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Dunning EE, Decourt B, Zawia NH, Shill HA, Sabbagh MN. Pharmacotherapies for the Treatment of Progressive Supranuclear Palsy: A Narrative Review. Neurol Ther 2024:10.1007/s40120-024-00614-9. [PMID: 38743312 DOI: 10.1007/s40120-024-00614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder resulting from the deposition of misfolded and neurotoxic forms of tau protein in specific areas of the midbrain, basal ganglia, and cortex. It is one of the most representative forms of tauopathy. PSP presents in several different phenotypic variations and is often accompanied by the development of concurrent neurodegenerative disorders. PSP is universally fatal, and effective disease-modifying therapies for PSP have not yet been identified. Several tau-targeting treatment modalities, including vaccines, monoclonal antibodies, and microtubule-stabilizing agents, have been investigated and have had no efficacy. The need to treat PSP and other tauopathies is critical, and many clinical trials investigating tau-targeted treatments are underway. In this review, the PubMed database was queried to collect information about preclinical and clinical research on PSP treatment. Additionally, the US National Library of Medicine's ClinicalTrials.gov website was queried to identify past and ongoing clinical trials relevant to PSP treatment. This narrative review summarizes our findings regarding these reports, which include potential disease-modifying drug trials, modifiable risk factor management, and symptom treatments.
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Affiliation(s)
- Elise E Dunning
- Creighton University School of Medicine - Phoenix, Phoenix, AZ, USA
| | - Boris Decourt
- Department of Pharmacology and Neuroscience School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Laboratory on Neurodegeneration and Translational Research, College of Medicine, Roseman University of Health Sciences, Las Vegas, NV, USA
| | - Nasser H Zawia
- Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
- Department of Biomedical and Pharmaceutical Sciences, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, USA
| | - Holly A Shill
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Marwan N Sabbagh
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
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Alster P, Otto-Ślusarczyk D, Szlufik S, Duszyńska-Wąs K, Drzewińska A, Wiercińska-Drapało A, Struga M, Kutyłowski M, Friedman A, Madetko-Alster N. The significance of glial cell line-derived neurotrophic factor analysis in Progressive Supranuclear Palsy. Sci Rep 2024; 14:2805. [PMID: 38307947 PMCID: PMC10837430 DOI: 10.1038/s41598-024-53355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/31/2024] [Indexed: 02/04/2024] Open
Abstract
Progressive Supranuclear Palsy (PSP) is an atypical parkinsonism. Major subtypes of the disease: PSP-Richardson's Syndrome (PSP-RS) and PSP Parkinsonism Predominant (PSP-P) vary in clinical features, the pathomechanism remains unexplored. The aim of this work is to analyze the relevance of glial cell line-derived neurotrophic factor (GDNF) evaluation in the serum and cerebrospinal fluid (CSF) in PSP subtypes and to verify its significance as a possible factor in the in vivo examination. Authors assessed the concentration of GDNF in the serum and CSF of 12 patients with PSP-RS, 12 with PSP-P and 12 controls. Additionally authors evaluated patients using Unified Parkinson's Disease Rating Scale-III part (UPDRS-III), Frontal Assessment Battery (FAB) and Magnetic Resonance Imaging (MRI). The evaluation revealed significantly increased concentrations of GDNF in the CSF among PSP-RS patients and substantially increased concentrations of GDNF in the serum in PSP-P. Though the GDNF concentrations differentiated PSP subtypes, no correlations between with clinical factors were observed however certain correlations with atrophic changes in MRI were detected. GDNF is a factor which may impact the pathogenesis of PSP. Possible implementation of GDNF as a therapeutic factor could be a perspective in the search for therapy in this currently incurable disease.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland.
