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Sturchio A, Duker AP, Muñoz-Sanjuan I, Espay AJ. Subtyping monogenic disorders: Huntington disease. Handb Clin Neurol 2023; 193:171-184. [PMID: 36803810 DOI: 10.1016/b978-0-323-85555-6.00003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Huntington disease is a highly disabling neurodegenerative disease characterized by psychiatric, cognitive, and motor deficits. The causal genetic mutation in huntingtin (Htt, also known as IT15), located on chromosome 4p16.3, leads to an expansion of a triplet coding for polyglutamine. The expansion is invariably associated with the disease when >39 repeats. Htt encodes for the protein huntingtin (HTT), which carries out many essential biological functions in the cell, in particular in the nervous system. The precise mechanism of toxicity is not known. Based on a one-gene-one-disease framework, the prevailing hypothesis ascribes toxicity to the universal aggregation of HTT. However, the aggregation process into mutant huntingtin (mHTT) is associated with a reduction of the levels of wild-type HTT. A loss of wild-type HTT may plausibly be pathogenic, contributing to the disease onset and progressive neurodegeneration. Moreover, many other biological pathways are altered in Huntington disease, such as in the autophagic system, mitochondria, and essential proteins beyond HTT, potentially explaining biological and clinical differences among affected individuals. As one gene does not mean one disease, future efforts at identifying specific Huntington subtypes are important to design biologically tailored therapeutic approaches that correct the corresponding biological pathways-rather than continuing to exclusively target the common denominator of HTT aggregation for elimination.
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Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden.
| | - Andrew P Duker
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
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Langbehn DR. Response to Lee et al. Am J Hum Genet 2022; 109:1341-1342. [PMID: 35803235 PMCID: PMC9300877 DOI: 10.1016/j.ajhg.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Douglas R. Langbehn
- Departments of Psychiatry and Biostatistics, The University of Iowa, Iowa City, IA 52242, USA,Corresponding author
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Brumfield OS, Zizzi CE, Dilek N, Alexandrou DG, Glidden AM, Rosero S, Weinstein J, Seabury J, Kaat A, McDermott MP, Dorsey ER, Heatwole CR. The Huntington's Disease Health Index: Initial Evaluation of a Disease-Specific Patient Reported Outcome Measure. J Huntingtons Dis 2022; 11:217-226. [PMID: 35527560 DOI: 10.3233/jhd-210506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When developed properly, disease-specific patient reported outcome measures have the potential to measure relevant changes in how a patient feels and functions in the context of a therapeutic trial. The Huntington's Disease Health Index (HD-HI) is a multifaceted disease-specific patient reported outcome measure (PROM) designed specifically to satisfy previously published FDA guidance for developing PROMs for product development and labeling claims. OBJECTIVE In preparation for clinical trials, we examine the validity, reliability, clinical relevance, and patient understanding of the Huntington's Disease Health Index (HD-HI). METHODS We partnered with 389 people with Huntington's disease (HD) and caregivers to identify the most relevant questions for the HD-HI. We subsequently utilized two rounds of factor analysis, cognitive interviews with fifteen individuals with HD, and test-retest reliability assessments with 25 individuals with HD to refine, evaluate, and optimize the HD-HI. Lastly, we determined the capability of the HD-HI to differentiate between groups of HD participants with high versus low total functional capacity score, prodromal versus manifest HD, and normal ambulation versus mobility impairment. RESULTS HD participants identified 13 relevant and unique symptomatic domains to be included as subscales in the HD-HI. All HD-HI subscales had a high level of internal consistency and reliability and were found by participants to have acceptable content, relevance, and usability. The total HD-HI score and each subscale score statistically differentiated between groups of HD participants with high versus low disease burden. CONCLUSION Initial evaluation of the HD-HI supports its validity and reliability as a PROM for assessing how individuals with HD feel and function.
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Affiliation(s)
- Olivia S Brumfield
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Christine E Zizzi
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Danae G Alexandrou
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Alistair M Glidden
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Spencer Rosero
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Jennifer Weinstein
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Jamison Seabury
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Aaron Kaat
- Department of Medical Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael P McDermott
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - E Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Chad R Heatwole
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
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Langbehn DR. Longer CAG repeat length is associated with shorter survival after disease onset in Huntington disease. Am J Hum Genet 2022; 109:172-179. [PMID: 34942093 DOI: 10.1016/j.ajhg.2021.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
It is well known that the length of the CAG trinucleotide expansion of the huntingtin gene is associated with many aspects of Huntington disease progression. These include age of clinical onset and rate of initial progression of disease severity. The relationship between CAG length and survival in Huntington disease is less studied. To address this, we obtained the complete Registry HD database from the European Huntington Disease Network and reanalyzed the time from reported age of disease onset until death. We conducted semiparametric proportional hazards modeling of 8,422 participants who had experienced onset of clinical Huntington disease, either retrospectively or prospectively. Of these, 826 had a recorded age of death. To avoid biased model estimates, retrospective onset ages were represented by left truncation at study entry. After controlling for onset age, which tends to be younger in those with longer CAG repeat lengths, we found that CAG length had a substantial and highly significant influence upon survival time after disease onset. For a fixed age of onset, longer CAG expansions were predictive of shorter survival. This is consistent with other known relationships between CAG length and disease severity. We also show that older onset age predicts shorter lifespan after controlling for CAG length and that the influence of CAG on survival length is substantially greater in women. We demonstrate that apparent contradictions between these and previous analyses of the same data are primarily due to the question of whether to control for clinical onset age in the analysis of time until death.
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Affiliation(s)
- Douglas R Langbehn
- Departments of Psychiatry and Biostatistics, The University of Iowa, Iowa City, IA 52242, USA.
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Pasha T, Zatorska A, Sharipov D, Rogelj B, Hortobágyi T, Hirth F. Karyopherin abnormalities in neurodegenerative proteinopathies. Brain 2021; 144:2915-2932. [PMID: 34019093 PMCID: PMC8194669 DOI: 10.1093/brain/awab201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 11/12/2022] Open
Abstract
Neurodegenerative proteinopathies are characterized by progressive cell loss that is preceded by the mislocalization and aberrant accumulation of proteins prone to aggregation. Despite their different physiological functions, disease-related proteins like tau, α-synuclein, TAR DNA binding protein-43, fused in sarcoma and mutant huntingtin, all share low complexity regions that can mediate their liquid-liquid phase transitions. The proteins' phase transitions can range from native monomers to soluble oligomers, liquid droplets and further to irreversible, often-mislocalized aggregates that characterize the stages and severity of neurodegenerative diseases. Recent advances into the underlying pathogenic mechanisms have associated mislocalization and aberrant accumulation of disease-related proteins with defective nucleocytoplasmic transport and its mediators called karyopherins. These studies identify karyopherin abnormalities in amyotrophic lateral sclerosis, frontotemporal dementia, Alzheimer's disease, and synucleinopathies including Parkinson's disease and dementia with Lewy bodies, that range from altered expression levels to the subcellular mislocalization and aggregation of karyopherin α and β proteins. The reported findings reveal that in addition to their classical function in nuclear import and export, karyopherins can also act as chaperones by shielding aggregation-prone proteins against misfolding, accumulation and irreversible phase-transition into insoluble aggregates. Karyopherin abnormalities can, therefore, be both the cause and consequence of protein mislocalization and aggregate formation in degenerative proteinopathies. The resulting vicious feedback cycle of karyopherin pathology and proteinopathy identifies karyopherin abnormalities as a common denominator of onset and progression of neurodegenerative disease. Pharmacological targeting of karyopherins, already in clinical trials as therapeutic intervention targeting cancers such as glioblastoma and viral infections like COVID-19, may therefore represent a promising new avenue for disease-modifying treatments in neurodegenerative proteinopathies.
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Affiliation(s)
- Terouz Pasha
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London SE5 9RT, UK
| | - Anna Zatorska
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London SE5 9RT, UK
| | - Daulet Sharipov
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London SE5 9RT, UK
| | - Boris Rogelj
- Jozef Stefan Institute, Department of Biotechnology, 1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Chemistry and Chemical Technology, 1000 Ljubljana, Slovenia
| | - Tibor Hortobágyi
- ELKH-DE Cerebrovascular and Neurodegenerative Research Group, Department of Neurology, University of Debrecen, 4032 Debrecen, Hungary
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK
| | - Frank Hirth
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London SE5 9RT, UK
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McAllister B, Gusella JF, Landwehrmeyer GB, Lee JM, MacDonald ME, Orth M, Rosser AE, Williams NM, Holmans P, Jones L, Massey TH. Timing and Impact of Psychiatric, Cognitive, and Motor Abnormalities in Huntington Disease. Neurology 2021; 96:e2395-e2406. [PMID: 33766994 PMCID: PMC8166441 DOI: 10.1212/wnl.0000000000011893] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/12/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To assess the prevalence, timing, and functional impact of psychiatric, cognitive, and motor abnormalities in Huntington disease (HD) gene carriers, we analyzed retrospective clinical data from individuals with manifest HD. Methods Clinical features of patients with HD were analyzed for 6,316 individuals in an observational study of the European Huntington's Disease Network (REGISTRY) from 161 sites across 17 countries. Data came from clinical history and the patient-completed Clinical Characteristics Questionnaire that assessed 8 symptoms: motor, cognitive, apathy, depression, perseverative/obsessive behavior, irritability, violent/aggressive behavior, and psychosis. Multiple logistic regression was used to analyze relationships between symptoms and functional outcomes. Results The initial manifestation of HD is increasingly likely to be motor and less likely to be psychiatric as age at presentation increases and is independent of pathogenic CAG repeat length. The Clinical Characteristics Questionnaire captures data on nonmotor symptom prevalence that correlate specifically with validated clinical measures. Psychiatric and cognitive symptoms are common in HD gene carriers, with earlier onsets associated with longer CAG repeats. Of patients with HD, 42.4% reported at least 1 psychiatric or cognitive symptom before motor symptoms, with depression most common. Each nonmotor symptom was associated with significantly reduced total functional capacity scores. Conclusions Psychiatric and cognitive symptoms are common and functionally debilitating in HD gene carriers. They require recognition and targeting with clinical outcome measures and treatments. However, because it is impossible to distinguish confidently between nonmotor symptoms arising from HD and primary psychiatric disorders, particularly in younger premanifest patients, nonmotor symptoms should not be used to make a clinical diagnosis of HD. Trial Registration Information ClinicalTrials.gov Identifier: NCT01590589
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Affiliation(s)
- Branduff McAllister
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - James F Gusella
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - G Bernhard Landwehrmeyer
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Jong-Min Lee
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Marcy E MacDonald
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Michael Orth
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Anne E Rosser
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Nigel M Williams
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Peter Holmans
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Lesley Jones
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland
| | - Thomas H Massey
- From the Division of Psychological Medicine and Clinical Neurosciences (B.M., N.M.W., P.H., L.J., T.H.M.), Brain Repair Group (A.E.R.), Schools of Medicine and Biosciences, and Neuroscience and Mental Health Research Institute (A.E.R.), Cardiff University, UK; Molecular Neurogenetic Unit (J.F.G., J.-M.L., M.E.M.), Center for Genomic Medicine, Massachusetts General Hospital; Department of Genetics (J.F.G., J.-M.L., M.E.M.), Harvard Medical School, Boston, MA; Department of Neurology (G.B.L.), University of Ulm, Germany; and Swiss Huntington's Disease Centre (M.O.), Siloah, Bern, Switzerland.
