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Olanow CW, McIntyre D, Matarazzo M, Leinonen M, McGarry A, Kamp C, Kennedy J, Torti M, Kruger R, Obeso JA, Stocchi F, Heller E, Kieburtz K. Continuous Levodopa Delivery with an Intraoral Micropump System: An Open-Label Pharmacokinetics and Clinical Study. Mov Disord 2024. [PMID: 38698639 DOI: 10.1002/mds.29824] [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] [Received: 12/06/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Double-blind studies have demonstrated that motor complications in Parkinson's disease (PD) can be reduced with continuous delivery of levodopa. The DopaFuse system is a novel, intraoral micropump that attaches to a retainer and uses a propellant to deliver levodopa/carbidopa (LD/CD) continuously into the mouth. OBJECTIVES Evaluate the safety, pharmacokinetics, and efficacy of LD/CD delivered via the DopaFuse system compared to treatment with intermittent doses of standard oral LD/CD in PD patients with motor fluctuations. METHODS This was a 2-week, open-label study (NCT04778176) in 16 PD patients treated with ≥4 levodopa doses/day and experiencing motor fluctuations. On Day 1 (clinic setting) patients received their usual dose of standard LD/CD; DopaFuse therapy was initiated on Day 2, and on Day 3 patients received DopaFuse plus a morning oral LD/CD dose. Patients returned home on Days 4-14 and returned for in-clinic assessment on Day 15. RESULTS Continuous DopaFuse delivery of LD/CD was associated with reduced variability in plasma levodopa levels compared to oral LD/CD (mean ± SD levodopa Fluctuation Index reduced from 2.15 ± 0.59 on Day1 to 1.50 ± 0.55 on Day 2 (P = 0.0129) and to 1.03 ± 0.53 on Day 3 (P < 0.0001)). This pharmacokinetic improvement translated into significantly reduced OFF time with DopaFuse therapy (reduction of -1.72 ± 0.37 h at Day 15; P = 0.0004) and increased ON time without severe dyskinesias (increase of 1.72 ± 0.37 h at Day 15; P = 0.0004) versus oral LD/CD administration. DopaFuse therapy was not associated with any clinically significant adverse events. CONCLUSIONS Continuous delivery of LD/CD using the DopaFuse system was associated with significantly less variability in plasma levodopa concentrations and reductions in OFF time compared to treatment with standard oral LD/CD therapy and was well tolerated. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- C Warren Olanow
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
- Clintrex Research Corporation, Sarasota, Florida, USA
| | - Deborah McIntyre
- Luxembourg Institute of Health, Transversal Translational Medicine, Strassen, Luxembourg
| | - Michele Matarazzo
- Centro Integral de Neurociencias AC (CINAC), Hospital Universitario HM Puerta del Sur, Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Mika Leinonen
- Clintrex Research Corporation, Sarasota, Florida, USA
| | - Andrew McGarry
- Clintrex Research Corporation, Sarasota, Florida, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Cornelia Kamp
- Clintrex Research Corporation, Sarasota, Florida, USA
- Center for Health & Technology, University of Rochester, Rochester, New York, USA
| | - Julie Kennedy
- Clintrex Research Corporation, Sarasota, Florida, USA
| | | | - Rejko Kruger
- Luxembourg Institute of Health, Transversal Translational Medicine, Strassen, Luxembourg
| | - José A Obeso
- CEU San Pablo University Madrid; Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - Fabrizio Stocchi
- University San Raffaele Roma and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | | | - Karl Kieburtz
- Clintrex Research Corporation, Sarasota, Florida, USA
- Center for Health & Technology, University of Rochester, Rochester, New York, USA
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Espay AJ, Stocchi F, Pahwa R, Albanese A, Ellenbogen A, Ferreira JJ, Giladi N, Gurevich T, Hassin-Baer S, Hernandez-Vara J, Isaacson SH, Kieburtz K, LeWitt PA, Lopez-Manzanares L, Olanow CW, Poewe W, Sarva H, Yardeni T, Adar L, Salin L, Lopes N, Sasson N, Case R, Rascol O. Safety and efficacy of continuous subcutaneous levodopa-carbidopa infusion (ND0612) for Parkinson's disease with motor fluctuations (BouNDless): a phase 3, randomised, double-blind, double-dummy, multicentre trial. Lancet Neurol 2024; 23:465-476. [PMID: 38499015 DOI: 10.1016/s1474-4422(24)00052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Conventional oral levodopa therapy for the treatment of Parkinson's disease can be associated with variations in plasma concentrations. Levodopa infusion strategies might provide more consistent drug delivery and fewer motor fluctuations. We aimed to assess the safety and efficacy of a continuous 24 h/day subcutaneous infusion of ND0612 (a levodopa-carbidopa solution) compared with oral immediate-release levodopa-carbidopa for the treatment of motor fluctuations in people with Parkinson's disease. METHODS We conducted a phase 3, randomised, double-blind, double-dummy, active-controlled, multicentre trial at 117 academic and community neurology sites in 16 countries, including in Europe, Israel, and the USA. Eligible participants were men and women aged 30 years or older with a diagnosis of Parkinson's disease (Hoehn and Yahr stage ≤3 in the on state) who experienced at least 2·5 h/day of off time. Participants underwent an open-label run-in phase (<12 weeks), during which time optimal regimens were established for both oral immediate-release levodopa-carbidopa and for 24 h/day subcutaneous ND0612 infusion (levodopa-carbidopa 60·0/7·5 mg/mL), with supplemental oral levodopa-carbidopa if needed. Participants were then randomly assigned (1:1) to 12 weeks of double-blind treatment with their optimised regimen of either subcutaneous ND0612 or oral levodopa-carbidopa, with matching oral or subcutaneous placebo given as required to maintain blinding. Randomisation was done via an interactive web response system, stratified by region, using a permuted block schedule. Participants, study partners, treating investigators, study site personnel, and the sponsor were masked to treatment group allocation. The primary efficacy endpoint was the change from baseline (ie, time of randomisation, when all patients were receiving an optimised open-label ND0612 regimen) to end of the double-blind phase in total daily on time without troublesome dyskinesia, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT04006210, and is complete. FINDINGS Between Sept 30, 2019, and April 8, 2022, 381 participants were enrolled, of whom 259 (68%) were randomly assigned, 128 (49%) to subcutaneous ND0612 and 131 (51%) to oral levodopa-carbidopa. 243 (94%) participants completed the study. Treatment with subcutaneous ND0612 provided an additional 1·72 h (95% CI 1·08 to 2·36) of on time without troublesome dyskinesia compared with oral levodopa-carbidopa (change from baseline of -0·48 h [-0·94 to -0·02] with subcutaneous ND0612 vs -2·20 h [-2·65 to -1·74] with oral levodopa-carbidopa; p<0·0001). Significant treatment differences favouring subcutaneous ND0612 were also found in the first four of nine prespecified hierarchical outcomes of daily off time (-1·40 h [95% CI -1·99 to -0·80]), Movement Disorders Society-Unified Parkinson's Disease Rating Scale part II scores (-3·05 [-4·28 to -1·81]), Patients Global Impression of Change (odds ratio [OR] 5·31 [2·67 to 10·58]), and Clinical Global Impression of Improvement (OR 7·23 [3·57 to 14·64]). Hierarchical testing ended after the fourth secondary endpoint. Adverse events were reported by 287 (89%) of 322 participants during open-label ND0612 optimisation, and by 103 (80%) of 128 in the ND0612 group and 97 (74%) of 131 in the oral levodopa-carbidopa group during the double-blind phase. The most common adverse events were infusion-site reactions (266 [83%] participants during open-label ND0612, and 73 [57%] in the ND0612 group vs 56 [43%] in the oral levodopa-carbidopa group during the double-blind phase), most of which were mild. Serious adverse events in four participants in the ND0612 group were related to study treatment (infusion-site cellulitis [n=2], infusion-site abscess and infusion-site ulcer [n=1]; and paraesthesia and peripheral sensorimotor neuropathy [n=1]). One participant in the ND0612 group died during the double-blind phase, but the death was not related to study treatment (fall leading to traumatic brain injury). INTERPRETATION Results of this phase 3 study showed that subcutaneous ND0612 used in combination with oral immediate-release levodopa-carbidopa increased on time without troublesome dyskinesia and reduced off time, with a favourable benefit-risk profile. ND0612 might offer a safe and efficacious subcutaneous levodopa infusion approach to managing motor fluctuations in people with Parkinson's disease. The ongoing open-label extension phase will provide further information on the long-term efficacy and safety of treatment. FUNDING NeuroDerm.
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Affiliation(s)
- Alberto J Espay
- James J and Joan A Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA.
| | - Fabrizio Stocchi
- Department of Neurology, University San Raffaele Roma and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Aaron Ellenbogen
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, USA
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nir Giladi
- Brain Institute, Tel Aviv Medical Center, Faculty of Medicine, Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Faculty of Medicine, Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Hernandez-Vara
- Neurology Department and Neurodegenerative Disorders Research Group, Vall D'Hebron Hospital, Barcelona, Spain; Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | | | - Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - C Warren Olanow
- Clintrex Research Corp, Sarasota, FL, USA; Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | | | | | | | - Olivier Rascol
- University of Toulouse 3, University Hospital of Toulouse, INSERM, Clinical Investigation Center CIC1436, Department of Neurosciences and Department of Clinical Pharmacology, Toulouse, France; NS-Park/FCRIN Network, Toulouse, France.
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Wyse RK, Isaacs T, Barker RA, Cookson MR, Dawson TM, Devos D, Dexter DT, Duffen J, Federoff H, Fiske B, Foltynie T, Fox S, Greenamyre JT, Kieburtz K, Kordower JH, Krainc D, Matthews H, Moore DJ, Mursaleen L, Schwarzschild MA, Stott SRW, Sulzer D, Svenningsson P, Tanner CM, Carroll C, Simon DK, Brundin P. Twelve Years of Drug Prioritization to Help Accelerate Disease Modification Trials in Parkinson's Disease: The International Linked Clinical Trials initiative. J Parkinsons Dis 2024:JPD230363. [PMID: 38578902 DOI: 10.3233/jpd-230363] [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: 04/07/2024]
Abstract
In 2011, the UK medical research charity Cure Parkinson's set up the international Linked Clinical Trials (iLCT) committee to help expedite the clinical testing of potentially disease modifying therapies for Parkinson's disease (PD). The first committee meeting was held at the Van Andel Institute in Grand Rapids, Michigan in 2012. This group of PD experts has subsequently met annually to assess and prioritize agents that may slow the progression of this neurodegenerative condition, using a systematic approach based on preclinical, epidemiological and, where possible, clinical data. Over the last 12 years, 171 unique agents have been evaluated by the iLCT committee, and there have been 21 completed clinical studies and 20 ongoing trials associated with the initiative. In this review, we briefly outline the iLCT process as well as the clinical development and outcomes of some of the top prioritized agents. We also discuss a few of the lessons that have been learnt, and we conclude with a perspective on what the next decade may bring, including the introduction of multi-arm, multi-stage clinical trial platforms and the possibility of combination therapies for PD.
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Affiliation(s)
| | | | - Roger A Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mark R Cookson
- Cell Biology and Gene Expression Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Devos
- Department of Medical Pharmacology & Neurology, University of Lille, CHU Lille, Lille Neurosciences and Cognition Inserm UMR-S-U1172, Lille, France
| | | | | | - Howard Federoff
- Henry and Susan Samueli College of Health Sciences, University of California, Irvine CA, USA
| | - Brian Fiske
- Research Programs, The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Thomas Foltynie
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Susan Fox
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - J Timothy Greenamyre
- Department of Neurology, Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karl Kieburtz
- Department of Neurology Center for Health & Technology, and University of Rochester, Rochester, NY, USA
| | - Jeffrey H Kordower
- ASU-Banner Neurodegenerative Disease Research Center and School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Dimitri Krainc
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | - David Sulzer
- Department of Neurology, Columbia University, New York, NY, USA
| | | | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Camille Carroll
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - David K Simon
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Patrik Brundin
- Neuroscience and Rare Diseases, Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
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Dorsey ER, Kinel D, Pawlik ME, Zafar M, Lettenberger SE, Coffey M, Auinger P, Hylton KL, Shaw CW, Adams JL, Barbano R, Braun MK, Schwarz HB, Lawrence BP, Kieburtz K, Tanner CM, de Miranda BR, Goldman SM. Dry-Cleaning Chemicals and a Cluster of Parkinson's Disease and Cancer: A Retrospective Investigation. Mov Disord 2024; 39:606-613. [PMID: 38389433 DOI: 10.1002/mds.29723] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Environmental exposure to trichloroethylene (TCE), a carcinogenic dry-cleaning chemical, may be linked to Parkinson's disease (PD). OBJECTIVE The objective of this study was to determine whether PD and cancer were elevated among attorneys who worked near a contaminated site. METHODS We surveyed and evaluated attorneys with possible exposure and assessed a comparison group. RESULTS Seventy-nine of 82 attorneys (96.3%; mean [SD] age: 69.5 [11.4] years; 89.9% men) completed at least one phase of the study. For comparison, 75 lawyers (64.9 [10.2] years; 65.3% men) underwent clinical evaluations. Four (5.1%) of them who worked near the polluted site reported PD, more than expected based on age and sex (1.7%; P = 0.01) but not significantly higher than the comparison group (n = 1 [1.3%]; P = 0.37). Fifteen (19.0%), compared to four in the comparison group (5.3%; P = 0.049), had a TCE-related cancer. CONCLUSIONS In a retrospective study, diagnoses of PD and TCE-related cancers appeared to be elevated among attorneys who worked next to a contaminated dry-cleaning site. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dan Kinel
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Meghan E Pawlik
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Maryam Zafar
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Lettenberger
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Madeleine Coffey
- Donald and Barbara Zucker School of Medicine, Uniondale, New York, USA
| | - Peggy Auinger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin L Hylton
- Kevin Hylton Environmental Services, Inc., Rochester, New York, USA
| | - Carol W Shaw
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Jamie L Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Richard Barbano
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Melanie K Braun
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Heidi B Schwarz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - B Paige Lawrence
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Caroline M Tanner
- Department of Neurology, UCSF Health, San Francisco, California, USA
| | - Briana R de Miranda
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samuel M Goldman
- Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco, San Francisco, California, USA
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Olanow CW, Hauser RA, Burdick DJ, Dhall R, de Marcaida JA, Gil RA, Kreitzman DL, Elmer LW, McGarry A, Kieburtz K. A Randomized Phase 3 Study Comparing P2B001 to its Components (Low-Dose Extended-Release Rasagiline and Pramipexole) and to Optimized Doses of Marketed Extended-Release Pramipexole in Early Parkinson's Disease. Mov Disord 2024; 39:350-359. [PMID: 37886872 DOI: 10.1002/mds.29642] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND There remains uncertainty as to the optimal way to initiate therapy for Parkinson's disease (PD) to maximize benefit and minimize adversity. OBJECTIVES The objective was to determine if P2B001 (a fixed, low-dose, extended-release [ER] combination of pramipexole 0.6 mg and rasagiline 0.75 mg) is superior to each of its components and compare its safety and efficacy to optimized treatment with marketed doses of pramipexole-ER. METHODS This was a 12-week, double-blind study (NCT03329508). Total of 544 untreated patients with PD were randomized (2:2:2:1) to treatment with P2B001, its individual components (pramipexole-ER 0.6 mg or rasagiline-ER 0.75 mg), or commercial doses of pramipexole-ER titrated to optimal dose (1.5-4.5 mg). The primary endpoint was change from baseline to week 12 in Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III. The key secondary endpoint was the change from baseline in the Epworth Sleepiness Scale (ESS) for P2B001 versus the titrated dose of pramipexole-ER. RESULTS P2B001 provided superior efficacy compared to each of its components; mean (95% CI) treatment differences in UPDRS II + III scores were -2.66 (95% CI, -4.33 to -1.00) versus pramipexole-ER 0.6 mg (P = 0.0018) and - 3.30 (95% CI, -4.96 to -1.63) versus rasagiline-ER 0.75 mg (P < 0.0001). P2B001 had comparable efficacy with the titrated dose of pramipexole-ER (mean, 3.2 mg), but significantly less worsening in daytime-sleepiness (ESS treatment difference: -2.66 [95% CI, -3.50 to -1.81]; P < 0.0001). P2B001 was well-tolerated with fewer sleep-related and dopaminergic adverse events than titrated doses of pramipexole-ER including somnolence, orthostatic hypotension, and neuropsychiatric side effects. CONCLUSIONS P2B001 had superior efficacy to its individual components and was comparable with commercially used doses of pramipexole-ER with less worsening of sleepiness and fewer dopaminergic adverse events. These findings support considering once-daily P2B001 as initial therapy for patients with early PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- C Warren Olanow
