda that emphasizes the identification of overexpressed genes that contribute demonstrably to abnormalities in cognition and behavior in model systems constitutes a rational next step. Normalizing expression of such genes may usher in an era of successful treatments applicable across the life span for those with DS.
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Affiliation(s)
- Renata Bartesaghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Stefano Vicari
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy,Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165-00146 Rome, Italy
| | - William C. Mobley
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093, USA
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3
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Abstract
Experimental work regarding corrective actions on chromosomes and genes, and control of gene products is yielding promising results. It opens the way to advances in dealing with the etiological aspects of Down syndrome and may lead to important changes in the life of individuals affected with this condition. A small number of molecules are being investigated in pharmacological research that may have positive effects on intellectual functioning. Studies of the pathological consequences of the amyloid cascade and the TAU pathology in the etiology of Alzheimer disease (AD), which is more frequent and occuring earlier in life in persons with Down syndrome (DS), are presented. The search for biological markers of AD and ways for constrasting its early manifestations are also discussed.
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Affiliation(s)
- Jean A. Rondal
- University of Liège, Cognitive Sciences, Building 32, Sart Tilman, Liège 4000, Belgium
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4
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On the Design of Broad-Based Neuropsychological Test Batteries to Assess the Cognitive Abilities of Individuals with Down Syndrome in the Context of Clinical Trials. Brain Sci 2018; 8:brainsci8120205. [PMID: 30486228 PMCID: PMC6315396 DOI: 10.3390/brainsci8120205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Down syndrome (DS) is the most common genetically-defined cause of intellectual disability. Neurodevelopmental deficits displayed by individuals with DS are generally global, however, disproportionate deficits in cognitive processes that depend heavily on the hippocampus and prefrontal cortex are also well documented. Additionally, DS is associated with relative strengths in visual processing and visuospatial short-term memory, and weaknesses in the verbal domain. Although reports of pharmacological rescuing of learning and memory deficits in mouse models of DS abound in the literature, proving the principle that cognitive ability of persons with DS can be boosted through pharmacological means is still an elusive goal. The design of customized batteries of neuropsychological efficacy outcome measures is essential for the successful implementation of clinical trials of potential cognitive enhancing strategies. Here, we review the neurocognitive phenotype of individuals with DS and major broad-based test batteries designed to quantify specific cognitive domains in these individuals, including the one used in a pilot trial of the drug memantine. The main goal is to illustrate the essential considerations in planning trials to enhance cognitive functions in individuals with DS, which should also have implications for the design of similar studies in individuals with other forms of intellectual disability.
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Hart SJ, Visootsak J, Tamburri P, Phuong P, Baumer N, Hernandez MC, Skotko BG, Ochoa-Lubinoff C, Liogier D'Ardhuy X, Kishnani PS, Spiridigliozzi GA. Pharmacological interventions to improve cognition and adaptive functioning in Down syndrome: Strides to date. Am J Med Genet A 2017; 173:3029-3041. [PMID: 28884975 DOI: 10.1002/ajmg.a.38465] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/02/2017] [Accepted: 08/10/2017] [Indexed: 12/21/2022]
Abstract
Although an increasing number of clinical trials have been developed for cognition in Down syndrome, there has been limited success to date in identifying effective interventions. This review describes the progression from pre-clinical studies with mouse models to human clinical trials research using pharmacological interventions to improve cognition and adaptive functioning in Down syndrome. We also provide considerations for investigators when conducting human clinical trials and describe strategies for the pharmaceutical industry to advance the field in drug discovery for Down syndrome. Future research focusing on earlier pharmaceutical interventions, development of appropriate outcome measures, and greater collaboration between industry, academia, advocacy, and regulatory groups will be important for addressing limitations from prior studies and developing potential effective interventions for cognition in Down syndrome.
