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Zheng Y, Cai H, Zhao J, Yu Z, Feng T. Alpha-Synuclein species in oral mucosa as potential biomarkers for multiple system atrophy. Front Aging Neurosci 2022; 14:1010064. [PMID: 36304930 PMCID: PMC9592697 DOI: 10.3389/fnagi.2022.1010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The definitive diagnosis of Multiple system atrophy (MSA) requires the evidence of abnormal deposition of α-Synuclein (α-Syn) through brain pathology which is unable to achieve in vivo. Deposition of α-Syn is not limited to the central nervous system (CNS), but also extended to peripheral tissues. Detection of pathological α-Syn deposition in extracerebral tissues also contributes to the diagnosis of MSA. We recently reported the increased expressions of α-Syn, phosphorylated α-Synuclein at Ser129 (pS129), and α-Syn aggregates in oral mucosal cells of Parkinson’s disease (PD), which serve as potential biomarkers for PD. To date, little is known about the α-Syn expression pattern in oral mucosa of MSA which is also a synucleinopathy. Here, we intend to investigate whether abnormal α-Syn deposition occurs in oral mucosal cells of MSA, and to determine whether α-Syn, pS129, and α-Syn aggregates in oral mucosa are potential biomarkers for MSA. Methods The oral mucosal cells were collected by using cytobrush from 42 MSA patients (23 MSA-P and 19 MSA-C) and 47 age-matched healthy controls (HCs). Immunofluorescence analysis was used to investigate the presence of α-Syn, pS129, and α-Syn aggregates in the oral mucosal cells. Then, the concentrations of α-Syn species in oral mucosa samples were measured using electrochemiluminescence assays. Results Immunofluorescence images indicated elevated α-Syn, pS129, and α-Syn aggregates levels in oral mucosal cells of MSA than HCs. The concentrations of three α-Syn species were significantly higher in oral mucosal cells of MSA than HCs (α-Syn, p < 0.001; pS129, p = 0.042; α-Syn aggregates, p < 0.0001). In MSA patients, the oral mucosa α-Syn levels negatively correlated with disease duration (r = −0.398, p = 0.009). The area under curve (AUC) of receiver operating characteristic (ROC) analysis using an integrative model including age, gender, α-Syn, pS129, and α-Syn aggregates for MSA diagnosis was 0.825, with 73.8% sensitivity and 78.7% specificity. Conclusion The α-Syn levels in oral mucosal cells elevated in patients with MSA, which may be promising biomarkers for MSA.
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Affiliation(s)
- Yuanchu Zheng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huihui Cai
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajia Zhao
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenwei Yu
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing, China
- *Correspondence: Zhenwei Yu,
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tao Feng,
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Jotanovic J, Milin-Lazovic J, Alafuzoff I. Gastrointestinal Biopsy Obtained During Cancer Screening, a Biological Marker for α-Synucleinopathy? J Neuropathol Exp Neurol 2022; 81:356-362. [PMID: 35388426 PMCID: PMC9041339 DOI: 10.1093/jnen/nlac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The hallmark alteration in α-synucleinopathies, α-synuclein, is observed not only in the brain but also in the peripheral tissues, particularly in the intestine. This suggests that endoscopic biopsies performed for colon cancer screening could facilitate the assessment of α-synuclein in the gastrointestinal (GI) tract. Using immunohistochemistry for α-synuclein, we assessed whether GI biopsies could be used to confirm an ongoing α-synucleinopathy. Seventy-four subjects with cerebral α-synucleinopathy in various Braak stages with concomitant GI biopsies were available for study. In 81% of the subjects, α-synuclein was seen in the mucosal/submucosal GI biopsies. Two subjects with severe cerebral α-synucleinopathy and a long delay between biopsy and death displayed no α-synuclein pathology in the gut, and 11 subjects with sparse cerebral α-synucleinopathy displayed GI α-synuclein up to 36 years prior to death. The finding that there was no GI α-synuclein in 19% of the subjects with cerebral α-synucleinopathy, and α-synuclein was observed in the gut of 11 subjects (15%) with sparse cerebral α-synucleinopathy even many years prior to death is unexpected and jeopardizes the use of assessment of α-synuclein in the peripheral tissue for confirmation of an ongoing cerebral α-synucleinopathy.
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Affiliation(s)
- Jelena Jotanovic
- Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Jelena Milin-Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Irina Alafuzoff
- Department of Pathology, Uppsala University Hospital, Uppsala, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Signaevsky M, Marami B, Prastawa M, Tabish N, Iida MA, Zhang XF, Sawyer M, Duran I, Koenigsberg DG, Bryce CH, Chahine LM, Mollenhauer B, Mosovsky S, Riley L, Dave KD, Eberling J, Coffey CS, Adler CH, Serrano GE, White CL, Koll J, Fernandez G, Zeineh J, Cordon-Cardo C, Beach TG, Crary JF. Antemortem detection of Parkinson's disease pathology in peripheral biopsies using artificial intelligence. Acta Neuropathol Commun 2022; 10:21. [PMID: 35164870 PMCID: PMC8842941 DOI: 10.1186/s40478-022-01318-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
The diagnosis of Parkinson's disease (PD) is challenging at all stages due to variable symptomatology, comorbidities, and mimicking conditions. Postmortem assessment remains the gold standard for a definitive diagnosis. While it is well recognized that PD manifests pathologically in the central nervous system with aggregation of α-synuclein as Lewy bodies and neurites, similar Lewy-type synucleinopathy (LTS) is additionally found in the peripheral nervous system that may be useful as an antemortem biomarker. We have previously found that detection of LTS in submandibular gland (SMG) biopsies is sensitive and specific for advanced PD; however, the sensitivity is suboptimal especially for early-stage disease. Further, visual microscopic assessment of biopsies by a neuropathologist to identify LTS is impractical for large-scale adoption. Here, we trained and validated a convolutional neural network (CNN) for detection of LTS on 283 digital whole slide images (WSI) from 95 unique SMG biopsies. A total of 8,450 LTS and 35,066 background objects were annotated following an inter-rater reliability study with Fleiss Kappa = 0.72. We used transfer learning to train a CNN model to classify image patches (151 × 151 pixels at 20× magnification) with and without the presence of LTS objects. The trained CNN model showed the following performance on image patches: sensitivity: 0.99, specificity: 0.99, precision: 0.81, accuracy: 0.99, and F-1 score: 0.89. We further tested the trained network on 1230 naïve WSI from the same cohort of research subjects comprising 42 PD patients and 14 controls. Logistic regression models trained on features engineered from the CNN predictions on the WSI resulted in sensitivity: 0.71, specificity: 0.65, precision: 0.86, accuracy: 0.69, and F-1 score: 0.76 in predicting clinical PD status, and 0.64 accuracy in predicting PD stage, outperforming expert neuropathologist LTS density scoring in terms of sensitivity but not specificity. These findings demonstrate the practical utility of a CNN detector in screening for LTS, which can translate into a computational tool to facilitate the antemortem tissue-based diagnosis of PD in clinical settings.
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4
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Alpha-synuclein oligomers and small nerve fiber pathology in skin are potential biomarkers of Parkinson's disease. NPJ Parkinsons Dis 2021; 7:119. [PMID: 34930911 PMCID: PMC8688481 DOI: 10.1038/s41531-021-00262-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
The proximity ligation assay (PLA) is a specific and sensitive technique for the detection of αSyn oligomers (αSyn-PLA), early and toxic species implicated in the pathogenesis of PD. We aimed to evaluate by skin biopsy the diagnostic and prognostic capacity of αSyn-PLA and small nerve fiber reduction in PD in a longitudinal study. αSyn-PLA was performed in the ankle and cervical skin biopsies of PD (n = 30), atypical parkinsonisms (AP, n = 23) including multiple system atrophy (MSA, n = 12) and tauopathies (AP-Tau, n = 11), and healthy controls (HC, n = 22). Skin biopsy was also analyzed for phosphorylated αSyn (P-αSyn) and 5G4 (αSyn-5G4), a conformation-specific antibody to aggregated αSyn. Intraepidermal nerve fiber density (IENFD) was assessed as a measure of small fiber neuropathy. αSyn-PLA signal was more expressed in PD and MSA compared to controls and AP-Tau. αSyn-PLA showed the highest diagnostic accuracy (PD vs. HC sensitivity 80%, specificity 77%; PD vs. AP-Tau sensitivity 80%, specificity 82%), however, P-αSyn and 5G4, possible markers of later phases, performed better when considering the ankle site alone. A small fiber neuropathy was detected in PD and MSA. A progression of denervation not of pathological αSyn was detected at follow-up and a lower IENFD at baseline was associated with a greater cognitive and motor decline in PD. A skin biopsy-derived compound marker, resulting from a linear discrimination analysis model of αSyn-PLA, P-αSyn, αSyn-5G4, and IENFD, stratified patients with accuracy (77.8%), including the discrimination between PD and MSA (84.6%). In conclusion, the choice of pathological αSyn marker and anatomical site influences the diagnostic performance of skin biopsy and can help in understanding the temporal dynamics of αSyn spreading in the peripheral nervous system during the disease. Skin denervation, not pathological αSyn is a potential progression marker for PD.
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Nakagaki T, Nishida N, Satoh K. Development of α-Synuclein Real-Time Quaking-Induced Conversion as a Diagnostic Method for α-Synucleinopathies. Front Aging Neurosci 2021; 13:703984. [PMID: 34650422 PMCID: PMC8510559 DOI: 10.3389/fnagi.2021.703984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy are characterized by aggregation of abnormal α-synuclein (α-syn) and collectively referred to as α-synucleinopathy. Because these diseases have different prognoses and treatments, it is desirable to diagnose them early and accurately. However, it is difficult to accurately diagnose these diseases by clinical symptoms because symptoms such as muscle rigidity, postural dysreflexia, and dementia sometimes overlap among these diseases. The process of conformational conversion and aggregation of α-syn has been thought similar to that of abnormal prion proteins that cause prion diseases. In recent years, in vitro conversion methods, such as real-time quaking-induced conversion (RT-QuIC), have been developed. This method has succeeded in amplifying and detecting trace amounts of abnormal prion proteins in tissues and central spinal fluid of patients by inducing conversion of recombinant prion proteins via shaking. Additionally, it has been used for antemortem diagnosis of prion diseases. Recently, aggregated α-syn has also been amplified and detected in patients by applying this method and many clinical studies have examined diagnosis using tissues or cerebral spinal fluid from patients. In this review, we discuss the utility and problems of α-syn RT-QuIC for antemortem diagnosis of α-synucleinopathies.