- Departments of Neurology and Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
- Clintrex Research Corporation, Sarasota, Florida, USA
| | - Robert A Hauser
- Department of Neurology, Parkinson Foundation Center of Excellence, University of South Florida, Tampa, Florida, USA
| | - Daniel J Burdick
- Booth Gardner Parkinson's Care Center, Eastside Neuroscience Institute, Evergreen Health Medical Center, Kirkland, WA, USA
| | - Rohit Dhall
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Ramon A Gil
- Hartford HealthCare Chase Family Movement Disorders Center, Vernon, Connecticut, USA
- Parkinson's Disease Treatment Center of SW Florida, Naples, Florida, USA
| | | | - Lawrence W Elmer
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Andrew McGarry
- Clintrex Research Corporation, Sarasota, Florida, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Karl Kieburtz
- Clintrex Research Corporation, Sarasota, Florida, USA
- Center for Health and Technology, University of Rochester, Rochester, New York, USA
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6
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Simuni T, Chahine LM, Poston K, Brumm M, Buracchio T, Campbell M, Chowdhury S, Coffey C, Concha-Marambio L, Dam T, DiBiaso P, Foroud T, Frasier M, Gochanour C, Jennings D, Kieburtz K, Kopil CM, Merchant K, Mollenhauer B, Montine T, Nudelman K, Pagano G, Seibyl J, Sherer T, Singleton A, Stephenson D, Stern M, Soto C, Tanner CM, Tolosa E, Weintraub D, Xiao Y, Siderowf A, Dunn B, Marek K. A biological definition of neuronal α-synuclein disease: towards an integrated staging system for research. Lancet Neurol 2024; 23:178-190. [PMID: 38267190 DOI: 10.1016/s1474-4422(23)00405-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 01/26/2024]
Abstract
Parkinson's disease and dementia with Lewy bodies are currently defined by their clinical features, with α-synuclein pathology as the gold standard to establish the definitive diagnosis. We propose that, given biomarker advances enabling accurate detection of pathological α-synuclein (ie, misfolded and aggregated) in CSF using the seed amplification assay, it is time to redefine Parkinson's disease and dementia with Lewy bodies as neuronal α-synuclein disease rather than as clinical syndromes. This major shift from a clinical to a biological definition of Parkinson's disease and dementia with Lewy bodies takes advantage of the availability of tools to assess the gold standard for diagnosis of neuronal α-synuclein (n-αsyn) in human beings during life. Neuronal α-synuclein disease is defined by the presence of pathological n-αsyn species detected in vivo (S; the first biological anchor) regardless of the presence of any specific clinical syndrome. On the basis of this definition, we propose that individuals with pathological n-αsyn aggregates are at risk for dopaminergic neuronal dysfunction (D; the second biological anchor). Our biological definition establishes a staging system, the neuronal α-synuclein disease integrated staging system (NSD-ISS), rooted in the biological anchors (S and D) and the degree of functional impairment caused by clinical signs or symptoms. Stages 0-1 occur without signs or symptoms and are defined by the presence of pathogenic variants in the SNCA gene (stage 0), S alone (stage 1A), or S and D (stage 1B). The presence of clinical manifestations marks the transition to stage 2 and beyond. Stage 2 is characterised by subtle signs or symptoms but without functional impairment. Stages 2B-6 require both S and D and stage-specific increases in functional impairment. A biological definition of neuronal α-synuclein disease and an NSD-ISS research framework are essential to enable interventional trials at early disease stages. The NSD-ISS will evolve to include the incorporation of data-driven definitions of stage-specific functional anchors and additional biomarkers as they emerge and are validated. Presently, the NSD-ISS is intended for research use only; its application in the clinical setting is premature and inappropriate.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen Poston
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Teresa Buracchio
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michelle Campbell
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Sohini Chowdhury
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | | | - Peter DiBiaso
- Patient Advisory Council, New York, NY, USA; Clinical Solutions and Strategic Partnerships, WCG Clinical, Princeton, NJ, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Mark Frasier
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline Gochanour
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Catherine M Kopil
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Thomas Montine
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kelly Nudelman
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Andrew Singleton
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Diane Stephenson
- Critical Path for Parkinson's, Critical Path Institute, Tucson, AZ, USA
| | - Matthew Stern
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Claudio Soto
- Amprion, San Diego, CA, USA; Mitchell Center for Alzheimer's Disease and Related Brain Disorders, Department of Neurology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, USA; Parkinson's Disease Research Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Weintraub
- University of Pennsylvania and the Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center Philadelphia, PA, USA
| | - Yuge Xiao
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Billy Dunn
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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7
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McGarry A, Rosanbalm S, Leinonen M, Olanow CW, To D, Bell A, Lee D, Chang J, Dubow J, Dhall R, Burdick D, Parashos S, Feuerstein J, Quinn J, Pahwa R, Afshari M, Ramirez-Zamora A, Chou K, Tarakad A, Luca C, Klos K, Bordelon Y, St Hiliare MH, Shprecher D, Lee S, Dawson TM, Roschke V, Kieburtz K. Safety, tolerability, and efficacy of NLY01 in early untreated Parkinson's disease: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2024; 23:37-45. [PMID: 38101901 DOI: 10.1016/s1474-4422(23)00378-2] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Converging lines of evidence suggest that microglia are relevant to Parkinson's disease pathogenesis, justifying exploration of therapeutic agents thought to attenuate pathogenic microglial function. We sought to test the safety and efficacy of NLY01-a brain-penetrant, pegylated, longer-lasting version of exenatide (a glucagon-like peptide-1 receptor agonist) that is believed to be anti-inflammatory via reduction of microglia activation-in Parkinson's disease. METHODS We report a 36-week, randomised, double-blind, placebo-controlled study of NLY01 in participants with early untreated Parkinson's disease conducted at 58 movement disorder clinics in the USA. Participants meeting UK Brain Bank or Movement Disorder Society research criteria for Parkinson's disease were randomly allocated (1:1:1) to one of two active treatment groups (2·5 mg or 5·0 mg NLY01) or matching placebo, based on a central computer-generated randomisation scheme using permuted block randomisation with varying block sizes. All participants, investigators, coordinators, study staff, and sponsor personnel were masked to treatment assignments throughout the study. The primary efficacy endpoint for the primary analysis population (defined as all randomly assigned participants who received at least one dose of study drug) was change from baseline to week 36 in the sum of Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II and III. Safety was assessed in the safety population (all randomly allocated participants who received at least one dose of the study drug) with documentation of adverse events, vital signs, electrocardiograms, clinical laboratory assessments, physical examination, and scales for suicidality, sleepiness, impulsivity, and depression. This trial is complete and registered at ClinicalTrials.gov, NCT04154072. FINDINGS The study took place between Jan 28, 2020, and Feb 16, 2023. 447 individuals were screened, of whom 255 eligible participants were randomly assigned (85 to each study group). One patient assigned to placebo did not receive study treatment and was not included in the primary analysis. At 36 weeks, 2·5 mg and 5·0 mg NLY01 did not differ from placebo with respect to change in sum scores on MDS-UPDRS parts II and III: difference versus placebo -0·39 (95% CI -2·96 to 2·18; p=0·77) for 2·5 mg and 0·36 (-2·28 to 3·00; p=0·79) for 5·0 mg. Treatment-emergent adverse events were similar across groups (reported in 71 [84%] of 85 patients on 2·5 mg NLY01, 79 [93%] of 85 on 5·0 mg, and 73 [87%] of 84 on placebo), with gastrointestinal disorders the most commonly observed class in active groups (52 [61%] for 2·5 mg, 64 [75%] for 5·0 mg, and 30 [36%] for placebo) and nausea the most common event overall (33 [39%] for 2·5 mg, 49 [58%] for 5·0 mg, and 16 [19%] for placebo). No deaths occurred during the study. INTERPRETATION NLY01 at 2·5 and 5·0 mg was not associated with any improvement in Parkinson's disease motor or non-motor features compared with placebo. A subgroup analysis raised the possibility of motor benefit in younger participants. Further study is needed to determine whether these exploratory observations are replicable. FUNDING D&D Pharmatech-Neuraly.
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Affiliation(s)
- Andrew McGarry
- Cooper Medical School at Rowan University, Camden, NJ, USA; Clintrex Research Corporation, Sarasota, FL, USA.
| | | | | | | | - Dennis To
- D&D Pharmatech - Neuraly, Gaithersburg, MD, USA
| | - Adam Bell
- D&D Pharmatech - Neuraly, Gaithersburg, MD, USA
| | - Daniel Lee
- D&D Pharmatech - Neuraly, Gaithersburg, MD, USA
| | | | - Jordan Dubow
- Clintrex Research Corporation, Sarasota, FL, USA
| | - Rohit Dhall
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniel Burdick
- Booth Gardner Parkinson's Care Center, Kirkland, WA, USA
| | | | - Jeanne Feuerstein
- Neurosciences Center at UC Health University of Colorado Hospital, Aurora, CO, USA
| | - Joseph Quinn
- Oregon Health and Sciences University, Portland, OR, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Kelvin Chou
- University of Michigan Medical Center, Ann Arbor, MI, USA
| | | | | | - Kevin Klos
- The Movement Disorder Clinic of Oklahoma, Tulsa, OK, USA
| | - Yvette Bordelon
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | - Seulki Lee
- D&D Pharmatech - Neuraly, Gaithersburg, MD, USA
| | - Ted M Dawson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Venuto CS, Smith G, Herbst K, Zielinski R, Yung NC, Grosset DG, Dorsey ER, Kieburtz K. Predicting Ambulatory Capacity in Parkinson's Disease to Analyze Progression, Biomarkers, and Trial Design. Mov Disord 2023; 38:1774-1785. [PMID: 37363815 PMCID: PMC10615710 DOI: 10.1002/mds.29519] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Parkinson's disease (PD), gait and balance is impaired, relatively resistant to available treatment and associated with falls and disability. Predictive models of ambulatory progression could enhance understanding of gait/balance disturbances and aid in trial design. OBJECTIVES To predict trajectories of ambulatory abilities from baseline clinical data in early PD, relate trajectories to clinical milestones, compare biomarkers, and evaluate trajectories for enrichment of clinical trials. METHODS Data from two multicenter, longitudinal, observational studies were used for model training (Tracking Parkinson's, n = 1598) and external testing (Parkinson's Progression Markers Initiative, n = 407). Models were trained and validated to predict individuals as having a "Progressive" or "Stable" trajectory based on changes of ambulatory capacity scores from the Movement Disorders Society Unified Parkinson's Disease Rating Scale parts II and III. Survival analyses compared time-to-clinical milestones and trial outcomes between predicted trajectories. RESULTS On external evaluation, a support vector machine model predicted Progressive trajectories using baseline clinical data with an accuracy, weighted-F1 (proportionally weighted harmonic mean of precision and sensitivity), and sensitivity/specificity of 0.735, 0.799, and 0.688/0.739, respectively. Over 4 years, the predicted Progressive trajectory was more likely to experience impaired balance, loss of independence, impaired function and cognition. Baseline dopamine transporter imaging and select biomarkers of neurodegeneration were significantly different between predicted trajectory groups. For an 18-month, randomized (1:1) clinical trial, sample size savings up to 30% were possible when enrollment was enriched for the Progressive trajectory versus no enrichment. CONCLUSIONS It is possible to predict ambulatory abilities from clinical data that are associated with meaningful outcomes in people with early PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Charles S. Venuto
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Greta Smith
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Konnor Herbst
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Robert Zielinski
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Biostatistics, Brown University, Providence, RI, USA
| | - Norman C.W. Yung
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Donald G. Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
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9
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Oertel WH, Müller HH, Unger MM, Schade-Brittinger C, Balthasar K, Articus K, Brinkman M, Venuto CS, Tracik F, Eberling J, Eggert KM, Kamp C, Kieburtz K, Boyd JT. Transdermal Nicotine Treatment and Progression of Early Parkinson's Disease. NEJM Evid 2023; 2:EVIDoa2200311. [PMID: 38320207 DOI: 10.1056/evidoa2200311] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Nicotine Treatment and Parkinson's DiseaseIn this randomized, controlled trial, patients with Parkinson's disease not on dopaminergic therapy were randomly assigned to receive transdermal nicotine or placebo. After 1 year, there was no difference in the change in Total Unified Parkinson's Disease Rating Scale score between groups.
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Affiliation(s)
- Wolfgang H Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
- Institute for Neurogenomics, Helmholtz Center for Environment and Health, Munich, Germany
- Kompetenznetz Parkinson e.V., Marburg, Germany
| | - Hans-Helge Müller
- Institute of Medical Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany
- Coordination Center for Clinical Studies, Marburg, Germany
| | - Marcus M Unger
- Department of Neurology, University des Saarlandes, Homburg, Saar, Germany
| | | | | | | | | | - C S Venuto
- Department of Neurology, Center for Health and Technology, University of Rochester Medical Center, Rochester, NY
| | | | | | - Karla M Eggert
- Department of Neurology, Philipps University Marburg, Marburg, Germany
- Kompetenznetz Parkinson e.V., Marburg, Germany
| | - Cornelia Kamp
- Department of Neurology, Center for Health and Technology, University of Rochester Medical Center, Rochester, NY
| | - Karl Kieburtz
- Department of Neurology, Center for Health and Technology, University of Rochester Medical Center, Rochester, NY
| | - James T Boyd
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington
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10
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Weintraub D, Picillo M, Cho HR, Caspell‐Garcia C, Blauwendraat C, Brown EG, Chahine LM, Coffey CS, Dobkin RD, Foroud T, Galasko D, Kieburtz K, Marek K, Merchant K, Mollenhauer B, Poston KL, Simuni T, Siderowf A, Singleton A, Seibyl J, Tanner CM. Impact of the Dopamine System on Long-Term Cognitive Impairment in Parkinson Disease: An Exploratory Study. Mov Disord Clin Pract 2023; 10:943-955. [PMID: 37332638 PMCID: PMC10272925 DOI: 10.1002/mdc3.13751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Little is known about the impact of the dopamine system on development of cognitive impairment (CI) in Parkinson disease (PD). Objectives We used data from a multi-site, international, prospective cohort study to explore the impact of dopamine system-related biomarkers on CI in PD. Methods PD participants were assessed annually from disease onset out to 7 years, and CI determined by applying cut-offs to four measures: (1) Montreal Cognitive Assessment; (2) detailed neuropsychological test battery; (3) Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) cognition score; and (4) site investigator diagnosis of CI (mild cognitive impairment or dementia). The dopamine system was assessed by serial Iodine-123 Ioflupane dopamine transporter (DAT) imaging, genotyping, and levodopa equivalent daily dose (LEDD) recorded at each assessment. Multivariate longitudinal analyses, with adjustment for multiple comparisons, determined the association between dopamine system-related biomarkers and CI, including persistent impairment. Results Demographic and clinical variables associated with CI were higher age, male sex, lower education, non-White race, higher depression and anxiety scores and higher MDS-UPDRS motor score. For the dopamine system, lower baseline mean striatum dopamine transporter values (P range 0.003-0.005) and higher LEDD over time (P range <0.001-0.01) were significantly associated with increased risk for CI. Conclusions Our results provide preliminary evidence that alterations in the dopamine system predict development of clinically-relevant, cognitive impairment in Parkinson's disease. If replicated and determined to be causative, they demonstrate that the dopamine system is instrumental to cognitive health status throughout the disease course. TRIAL REGISTRATION Parkinson's Progression Markers Initiative is registered with ClinicalTrials.gov (NCT01141023).