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Zielonka D, Stawinska-Witoszynska B. Gender Differences in Non-sex Linked Disorders: Insights From Huntington's Disease. Front Neurol 2020; 11:571. [PMID: 32733356 PMCID: PMC7358529 DOI: 10.3389/fneur.2020.00571] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Daniel Zielonka
- The Department of Public Health, The Poznan University of Medical Sciences, Poznań, Poland
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Glidden AM, Luebbe EA, Elson MJ, Goldenthal SB, Snyder CW, Zizzi CE, Dorsey ER, Heatwole CR. Patient-reported impact of symptoms in Huntington disease: PRISM-HD. Neurology 2020; 94:e2045-e2053. [PMID: 32193209 DOI: 10.1212/wnl.0000000000008906] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/20/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the frequency and relative importance of symptoms experienced by adults with Huntington disease (HD) and to identify factors associated with a higher disease burden. METHODS We performed 40 qualitative interviews (n = 20 with HD, n = 20 caregivers) and analyzed 2,082 quotes regarding the symptomatic burden of HD. We subsequently performed a cross-sectional study with 389 participants (n = 156 with HD [60 of whom were prodromal], n = 233 caregivers) to assess the prevalence and relative importance (scale 0-4) of 216 symptoms and 15 symptomatic themes in HD. Cross-correlation analysis was performed based on sex, disease duration, age, number of CAG repeats, disease burden, Total Functional Capacity score, employment status, disease status, and ambulatory status. RESULTS The symptomatic themes with the highest prevalence in HD were emotional issues (83.0%), fatigue (82.5%), and difficulty thinking (77.0%). The symptomatic themes with the highest relative importance to participants were difficulty thinking (1.91), impaired sleep or daytime sleepiness (1.90), and emotional issues (1.81). High Total Functional Capacity scores, being employed, and having prodromal HD were associated with a lower prevalence of symptomatic themes. Despite reporting no clinical features of the disease, prodromal individuals demonstrated high rates of emotional issues (71.2%) and fatigue (69.5%). There was concordance between the prevalence of symptoms reported by manifest individuals and caregivers. CONCLUSIONS Many symptomatic themes affect the lives of those with HD. These themes have a variable level of importance to the HD population and are identified both by those with HD and by their caregivers.
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Affiliation(s)
- Alistair M Glidden
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - Elizabeth A Luebbe
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - Molly J Elson
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - Steven B Goldenthal
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - Christopher W Snyder
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - Christine E Zizzi
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - E Ray Dorsey
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor
| | - Chad R Heatwole
- From the Center for Health + Technology (A.M.G., C.W.S., C.E.Z., E.R.D., C.R.H.) and Department of Neurology (E.A.L., E.R.D., C.R.H.), University of Rochester Medical Center, NY; Emory School of Medicine (M.J.E.), Emory University, Atlanta, GA; and University of Michigan Medical School (S.B.G.), University of Michigan, Ann Arbor.
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McGarry A, McDermott MP, Kieburtz K, Peng J, Cudkowicz M. Baseline Variables Associated with Functional Decline in 2CARE, A Randomized Clinical Trial in Huntington's Disease. J Huntingtons Dis 2020; 9:47-58. [PMID: 31985471 DOI: 10.3233/jhd-190391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the clearly recognized progressive functional decline of Huntington's disease (HD), detailed investigations of factors associated with the rate of functional progression are limited. OBJECTIVE Understanding factors associated with functional decline through examination of existing HD clinical databases may improve efforts to mitigate it. METHODS We analyzed data from 2CARE, a randomized clinical trial with up to 5 years of follow-up, to assess potential risk factors for more rapid functional decline in HD. RESULTS Variables associated with faster functional decline included worse motor performance, worse cognitive test scores, female sex, lower weight and body mass index, and a higher CAG repeat length, especially in younger people. CONCLUSION While our data are limited to the structured environment and homogeneity of a clinical trial, attention to several of the identified risk factors may be useful towards managing functional decline over time. The observation that women progress faster than men, while potentially confounded by an association between sex and weight, deserves further study.
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Affiliation(s)
- Andrew McGarry
- Cooper University Healthcare at Rowan University, Camden, NJ, USA
| | | | | | - Jing Peng
- The Ohio State University, Columbus, OH, USA
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Gallardo-Orihuela A, Hervás-Corpión I, Hierro-Bujalance C, Sanchez-Sotano D, Jiménez-Gómez G, Mora-López F, Campos-Caro A, Garcia-Alloza M, Valor LM. Transcriptional correlates of the pathological phenotype in a Huntington's disease mouse model. Sci Rep 2019; 9:18696. [PMID: 31822756 PMCID: PMC6904489 DOI: 10.1038/s41598-019-55177-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
Huntington disease (HD) is a fatal neurodegenerative disorder without a cure that is caused by an aberrant expansion of CAG repeats in exon 1 of the huntingtin (HTT) gene. Although a negative correlation between the number of CAG repeats and the age of disease onset is established, additional factors may contribute to the high heterogeneity of the complex manifestation of symptoms among patients. This variability is also observed in mouse models, even under controlled genetic and environmental conditions. To better understand this phenomenon, we analysed the R6/1 strain in search of potential correlates between pathological motor/cognitive phenotypical traits and transcriptional alterations. HD-related genes (e.g., Penk, Plk5, Itpka), despite being downregulated across the examined brain areas (the prefrontal cortex, striatum, hippocampus and cerebellum), exhibited tissue-specific correlations with particular phenotypical traits that were attributable to the contribution of the brain region to that trait (e.g., striatum and rotarod performance, cerebellum and feet clasping). Focusing on the striatum, we determined that the transcriptional dysregulation associated with HD was partially exacerbated in mice that showed poor overall phenotypical scores, especially in genes with relevant roles in striatal functioning (e.g., Pde10a, Drd1, Drd2, Ppp1r1b). However, we also observed transcripts associated with relatively better outcomes, such as Nfya (CCAAT-binding transcription factor NF-Y subunit A) plus others related to neuronal development, apoptosis and differentiation. In this study, we demonstrated that altered brain transcription can be related to the manifestation of HD-like symptoms in mouse models and that this can be extrapolated to the highly heterogeneous population of HD patients.
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Affiliation(s)
- Andrea Gallardo-Orihuela
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Irati Hervás-Corpión
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Carmen Hierro-Bujalance
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Plaza Fragela, 11003, Cádiz, Spain
| | - Daniel Sanchez-Sotano
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Plaza Fragela, 11003, Cádiz, Spain
| | - Gema Jiménez-Gómez
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Francisco Mora-López
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Servicio de Inmunología, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Antonio Campos-Caro
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain
| | - Monica Garcia-Alloza
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain.,Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Plaza Fragela, 11003, Cádiz, Spain
| | - Luis M Valor
- Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain. .,Unidad de Investigación, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain.
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11
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Langbehn DR, Stout JC, Gregory S, Mills JA, Durr A, Leavitt BR, Roos RAC, Long JD, Owen G, Johnson HJ, Borowsky B, Craufurd D, Reilmann R, Landwehrmeyer GB, Scahill RI, Tabrizi SJ. Association of CAG Repeats With Long-term Progression in Huntington Disease. JAMA Neurol 2019; 76:1375-1385. [PMID: 31403680 PMCID: PMC6692683 DOI: 10.1001/jamaneurol.2019.2368] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/02/2019] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In Huntington disease (HD), mutation severity is defined by the length of the CAG trinucleotide sequence, a well-known predictor of clinical onset age. The association with disease trajectory is less well characterized. Quantifiable summary measures of trajectory applicable over decades of early disease progression are lacking. An accurate model of the age-CAG association with early progression is critical to clinical trial design, informing both sample size and intervention timing. OBJECTIVE To succinctly capture the decades-long early progression of HD and its dependence on CAG repeat length. DESIGN, SETTING, AND PARTICIPANTS Prospective study at 4 academic HD treatment and research centers. Participants were the combined sample from the TRACK-HD and Track-On HD studies consisting of 290 gene carriers (presymptomatic to stage II), recruited from research registries at participating centers, and 153 nonbiologically related controls, generally spouses or friends. Recruitment was targeted to match a balanced, prespecified spectrum of age, CAG repeat length, and diagnostic status. In the TRACK-HD and Track-On HD studies, 13 and 5 potential participants, respectively, failed study screening. Follow-up ranged from 0 to 6 years. The study dates were January 2008 to November 2014. These analyses were performed between December 2015 and January 2019. MAIN OUTCOMES AND MEASURES The outcome measures were principal component summary scores of motor-cognitive function and of brain volumes. The main outcome was the association of these scores with age and CAG repeat length. RESULTS We analyzed 2065 visits from 443 participants (247 female [55.8%]; mean [SD] age, 44.4 [10.3] years). Motor-cognitive measures were highly correlated and had similar CAG repeat length-dependent associations with age. A composite summary score accounted for 67.6% of their combined variance. This score was well approximated by a score combining 3 items (total motor score, Symbol Digit Modalities Test, and Stroop word reading) from the Unified Huntington's Disease Rating Scale. For either score, initial progression age and then acceleration rate were highly CAG repeat length dependent. The acceleration continues through at least stage II disease. In contrast, 3 distinct patterns emerged among brain measures (basal ganglia, gray matter, and a combination of whole-brain, ventricular, and white matter volumes). The basal ganglia pattern showed considerable change in even the youngest participants but demonstrated minimal acceleration of loss with aging. Each clinical and brain summary score was strongly associated with the onset and rate of decline in total functional capacity. CONCLUSIONS AND RELEVANCE Results of this study suggest that succinct summary measures of function and brain loss characterize HD progression across a wide disease span. CAG repeat length strongly predicts their decline rate. This work aids our understanding of the age and CAG repeat length-dependent association between changes in the brain and clinical manifestations of HD.
