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Environmental stimulation in Huntington disease patients and animal models. Neurobiol Dis 2022; 171:105725. [DOI: 10.1016/j.nbd.2022.105725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 01/07/2023] Open
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Ferreira JJ, Rodrigues FB, Duarte GS, Mestre TA, Bachoud-Levi AC, Bentivoglio AR, Burgunder JM, Cardoso F, Claassen DO, Landwehrmeyer GB, Kulisevsky J, Nirenberg MJ, Rosser A, Roth J, Seppi K, Slawek J, Furr-Stimming E, Tabrizi SJ, Walker FO, Vandenberghe W, Costa J, Sampaio C. A MDS Evidence-Based Review on Treatments for Huntington's Disease. Mov Disord 2021; 37:25-35. [PMID: 34842303 DOI: 10.1002/mds.28855] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is a rare neurodegenerative disorder with protean clinical manifestations. Its management is challenging, consisting mainly of off-label treatments. OBJECTIVES The International Parkinson and Movement Disorder Society commissioned a task force to review and evaluate the evidence of available therapies for HD gene expansion carriers. METHODS We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eligible randomized controlled trials were identified via an electronic search of the CENTRAL, MEDLINE, and EMBASE databases. All eligible trials that evaluated one or more of 33 predetermined clinical questions were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool. A framework was adapted to allow for efficacy and safety conclusions to be drawn from the balance between the GRADE level of evidence and the importance of the benefit/harm of the intervention. RESULTS Twenty-two eligible studies involving 17 interventions were included, providing data to address 8 clinical questions. These data supported a likely effect of deutetrabenazine on motor impairment, chorea, and dystonia and of tetrabenazine on chorea. The data did not support a disease-modifying effect for premanifest and manifest HD. There was no eligible evidence to support the use of specific treatments for depression, psychosis, irritability, apathy, or suicidality. Similarly, no evidence was eligible to support the use of physiotherapy, occupational therapy, exercise, dietary, or surgical treatments. CONCLUSIONS Data for therapeutic interventions in HD are limited and support only the use of VMAT2 inhibitors for specific motor symptoms. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Filipe B Rodrigues
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal.,UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago A Mestre
- Parkinson disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Anne-Catherine Bachoud-Levi
- National Centre of Reference for Huntington's Disease, Neurology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Neuropsychologie Interventionelle Lab, INSERM U955 E01B, PSL University, Paris, France.,Université Paris Est Créteil, Créteil, France
| | - Anna Rita Bentivoglio
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jean-Marc Burgunder
- Swiss Huntington Center, Neurozentrum Siloah AG, Muri bei Bern, Switzerland.,Department of Neurology, University of Bern, Bern, Switzerland
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department of the Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Daniel O Claassen
- Department of Neurology, Division of Behavioral and Cognitive Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut d´Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Melissa J Nirenberg
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne Rosser
- Neuroscience and Mental Health Research Institute (Brain Research And Intracranial Neurotherapeutics Unit), Cardiff, United Kingdom
| | - Jan Roth
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Jaroslaw Slawek
- Division of Psychiatric-Neurological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.,Neurology and Stroke Department, St. Adalbert Hospital, Gdansk, Poland
| | - Erin Furr-Stimming
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Sarah J Tabrizi
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom.,UK Dementia Research Institute, University College London, London, United Kingdom
| | - Francis O Walker
- Division of Neuromuscular Disorders, Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wim Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Sampaio
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
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Brownstein MJ, Simon NG, Long JD, Yankey J, Maibach HT, Cudkowicz M, Coffey C, Conwit RA, Lungu C, Anderson KE, Hersch SM, Ecklund DJ, Damiano EM, Itzkowitz DE, Lu S, Chase MK, Shefner JM, McGarry A, Thornell B, Gladden C, Costigan M, O’Suilleabhain P, Marshall FJ, Chesire AM, Deritis P, Adams JL, Hedera P, Lowen K, Rosas HD, Hiller AL, Quinn J, Keith K, Duker AP, Gruenwald C, Molloy A, Jacob C, Factor S, Sperin E, Bega D, Brown ZR, Seeberger LC, Sung VW, Benge M, Kostyk SK, Daley AM, Perlman S, Suski V, Conlon P, Barrett MJ, Lowenhaupt S, Quigg M, Perlmutter JS, Wright BA, Most E, Schwartz GJ, Lamb J, Chuang RS, Singer C, Marder K, Moran JA, Singleton JR, Zorn M, Wall PV, Dubinsky RM, Gray C, Drazinic C. Safety and Tolerability of SRX246, a Vasopressin 1a Antagonist, in Irritable Huntington's Disease Patients-A Randomized Phase 2 Clinical Trial. J Clin Med 2020; 9:E3682. [PMID: 33207828 PMCID: PMC7696926 DOI: 10.3390/jcm9113682] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
SRX246 is a vasopressin (AVP) 1a receptor antagonist that crosses the blood-brain barrier. It reduced impulsive aggression, fear, depression and anxiety in animal models, blocked the actions of intranasal AVP on aggression/fear circuits in an experimental medicine fMRI study and demonstrated excellent safety in Phase 1 multiple-ascending dose clinical trials. The present study was a 3-arm, multicenter, randomized, placebo-controlled, double-blind, 12-week, dose escalation study of SRX246 in early symptomatic Huntington's disease (HD) patients with irritability. Our goal was to determine whether SRX246 was safe and well tolerated in these HD patients given its potential use for the treatment of problematic neuropsychiatric symptoms. Participants were randomized to receive placebo or to escalate to 120 mg twice daily or 160 mg twice daily doses of SRX246. Assessments included standard safety tests, the Unified Huntington's Disease Rating Scale (UHDRS), and exploratory measures of problem behaviors. The groups had comparable demographics, features of HD and baseline irritability. Eighty-two out of 106 subjects randomized completed the trial on their assigned dose of drug. One-sided exact-method confidence interval tests were used to reject the null hypothesis of inferior tolerability or safety for each dose group vs. placebo. Apathy and suicidality were not affected by SRX246. Most adverse events in the active arms were considered unlikely to be related to SRX246. The compound was safe and well tolerated in HD patients and can be moved forward as a candidate to treat irritability and aggression.