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Affiliation(s)
- Takehiro Nakagaki
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriyuki Nishida
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsuya Satoh
- Department of Health Sciences, Unit of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Huang PL, Wang SJ, Sun RF, Zhu ZM, Li XL, Li WS, Wang MY, Lin M, Gong WJ. Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation: a case-control study. Neural Regen Res 2021; 17:1051-1058. [PMID: 34558532 PMCID: PMC8552866 DOI: 10.4103/1673-5374.324863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively improve impaired swallowing in Parkinson's disease (PD) patients with dysphagia. However, little is known about how rTMS affects the corresponding brain regions in this patient group. In this case-control study, we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy, Capital Medical University. The patients received high-frequency rTMS of the motor cortex once per day for 10 successive days. Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls. The results revealed that before treatment, PD patients with dysphagia showed greater activation in the precentral gyrus, supplementary motor area, and cerebellum compared with healthy controls, and this enhanced activation was weakened after treatment. Furthermore, before treatment, PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus, caudate nucleus, and left thalamus compared with healthy controls, and this activation increased after treatment. In addition, PD patients with dysphagia reported improved subjective swallowing sensations after rTMS. These findings suggest that swallowing function in PD patients with dysphagia improved after rTMS of the motor cortex. This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus. The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University (approval No. 2018bkky017) on March 6, 2018 and was registered with Chinese Clinical Trial Registry (registration No. ChiCTR 1800017207) on July 18, 2018.
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Affiliation(s)
- Pei-Ling Huang
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Song-Jian Wang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Rui-Feng Sun
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Zi-Man Zhu
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Xiao-Ling Li
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Wen-Shan Li
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Meng-Yue Wang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Meng Lin
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wei-Jun Gong
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
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7
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Cheslow L, Snook AE, Waldman SA. Emerging targets for the diagnosis of Parkinson's disease: examination of systemic biomarkers. Biomark Med 2021; 15:597-608. [PMID: 33988462 DOI: 10.2217/bmm-2020-0654] [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: 11/21/2022] Open
Abstract
Parkinson's disease (PD) is a highly prevalent and irreversible neurodegenerative disorder that is typically diagnosed in an advanced stage. Currently, there are no approved biomarkers that reliably identify PD patients before they have undergone extensive neuronal damage, eliminating the opportunity for future disease-modifying therapies to intervene in disease progression. This unmet need for diagnostic and therapeutic biomarkers has fueled PD research for decades, but these efforts have not yet yielded actionable results. Recently, studies exploring mechanisms underlying PD progression have offered insights into multisystemic contributions to pathology, challenging the classic perspective of PD as a disease isolated to the brain. This shift in understanding has opened the door to potential new biomarkers from multiple sites in the body. This review focuses on emerging candidates for PD biomarkers in the context of current diagnostic approaches and multiple organ systems that contribute to disease.
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Affiliation(s)
- Lara Cheslow
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Adam E Snook
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Scott A Waldman
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107, USA
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8
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Perra D, Bongianni M, Novi G, Janes F, Bessi V, Capaldi S, Sacchetto L, Tagliapietra M, Schenone G, Morbelli S, Fiorini M, Cattaruzza T, Mazzon G, Orrù CD, Catalan M, Polverino P, Bernardini A, Pellitteri G, Valente M, Bertolotti C, Nacmias B, Maggiore G, Cavallaro T, Manganotti P, Gigli G, Monaco S, Nobili F, Zanusso G. Alpha-synuclein seeds in olfactory mucosa and cerebrospinal fluid of patients with dementia with Lewy bodies. Brain Commun 2021; 3:fcab045. [PMID: 33870192 PMCID: PMC8042247 DOI: 10.1093/braincomms/fcab045] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 01/09/2023] Open
Abstract
In patients with suspected dementia with Lewy bodies, the detection of the disease-associated α-synuclein in easily accessible tissues amenable to be collected using minimally invasive procedures remains a major diagnostic challenge. This approach has the potential to take advantage of modern molecular assays for the diagnosis of α-synucleinopathy and, in turn, to optimize the recruitment and selection of patients in clinical trials, using drugs directed at counteracting α-synuclein aggregation. In this study, we explored the diagnostic accuracy of α-synuclein real-time quaking-induced conversion assay by testing olfactory mucosa and CSF in patients with a clinical diagnosis of probable (n = 32) or prodromal (n = 5) dementia with Lewy bodies or mixed degenerative dementia (dementia with Lewy bodies/Alzheimer's disease) (n = 6). Thirty-eight patients with non-α-synuclein-related neurodegenerative and non-neurodegenerative disorders, including Alzheimer's disease (n = 10), sporadic Creutzfeldt-Jakob disease (n = 10), progressive supranuclear palsy (n = 8), corticobasal syndrome (n = 1), fronto-temporal dementia (n = 3) and other neurological conditions (n = 6) were also included, as controls. All 81 patients underwent olfactory swabbing while CSF was obtained in 48 participants. At the initial blinded screening of olfactory mucosa samples, 38 out of 81 resulted positive while CSF was positive in 19 samples out of 48 analysed. After unblinding of the results, 27 positive olfactory mucosa were assigned to patients with probable dementia with Lewy bodies, five with prodromal dementia with Lewy bodies and three to patients with mixed dementia, as opposed to three out 38 controls. Corresponding results of CSF testing disclosed 10 out 10 positive samples in patients with probable dementia with Lewy bodies and six out of six with mixed dementia, in addition to three out of 32 for controls. The accuracy among results of real-time quaking-induced conversion assays and clinical diagnoses was 86.4% in the case of olfactory mucosa and 93.8% for CSF. For the first time, we showed that α-synuclein real-time quaking-induced conversion assay detects α-synuclein aggregates in olfactory mucosa of patients with dementia with Lewy bodies and with mixed dementia. Additionally, we provided preliminary evidence that the combined testing of olfactory mucosa and CSF raised the concordance with clinical diagnosis potentially to 100%. Our results suggest that nasal swabbing might be considered as a first-line screening procedure in patients with a diagnosis of suspected dementia with Lewy bodies followed by CSF analysis, as a confirmatory test, when the result in the olfactory mucosa is incongruent with the initial clinical diagnosis.
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Affiliation(s)
- Daniela Perra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Matilde Bongianni
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Giovanni Novi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, 50134 University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Stefano Capaldi
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, 37134 Verona, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Guido Schenone
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Health Science (DISSAL), University of Genova, 16132 Genova, Italy
| | - Michele Fiorini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Tatiana Cattaruzza
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Giulia Mazzon
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Christina D Orrù
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, 59840 Montana, USA
| | - Mauro Catalan
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Paola Polverino
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Gaia Pellitteri
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Mariarosa Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Claudio Bertolotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera- Universitaria Careggi, 50134 Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, 50134 Florence, Italy
| | - Tiziana Cavallaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Gianluigi Gigli
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child health (DINOGMI), University of Genova, 16132 Genova, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
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Wang Z, Becker K, Donadio V, Siedlak S, Yuan J, Rezaee M, Incensi A, Kuzkina A, Orrú CD, Tatsuoka C, Liguori R, Gunzler SA, Caughey B, Jimenez-Capdeville ME, Zhu X, Doppler K, Cui L, Chen SG, Ma J, Zou WQ. Skin α-Synuclein Aggregation Seeding Activity as a Novel Biomarker for Parkinson Disease. JAMA Neurol 2020; 78:2771032. [PMID: 32986090 PMCID: PMC7522783 DOI: 10.1001/jamaneurol.2020.3311] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/06/2020] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Deposition of the pathological α-synuclein (αSynP) in the brain is the hallmark of synucleinopathies, including Parkinson disease (PD), Lewy body dementia (LBD), and multiple system atrophy (MSA). Whether real-time quaking-induced conversion (RT-QuIC) and protein misfolding cyclic amplification (PMCA) assays can sensitively detect skin biomarkers for PD and non-PD synucleinopathies remains unknown. OBJECTIVE To develop sensitive and specific skin biomarkers for antemortem diagnosis of PD and other synucleinopathies. DESIGN, SETTING, AND PARTICIPANTS This retrospective and prospective diagnostic study evaluated autopsy and biopsy skin samples from neuropathologically and clinically diagnosed patients with PD and controls without PD. Autopsy skin samples were obtained at 3 medical centers from August 2016 to September 2019, and biopsy samples were collected from 3 institutions from August 2018 to November 2019. Based on neuropathological and clinical diagnoses, 57 cadavers with synucleinopathies and 73 cadavers with nonsynucleinopathies as well as 20 living patients with PD and 21 living controls without PD were included. Specifically, cadavers and participants had PD, LBD, MSA, Alzheimer disease, progressive supranuclear palsy, or corticobasal degeneration or were nonneurodegenerative controls (NNCs). A total of 8 approached biopsy participants either refused to participate in or were excluded from this study due to uncertain clinical diagnosis. Data were analyzed from September 2019 to April 2020. MAIN OUTCOMES AND MEASURES Skin αSynP seeding activity was analyzed by RT-QuIC and PMCA assays. RESULTS A total of 160 autopsied skin specimens from 140 cadavers (85 male cadavers [60.7%]; mean [SD] age at death, 76.8 [10.1] years) and 41 antemortem skin biopsies (27 male participants [66%]; mean [SD] age at time of biopsy, 65.3 [9.2] years) were analyzed. RT-QuIC analysis of αSynP seeding activity in autopsy abdominal skin samples from 47 PD cadavers and 43 NNCs revealed 94% sensitivity (95% CI, 85-99) and 98% specificity (95% CI, 89-100). As groups, RT-QuIC also yielded 93% sensitivity (95% CI, 85-97) and 93% specificity (95% CI, 83-97) among 57 cadavers with synucleinopathies (PD, LBD, and MSA) and 73 cadavers without synucleinopathies (Alzheimer disease, progressive supranuclear palsy, corticobasal degeneration, and NNCs). PMCA showed 82% sensitivity (95% CI, 76-88) and 96% specificity (95% CI, 85-100) with autopsy abdominal skin samples from PD cadavers. From posterior cervical and leg skin biopsy tissues from patients with PD and controls without PD, the sensitivity and specificity were 95% (95% CI, 77-100) and 100% (95% CI, 84-100), respectively, for RT-QuIC and 80% (95% CI, 49-96) and 90% (95% CI, 60-100) for PMCA. CONCLUSIONS AND RELEVANCE This study provides proof-of-concept that skin αSynP seeding activity may serve as a novel biomarker for antemortem diagnoses of PD and other synucleinopathies.