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Affiliation(s)
| | - Julie C. Stout
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Sarah Gregory
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | | | - Alexandra Durr
- Institut du Cerveau et de la Moelle Epinière (ICM), Genetic Department, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité 1127, Le Centre National de la Recherche Scientifique, Unités Mixtes de Recherche 7225, Pitié-Salpêtrière University Hospital, Paris, France
| | - Blair R. Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymund A. C. Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Gail Owen
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Hans J. Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City
| | | | - David Craufurd
- Manchester Academic Health Sciences Centre, Central Manchester University Hospitals National Health Service Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Ralf Reilmann
- George-Huntington-Institute, Department of Radiology, University of Münster, Münster, Germany
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | | | - Rachael I. Scahill
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Sarah J. Tabrizi
- Huntington’s Disease Centre, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
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12
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Aktar F, Burudpakdee C, Polanco M, Pei S, Swayne TC, Lipke PN, Emtage L. The huntingtin inclusion is a dynamic phase-separated compartment. Life Sci Alliance 2019; 2:2/5/e201900489. [PMID: 31527136 PMCID: PMC6749095 DOI: 10.26508/lsa.201900489] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
Inclusions of disordered protein are a characteristic feature of most neurodegenerative diseases, including Huntington's disease. Huntington's disease is caused by expansion of a polyglutamine tract in the huntingtin protein; mutant huntingtin protein (mHtt) is unstable and accumulates in large intracellular inclusions both in affected individuals and when expressed in eukaryotic cells. Using mHtt-GFP expressed in Saccharomyces cerevisiae, we find that mHtt-GFP inclusions are dynamic, mobile, gel-like structures that concentrate mHtt together with the disaggregase Hsp104. Although inclusions may associate with the vacuolar membrane, the association is reversible and we find that inclusions of mHtt in S. cerevisiae are not taken up by the vacuole or other organelles. Instead, a pulse-chase study using photoconverted mHtt-mEos2 revealed that mHtt is directly and continuously removed from the inclusion body. In addition to mobile inclusions, we also imaged and tracked the movements of small particles of mHtt-GFP and determine that they move randomly. These observations suggest that inclusions may grow through the collision and coalescence of small aggregative particles.
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Affiliation(s)
- Fahmida Aktar
- Biology Department, City University of New York, York College, Queens, NY, USA
| | | | - Mercedes Polanco
- Biology Department, City University of New York, York College, Queens, NY, USA
| | - Sen Pei
- Biology Department, City University of New York, York College, Queens, NY, USA
| | - Theresa C Swayne
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Peter N Lipke
- Biology Department, City University of New York, Brooklyn College, Brooklyn, NY, USA.,Molecular, Cellular and Developmental Biology Program, City University of New York Graduate Center, New York, NY, USA
| | - Lesley Emtage
- Biology Department, City University of New York, York College, Queens, NY, USA .,Molecular, Cellular and Developmental Biology Program, City University of New York Graduate Center, New York, NY, USA
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13
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Federspiel JD, Greco TM, Lum KK, Cristea IM. Hdac4 Interactions in Huntington's Disease Viewed Through the Prism of Multiomics. Mol Cell Proteomics 2019; 18:S92-S113. [PMID: 31040226 PMCID: PMC6692770 DOI: 10.1074/mcp.ra118.001253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/27/2019] [Indexed: 12/29/2022] Open
Abstract
Huntington's disease (HD) is a monogenic disorder, driven by the expansion of a trinucleotide (CAG) repeat within the huntingtin (Htt) gene and culminating in neuronal degeneration in the brain, predominantly in the striatum and cortex. Histone deacetylase 4 (Hdac4) was previously found to contribute to the disease progression, providing a potential therapeutic target. Hdac4 knockdown reduced accumulation of misfolded Htt protein and improved HD phenotypes. However, the underlying mechanism remains unclear, given its independence on deacetylase activity and the predominant cytoplasmic Hdac4 localization in the brain. Here, we undertook a multiomics approach to uncover the function of Hdac4 in the context of HD pathogenesis. We characterized the interactome of endogenous Hdac4 in brains of HD mouse models. Alterations in interactions were investigated in response to Htt polyQ length, comparing mice with normal (Q20) and disease (Q140) Htt, at both pre- and post-symptomatic ages (2 and 10 months, respectively). Parallel analyses for Hdac5, a related class IIa Hdac, highlighted the unique interaction network established by Hdac4. To validate and distinguish interactions specifically enhanced in an HD-vulnerable brain region, we next characterized endogenous Hdac4 interactions in dissected striata from this HD mouse series. Hdac4 associations were polyQ-dependent in the striatum, but not in the whole brain, particularly in symptomatic mice. Hdac5 interactions did not exhibit polyQ dependence. To identify which Hdac4 interactions and functions could participate in HD pathogenesis, we integrated our interactome with proteome and transcriptome data sets generated from the striata. We discovered an overlap in enriched functional classes with the Hdac4 interactome, particularly in vesicular trafficking and synaptic functions, and we further validated the Hdac4 interaction with the Wiskott-Aldrich Syndrome Protein and SCAR Homolog (WASH) complex. This study expands the knowledge of Hdac4 regulation and functions in HD, adding to the understanding of the molecular underpinning of HD phenotypes.
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Affiliation(s)
- Joel D Federspiel
- Department of Molecular Biology, Princeton University, Washington Road, Princeton, NJ 08544
| | - Todd M Greco
- Department of Molecular Biology, Princeton University, Washington Road, Princeton, NJ 08544
| | - Krystal K Lum
- Department of Molecular Biology, Princeton University, Washington Road, Princeton, NJ 08544
| | - Ileana M Cristea
- Department of Molecular Biology, Princeton University, Washington Road, Princeton, NJ 08544.
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14
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Abstract
Huntington's chorea (Huntington's disease, HD) is a genetic disorder caused by autosomal dominant mutation, leading to progressive neurodegenerative changes in the central nervous system. Involuntary movements such as chorea occur typically in HD patients, accompanied by progressive cognitive and psychiatric disturbances. Other common symptoms of HD are circadian and sleep abnormalities, which are observed from the earliest stages of the disease or even before the occurrence of clinical symptoms. The most common sleep problems reported by HD patients include insomnia, difficulties in falling asleep, frequent nocturnal awakenings, and excessive daytime sleepiness. Also, specific changes in sleep architecture have been identified in HD. In this paper, we review studies on sleep and circadian rhythm disorders in HD. We outline findings concerning sleep patterns and disturbances of circadian rhythms in HD patients, as well as the role of psychiatric disorders and motor disorders in HD patients' sleep problems. We also discuss problems related to the different methods of diagnosing sleep disorders in HD. Furthermore, the adverse effects of medication used for the treatment of core HD symptoms as one of the sources of sleep disturbances in HD are emphasized. In conclusion, the diversity and complexity of the determinants of sleep and circadian rhythm disorders in HD are highlighted. Finally, the relevance of effective treatment to improve patients' functioning and quality of life as well as the potential relief of their cognitive and emotional symptoms is addressed.
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Affiliation(s)
| | - Lukasz Krzywoszanski
- Neurocognitive Psychology Unit, Chair of Psychology, Faculty of Pedagogy, Pedagogical University of Krakow, Krakow, Poland
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15
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Podvin S, Reardon HT, Yin K, Mosier C, Hook V. Multiple clinical features of Huntington's disease correlate with mutant HTT gene CAG repeat lengths and neurodegeneration. J Neurol 2018; 266:551-564. [PMID: 29956026 DOI: 10.1007/s00415-018-8940-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
Huntington's disease (HD) is a fatal neurodegenerative disease caused by mutant HTT gene expansions of CAG triplet repeat numbers that are inherited in an autosomal dominant manner. HD patients display multiple clinical features that are correlated with HTT CAG repeat numbers that include age of disease onset, motor dysfunction, cognitive deficits, compromised daily living capacity, and brain neurodegeneration. It is important to understand the significant relationships of the multiple HD clinical deficits correlated with the number of mutant HTT CAG expansions that are the genetic basis for HD disabilities. Therefore, this review highlights the significant correlations of the HD clinical features of age of onset, motor and cognitive disabilities, decline in living capabilities, weight loss, risk of death, and brain neurodegeneration with respect to their associations with CAG repeat lengths of the HTT gene. Quantitative HTT gene expression patterns analyzed in normal adult human brain regions demonstrated its distribution in areas known to undergo neurodegeneration in HD, as well as in other brain regions. Future investigation of the relationships of the spectrum of clinical HD features with mutant HTT molecular mechanisms will be important to gain understanding of how mutant CAG expansions of the HTT gene result in the devastating disabilities of HD patients.
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Affiliation(s)
- Sonia Podvin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Holly T Reardon
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Katrina Yin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Charles Mosier
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Vivian Hook
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA.
- Department of Neurosciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA.
- Department of Pharmacology, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA.