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Affiliation(s)
- Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jeannie Visootsak
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Paul Tamburri
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Patrick Phuong
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center New York, New York, New York
| | - Nicole Baumer
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Down Syndrome Program, Developmental Medicine Center, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Maria-Clemencia Hernandez
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Brian G Skotko
- Harvard Medical School, Boston, Massachusetts.,Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Cesar Ochoa-Lubinoff
- Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Xavier Liogier D'Ardhuy
- F. Hoffmann-La Roche, Roche Pharma Research and Early Development, Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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6
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Keeling LA, Spiridigliozzi GA, Hart SJ, Baker JA, Jones HN, Kishnani PS. Challenges in measuring the effects of pharmacological interventions on cognitive and adaptive functioning in individuals with Down syndrome: A systematic review. Am J Med Genet A 2017; 173:3058-3066. [PMID: 28857390 DOI: 10.1002/ajmg.a.38416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 12/16/2022]
Abstract
We systematically reviewed the measures used in pharmaceutical trials in children/adults with Down syndrome without dementia. Our purpose was to identify developmentally appropriate outcome measures capable of detecting changes in cognitive and adaptive functioning in this population. Eleven studies were included and used diverse outcome measures across the domains of language, memory, attention, behavior, and executive/adaptive functioning. Our results highlight the challenges in selecting measures capable of capturing improvements in pharmaceutical trials in individuals with DS. We offer suggestions to enhance future research, including: conducting studies with larger samples of participants with a range of developmental abilities; modifying existing/developing novel outcome measures; incorporating advances from related areas and DS observational studies; and considering alternative analytic techniques to characterize treatment effects.
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Affiliation(s)
- Lori A Keeling
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jane A Baker
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Harrison N Jones
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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7
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Edgin JO, Anand P, Rosser T, Pierpont EI, Figueroa C, Hamilton D, Huddleston L, Mason G, Spanò G, Toole L, Nguyen-Driver M, Capone G, Abbeduto L, Maslen C, Reeves RH, Sherman S. The Arizona Cognitive Test Battery for Down Syndrome: Test-Retest Reliability and Practice Effects. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:215-234. [PMID: 28452581 PMCID: PMC6215707 DOI: 10.1352/1944-7558-122.3.215] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A multisite study investigated the test-retest reliability and practice effects of a battery of assessments to measure neurocognitive function in individuals with Down syndrome (DS). The study aimed to establish the appropriateness of these measures as potential endpoints for clinical trials. Neurocognitive tasks and parent report measures comprising the Arizona Cognitive Test Battery (ACTB) were administered to 54 young participants with DS (7-20 years of age) with mild to moderate levels of intellectual disability in an initial baseline evaluation and a follow-up assessment 3 months later. Although revisions to ACTB measures are indicated, results demonstrate adequate levels of reliability and resistance to practice effects for some measures. The ACTB offers viable options for repeated testing of memory, motor planning, behavioral regulation, and attention. Alternative measures of executive functioning are required.
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Affiliation(s)
- Jamie O Edgin
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Payal Anand
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Tracie Rosser
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Elizabeth I Pierpont
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Carlos Figueroa
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Debra Hamilton
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Lillie Huddleston
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Gina Mason
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Goffredina Spanò
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Lisa Toole
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Mina Nguyen-Driver
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - George Capone
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Leonard Abbeduto
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Cheryl Maslen
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Roger H Reeves
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
| | - Stephanie Sherman