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Affiliation(s)
- Zerui Wang
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Katelyn Becker
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, Michigan
| | - Vincenzo Donadio
- IRCCS Institute of Neurological Sciences of Bologna, Complex Operational Unit Clinica Neurologica, Bologna, Italy
| | - Sandra Siedlak
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jue Yuan
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Masih Rezaee
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Alex Incensi
- IRCCS Institute of Neurological Sciences of Bologna, Complex Operational Unit Clinica Neurologica, Bologna, Italy
| | - Anastasia Kuzkina
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Christina D. Orrú
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, Hamilton, Montana
| | - Curtis Tatsuoka
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences of Bologna, Complex Operational Unit Clinica Neurologica, Bologna, Italy
| | - Steven A. Gunzler
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, Hamilton, Montana
| | | | - Xiongwei Zhu
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kathrin Doppler
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Li Cui
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shu G. Chen
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jiyan Ma
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, Michigan
| | - Wen-Quan Zou
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- National Center for Regenerative Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Manne S, Kondru N, Jin H, Serrano GE, Anantharam V, Kanthasamy A, Adler CH, Beach TG, Kanthasamy AG. Blinded RT-QuIC Analysis of α-Synuclein Biomarker in Skin Tissue From Parkinson's Disease Patients. Mov Disord 2020; 35:2230-2239. [PMID: 32960470 DOI: 10.1002/mds.28242] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND An unmet clinical need in Parkinson's disease (PD) is to identify biomarkers for diagnosis, preferably in peripherally accessible tissues such as skin. Immunohistochemical studies have detected pathological α-synuclein (αSyn) in skin biopsies from PD patients albeit sensitivity needs to be improved. OBJECTIVE Our study provides the ultrasensitive detection of pathological αSyn present in the skin of PD patients, and thus, pathological αSyn in skin could be a potential biomarker for PD. METHODS The real-time quaking-induced conversion assay was used to detect pathological αSyn present in human skin tissues. Further, we optimized this ultra-sensitive and specific assay for both frozen and formalin-fixed paraffin-embedded sections of skin tissues. We determined the seeding kinetics of the αSyn present in the skin from autopsied subjects consisting of frozen skin tissues from 25 PD and 25 controls and formalin-fixed paraffin-embedded skin sections from 12 PD and 12 controls. RESULTS In a blinded study of skin tissues from autopsied subjects, we correctly identified 24/25 PD and 24/25 controls using frozen skin tissues (96% sensitivity and 96% specificity) compared to 9/12 PD and 10/12 controls using formalin-fixed paraffin-embedded skin sections (75% sensitivity and 83% specificity). CONCLUSIONS Our blinded study results clearly demonstrate the feasibility of using skin tissues for clinical diagnosis of PD by detecting pathological αSyn. Moreover, this peripheral biomarker discovery study may have broader translational value in detecting misfolded proteins in skin samples as a longitudinal progression marker. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sireesha Manne
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA.,Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Naveen Kondru
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA.,Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Huajun Jin
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Geidy E Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Vellareddy Anantharam
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Arthi Kanthasamy
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Charles H Adler
- Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Anumantha G Kanthasamy
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
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11
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Chahine LM, Beach TG, Brumm MC, Adler CH, Coffey CS, Mosovsky S, Caspell-Garcia C, Serrano GE, Munoz DG, White CL, Crary JF, Jennings D, Taylor P, Foroud T, Arnedo V, Kopil CM, Riley L, Dave KD, Mollenhauer B. In vivo distribution of α-synuclein in multiple tissues and biofluids in Parkinson disease. Neurology 2020; 95:e1267-e1284. [PMID: 32747521 PMCID: PMC7538226 DOI: 10.1212/wnl.0000000000010404] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective The Systemic Synuclein Sampling Study (S4) measured α-synuclein in multiple tissues and biofluids within the same patients with Parkinson disease (PD) vs healthy controls (HCs). Methods S4 was a 6-site cross-sectional observational study of participants with early, moderate, or advanced PD and HCs. Motor and nonmotor measures and dopamine transporter SPECT were obtained. Biopsies of skin, colon, submandibular gland (SMG), CSF, saliva, and blood were collected. Tissue biopsy sections were stained with 5C12 monoclonal antibody against pathologic α-synuclein; digital images were interpreted by neuropathologists blinded to diagnosis. Biofluid total α-synuclein was quantified using ELISA. Results The final cohort included 59 patients with PD and 21 HCs. CSF α-synuclein was lower in patients with PD vs HCs; sensitivity/specificity of CSF α-synuclein for PD diagnosis was 87.0%/63.2%, respectively. Sensitivity of α-synuclein immunoreactivity for PD diagnosis was 56.1% for SMG and 24.1% for skin; specificity was 92.9% and 100%, respectively. There were no significant relationships between different measures of α-synuclein within participants. Conclusions S4 confirms lower total α-synuclein levels in CSF in patients with PD compared to HCs, but specificity is low. In contrast, α-synuclein immunoreactivity in skin and SMG is specific for PD but sensitivity is low. Relationships within participants across different tissues and biofluids could not be demonstrated. Measures of pathologic forms of α-synuclein with higher accuracy are critically needed. Classification of evidence This study provides Class III evidence that total CSF α-synuclein does not accurately distinguish patients with PD from HCs, and that monoclonal antibody staining for SMG and skin total α-synuclein is specific but not sensitive for PD diagnosis.
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Affiliation(s)
- Lana M Chahine
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany.
| | - Thomas G Beach
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Michael C Brumm
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Charles H Adler
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Christopher S Coffey
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Sherri Mosovsky
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Chelsea Caspell-Garcia
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Geidy E Serrano
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - David G Munoz
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Charles L White
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - John F Crary
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Danna Jennings
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Peggy Taylor
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Tatiana Foroud
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Vanessa Arnedo
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Catherine M Kopil
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Lindsey Riley
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Kuldip D Dave
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Brit Mollenhauer
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
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12
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Merchant KM, Cedarbaum JM, Brundin P, Dave KD, Eberling J, Espay AJ, Hutten SJ, Javidnia M, Luthman J, Maetzler W, Menalled L, Reimer AN, Stoessl AJ, Weiner DM. A Proposed Roadmap for Parkinson's Disease Proof of Concept Clinical Trials Investigating Compounds Targeting Alpha-Synuclein. JOURNAL OF PARKINSONS DISEASE 2020; 9:31-61. [PMID: 30400107 PMCID: PMC6398545 DOI: 10.3233/jpd-181471] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The convergence of human molecular genetics and Lewy pathology of Parkinson's disease (PD) have led to a robust, clinical-stage pipeline of alpha-synuclein (α-syn)-targeted therapies that have the potential to slow or stop the progression of PD and other synucleinopathies. To facilitate the development of these and earlier stage investigational molecules, the Michael J. Fox Foundation for Parkinson's Research convened a group of leaders in the field of PD research from academia and industry, the Alpha-Synuclein Clinical Path Working Group. This group set out to develop recommendations on preclinical and clinical research that can de-risk the development of α-syn targeting therapies. This consensus white paper provides a translational framework, from the selection of animal models and associated end-points to decision-driving biomarkers as well as considerations for the design of clinical proof-of-concept studies. It also identifies current gaps in our biomarker toolkit and the status of the discovery and validation of α-syn-associated biomarkers that could help fill these gaps. Further, it highlights the importance of the emerging digital technology to supplement the capture and monitoring of clinical outcomes. Although the development of disease-modifying therapies targeting α-syn face profound challenges, we remain optimistic that meaningful strides will be made soon toward the identification and approval of disease-modifying therapeutics targeting α-syn.
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Affiliation(s)
- Kalpana M Merchant
- Vincere Biosciences, Inc., and Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Patrik Brundin
- Van Andel Research Institute, Center for Neurodegenerative Science, Grand Rapids, MI, USA
| | - Kuldip D Dave
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Jamie Eberling
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Alberto J Espay
- UC Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Monica Javidnia
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Liliana Menalled
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Alyssa N Reimer
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Center, University of British Columbia, Vancouver, BC, Canada
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13
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Beach TG, Adler CH, Zhang N, Serrano GE, Sue LI, Driver-Dunckley E, Mehta SH, Zamrini EE, Sabbagh MN, Shill HA, Belden CM, Shprecher DR, Caselli RJ, Reiman EM, Davis KJ, Long KE, Nicholson LR, Intorcia AJ, Glass MJ, Walker JE, Callan MM, Oliver JC, Arce R, Gerkin RC. Severe hyposmia distinguishes neuropathologically confirmed dementia with Lewy bodies from Alzheimer's disease dementia. PLoS One 2020; 15:e0231720. [PMID: 32320406 PMCID: PMC7176090 DOI: 10.1371/journal.pone.0231720] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/30/2020] [Indexed: 11/19/2022] Open
Abstract
Many subjects with neuropathologically-confirmed dementia with Lewy bodies (DLB) are never diagnosed during life, instead being categorized as Alzheimer's disease dementia (ADD) or unspecified dementia. Unrecognized DLB therefore is a critical impediment to clinical studies and treatment trials of both ADD and DLB. There are studies that suggest that olfactory function tests may be able to distinguish DLB from ADD, but few of these had neuropathological confirmation of diagnosis. We compared University of Pennsylvania Smell Identification Test (UPSIT) results in 257 subjects that went on to autopsy and neuropathological examination. Consensus clinicopathological diagnostic criteria were used to define ADD and DLB, as well as Parkinson's disease with dementia (PDD), with (PDD+AD) or without (PDD-AD) concurrent AD; a group with ADD and Lewy body disease (LBD) not meeting criteria for DLB (ADLB) and a clinically normal control group were also included. The subjects with DLB, PDD+AD and PDD-AD all had lower (one-way ANOVA p < 0.0001, pairwise Bonferroni p < 0.05) first and mean UPSIT scores than the ADD, ADLB or control groups. For DLB subjects with first and mean UPSIT scores less than 20 and 17, respectively, Firth logistic regression analysis, adjusted for age, gender and mean MMSE score, conferred statistically significant odds ratios of 17.5 and 18.0 for the diagnosis, vs ADD. For other group comparisons (PDD+AD and PDD-AD vs ADD) and UPSIT cutoffs of 17, the same analyses resulted in odds ratios ranging from 16.3 to 31.6 (p < 0.0001). To our knowledge, this is the largest study to date comparing olfactory function in subjects with neuropathologically-confirmed LBD and ADD. Olfactory function testing may be a convenient and inexpensive strategy for enriching dementia studies or clinical trials with DLB subjects, or conversely, reducing the inclusion of DLB subjects in ADD studies or trials.