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Affiliation(s)
- Michael J. Brownstein
- Azevan Pharmaceuticals, Inc., Bethlehem, PA 18015, USA; (N.G.S.); (H.T.M.); (E.M.D.); (D.E.I.); (S.L.)
| | - Neal G. Simon
- Azevan Pharmaceuticals, Inc., Bethlehem, PA 18015, USA; (N.G.S.); (H.T.M.); (E.M.D.); (D.E.I.); (S.L.)
- Department of Biological Sciences, Lehigh University, Bethlehem, PA 18015, USA
| | - Jeffrey D. Long
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA; (J.D.L.); (J.Y.); (C.C.); (D.J.E.); (M.C.)
| | - Jon Yankey
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA; (J.D.L.); (J.Y.); (C.C.); (D.J.E.); (M.C.)
| | - Hilda T. Maibach
- Azevan Pharmaceuticals, Inc., Bethlehem, PA 18015, USA; (N.G.S.); (H.T.M.); (E.M.D.); (D.E.I.); (S.L.)
| | - Merit Cudkowicz
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (M.C.); (S.M.H.); (M.K.C.); (B.T.); (C.G.); (H.D.R.)
| | - Christopher Coffey
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA; (J.D.L.); (J.Y.); (C.C.); (D.J.E.); (M.C.)
| | - Robin A. Conwit
- National Institutes of Health, NINDS, Bethesda, MD 20852, USA; (R.A.C.); (C.L.)
| | - Codrin Lungu
- National Institutes of Health, NINDS, Bethesda, MD 20852, USA; (R.A.C.); (C.L.)
| | - Karen E. Anderson
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC 20007, USA;
| | - Steven M. Hersch
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (M.C.); (S.M.H.); (M.K.C.); (B.T.); (C.G.); (H.D.R.)
- Voyager Therapeutics Inc., Cambridge, MA 02139, USA
| | - Dixie J. Ecklund
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA; (J.D.L.); (J.Y.); (C.C.); (D.J.E.); (M.C.)
| | - Eve M. Damiano
- Azevan Pharmaceuticals, Inc., Bethlehem, PA 18015, USA; (N.G.S.); (H.T.M.); (E.M.D.); (D.E.I.); (S.L.)
| | - Debra E. Itzkowitz
- Azevan Pharmaceuticals, Inc., Bethlehem, PA 18015, USA; (N.G.S.); (H.T.M.); (E.M.D.); (D.E.I.); (S.L.)
| | - Shifang Lu
- Azevan Pharmaceuticals, Inc., Bethlehem, PA 18015, USA; (N.G.S.); (H.T.M.); (E.M.D.); (D.E.I.); (S.L.)
- Department of Biological Sciences, Lehigh University, Bethlehem, PA 18015, USA
| | - Marianne K. Chase
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (M.C.); (S.M.H.); (M.K.C.); (B.T.); (C.G.); (H.D.R.)
| | - Jeremy M. Shefner
- Barrow Neurological Institute, Phoenix, AZ 85013, USA;
- Department of Neurology, College of Medicine, The University of Arizona, Phoenix, AZ 85004, USA
- Department of Neurology, College of Medicine, Creighton University, Phoenix, AZ 85013, USA
| | - Andrew McGarry
- Department of Neurology, Cooper University Hospital, Camden, NJ 08103, USA;
| | - Brenda Thornell
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (M.C.); (S.M.H.); (M.K.C.); (B.T.); (C.G.); (H.D.R.)
| | - Catherine Gladden
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (M.C.); (S.M.H.); (M.K.C.); (B.T.); (C.G.); (H.D.R.)
| | - Michele Costigan
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA; (J.D.L.); (J.Y.); (C.C.); (D.J.E.); (M.C.)
| | | | - Frederick J. Marshall
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14618, USA; (F.J.M.); (A.M.C.); (P.D.); (J.L.A.)
| | - Amy M. Chesire
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14618, USA; (F.J.M.); (A.M.C.); (P.D.); (J.L.A.)
| | - Paul Deritis
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14618, USA; (F.J.M.); (A.M.C.); (P.D.); (J.L.A.)
| | - Jamie L. Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14618, USA; (F.J.M.); (A.M.C.); (P.D.); (J.L.A.)
| | - Peter Hedera
- Department of Neurology, Vanderbilt University, Nashville, TN 37212, USA; (P.H.); (K.L.)
| | - Kelly Lowen
- Department of Neurology, Vanderbilt University, Nashville, TN 37212, USA; (P.H.); (K.L.)
| | - H. Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (M.C.); (S.M.H.); (M.K.C.); (B.T.); (C.G.); (H.D.R.)
| | - Amie L. Hiller
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA; (A.L.H.); (J.Q.); (K.K.)
| | - Joseph Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA; (A.L.H.); (J.Q.); (K.K.)
| | - Kellie Keith
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA; (A.L.H.); (J.Q.); (K.K.)
| | - Andrew P. Duker
- Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA; (A.P.D.); (C.G.); (A.M.); (C.J.)