| | | | - Stanisław Szlufik
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Karolina Duszyńska-Wąs
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Agnieszka Drzewińska
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Hepatology and Infectious and Tropical Diseases, Medical University of Warsaw, Provincial Infectious Diseases Hospital in Warsaw, Warsaw, Poland
| | - Marta Struga
- Department of Biochemistry, Medical University of Warsaw, Warsaw, Poland
| | - Michał Kutyłowski
- Department of Diagnostic Imaging, Brodno Mazovian Hospital, Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Natalia Madetko-Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
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Alster P, Madetko-Alster N, Migda B, Nieciecki M, Koziorowski D, Królicki L. The Assessment of Subregions in the Frontal Lobe May Be Feasible in the Differential Diagnosis of Progressive Supranuclear Palsy-Parkinsonism Predominant (PSP-P) and Multiple System Atrophy (MSA). Diagnostics (Basel) 2022; 12:diagnostics12102421. [PMID: 36292111 PMCID: PMC9600948 DOI: 10.3390/diagnostics12102421] [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] [Received: 09/10/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P) is associated with moderate responsiveness to levodopa treatment and a possible lack of typical PSP milestones. The clinical manifestation of PSP-P poses difficulties in neurological examination. In the early stages it is often misdiagnosed as Parkinson’s Disease, and in the more advanced stages PSP-P shows more symptoms in common with Multiple System Atrophy—Parkinsonian type (MSA-P). The small number of tools enabling differential diagnosis of PSP-P and MSA leads to the necessity of searching for parameters facilitating in vivo diagnosis. In this study, 14 patients with PSP-P and 21 patients with MSA-P were evaluated using Single Photon Emission Computed Tomography. Considering the fact that PSP is linked with frontal deficits, regions of the frontal lobe were assessed in the context of hypoperfusion and their possible usefulness in the differential diagnosis with MSA-P. The outcome of the work revealed that the right middle frontal gyrus was the region most significantly affected in PSP-P.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland
- Correspondence:
| | | | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Michał Nieciecki
- Department of Nuclear Medicine, Children’s Memorial Health Institute, 04-736 Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
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Connectivity Alterations in Vascular Parkinsonism: A Structural Covariance Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the structural covariance between the striatum and large-scale brain regions in patients with vascular parkinsonism (VP) compared to Parkinson’s disease (PD) and control subjects, and then explore the relationship between brain connectivity and the clinical features of our patients. Forty subjects (13 VP, 15 PD, and 12 age-and-sex-matched healthy controls) were enrolled in this study. They each underwent a careful clinical and neuropsychological evaluation, DAT-SPECT scintigraphy and 3T MRI scan. While there were no differences between PD and VP in the disease duration and severity, nor in terms of the DAT-SPECT evaluations, VP patients had a reduction in structural covariance between the bilateral corpus striatum (both putamen and caudate) and several brain regions, including the insula, thalamus, hippocampus, anterior cingulate cortex and orbito-frontal cortex compared to PD and controls. VP patients also showed lower scores on several neuropsychological tests. Interestingly, in the VP group, structural connectivity alterations were significantly related to cognitive evaluations exploring executive functions, memory, anxiety and depression. This compelling evidence suggests that structural disconnection in the basal ganglia circuits spreading in critical cortical regions may be involved in the pathophysiology of cognitive impairment in VP.