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Affiliation(s)
- Daniel Weintraub
- Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marina Picillo
- Assistant Professor in Neurology at the Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoItaly
| | - Hyunkeun Ryan Cho
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | | | - Cornelis Blauwendraat
- Center for Alzheimer's and Related Dementias, and the Integrative Neurogenomics Unit, Laboratory of NeurogeneticsNational Institute on Aging, National Institutes of HealthBethesdaMarylandUSA
| | - Ethan G. Brown
- Department of NeurologyWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | - Roseanne D. Dobkin
- Department of PsychiatryRutgers University, Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Tatiana Foroud
- Department of Medical and Molecular GeneticsIndiana UniversityIndianapolisIndianaUSA
| | - Doug Galasko
- Department of NeurologyUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Karl Kieburtz
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenConnecticutUSA
| | - Kalpana Merchant
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Brit Mollenhauer
- Department of NeurologyUniversity Medical Center GoettingenGoettingenGermany
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford UniversityStanfordCaliforniaUSA
| | - Tanya Simuni
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Andrew Siderowf
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew Singleton
- Center for Alzheimer's and Related Dementias, and the Molecular Genetics SectionLaboratory of Neurogenetics, National Institute on Aging, National Institutes of HealthBethesdaMarylandUSA
| | - John Seibyl
- Institute for Neurodegenerative DisordersNew HavenConnecticutUSA
| | - Caroline M. Tanner
- Department of NeurologyWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
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11
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Siderowf A, Concha-Marambio L, Lafontant DE, Farris CM, Ma Y, Urenia PA, Nguyen H, Alcalay RN, Chahine LM, Foroud T, Galasko D, Kieburtz K, Merchant K, Mollenhauer B, Poston KL, Seibyl J, Simuni T, Tanner CM, Weintraub D, Videnovic A, Choi SH, Kurth R, Caspell-Garcia C, Coffey CS, Frasier M, Oliveira LMA, Hutten SJ, Sherer T, Marek K, Soto C. Assessment of heterogeneity among participants in the Parkinson's Progression Markers Initiative cohort using α-synuclein seed amplification: a cross-sectional study. Lancet Neurol 2023; 22:407-417. [PMID: 37059509 PMCID: PMC10627170 DOI: 10.1016/s1474-4422(23)00109-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Emerging evidence shows that α-synuclein seed amplification assays (SAAs) have the potential to differentiate people with Parkinson's disease from healthy controls. We used the well characterised, multicentre Parkinson's Progression Markers Initiative (PPMI) cohort to further assess the diagnostic performance of the α-synuclein SAA and to examine whether the assay identifies heterogeneity among patients and enables the early identification of at-risk groups. METHODS This cross-sectional analysis is based on assessments done at enrolment for PPMI participants (including people with sporadic Parkinson's disease from LRRK2 and GBA variants, healthy controls, prodromal individuals with either rapid eye movement sleep behaviour disorder (RBD) or hyposmia, and non-manifesting carriers of LRRK2 and GBA variants) from 33 participating academic neurology outpatient practices worldwide (in Austria, Canada, France, Germany, Greece, Israel, Italy, the Netherlands, Norway, Spain, the UK, and the USA). α-synuclein SAA analysis of CSF was performed using previously described methods. We assessed the sensitivity and specificity of the α-synuclein SAA in participants with Parkinson's disease and healthy controls, including subgroups based on genetic and clinical features. We established the frequency of positive α-synuclein SAA results in prodromal participants (RBD and hyposmia) and non-manifesting carriers of genetic variants associated with Parkinson's disease, and compared α-synuclein SAA to clinical measures and other biomarkers. We used odds ratio estimates with 95% CIs to measure the association between α-synuclein SAA status and categorical measures, and two-sample 95% CIs from the resampling method to assess differences in medians between α-synuclein SAA positive and negative participants for continuous measures. A linear regression model was used to control for potential confounders such as age and sex. FINDINGS This analysis included 1123 participants who were enrolled between July 7, 2010, and July 4, 2019. Of these, 545 had Parkinson's disease, 163 were healthy controls, 54 were participants with scans without evidence of dopaminergic deficit, 51 were prodromal participants, and 310 were non-manifesting carriers. Sensitivity for Parkinson's disease was 87·7% (95% CI 84·9-90·5), and specificity for healthy controls was 96·3% (93·4-99·2). The sensitivity of the α-synuclein SAA in sporadic Parkinson's disease with the typical olfactory deficit was 98·6% (96·4-99·4). The proportion of positive α-synuclein SAA was lower than this figure in subgroups including LRRK2 Parkinson's disease (67·5% [59·2-75·8]) and participants with sporadic Parkinson's disease without olfactory deficit (78·3% [69·8-86·7]). Participants with LRRK2 variant and normal olfaction had an even lower α-synuclein SAA positivity rate (34·7% [21·4-48·0]). Among prodromal and at-risk groups, 44 (86%) of 51 of participants with RBD or hyposmia had positive α-synuclein SAA (16 of 18 with hyposmia, and 28 of 33 with RBD). 25 (8%) of 310 non-manifesting carriers (14 of 159 [9%] LRRK2 and 11 of 151 [7%] GBA) were positive. INTERPRETATION This study represents the largest analysis so far of the α-synuclein SAA for the biochemical diagnosis of Parkinson's disease. Our results show that the assay classifies people with Parkinson's disease with high sensitivity and specificity, provides information about molecular heterogeneity, and detects prodromal individuals before diagnosis. These findings suggest a crucial role for the α-synuclein SAA in therapeutic development, both to identify pathologically defined subgroups of people with Parkinson's disease and to establish biomarker-defined at-risk cohorts. FUNDING PPMI is funded by the Michael J Fox Foundation for Parkinson's Research and funding partners, including: Abbvie, AcureX, Aligning Science Across Parkinson's, Amathus Therapeutics, Avid Radiopharmaceuticals, Bial Biotech, Biohaven, Biogen, BioLegend, Bristol-Myers Squibb, Calico Labs, Celgene, Cerevel, Coave, DaCapo Brainscience, 4D Pharma, Denali, Edmond J Safra Foundation, Eli Lilly, GE Healthcare, Genentech, GlaxoSmithKline, Golub Capital, Insitro, Janssen Neuroscience, Lundbeck, Merck, Meso Scale Discovery, Neurocrine Biosciences, Prevail Therapeutics, Roche, Sanofi Genzyme, Servier, Takeda, Teva, UCB, VanquaBio, Verily, Voyager Therapeutics, and Yumanity.
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Affiliation(s)
- Andrew Siderowf
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | | | - David-Erick Lafontant
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Carly M Farris
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Yihua Ma
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Paula A Urenia
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Hieu Nguyen
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Roy N Alcalay
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Paracelsus-Elena Klinik, Kassel, and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; Parkinson's Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Aleksandar Videnovic
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seung Ho Choi
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Ryan Kurth
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Mark Frasier
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Luis M A Oliveira
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Samantha J Hutten
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Claudio Soto
- Research and Development Unit, Amprion, San Diego, CA, USA; Department of Neurology, University of Texas McGovern Medical School at Houston, TX, USA
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12
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Dorsey ER, Zafar M, Lettenberger SE, Pawlik ME, Kinel D, Frissen M, Schneider RB, Kieburtz K, Tanner CM, De Miranda BR, Goldman SM, Bloem BR. Trichloroethylene: An Invisible Cause of Parkinson's Disease? J Parkinsons Dis 2023; 13:203-218. [PMID: 36938742 PMCID: PMC10041423 DOI: 10.3233/jpd-225047] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The etiologies of Parkinson's disease (PD) remain unclear. Some, such as certain genetic mutations and head trauma, are widely known or easily identified. However, these causes or risk factors do not account for the majority of cases. Other, less visible factors must be at play. Among these is a widely used industrial solvent and common environmental contaminant little recognized for its likely role in PD: trichloroethylene (TCE). TCE is a simple, six-atom molecule that can decaffeinate coffee, degrease metal parts, and dry clean clothes. The colorless chemical was first linked to parkinsonism in 1969. Since then, four case studies involving eight individuals have linked occupational exposure to TCE to PD. In addition, a small epidemiological study found that occupational or hobby exposure to the solvent was associated with a 500% increased risk of developing PD. In multiple animal studies, the chemical reproduces the pathological features of PD.Exposure is not confined to those who work with the chemical. TCE pollutes outdoor air, taints groundwater, and contaminates indoor air. The molecule, like radon, evaporates from underlying soil and groundwater and enters homes, workplaces, or schools, often undetected. Despite widespread contamination and increasing industrial, commercial, and military use, clinical investigations of TCE and PD have been limited. Here, through a literature review and seven illustrative cases, we postulate that this ubiquitous chemical is contributing to the global rise of PD and that TCE is one of its invisible and highly preventable causes. Further research is now necessary to examine this hypothesis.
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Affiliation(s)
- E Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Maryam Zafar
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Meghan E Pawlik
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Dan Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Myrthe Frissen
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders; Nijmegen, the Netherlands
| | - Ruth B Schneider
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Caroline M Tanner
- Weill Institute for Neurosciences, Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Briana R De Miranda
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel M Goldman
- Division of Occupational and Environmental Medicine, San Francisco Veterans Affairs Health Care System, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Bastiaan R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders; Nijmegen, the Netherlands
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13
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Brumm MC, Siderowf A, Simuni T, Burghardt E, Choi SH, Caspell-Garcia C, Chahine LM, Mollenhauer B, Foroud T, Galasko D, Merchant K, Arnedo V, Hutten SJ, O’Grady AN, Poston KL, Tanner CM, Weintraub D, Kieburtz K, Marek K, Coffey CS. Parkinson's Progression Markers Initiative: A Milestone-Based Strategy to Monitor Parkinson's Disease Progression. J Parkinsons Dis 2023; 13:899-916. [PMID: 37458046 PMCID: PMC10578214 DOI: 10.3233/jpd-223433] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Identifying a meaningful progression metric for Parkinson's disease (PD) that reflects heterogeneity remains a challenge. OBJECTIVE To assess the frequency and baseline predictors of progression to clinically relevant motor and non-motor PD milestones. METHODS Using data from the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort, we monitored 25 milestones across six domains ("walking and balance"; "motor complications"; "cognition"; "autonomic dysfunction"; "functional dependence"; "activities of daily living"). Milestones were intended to be severe enough to reflect meaningful disability. We assessed the proportion of participants reaching any milestone; evaluated which occurred most frequently; and conducted a time-to-first-event analysis exploring whether baseline characteristics were associated with progression. RESULTS Half of participants reached at least one milestone within five years. Milestones within the cognitive, functional dependence, and autonomic dysfunction domains were reached most often. Among participants who reached a milestone at an annual follow-up visit and remained active in the study, 82% continued to meet criteria for any milestone at one or more subsequent annual visits and 55% did so at the next annual visit. In multivariable analysis, baseline features predicting faster time to reaching a milestone included age (p < 0.0001), greater MDS-UPDRS total scores (p < 0.0001), higher GDS-15 depression scores (p = 0.0341), lower dopamine transporter binding (p = 0.0043), and lower CSF total α-synuclein levels (p = 0.0030). Symptomatic treatment was not significantly associated with reaching a milestone (p = 0.1639). CONCLUSION Clinically relevant milestones occur frequently, even in early PD. Milestones were significantly associated with baseline clinical and biological markers, but not with symptomatic treatment. Further studies are necessary to validate these results, further assess the stability of milestones, and explore translating them into an outcome measure suitable for observational and therapeutic studies.
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Affiliation(s)
- Michael C. Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elliot Burghardt
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Seung Ho Choi
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Samantha J. Hutten
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Alyssa N. O’Grady
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Kathleen L. Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, SanFrancisco, CA, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Departmentof Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - on behalf of the Parkinson’s Progression Markers Initiative
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, University of California, San Diego, CA, USA
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, SanFrancisco, CA, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Departmentof Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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14
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Liu Y, Zhang G, Tarolli CG, Hristov R, Jensen-Roberts S, Waddell EM, Myers TL, Pawlik ME, Soto JM, Wilson RM, Yang Y, Nordahl T, Lizarraga KJ, Adams JL, Schneider RB, Kieburtz K, Ellis T, Dorsey ER, Katabi D. Monitoring gait at home with radio waves in Parkinson's disease: A marker of severity, progression, and medication response. Sci Transl Med 2022; 14:eadc9669. [PMID: 36130014 DOI: 10.1126/scitranslmed.adc9669] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Parkinson's disease (PD) is the fastest-growing neurological disease in the world. A key challenge in PD is tracking disease severity, progression, and medication response. Existing methods are semisubjective and require visiting the clinic. In this work, we demonstrate an effective approach for assessing PD severity, progression, and medication response at home, in an objective manner. We used a radio device located in the background of the home. The device detected and analyzed the radio waves that bounce off people's bodies and inferred their movements and gait speed. We continuously monitored 50 participants, with and without PD, in their homes for up to 1 year. We collected over 200,000 gait speed measurements. Cross-sectional analysis of the data shows that at-home gait speed strongly correlates with gold-standard PD assessments, as evaluated by the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III subscore and total score. At-home gait speed also provides a more sensitive marker for tracking disease progression over time than the widely used MDS-UPDRS. Further, the monitored gait speed was able to capture symptom fluctuations in response to medications and their impact on patients' daily functioning. Our study shows the feasibility of continuous, objective, sensitive, and passive assessment of PD at home and hence has the potential of improving clinical care and drug clinical trials.
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Affiliation(s)
- Yingcheng Liu
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Guo Zhang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | - Stella Jensen-Roberts
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Emma M Waddell
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Taylor L Myers
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Meghan E Pawlik
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Julia M Soto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Renee M Wilson
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Yuzhe Yang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Timothy Nordahl
- Department of Physical Therapy & Athletic Training, Center for Neurorehabilitation, Boston University College of Health and Rehabilitation: Sargent College, Boston, MA 02215, USA
| | - Karlo J Lizarraga
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jamie L Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Ruth B Schneider
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Terry Ellis
- Department of Physical Therapy & Athletic Training, Center for Neurorehabilitation, Boston University College of Health and Rehabilitation: Sargent College, Boston, MA 02215, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Dina Katabi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Emerald Innovations Inc., Cambridge, MA 02142, USA
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15
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MacPherson A, Gumnit E, Ouimet C, Hutchinson N, Kieburtz K, Pearson TS, Kimmelman J. Quantifying Patient Investment in Novel Neurological Drug Development. Neurotherapeutics 2022; 19:1507-1513. [PMID: 35764764 PMCID: PMC9606150 DOI: 10.1007/s13311-022-01259-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 10/17/2022] Open
Abstract
While the drug development literature provides numerous estimates of the financial costs to bring a new drug to market, the investment of patient-participants in the research process has not been described. Trial participants and their caregivers, like companies, invest time and undertake risk when they participate in prelicense trials. We determined the average number of patient-participants needed to develop a novel neurological drug. We created a cohort of 108 unapproved drugs first tested for efficacy between 2006 and 2011 and used ClinicalTrials.gov to capture enrollment in all subsequent prelicense trials of these drugs over a 9-year period. Our primary outcome was the average number of patients enrolled in prelicense neurological drug trials per drug that ultimately attained FDA approval, including patients who participated in both successful and unsuccessful development efforts. Five drugs (4.6%) were FDA approved, and 66,751 patient-participants were enrolled across successful and unsuccessful drug development efforts, resulting in an average of 13,350 patients for each drug attaining approval (95% CI 7155 to 54,954). Our estimates reveal the substantial amount patients and their caregivers contribute to private drug development.