- Jamie O. Edgin and Payal Anand, University of Arizona; Tracie Rosser, Emory University; Elizabeth I. Pierpont, University of Wisconsin-Madison and University of Minnesota; Carlos Figueroa, University of Arizona; Debra Hamilton and Lillie Huddleston, Georgia State University; Gina Mason, Cornell University; Goffredina Spanò, University of Arizona; Lisa Toole, Johns Hopkins University; Mina Nguyen-Driver, Oregon Health Sciences University; George Capone, Johns Hopkins University; Leonard Abbeduto, University of Wisconsin-Madison and University of California, Davis; Cheryl Maslen, Oregon Health Sciences University; Roger H. Reeves, Johns Hopkins University; and Stephanie Sherman, Emory University
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8
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Jensen KB, Kirsch I, Pontén M, Rosén A, Yang K, Gollub RL, des Portes V, Kaptchuk TJ, Curie A. Certainty of genuine treatment increases drug responses among intellectually disabled patients. Neurology 2017; 88:1912-1918. [PMID: 28424273 PMCID: PMC5444309 DOI: 10.1212/wnl.0000000000003934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 02/28/2017] [Indexed: 02/06/2023] Open
Abstract
Objective: To determine the placebo component of treatment responses in patients with intellectual disability (ID). Methods: A statistical meta-analysis comparing bias-corrected effect sizes (Hedges g) of drug responses in open-label vs placebo-controlled clinical trials was performed, as these trial types represent different certainty of receiving genuine treatment (100% vs 50%). Studies in fragile X, Down, Prader-Willi, and Williams syndrome published before June 2015 were considered. Results: Seventeen open-label trials (n = 261, 65% male; mean age 23.6 years; mean trial duration 38 weeks) and 22 placebo-controlled trials (n = 721, 62% male; mean age 17.1 years; mean trial duration 35 weeks) were included. The overall effect size from pre to post treatment in open-label studies was g = 0.602 (p = 0.001). The effect of trial type was statistically significant (p = 0.001), and revealed higher effect sizes in studies with 100% likelihood of getting active drug, compared to both the drug and placebo arm of placebo-controlled trials. We thus provide evidence for genuine placebo effects, not explainable by natural history or regression toward the mean, among patients with ID. Conclusions: Our data suggest that clinical trials in patients with severe cognitive deficits are influenced by the certainty of receiving genuine medication, and open-label design should thus not be used to evaluate the effect of pharmacologic treatments in ID, as the results will be biased by an enhanced placebo component.
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Affiliation(s)
- Karin B Jensen
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France.
| | - Irving Kirsch
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Moa Pontén
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Annelie Rosén
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Kathy Yang
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Randy L Gollub
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Vincent des Portes
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Ted J Kaptchuk
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
| | - Aurore Curie
- From the Department of Clinical Neuroscience (K.B.J., M.P., A.R.), Karolinska Institute, Sweden; Program in Placebo Studies (I.K., T.J.K.), BIDMC, Harvard Medical School; Department of Psychiatry (K.Y., R.L.G.), Massachusetts General Hospital, Boston; Institut des Sciences Cognitives (V.d.P., A.C.), Bron; Université Claude Bernard Lyon 1 (V.d.P., A.C.); Centre de Référence Déficiences Intellectuelles de Causes Rares (V.d.P., A.C.), Hôpital Femmes Mères Enfants, Hospices Civils de Lyon; and EPICIME-CIC1407/INSERM (A.C.), Bron, France
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9
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Guedj F, Pennings JLA, Massingham LJ, Wick HC, Siegel AE, Tantravahi U, Bianchi DW. An Integrated Human/Murine Transcriptome and Pathway Approach To Identify Prenatal Treatments For Down Syndrome. Sci Rep 2016; 6:32353. [PMID: 27586445 PMCID: PMC5009456 DOI: 10.1038/srep32353] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/27/2016] [Indexed: 01/23/2023] Open
Abstract
Anatomical and functional brain abnormalities begin during fetal life in Down syndrome (DS). We hypothesize that novel prenatal treatments can be identified by targeting signaling pathways that are consistently perturbed in cell types/tissues obtained from human fetuses with DS and mouse embryos. We analyzed transcriptome data from fetuses with trisomy 21, age and sex-matched euploid controls, and embryonic day 15.5 forebrains from Ts1Cje, Ts65Dn, and Dp16 mice. The new datasets were compared to other publicly available datasets from humans with DS. We used the human Connectivity Map (CMap) database and created a murine adaptation to identify FDA-approved drugs that can rescue affected pathways. USP16 and TTC3 were dysregulated in all affected human cells and two mouse models. DS-associated pathway abnormalities were either the result of gene dosage specific effects or the consequence of a global cell stress response with activation of compensatory mechanisms. CMap analyses identified 56 molecules with high predictive scores to rescue abnormal gene expression in both species. Our novel integrated human/murine systems biology approach identified commonly dysregulated genes and pathways. This can help to prioritize therapeutic molecules on which to further test safety and efficacy. Additional studies in human cells are ongoing prior to pre-clinical prenatal treatment in mice.