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Affiliation(s)
- Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Geidy E. Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Lucia I. Sue
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | | | - Shayamal H. Mehta
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Edouard E. Zamrini
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Marwan N. Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, United States of America
| | - Holly A. Shill
- Barrow Neurological Institute, Phoenix, Arizona, United States of America
| | - Christine M. Belden
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - David R. Shprecher
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Richard J. Caselli
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Eric M. Reiman
- Banner Alzheimer’s Institute, Phoenix, Arizona, United States of America
| | - Kathryn J. Davis
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Kathy E. Long
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Lisa R. Nicholson
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Anthony J. Intorcia
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Michael J. Glass
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Jessica E. Walker
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Michael M. Callan
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Javon C. Oliver
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Richard Arce
- Banner Sun Health Research Institute, Sun City, Arizona, United States of America
| | - Richard C. Gerkin
- School of Life Sciences, Arizona State University, Tempe, Arizona, United States of America
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14
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Dube U, Ibanez L, Budde JP, Benitez BA, Davis AA, Harari O, Iles MM, Law MH, Brown KM, Cruchaga C. Overlapping genetic architecture between Parkinson disease and melanoma. Acta Neuropathol 2020; 139:347-364. [PMID: 31845298 PMCID: PMC7379325 DOI: 10.1007/s00401-019-02110-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022]
Abstract
Epidemiologic studies have reported inconsistent results regarding an association between Parkinson disease (PD) and cutaneous melanoma (melanoma). Identifying shared genetic architecture between these diseases can support epidemiologic findings and identify common risk genes and biological pathways. Here, we apply polygenic, linkage disequilibrium-informed methods to the largest available case-control, genome-wide association study summary statistic data for melanoma and PD. We identify positive and significant genetic correlation (correlation: 0.17, 95% CI 0.10-0.24; P = 4.09 × 10-06) between melanoma and PD. We further demonstrate melanoma and PD-inferred gene expression to overlap across tissues (correlation: 0.14, 95% CI 0.06 to 0.22; P = 7.87 × 10-04) and highlight seven genes including PIEZO1, TRAPPC2L, and SOX6 as potential mediators of the genetic correlation between melanoma and PD. These findings demonstrate specific, shared genetic architecture between PD and melanoma that manifests at the level of gene expression.
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Affiliation(s)
- Umber Dube
- Medical Scientist Training Program, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave. CB8134, St. Louis, MO, 63110, USA
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, 660 S. Euclid Ave. B8111, St. Louis, MO, 63110, USA
| | - Laura Ibanez
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave. CB8134, St. Louis, MO, 63110, USA
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, 660 S. Euclid Ave. B8111, St. Louis, MO, 63110, USA
| | - John P Budde
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave. CB8134, St. Louis, MO, 63110, USA
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, 660 S. Euclid Ave. B8111, St. Louis, MO, 63110, USA
| | - Bruno A Benitez
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave. CB8134, St. Louis, MO, 63110, USA
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, 660 S. Euclid Ave. B8111, St. Louis, MO, 63110, USA
| | - Albert A Davis
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Oscar Harari
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave. CB8134, St. Louis, MO, 63110, USA
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, 660 S. Euclid Ave. B8111, St. Louis, MO, 63110, USA
| | - Mark M Iles
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kevin M Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave. CB8134, St. Louis, MO, 63110, USA.
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA.
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, 660 S. Euclid Ave. B8111, St. Louis, MO, 63110, USA.
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15
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Manne S, Kondru N, Jin H, Anantharam V, Huang X, Kanthasamy A, Kanthasamy AG. α-Synuclein real-time quaking-induced conversion in the submandibular glands of Parkinson's disease patients. Mov Disord 2019; 35:268-278. [PMID: 31758740 DOI: 10.1002/mds.27907] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Identification of a peripheral biomarker is a major roadblock in the diagnosis of PD. Immunohistological identification of p-serine 129 α-synuclein in the submandibular gland tissues of PD patients has been recently reported. OBJECTIVE We report on a proof-of-principle study for using an ultra-sensitive and specific, real-time quaking-induced conversion assay to detect pathological α-synuclein in the submandibular gland tissues of PD patients. METHODS The α-synuclein real-time quaking-induced conversion assay was used to detect and quantify pathological α-synuclein levels in PD, incidental Lewy body disease, and control submandibular gland tissues as well as in formalin-fixed paraffin-embedded sections. RESULTS We determined the quantitative seeding kinetics of pathological α-synuclein present in submandibular gland tissues from autopsied subjects using the α-synuclein real-time quaking-induced conversion assay. A total of 32 cases comprising 13 PD, 3 incidental Lewy body disease, and 16 controls showed 100% sensitivity and 94% specificity. Interestingly, both PD and incidental Lewy body disease tissues showed 100% concordance for elevated levels of pathological α-synuclein seeding activity compared to control tissues. End-point dilution kinetic analyses revealed that the submandibular gland had a wide dynamic range of pathological α-synuclein seeding activity. CONCLUSIONS Our results are the first to demonstrate the utility of using the real-time quaking-induced conversion assay on peripherally accessible submandibular gland tissues and formalin-fixed paraffin-embedded tissue sections to detect PD-related pathological changes with high sensitivity and specificity. Additionally, the detection of seeding activity from incidental Lewy body disease cases containing immunohistochemically undetected pathological α-synuclein demonstrates the α-synuclein real-time quaking-induced conversion assay's potential utility for identifying prodromal PD in submandibular gland tissues. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sireesha Manne
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Naveen Kondru
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Huajun Jin
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Vellareddy Anantharam
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Xuemei Huang
- Department of Neurology and Pharmacology, Neurosurgery, Radiology, and Kinesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Arthi Kanthasamy
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
| | - Anumantha G Kanthasamy
- Department of Biomedical Sciences, Parkinson's Disorder Research Program, Iowa Center for Advanced Neurotoxicology, Iowa State University, Ames, Iowa, USA
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16
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Chahine LM, Beach TG, Seedorff N, Caspell-Garcia C, Coffey CS, Brumm M, Adler CH, Serrano GE, Linder C, Mosovsky S, Foroud T, Riss H, Ecklund D, Seibyl J, Jennings D, Arnedo V, Riley L, Dave KD, Mollenhauer B. Feasibility and Safety of Multicenter Tissue and Biofluid Sampling for α-Synuclein in Parkinson's Disease: The Systemic Synuclein Sampling Study (S4). JOURNAL OF PARKINSONS DISEASE 2019; 8:517-527. [PMID: 30248065 PMCID: PMC6226302 DOI: 10.3233/jpd-181434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: α-synuclein is a lead Parkinson’s disease (PD) biomarker. There are conflicting reports regarding accuracy of α-synuclein in different tissues and biofluids as a PD biomarker, and the within-subject anatomical distribution of α-synuclein is not well described. The Systemic Synuclein Sampling Study (S4) aims to address these gaps in knowledge. The S4 is a multicenter, cross-sectional, observational study evaluating α-synuclein in multiple tissues and biofluids in PD and healthy controls (HC). Objective: To describe the baseline characteristics of the S4 cohort and safety and feasibility of this study. Methods: Participants underwent motor and non-motor clinical assessments, dopamine transporter SPECT, biofluid collection (cerebrospinal fluid, saliva, and blood), and tissue biopsies (skin, sigmoid colon, and submandibular gland). Biopsy adequacy was determined based on presence of adequate target tissue. Tissue sections were stained with the 5C12 monoclonal antibody against unmodified α-synuclein. All specimens were acquired and processed in a standardized manner. Adverse events were systematically recorded. Results: The final cohort consists of 82 participants (61 PD, 21 HC). In 68 subjects (83%), all types of specimens were obtained but only 50 (61%) of subjects had all specimens both collected and evaluable for α-synuclein. Mild adverse events were common, especially for submandibular gland biopsy, but only 1 severe adverse event occurred. Conclusion: Multicenter tissue and biofluid sampling for α-synuclein is feasible and generally safe. S4 will inform understanding of the concurrent distribution of α-synuclein pathology and biomarkers in biofluids and peripheral nervous system in PD.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Nicholas Seedorff
- Department of Biostatistics, The University of Iowa, Iowa City, IA, USA
| | | | | | - Michael Brumm
- Department of Biostatistics, The University of Iowa, Iowa City, IA, USA
| | | | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Carly Linder
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sherri Mosovsky
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Holly Riss
- Department of Biostatistics, The University of Iowa, Iowa City, IA, USA
| | - Dixie Ecklund
- Department of Biostatistics, The University of Iowa, Iowa City, IA, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | | | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - K D Dave
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center Goettingen, Goettingen, Germany
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17