| | - Christina Gruenwald
- Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA; (A.P.D.); (C.G.); (A.M.); (C.J.)
| | - Angela Molloy
- Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA; (A.P.D.); (C.G.); (A.M.); (C.J.)
| | - Cara Jacob
- Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA; (A.P.D.); (C.G.); (A.M.); (C.J.)
| | - Stewart Factor
- Department of Neurology, Emory University, Atlanta, GA 30322, USA; (S.F.); (E.S.)
| | - Elaine Sperin
- Department of Neurology, Emory University, Atlanta, GA 30322, USA; (S.F.); (E.S.)
| | - Danny Bega
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (D.B.); (Z.B.)
| | - Zsazsa R. Brown
- Department of Neurology, Northwestern University, Chicago, IL 60611, USA; (D.B.); (Z.B.)
| | - Lauren C. Seeberger
- Department of Neurology, University of Colorado Denver, Aurora, CO 80045, USA;
| | - Victor W. Sung
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; (V.W.S.); (M.B)
| | - Melanie Benge
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; (V.W.S.); (M.B)
| | - Sandra K. Kostyk
- Department of Neurology, Ohio State University, Columbus, OH 43210, USA; (S.K.K.); (A.M.D.)
| | - Allison M. Daley
- Department of Neurology, Ohio State University, Columbus, OH 43210, USA; (S.K.K.); (A.M.D.)
| | - Susan Perlman
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Valerie Suski
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (V.S.); (P.C.)
| | - Patricia Conlon
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (V.S.); (P.C.)
| | - Matthew J. Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA; (M.J.B.); (S.L.); (M.Q.)
| | - Stephanie Lowenhaupt
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA; (M.J.B.); (S.L.); (M.Q.)
| | - Mark Quigg
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA; (M.J.B.); (S.L.); (M.Q.)
| | - Joel S. Perlmutter
- Department of Neurology, Washington University, Saint Louis, MO 63110, USA; (J.S.P.); (E.M.)
| | - Brenton A. Wright
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92121, USA;
| | - Elaine Most
- Department of Neurology, Washington University, Saint Louis, MO 63110, USA; (J.S.P.); (E.M.)
| | - Guy J. Schwartz
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (G.J.S.); (J.L.)
| | - Jessica Lamb
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (G.J.S.); (J.L.)
| | - Rosalind S. Chuang
- Department of Neurology, Swedish Medical Center, Seattle, WA 98122, USA;
| | - Carlos Singer
- Department of Neurology, University of Miami, Miami, FL 33136, USA;
| | - Karen Marder
- Department of Neurology, Columbia University, New York, NY 10032, USA; (K.M.); (J.A.M.)
| | - Joyce A. Moran
- Department of Neurology, Columbia University, New York, NY 10032, USA; (K.M.); (J.A.M.)
| | - John R. Singleton
- Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA; (J.R.S.); (M.Z.); (P.V.W.)
| | - Meghan Zorn
- Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA; (J.R.S.); (M.Z.); (P.V.W.)
| | - Paola V. Wall
- Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA; (J.R.S.); (M.Z.); (P.V.W.)
| | - Richard M. Dubinsky
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (R.M.D.); (C.G.)
| | - Carolyn Gray
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (R.M.D.); (C.G.)
| | - Carolyn Drazinic
- Department of Clinical Sciences, Florida State University, Tallahassee, FL 32306, USA;
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Reactive Species in Huntington Disease: Are They Really the Radicals You Want to Catch? Antioxidants (Basel) 2020; 9:antiox9070577. [PMID: 32630706 PMCID: PMC7401865 DOI: 10.3390/antiox9070577] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
Huntington disease (HD) is a neurodegenerative condition and one of the so-called rare or minority diseases, due to its low prevalence (affecting 1–10 of every 100,000 people in western countries). The causative gene, HTT, encodes huntingtin, a protein with a yet unknown function. Mutant huntingtin causes a range of phenotypes, including oxidative stress and the activation of microglia and astrocytes, which leads to chronic inflammation of the brain. Although substantial efforts have been made to find a cure for HD, there is currently no medical intervention able to stop or even delay progression of the disease. Among the many targets of therapeutic intervention, oxidative stress and inflammation have been extensively studied and some clinical trials have been promoted to target them. In the present work, we review the basic research on oxidative stress in HD and the strategies used to fight it. Many of the strategies to reduce the phenotypes associated with oxidative stress have produced positive results, yet no substantial functional recovery has been observed in animal models or patients with the disease. We discuss possible explanations for this and suggest potential ways to overcome it.
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Dickey AS, La Spada AR. Therapy development in Huntington disease: From current strategies to emerging opportunities. Am J Med Genet A 2017; 176:842-861. [PMID: 29218782 DOI: 10.1002/ajmg.a.38494] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Abstract
Huntington disease (HD) is a progressive autosomal dominant neurodegenerative disorder in which patients typically present with uncontrolled involuntary movements and subsequent cognitive decline. In 1993, a CAG trinucleotide repeat expansion in the coding region of the huntingtin (HTT) gene was identified as the cause of this disorder. This extended CAG repeat results in production of HTT protein with an expanded polyglutamine tract, leading to pathogenic HTT protein conformers that are resistant to protein turnover, culminating in cellular toxicity and neurodegeneration. Research into the mechanistic basis of HD has highlighted a role for bioenergetics abnormalities stemming from mitochondrial dysfunction, and for synaptic defects, including impaired neurotransmission and excitotoxicity. Interference with transcription regulation may underlie the mitochondrial dysfunction. Current therapies for HD are directed at treating symptoms, as there are no disease-modifying therapies. Commonly prescribed drugs for involuntary movement control include tetrabenazine, a potent and selective inhibitor of vesicular monoamine transporter 2 that depletes synaptic monoamines, and olanzapine, an atypical neuroleptic that blocks the dopamine D2 receptor. Various drugs are used to treat non-motor features. The HD therapeutic pipeline is robust, as numerous efforts are underway to identify disease-modifying treatments, with some small compounds and biological agents moving into clinical trials. Especially encouraging are dosage reduction strategies, including antisense oligonucleotides, and molecules directed at transcription dysregulation. Given the depth and breadth of current HD drug development efforts, there is reason to believe that disease-modifying therapies for HD will emerge, and this achievement will have profound implications for the entire neurotherapeutics field.