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Affiliation(s)
- Amanda MacPherson
- Department of Equity, Ethics and Policy, McGill University School of Population and Global Health, 2001 McGill College Avenue, Montreal, QC, H3A 1G1 Canada
| | - Elias Gumnit
- Department of Equity, Ethics and Policy, McGill University School of Population and Global Health, 2001 McGill College Avenue, Montreal, QC, H3A 1G1 Canada
| | - Charlotte Ouimet
- Department of Equity, Ethics and Policy, McGill University School of Population and Global Health, 2001 McGill College Avenue, Montreal, QC, H3A 1G1 Canada
| | - Nora Hutchinson
- Department of Equity, Ethics and Policy, McGill University School of Population and Global Health, 2001 McGill College Avenue, Montreal, QC, H3A 1G1 Canada
| | - Karl Kieburtz
- Department of Neurology, University of Rochester, Rochester, NY USA
| | - Toni S. Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
| | - Jonathan Kimmelman
- Department of Equity, Ethics and Policy, McGill University School of Population and Global Health, 2001 McGill College Avenue, Montreal, QC, H3A 1G1 Canada
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16
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Paracha M, Herbst K, Kieburtz K, Venuto CS. Prevalence and incidence of non‐motor symptoms in individuals with and without Parkinson's disease. Mov Disord Clin Pract 2022; 9:961-966. [PMID: 36247906 PMCID: PMC9547141 DOI: 10.1002/mdc3.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/02/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background The prevalence ratio (PR) and incidence rate ratio (IRR) of nonmotor symptoms (NMS) were calculated for early Parkinson's disease (PD) versus non‐PD from 2 observational studies. Methods NMS were assessed through the self‐reported Non‐Motor Symptom Questionnaire in the online Fox Insight study and through self‐ and clinician‐rated scales in the Parkinson's Progression Marker Initiative (PPMI) study. Age‐ and sex‐adjusted/matched PR and IRR were estimated for each NMS by PD status using Poisson regression. Results Most NMS occurred more frequently in PD. Among 15,194 Fox Insight participants, sexual dysfunction had the largest adjusted PR (12.4 [95% CI, 6.9–22.2]) and dysgeusia/hyposmia had the largest adjusted IRR over a 2‐year median follow‐up (17.0 [95% CI, 7.8–37.1]). Among 607 PPMI participants, anosmia had the largest PR (16.6 [95% CI, 6.1–44.8]). During the 7‐year median follow‐up, hallucinations had the largest IRR (13.5 [95% CI, 6.3–28.8]). Conclusion Although many NMS are more common in early PD than in non‐PD, their occurrence may differ with time (hallucinations) or data collection methods (sexual dysfunction).
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Affiliation(s)
- Mariam Paracha
- Center for Health + Technology University of Rochester Rochester NY
- Department of Science and Mathematics, National Technical Institute for the Deaf Rochester Institute of Technology Rochester NY
- Department of Neurology University of Rochester Rochester NY
| | - Konnor Herbst
- Center for Health + Technology University of Rochester Rochester NY
| | - Karl Kieburtz
- Center for Health + Technology University of Rochester Rochester NY
- Department of Neurology University of Rochester Rochester NY
| | - Charles S. Venuto
- Center for Health + Technology University of Rochester Rochester NY
- Department of Neurology University of Rochester Rochester NY
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17
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Omberg L, Chaibub Neto E, Perumal TM, Pratap A, Tediarjo A, Adams J, Bloem BR, Bot BM, Elson M, Goldman SM, Kellen MR, Kieburtz K, Klein A, Little MA, Schneider R, Suver C, Tarolli C, Tanner CM, Trister AD, Wilbanks J, Dorsey ER, Mangravite LM. Remote smartphone monitoring of Parkinson's disease and individual response to therapy. Nat Biotechnol 2022; 40:480-487. [PMID: 34373643 DOI: 10.1038/s41587-021-00974-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
Remote health assessments that gather real-world data (RWD) outside clinic settings require a clear understanding of appropriate methods for data collection, quality assessment, analysis and interpretation. Here we examine the performance and limitations of smartphones in collecting RWD in the remote mPower observational study of Parkinson's disease (PD). Within the first 6 months of study commencement, 960 participants had enrolled and performed at least five self-administered active PD symptom assessments (speeded tapping, gait/balance, phonation or memory). Task performance, especially speeded tapping, was predictive of self-reported PD status (area under the receiver operating characteristic curve (AUC) = 0.8) and correlated with in-clinic evaluation of disease severity (r = 0.71; P < 1.8 × 10-6) when compared with motor Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Although remote assessment requires careful consideration for accurate interpretation of RWD, our results support the use of smartphones and wearables in objective and personalized disease assessments.
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Affiliation(s)
| | | | | | - Abhishek Pratap
- Sage Bionetworks, Seattle, WA, USA.,Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | | | - Jamie Adams
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Bastiaan R Bloem
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands
| | | | - Molly Elson
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Samuel M Goldman
- Department of Neurology, University of California-San Francisco and Parkinson's Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | | | - Karl Kieburtz
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Max A Little
- School of Computer Science, University of Birmingham, Birmingham, UK.,Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ruth Schneider
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Christopher Tarolli
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Caroline M Tanner
- Department of Neurology, University of California-San Francisco and Parkinson's Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | | | | | - E Ray Dorsey
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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18
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Poewe W, Stocchi F, Arkadir D, Ebersbach G, Ellenbogen AL, Giladi N, Isaacson SH, Kieburtz K, LeWitt P, Olanow CW, Simuni T, Thomas A, Zlotogorski A, Adar L, Case R, Oren S, Fuchs Orenbach S, Rosenfeld O, Sasson N, Yardeni T, Espay AJ. Subcutaneous Levodopa Infusion for Parkinson's Disease: 1-Year Data from the Open-Label BeyoND Study. Mov Disord 2021; 36:2687-2692. [PMID: 34496081 PMCID: PMC9291977 DOI: 10.1002/mds.28758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Continuous, subcutaneous (SC) levodopa/carbidopa infusion with ND0612 is under development as a treatment for patients with Parkinson's disease (PD) and motor fluctuations. OBJECTIVE Evaluate 1-year safety data. METHODS BeyoND is an open-label study evaluating the long-term safety of two ND0612 dosing regimens. RESULTS Of the 214 enrolled patients (24-hour SC infusion: n = 90; 16-hour SC infusion: n = 124), 120 (56%) completed 12 months of treatment. Leading causes for study discontinuation were consent withdrawal (19.6%) and adverse events (17.3%). Rates of discontinuation were reduced from 49% to 29% after a protocol revision and retraining. Systemic safety was typical for PD patients treated with levodopa/carbidopa. Most patients experienced infusion site reactions, particularly nodules (30.8%) and hematoma (25.2%), which were judged mostly mild to moderate and led to discontinuation in only 10.3% of the participants. CONCLUSIONS Subcutaneous levodopa/carbidopa continuous infusion with ND0612 is generally safe, with typical infusion site reactions for SC delivery as the main adverse event. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - David Arkadir
- Department of Neurology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Georg Ebersbach
- Movement Disorder Clinic, Beelitz-Heilstaetten, Beelitz, Germany
| | - Aaron L Ellenbogen
- Michigan Institute for Neurological Disorders, Farmington Hills, Michigan, USA
| | - Nir Giladi
- Tel Aviv Medical Center, Sackler School of Medicine, Sagol School of Neurosciences, Neurological Institute, Tel-Aviv University, Tel Aviv, Israel
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida, USA
| | - Karl Kieburtz
- Departments of Neurology, Wayne State University School of Medicine and Henry Ford Hospital, Detroit, Michigan, USA
| | | | - C Warren Olanow
- Departments of Neurology, Wayne State University School of Medicine and Henry Ford Hospital, Detroit, Michigan, USA
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences and Center of Advanced Studies and Technology CAST, University Chieti Pescara, Chieti, Italy
| | - Abraham Zlotogorski
- Department of Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | | | | | | | | | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
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19
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Lungu C, Cedarbaum JM, Dawson TM, Dorsey ER, Faraco C, Federoff HJ, Fiske B, Fox R, Goldfine AM, Kieburtz K, Macklin EA, Matthews H, Rafaloff G, Saunders-Pullman R, Schor NF, Schwarzschild MA, Sieber BA, Simuni T, Surmeier DJ, Tamiz A, Werner MH, Wright CB, Wyse R. Seeking progress in disease modification in Parkinson disease. Parkinsonism Relat Disord 2021; 90:134-141. [PMID: 34561166 DOI: 10.1016/j.parkreldis.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Disease modification in Parkinson disease (PD) has remained an elusive goal, in spite of large investments over several decades. Following a large meeting of experts, this review article discusses the state of the science, possible reasons for past PD trials' failures to demonstrate disease-modifying benefit, and potential solutions. METHODS The National Institute of Neurological Disorders and Stroke (NINDS) convened a meeting including leaders in the field and representatives of key stakeholder groups to discuss drug therapy with the goal of disease modification in PD. RESULTS Important lessons can be learned from previous attempts, as well as from other fields. The selection process for therapeutic targets and agents differs among various organizations committed to therapeutic development. The areas identified as critical to target in future research include the development of relevant biomarkers, refinements of the targeted patient populations, considerations of novel trial designs, and improving collaborations between all stakeholders. CONCLUSIONS We identify potential barriers to progress in disease modification for Parkinson's and propose a set of research priorities that may improve the likelihood of success.
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Affiliation(s)
- Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 6001 Executive Blvd, #2188, Rockville, MD, 20852, USA.
| | | | - Ted M Dawson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Ray Dorsey
- University of Rochester Medical Center, Rochester, NY, USA
| | - Carlos Faraco
- Division of Clinical Research, NINDS, NIH, Bethesda, MD, USA
| | | | - Brian Fiske
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Robert Fox
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Karl Kieburtz
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | | | | | | | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dalton J Surmeier
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amir Tamiz
- Division of Translational Research, NINDS, NIH, Bethesda, MD, USA
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20
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Kieburtz K, Dorsey ER. Parkinson disease risks: correctly identifying environmental factors for a chronic disease. J Clin Invest 2021; 131:e150252. [PMID: 34060482 DOI: 10.1172/jci150252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Parkinson disease (PD) is now the world's fastest growing brain disease; however, the factors underlying this rise are unclear. The past 25 years has witnessed a vast expansion in our understanding of the genetics of PD, but few individuals with PD carry one of the major known genetic risk factors. Environmental factors, including individual (e.g., medications) and ambient (e.g., pollutants), may contribute to this rise. In this issue of the JCI, Sasane et al. examined the risk of PD associated with medications commonly used to treat benign prostatic hypertrophy. In contrast with previous studies, certain α1 receptor antagonists failed to lower PD risk. Rather, the commonly used comparator drug, tamsulosin, increased PD risk. This finding highlights the importance of selecting comparator groups to correctly identify risk factors. Future studies to address the rise of PD with emphasis on both individual as well as the understudied ambient environmental factors are warranted.
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21
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Kieburtz K, Olanow CW. Reply to: "A New Approach to the Development of Disease-Modifying Therapies for PD". Mov Disord 2021; 36:1281-1282. [PMID: 33991446 DOI: 10.1002/mds.28588] [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] [Received: 03/05/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Karl Kieburtz
- Clintrex Research Corporation, Sarasota, Florida, USA.,Center for Health & Technology, University of Rochester, Rochester, New York, USA
| | - C Warren Olanow
- Clintrex Research Corporation, Sarasota, Florida, USA.,Department of Neurology and Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
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22
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Abstract
The proposed triple aim of health care-enhanced patient experience, improved population health, and reduced per capita costs-can be applied to clinical research. A triple aim for clinical research would (1) improve the individual research participant's experience; (2) promote the health of populations; and (3) reduce per capita costs of clinical research. Such an approach is possible by designing trials around the needs of participants rather than sites, embracing digital measures of health, and advancing decentralized studies. Recent studies, including those evaluating therapies for COVID-19, have demonstrated the value of such an approach. Accelerating the adoption of these methods can help fulfill this new triple aim of clinical research.
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Affiliation(s)
- E Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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23
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Chahine LM, Brumm MC, Caspell-Garcia C, Oertel W, Mollenhauer B, Amara A, Fernandez-Arcos A, Tolosa E, Simonet C, Hogl B, Videnovic A, Hutten SJ, Tanner C, Weintraub D, Burghardt E, Coffey C, Cho HR, Kieburtz K, Poston KL, Merchant K, Galasko D, Foroud T, Siderowf A, Marek K, Simuni T, Iranzo A. Dopamine transporter imaging predicts clinically-defined α-synucleinopathy in REM sleep behavior disorder. Ann Clin Transl Neurol 2020; 8:201-212. [PMID: 33321002 PMCID: PMC7818144 DOI: 10.1002/acn3.51269] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 09/28/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Individuals with idiopathic rapid eye movement sleep behavior disorder (iRBD) are at high risk for a clinical diagnosis of an α-synucleinopathy (aSN). They could serve as a key population for disease-modifying trials. Abnormal dopamine transporter (DAT) imaging is a strong candidate biomarker for risk of aSN diagnosis in iRBD. Our primary objective was to identify a quantitative measure of DAT imaging that predicts diagnosis of clinically-defined aSN in iRBD. METHODS The sample included individuals with iRBD, early Parkinson's Disease (PD), and healthy controls (HC) enrolled in the Parkinson Progression Marker Initiative, a longitudinal, observational, international, multicenter study. The iRBD cohort was enriched with individuals with abnormal DAT binding at baseline. Motor and nonmotor measures were compared across groups. DAT specific binding ratios (SBR) were used to calculate the percent of expected DAT binding for age and sex using normative data from HCs. Receiver operative characteristic analyses identified a baseline DAT binding cutoff that distinguishes iRBD participants diagnosed with an aSN in follow-up versus those not diagnosed. RESULTS The sample included 38 with iRBD, 205 with PD, and 92 HC who underwent DAT-SPECT at baseline. Over 4.7 years of mean follow-up, 14 (36.84%) with iRBD were clinically diagnosed with aSN. Risk of aSN diagnosis was significantly elevated among those with baseline putamen SBR ≤ 48% of that expected for age and sex, relative to those above this cutoff (hazard ratio = 17.8 [95%CI: 3.79-83.3], P = 0.0003). CONCLUSION We demonstrate the utility of DAT SBR to identify individuals with iRBD with increased short-term risk of an aSN diagnosis.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael C Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.,Paracelsus-Elena-Klinik, Kassel, Germany
| | - Amy Amara
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Eduardo Tolosa
- Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Simonet
- Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Birgit Hogl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Caroline Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Daniel Weintraub
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elliot Burghardt
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Hyunkeun R Cho
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
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24
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Kieburtz K, Katz R, McGarry A, Olanow CW. A New Approach to the Development of Disease-Modifying Therapies for PD; Fighting Another Pandemic. Mov Disord 2020; 36:59-63. [PMID: 33026697 PMCID: PMC7891378 DOI: 10.1002/mds.28310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/14/2023] Open
Abstract
A disease‐modifying therapy that slows disease progression and development of disability is the major unmet need in the treatment of Parkinson's disease. Recent scientific advances suggest many promising and exciting new interventions. However, despite these opportunities, the cost, time and uncertainty of being able to receive an indication as a disease‐modifying therapy has caused many pharmaceutical companies to abandon development of potentially disease‐modifying drugs. We propose a new approach to development of these agents that will reduce the cost and facilitate approval of putative disease‐modifying drugs that should prove acceptable to pharmaceutical companies and regulatory agencies. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Karl Kieburtz
- Clintrex Research Corporation, Sarasota, Florida, USA.,Center for Health & Technology, University of Rochester, Rochester, New York, USA
| | - Russell Katz
- Clintrex Research Corporation, Sarasota, Florida, USA
| | - Andrew McGarry
- Clintrex Research Corporation, Sarasota, Florida, USA.,Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - C Warren Olanow
- Clintrex Research Corporation, Sarasota, Florida, USA.,Department of Neurology and Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
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25
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Fischer DL, Auinger P, Goudreau JL, Cole-Strauss A, Kieburtz K, Elm JJ, Hacker ML, Charles PD, Lipton JW, Pickut BA, Sortwell CE. BDNF rs6265 Variant Alters Outcomes with Levodopa in Early-Stage Parkinson's Disease. Neurotherapeutics 2020; 17:1785-1795. [PMID: 33215284 PMCID: PMC7851242 DOI: 10.1007/s13311-020-00965-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Disease outcomes are heterogeneous in Parkinson's disease and may be predicted by gene variants. This study investigated if the BDNF rs6265 single nucleotide polymorphism (SNP) is associated with differential outcomes with specific pharmacotherapy treatment strategies in the "NIH Exploratory Trials in PD Long-term Study 1" (NET-PD LS-1, n = 540). DNA samples were genotyped for the rs6265 SNP and others (rs11030094, rs10501087, rs1491850, rs908867, and rs1157659). The primary measures were the Unified Parkinson's Disease Rating Scale (UPDRS) and its motor component (UPDRS-III). Groups were divided by genotype and treatment regimen (levodopa monotherapy vs levodopa with other medications vs no levodopa). T allele carriers were associated with worse UPDRS outcomes compared to C/C subjects when treated with levodopa monotherapy (+ 6 points, p = 0.02) and to T allele carriers treated with no levodopa treatment strategies (UPDRS: + 8 points, p = 0.01; UPDRS-III: + 6 points, p = 0.01). Similar effects of worse outcomes associated with levodopa monotherapy were observed in the BDNF rs11030094, rs10501087, and rs1491850 SNPs. This study suggests the levodopa monotherapy strategy is associated with worse disease outcomes in BDNF rs6265 T carriers. Pending prospective validation, BDNF variants may be precision medicine factors to consider for symptomatic treatment decisions for early-stage PD patients.