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Jankovic J, Goodman I, Safirstein B, Marmon TK, Schenk DB, Koller M, Zago W, Ness DK, Griffith SG, Grundman M, Soto J, Ostrowitzki S, Boess FG, Martin-Facklam M, Quinn JF, Isaacson SH, Omidvar O, Ellenbogen A, Kinney GG. Safety and Tolerability of Multiple Ascending Doses of PRX002/RG7935, an Anti-α-Synuclein Monoclonal Antibody, in Patients With Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2019; 75:1206-1214. [PMID: 29913017 DOI: 10.1001/jamaneurol.2018.1487] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Aggregated α-synuclein is believed to be central to the pathogenesis of Parkinson disease (PD). PRX002/RG7935 (PRX002) is a humanized monoclonal antibody designed to target aggregated forms of α-synuclein, thereby inhibiting neuron-to-neuron transfer of presumed pathogenic forms of α-synuclein, potentially resulting in neuronal protection and slowing disease progression. Objective To evaluate the safety and tolerability of multiple intravenous infusions of PRX002 in patients with idiopathic PD. Design, Setting, and Participants Multicenter, randomized, double-blind, placebo-controlled, multiple ascending-dose trial at 8 US study centers from July 2014 to September 2016. Eligible participants were aged 40 to 80 years with mild to moderate idiopathic PD (Hoehn and Yahr stages 1-3). Interventions Participants were enrolled into 6 ascending-dose cohorts and randomly assigned to receive PRX002 (0.3 mg/kg, 1.0 mg/kg, 3.0 mg/kg, 10 mg/kg, 30 mg/kg, or 60 mg/kg) or placebo. Participants received 3 intravenous infusions every 4 weeks of PRX002 or placebo and were monitored during a 24-week observational period. Main Outcomes and Measures Safety and tolerability assessments included physical and neurological examinations, laboratory tests, vital signs, and adverse events. Pharmacokinetic parameters included maximum PRX002 concentration, area under the curve, and half-life. Results Of the 80 participants, most were white (97.5%; n = 78) and male (80%; n = 64); median (SD) age was 58 (8.4) years. PRX002 was generally safe and well tolerated; no serious or severe PRX002-related treatment-emergent adverse events (TEAEs) were reported. The TEAEs experienced by at least 5% of patients receiving PRX002, irrespective of relatedness to study drug, were constipation (9.1%; n = 5), infusion reaction (7.3%; n = 4), diarrhea (5.5%; n = 3), headache (5.5%; n = 3), peripheral edema (5.5%; n = 3), post-lumbar puncture syndrome (5.5%; n = 3), and upper respiratory tract infection (5.5%; n = 3). No antidrug antibodies were detected. Serum PRX002 levels increased in an approximately dose-proportional manner; mean terminal elimination half-life was similar across all doses (10.2 days). Rapid dose- and time-dependent mean reductions from baseline vs placebo in free serum α-synuclein levels of up to 97% were seen after a single infusion at the highest dose (F78,284 = 1.66; P = .002), with similar reductions after 2 additional infusions. Mean cerebrospinal fluid PRX002 concentration increased with PRX002 dose and was approximately 0.3% relative to serum across all dose cohorts. Conclusions and Relevance Single and multiple doses of PRX002 were generally safe and well tolerated and resulted in robust binding of peripheral α-synuclein and dose-dependent increases of PRX002 in cerebrospinal fluid, reaching cerebrospinal fluid concentrations that may be expected to engage extracellular aggregated α-synuclein in the brain. Findings support the design of an ongoing phase 2 clinical study (NCT03100149). Trial Registration ClinicalTrials.gov Identifier: NCT02157714.
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas
| | | | | | - Tonya K Marmon
- Prothena Biosciences Inc, South San Francisco, California
| | - Dale B Schenk
- Prothena Biosciences Inc, South San Francisco, California
| | - Martin Koller
- Prothena Biosciences Inc, South San Francisco, California
| | - Wagner Zago
- Prothena Biosciences Inc, South San Francisco, California
| | - Daniel K Ness
- Prothena Biosciences Inc, South San Francisco, California
| | | | - Michael Grundman
- University of California, San Diego.,Global R&D Partners, LLC, San Diego, California
| | - Jay Soto
- Prothena Biosciences Inc, South San Francisco, California
| | - Susanne Ostrowitzki
- Genentech Inc, Product Development, Neuroscience, South San Francisco, California
| | | | | | - Joseph F Quinn
- Oregon Health & Science University, Portland.,Portland Veterans Affairs Medical Center, Portland, Oregon
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida
| | - Omid Omidvar
- Collaborative Neuroscience Network LLC, Long Beach, California
| | | | - Gene G Kinney
- Prothena Biosciences Inc, South San Francisco, California
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18
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Beach TG, Serrano GE, Kremer T, Canamero M, Dziadek S, Sade H, Derkinderen P, Corbillé AG, Letournel F, Munoz DG, White CL, Schneider J, Crary JF, Sue LI, Adler CH, Glass MJ, Intorcia AJ, Walker JE, Foroud T, Coffey CS, Ecklund D, Riss H, Goßmann J, König F, Kopil CM, Arnedo V, Riley L, Linder C, Dave KD, Jennings D, Seibyl J, Mollenhauer B, Chahine L. Immunohistochemical Method and Histopathology Judging for the Systemic Synuclein Sampling Study (S4). J Neuropathol Exp Neurol 2019; 77:793-802. [PMID: 30107604 DOI: 10.1093/jnen/nly056] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Immunohistochemical (IHC) α-synuclein (Asyn) pathology in peripheral biopsies may be a biomarker of Parkinson disease (PD). The multi-center Systemic Synuclein Sampling Study (S4) is evaluating IHC Asyn pathology within skin, colon and submandibular gland biopsies from 60 PD and 20 control subjects. Asyn pathology is being evaluated by a blinded panel of specially trained neuropathologists. Preliminary work assessed 2 candidate immunoperoxidase methods using a set of PD and control autopsy-derived sections from formalin-fixed, paraffin-embedded blocks of the 3 tissues. Both methods had 100% specificity; one, utilizing the 5C12 monoclonal antibody, was more sensitive in skin (67% vs 33%), and was chosen for further use in S4. Four trainee neuropathologists were trained to perform S4 histopathology readings; in subsequent testing, their scoring was compared to that of the trainer neuropathologist on both glass slides and digital images. Specificity and sensitivity were both close to 100% with all readers in all tissue types on both glass slides and digital images except for skin, where sensitivity averaged 75% with digital images and 83.5% with glass slides. Semiquantitative (0-3) density score agreement between trainees and trainer averaged 67% for glass slides and 62% for digital images.
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Affiliation(s)
- Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Thomas Kremer
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Marta Canamero
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Sebastian Dziadek
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Hadassah Sade
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffman-La Roche, Ltd, Basel, Switzerland.,Roche Pharma Research and Early Development, Roche Innovation Center, Munich, Penzberg, Germany
| | - Pascal Derkinderen
- Department of Neurology, CHU Nantes, Inserm, U1235, Nantes University, Nantes F-44035, France.,CHU Angers, Neurobiology and Neuropathology Laboratory, Angers F-49033, France
| | - Anne-Gaëlle Corbillé
- Department of Neurology, CHU Nantes, Inserm, U1235, Nantes University, Nantes F-44035, France.,CHU Angers, Neurobiology and Neuropathology Laboratory, Angers F-49033, France
| | - Franck Letournel
- Department of Neurology, CHU Nantes, Inserm, U1235, Nantes University, Nantes F-44035, France.,CHU Angers, Neurobiology and Neuropathology Laboratory, Angers F-49033, France
| | - David G Munoz
- Laboratory Medicine and Keenan Research Centre for Biomedical Research of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - John F Crary
- Department of Pathology, Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lucia I Sue
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Charles H Adler
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Michael J Glass
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Anthony J Intorcia
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Jessica E Walker
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Tatiana Foroud
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Dixie Ecklund
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Holly Riss
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | | | - Fatima König
- Targos Molecular Pathology GmbH, Kassel, Germany
| | - Catherine M Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Carly Linder
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kuldip D Dave
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center Goettingen, Goettingen, Germany
| | - Lana Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
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19
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Coon EA, Singer W, Low PA. Pure Autonomic Failure. Mayo Clin Proc 2019; 94:2087-2098. [PMID: 31515103 PMCID: PMC6826339 DOI: 10.1016/j.mayocp.2019.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
Pure autonomic failure (PAF) is a neurodegenerative disorder of the autonomic nervous system clinically characterized by orthostatic hypotension. The disorder has also been known as Bradbury-Eggleston syndrome, named for the authors of the 1925 seminal description. Patients typically present in midlife or later with orthostatic hypotension or syncope. Autonomic failure may also manifest as genitourinary, bowel, and thermoregulatory dysfunction. With widespread involvement, patients may present to a variety of different specialties and require multidisciplinary treatment approaches. Pathologically, PAF is characterized by predominantly peripheral deposition of α-synuclein. However, patients with PAF may progress into other synucleinopathies with central nervous system involvement.
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20
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Kuzkina A, Schulmeyer L, Monoranu CM, Volkmann J, Sommer C, Doppler K. The aggregation state of α-synuclein deposits in dermal nerve fibers of patients with Parkinson's disease resembles that in the brain. Parkinsonism Relat Disord 2019; 64:66-72. [DOI: 10.1016/j.parkreldis.2019.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
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21
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Xie F, Gao X, Yang W, Chang Z, Yang X, Wei X, Huang Z, Xie H, Yue Z, Zhou F, Wang Q. Advances in the Research of Risk Factors and Prodromal Biomarkers of Parkinson's Disease. ACS Chem Neurosci 2019; 10:973-990. [PMID: 30590011 DOI: 10.1021/acschemneuro.8b00520] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease in the world. With the advent of an aging population and improving life expectancy worldwide, the number of PD patients is expected to increase, which may lead to an urgent need for effective preventive and diagnostic strategies for PD. Although there is increasing research regarding the pathogenesis of PD, there is limited knowledge regarding the prevention of PD. Moreover, the diagnosis of PD depends on clinical criteria, which require the occurrence of bradykinesia and at least one symptom of rest tremor or rigidity. However, converging evidence from clinical, genetic, neuropathological, and imaging studies suggests the initiation of PD-specific pathology prior to the initial presentation of these classical motor clinical features by years or decades. This latent stage of neurodegeneration in PD is a particularly important stage for effective neuroprotective therapies, which might retard the progression or prevent the onset of PD. Therefore, the exploration of risk factors and premotor biomarkers is not only crucial to the early diagnosis of PD but is also helpful in the development of effective neuroprotection and health care strategies for appropriate populations at risk for PD. In this review, we searched and summarized ∼249 researches and 31 reviews focusing on the risk factors and prodromal biomarkers of PD and published in MEDLINE.