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Affiliation(s)
- Audrey S Dickey
- Departments of Neurology, Neurobiology, and Cell Biology, Duke Center for Neurodegeneration & Neurotherapeutics, Duke University Medical Center, Durham, North Carolina
| | - Albert R La Spada
- Departments of Neurology, Neurobiology, and Cell Biology, Duke Center for Neurodegeneration & Neurotherapeutics, Duke University Medical Center, Durham, North Carolina
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Stout JC, Andrews SC, Glikmann-Johnston Y. Cognitive assessment in Huntington disease clinical drug trials. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:227-244. [PMID: 28947120 DOI: 10.1016/b978-0-12-801893-4.00019-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several Huntington disease (HD) clinical trials are in progress and on the horizon. Potential treatments are increasingly being targeted at ameliorating the cognitive decline in HD. This necessitates a careful consideration of trial designs, including endpoint strategies suitable for testing cognitive function. The aim of this chapter is to evaluate and consider the use of cognitive measures in HD clinical trials. We first consider the role of cognition in clinical trial endpoint models, including a review of previous HD clinical trials that have included cognitive measures. We evaluate strategies for selecting cognitive tools for HD clinical trials, and consider cognitive assessments that have been used in other neuropsychiatric disorders, namely Alzheimer disease and schizophrenia. Next, we describe a general framework for selecting patient-based outcomes in clinical trials, and apply this framework to the selection of cognitive outcomes. Using the HD-Cognitive Assessment Battery (HD-CAB), a new cognitive battery designed for clinical trials, we illustrate the evaluation of cognitive outcomes in terms of their responsivity, reliability, validity, appropriateness, precision, interpretability, feasibility, and acceptability. Finally, we articulate a pathway for continued development of cognitive tools that would pave the way for finding treatments that ameliorate cognitive decline in HD.
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Affiliation(s)
- Julie C Stout
- School of Psychological Sciences, and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Victoria, Australia.
| | - Sophie C Andrews
- School of Psychological Sciences, and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Victoria, Australia
| | - Yifat Glikmann-Johnston
- School of Psychological Sciences, and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Victoria, Australia
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Abstract
Redox homeostasis is crucial for proper cellular functions, including receptor tyrosine kinase signaling, protein folding, and xenobiotic detoxification. Under basal conditions, there is a balance between oxidants and antioxidants. This balance facilitates the ability of oxidants, such as reactive oxygen species, to play critical regulatory functions through a direct modification of a small number of amino acids (e.g. cysteine) on signaling proteins. These signaling functions leverage tight spatial, amplitude, and temporal control of oxidant concentrations. However, when oxidants overwhelm the antioxidant capacity, they lead to a harmful condition of oxidative stress. Oxidative stress has long been held to be one of the key players in disease progression for Huntington's disease (HD). In this review, we will critically review this evidence, drawing some intermediate conclusions, and ultimately provide a framework for thinking about the role of oxidative stress in the pathophysiology of HD.
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Affiliation(s)
- Amit Kumar
- Burke Medical Research Institute, White Plains, NY, USA
- Brain and Mind Research Institute, Weill Medical College of Cornell University, New York, NY, USA
- Department of Neurology, Weill Medical College of Cornell University, New York, NY, USA
| | - Rajiv R. Ratan
- Burke Medical Research Institute, White Plains, NY, USA
- Brain and Mind Research Institute, Weill Medical College of Cornell University, New York, NY, USA
- Department of Neurology, Weill Medical College of Cornell University, New York, NY, USA
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Constantinescu R, Romer M, Zetterberg H, Rosengren L, Kieburtz K. Increased levels of total tau protein in the cerebrospinal fluid in Huntington’s disease. Parkinsonism Relat Disord 2011; 17:714-5. [DOI: 10.1016/j.parkreldis.2011.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/29/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022]
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Frank S. Tetrabenazine as anti-chorea therapy in Huntington disease: an open-label continuation study. Huntington Study Group/TETRA-HD Investigators. BMC Neurol 2009; 9:62. [PMID: 20021666 PMCID: PMC2804668 DOI: 10.1186/1471-2377-9-62] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 12/18/2009] [Indexed: 11/25/2022] Open
Abstract
Background Tetrabenazine (TBZ) selectively depletes central monoamines by reversibly binding to the type-2 vesicular monoamine transporter. A previous double blind study in Huntington disease (HD) demonstrated that TBZ effectively suppressed chorea, with a favorable short-term safety profile (Neurology 2006;66:366-372). The objective of this study was to assess the long-term safety and effectiveness of TBZ for chorea in HD. Methods Subjects who completed the 13-week, double blind protocol were invited to participate in this open label extension study for up to 80 weeks. Subjects were titrated to the best individual dose or a maximum of 200 mg/day. Chorea was assessed using the Total Maximal Chorea (TMC) score from the Unified Huntington Disease Rating Scale. Results Of the 75 participants, 45 subjects completed 80 weeks. Three participants terminated due to adverse events (AEs) including depression, delusions with associated previous suicidal behavior, and vocal tics. One subject died due to breast cancer. The other 26 subjects chose not to continue on with each ensuing extension for various reasons. When mild and unrelated AEs were excluded, the most commonly reported AEs (number of subjects) were sedation/somnolence (18), depressed mood (17), anxiety (13), insomnia (10), and akathisia (9). Parkinsonism and dysphagia scores were significantly increased at week 80 compared to baseline. At week 80, chorea had significantly improved from baseline with a mean reduction in the TMC score of 4.6 (SD 5.5) units. The mean dosage at week 80 was 63.4 mg (range 12.5-175 mg). Conclusions TBZ effectively suppresses HD-related chorea for up to 80 weeks. Patients treated chronically with TBZ should be monitored for parkinsonism, dysphagia and other side effects including sleep disturbance, depression, anxiety, and akathisia. Trial Registration Clinicaltrials.gov registration number (initial study): NCT00219804