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Affiliation(s)
- D Luke Fischer
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
| | - Peggy Auinger
- Center for Health and Technology, Department of Neurology, University of Rochester, Rochester, NY, USA
| | - John L Goudreau
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Allyson Cole-Strauss
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
| | - Karl Kieburtz
- Center for Health and Technology, Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Jordan J Elm
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jack W Lipton
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Barbara A Pickut
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Caryl E Sortwell
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, 400 Monroe Avenue NW, Grand Rapids, MI, 49503-2532, USA.
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA.
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26
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Mollenhauer B, Dakna M, Kruse N, Galasko D, Foroud T, Zetterberg H, Schade S, Gera RG, Wang W, Gao F, Frasier M, Chahine LM, Coffey CS, Singleton AB, Simuni T, Weintraub D, Seibyl J, Toga AW, Tanner CM, Kieburtz K, Marek K, Siderowf A, Cedarbaum JM, Hutten SJ, Trenkwalder C, Graham D. Validation of Serum Neurofilament Light Chain as a Biomarker of Parkinson's Disease Progression. Mov Disord 2020; 35:1999-2008. [PMID: 32798333 PMCID: PMC8017468 DOI: 10.1002/mds.28206] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/19/2020] [Indexed: 01/15/2023] Open
Abstract
Background: The objective of this study was to assess neurofilament light chain as a Parkinson’s disease biomarker. Methods: We quantified neurofilament light chain in 2 independent cohorts: (1) longitudinal cerebrospinal fluid samples from the longitudinal de novo Parkinson’s disease cohort and (2) a large longitudinal cohort with serum samples from Parkinson’s disease, other cognate/neurodegenerative disorders, healthy controls, prodromal conditions, and mutation carriers. Results: In the Parkinson’s Progression Marker Initiative cohort, mean baseline serum neurofilament light chain was higher in Parkinson’s disease patients (13 ± 7.2 pg/mL) than in controls (12 ± 6.7 pg/mL), P = 0.0336. Serum neurofilament light chain increased longitudinally in Parkinson’s disease patients versus controls (P < 0.01). Motor scores were positively associated with neurofilament light chain, whereas some cognitive scores showed a negative association. Conclusions: Neurofilament light chain in serum samples is increased in Parkinson’s disease patients versus healthy controls, increases over time and with age, and correlates with clinical measures of Parkinson’s disease severity. Although the specificity of neurofilament light chain for Parkinson’s disease is low, it is the first blood-based biomarker candidate that could support disease stratification of Parkinson’s disease versus other cognate/neurodegenerative disorders, track clinical progression, and possibly assess responsiveness to neuroprotective treatments. However, use of neurofilament light chain as a biomarker of response to neuroprotective interventions remains to be assessed.
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Affiliation(s)
- Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.,Paracelsus-Elena Klinik, Kassel, Germany
| | - Mohammed Dakna
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Niels Kruse
- Department of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,UK Dementia Research Institute at UCL, London, United Kingdom
| | - Sebastian Schade
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Roland G Gera
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Wenting Wang
- Biostatistics, Biogen, Cambridge, Massachusetts, USA
| | - Feng Gao
- Biostatistics, Biogen, Cambridge, Massachusetts, USA
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Andrew B Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Tanya Simuni
- Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, University of Southern California, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA, and Parkinson's Disease Research Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Karl Kieburtz
- Clinical Trials Coordination Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth Marek
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA.,Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Danielle Graham
- Discovery and Early Development Biomarkers, Biogen, Cambridge, Massachusetts, USA
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27
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Chahine LM, Siderowf A, Barnes J, Seedorff N, Caspell-Garcia C, Simuni T, Coffey CS, Galasko D, Mollenhauer B, Arnedo V, Daegele N, Frasier M, Tanner C, Kieburtz K, Marek K. Predicting Progression in Parkinson's Disease Using Baseline and 1-Year Change Measures. J Parkinsons Dis 2020; 9:665-679. [PMID: 31450510 PMCID: PMC6839498 DOI: 10.3233/jpd-181518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improved prediction of Parkinson's disease (PD) progression is needed to support clinical decision-making and to accelerate research trials. OBJECTIVES To examine whether baseline measures and their 1-year change predict longer-term progression in early PD. METHODS Parkinson's Progression Markers Initiative study data were used. Participants had disease duration ≤2 years, abnormal dopamine transporter (DAT) imaging, and were untreated with PD medications. Baseline and 1-year change in clinical, cerebrospinal fluid (CSF), and imaging measures were evaluated as candidate predictors of longer-term (up to 5 years) change in Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score and DAT specific binding ratios (SBR) using linear mixed-effects models. RESULTS Among 413 PD participants, median follow-up was 5 years. Change in MDS-UPDRS from year-2 to last follow-up was associated with disease duration (β= 0.351; 95% CI = 0.146, 0.555), male gender (β= 3.090; 95% CI = 0.310, 5.869), and baseline (β= -0.199; 95% CI = -0.315, -0.082) and 1-year change (β= 0.540; 95% CI = 0.423, 0.658) in MDS-UPDRS; predictors in the model accounted for 17.6% of the variance in outcome. Predictors of percent change in mean SBR from year-2 to last follow-up included baseline rapid eye movement sleep behavior disorder score (β= -0.6229; 95% CI = -1.2910, 0.0452), baseline (β= 7.232; 95% CI = 2.268, 12.195) and 1-year change (β= 45.918; 95% CI = 35.994,55.843) in mean striatum SBR, and 1-year change in autonomic symptom score (β= -0.325;95% CI = -0.695, 0.045); predictors in the model accounted for 44.1% of the variance. CONCLUSIONS Baseline clinical, CSF, and imaging measures in early PD predicted change in MDS-UPDRS and dopamine-transporter binding, but the predictive value of the models was low. Adding the short-term change of possible predictors improved the predictive value, especially for modeling change in dopamine-transporter binding.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janel Barnes
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Nicholas Seedorff
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany and Paracelsus-Elena-Klinik, Kassel, Germany
| | | | - Nichole Daegele
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Mark Frasier
- The Michael J. Fox Foundation, New York, NY, USA
| | - Caroline Tanner
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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28
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Javidnia M, Shoulson I, Kieburtz K, Venuto CS. Pharmacotherapy Use for Non-Motor Symptoms Among de novo Parkinson's Disease Parkinson's Progression Markers Initiative Participants. J Parkinsons Dis 2020; 10:1239-1243. [PMID: 32417797 DOI: 10.3233/jpd-201973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parkinson's disease (PD) patients experience a range of non-motor symptoms that are believed to be related to disease pathophysiology, many of which are treatable by medications. Among newly-diagnosed PD participants in the Parkinson's Progression Markers Initiative study, we describe (1) the frequency of medication use for common non-motor symptoms, and (2) when non-motor symptomatic treatment was initiated relative to PD diagnosis. Non-motor medication use was reported by 73% of participants, most commonly for depression, constipation, and anxiety. Treatment of some non-motor symptoms, notably depression, antedated diagnosis. These data may be useful for studies of non-motor symptoms in PD.
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Affiliation(s)
- Monica Javidnia
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ira Shoulson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Charles S Venuto
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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29
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Irwin DJ, Fedler J, Coffey CS, Caspell-Garcia C, Kang JH, Simuni T, Foroud T, Toga AW, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten S, Weintraub D, Mollenhauer B, Galasko DR, Siderowf A, Marek K, Trojanowski JQ, Shaw LM. Evolution of Alzheimer's Disease Cerebrospinal Fluid Biomarkers in Early Parkinson's Disease. Ann Neurol 2020; 88:574-587. [PMID: 32542885 PMCID: PMC7497251 DOI: 10.1002/ana.25811] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 11/05/2019] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We analyzed the longitudinal profile of Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers in early Parkinson's disease (PD) compared with healthy controls (HCs) and tested baseline CSF biomarkers for prediction of clinical decline in PD. METHODS Amyloid-β 1 to 42 (Aβ42 ), total tau (t-tau) and phosphorylated tau (p-tau) at the threonine 181 position were measured using the high-precision Roche Elecsys electrochemiluminescence immunoassay in all available CSF samples from longitudinally studied patients with PD (n = 416) and HCs (n = 192) followed for up to 3 years in the Parkinson's Progression Markers Initiative (PPMI). Longitudinal CSF and clinical data were analyzed with linear-mixed effects models. RESULTS We found patients with PD had lower CSF t-tau (median = 157.7 pg/mL; range = 80.9-467.0); p-tau (median = 13.4 pg/mL; range = 8.0-40.1), and Aβ42 (median = 846.2 pg/mL; range = 238.8-3,707.0) than HCs at baseline (CSF t-tau median = 173.5 pg/mL; range = 82.0-580.8; p-tau median = 15.4 pg/mL; range = 8.1-73.6; and Aβ42 median = 926.5 pg/mL; range = 239.1-3,297.0; p < 0.05-0.001) and a moderate-to-strong correlation among these biomarkers in both patients with PD and HCs (Rho = 0.50-0.97; p < 0.001). Of the patients with PD, 31.5% had pathologically low levels of CSF Aβ42 at baseline and these patients with PD had lower p-tau levels (median = 10.8 pg/mL; range = 8.0-32.8) compared with 27.7% of HCs with pathologically low CSF Aβ42 (CSF p-tau median = 12.8 pg/mL; range 8.2-73.6; p < 0.03). In longitudinal CSF analysis, we found patients with PD had greater decline in CSF Aβ42 (mean difference = -41.83 pg/mL; p = 0.03) and CSF p-tau (mean difference = -0.38 pg/mL; p = 0.03) at year 3 compared with HCs. Baseline CSF Aβ42 values predicted small but measurable decline on cognitive, autonomic, and motor function in early PD. INTERPRETATION Our data suggest baseline CSF AD biomarkers may have prognostic value in early PD and that the dynamic change of these markers, although modest over a 3-year period, suggest biomarker profiles in PD may deviate from healthy aging. ANN NEUROL 2020;88:574-587.
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Affiliation(s)
- David J Irwin
- Department of Neurology, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Janel Fedler
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Ju Hee Kang
- Department of Pharmacology & Clinical Pharmacology, Inha University, Incheon, South Korea
| | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, University of Southern California, Los Angeles, CA, USA
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Daniel Weintraub
- Department of Neurology, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry Perelman, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Michael J. Crescenz VA Medical Center, Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center, Göttingen Paracelsus-Elena-Klinik, Kassel, Germany
| | - Douglas R Galasko
- Department of Neurology, University of San Diego, San Diego, CA, USA
| | - Andrew Siderowf
- Department of Neurology, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Olanow CW, Standaert DG, Kieburtz K, Viegas TX, Moreadith R. Once‐Weekly
Subcutaneous Delivery of
Polymer‐Linked
Rotigotine (
SER
‐214) Provides Continuous Plasma Levels in Parkinson's Disease Patients. Mov Disord 2020; 35:1055-1061. [DOI: 10.1002/mds.28027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- C. Warren Olanow
- Departments of Neurology and NeuroscienceMount Sinai School of Medicine New York New York USA
- Clintrex Research Corporation Sarasota Florida USA
| | | | - Karl Kieburtz
- Clintrex Research Corporation Sarasota Florida USA
- Department of NeurologyUniversity of Rochester Rochester New York USA
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Espay AJ, Kalia LV, Gan-Or Z, Williams-Gray CH, Bedard PL, Rowe SM, Morgante F, Fasano A, Stecher B, Kauffman MA, Farrer MJ, Coffey CS, Schwarzschild MA, Sherer T, Postuma RB, Strafella AP, Singleton AB, Barker RA, Kieburtz K, Olanow CW, Lozano A, Kordower JH, Cedarbaum JM, Brundin P, Standaert DG, Lang AE. Disease modification and biomarker development in Parkinson disease: Revision or reconstruction? Neurology 2020; 94:481-494. [PMID: 32102975 PMCID: PMC7220234 DOI: 10.1212/wnl.0000000000009107] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/16/2020] [Indexed: 02/02/2023] Open
Abstract
A fundamental question in advancing Parkinson disease (PD) research is whether it represents one disorder or many. Does each genetic PD inform a common pathobiology or represent a unique entity? Do the similarities between genetic and idiopathic forms of PD outweigh the differences? If aggregates of α-synuclein in Lewy bodies and Lewy neurites are present in most (α-synucleinopathies), are they also etiopathogenically significant in each (α-synuclein pathogenesis)? Does it matter that postmortem studies in PD have demonstrated that mixed protein-aggregate pathology is the rule and pure α-synucleinopathy the exception? Should we continue to pursue convergent biomarkers that are representative of the diverse whole of PD or subtype-specific, divergent biomarkers, present in some but absent in most? Have clinical trials that failed to demonstrate efficacy of putative disease-modifying interventions been true failures (shortcomings of the hypotheses, which should be rejected) or false failures (shortcomings of the trials; hypotheses should be preserved)? Each of these questions reflects a nosologic struggle between the lumper's clinicopathologic model that embraces heterogeneity of one disease and the splitter's focus on a pathobiology-specific set of diseases. Most important, even if PD is not a single disorder, can advances in biomarkers and disease modification be revised to concentrate on pathologic commonalities in large, clinically defined populations? Or should our efforts be reconstructed to focus on smaller subgroups of patients, distinguished by well-defined molecular characteristics, regardless of their phenotypic classification? Will our clinical trial constructs be revised to target larger and earlier, possibly even prodromal, cohorts? Or should our trials efforts be reconstructed to target smaller but molecularly defined presymptomatic or postsymptomatic cohorts? At the Krembil Knowledge Gaps in Parkinson's Disease Symposium, the tentative answers to these questions were discussed, informed by the failures and successes of the fields of breast cancer and cystic fibrosis.