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16
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Walker T, Ghosh B, Kipps C. Assessing Decline: Visualising Progression in Huntington's Disease using a Clinical Dashboard with Enroll-HD Data. J Huntingtons Dis 2018; 6:139-147. [PMID: 28550266 DOI: 10.3233/jhd-170234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Huntington's disease (HD), it remains unclear how symptom severity and rate of symptomatic change relates to age and CAG repeat number (CAGn). It is often difficult for clinicians to assess whether an affected individual's symptoms are progressing at a similar rate to their affected peers, limiting their ability to intervene at the most appropriate time. OBJECTIVE To develop a clinical dashboard that compares an individual's total motor score (TMS), total functional capacity (TFC) and symbol digit modality test (SDMT) scores against a global cohort, controlling for age and CAGn. The dashboard could then be used by clinicians to identify individuals progressing at a disproportionate rate to his or her peers. METHODS Annualised longitudinal clinical assessment scores from the Enroll-HD dataset were used to generate decline trajectories of the global cohort, allowing cross-sectional (TMS n = 734; TFC n = 734; SDMT n = 694) and longitudinal (TMS n = 270; TFC n = 270; SDMT n = 247) comparison with individual clinical symptom rating scores, to assess decline relative to affected peers. RESULTS An electronic dashboard with a dynamic output display was created that rapidly compares clinical symptom rating scores of a specific individual against affected peers from a global cohort of comparable CAGn. CONCLUSIONS This study shows the potential for use of multi-centre trial data in allowing comparison of the individual to a larger group to facilitate improved decision-making for individual patients. Visualisation of these metrics via a clinical dashboard demonstrates how it may aid identification of those with disproportionate decline, offering potential for intervention at specific critical points in the disease course.
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Affiliation(s)
- Thomas Walker
- Clinical Neurosciences, University ofSouthampton, Life Sciences Building, Highfield Campus, Southampton, UK
| | - Boyd Ghosh
- Clinical Neurosciences, University ofSouthampton, Life Sciences Building, Highfield Campus, Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher Kipps
- Clinical Neurosciences, University ofSouthampton, Life Sciences Building, Highfield Campus, Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Wessex NIHR CLAHRC, University ofSouthampton, Life Sciences Building, Highfield Campus, Southampton, UK
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17
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Wu D, Faria AV, Younes L, Mori S, Brown T, Johnson H, Paulsen JS, Ross CA, Miller MI. Mapping the order and pattern of brain structural MRI changes using change-point analysis in premanifest Huntington's disease. Hum Brain Mapp 2017; 38:5035-5050. [PMID: 28657159 PMCID: PMC5766002 DOI: 10.1002/hbm.23713] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023] Open
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder that progressively affects motor, cognitive, and emotional functions. Structural MRI studies have demonstrated brain atrophy beginning many years prior to clinical onset ("premanifest" period), but the order and pattern of brain structural changes have not been fully characterized. In this study, we investigated brain regional volumes and diffusion tensor imaging (DTI) measurements in premanifest HD, and we aim to determine (1) the extent of MRI changes in a large number of structures across the brain by atlas-based analysis, and (2) the initiation points of structural MRI changes in these brain regions. We adopted a novel multivariate linear regression model to detect the inflection points at which the MRI changes begin (namely, "change-points"), with respect to the CAG-age product (CAP, an indicator of extent of exposure to the effects of CAG repeat expansion). We used approximately 300 T1-weighted and DTI data from premanifest HD and control subjects in the PREDICT-HD study, with atlas-based whole brain segmentation and change-point analysis. The results indicated a distinct topology of structural MRI changes: the change-points of the volumetric measurements suggested a central-to-peripheral pattern of atrophy from the striatum to the deep white matter; and the change points of DTI measurements indicated the earliest changes in mean diffusivity in the deep white matter and posterior white matter. While interpretation needs to be cautious given the cross-sectional nature of the data, these findings suggest a spatial and temporal pattern of spread of structural changes within the HD brain. Hum Brain Mapp 38:5035-5050, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dan Wu
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Andreia V. Faria
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Laurent Younes
- Center for Imaging Science, Johns Hopkins UniversityBaltimoreMaryland
- Institute for Computational Medicine, Johns Hopkins UniversityBaltimoreMaryland
- Department of Applied Mathematics and StatisticsJohns Hopkins UniversityBaltimoreMaryland
| | - Susumu Mori
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger InstituteBaltimoreMaryland
| | - Timothy Brown
- Center for Imaging Science, Johns Hopkins UniversityBaltimoreMaryland
| | - Hans Johnson
- Department of Electrical and Computer EngineeringUniversity of IowaIowa CityIowa
| | - Jane S. Paulsen
- Departments of Psychiatry, Neurology, Psychology and NeurosciencesUniversity of IowaIowa CityIowa
| | - Christopher A. Ross
- Division of Neurobiology, Departments of Psychiatry, Neurology, Neuroscience and Pharmacology, and Program in Cellular and Molecular MedicineJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Michael I. Miller
- Center for Imaging Science, Johns Hopkins UniversityBaltimoreMaryland
- Institute for Computational Medicine, Johns Hopkins UniversityBaltimoreMaryland
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMaryland
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18
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Abstract
Huntington disease (HD) is an autosomal dominant neurodegenerative condition caused by a CAG trinucleotide expansion in the huntingtin gene. At present, the HD field is experiencing exciting times with the assessment for the first time in human subjects of interventions aimed at core disease mechanisms. Out of a portfolio of interventions that claim a potential disease-modifying effect in HD, the target huntingtin has more robust validation. In this review, we discuss the spectrum of huntingtin-lowering therapies that are currently being considered. We provide a critical appraisal of the validation of huntingtin as a drug target, describing the advantages, challenges, and limitations of the proposed therapeutic interventions. The development of these new therapies relies strongly on the knowledge of HD pathogenesis and the ability to translate this knowledge into validated pharmacodynamic biomarkers. Altogether, the goal is to support a rational drug development that is ethical and cost-effective. Among the pharmacodynamic biomarkers under development, the quantification of mutant huntingtin in the cerebral spinal fluid and PET imaging targeting huntingtin or phosphodiesterase 10A deserve special attention. Huntingtin-lowering therapeutics are eagerly awaited as the first interventions that may be able to change the course of HD in a meaningful way.
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Affiliation(s)
- Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, 155 Village Boulevard, Suite 200, Princeton, USA. .,Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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19
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Daldin M, Fodale V, Cariulo C, Azzollini L, Verani M, Martufi P, Spiezia MC, Deguire SM, Cherubini M, Macdonald D, Weiss A, Bresciani A, Vonsattel JPG, Petricca L, Marsh JL, Gines S, Santimone I, Marano M, Lashuel HA, Squitieri F, Caricasole A. Polyglutamine expansion affects huntingtin conformation in multiple Huntington's disease models. Sci Rep 2017; 7:5070. [PMID: 28698602 PMCID: PMC5505970 DOI: 10.1038/s41598-017-05336-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/14/2017] [Indexed: 12/29/2022] Open
Abstract
Conformational changes in disease-associated or mutant proteins represent a key pathological aspect of Huntington’s disease (HD) and other protein misfolding diseases. Using immunoassays and biophysical approaches, we and others have recently reported that polyglutamine expansion in purified or recombinantly expressed huntingtin (HTT) proteins affects their conformational properties in a manner dependent on both polyglutamine repeat length and temperature but independent of HTT protein fragment length. These findings are consistent with the HD mutation affecting structural aspects of the amino-terminal region of the protein, and support the concept that modulating mutant HTT conformation might provide novel therapeutic and diagnostic opportunities. We now report that the same conformational TR-FRET based immunoassay detects polyglutamine- and temperature-dependent changes on the endogenously expressed HTT protein in peripheral tissues and post-mortem HD brain tissue, as well as in tissues from HD animal models. We also find that these temperature- and polyglutamine-dependent conformational changes are sensitive to bona-fide phosphorylation on S13 and S16 within the N17 domain of HTT. These findings provide key clinical and preclinical relevance to the conformational immunoassay, and provide supportive evidence for its application in the development of therapeutics aimed at correcting the conformation of polyglutamine-expanded proteins as well as the pharmacodynamics readouts to monitor their efficacy in preclinical models and in HD patients.
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Affiliation(s)
- Manuel Daldin
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - Valentina Fodale
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy.,IRBM Promidis, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - Cristina Cariulo
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - Lucia Azzollini
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy.,IRBM Promidis, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - Margherita Verani
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy.,IRBM Promidis, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - Paola Martufi
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | | | - Sean M Deguire
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Brain Mind Institute, Station 19, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Marta Cherubini
- Departamento de Ciencias Biomedicas, Facultat de Medicina, Instituto de Neurociencias, Universitat de Barcelona, Barcelona, Spain
| | | | - Andreas Weiss
- IRBM Promidis, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy.,Evotec AG, Manfred Eigen Campus, Hamburg, Germany
| | - Alberto Bresciani
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - Jean-Paul Gerard Vonsattel
- Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Lara Petricca
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy.,IRBM Promidis, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy
| | - J Lawrence Marsh
- Department of Developmental and Cell Biology, University of California, Irvine, 92697, USA
| | - Silvia Gines
- Departamento de Ciencias Biomedicas, Facultat de Medicina, Instituto de Neurociencias, Universitat de Barcelona, Barcelona, Spain
| | - Iolanda Santimone
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimo Marano
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Hilal A Lashuel
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Brain Mind Institute, Station 19, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andrea Caricasole
- IRBM Science Park, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy. .,IRBM Promidis, Via Pontina km 30.600, 00071, Pomezia, Rome, Italy.
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20
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Chao TK, Hu J, Pringsheim T. Risk factors for the onset and progression of Huntington disease. Neurotoxicology 2017; 61:79-99. [PMID: 28111121 DOI: 10.1016/j.neuro.2017.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 01/10/2023]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder characterized by chorea, behavioural and psychiatric manifestations, and dementia, caused by a CAG triplet repeat expansion in the huntingtin gene. Systematic review of the literature was conducted to determine the risk factors for the onset and progression of HD. Multiple databases were searched, using terms specific to Huntington disease and to studies of aetiology, risk, prevention and genetics, limited to studies on human subjects published in English or French between 1950 and 2010. Two reviewers independently screened the abstracts and identified potentially relevant articles for full-text review using predetermined inclusion criteria. Three major categories of risk factors for onset of HD were identified: CAG repeat length in the huntingtin gene, CAG instability, and genetic modifiers. Of these, CAG repeat length in the huntingtin gene is the most important risk factor. For the progression of HD: genetic, demographic, past medical/clinical and environmental risk factors have been studied. Of these factors, genetic factors appear to play the most important role in the progression of HD. Among the potential risk factors, CAG repeat length in the mutant allele was found to be a relatively consistent and significant risk factor for the progression of HD, especially in motor, cognitive, and other neurological symptom deterioration. In addition, there were many consistent results in the literature indicating that a higher number of CAG repeats was associated with shorter survival, faster institutionalization, and earlier percutaneous endoscopic gastrostomy.