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Abstract
Huntington's disease (HD) is a relentless neurodegenerative disease that results in profound disability through a triad of motor, cognitive and neuropsychiatric symptoms. At present, there are very few therapeutic interventions available with the exception of a limited number of drugs that offer mild symptomatic relief. Although the genetic basis of the disease has been identified, the mechanisms behind the cellular pathogenesis are still not clear and as a result no candidate drugs with the potential for disease modification have been found clinically until now. One of the major limitations in assessing the usefulness of drug treatments in HD is the lack of well-designed, double-blind, placebo-controlled clinical trials. Most studies have been open-label, using a small number of patients and tend to concentrate on the motor features of the disease, primarily the chorea. This review discusses the treatments now used for HD before evaluating the newer drugs at present being explored in both the clinic and in the laboratory in mouse models of the disease.
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Affiliation(s)
- Sarah L Mason
- Cambridge Centre for Brain Repair, ED Adrian Building, Forvie Site, Robinson Way, Cambridge CB20PY, UK.
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Mestre T, Ferreira J, Coelho MM, Rosa M, Sampaio C. Therapeutic interventions for symptomatic treatment in Huntington's disease. Cochrane Database Syst Rev 2009:CD006456. [PMID: 19588393 DOI: 10.1002/14651858.cd006456.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Huntington's disease (HD) is an orphan autosomal dominant neurodegenerative disorder caused by the amplification of a nucleic acids triplet repeat. It is characterised by core symptoms of chorea, progressive dementia and psychiatric manifestations such as depression, irritability, apathy and psychosis. In current clinical practice, drugs exist that seem to improve symptoms for HD patients. However, their effectiveness has not been fully measured. OBJECTIVES To evaluate the effectiveness of the available interventions for the symptomatic treatment of HD. SEARCH STRATEGY The search strategy developed for the Movement Disorders Group was undertaken. Cochrane Controlled Trials Register, Medline, EMBASE and Clinical Trials Database of the United States National Institute of Health were thoroughly searched up until December 2007. SELECTION CRITERIA All randomised, double-blinded, placebo-controlled clinical trials conducted on any symptomatic therapy used for HD with at least ten participants were included. Participants should have HD clinical features and a confirmatory genetic diagnosis or a compatible family history. All disease variants and ages of disease onset were included. Cross-over studies were included. All pharmacological and non-pharmacological interventions aimed at the control of signs and symptoms associated with HD were to be selected. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the identified trials for eligibility. In the selected trials, the assessment of their methodological quality was done according to the Cochrane Collaboration handbook, and eligible data were registered onto standardised forms. If possible, an intention-to-treat analysis was conducted. When data were not available in the original publication, the principal investigator of the trial was contacted. A meta-analysis was conducted when possible and otherwise the descriptive summary of the results was provided. The software Revman 5.0.15 was used for statistical analysis. MAIN RESULTS 22 trials (1254 participants) were included. Nine trials had a cross-over design and 13 were conducted in parallel. Study duration ranged from 2 to 80 weeks. Various pharmacological interventions were studied, mostly, they were anti-dopaminergic drugs (n = 5), glutamate receptor antagonists (n = 5) and energy metabolites (n = 5). Only tetrabenazine showed a clear efficacy for the control of chorea. The remaining pharmacological interventions revealed no clear effectiveness. AUTHORS' CONCLUSIONS No intervention proved to have a consistent symptomatic control in HD. Tetrabenazine is the anti-choreic drug with the best quality data available. Other symptomatic areas should be explored by well-designed randomised placebo-controlled studies.
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Affiliation(s)
- Tiago Mestre
- Neurological Clinical Research Unit, Institute of Molecular Medicine, Hospital de Santa Maria, Av. Prof. Egas Moniz, Lisboa, Portugal, 1649-028
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Constantinescu R, Romer M, Oakes D, Rosengren L, Kieburtz K. Levels of the light subunit of neurofilament triplet protein in cerebrospinal fluid in Huntington's disease. Parkinsonism Relat Disord 2009; 15:245-8. [DOI: 10.1016/j.parkreldis.2008.05.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 05/05/2008] [Accepted: 05/19/2008] [Indexed: 11/24/2022]
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14
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Delivery of peptide and protein drugs over the blood-brain barrier. Prog Neurobiol 2009; 87:212-51. [PMID: 19395337 DOI: 10.1016/j.pneurobio.2008.12.002] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 11/11/2008] [Accepted: 12/17/2008] [Indexed: 12/12/2022]
Abstract
Peptide and protein (P/P) drugs have been identified as showing great promises for the treatment of various neurodegenerative diseases. A major challenge in this regard, however, is the delivery of P/P drugs over the blood-brain barrier (BBB). Intense research over the last 25 years has enabled a better understanding of the cellular and molecular transport mechanisms at the BBB, and several strategies for enhanced P/P drug delivery over the BBB have been developed and tested in preclinical and clinical-experimental research. Among them, technology-based approaches (comprising functionalized nanocarriers and liposomes) and pharmacological strategies (such as the use of carrier systems and chimeric peptide technology) appear to be the most promising ones. This review combines a comprehensive overview on the current understanding of the transport mechanisms at the BBB with promising selected strategies published so far that can be applied to facilitate enhanced P/P drug delivery over the BBB.