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Affiliation(s)
- Faycal Guedj
- Mother Infant Research Institute, Tufts Medical Center and the Floating Hospital for Children, Boston, MA, United States
| | - Jeroen LA Pennings
- Center for Health Protection (GZB), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Lauren J Massingham
- Mother Infant Research Institute, Tufts Medical Center and the Floating Hospital for Children, Boston, MA, United States
| | - Heather C Wick
- Department of Computer Science, Tufts University, Medford, MA, United States
| | - Ashley E Siegel
- Mother Infant Research Institute, Tufts Medical Center and the Floating Hospital for Children, Boston, MA, United States
| | - Umadevi Tantravahi
- Department of Pathology, Women and Infants' Hospital, Providence, RI, United States
| | - Diana W Bianchi
- Mother Infant Research Institute, Tufts Medical Center and the Floating Hospital for Children, Boston, MA, United States
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Spiridigliozzi GA, Hart SJ, Heller JH, Schneider HE, Baker JA, Weadon C, Capone GT, Kishnani PS. Safety and efficacy of rivastigmine in children with Down syndrome: A double blind placebo controlled trial. Am J Med Genet A 2016; 170:1545-55. [PMID: 27061338 DOI: 10.1002/ajmg.a.37650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/11/2016] [Indexed: 11/06/2022]
Abstract
Individuals with Down syndrome (DS) have decreased cholinergic function and an uneven profile of cognitive abilities, with more pronounced deficits in learning, memory, and expressive language. Cholinesterase inhibitors may improve cognitive function in adults and adolescents with DS, but studies in children with DS have been limited. This study aimed to: (i) investigate the safety and efficacy of rivastigmine treatment; (ii) build upon our open-label studies in children with DS in a double-blind, placebo-controlled clinical trial; and (iii) investigate specific cognitive domains that may respond to rivastigmine treatment. We conducted a 20-week double-blind, placebo-controlled trial to investigate the safety and efficacy of rivastigmine in 22 children and adolescents with DS aged 10-17 years. Safety measures included reports of adverse events, laboratory parameters, and electrocardiograms. Efficacy measures included parental assessments of adaptive behavior and executive function, and direct measures of language and memory. No group differences were found on safety measures and 22 of 24 participants that passed study screening completed the study. The results did not demonstrate evidence for significant improvement in aspects of cognition, language, or overall function in the children receiving rivastigmine. Our results suggest that rivastigmine is safe and well-tolerated for children and adolescents with DS, but may not be effective for improving performance on the selected measures in this study. However, larger samples and/or alternate measures could possibly reveal improvements in cognitive function with rivastigmine treatment. Further research is needed to define a battery of cognitive measures that is sensitive to treatment effects in DS. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - James H Heller
- Formerly of Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Heather E Schneider
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jane Ann Baker
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Cathleen Weadon
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland
| | - George T Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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11
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Gardiner KJ. Pharmacological approaches to improving cognitive function in Down syndrome: current status and considerations. Drug Des Devel Ther 2014; 9:103-25. [PMID: 25552901 PMCID: PMC4277121 DOI: 10.2147/dddt.s51476] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Down syndrome (DS), also known as trisomy 21, is the most common genetic cause of intellectual disability (ID). Although ID can be mild, the average intelligence quotient is in the range of 40-50. All individuals with DS will also develop the neuropathology of Alzheimer's disease (AD) by the age of 30-40 years, and approximately half will display an AD-like dementia by the age of 60 years. DS is caused by an extra copy of the long arm of human chromosome 21 (Hsa21) and the consequent elevated levels of expression, due to dosage, of trisomic genes. Despite a worldwide incidence of one in 700-1,000 live births, there are currently no pharmacological treatments available for ID or AD in DS. However, over the last several years, very promising results have been obtained with a mouse model of DS, the Ts65Dn. A diverse array of drugs has been shown to rescue, or partially rescue, DS-relevant deficits in learning and memory and abnormalities in cellular and electrophysiological features seen in the Ts65Dn. These results suggest that some level of amelioration or prevention of cognitive deficits in people with DS may be possible. Here, we review information from the preclinical evaluations in the Ts65Dn, how drugs were selected, how efficacy was judged, and how outcomes differ, or not, among studies. We also summarize the current state of human clinical trials for ID and AD in DS. Lastly, we describe the genetic limitations of the Ts65Dn as a model of DS, and in the preclinical testing of pharmacotherapeutics, and suggest additional targets to be considered for potential pharmacotherapies.