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21
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Malek N, Newman EJ. Hereditary chorea - what else to consider when the Huntington's disease genetics test is negative? Acta Neurol Scand 2017; 135:25-33. [PMID: 27150574 DOI: 10.1111/ane.12609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
Chorea, cognitive, behavioural and psychiatric disturbance occur in varying combinations in Huntington's disease (HD). This is often easy to recognise particularly in the presence of an autosomal dominant history. Whilst HD may be the most common aetiology of such a presentation, several HD phenocopies should be considered if genetic testing for HD is negative. We searched PubMed and the Cochrane Database from January 1, 1946 up to January 1, 2016, combining the search terms: 'chorea', 'Huntington's disease', 'HDL' and 'phenocopies'. HD phenocopies frequently display additional movement disorders such as myoclonus, dystonia, parkinsonism and tics. Here, we discuss the phenotypes, and investigations of HD-like disorders where the combination of progressive chorea and cognitive impairment is obvious, but HD gene test result is negative. Conditions presenting with sudden onset chorea such as vascular, infectious and autoimmune causes are not the primary focus of our discussion, but we will make a passing reference to these as some of these conditions are potentially treatable. Hereditary forms of chorea are a heterogeneous group of conditions and this number is increasing. While most of these conditions are not curable, molecular genetic testing has enabled many of these disorders to be distinguished from HD. Getting a precise diagnosis may enable patients and their families to better understand the nature of their condition.
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Affiliation(s)
- N. Malek
- Department of Neurology; Institute of Neurosciences; Queen Elizabeth University Hospital; Glasgow UK
| | - E. J. Newman
- Department of Neurology; Institute of Neurosciences; Queen Elizabeth University Hospital; Glasgow UK
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22
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de Diego-Balaguer R, Schramm C, Rebeix I, Dupoux E, Durr A, Brice A, Charles P, Cleret de Langavant L, Youssov K, Verny C, Damotte V, Azulay JP, Goizet C, Simonin C, Tranchant C, Maison P, Rialland A, Schmitz D, Jacquemot C, Fontaine B, Bachoud-Lévi AC. COMT Val158Met Polymorphism Modulates Huntington's Disease Progression. PLoS One 2016; 11:e0161106. [PMID: 27657697 PMCID: PMC5033325 DOI: 10.1371/journal.pone.0161106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
Little is known about the genetic factors modulating the progression of Huntington's disease (HD). Dopamine levels are affected in HD and modulate executive functions, the main cognitive disorder of HD. We investigated whether the Val158Met polymorphism of the catechol-O-methyltransferase (COMT) gene, which influences dopamine (DA) degradation, affects clinical progression in HD. We carried out a prospective longitudinal multicenter study from 1994 to 2011, on 438 HD gene carriers at different stages of the disease (34 pre-manifest; 172 stage 1; 130 stage 2; 80 stage 3; 17 stage 4; and 5 stage 5), according to Total Functional Capacity (TFC) score. We used the Unified Huntington's Disease Rating Scale to evaluate motor, cognitive, behavioral and functional decline. We genotyped participants for COMT polymorphism (107 Met-homozygous, 114 Val-homozygous and 217 heterozygous). 367 controls of similar ancestry were also genotyped. We compared clinical progression, on each domain, between groups of COMT polymorphisms, using latent-class mixed models accounting for disease duration and number of CAG (cytosine adenine guanine) repeats. We show that HD gene carriers with fewer CAG repeats and with the Val allele in COMT polymorphism displayed slower cognitive decline. The rate of cognitive decline was greater for Met/Met homozygotes, which displayed a better maintenance of cognitive capacity in earlier stages of the disease, but had a worse performance than Val allele carriers later on. COMT polymorphism did not significantly impact functional and behavioral performance. Since COMT polymorphism influences progression in HD, it could be used for stratification in future clinical trials. Moreover, DA treatments based on the specific COMT polymorphism and adapted according to disease duration could potentially slow HD progression.
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Affiliation(s)
- Ruth de Diego-Balaguer
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- ICREA, 08010, Barcelona, Spain
- Universitat de Barcelona, Departament de Cognició, Desenvolupament i Psicologia de L’Educació, 08035, Barcelona, Spain
- IDIBELL, Unitat de Cognició i Plasticitat Cerebral, 08907, L’Hospitalet de Llobregat, Spain
- Institut de Neurociència, Universitat de Barcelona, Barcelona, Spain
| | - Catherine Schramm
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
| | - Isabelle Rebeix
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Emmanuel Dupoux
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Laboratoire de Sciences Cognitives et Psycholinguistique, ENS-EHESS-CNRS, Paris, 75005, France
| | - Alexandra Durr
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Alexis Brice
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Perrine Charles
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Laurent Cleret de Langavant
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, 94000, Créteil, France
| | - Katia Youssov
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, 94000, Créteil, France
| | - Christophe Verny
- CHU d'Angers, Centre de Référence des Maladies Neurogénétiques, Service de Neurologie, 49933, Angers, France
| | - Vincent Damotte
- INSERM-UPMC-CNRS, UMR 7225–1127, Institut Cerveau Moelle-ICM, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Jean-Philippe Azulay
- CHU de Marseille—Hôpital de la Timone, Service de Neurologie et Pathologie du Mouvement, 13385, Marseille, France
| | - Cyril Goizet
- CHU de Bordeaux-GH Sud—Hôpital Haut-Lévêque, Service de Neurologie, 33604, Pessac, France
| | - Clémence Simonin
- CHRU de Lille, Service de Neurologie et Pathologie du Mouvement, 59000, Lille, France
- INSERM UMR-S 1172, JPArc, centre de recherche Jean-Pierre-Aubert neurosciences et cancer, Université de Lille, 59000, Lille, France
| | - Christine Tranchant
- CHU de Strasbourg—Hôpital de Hautepierre, Service de Neurologie, 67098, Strasbourg, France
| | - Patrick Maison
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique, 94000, Créteil, France
| | - Amandine Rialland
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique, 94000, Créteil, France
| | - David Schmitz
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique, 94000, Créteil, France
| | - Charlotte Jacquemot
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
| | - Bertrand Fontaine
- Assistance Publique-Hôpitaux de Paris, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, 74013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, 74013, Paris, France
| | - Anne-Catherine Bachoud-Lévi
- INSERM U955, Equipe 01 Neuropsychologie Interventionnelle, 94000, Créteil, France
- Département d’Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, 75005, Paris, France
- Université Paris Est, Faculté de Médecine, 94000, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladie de Huntington, Service de Neurologie, Hôpital Henri Mondor-Albert Chenevier, 94000, Créteil, France
- * E-mail:
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23
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Zinzi P, Salmaso D, De Grandis R, Graziani G, Maceroni S, Bentivoglio A, Zappata P, Frontali M, Jacopini G. Effects of an intensive rehabilitation programme on patients with Huntington's disease: a pilot study. Clin Rehabil 2016; 21:603-13. [PMID: 17702702 DOI: 10.1177/0269215507075495] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effects of an intensive, inpatient rehabilitation programme on individuals affected by Huntington's disease. Design: A pilot study. Within-subjects design. Setting: Inpatient rehabilitation home of the Italian welfare system. Subjects: Forty patients, early and middle stage of the disease, were recruited to an intensive, inpatient rehabilitation protocol. Interventions: The treatment programme included respiratory exercises and speech therapy, physical and occupational therapy and cognitive rehabilitation exercises. The programme involved three-week admission periods of intensive treatment that could be repeated three times a year. Main measures: A standard clinical assessment was performed at the beginning of each admission using the Zung Depression Scale, Mini-Mental State Examination (MMSE), Barthel Index, Tinetti Scale and Physical Performance Test (PPT). Tinetti and PPT were also used at the end of each admission to assess the outcomes in terms of motor and functional performance. Results: Each three-week period of treatment resulted in highly significant ( P < 0.001) improvements of motor performance and daily life activities. The average increase was 4.7 for Tinetti and 5.21 for PPT scores. No carry-over effect from one admission to the next was apparent but at the same time, no motor decline was detected over two years, indicating that patients maintained a constant level of functional, cognitive as well as motor performance. Conclusions: Intensive rehabilitation treatments may positively influence the maintenance of functional and motor performance in patients with Huntington's disease.
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Abstract
This article reviews studies of risk awareness of carriers of genetic disorders and individuals who attend genetic counselling. It focuses upon investigations of recall of risk estimates following counselling. Six factors are discussed which may influence individuals' recall of genetic risk estimates. These include: mode of genetic transmission, counsellees' reproductive behaviour or intentions, time delay between counselling and data collection, prior familiarity with the disorder, subjective perceptions of risk, and the way that risk information is presented during counselling. It is argued that using counsellees' recall of genetic risk estimates as a measure of the effectiveness of counselling is problematic, both at a methodological and conceptual level. It is suggested that assessments of the effectiveness of genetic counselling must involve an approach which conceptualizes counselling as a dynamic process in which both counsellee and counsellor have active roles to play.
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25
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Abstract
Huntington's disease (HD) is an autosomal dominant inherited neurodegenerative disease with the typical manifestations of involuntary movements, psychiatric and behavior disorders, and cognitive impairment. It is caused by the dynamic mutation in CAG triplet repeat number in exon 1 of huntingtin (HTT) gene. The symptoms of HD especially the age at onset are related to the genetic characteristics, both the CAG triplet repeat and the modified factors. Here, we reviewed the recent advancement on the genotype-phenotype relationship of HD, mainly focus on the characteristics of different expanded CAG repeat number, genetic modifiers, and CCG repeat number in the 3' end of CAG triplet repeat and their effects on the phenotype. We also reviewed the special forms of HD (juvenile HD, atypical onset HD, and homozygous HD) and their phenotype-genotype correlations. The review will aid clinicians to predict the onset age and disease course of HD, give the genetic counseling, and accelerate research into the HD mechanism.
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Affiliation(s)
- Yi-Min Sun
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan-Bin Zhang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China.,Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China.