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15
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A study of chorea after tetrabenazine withdrawal in patients with Huntington disease. Clin Neuropharmacol 2008; 31:127-33. [PMID: 18520979 DOI: 10.1097/wnf.0b013e3180ca77ea] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess tetrabenazine (TBZ) efficacy by evaluating the change in Huntington disease-associated chorea resulting from TBZ treatment withdrawal. METHODS Thirty patients treated in the long term were randomized to 1 of 3 groups assigned to withdraw from TBZ in a double-blind, staggered fashion during a 5-day period. RESULTS The chorea scores of subjects withdrawn from TBZ treatment increased by 5.3 units from days 1 to 3, whereas the scores of the group with partial or no withdrawal of TBZ treatment increased by 3.0 units (P = 0.0773). A post hoc analysis of the linear trend was positive for reemergent chorea (P = 0.0486). No serious adverse events were reported after abrupt withdrawal of TBZ treatment. CONCLUSIONS The trend for reemergence of chorea in patients with Huntington disease who were withdrawn from TBZ treatment is consistent with the findings from previous studies, thus showing the effectiveness of TBZ in reducing chorea.
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16
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Abstract
The ultimate goal for Huntington's disease (HD) therapeutics is to develop disease-modifying neuroprotective therapies that can delay or prevent illness in those who are at genetic risk and can slow progression in those who are affected clinically. Neuroprotection is the preservation of neuronal structure, function, and viability, and neuroprotective therapy is thus targeted at the underlying pathology of HD, rather than at its specific symptoms. Preclinical target discovery research in HD is identifying numerous distinct targets, along with options for modulating them, with some proceeding into large-scale efficacy studies in early symptomatic HD subjects. The first pilot studies of neuroprotective compounds in premanifest HD are also soon to begin. This review discusses the opportunities for neuroprotection in HD, clinical methodology in premanifest and manifest HD, the clinical assessment of neuroprotection, molecular targets and therapeutic leads, and the current state of clinical development.
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Affiliation(s)
- Steven M Hersch
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129-4404, USA.
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17
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Durr A. Therapeutic approach in Huntington's disease. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:631-638. [PMID: 18631784 DOI: 10.1016/s0072-9752(07)01258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Alexandra Durr
- INSERM Unit U679, Departement de Génétique, Pierre and Marie Curie-Paris 6 University, UMR S679, Federative Institute for Neuroscience Research (IFR70), and APHP, La Salpêtriere Hospital, Paris, France.
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Bonelli RM, Hofmann P. A systematic review of the treatment studies in Huntington's disease since 1990. Expert Opin Pharmacother 2007; 8:141-53. [PMID: 17257085 DOI: 10.1517/14656566.8.2.141] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Huntington's disease (HD) is an autosomal dominant, inherited, neuropsychiatric disease that gives rise to progressive motor, cognitive and behavioural symptoms. Current drug therapy has no effect on the progression of disability, and the need for any pharmacological treatment should be carefully considered. Hyperkinesias and psychiatric symptoms may respond well to pharmacotherapy, but neuropsychological deficits and dementia remain untreatable. Pharmacological intervention in the treatment of the movement disorder of HD is aimed at restoring the balance of neurotransmitters in the basal ganglia. A surprising amount of current drug therapy of HD in clinical practice is based on studies published before 1990. The authors conducted a systematic review of pharmacological therapy in HD using the available papers that were published between 1990 and 2006.
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Affiliation(s)
- Raphael M Bonelli
- University Clinic of Psychiatry, Graz Medical University, Auenbruggerplatz 31, A-8036 Graz, Austria.
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19
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Abstract
Huntington's disease (HD) is a progressive and fatal neurological disorder caused by an expanded CAG repeat in the gene coding for the protein, huntingtin. There is no clinically proven treatment for HD. Although the exact cause of neuronal death in HD remains unknown, it has been postulated that the abnormal aggregation of the mutant huntingtin protein may cause toxic effects in neurons, leading to a cascade of pathogenic mechanisms associated with transcriptional dysfunction, oxidative stress, mitochondrial alterations, apoptosis, bioenergetic defects and subsequent excitotoxicity. Understanding how these processes interrelate has become important in identifying a pharmacotherapy in HD and in the design of clinical trials. A number of drug compounds that separately target these mechanisms have significantly improved the clinical and neuropathological phenotype of HD transgenic mice and, as such, are immediate candidates for human clinical trials in HD patients. These compounds are discussed herein.
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Affiliation(s)
- Hoon Ryu
- Boston University School of Medicine, Edith Nourse Rogers Veterans Administration Medical Center, Bedford, Massachusetts 01730, USA
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20
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Leegwater-Kim J, Cha JHJ. The paradigm of Huntington's disease: therapeutic opportunities in neurodegeneration. NeuroRx 2005; 1:128-38. [PMID: 15717013 PMCID: PMC534918 DOI: 10.1602/neurorx.1.1.128] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite a relatively small number of affected patients, Huntington's disease (HD) has been a historically important disease, embodying many of the major themes in modern neuroscience, including molecular genetics, selective neuronal vulnerability, excitotoxicity, mitochondrial dysfunction, apoptosis, and transcriptional dysregulation. The discovery of the HD gene in 1993 opened the door to the mechanisms of HD pathogenesis. Multiple pathologic mechanisms have been discovered, each one serving as a potential therapeutic target. HD thus continues to serve as a paradigmatic disorder, with basic bench research generating clinically relevant insights and stimulating the development of therapeutic human trials.