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Affiliation(s)
- Fen Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Xiaoya Gao
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Wanlin Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Zihan Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Xiaobo Wei
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Zifeng Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Huifang Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Zhenyu Yue
- Department of Neurology, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, Hess Research Center Ninth Floor, New York, New York 10029, United States
| | - Fengli Zhou
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
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Jeziorska M, Atkinson A, Kass-Iliyya L, Javed S, Kobylecki C, Gosal D, Marshall A, Silverdale M, Malik RA. Increased Intraepidermal Nerve Fiber Degeneration and Impaired Regeneration Relate to Symptoms and Deficits in Parkinson's Disease. Front Neurol 2019; 10:111. [PMID: 30837937 PMCID: PMC6383044 DOI: 10.3389/fneur.2019.00111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Previous studies have shown cutaneous small fiber pathology in patients with Parkinson's disease (PD). These studies have focused on nerve degeneration, but recent reports suggest that nerve regeneration may also be important in PD pathology. Objective: To establish the extent of intraepidermal nerve fiber (IENF) degeneration and regeneration and its relationship to clinical and neurological deficits in Parkinson's disease (PD). Methods: Twenty-three PD patients and 10 age-matched controls underwent skin biopsy and assessment of somatic and autonomic symptoms and deficits. We have assessed Intraepidermal Nerve Fiber Density (IENFD) using standard PGP9.5 staining and GAP-43 to assess Mean Axonal Length (MAL) and Intraepidermal Total Nerve Fiber Length (IETNFL). Results: IENFD (p < 0.0001), MAL (p < 0.0001), IETNFL/Area (p = 0.009), and IETNFL/Length (p = 0.04) were significantly reduced in patients with PD compared to controls. IENFD correlated significantly with disease duration (p = 0.03), cumulative levodopa dose (p = 0.02), Unified Parkinson's Disease Rating Scale, Part III (UPDRS-III) (p = 0.01), Schwab and England Activities of Daily Living (ADL) (p = 0.03), NSP (p = 0.03), and 30:15 ratio (p = 0.03). IETNFL/Area correlated with the Autonomic Scale for Outcomes in Parkinson's Disease (SCOPA-AUT) (p = 0.03) and Diabetic Neuropathy Symptom score (DNS) (p = 0.04) and IETNFL/Length correlated with DNS (p = 0.03). MAL correlated with SCOPA-AUT (p = 0.01), DNS (p = 0.02), and DB-HRV (p = 0.02). Conclusion: Increased IENF degeneration and impaired regeneration correlates with somatic and autonomic symptoms and deficits in patients with PD.
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Affiliation(s)
- Maria Jeziorska
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew Atkinson
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Lewis Kass-Iliyya
- Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.,Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Saad Javed
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Christopher Kobylecki
- Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.,Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - David Gosal
- Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Andrew Marshall
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Department of Clinical Neurophysiology, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Monty Silverdale
- Department of Neurology, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.,Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.,Weill Cornell Medicine-Qatar, Doha, Qatar
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23
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Donadio V. Skin nerve α-synuclein deposits in Parkinson's disease and other synucleinopathies: a review. Clin Auton Res 2018; 29:577-585. [PMID: 30506233 DOI: 10.1007/s10286-018-0581-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE The in vivo diagnosis of synucleinopathies is an important research aim since clinical diagnostic criteria show low accuracy. The skin innervation, especially the autonomic subdivision, is a useful region to search for abnormal α-syn aggregates in synucleinopathies since the peripheral sympathetic nerves can be the earliest-affected neural region and autonomic symptoms may precede the classical symptoms of these disorders. METHODS The major advantages of skin biopsy as an in vivo diagnostic tool for synucleinopathies are that it is an inexpensive and easy-to-perform technique requiring only limited facilities, and that it is repeatable in long-term studies as it causes only minor discomfort to the patient. RESULTS This review analyzes current progress in this area of research that may facilitate the standardization of this method, potentially eliminating differences among laboratories in the implementation of the method. CONCLUSIONS The most suitable and commonly used technique for identifying in vivo α-syn aggregates in skin nerves is indirect immunofluorescence, although several aspects of this approach need to be standardized, particularly when synucleinopathies without autonomic failure present a patchy distribution of abnormal α-syn aggregates in skin nerves. By contrast, synucleinopathies with autonomic failure may present widespread diffusion of abnormal aggregates in autonomic skin nerves.
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Affiliation(s)
- Vincenzo Donadio
- IRCCS Istituto Delle Scienze Neurologiche di Bologna (Italy), UOC Clinica Neurologica, Via Altura 3, 40139, Bologna, Italy.
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24
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Melli G, Vacchi E, Biemmi V, Galati S, Staedler C, Ambrosini R, Kaelin-Lang A. Cervical skin denervation associates with alpha-synuclein aggregates in Parkinson disease. Ann Clin Transl Neurol 2018; 5:1394-1407. [PMID: 30480033 PMCID: PMC6243385 DOI: 10.1002/acn3.669] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 01/22/2023] Open
Abstract
Objective Autonomic nervous system is involved at the onset of Parkinson disease (PD), and alpha‐synuclein (α‐Syn) and its phosphorylated form (p‐αSyn) have been detected in dermal autonomic nerve fibers of PD. We assessed disease specific conformation variant of α‐Syn immunoreactivity in cutaneous nerves and characterized skin denervation patterns in PD and atypical parkinsonism (AP). Methods We enrolled 49 subjects, 19 with PD, 17 age‐matched healthy controls, and 13 with AP. The manifestations of disease were rated on clinical scales. Skin biopsies from ankle, thigh, and neck were analyzed by immunofluorescence for p‐αSyn, 5G4 as a conformation specific antibody to pathogenic α‐Syn and PGP9.5 as axonal marker. Intraepidermal nerve fiber density was measured in all anatomical sites as marker of neurodegeneration. Thirteen of the 19 PD underwent a 1 year follow‐up visit plus skin biopsies. Results PD subjects displayed more severe cervical skin denervation (P < 0.03), which correlated to disease duration and worsened between initial and follow‐up examination (P < 0.001). p‐αSyn and 5G4 were equally sensitive and specific for the diagnosis of PD (area under the ROC was 0.839 for p‐αSyn and 0.886 for 5G4). PD and AP with possible alpha‐synucleinopathies share the features of marked cervical denervation and the presence of 5G4. In contrast AP with possible tauopathies were normal. Interpretation Conformational specific forms of α‐Syn are detectable in skin biopsy by immunofluorescence in PD, with a promising diagnostic efficiency similar to p‐αSyn. Cervical cutaneous denervation correlates with disease duration and increases over time standing out as a potential biomarker of PD progression.
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Affiliation(s)
- Giorgia Melli
- Laboratory for Biomedical Neurosciences Neurocentre of Southern Switzerland Via ai Söi 24. CH-6807 Torricella-Taverne Switzerland.,Neurology Department Neurocentre of Southern Switzerland Via Tesserete 46 CH-6900 Lugano Switzerland
| | - Elena Vacchi
- Laboratory for Biomedical Neurosciences Neurocentre of Southern Switzerland Via ai Söi 24. CH-6807 Torricella-Taverne Switzerland
| | - Vanessa Biemmi
- Laboratory for Biomedical Neurosciences Neurocentre of Southern Switzerland Via ai Söi 24. CH-6807 Torricella-Taverne Switzerland
| | - Salvatore Galati
- Laboratory for Biomedical Neurosciences Neurocentre of Southern Switzerland Via ai Söi 24. CH-6807 Torricella-Taverne Switzerland.,Neurology Department Neurocentre of Southern Switzerland Via Tesserete 46 CH-6900 Lugano Switzerland
| | - Claudio Staedler
- Neurology Department Neurocentre of Southern Switzerland Via Tesserete 46 CH-6900 Lugano Switzerland
| | - Roberto Ambrosini
- Department of Environmental Science and Policy University of Milan Via Celoria 26, I-20133 Milan Italy
| | - Alain Kaelin-Lang
- Laboratory for Biomedical Neurosciences Neurocentre of Southern Switzerland Via ai Söi 24. CH-6807 Torricella-Taverne Switzerland.,Neurology Department Neurocentre of Southern Switzerland Via Tesserete 46 CH-6900 Lugano Switzerland.,Department of Neurology Inselspital Bern University Hospital University of Bern Freiburgstrasse 4,3010 Bern Switzerland
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25
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Cova I, Priori A. Diagnostic biomarkers for Parkinson's disease at a glance: where are we? J Neural Transm (Vienna) 2018; 125:1417-1432. [PMID: 30145631 PMCID: PMC6132920 DOI: 10.1007/s00702-018-1910-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder whose aetiology remains unclear: degeneration involves several neurotransmission systems, resulting in a heterogeneous disease characterized by motor and non-motor symptoms. PD causes progressive disability that responds only to symptomatic therapies. Future advances include neuroprotective strategies for use in at-risk populations before the clinical onset of disease, hence the continuing need to identify reliable biomarkers that can facilitate the clinical diagnosis of PD. In this evaluative review, we summarize information on potential diagnostic biomarkers for use in the clinical and preclinical stages of PD.
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Affiliation(s)
- Ilaria Cova
- Neurology Unit, L. Sacco University Hospital, Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy.