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26
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Schramm C, Katsahian S, Youssov K, Démonet JF, Krystkowiak P, Supiot F, Verny C, Cleret de Langavant L, Bachoud-Lévi AC. How to Capitalize on the Retest Effect in Future Trials on Huntington's Disease. PLoS One 2015; 10:e0145842. [PMID: 26714284 PMCID: PMC4703129 DOI: 10.1371/journal.pone.0145842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022] Open
Abstract
The retest effect-improvement of performance on second exposure to a task-may impede the detection of cognitive decline in clinical trials for neurodegenerative diseases. We assessed the impact of the retest effect in Huntington's disease trials, and investigated its possible neutralization. We enrolled 54 patients in the Multicentric Intracerebral Grafting in Huntington's Disease (MIG-HD) trial and 39 in the placebo arm of the Riluzole trial in Huntington's Disease (RIL-HD). All were assessed with the Unified Huntington's Disease Rating Scale (UHDRS) plus additional cognitive tasks at baseline (A1), shortly after baseline (A2) and one year later (A3). We used paired t-tests to analyze the retest effect between A1 and A2. For each task of the MIG-HD study, we used a stepwise algorithm to design models predictive of patient performance at A3, which we applied to the RIL-HD trial for external validation. We observed a retest effect in most cognitive tasks. A decline in performance at one year was detected in 3 of the 15 cognitive tasks with A1 as the baseline, and 9 of the 15 cognitive tasks with A2 as the baseline. We also included the retest effect in performance modeling and showed that it facilitated performance prediction one year later for 14 of the 15 cognitive tasks. The retest effect may mask cognitive decline in patients with neurodegenerative diseases. The dual baseline can improve clinical trial design, and better prediction should homogenize patient groups, resulting in smaller numbers of participants being required.
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Affiliation(s)
- Catherine Schramm
- INSERM U955 E01, Neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Créteil, France
- INSERM UMRS1138 E22, Science de l'information au service de la médecine personnalisée, Centre de Recherche des Cordeliers, Université Paris 5, Université Paris 6, Paris, France
- Université Paris Est, Faculté de Médecine, Créteil, France
- Ecole Normale Supérieure, Institut d’Etude de la Cognition, Paris, France
| | - Sandrine Katsahian
- INSERM UMRS1138 E22, Science de l'information au service de la médecine personnalisée, Centre de Recherche des Cordeliers, Université Paris 5, Université Paris 6, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service d’informatique et statistiques, Hôpital Européen Georges Pompidou, Paris, France
| | - Katia Youssov
- INSERM U955 E01, Neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Créteil, France
- Université Paris Est, Faculté de Médecine, Créteil, France
- Ecole Normale Supérieure, Institut d’Etude de la Cognition, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre National de Référence pour la Maladie de Huntington, Hôpital Henri Mondor, Créteil, France
| | - Jean-François Démonet
- Leenaards Memory Centre, Clinical Neurosciences Department, CHUV Lausanne, Lausanne, Switzerland
| | - Pierre Krystkowiak
- Centre Hospitalier Universitaire d'Amiens, Service de neurologie, Amiens, France
- EA 4559 - Laboratoire de Neurosciences Fonctionnelles et Pathologie (LNFP), Université de Picardie Jules Verne (UPJV), Amiens, France
- SFR CAP-Santé (FED 4231), Amiens, France
| | - Frédéric Supiot
- Hôpital Erasme ULB, Service de Neurologie, Bruxelles, Belgium
| | - Christophe Verny
- CHU d'Angers, Centre de Référence des Maladies Neurogénétiques, Service de Neurologie, Angers, France
| | - Laurent Cleret de Langavant
- INSERM U955 E01, Neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Créteil, France
- Université Paris Est, Faculté de Médecine, Créteil, France
- Ecole Normale Supérieure, Institut d’Etude de la Cognition, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre National de Référence pour la Maladie de Huntington, Hôpital Henri Mondor, Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- INSERM U955 E01, Neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Créteil, France
- Université Paris Est, Faculté de Médecine, Créteil, France
- Ecole Normale Supérieure, Institut d’Etude de la Cognition, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre National de Référence pour la Maladie de Huntington, Hôpital Henri Mondor, Créteil, France
- * E-mail:
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Abstract
Huntington disease (HD) is an autosomal dominant inherited neurodegenerative disease characterized by progressive motor, behavioral, and cognitive decline, culminating in death. It is caused by an expanded CAG repeat in the huntingtin gene. Even years before symptoms become overt, mutation carriers show subtle but progressive striatal and cerebral white matter atrophy by volumetric MRI. Although there is currently no direct treatment of HD, management options are available for several symptoms. A better understanding of HD pathogenesis, and more sophisticated clinical trials using newer biomarkers, may lead to meaningful treatments. This article reviews the current knowledge of HD pathogenesis and treatment.
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Affiliation(s)
- Praveen Dayalu
- Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Roger L Albin
- Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Neuroscience Research, Veterans Affairs Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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28
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Gusella JF, MacDonald ME, Lee JM. Genetic modifiers of Huntington's disease. Mov Disord 2014; 29:1359-65. [DOI: 10.1002/mds.26001] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- James F. Gusella
- Molecular Neurogenetics Unit, Department of Neurology and Center for Human Genetic Research; Massachusetts General Hospital; Boston Massachusetts USA
| | - Marcy E. MacDonald
- Molecular Neurogenetics Unit, Department of Neurology and Center for Human Genetic Research; Massachusetts General Hospital; Boston Massachusetts USA
| | - Jong-Min Lee
- Molecular Neurogenetics Unit, Department of Neurology and Center for Human Genetic Research; Massachusetts General Hospital; Boston Massachusetts USA
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29
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Margulis J, Finkbeiner S. Proteostasis in striatal cells and selective neurodegeneration in Huntington's disease. Front Cell Neurosci 2014; 8:218. [PMID: 25147502 PMCID: PMC4124811 DOI: 10.3389/fncel.2014.00218] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/17/2014] [Indexed: 12/23/2022] Open
Abstract
Selective neuronal loss is a hallmark of neurodegenerative diseases, including Huntington’s disease (HD). Although mutant huntingtin, the protein responsible for HD, is expressed ubiquitously, a subpopulation of neurons in the striatum is the first to succumb. In this review, we examine evidence that protein quality control pathways, including the ubiquitin proteasome system, autophagy, and chaperones, are significantly altered in striatal neurons. These alterations may increase the susceptibility of striatal neurons to mutant huntingtin-mediated toxicity. This novel view of HD pathogenesis has profound therapeutic implications: protein homeostasis pathways in the striatum may be valuable targets for treating HD and other misfolded protein disorders.
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Affiliation(s)
- Julia Margulis
- Gladstone Institute of Neurological Disease, J. David Gladstone Institutes San Francisco, CA, USA ; Department of Neurology, University of California at San Francisco San Francisco, CA, USA ; Department of Physiology, University of California at San Francisco San Francisco, CA, USA
| | - Steven Finkbeiner
- Gladstone Institute of Neurological Disease, J. David Gladstone Institutes San Francisco, CA, USA ; Department of Neurology, University of California at San Francisco San Francisco, CA, USA ; Department of Physiology, University of California at San Francisco San Francisco, CA, USA ; Taube/Koret Center for Huntington's Disease Research San Francisco, CA, USA
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Salem L, Saleh N, Youssov K, Olivier A, Charles P, Scherer C, Verny C, Bachoud-Lévi AC, Maison P. The most appropriate primary outcomes to design clinical trials on Huntington's disease: meta-analyses of cohort studies and randomized placebo-controlled trials. Fundam Clin Pharmacol 2014; 28:700-10. [DOI: 10.1111/fcp.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 03/07/2014] [Accepted: 04/01/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Linda Salem
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Pharmacologie clinique; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
| | - Nadine Saleh
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Katia Youssov
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Audrey Olivier
- CHU Angers; Département de Neurologie; Angers 49000 France
| | - Perrine Charles
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | | | | | - Anne-Catherine Bachoud-Lévi
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Patrick Maison
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Pharmacologie clinique; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
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Pal R, Alves G, Larsen JP, Møller SG. New insight into neurodegeneration: the role of proteomics. Mol Neurobiol 2014; 49:1181-99. [PMID: 24323427 DOI: 10.1007/s12035-013-8590-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/06/2013] [Indexed: 12/11/2022]
Abstract
Recent advances within the field of proteomics, including both upstream and downstream protocols, have fuelled a transition from simple protein identification to functional analysis. A battery of proteomics approaches is now being employed for the analysis of protein expression levels, the monitoring of cellular activities and for gaining an increased understanding into biochemical pathways. Combined, these approaches are changing the way we study disease by allowing accurate and targeted, large scale protein analysis, which will provide invaluable insight into disease pathogenesis. Neurodegenerative disorders, including Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), amyotrophic lateral sclerosis (ALS), prion disease, and other diseases that affect the neuromuscular system, are a leading cause of disability in the aging population. There are no effective intervention strategies for these disorders and diagnosis is challenging as it relies primarily on clinical symptomatic features, which often overlap at early stages of disease. There is, therefore, an urgent need to develop reliable biomarkers to improve early and specific diagnosis, to track disease progression, to measure molecular responses towards treatment regimes and ultimately devise new therapeutic strategies. To accomplish this, a better understanding of disease mechanisms is needed. In this review we summarize recent advances in the field of proteomics applicable to neurodegenerative disorders, and how these advances are fueling our understanding, diagnosis, and treatment of these complex disorders.