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Affiliation(s)
- Julie Leegwater-Kim
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129-4404, USA
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21
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Abstract
Huntington's disease (HD) is an autosomal dominant, inherited, neuropsychiatric disease which gives rise to progressive motor, cognitive and behavioural symptoms. Its core pathology involves degeneration of the basal ganglia, in particular, the caudate and putamen, and is caused by a single autosomal gene coding for a mutated form of the protein, huntingtin. At the present time, the only treatment options available in HD are symptomatic. There are several substances available today for the treatment of chorea. Other neurological symptoms, such as dystonia, can be treated, but treatment is associated with a high risk of adverse events. Psychiatric symptoms, on the other hand, are often amenable to treatment and relief of these symptoms may provide significant improvement in quality of life.
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Affiliation(s)
- Raphael M Bonelli
- University of Clinic of Psychiatry, Karl-Franzens University Graz, Graz, Austria.
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22
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Aylward EH, Rosenblatt A, Field K, Yallapragada V, Kieburtz K, McDermott M, Raymond LA, Almqvist EW, Hayden M, Ross CA. Caudate volume as an outcome measure in clinical trials for Huntington’s disease: a pilot study. Brain Res Bull 2003; 62:137-41. [PMID: 14638387 DOI: 10.1016/j.brainresbull.2003.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous research has demonstrated that longitudinal change in caudate volume could be observed over a period of 3 years in subjects with Huntington's disease (HD). The current pilot study was designed to determine whether measurement of caudate change on magnetic resonance imaging (MRI) is a feasible and valid outcome measure in an actual clinical trial situation. We measured caudate volumes on pre- and post-treatment MRI scans from 19 patients at two sites who were participating in CARE-HD (Co-enzyme Q10 and Remacemide: Evaluation in Huntington's Disease), a 30-month clinical trial of remacemide and co-enzyme Q(10) in symptomatic patients with HD. Results from this pilot study indicated that decrease in caudate volume was significant over time. Power analysis indicated that relatively small numbers of subjects would be needed in clinical trials using caudate volume as an outcome measure. Advantages and disadvantages of using MRI caudate volume as an outcome measure are presented. We recommend the adoption of quantitative neuroimaging of caudate volume as an outcome measure in future clinical trials for treatments of HD.
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Affiliation(s)
- E H Aylward
- Department of Radiology, University of Washington, Box 357115, Seattle, WA 98195, USA.
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23
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Abstract
Oxidative stress is a ubiquitously observed hallmark of neurodegenerative disorders. Neuronal cell dysfunction and cell death due to oxidative stress may causally contribute to the pathogenesis of progressive neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease, as well as acute syndromes of neurodegeneration, such as ischaemic and haemorrhagic stroke. Neuroprotective antioxidants are considered a promising approach to slowing the progression and limiting the extent of neuronal cell loss in these disorders. The clinical evidence demonstrating that antioxidant compounds can act as protective drugs in neurodegenerative disease, however, is still relatively scarce. In the following review, the available data from clinical, animal and cell biological studies regarding the role of antioxidant neuroprotection in progressive neurodegenerative disease will be summarised, focussing particularly on Alzheimer's disease, Parkinson's disease, Huntington's disease and amyotrophic lateral sclerosis. The general complications in developing potent neuroprotective antioxidant drugs directed against these long-term degenerative conditions will also be discussed. The major challenges for drug development are the slow kinetics of disease progression, the unsolved mechanistic questions concerning the final causalities of cell death, the necessity to attain an effective permeation of the blood-brain barrier and the need to reduce the high concentrations currently required to evoke protective effects in cellular and animal model systems. Finally, an outlook as to which direction antioxidant drug development and clinical practice may be leading to in the near future will be provided.
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Affiliation(s)
- Bernd Moosmann
- Center for Neuroscience and Aging, The Burnham Institute, La Jolla, CA 92037, USA
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24
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Halliwell B. Role of free radicals in the neurodegenerative diseases: therapeutic implications for antioxidant treatment. Drugs Aging 2002; 18:685-716. [PMID: 11599635 DOI: 10.2165/00002512-200118090-00004] [Citation(s) in RCA: 1003] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Free radicals and other so-called 'reactive species' are constantly produced in the brain in vivo. Some arise by 'accidents of chemistry', an example of which may be the leakage of electrons from the mitochondrial electron transport chain to generate superoxide radical (O2*-). Others are generated for useful purposes, such as the role of nitric oxide in neurotransmission and the production of O2*- by activated microglia. Because of its high ATP demand, the brain consumes O2 rapidly, and is thus susceptible to interference with mitochondrial function, which can in turn lead to increased O2*- formation. The brain contains multiple antioxidant defences, of which the mitochondrial manganese-containing superoxide dismutase and reduced glutathione seem especially important. Iron is a powerful promoter of free radical damage, able to catalyse generation of highly reactive hydroxyl, alkoxyl and peroxyl radicals from hydrogen peroxide and lipid peroxides, respectively. Although most iron in the brain is stored in ferritin, 'catalytic' iron is readily mobilised from injured brain tissue. Increased levels of oxidative damage to DNA, lipids and proteins have been detected by a range of assays in post-mortem tissues from patients with Parkinson's disease, Alzheimer's disease and amyotrophic lateral sclerosis, and at least some of these changes may occur early in disease progression. The accumulation and precipitation of proteins that occur in these diseases may be aggravated by oxidative damage, and may in turn cause more oxidative damage by interfering with the function of the proteasome. Indeed, it has been shown that proteasomal inhibition increases levels of oxidative damage not only to proteins but also to other biomolecules. Hence, there are many attempts to develop antioxidants that can cross the blood-brain barrier and decrease oxidative damage. Natural antioxidants such as vitamin E (tocopherol), carotenoids and flavonoids do not readily enter the brain in the adult, and the lazaroid antioxidant tirilazad (U-74006F) appears to localise in the blood-brain barrier. Other antioxidants under development include modified spin traps and low molecular mass scavengers of O2*-. One possible source of lead compounds is the use of traditional remedies claimed to improve brain function. Little is known about the impact of dietary antioxidants upon the development and progression of neurodegenerative diseases, especially Alzheimer's disease. Several agents already in therapeutic use might exert some of their effects by antioxidant action, including selegiline (deprenyl), apomorphine and nitecapone.