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26
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Non-cell-autonomous actions of α-synuclein: Implications in glial synucleinopathies. Prog Neurobiol 2018; 169:158-171. [DOI: 10.1016/j.pneurobio.2018.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/24/2017] [Accepted: 06/30/2018] [Indexed: 01/11/2023]
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27
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Beach TG, Adler CH. Importance of low diagnostic Accuracy for early Parkinson's disease. Mov Disord 2018; 33:1551-1554. [PMID: 30288780 PMCID: PMC6544441 DOI: 10.1002/mds.27485] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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28
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Ortuño-Lizarán I, Beach TG, Serrano GE, Walker DG, Adler CH, Cuenca N. Phosphorylated α-synuclein in the retina is a biomarker of Parkinson's disease pathology severity. Mov Disord 2018; 33:1315-1324. [PMID: 29737566 PMCID: PMC6146055 DOI: 10.1002/mds.27392] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND PD patients often have visual alterations, for example, loss of visual acuity, contrast sensitivity or motion perception, and diminished electroretinogram responses. PD pathology is mainly characterized by the accumulation of pathological α-synuclein deposits in the brain, but little is known about how synucleinopathy affects the retina. OBJECTIVE To study the correlation between α-synuclein deposits in the retina and brain of autopsied subjects with PD and incidental Lewy body disease. METHODS We evaluated the presence of phosphorylated α-synuclein in the retina of autopsied subjects with PD (9 subjects), incidental Lewy body disease (4 subjects), and controls (6 subjects) by immunohistochemistry and compared the retinal synucleinopathy with brain disease severity indicators. RESULTS Whereas controls did not show any phosphorylated α-synuclein immunoreactivity in their retina, all PD subjects and 3 of 4 incidental Lewy body disease subjects had phosphorylated α-synuclein deposits in ganglion cell perikarya, dendrites, and axons, some of them resembling brain Lewy bodies and Lewy neurites. The Lewy-type synucleinopathy density in the retina significantly correlated with Lewy-type synucleinopathy density in the brain, with the Unified Parkinson's disease pathology stage and with the motor UPDRS. CONCLUSION These data suggest that phosphorylated α-synuclein accumulates in the retina in parallel with that in the brain, including in early stages preceding development of clinical signs of parkinsonism or dementia. Therefore, the retina may provide an in vivo indicator of brain pathology severity, and its detection could help in the diagnosis and monitoring of disease progression. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | | | - Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, Spain
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29
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Martinez-Valbuena I, Amat-Villegas I, Valenti-Azcarate R, Carmona-Abellan MDM, Marcilla I, Tuñon MT, Luquin MR. Interaction of amyloidogenic proteins in pancreatic β cells from subjects with synucleinopathies. Acta Neuropathol 2018. [PMID: 29536165 DOI: 10.1007/s00401-018-1832-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Parkinson's disease patients experience a wide range of non-motor symptoms that may be provoked by deposits of phosphorylated α-synuclein in the peripheral nervous system. Pre-existing diabetes mellitus might be a risk factor for developing Parkinson's disease, and indeed, nearly 60% of Parkinson's disease patients are insulin resistant. Thus, we have investigated whether phosphorylated α-synuclein is deposited in pancreatic tissue of subjects with synucleinopathies. We studied pancreatic tissue from 39 subjects diagnosed with Parkinson's disease, Lewy body Dementia or incidental Lewy bodies disease, as well as that from 34 subjects with diabetes mellitus and a normal neuropathological examination, and 52 subjects with a normal neuropathological examination. We examined the pancreatic accumulation of phosphorylated α-synuclein and of the islet amyloid polypeptide precursor (IAPP), an amyloidogenic protein that plays an unknown role in diabetes mellitus, but that can promote α-synuclein amyloid deposition in vitro. Moreover, we performed proximity ligation assays to assess whether these two proteins interact in the pancreas of these subjects. Cytoplasmic phosphorylated α-synuclein deposits were found in the pancreatic β cells of 14 subjects with Parkinson's disease (93%), in 11 subjects with Lewy body Dementia (85%) and in 8 subjects with incidental Lewy body disease (73%). Furthermore, we found similar phosphorylated α-synuclein inclusions in 23 subjects with a normal neuropathological examination but with diabetes mellitus (68%) and in 9 control subjects (17%). In addition, IAPP/α-synuclein interactions appear to occur in patients with pancreatic inclusions of phosphorylated α-synuclein. The presence of phosphorylated α-synuclein inclusions in pancreatic β cells provides a new evidence of a mechanism that is potentially common to the pathogenesis of diabetes mellitus, PD and DLB. Moreover, the interaction of IAPP and α-synuclein in the pancreatic β cells of patients may represent a novel target for the development of strategies to treat these diseases.
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Affiliation(s)
- Ivan Martinez-Valbuena
- Neurology Department, Clinica Universidad de Navarra, Avenida de Pio XII 36, 31008, Pamplona, Navarra, Spain
- Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Irene Amat-Villegas
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
- Pathology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Rafael Valenti-Azcarate
- Neurology Department, Clinica Universidad de Navarra, Avenida de Pio XII 36, 31008, Pamplona, Navarra, Spain
- Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Maria Del Mar Carmona-Abellan
- Neurology Department, Clinica Universidad de Navarra, Avenida de Pio XII 36, 31008, Pamplona, Navarra, Spain
- Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Irene Marcilla
- Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Maria-Teresa Tuñon
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
- Pathology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Maria-Rosario Luquin
- Neurology Department, Clinica Universidad de Navarra, Avenida de Pio XII 36, 31008, Pamplona, Navarra, Spain.
- Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain.
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30
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Ekmark-Lewén S, Lindström V, Gumucio A, Ihse E, Behere A, Kahle PJ, Nordström E, Eriksson M, Erlandsson A, Bergström J, Ingelsson M. Early fine motor impairment and behavioral dysfunction in (Thy-1)-h[A30P] alpha-synuclein mice. Brain Behav 2018; 8:e00915. [PMID: 29541535 PMCID: PMC5840441 DOI: 10.1002/brb3.915] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Intraneuronal inclusions of alpha-synuclein are commonly found in the brain of patients with Parkinson's disease and other α-synucleinopathies. The correlation between alpha-synuclein pathology and symptoms has been studied in various animal models. In (Thy-1)-h[A30P] alpha-synuclein transgenic mice, behavioral and motor abnormalities were reported from 12 and 15 months, respectively. The aim of this study was to investigate whether these mice also display symptoms at earlier time points. METHODS We analyzed gait deficits, locomotion, and behavioral profiles in (Thy-1)-h[A30P] alpha-synuclein and control mice at 2, 8, and 11 months of age. In addition, inflammatory markers, levels of alpha-synuclein oligomers, and tyrosine hydroxylase reactivity were studied. RESULTS Already at 2 months of age, transgenic mice displayed fine motor impairments in the challenging beam test that progressively increased up to 11 months of age. At 8 months, transgenic mice showed a decreased general activity with increased risk-taking behavior in the multivariate concentric square field test. Neuropathological analyses of 8- and 11-month-old mice revealed accumulation of oligomeric alpha-synuclein in neuronal cell bodies. In addition, a decreased presence of tyrosine hydroxylase suggests a dysregulation of the dopaminergic system in the transgenic mice, which in turn may explain some of the motor impairments observed in this mouse model. CONCLUSIONS Taken together, our results show that the (Thy-1)-h[A30P] alpha-synuclein transgenic mouse model displays early Parkinson's disease-related symptoms with a concomitant downregulation of the dopaminergic system. Thus, this should be an appropriate model to study early phenotypes of alpha-synucleinopathies.
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Affiliation(s)
- Sara Ekmark-Lewén
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Veronica Lindström
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Astrid Gumucio
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Elisabeth Ihse
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Anish Behere
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Philipp J Kahle
- Department of Neurodegeneration Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases Tübingen Germany
| | | | | | - Anna Erlandsson
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Joakim Bergström
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
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31
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Lionnet A, Leclair-Visonneau L, Neunlist M, Murayama S, Takao M, Adler CH, Derkinderen P, Beach TG. Does Parkinson's disease start in the gut? Acta Neuropathol 2018; 135:1-12. [PMID: 29039141 DOI: 10.1007/s00401-017-1777-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
Parkinson's disease (PD) is pathologically characterized by the presence of intraneuronal inclusions, termed Lewy bodies and Lewy neurites, whose main component is alpha-synuclein. Based on the topographic distribution of Lewy bodies and neurites established after autopsy from PD patients, Braak and coworkers hypothesized that PD pathology may start in the gastrointestinal tract then spread through the vagus nerve to the brain. This hypothesis has been reinforced by the discovery that alpha-synuclein may be capable of spreading transcellularly, thereby providing a mechanistic basis for Braak's hypothesis. This 'gut to brain' scenario has ignited heated debates within the movement disorders community and prompted a large number of studies in both humans and animals. Here, we review the arguments for and against the gut as the origin of PD. We conclude that the human autopsy evidence does not support the hypothesis and that it is too early to draw any definitive conclusions. We discuss how this issue might be further addressed in future research.
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Affiliation(s)
- Arthur Lionnet
- Department of Neurology, CHU Nantes, 44093, Nantes, France
- Inserm, U1235, 1, rue Gaston Veil, 44035, Nantes Cedex 1, France
| | - Laurène Leclair-Visonneau
- Inserm, U1235, 1, rue Gaston Veil, 44035, Nantes Cedex 1, France
- Nantes University, 44035, Nantes, France
- Department of Clinical Neurophysiology, CHU Nantes, 44093, Nantes, France
| | - Michel Neunlist
- Inserm, U1235, 1, rue Gaston Veil, 44035, Nantes Cedex 1, France
- Nantes University, 44035, Nantes, France
| | - Shigeo Murayama
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Masaki Takao
- Department of Neurology, Saitama International Medical Center, Saitama Medical University, Yamane, Hidaka, Saitama, 350-1298, Japan
| | | | - Pascal Derkinderen
- Department of Neurology, CHU Nantes, 44093, Nantes, France.
- Inserm, U1235, 1, rue Gaston Veil, 44035, Nantes Cedex 1, France.
- Nantes University, 44035, Nantes, France.