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Shin H, Kim MH, Lee SJ, Lee KH, Kim MJ, Kim JS, Cho JW. Decreased Metabolism in the Cerebral Cortex in Early-Stage Huntington's Disease: A Possible Biomarker of Disease Progression? J Clin Neurol 2013; 9:21-5. [PMID: 23346156 PMCID: PMC3543905 DOI: 10.3988/jcn.2013.9.1.21] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 01/28/2023] Open
Abstract
Background and Purpose Huntington's disease (HD) is an autosomal-dominant inherited neurodegenerative disorder. Genetic analysis of abnormal CAG expansion in the IT15 gene allows disease confirmation even in the preclinical stage. However, because there is no treatment to cure or delay the progression of this disease, monitoring of biological markers that predict progression is warranted. Methods FDG-PET was applied to 13 patients with genetically confirmed HD in the early stage of the disease. We recorded the initial and follow-up statuses of patients using the Independence Scale (IS) of the Unified Huntington's Disease Rating Scale. The progression rate (PR) was calculated as the annual change in the IS. The patients were divided into two groups with faster and slower progression, using the median value of the PR as the cut-off. FDG-PET data were analyzed using regions of interest, and compared among the two patient groups and 11 age- and sex-matched controls. Results The mean CAG repeat size in patients was 44.7. The CAG repeat length was inversely correlated with the age at onset as reported previously, but was not correlated with the clinical PR. Compared with normal controls, hypometabolism was observed even at very early stages of the disease in the bilateral frontal, temporal, and parietal cortices on FDG-PET. The decreases in metabolism in the bilateral frontal, parietal, and right temporal cortices were much greater in the faster-progression group than in the slower-progression group. Conclusions A decrease in cortical glucose metabolism is suggested as a predictor for identifying a more rapid form of progression in patients with early-stage HD.
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Affiliation(s)
- Hyeeun Shin
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Deajeon, Korea
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Abstract
Huntington's disease (HD) is an inherited neurodegenerative disease that is characterized by movement abnormalities, cognitive impairment, and abnormal behavior as well as sleep and weight problems. It is an autosomal dominant disorder caused by a mutation in the huntingtin gene on the short arm of chromosome 4, which results in the progressive degeneration of the basal ganglia (caudate, putamen, and globus pallidus), cerebral cortex, brainstem, thalamus, and hypothalamus. This chapter considers four avenues of research: (a) the restoration of neurogenesis as an endogenous cell therapy in HD, (b) fetal tissue transplantation, (c) stem cell transplantation, and finally (d) the use of endogenous trophic factors such as brain derived neurotrophic factor.
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Rosenblatt A, Kumar BV, Mo A, Welsh CS, Margolis RL, Ross CA. Age, CAG repeat length, and clinical progression in Huntington's disease. Mov Disord 2011; 27:272-6. [PMID: 22173986 DOI: 10.1002/mds.24024] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/23/2011] [Accepted: 10/12/2011] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to further explore the effect of CAG repeat length on the rate of clinical progression in patients with Huntington's disease. The dataset included records for 569 subjects followed prospectively at the Baltimore Huntington's Disease Center. Participants were seen for a mean of 7.1 visits, with a mean follow-up of 8.2 years. Subjects were evaluated using the Quantified Neurologic Examination and its Motor Impairment subscale, the Mini-Mental State Examination, and the Huntington's disease Activities of Daily Living Scale. By itself, CAG repeat length showed a statistically significant but small effect on the progression of all clinical measures. Contrary to our previous expectations, controlling for age of onset increased the correlation between CAG repeat length and progression of all variables by 69% to 159%. Graphical models further supported the idea that individuals with smaller triplet expansions experience a more gradual decline. CAG repeat length becomes an important determinant of clinical prognosis when accounting for age of onset. This suggests that the aging process itself influences clinical outcomes in Huntington's disease. Inconsistent results in prior studies examining CAG repeat length and progression may indeed reflect a lack of age adjustment.
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Affiliation(s)
- Adam Rosenblatt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Rosas HD, Reuter M, Doros G, Lee SY, Triggs T, Malarick K, Fischl B, Salat DH, Hersch SM. A tale of two factors: what determines the rate of progression in Huntington's disease? A longitudinal MRI study. Mov Disord 2011; 26:1691-7. [PMID: 21611979 DOI: 10.1002/mds.23762] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 02/22/2011] [Accepted: 03/28/2011] [Indexed: 11/10/2022] Open
Abstract
Over the past several years, increased attention has been devoted to understanding regionally selective brain changes that occur in Huntington's disease and their relationships to phenotypic variability. Clinical progression is also heterogeneous, and although CAG repeat length influences age of onset, its role, if any, in progression has been less clear. We evaluated progression in Huntington's disease using a novel longitudinal magnetic resonance imaging analysis. Our hypothesis was that the rate of brain atrophy is influenced by the age of onset of Huntington's disease. We scanned 22 patients with Huntington's disease at approximately 1-year intervals; individuals were divided into 1 of 3 groups, determined by the relative age of onset. We found significant differences in the rates of atrophy of cortex, white matter, and subcortical structures; patients who developed symptoms earlier demonstrated the most rapid rates of atrophy compared with those who developed symptoms during middle age or more advanced age. Rates of cortical atrophy were topologically variable, with the most rapid changes occurring in sensorimotor, posterior frontal, and portions of the parietal cortex. There were no significant differences in the rates of atrophy in basal ganglia structures. Although both CAG repeat length and age influenced the rate of change in some regions, there was no significant correlation in many regions. Rates of regional brain atrophy seem to be influenced by the age of onset of Huntington's disease symptoms and are only partially explained by CAG repeat length. These findings suggest that other genetic, epigenetic, and environmental factors play important roles in neurodegeneration in Huntington's disease.
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Affiliation(s)
- H Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts, USA.
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Politis M, Pavese N, Tai YF, Kiferle L, Mason SL, Brooks DJ, Tabrizi SJ, Barker RA, Piccini P. Microglial activation in regions related to cognitive function predicts disease onset in Huntington's disease: a multimodal imaging study. Hum Brain Mapp 2011; 32:258-70. [PMID: 21229614 DOI: 10.1002/hbm.21008] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disorder associated with motor, cognitive and psychiatric deficits. This study, using a multimodal imaging approach, aims to assess in vivo the functional and structural integrity of regions and regional networks linked with motor, cognitive and psychiatric function. Predicting disease onset in at risk individuals is problematic and thus we sought to investigate this by computing the 5-year probability of HD onset (p5 HD) and relating it to imaging parameters. Using MRI, (11)C-PK11195 and (11)C-raclopride PET, we have investigated volumes, levels of microglial activation and D2/D3 receptor binding in CAG repeat-matched groups of premanifest and symptomatic HD gene carriers. Findings were correlated with disease-burden and UHDRS scores. Atrophy was detected in sensorimotor striatum (SMST), substantia nigra, orbitofrontal and anterior prefrontal cortex in the premanifest HD. D2/D3 receptor binding was reduced and microglial activation increased in SMST and associative striatum (AST), bed nucleus of the stria terminalis, the amygdala and the hypothalamus. In symptomatic HD cases this extended to involve atrophy in globus pallidus, limbic striatum, the red nuclei, anterior cingulate cortex, and insula. D2/D3 receptor binding was additionally reduced in substantia nigra, globus pallidus, limbic striatum, anterior cingulate cortex and insula, and microglial activation increased in globus pallidus, limbic striatum and anterior prefrontal cortex. In premanifest HD, increased levels of microglial activation in the AST and in the regional network associated with cognitive function correlated with p5 HD onset. These data suggest that pathologically activated microglia in AST and other areas related to cognitive function, maybe better predictors of clinical onset and stresses the importance of early cognitive assessment in HD.
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Affiliation(s)
- Marios Politis
- Department of Clinical Neurosciences and MRC Clinical Sciences Centre, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK.
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Whan V, Hobbs M, McWilliam S, Lynn DJ, Lutzow YS, Khatkar M, Barendse W, Raadsma H, Tellam RL. Bovine proteins containing poly-glutamine repeats are often polymorphic and enriched for components of transcriptional regulatory complexes. BMC Genomics 2010; 11:654. [PMID: 21092319 PMCID: PMC3014979 DOI: 10.1186/1471-2164-11-654] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 11/23/2010] [Indexed: 11/12/2022] Open
Abstract
Background About forty human diseases are caused by repeat instability mutations. A distinct subset of these diseases is the result of extreme expansions of polymorphic trinucleotide repeats; typically CAG repeats encoding poly-glutamine (poly-Q) tracts in proteins. Polymorphic repeat length variation is also apparent in human poly-Q encoding genes from normal individuals. As these coding sequence repeats are subject to selection in mammals, it has been suggested that normal variations in some of these typically highly conserved genes are implicated in morphological differences between species and phenotypic variations within species. At present, poly-Q encoding genes in non-human mammalian species are poorly documented, as are their functions and propensities for polymorphic variation. Results The current investigation identified 178 bovine poly-Q encoding genes (Q ≥ 5) and within this group, 26 genes with orthologs in both human and mouse that did not contain poly-Q repeats. The bovine poly-Q encoding genes typically had ubiquitous expression patterns although there was bias towards expression in epithelia, brain and testes. They were also characterised by unusually large sizes. Analysis of gene ontology terms revealed that the encoded proteins were strongly enriched for functions associated with transcriptional regulation and many contributed to physical interaction networks in the nucleus where they presumably act cooperatively in transcriptional regulatory complexes. In addition, the coding sequence CAG repeats in some bovine genes impacted mRNA splicing thereby generating unusual transcriptional diversity, which in at least one instance was tissue-specific. The poly-Q encoding genes were prioritised using multiple criteria for their likelihood of being polymorphic and then the highest ranking group was experimentally tested for polymorphic variation within a cattle diversity panel. Extensive and meiotically stable variation was identified. Conclusions Transcriptional diversity can potentially be generated in poly-Q encoding genes by the impact of CAG repeat tracts on mRNA alternative splicing. This effect, combined with the physical interactions of the encoded proteins in large transcriptional regulatory complexes suggests that polymorphic variations of proteins in these complexes have strong potential to affect phenotype.
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Affiliation(s)
- Vicki Whan
- CSIRO Livestock Industries, Queensland Bioscience Precinct, 306 Carmody Rd, St Lucia, Queensland 4067, Australia
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Abstract
Huntington disease (HD) is a severe incurable nervous system disease that generally has an onset age of around 35-50, and is caused by a dominantly transmitted expansion mutation. A genetic test allows persons at risk, i.e., offspring or siblings of affected individuals, to discover their genetic status. Unaffected mutation-positive subjects will manifest HD sometime during life. Despite major advances in research on pathogenic mechanisms, no studies have yet fully validated preventive therapy or biomarkers for use before the symptoms become clinically manifest. Seeking brain and peripheral biomarkers is a requisite to develop a cure for HD. Changes in the brain can be observed in vivo using methods such as structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI), and positron emission tomography (PET), detecting volumetric changes, microstructural and connectivity alterations, abnormalities in brain activity in response to specific tasks, and abnormalities in metabolism and receptor distribution. Although all these imaging techniques can detect early markers in asymptomatic HD gene carriers for premanifest screening and pharmacological responses to therapeutic interventions no single modality has yet provided and validated an optimal marker probably because this task requires an integrative multimodal imaging approach. In this article, we review the findings from imaging procedures in the attempt to identify potential brain markers, so-called dry biomarkers, for possible application to further, yet unavailable, neuroprotective preventive therapies for HD manifestations.