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Affiliation(s)
- B Halliwell
- Department of Biochemistry, Faculty of Medicine, National University of Singapore, Singapore.
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25
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Abstract
Huntington's disease (HD) is one of eight progressive neurodegenerative disorders in which the underlying mutation is a CAG expansion encoding a polyglutamine tract. There are currently no cures or even effective therapies for HD. Effective strategies have remained elusive because little is known about either the mechanisms of expansion or the mechanism of polyglutamine-mediated neuronal death. However, recent advances in understanding the basic mechanisms of expansion and toxicity have renewed hope that a therapeutic strategy might someday be possible. Strategies effective in the treatment of HD are likely to be relevant in the treatment of a range of neurological and neurodegenerative disorders.
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Affiliation(s)
- C T McMurray
- Dept Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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26
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Moosmann B, Skutella T, Beyer K, Behl C. Protective activity of aromatic amines and imines against oxidative nerve cell death. Biol Chem 2001; 382:1601-12. [PMID: 11767950 DOI: 10.1515/bc.2001.195] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Oxidative stress is a widespread phenomenon in the pathology of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. Neuronal cell death due to oxidative stress may causally contribute to the pathogeneses of these diseases. Therefore, neuroprotective antioxidants are considered to be a promising approach to slow down disease progression. We have investigated different aromatic amine and imine compounds for neuroprotective antioxidant functions in cell culture, and found that these compounds possess excellent cytoprotective potential in diverse paradigms of oxidative neuronal cell death, including clonal cell lines, primary cerebellar neurons, and organotypic hippocampal slice cultures. Aromatic amines and imines are effective against oxidative glutamate toxicity, glutathione depletion, and hydrogen peroxide toxicity. Their mode of action as direct antioxidants was experimentally confirmed by electron spin resonance spectroscopy, cell-free brain lipid peroxidation assays, and intracellular peroxide measurements. With half-maximal effective concentrations of 20-75 nM in different neuroprotection experiments, the aromatic imines phenothiazine, phenoxazine, and iminostilbene proved to be about two orders of magnitude more effective than common phenolic antioxidants. This remarkable efficacy could be directly correlated to calculated properties of the compounds by means of a novel, quantitative structure-activity relationship model. We conclude that bridged bisarylimines with a single free NH-bond, such as iminostilbene, are superior neuroprotective antioxidants, and may be promising lead structures for rational drug development.
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Affiliation(s)
- B Moosmann
- Max-Planck-Institute of Psychiatry, Munich, Germany
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Abstract
Huntington's disease (HD) is an inherited autosomal dominant disorder characterized by neurologic, cognitive, and psychiatric symptomatology. Psychiatric symptoms in HD are often amenable to treatment, and relief of these symptoms may provide significant improvement in quality of life. This review will briefly describe neurologic, neuropsychologic and brain imaging data, and then review psychiatric syndromes seen in HD and their treatment.
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Affiliation(s)
- K E Anderson
- Gertrude H. Sergievsky Center, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
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Aylward EH, Codori AM, Rosenblatt A, Sherr M, Brandt J, Stine OC, Barta PE, Pearlson GD, Ross CA. Rate of caudate atrophy in presymptomatic and symptomatic stages of Huntington's disease. Mov Disord 2000; 15:552-60. [PMID: 10830423 DOI: 10.1002/1531-8257(200005)15:3<552::aid-mds1020>3.0.co;2-p] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Previous research by our group demonstrated a longitudinal change in caudate volume for symptomatic subjects with Huntington's disease (HD), and suggested that volume of the caudate may be a useful outcome measure for therapeutic studies in symptomatic patients. The current study was designed to determine whether longitudinal change in caudate atrophy could be documented in presymptomatic carriers of the HD gene mutation, and to compare rate of change in these subjects with rate of change in mildly and moderately affected symptomatic patients. We measured caudate volumes on serial magnetic resonance image scans from 30 patients at three stages of HD: 10 presymptomatic; 10 with mild symptoms, as indicated by scores on the Quantified Neurological Exam (QNE) < or =35; and 10 with moderate symptoms (QNE >45). The mean interscan interval was 36 months. When analyzed separately, both symptomatic groups and the presymptomatic group demonstrated a significant change in caudate volume over time. Amount of change over time did not differ significantly among the three groups. We conclude that change in caudate volume may be a useful outcome measure for assessing treatment effectiveness in both presymptomatic and symptomatic subjects.
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Affiliation(s)
- E H Aylward
- Division of Psychiatric Neuroimaging, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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