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Pillas D, Klein A, Gasalla T, Avbersek A, Thompson A, Wright J, Mellor J, Scowcroft A. The Burden of Progressive Supranuclear Palsy on Patients, Caregivers, and Healthcare Systems by PSP Phenotype: A Cross-Sectional Study. Front Neurol 2022; 13:821570. [PMID: 35865639 PMCID: PMC9295700 DOI: 10.3389/fneur.2022.821570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a rare, relentlessly progressive, ultimately fatal neurodegenerative brain disease. The objective of this study was to assess the burden of PSP on patients, caregivers, and healthcare systems by PSP phenotype. Data were drawn from the Adelphi PSP Disease Specific Programme™, a cross-sectional study of neurologists and people living with PSP in the United States of America, France, Germany, Italy, Spain, and the United Kingdom. All people living with PSP with a reported phenotype were included. PSP phenotype was reported for 242 patients (mean age: 70.2 years, 58% male): PSP-Richardson's syndrome, n = 96; PSP-predominant Parkinsonism, n = 88; PSP-predominant corticobasal syndrome, n = 28; PSP-predominant speech/language disorder, n = 12; PSP-progressive gait freezing, n = 9; PSP-predominant frontal presentation, n = 9. Most patients reported impaired cognitive, motor, behavioral and ocular functionality; 67–100% of patients (across phenotypes) had moderate-to-severe disease at the time of data collection. Post-diagnosis, the majority were provided with a visual and/or mobility aid (55–100%, across phenotypes), and/or required home modification to facilitate their needs (55–78%, across phenotypes). Patients required multiple types of healthcare professionals for disease management (mean 3.6–4.4, across phenotypes), and the majority reported receiving care from at least one caregiver (mean 1.3–1.8, across phenotypes). There is a high burden on patients, caregivers, and healthcare systems across all PSP phenotypes. Although phenotypes manifest different symptoms and are associated with different diagnostic pathways, once diagnosed with PSP, patients typically receive similar care.
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Affiliation(s)
| | | | | | | | | | - Jack Wright
- Rare Disease Franchise, Adelphi Real World, Bollington, United Kingdom
| | - Jennifer Mellor
- Rare Disease Franchise, Adelphi Real World, Bollington, United Kingdom
| | - Anna Scowcroft
- UCB Pharma, Brussels, Belgium
- *Correspondence: Anna Scowcroft
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Survival in Korean Patients with Frontotemporal Dementia Syndrome: Association with Behavioral Features and Parkinsonism. J Clin Med 2022; 11:jcm11082260. [PMID: 35456351 PMCID: PMC9025342 DOI: 10.3390/jcm11082260] [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] [Received: 04/04/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 02/05/2023] Open
Abstract
We investigated the survival time of each clinical syndrome of frontotemporal dementia (FTD) and the impacts of behavioral and motor features on survival of FTD. A total of 216 patients with FTD [82 behavioral variant FTD (bvFTD), 78 semantic variant primary progressive aphasia (svPPA), 43 non-fluent/agrammatic variant PPA (nfvPPA), 13 FTD-motor neuron disease (MND)] were enrolled from 16 centers across Korea. Behaviors and parkinsonism were assessed using the Frontal Behavioral Inventory and Unified Parkinson’s Disease Rating Scale Part III, respectively. The Kaplan–Meier method was used for the survival analysis and the Cox proportional hazards model was applied for analysis of the effect of behavioral and motor symptoms on survival, after controlling vascular risk factors and cancer. An overall median survival of FTD was 12.1 years. The survival time from onset was shortest for FTD-MND and longest for svPPA. The median survival time of patients with bvFTD was unavailable but likely comparable to that of patients with nfvPPA. In the bvFTD group, negative behavioral symptoms and akinetic rigidity were significantly associated with survival. In the nfvPPA group, the presence of dysarthria had a negative impact on survival. These findings provide useful information to clinicians planning for care.