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Affiliation(s)
- Mouna Esmaeilzadeh
- Department of Clinical Neuroscience, Stockholm Brain Institute, Karolinska Institutet, PET Centre, Karolinska University Hospital, Stockholm, Sweden
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Abstract
Lentiviral-mediated gene transfer in vivo or in cultured mammalian neurons can be used to address a wide variety of biological questions, to design animal models for specific neurodegenerative pathologies, or to test potential therapeutic approaches in a variety of brain disorders. Lentiviruses can infect nondividing cells, thereby allowing stable gene transfer in postmitotic cells such as mature neurons. An important contribution has been the use of inducible vectors: the same animal can thus be used repeatedly in the doxycycline-on or -off state, providing a powerful mean for assessing the function of a gene candidate in a disorder within a specific neuronal circuit. Furthermore, lentivirus vectors provide a unique tool to integrate siRNA expression constructs with the aim to locally knockdown expression of a specific gene, enabling to assess the function of a gene in a very specific neuronal pathway. Lentiviral vector-mediated delivery of short hairpin RNA results in persistent knockdown of gene expression in the brain. Therefore, the use of lentiviruses for stable expression of siRNA in brain is a powerful aid to probe gene functions in vivo and for gene therapy of diseases of the central nervous system. In this chapter, I review the applications of lentivirus-mediated gene transfer in the investigation of specific gene candidates involved in major brain disorders and neurodegenerative processes. Major applications have been in polyglutamine disorders, such as synucleinopathies and Parkinson's disease, or in investigating gene function in Huntington's disease, dystonia, or muscular dystrophy. Recently, lentivirus gene transfer has been an invaluable tool for evaluation of gene function in behavioral disorders such as drug addiction and attention-deficit hyperactivity disorder or in learning and cognition.
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Affiliation(s)
- Jean-Luc Dreyer
- Division of Biochemistry, Department of Medicine, University of Fribourg, Fribourg, Switzerland.
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Puri BK, Manku MS. Copy number variation, eicosapentaenoic acid and neurological disorders. J Nutrigenet Nutrigenomics 2010; 3:151-6. [PMID: 21474947 DOI: 10.1159/000324349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Basant K Puri
- MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
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Abstract
BACKGROUND Huntington's disease (HD) is an autosomal dominant neurodegenerative disease with an average onset between the fourth and fifth decade of life; it leads to death 15 to 20 years after the onset of symptoms. Although several drugs seem effective in controlling the incapacitating manifestations of HD, no specific therapy is known. The present review aims at analysing the best available data on therapeutic interventions investigated with the goal of modifying the progression of the disease as measured in terms of survival, disability or progression of HD core symptoms. OBJECTIVES Evaluate the effectiveness of therapeutic interventions aimed at modifying disease progression in HD. SEARCH STRATEGY The search strategy developed for the Movement Disorders Group was undertaken. The Cochrane Controlled Trials Register, Medline, EMBASE and Clinical Trials Database of the United States National Institute of Health were thoroughly searched until December 2007. SELECTION CRITERIA All randomised, double-blinded, placebo-controlled clinical trials of therapeutics investigated with the goal of modifying disease progression in HD were included. Participants should have genetically confirmed diagnosis of HD or compatible symptoms and a family history. Trials had a follow-up duration of more than three months and at least ten participants. All pharmacological and non-pharmacological interventions were included. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the eligibility of identified trials. The methodological quality was assessed and eligible data were registered onto standardised forms. An intention-to-treat analysis was conducted, when feasible. If data were not available in the original publication, the principal investigator of the trial was contacted for further information. A meta-analysis was to be conducted when possible; otherwise, a descriptive summary of the results was provided. The software Revman 5.0.15 was used for statistical analysis. MAIN RESULTS Eight trials were included involving a total of 1366 HD patients. The duration of the studies ranged between 30 and 144 weeks (median: 52 weeks). The following interventions were selected: vitamin E, Idebenone, Baclofen, Lamotrigine, creatine, coenzyme Q10 + Remacemide, ethyl-eicosapentanoic acid and Riluzole. No trials produced positive results for the selected efficacy outcome measures. A descriptive summary of the trials is provided. The selected interventions were found to be generally safe and well tolerated. AUTHORS' CONCLUSIONS Only pharmacological interventions were included and none proved to be effective as a disease-modifying therapy for HD. Further trials with greater methodological quality should be conducted using more sensitive biological markers. Pre-symptomatic mutation carriers should be included in future studies.
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Affiliation(s)
- Tiago Mestre
- Institute of Molecular MedicineNeurological Clinical Research UnitHospital de Santa MariaAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Joaquim Ferreira
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaHospital de Santa MariaAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Miguel M Coelho
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaHospital de Santa MariaAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Mário Rosa
- Institute of Molecular MedicineNeurological Clinical Research UnitHospital de Santa MariaAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Cristina Sampaio
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaHospital de Santa MariaAv. Prof. Egas MonizLisboaPortugal1649‐028
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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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Netravathi M, Pal PK, Purushottam M, Thennarasu K, Mukherjee M, Jain S. Spinocerebellar ataxias types 1, 2 and 3: Age adjusted clinical severity of disease at presentation correlates with size of CAG repeat lengths. J Neurol Sci 2009; 277:83-6. [DOI: 10.1016/j.jns.2008.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 10/13/2008] [Accepted: 10/17/2008] [Indexed: 11/22/2022]
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van Oostrom JCH, Dekker M, Willemsen ATM, de Jong BM, Roos RAC, Leenders KL. Changes in striatal dopamine D2 receptor binding in pre-clinical Huntington's disease. Eur J Neurol 2008; 16:226-31. [PMID: 19138335 DOI: 10.1111/j.1468-1331.2008.02390.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Carriers of the Huntington disease (HD) mutation develop a progressive neurodegenerative disorder after a pre-clinical phase. We examined the value of (11)C-raclopride PET (RAC) as a biomarker for pre-clinical HD pathophysiology. METHODS In a prospective cohort study with clinical and neuropsychological assessment we collected complete RAC data in 18 pre-clinical mutation carriers (HD-PMC) and 11 controls. Follow-up was 2 years. We calculated striatal RAC binding potential (BP) to measure dopamine D2 receptor availability. RESULTS No HD-PMC had overt neuropsychological dysfunction. RAC-BP in putamen was abnormal in up to 44% of HD-PMC. The rate of RAC-BP decline (2.6% per year) was not significantly higher than in controls. Follow-up putaminal BP correlated weakly with predicted distance to onset of clinical HD (P = 0.034), but the rate of decline did not. Three HD-PMC developed motor abnormalities suspect for HD but did not show an increased rate of decline of putaminal BP. CONCLUSIONS Many HD-PMC have striatal abnormalities but we found no clearly increased rate of D2 receptor changes around the onset of clinical HD. A longer follow-up of the present study cohort is needed to establish the value of RAC-BP in assessing the risk of clinical conversion from striatal D2 binding data.
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Affiliation(s)
- J C H van Oostrom
- Department of Neurology, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands.
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Puri BK, Bydder GM, Manku MS, Clarke A, Waldman AD, Beckmann CF. Reduction in Cerebral Atrophy Associated with Ethyl-Eicosapentaenoic Acid Treatment in Patients with Huntington's Disease. J Int Med Res 2008; 36:896-905. [DOI: 10.1177/147323000803600505] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ultra-pure ethyl-eicosapentaenoic acid (ethyl-EPA), a semi-synthetic ethyl ester of eicosapentaenoic acid, is associated with clinical improvement in motor functioning in Huntington's disease. The aim was to determine the extent to which it might reduce the rate of progress of cerebral atrophy. High-resolution cerebral magnetic resonance imaging scans were acquired at baseline, 6 months and 1 year in up to 34 patients with stage I or II Huntington's disease who took part in a randomized, double-blind, placebo-controlled trial of ethyl-EPA. For each subject and each pair of structural images, the two-timepoint brain volume change was calculated in a double-blind manner. Significant group-level reductions in brain atrophy were observed in the head of the caudate nucleus and the posterior thalamus. These findings show that treatment with ethyl-EPA is associated with significant reduction in brain atrophy, particularly in the caudate and thalamus. No other drug tested in Huntington's disease has shown this effect.
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Affiliation(s)
- BK Puri
- MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - GM Bydder
- Department of Radiology, University of California at San Diego, School of Medicine, San Diego, CA, USA
| | - MS Manku
- Amarin Neuroscience Ltd, Magdalen Centre North, Oxford Science Park, Oxford, UK
| | - A Clarke
- Amarin Neuroscience Ltd, Magdalen Centre North, Oxford Science Park, Oxford, UK
| | - AD Waldman
- MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
- Department of Imaging, Imperial College London, Charing Cross Hospital and Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - CF Beckmann
- Clinical Neuroscience Department, Imperial College London, Hammersmith Hospital, London, UK and FMRIB Centre, Department of Clinical Neurology, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Ravina B, Romer M, Constantinescu R, Biglan K, Brocht A, Kieburtz K, Shoulson I, McDermott MP. The relationship between CAG repeat length and clinical progression in Huntington's disease. Mov Disord 2008; 23:1223-7. [DOI: 10.1002/mds.21988] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Nannenga BL, Zameer A, Sierks MR. Anti-oligomeric single chain variable domain antibody differentially affects huntingtin and α-synuclein aggregates. FEBS Lett 2008; 582:517-22. [DOI: 10.1016/j.febslet.2008.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/02/2008] [Accepted: 01/16/2008] [Indexed: 12/13/2022]
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Youssov K, Bachoud-Lévi AC. Malattia di Huntington: aspetti diagnostici attuali e applicazioni pratiche. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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