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Affiliation(s)
- Alberto J Espay
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI.
| | - Lorraine V Kalia
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Ziv Gan-Or
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Caroline H Williams-Gray
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Philippe L Bedard
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Steven M Rowe
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Francesca Morgante
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Alfonso Fasano
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Benjamin Stecher
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Marcelo A Kauffman
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Matthew J Farrer
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Chris S Coffey
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Michael A Schwarzschild
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Todd Sherer
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Ronald B Postuma
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Antonio P Strafella
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Andrew B Singleton
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Roger A Barker
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Karl Kieburtz
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - C Warren Olanow
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Andres Lozano
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Jeffrey H Kordower
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Jesse M Cedarbaum
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Patrik Brundin
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - David G Standaert
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
| | - Anthony E Lang
- From the Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Edmond J. Safra Program in Parkinson's Disease (L.V.K.), Krembil Research Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurology and Neurosurgery (Z.G.-O.), Montreal Neurological Institute, and Department of Human Genetics (Z.G.-O.), McGill University, Montreal, Quebec, Canada; Department of Clinical Neurosciences (C.H.W.-G.), John van Geest Centre for Brain Repair, University of Cambridge, UK; Division of Medical Oncology and Hematology (P.L.B.), Princess Margaret Cancer Centre, University Health Network, and Department of Medicine (P.L.B.), University of Toronto, Ontario, Canada; Departments of Medicine (S.M.R.), Pediatrics (S.M.R.), Cell Developmental and Integrative Biology (S.M.R.), and Neurology (D.G.S.), University of Alabama at Birmingham; Department of Clinical and Experimental Medicine (F.M.), University of Messina, Italy; Institute of Molecular and Clinical Sciences (F.M.), St George's University of London, UK; Edmond J. Safra Program in Parkinson's Disease (A.F., A.P.S., A.E.L.), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto; Krembil Research Institute (A.F., A.P.S., A.E.L.); Tomorrow Edition (B.S.), Toronto, Ontario, Canada; Consultorio y Laboratorio de Neurogenética (M.A.K.), Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA; Programa de Medicina de Precision y Genomica Clinica (M.A.K.), Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina; Clinical Genomics Program (M.J.F.), Norman Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida Clinical and Translational Science Institute, Gainesville; Clinical Trials Statistical & Data Management Center (C.S.C.), University of Iowa College of Public Health, Iowa City; Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Michael J. Fox Foundation for Parkinson's Research (T.S.), New York City, NY; Department of Neurology (R.B.P.), Montreal General Hospital, Quebec; Research Imaging Centre (A.P.S.), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada; Laboratory of Neurogenetics (A.B.S.), National Institute on Aging, NIH, Bethesda, MD; Department of Clinical Neurosciences (R.A.B.), John van Geest Centre for Brain Repair, WT-MRC Cambridge Stem Cell Institute, University of Cambridge, UK; Clinical Trials Coordination Center (K.K.), University of Rochester Medical Center, NY; Department of Neurology and Neuroscience (C.W.O.), Mount Sinai School of Medicine, New York, NY; Clintrex LLC (C.W.O.), Sarasota, FL; Division of Neurosurgery (A.L.), Krembil Neuroscience Institute, Toronto Western Hospital, Ontario, Canada; Department of Neurological Sciences (J.H.K.), Rush University Medical Center, Chicago, IL; Coeruleus Clinical Sciences (J.M.C.), Woodbridge, CT; and Center for Neurodegenerative Science (P.B.), Van Andel Institute, Grand Rapids, MI
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Simuni T, Brumm MC, Uribe L, Caspell-Garcia C, Coffey CS, Siderowf A, Alcalay RN, Trojanowski JQ, Shaw LM, Seibyl J, Singleton A, Toga AW, Galasko D, Foroud T, Nudelman K, Tosun-Turgut D, Poston K, Weintraub D, Mollenhauer B, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten S, Bressman S, Marek K. Clinical and Dopamine Transporter Imaging Characteristics of Leucine Rich Repeat Kinase 2 (LRRK2) and Glucosylceramidase Beta (GBA) Parkinson's Disease Participants in the Parkinson's Progression Markers Initiative: A Cross-Sectional Study. Mov Disord 2020; 35:833-844. [PMID: 32073681 DOI: 10.1002/mds.27989] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are limited data on the phenotypic and dopamine transporter (DAT) imaging characterization of the Parkinson's disease (PD) patients with leucine rich kinase 2 (LRRK2) and glucosylceramidase beta (GBA) mutations. OBJECTIVE The objective of this study was to examine baseline clinical and DAT imaging characteristics in GBA and LRRK2 mutation carriers with early PD compared with sporadic PD. METHODS The Parkinson's Progression Markers Initiative is an ongoing observational longitudinal study that enrolled participants with sporadic PD, LRRK2 and GBA PD carriers from 33 sites worldwide. All participants are assessed annually with a battery of motor and nonmotor scales, 123-I Ioflupane DAT imaging, and biologic variables. RESULTS We assessed 158 LRRK2 (89% G2019S), 80 GBA (89 %N370S), and 361 sporadic PD participants with the mean (standard deviation) disease duration of 2.9 (1.9), 3.1 (2.0), and 2.6 (0.6) years, respectively. When compared with sporadic PD, the GBA PD patients had no difference in any motor, cognitive, or autonomic features. The LRRK2 PD patients had less motor disability and lower rapid eye movement behavior disorder questionnaire scores, but no meaningful difference in cognitive or autonomic features. Both genetic cohorts had a higher score on the impulse control disorders scale when compared with sporadic PD, but no difference in other psychiatric features. Both genetic PD cohorts had less loss of dopamine transporter on DAT imaging when compared with sporadic PD. CONCLUSIONS We confirm previous reports of milder phenotype associated with LRRK2-PD. A previously reported more aggressive phenotype in GBA-PD is not evident early in the disease in N370s carriers. This observation identifies a window for potential disease-modifying interventions. Longitudinal data will be essential to define the slope of progression for both genetic cohorts. TRIAL REGISTRATION ClinicalTrials.gov (NCT01141023). © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael C Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy N Alcalay
- Department of Neurology, The Taub Institite for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - John Q Trojanowski
- Departments of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie M Shaw
- Departments of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda, Maryland, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, California, USA
| | - Doug Galasko
- Department of Neurology, University of California, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Kelly Nudelman
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Duygu Tosun-Turgut
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alyssa Reimer
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Samantha Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Susan Bressman
- Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
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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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Feustel AC, MacPherson A, Fergusson DA, Kieburtz K, Kimmelman J. Risks and benefits of unapproved disease-modifying treatments for neurodegenerative disease. Neurology 2020; 94:e1-e14. [PMID: 31792092 PMCID: PMC7011691 DOI: 10.1212/wnl.0000000000008699] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine whether patients randomized to unapproved, disease-modifying interventions in neurodegenerative disease trials have better outcomes than patients randomized to placebo by performing a systematic review and meta-analysis of risk and benefit experienced by patients in randomized placebo-controlled trials testing investigational treatments for Alzheimer disease, Parkinson disease, Huntington disease, or amyotrophic lateral sclerosis (ALS). METHODS We searched MEDLINE, Embase, and ClinicalTrials.gov for results of randomized trials testing non-Food and Drug Administration-approved, putatively disease-modifying interventions from January 2005 to May 2018. Trial characteristics were double-extracted. Coprimary endpoints were the treatment advantage over placebo on efficacy (standardized mean difference in outcomes) and safety (risk ratios of serious adverse events and withdrawals due to adverse events), calculated with random effects meta-analyses. The study was registered on PROSPERO (CRD42018103798). RESULTS We included 113 trials (n = 39,875 patients). There was no significant efficacy advantage associated with assignment to putatively disease-modifying interventions compared to placebo for Alzheimer disease (standardized mean difference [SMD] -0.03, 95% confidence interval [CI] -0.07 to 0.01), Parkinson disease (SMD -0.09, 95% CI -0.32 to 0.15), ALS (SMD 0.02, 95% CI -0.25 to 0.30), or Huntington disease (0.02, 95% CI -0.27 to 0.31). Patients with Alzheimer disease assigned to active treatment were at higher risk of experiencing serious adverse events (risk ratio [RR] 1.15, 95% CI 1.04-1.27) and withdrawals due to adverse events (RR 1.44, 95% CI 1.21-1.70). CONCLUSIONS Assignment to active treatment was not beneficial for any of the indications examined and may have been slightly disadvantageous for patients with Alzheimer disease. Our findings suggest that patients with neurodegenerative diseases are not, on the whole, harmed by assignment to placebo when participating in trials.
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Affiliation(s)
- Aden C Feustel
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Amanda MacPherson
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Dean A Fergusson
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Karl Kieburtz
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Jonathan Kimmelman
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY.
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Barker RA, Björklund A, Gash DM, Whone A, Van Laar A, Kordower JH, Bankiewicz K, Kieburtz K, Saarma M, Booms S, Huttunen HJ, Kells AP, Fiandaca MS, Stoessl AJ, Eidelberg D, Federoff H, Voutilainen MH, Dexter DT, Eberling J, Brundin P, Isaacs L, Mursaleen L, Bresolin E, Carroll C, Coles A, Fiske B, Matthews H, Lungu C, Wyse RK, Stott S, Lang AE. GDNF and Parkinson's Disease: Where Next? A Summary from a Recent Workshop. J Parkinsons Dis 2020; 10:875-891. [PMID: 32508331 PMCID: PMC7458523 DOI: 10.3233/jpd-202004] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
The concept of repairing the brain with growth factors has been pursued for many years in a variety of neurodegenerative diseases including primarily Parkinson's disease (PD) using glial cell line-derived neurotrophic factor (GDNF). This neurotrophic factor was discovered in 1993 and shown to have selective effects on promoting survival and regeneration of certain populations of neurons including the dopaminergic nigrostriatal pathway. These observations led to a series of clinical trials in PD patients including using infusions or gene delivery of GDNF or the related growth factor, neurturin (NRTN). Initial studies, some of which were open label, suggested that this approach could be of value in PD when the agent was injected into the putamen rather than the cerebral ventricles. In subsequent double-blind, placebo-controlled trials, the most recent reporting in 2019, treatment with GDNF did not achieve its primary end point. As a result, there has been uncertainty as to whether GDNF (and by extrapolation, related GDNF family neurotrophic factors) has merit in the future treatment of PD. To critically appraise the existing work and its future, a special workshop was held to discuss and debate this issue. This paper is a summary of that meeting with recommendations on whether there is a future for this therapeutic approach and also what any future PD trial involving GDNF and other GDNF family neurotrophic factors should consider in its design.
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Affiliation(s)
- Roger A. Barker
- Cambridge Centre for Brain Repair, Department of Clinical Neuroscience and WT-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | | | - Don M. Gash
- Professor Emeritus of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol and Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | | | - Jeffrey H. Kordower
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Krystof Bankiewicz
- Neurological Surgery, Gilbert and Kathryn Mitchell Endowed Chair, Director, Brain Health and Performance Center, The Ohio State University, Department of Neurological Surgery, Columbus, OH, USA
| | - Karl Kieburtz
- Center for Health & Technology, and the Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mart Saarma
- Institute of Biotechnology, HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Henri J. Huttunen
- Herantis Pharma Plc, Finland
- Neuroscience Center, HiLIFE, University of Helsinki, Finland
| | | | | | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre & Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Howard Federoff
- School of Medicine, Susan and Henry College of Health Sciences, University of California, Irvine and CEO, Aspen Neuroscience, San Diego, CA, USA
| | | | | | - Jamie Eberling
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | | | - Leah Mursaleen
- The Cure Parkinson’s Trust, London, UK
- School of Life Sciences, University of Westminster, UK and School of Pharmacy, University College London, UK
| | | | | | - Alasdair Coles
- Department of Clinical Neuroscience, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Brian Fiske
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Rockville, MD, USA
| | | | | | - Anthony E. Lang
- The Edmond J Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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McGarry A, Auinger P, Kieburtz K, Geva M, Mehra M, Abler V, Grachev ID, Gordon MF, Savola JM, Gandhi S, Papapetropoulos S, Hayden M. Additional Safety and Exploratory Efficacy Data at 48 and 60 Months from Open-HART, an Open-Label Extension Study of Pridopidine in Huntington Disease. J Huntingtons Dis 2020; 9:173-184. [PMID: 32508327 DOI: 10.3233/jhd-190393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Open-HART was an open-label extension of HART, a randomized, double-blind, placebo-controlled study of pridopidine in Huntington disease (HD). Previously, we reported safety and exploratory efficacy data after 36 months of treatment with pridopidine 45 mg twice daily. In the interim, emerging data suggests pridopidine may have neuroprotective effects mediated by sigma-1 receptor agonism. OBJECTIVE To report additional safety and exploratory efficacy data for continued open-label use of 45 mg BID pridopidine at 48 and 60 months. METHODS Patients in Open-HART were followed up to or greater than 60 months. Adverse events, concomitant medications, vital signs, laboratory values, and ECG data were monitored. Rates of decline in total functional capacity (TFC) and total motor score (TMS) over 60 months were evaluated in an exploratory analysis and compared between Open-HART and placebo recipients from the 2CARE trial. To account for missing data, sensitivity analyses were performed. RESULTS Of the original Open-HART baseline cohort (N = 118), 40 remained in the study at 48 months and 33 at 60 months. Pridopidine remained safe and well tolerated over the 60-month interval. TFC and TMS at 48 and 60 months remained stable, showing less decline at these timepoints compared to historical placebo controls from the 2CARE trial. TFC differences at 48 and 60 months observed remained nominally significant after sensitivity analysis. CONCLUSION The 45 mg BID pridopidine dosage remained safe and tolerable over 60 months. Exploratory analyses show TFC and TMS stability at 48 and 60 months, in contrast to placebo historical controls from the 2CARE trial. Results are consistent with data reported from the recent Phase 2 PRIDE-HD trial showing less functional decline in the pridopidine 45 mg BID treated group at 52 weeks.
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Affiliation(s)
- Andrew McGarry
- Cooper University Health Care at Rowan University, Camden, NJ, USA
| | - Peggy Auinger
- University of Rochester Medical Center, Rochester, NY, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Munish Mehra
- Tigermed Data Solutions, Bengaluru, Karnataka, India
| | - Victor Abler
- Teva Pharmaceutical Industries, Kansas City, MO, USA
| | | | | | | | - Sanjay Gandhi
- Teva Pharmaceutical Industries, Kansas City, MO, USA
| | | | - Michael Hayden
- Prilenia Therapeutics, Herzliya, Israel
- CMMT, UBC, Canada
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McGarry A, Leinonen M, Kieburtz K, Geva M, Olanow CW, Hayden M. Effects of Pridopidine on Functional Capacity in Early-Stage Participants from the PRIDE-HD Study. J Huntingtons Dis 2020; 9:371-380. [PMID: 33164941 PMCID: PMC7836066 DOI: 10.3233/jhd-200440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND No pharmacological treatment has been demonstrated to provide a functional benefit for persons with Huntington's disease (HD). Pridopidine is a sigma-1-receptor agonist shown to have beneficial effects in preclinical models of HD. OBJECTIVE To further explore the effect of pridopidine on Total Functional Capacity (TFC) in the recent double-blind, placebo-controlled PRIDE-HD study. METHODS We performed post-hoc analyses to evaluate the effect of pridopidine on TFC at 26 and 52 weeks. Participants were stratified according to baseline TFC score and analyzed using repeated measures (MMRM) and multiple imputation assuming missing not-at-random (MNAR) and worst-case scenarios. RESULTS The pridopidine 45 mg bid dosage demonstrated a beneficial effect on TFC for the entire population at week 52 of 0.87 (nominal p = 0.0032). The effect was more pronounced for early HD participants (HD1/HD2, TFC = 7-13), with a change from placebo of 1.16 (nominal p = 0.0003). This effect remained nominally significant using multiple imputation with missing not at random assumption as a sensitivity analysis. Responder analyses showed pridopidine 45 mg bid reduced the probability of TFC decline in early HD patients at Week 52 (nominal p = 0.02). CONCLUSION Pridopidine 45 mg bid results in a nominally significant reduction in TFC decline at 52 weeks compared to placebo, particularly in patients with early-stage HD.