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Alster P, Nieciecki M, Migda B, Kutyłowski M, Madetko N, Duszyńska-Wąs K, Charzyńska I, Koziorowski D, Królicki L, Friedman A. The Strengths and Obstacles in the Differential Diagnosis of Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P) and Multiple System Atrophy (MSA) Using Magnetic Resonance Imaging (MRI) and Perfusion Single Photon Emission Computed Tomography (SPECT). Diagnostics (Basel) 2022; 12:diagnostics12020385. [PMID: 35204476 PMCID: PMC8871165 DOI: 10.3390/diagnostics12020385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple System Atrophy—Parkinsonism Predominant (MSA-P) and Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P) are the clinical manifestations of atypical parkinsonism. Currently, there are no efficient in vivo methods available relating to neuroimaging or biochemical analysis in the examination of these entities. Among the advanced methods available, using positron emission tomography is constrained by high cost and low accessibility. In this study the authors examined patients with two types of atypical parkinsonism—MSA-P and PSP-P, which are difficult to differentiate, especially in the early years of their development. The aim of this study was to assess whether the examination of patients in the period following the early years (3–6-year duration of symptoms) could be enhanced by perfusion single photon emission computed tomography (SPECT), magnetic resonance imaging (MRI) or evaluation of cognitive abilities. Extended examination using MRI and perfusion SPECT showed that the evaluation of the mesencephalon/pons ratio, mesencephalic volume decrease, the Magnetic Resonance Parkinsonism Index (MRPI) and frontal perfusion should be considered more feasible than screening cognitive evaluation in MSA-P and PSP-P with a 3–6-year duration of symptoms.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (N.M.); (K.D.-W.); (D.K.); (A.F.)
- Correspondence:
| | - Michał Nieciecki
- Department of Nuclear Medicine, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, 03-242 Warsaw, Poland;
| | - Michał Kutyłowski
- Department of Radiology, Mazovian Brodnowski Hospital, 03-242 Warsaw, Poland;
| | - Natalia Madetko
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (N.M.); (K.D.-W.); (D.K.); (A.F.)
| | - Karolina Duszyńska-Wąs
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (N.M.); (K.D.-W.); (D.K.); (A.F.)
| | - Ingeborga Charzyńska
- Department of Nuclear Medicine, Mazovian Brodno Hospital, 03-242 Warsaw, Poland; (I.C.); (L.K.)
| | - Dariusz Koziorowski
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (N.M.); (K.D.-W.); (D.K.); (A.F.)
| | - Leszek Królicki
- Department of Nuclear Medicine, Mazovian Brodno Hospital, 03-242 Warsaw, Poland; (I.C.); (L.K.)
- Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (N.M.); (K.D.-W.); (D.K.); (A.F.)
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Diagnostic Performance of the Magnetic Resonance Parkinsonism Index in Differentiating Progressive Supranuclear Palsy from Parkinson's Disease: An Updated Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 12:diagnostics12010012. [PMID: 35054178 PMCID: PMC8774886 DOI: 10.3390/diagnostics12010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and Parkinson's disease (PD) are difficult to differentiate especially in the early stages. We aimed to investigate the diagnostic performance of the magnetic resonance parkinsonism index (MRPI) in differentiating PSP from PD. A systematic literature search of PubMed-MEDLINE and EMBASE was performed to identify original articles evaluating the diagnostic performance of the MRPI in differentiating PSP from PD published up to 20 February 2021. The pooled sensitivity, specificity, and 95% CI were calculated using the bivariate random-effects model. The area under the curve (AUC) was calculated using a hierarchical summary receiver operating characteristic (HSROC) model. Meta-regression was performed to explain the effects of heterogeneity. A total of 14 original articles involving 484 PSP patients and 1243 PD patients were included. In all studies, T1-weighted images were used to calculate the MRPI. Among the 14 studies, nine studies used 3D T1-weighted images. The pooled sensitivity and specificity for the diagnostic performance of the MRPI in differentiating PSP from PD were 96% (95% CI, 87-99%) and 98% (95% CI, 91-100%), respectively. The area under the HSROC curve was 0.99 (95% CI, 0.98-1.00). Heterogeneity was present (sensitivity: I2 = 97.29%; specificity: I2 = 98.82%). Meta-regression showed the association of the magnet field strength with heterogeneity. Studies using 3 T MRI showed significantly higher sensitivity (100%) and specificity (100%) than those of studies using 1.5 T MRI (sensitivity of 98% and specificity of 97%) (p < 0.01). Thus, the MRPI could accurately differentiate PSP from PD and support the implementation of appropriate management strategies for patients with PSP.
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