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Affiliation(s)
- Katheleen J Gardiner
- Linda Crnic Institute for Down Syndrome, Department of Pediatrics, Department of Biochemistry and Molecular Genetics, Human Medical Genetics and Genomics Program, Neuroscience Program, University of Colorado School of Medicine, Aurora, CO, USA
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12
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Das D, Phillips C, Hsieh W, Sumanth K, Dang V, Salehi A. Neurotransmitter-based strategies for the treatment of cognitive dysfunction in Down syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:140-8. [PMID: 24842803 DOI: 10.1016/j.pnpbp.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 01/10/2023]
Abstract
Down syndrome (DS) is a multisystem disorder affecting the cardiovascular, respiratory, gastrointestinal, neurological, hematopoietic, and musculoskeletal systems and is characterized by significant cognitive disability and a possible common pathogenic mechanism with Alzheimer's disease. During the last decade, numerous studies have supported the notion that the triplication of specific genes on human chromosome 21 plays a significant role in cognitive dysfunction in DS. Here we reviewed studies in trisomic mouse models and humans, including children and adults with DS. In order to identify groups of genes that contribute to cognitive disability in DS, multiple mouse models of DS with segmental trisomy have been generated. Over-expression of these particular genes in DS can lead to dysfunction of several neurotransmitter systems. Therapeutic strategies for DS have either focused on normalizing the expression of triplicated genes with important roles in DS or restoring the function of these systems. Indeed, our extensive review of studies on the pathogenesis of DS suggests that one plausible strategy for the treatment of cognitive dysfunction is to target the cholinergic, serotonergic, GABA-ergic, glutamatergic, and norepinephrinergic system. However, a fundamental strategy for treatment of cognitive dysfunction in DS would include reducing to normal levels the expression of specific triplicated genes in affected systems before the onset of neurodegeneration.
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Affiliation(s)
- Devsmita Das
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Cristy Phillips
- Department of Physical Therapy, P.O. Box 910, Arkansas State University, State University, AR, USA
| | - Wayne Hsieh
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA
| | - Krithika Sumanth
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA
| | - Van Dang
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Ahmad Salehi
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
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13
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Raucci U, Vanacore N, Cecchetti C, Russo MS, Rossi R, Pirozzi N. Transient Cardiac Effects in a Child with Acute Cholinergic Syndrome Due to Rivastigmine Poisoning. J Emerg Med 2014; 47:21-5. [DOI: 10.1016/j.jemermed.2013.11.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 10/22/2013] [Accepted: 11/17/2013] [Indexed: 12/01/2022]
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Abstract
Down syndrome is the commonest chromosomal disorder causing mild to moderate intellectual disability, yet it is one of the neglected disorder amongst practicing physicians. Children with Down syndrome when intervened early by speech therapy, physiotherapy and occupational therapy and given proper medical attention for different health issues, can have a better long term outcome as compared to other genetic causes of intellectual disability. This paper would help the general practitioners to identify children with Down syndrome and to manage the common problems associated with this condition.
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de la Torre R, Dierssen M. Therapeutic approaches in the improvement of cognitive performance in Down syndrome. PROGRESS IN BRAIN RESEARCH 2012; 197:1-14. [DOI: 10.1016/b978-0-444-54299-1.00001-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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