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Affiliation(s)
- Andrew McGarry
- Cooper University Healthcare at Rowan University, Camden, NJ, USA
- Clintrex Research Corporation, Sarasota, FL, USA
| | | | | | | | - C. Warren Olanow
- Mount Sinai School of Medicine, New York City, NY, USA
- Clintrex Research Corporation, Sarasota, FL, USA
| | - Michael Hayden
- Prilenia Therapeutics, Herzliya, Israel
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Dorsey ER, Omberg L, Waddell E, Adams JL, Adams R, Ali MR, Amodeo K, Arky A, Augustine EF, Dinesh K, Hoque ME, Glidden AM, Jensen-Roberts S, Kabelac Z, Katabi D, Kieburtz K, Kinel DR, Little MA, Lizarraga KJ, Myers T, Riggare S, Rosero SZ, Saria S, Schifitto G, Schneider RB, Sharma G, Shoulson I, Stevenson EA, Tarolli CG, Luo J, McDermott MP. Deep Phenotyping of Parkinson's Disease. J Parkinsons Dis 2020; 10:855-873. [PMID: 32444562 PMCID: PMC7458535 DOI: 10.3233/jpd-202006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/13/2022]
Abstract
Phenotype is the set of observable traits of an organism or condition. While advances in genetics, imaging, and molecular biology have improved our understanding of the underlying biology of Parkinson's disease (PD), clinical phenotyping of PD still relies primarily on history and physical examination. These subjective, episodic, categorical assessments are valuable for diagnosis and care but have left gaps in our understanding of the PD phenotype. Sensors can provide objective, continuous, real-world data about the PD clinical phenotype, increase our knowledge of its pathology, enhance evaluation of therapies, and ultimately, improve patient care. In this paper, we explore the concept of deep phenotyping-the comprehensive assessment of a condition using multiple clinical, biological, genetic, imaging, and sensor-based tools-for PD. We discuss the rationale for, outline current approaches to, identify benefits and limitations of, and consider future directions for deep clinical phenotyping.
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Affiliation(s)
- E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jamie L. Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Roy Adams
- Machine Learning, AI and Healthcare Lab, Johns Hopkins University, Baltimore, MD, USA
| | | | - Katherine Amodeo
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Abigail Arky
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika F. Augustine
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | | | - Alistair M. Glidden
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stella Jensen-Roberts
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Zachary Kabelac
- Department of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dina Katabi
- Department of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel R. Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Max A. Little
- School of Computer Science, University of Birmingham, UK
- Massachusetts Institute of Technology, MA, USA
| | - Karlo J. Lizarraga
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sara Riggare
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Suchi Saria
- Machine Learning, AI and Healthcare Lab, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Statistics, and Health Policy, Johns Hopkins University, MD, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ruth B. Schneider
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ira Shoulson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Grey Matter Technologies, Sarasota, FL, USA
| | - E. Anna Stevenson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher G. Tarolli
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jiebo Luo
- Department of Computer Science, University of Rochester, Rochester, NY, USA
| | - Michael P. McDermott
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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Simuni T, Uribe L, Cho HR, Caspell-Garcia C, Coffey CS, Siderowf A, Trojanowski JQ, Shaw LM, Seibyl J, Singleton A, Toga AW, Galasko D, Foroud T, Tosun D, Poston K, Weintraub D, Mollenhauer B, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten SJ, Bressman S, Marek K. Clinical and dopamine transporter imaging characteristics of non-manifest LRRK2 and GBA mutation carriers in the Parkinson's Progression Markers Initiative (PPMI): a cross-sectional study. Lancet Neurol 2019; 19:71-80. [PMID: 31678032 DOI: 10.1016/s1474-4422(19)30319-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Parkinson's Progression Markers Initiative (PPMI) is an ongoing observational, longitudinal cohort study of participants with Parkinson's disease, healthy controls, and carriers of the most common Parkinson's disease-related genetic mutations, which aims to define biomarkers of Parkinson's disease diagnosis and progression. All participants are assessed annually with a battery of motor and non-motor scales, 123-I Ioflupane dopamine transporter (DAT) imaging, and biological variables. We aimed to examine whether non-manifesting carriers of LRRK2 and GBA mutations have prodromal features of Parkinson's disease that correlate with reduced DAT binding. METHODS This cross-sectional analysis is based on assessments done at enrolment in the subset of non-manifesting carriers of LRRK2 and GBA mutations enrolled into the PPMI study from 33 participating sites worldwide. The primary objective was to examine baseline clinical and DAT imaging characteristics in non-manifesting carriers with GBA and LRRK2 mutations compared with healthy controls. DAT deficit was defined as less than 65% of putamen striatal binding ratio expected for the individual's age. We used t tests, χ2 tests, and Fisher's exact tests to compare baseline demographics across groups. An inverse probability weighting method was applied to control for potential confounders such as age and sex. To account for multiple comparisons, we applied a family-wise error rate to each set of analyses. This study is registered with ClinicalTrials.gov, number NCT01141023. FINDINGS Between Jan 1, 2014, and Jan 1, 2019, the study enrolled 208 LRRK2 (93% G2019S) and 184 GBA (96% N370S) non-manifesting carriers. Both groups were similar with respect to mean age, and about 60% were female. Of the 286 (73%) non-manifesting carriers that had DAT imaging results, 18 (11%) LRRK2 and four (3%) GBA non-manifesting carriers had a DAT deficit. Compared with healthy controls, both LRRK2 and GBA non-manifesting carriers had significantly increased mean scores on the Movement Disorders Society Unified Parkinson's Disease Rating Scale (total score 4·6 [SD 4·4] healthy controls vs 8·4 [7·3] LRRK2 vs 9·5 [9·2] GBA, p<0·0001 for both comparisons) and the Scale for Outcomes for PD - autonomic function (5·8 [3·7] vs 8·1 [5·9] and 8·4 [6·0], p<0·0001 for both comparisons). There was no difference in daytime sleepiness, anxiety, depression, impulsive-compulsive disorders, blood pressure, urate, and rapid eye movement (REM) behaviour disorder scores. Hyposmia was significantly more common only in LRRK2 non-manifesting carriers (69 [36%] of 194 healthy controls vs 114 [55%] of 208 LRRK2 non-manifesting carriers; p=0·0003). Finally, GBA but not LRRK2 non-manifesting carriers showed increased DAT striatal binding ratios compared with healthy controls in the caudate (healthy controls 2·98 [SD 0·63] vs GBA 3·26 [0·63]; p<0·0001), putamen (2·15 [0·56] vs 2·48 [0·52]; p<0·0001), and striatum (2·56 [0·57] vs 2·87 [0·55]; p<0·0001). INTERPRETATION Our data show evidence of subtle motor and non-motor signs of Parkinson's disease in non-manifesting carriers compared with healthy controls that can precede DAT deficit. Longitudinal data will be essential to confirm these findings and define the trajectory and predictors for development of Parkinson's disease. FUNDING Michael J Fox Foundation for Parkinson's Research.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hyunkeun Ryan Cho
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Andrew Siderowf
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda, MD, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, CA, USA
| | - Doug Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Duygu Tosun
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Daniel Weintraub
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Departments of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany; Paracelsus-Elena-Klinik, Kassel, Germany
| | - Caroline M Tanner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alyssa Reimer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Samantha J Hutten
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Susan Bressman
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Mollenhauer B, Caspell-Garcia CJ, Coffey CS, Taylor P, Singleton A, Shaw LM, Trojanowski JQ, Frasier M, Simuni T, Iranzo A, Oertel W, Siderowf A, Weintraub D, Seibyl J, Toga AW, Tanner CM, Kieburtz K, Chahine LM, Marek K, Galasko D. Longitudinal analyses of cerebrospinal fluid α-Synuclein in prodromal and early Parkinson's disease. Mov Disord 2019; 34:1354-1364. [PMID: 31361367 PMCID: PMC7098385 DOI: 10.1002/mds.27806] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 04/02/2019] [Revised: 06/17/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Aggregation of α-synuclein is central to the pathophysiology of PD. Biomarkers related to α-synuclein may be informative for PD diagnosis/progression. OBJECTIVES To analyze α-synuclein in CSF in drug-naïve PD, healthy controls, and prodromal PD in the Parkinson's Progression Markers Initiative. METHODS Over up to 36-month follow-up, CSF total α-synuclein and its association with MDS-UPDRS motor scores, cognitive assessments, and dopamine transporter imaging were assessed. RESULTS The inception cohort included PD (n = 376; age [mean {standard deviation} years]: 61.7 [9.62]), healthy controls (n = 173; age, 60.9 [11.3]), hyposmics (n = 16; age, 68.3 [6.15]), and idiopathic rapid eye movement sleep behavior disorder (n = 32; age, 69.3 [4.83]). Baseline CSF α-synuclein was lower in manifest and prodromal PD versus healthy controls. Longitudinal α-synuclein decreased significantly in PD at 24 and 36 months, did not change in prodromal PD over 12 months, and trended toward an increase in healthy controls. The decrease in PD was not shown when CSF samples with high hemoglobin concentration were removed from the analysis. CSF α-synuclein changes did not correlate with longitudinal MDS-UPDRS motor scores or dopamine transporter scan. CONCLUSIONS CSF α-synuclein decreases early in the disease, preceding motor PD. CSF α-synuclein does not correlate with progression and therefore does not reflect ongoing dopaminergic neurodegeneration. Decreased CSF α-synuclein may be an indirect index of changes in the balance between α-synuclein secretion, solubility, or aggregation in the brain, reflecting its overall turnover. Additional biomarkers more directly related to α-synuclein pathophysiology and disease progression and other markers to be identified by, for example, proteomics and metabolomics are needed. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Göttingen, Germany; and Paracelsus-Elena Klinik, Kassel, Germany
| | | | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Andy Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Leslie M. Shaw
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Q. Trojanowski
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson’s Research, New York, New York, USA
| | - Tanya Simuni
- Parkinson’s Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex Iranzo
- Neurological Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Andrew Siderowf
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Weintraub
- Department of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Arthur W. Toga
- University of Southern California, Laboratory of Neuro Imaging, Los Angeles, California, USA
| | - Caroline M. Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Karl Kieburtz
- Clinical Trials Coordination Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
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McGarry A, McDermott MP, Kieburtz K, Fung WLA, McCusker E, Peng J, de Blieck EA, Cudkowicz M. Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial. Neurology 2019; 92:e1643-e1651. [PMID: 30850442 DOI: 10.1212/wnl.0000000000007244] [Citation(s) in RCA: 16] [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] [Received: 07/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Most suicidality literature in Huntington disease (HD) is based on natural history studies or retrospective reviews, but reports on risk factors from clinical trials are limited. METHODS We analyzed 609 participants from 2CARE, a randomized, double-blind, placebo-controlled clinical trial with up to 5 years of follow-up, for risk factors related to suicidality. The primary outcome variable was the time from randomization until the first occurrence of either suicidal ideation or attempt. We also considered time from randomization until the first suicide attempt as a secondary outcome variable. RESULTS Depression, anxiety, bipolar disorder, antidepressant or anxiolytic use, and prior suicide attempt at baseline were associated with time to ideation or attempt. Baseline employment status, marital status, CAG repeat length, tetrabenazine use, and treatment assignment (coenzyme Q10 or placebo) were not associated with suicidality. Time-dependent variables from the Unified Huntington's Disease Rating Scale Behavioral Assessment were associated with time to suicidal ideation or attempt, driven mainly by items related to depressed mood, low self-esteem/guilt, anxiety, suicidal thoughts, irritability, and compulsions. Variables associated with time to suicide attempt alone were generally similar. CONCLUSION These data suggest psychiatric comorbidities in HD are predictive of suicidal behavior while participating in clinical trials, reinforcing the importance of clinical surveillance and treatment towards lessening risk during participation and perhaps beyond. Designing a composite algorithm for early prediction of suicide attempts in HD may be of value, particularly given anticipated trials aimed at disease modification are likely to be long-term. CLINICALTRIALSGOV IDENTIFIER NCT00608881.
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Affiliation(s)
- Andrew McGarry
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA.
| | - Michael P McDermott
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Karl Kieburtz
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Wai Lun Alan Fung
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Elizabeth McCusker
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Jing Peng
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Elisabeth A de Blieck
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
| | - Merit Cudkowicz
- From Cooper University Healthcare at Rowan University (A.M.), Camden, NJ; University of Rochester (M.P.M., K.K., E.A.d.B.), NY; North York General Hospital (W.L.A.F.), University of Toronto, Canada; Westmead Hospital (E.M.), Australia; The Ohio State University (J.P.), Columbus; and Harvard Medical School (M.C.), Boston, MA
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Prakash N, Caspell-Garcia C, Coffey C, Siderowf A, Tanner CM, Kieburtz K, Mollenhauer B, Galasko D, Merchant K, Foroud T, Chahine LM, Weintraub D, Casaceli C, Dorsey R, Wilson R, Herzog M, Daegele N, Arnedo V, Frasier M, Sherer T, Marek K, Frank S, Jennings D, Simuni T. Feasibility and safety of lumbar puncture in the Parkinson's disease research participants: Parkinson's Progression Marker Initiative (PPMI). Parkinsonism Relat Disord 2019; 62:201-209. [PMID: 30738748 DOI: 10.1016/j.parkreldis.2018.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the feasibility, safety and tolerability of lumbar punctures (LPs) in research participants with early Parkinson disease (PD), subjects without evidence of dopaminergic deficiency (SWEDDs) and healthy volunteers (HC). BACKGROUND Cerebrospinal fluid (CSF) analysis is becoming an essential part of the biomarkers discovery effort in PD with still limited data on safety and feasibility of serial LPs in PD participants. DESIGN/METHODS Parkinson's Progression Marker Initiative (PPMI) is a longitudinal observation study designed to identify PD progression biomarkers. All PPMI participants undergo LP at baseline, 6, 12 months and yearly thereafter. CSF collection is performed by a trained investigator using predominantly atraumatic needles. Adverse events (AEs) are monitored by phone one week after LP completion. We analyzed safety data from baseline LPs. RESULTS PPMI enrolled 683 participants (423 PD/196 HC/64 SWEDDs) from 23 study sites. CSF was collected at baseline in 97.5% of participants, of whom 5.4% underwent collection under fluoroscopy. 23% participants reported any related AEs, 68% of all AE were mild while 5.6% were severe. The most common AEs were headaches (13%) and low back pain (6.5%) and both occurred more commonly in HC and SWEDDs compared to PD participants. Factors associated with higher incidence of AEs across the cohorts included female gender, younger age and use of traumatic needles with larger diameter. AEs largely did not impact compliance with the future LPs. CONCLUSIONS LPs are safe and feasible in PD research participants. Specific LP techniques (needle type and gauge) may reduce the overall incidence of AEs.
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Affiliation(s)
- Neha Prakash
- Northwestern University Feinberg School of Medicine, USA.
| | | | | | | | | | | | - Brit Mollenhauer
- Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Goettingen, Germany.
| | | | | | | | | | | | | | - Ray Dorsey
- University of Rochester Medical Center, USA.
| | - Renee Wilson
- Clinical Trial Coordination Center, University of Rochester Medical Center, USA.
| | | | | | | | | | | | - Ken Marek
- Institute for Neurodegenerative Disorders, USA.
| | - Samuel Frank
- Harvard Medical School, Beth Israel Deaconess Medical Center, Parkinson's Disease and Movement Disorders Center, Director of the HDSA Center of Excellence, USA.
| | | | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, USA.