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, AZ, 85351, USA
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32
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Should Skin Biopsies Be Performed in Patients Suspected of Having Parkinson's Disease? PARKINSONS DISEASE 2017; 2017:6064974. [PMID: 29214093 PMCID: PMC5682910 DOI: 10.1155/2017/6064974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022]
Abstract
In patients with Parkinson's disease (PD), the molecularly misfolded form of α-synuclein was recently identified in cutaneous autonomic nerve fibers which displayed increased accumulation even in early disease stages. However, the underlying mechanisms of synucleinopathic nerve damage and its implication for brain pathology in later life remain to be elucidated. To date, specific diagnostic tools to evaluate small fiber pathology and to discriminate neurodegenerative proteinopathies are rare. Recently, research has indicated that deposition of α-synuclein in cutaneous nerve fibers quantified via immunohistochemistry in superficial skin biopsies might be a valid marker of PD which could facilitate early diagnosis and monitoring of disease progression. However, lack of standardization of techniques to quantify neural α-synuclein deposition limits their utility in clinical practice. Additional challenges include the identification of potential distinct morphological patterns of intraneural α-synuclein deposition among synucleinopathies to facilitate diagnostic discrimination and determining the degree to which structural damage relates to dysfunction of nerve fibers targeted by α-synuclein. Answering these questions might improve our understanding of the pathophysiological role of small fiber neuropathy in Parkinson's disease, help identify new treatment targets, and facilitate assessment of response to neuroprotective treatment.
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Brundin P, Dave KD, Kordower JH. Therapeutic approaches to target alpha-synuclein pathology. Exp Neurol 2017; 298:225-235. [PMID: 28987463 DOI: 10.1016/j.expneurol.2017.10.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 01/09/2023]
Abstract
Starting two decades ago with the discoveries of genetic links between alpha-synuclein and Parkinson's disease risk and the identification of aggregated alpha-synuclein as the main protein constituent of Lewy pathology, alpha-synuclein has emerged as the major therapeutic target in Parkinson's disease and related synucleinopathies. Following the suggestion that alpha-synuclein pathology gradually spreads through the nervous system following a stereotypic pattern and the discovery that aggregated forms of alpha-synuclein can propagate pathology from one cell to another, and thereby probably aggravate existing deficits as well as generate additional symptoms, the idea that alpha-synuclein is a viable therapeutic target gained further support. In this review we describe current challenges and possibilities with alpha-synuclein as a therapeutic target. We briefly highlight gaps in the knowledge of the role of alpha-synuclein in disease, and propose that a deeper understanding of the pathobiology of alpha-synuclein can lead to improved therapeutic strategies. We describe several treatment approaches that are currently being tested in advanced animal experiments or already are in clinical trials. We have divided them into approaches that reduce alpha-synuclein production; inhibit alpha-synuclein aggregation inside cells; promote its degradation either inside or outside cells; and reduce its uptake by neighbouring cells following release from already affected neurons. Finally, we briefly discuss challenges related to the clinical testing of alpha-synuclein therapies, for example difficulties in monitoring target engagement and the need for relatively large trials of long duration. We conclude that alpha-synuclein remains one of the most compelling therapeutic targets for Parkinson's disease, and related synucleinopathies, and that the multitude of approaches being tested provides hope for the future.
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Affiliation(s)
- Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI 49503, USA.
| | - Kuldip D Dave
- The Michael J Fox Foundation, New York, NY 10017, USA
| | - Jeffrey H Kordower
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI 49503, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
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Chahine LM, Stern MB. Parkinson's Disease Biomarkers: Where Are We and Where Do We Go Next? Mov Disord Clin Pract 2017; 4:796-805. [PMID: 30363472 DOI: 10.1002/mdc3.12545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 12/16/2022] Open
Abstract
Background Objective measures of Parkinson's disease (PD) are needed for purposes of diagnosis and prognostication, as well as identification of those at risk of PD. In this qualitative review, we provide an overview of the current state of the field of PD biomarker development, delineate challenges, and discuss how the field is evolving. Methods A search of PubMed was conducted for articles pertaining to objective biomarkers for PD. Articles were selected based on relevance and methodology; where available, meta-analyses, systematic reviews, and comprehensive qualitative review articles were preferentially referenced. Results There are several potential sources of objective PD biomarkers including biofluids, peripheral tissue, imaging, genetics, and technology based objective motor testing. Approaches to biomarker identification include the candidate biomarker approach and unbiased discovery methods, each of which has advantages and disadvantages. Several emerging techniques hold promise in each of these areas. Advances in technology and bioinformatics, and the increasing availability of biobanks, are expected to facilitate future PD biomarker development. Conclusions The field of objective biomarkers for PD has made great progress but much remains to be done in translating putative biomarkers into tools useful in the clinic and for research. Multimodal biomarker platforms have the potential to capitalize on the utility and strengths of individual biomarkers. Rigorous methodology and standards for replication of findings will be key to meaningful progress in the field.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology Parkinson's Disease and Movement Disorders Center Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Matthew B Stern
- Department of Neurology Parkinson's Disease and Movement Disorders Center Perelman School of Medicine University of Pennsylvania Philadelphia PA
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Non-CNS pathogenic origin of Parkinson's disease. J Neurol 2017; 264:2027-2030. [PMID: 28808780 DOI: 10.1007/s00415-017-8588-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
The gut with its variety of microbiota may serve as an etiological origin of diseases. Gut microbes may also play a role in the pathogenesis of diseases beyond their simple nutritional maintenance and support. For example, gut protein aggregation, possibly aided by microbes as well as nasal influences, might be linked to disease that may move to the brain through the vagus nerve. To this end, Braak has offered a "dual-hit" hypothesis that proposes a novel etiology for Parkinson's disease (PD). The hypothesis places the initial origin of the disease in the nose and the gastrointestinal tract (GI) after infection by an unknown pathogen that could aggregate in the gut and then eventually spread to the brain via the autonomic plexuses. Gut health functioning, therefore, may affect brain status and behavior. A protein known as alpha-synuclein accumulates in brains of people with Parkinson's disease that is also present in the GI before the onset of motor symptoms. Therefore, the stomach, previously thought to be a stable mechanism throughout life, might explain some etiological origins of disease. Finally, the vagus nerve of the autonomic system that extends from the brain to the abdomen and exercises both sympathetic and parasympathetic roles might be associated with PD diagnosis along with Lewy body influences.
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Abstract
Measures of the severity of cognitive impairment or parkinsonism are the usual endpoints in clinical trials for Alzheimer’s disease (AD) and Parkinson’s disease (PD), but are critically hampered by their lack of disease sensitivity and specificity. Due to the high failure rate of clinical trials, the rate of regulatory approval for efficacious new drugs has stagnated in the past few decades, with the gap between basic science discovery and clinical application metaphorically termed the “Valley of Death”. While the causes for this are probably multiple and complex, the usage of biomarkers as surrogate endpoints, particularly when they are molecularly-specific for the disease, has achieved some success in cancer trials, and it is likely that neurodegenerative disease trials would benefit from the same approach. As dementia and parkinsonism are not disease-specific clinical syndromes, both AD and PD trials have been flawed by reliance on clinical diagnosis and clinical endpoints. Clinical improvement has been a requirement for regulatory approval, but molecularly-specific biomarkers should improve both diagnostic accuracy and tracking of disease progression, allowing quicker screening of drug candidates. However, even when a molecularly-specific biomarker is found, such as amyloid imaging for AD, it may not reflect the entire extant molecular disease repertoire and may not serve equally well in the different roles of preclinical detection, diagnostic confirmation and surrogate endpoint, necessitating the usage of two, three or more biomarkers, deployed in series or in parallel.
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Blesa J, Trigo-Damas I, del Rey NLG, Obeso JA. The use of nonhuman primate models to understand processes in Parkinson’s disease. J Neural Transm (Vienna) 2017; 125:325-335. [DOI: 10.1007/s00702-017-1715-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
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Corbillé AG, Preterre C, Rolli-Derkinderen M, Coron E, Neunlist M, Lebouvier T, Derkinderen P. Biochemical analysis of α-synuclein extracted from control and Parkinson's disease colonic biopsies. Neurosci Lett 2017; 641:81-86. [PMID: 28126589 DOI: 10.1016/j.neulet.2017.01.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 01/20/2023]
Abstract
Lewy bodies and neurites, the pathological hallmarks found in the brain of Parkinson's disease (PD) patients, are primarily composed of aggregated and hyperphosphorylated alpha-synuclein. The observation that alpha-synuclein inclusions are also found in the gut of the vast majority of parkinsonian patients has led to an increasing number of studies aimed at developing diagnostic procedures based on the detection of pathological alpha-synuclein in gastrointestinal biopsies. The previous studies, which have all used immunohistochemistry for the detection of alpha-synuclein, have provided conflicting results. In the current survey, we used a different approach by analyzing the immunoreactivity pattern of alpha-synuclein separated by one- and two-dimensional electrophoresis, in colonic biopsies from PD subjects and healthy individuals. We did not observe any differences between controls and PD in the expression levels, phosphorylation or aggregation status of alpha-synuclein. Overall, our study suggests that the two biochemical methods tested here are not adequate for the prediction of PD using gastrointestinal biopsies. Further studies, using other biochemical approaches, are warranted to test whether there exists specific forms of pathological alpha-synuclein that distinguish PD from control subjects.
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Affiliation(s)
- Anne-Gaëlle Corbillé
- Inserm, U913, Nantes F-44035, France; Nantes University, Nantes F-44035, France; CHU Nantes, Department of Neurology, Nantes F-44093, France
| | - Cécile Preterre
- Inserm, U913, Nantes F-44035, France; Nantes University, Nantes F-44035, France; CHU Nantes, Department of Neurology, Nantes F-44093, France
| | - Malvyne Rolli-Derkinderen
- Inserm, U913, Nantes F-44035, France; Nantes University, Nantes F-44035, France; CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes F-44093, France
| | - Emmanuel Coron
- Inserm, U913, Nantes F-44035, France; Nantes University, Nantes F-44035, France; CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes F-44093, France
| | - Michel Neunlist
- Inserm, U913, Nantes F-44035, France; Nantes University, Nantes F-44035, France; CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes F-44093, France
| | - Thibaud Lebouvier
- Centre Mémoire de Ressources et de Recherche (CMRR), Lille F-59037, France
| | - Pascal Derkinderen
- Inserm, U913, Nantes F-44035, France; Nantes University, Nantes F-44035, France; CHU Nantes, Department of Neurology, Nantes F-44093, France.
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