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Warren Olanow C, Torti M, Kieburtz K, Leinonen M, Vacca L, Grassini P, Heller A, Heller E, Stocchi F. Continuous versus intermittent oral administration of levodopa in Parkinson's disease patients with motor fluctuations: A pharmacokinetics, safety, and efficacy study. Mov Disord 2019; 34:425-429. [PMID: 30653246 DOI: 10.1002/mds.27610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laboratory and clinical evidence indicate that continous delivery of levodopa is associated with reduced motor complications compared to standard intermittent levodopa. OBJECTIVE To assess the pharmacokinetics and efficacy of continuous oral delivery of l-dopa/carbidopa in PD patients with motor fluctuations. METHODS Eighteen PD patients with motor fluctuations were enrolled in an open-label study comparing pharmacokinetics and efficacy measures between standard intermittent oral l-dopa/carbidopa and "continuous" oral l-dopa/carbidopa. Continuous treatment was operationally defined as sips of an l-dopa dispersion at 5- to 10-minute intervals. On day 1, patients received their usual oral l-dopa/carbidopa doses. On day 2, patients received l-dopa/carbidopa dose by "continuous" oral administration. On day 3, patients received a single dose of oral l-dopa/carbidopa followed by continuous administration of l-dopa/carbidopa. Each study period was 8 hours, and the total l-dopa/carbidopa dose administered was the same on each day. Analyses of variability were primarily-based samples drawn between 4 and 8 hours when subjects were in a relative steady state. RESULTS There was less variability in plasma l-dopa concentration with continuous versus intermittent oral l-dopa/carbidopa treatment (fluctuation index was 0.99 ± 0.09 vs. 1.38 ± 0.12 [P < 0.001] and coefficient of variation was 0.35 ± 0.03 vs. 0.49 ± 0.04 [P < 0.001]). Mean OFF time was decreased by 43% (P < 0.001) with continuous oral l-dopa therapy. No safety or tolerability issues were observed. CONCLUSIONS Continuous oral delivery of l-dopa/carbidopa was associated with less plasma variability and reduced off time in comparison to standard intermittent oral l-dopa/carbidopa therapy. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- C Warren Olanow
- Clintrex, LLC, Sarasota, FLorida, USA.,Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA.,Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
| | - Margherita Torti
- Institute for Research and Medical Care, IRCCS, San Raffaele, Rome, Italy
| | - Karl Kieburtz
- Clintrex, LLC, Sarasota, FLorida, USA.,Department of Neurology, University of Rochester, Rochester, New York, USA
| | | | - Laura Vacca
- Institute for Research and Medical Care, IRCCS, San Raffaele, Rome, Italy
| | - Paola Grassini
- Institute for Research and Medical Care, IRCCS, San Raffaele, Rome, Italy
| | | | | | - Fabrizio Stocchi
- Institute for Research and Medical Care, IRCCS, San Raffaele, Rome, Italy
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Paulsen JS, Lourens S, Kieburtz K, Zhang Y. Sample enrichment for clinical trials to show delay of onset in huntington disease. Mov Disord 2019; 34:274-280. [PMID: 30644132 DOI: 10.1002/mds.27595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/19/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Disease-modifying clinical trials in persons without symptoms are often limited in methods to assess the impact associated with experimental therapeutics. This study suggests sample enrichment approaches to facilitate preventive trials to delay disease onset in individuals with the dominant gene for Huntington disease. METHODS Using published onset prediction indexes, we conducted the receiver operating curve analysis for diagnosis within a 3-year clinical trial time frame. We determined optimal cut points on the indexes for participant recruitment and then conducted sample size and power calculations to detect varying effect sizes for treatment efficacy in reducing 3-year rates of disease onset (or diagnosis). RESULTS Area under the curve for 3 onset prediction indexes all demonstrated excellent value in sample enrichment methodology, with the best-performing index being the multivariate risk score (MRS). CONCLUSIONS This study showed that conducting an intervention trial in premanifest and prodromal individuals with the gene expansion for Huntington disease is highly feasible using sample enrichment recruitment methods. Ongoing natural history studies are highly likely to indicate additional markers of disease prior to diagnosis. Statistical modeling of identified markers can facilitate participant enrichment to increase the likelihood of detecting a difference between treatment arms in a cost-effective and efficient manner. Such variations may expedite translation of emerging therapies to persons in an earlier phase of the disease. TRIAL REGISTRATION PREDICT-HD is registered with www.clinicaltrials.gov, number NCT00051324. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jane S Paulsen
- Departments of Neurology, Psychiatry, and Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Spencer Lourens
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, Indiana, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ying Zhang
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, Indiana, USA
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Reilmann R, McGarry A, Grachev ID, Savola JM, Borowsky B, Eyal E, Gross N, Langbehn D, Schubert R, Wickenberg AT, Papapetropoulos S, Hayden M, Squitieri F, Kieburtz K, Landwehrmeyer GB. Safety and efficacy of pridopidine in patients with Huntington's disease (PRIDE-HD): a phase 2, randomised, placebo-controlled, multicentre, dose-ranging study. Lancet Neurol 2018; 18:165-176. [PMID: 30563778 DOI: 10.1016/s1474-4422(18)30391-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous trials have shown that pridopidine might reduce motor impairment in patients with Huntington's disease. The aim of this study was to ascertain whether higher doses of pridopidine than previously tested reduce motor symptoms in a dose-dependent manner while maintaining acceptable safety and tolerability. METHODS PRIDE-HD was a randomised, placebo-controlled, phase 2, dose-ranging study in adults (aged ≥21 years) with Huntington's disease at outpatient clinics in 53 sites across 12 countries (Australia, Austria, Canada, Denmark, France, Germany, Italy, Poland, Russia, the Netherlands, the UK, and the USA). Eligible patients had clinical onset after age 18 years, 36 or more cytosine-adenine-guanine repeats in the huntingtin gene, motor symptoms (Unified Huntington's Disease Rating Scale total motor score [UHDRS-TMS] ≥25 points), and reduced independence (UHDRS independence score ≤90%). Patients were randomly assigned (1:1:1:1:1) with centralised interactive-response technology to receive one of four doses of pridopidine (45, 67·5, 90, or 112·5 mg) or placebo orally twice a day for 52 weeks. Randomisation was stratified within centres by neuroleptic drug use. The primary efficacy endpoint was change in the UHDRS-TMS from baseline to 26 weeks, which was assessed in all randomised patients who received at least one dose of study drug and had at least one post-baseline efficacy assessment (full analysis set). Participants and investigators were masked to treatment assignment. This trial is registered with EudraCT (2013-001888-23) and ClinicalTrials.gov (NCT02006472). FINDINGS Between Feb 13, 2014, and July 5, 2016, 408 patients were enrolled and randomly assigned to receive placebo (n=82) or pridopidine 45 mg (n=81), 67·5 mg (n=82), 90 mg (n=81), or 112·5 mg (n=82) twice daily for 26 weeks. The full analysis set included 397 patients (81 in the placebo group, 75 in the 45 mg group, 79 in the 67·5 mg group, 81 in the 90 mg group, and 81 in the 112·5 mg group). Pridopidine did not significantly change the UHDRS-TMS at 26 weeks compared with placebo at any dose. The most frequent adverse events across all groups were diarrhoea, vomiting, nasopharyngitis, falls, headache, insomnia, and anxiety. The most common treatment-related adverse events were insomnia, diarrhoea, nausea, and dizziness. Serious adverse events occurred in the pridopidine groups only and were most frequently falls (n=5), suicide attempt (n=4), suicidal ideation (n=3), head injury (n=3), and aspiration pneumonia (n=3). No new safety or tolerability concerns emerged in this study. One death in the pridopidine 112·5 mg group due to aspiration pneumonia was considered to be possibly related to the study drug. INTERPRETATION Pridopidine did not improve the UHDRS-TMS at week 26 compared with placebo and, thus, the results of secondary or tertiary analyses in previous trials were not replicated. A potentially strong placebo effect needs to be ruled out in future studies. FUNDING Teva Pharmaceutical Industries.
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Affiliation(s)
- Ralf Reilmann
- George Huntington Institute, Münster, Germany; Department of Clinical Radiology, University of Münster, Münster, Germany; Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Andrew McGarry
- Movement Disorders Center, Cooper University Health Care, Camden, NJ, USA
| | | | | | | | - Eli Eyal
- Teva Pharmaceutical Industries, Petach Tikva, Israel
| | | | - Douglas Langbehn
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Ferdinando Squitieri
- Unita' Operativa Ricerca e Cura Huntington e Malattie Rare, Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Karl Kieburtz
- Center for Health & Technology, University of Rochester Medical Center, Rochester, NY, USA
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46
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Marek K, Chowdhury S, Siderowf A, Lasch S, Coffey CS, Caspell‐Garcia C, Simuni T, Jennings D, Tanner CM, Trojanowski JQ, Shaw LM, Seibyl J, Schuff N, Singleton A, Kieburtz K, Toga AW, Mollenhauer B, Galasko D, Chahine LM, Weintraub D, Foroud T, Tosun‐Turgut D, Poston K, Arnedo V, Frasier M, Sherer T. The Parkinson's progression markers initiative (PPMI) - establishing a PD biomarker cohort. Ann Clin Transl Neurol 2018; 5:1460-1477. [PMID: 30564614 PMCID: PMC6292383 DOI: 10.1002/acn3.644] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [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: 02/22/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The Parkinson's Progression Markers Initiative (PPMI) is an observational, international study designed to establish biomarker-defined cohorts and identify clinical, imaging, genetic, and biospecimen Parkinson's disease (PD) progression markers to accelerate disease-modifying therapeutic trials. METHODS A total of 423 untreated PD, 196 Healthy Control (HC) and 64 SWEDD (scans without evidence of dopaminergic deficit) subjects were enrolled at 24 sites. To enroll PD subjects as early as possible following diagnosis, subjects were eligible with only asymmetric bradykinesia or tremor plus a dopamine transporter (DAT) binding deficit on SPECT imaging. Acquisition of data was standardized as detailed at www.ppmi-info.org. RESULTS Approximately 9% of enrolled subjects had a single PD sign at baseline. DAT imaging excluded 16% of potential PD subjects with SWEDD. The total MDS-UPDRS for PD was 32.4 compared to 4.6 for HC and 28.2 for SWEDD. On average, PD subjects demonstrated 45% and 68% reduction in mean striatal and contralateral putamen Specific Binding Ratios (SBR), respectively. Cerebrospinal fluid (CSF) was acquired from >97% of all subjects. CSF (PD/HC/SWEDD pg/mL) α-synuclein (1845/2204/2141) was reduced in PD vs HC or SWEDD (P < 0.03). Similarly, t-tau (45/53) and p-tau (16/18) were reduced in PD versus HC (P < 0.01). INTERPRETATION PPMI has detailed the biomarker signature for an early PD cohort defined by clinical features and imaging biomarkers. This strategy provides the framework to establish biomarker cohorts and to define longitudinal progression biomarkers to support future PD treatment trials.
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Affiliation(s)
- Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | - Sohini Chowdhury
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | | | - Shirley Lasch
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | | | | | | | | | | | | | | | - John Seibyl
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | | | | | - Karl Kieburtz
- Clinical Trials Coordination CenterUniversity of RochesterRochesterNew York
| | | | | | | | | | | | | | | | | | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | - Todd Sherer
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
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47
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McGarry A, Kieburtz K, Abler V, Grachev ID, Gandhi S, Auinger P, Papapetropoulos S, Hayden M. Safety and Exploratory Efficacy at 36 Months in Open-HART, an Open-Label Extension Study of Pridopidine in Huntington's Disease. J Huntingtons Dis 2018; 6:189-199. [PMID: 28826192 DOI: 10.3233/jhd-170241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/03/2023]
Abstract
BACKGROUND Open-HART is an open-label extension of HART, a randomized, placebo-controlled, dose-ranging, parallel-group study. OBJECTIVE To evaluate safety and exploratory efficacy of open-label pridopidine over 36 months in subjects with Huntington's disease (HD). METHODS Open-HART subjects were treated with pridopidine 45 mg twice daily (BID). After initial evaluation by telephone (Week 1) and in person (Month 1), in-person visits occurred every 3 months, alternating between safety and clinical visits (safety plus Unified Huntington's Disease Rating Scale [UHDRS] assessment). The UHDRS was performed for pre-specified analysis as a secondary outcome measure. Adverse events (AEs), laboratory values, and electrocardiography were monitored throughout. RESULTS Most subjects (89%) reported at least one AE, with 30% experiencing treatment-related AEs. The most common AEs during the first year were falls (12.7%), anxiety (9.3%), insomnia (8.5%), irritability (6.8%), and depression (5.9%). Ninety-nine percent of subjects took concomitant medications. Two seizures were reported as AEs. No arrhythmias or suicide attempts were reported. Five deaths occurred, all considered treatment unrelated. Secondary exploratory analyses of subjects on pridopidine demonstrated motor deterioration (as measured by the UHDRS total motor score) consistent with HD's natural history, as shown in large observational studies. A post-hoc, exploratory analysis of TFC performance compared to placebo groups from other long-term HD studies demonstrated no significant effect for pridopidine on TFC progression after correction for multiple comparisons. CONCLUSIONS Pridopidine 45 mg BID was generally safe and tolerable in HD subjects over 36 months. TMS declined in a manner consistent with the known natural history of HD.
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Affiliation(s)
- Andrew McGarry
- Cooper University Health Care at Rowan University, Camden, NJ, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Victor Abler
- Teva Pharmaceutical Industries, Kansas City, MO, USA
| | | | | | - Peggy Auinger
- University of Rochester Medical Center, Rochester, NY, USA
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48
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Kieburtz K, Reilmann R, Olanow CW. Huntington's disease: Current and future therapeutic prospects. Mov Disord 2018; 33:1033-1041. [DOI: 10.1002/mds.27363] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 01/04/2023] Open
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49
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Litvan I, Kieburtz K, Tröster AI, Aarsland D. Strengths and challenges in conducting clinical trials in Parkinson's disease mild cognitive impairment. Mov Disord 2018; 33:520-527. [PMID: 29573469 DOI: 10.1002/mds.27345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 12/19/2022] Open
Abstract
Treatments to slow the progression of cognitive dysfunction to dementia and improve the quality of life of persons with Parkinson's disease (PD) are desperately needed. Because PD mild cognitive impairment is considered a transitional stage before dementia, it opens a window to timely intervention. This article critically reviews the strengths and challenges of pharmacologic and nonpharmacologic clinical therapeutic trials in PD mild cognitive impairment conducted during the past 5 years, including ongoing trials. Relatively few high-quality trials have been conducted, and some important factors in designing future clinical trials are discussed. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Irene Litvan
- University of California San Diego, Department of Neurosciences, Parkinson and Other Movement Disorders Center, San Diego, California, USA
| | - Karl Kieburtz
- Center for Health & Technology, University of Rochester Medical Center, Rochester, New York, USA.,Clintrex LLC, Sarasota, Florida
| | - Alexander I Tröster
- Barrow Neurological Institute, Department of Clinical Neuropsychology and Barrow Center for Neuromodulation, Phoenix, Arizona, USA
| | - Dag Aarsland
- King's College, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Centre for Age-Related Diseases, Stavanger.,Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
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50
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Simuni T, Siderowf A, Lasch S, Coffey CS, Caspell-Garcia C, Jennings D, Tanner CM, Trojanowski JQ, Shaw LM, Seibyl J, Schuff N, Singleton A, Kieburtz K, Toga AW, Mollenhauer B, Galasko D, Chahine LM, Weintraub D, Foroud T, Tosun D, Poston K, Arnedo V, Frasier M, Sherer T, Chowdhury S, Marek K. Longitudinal Change of Clinical and Biological Measures in Early Parkinson's Disease: Parkinson's Progression Markers Initiative Cohort. Mov Disord 2018; 33:771-782. [PMID: 29572948 PMCID: PMC6001458 DOI: 10.1002/mds.27361] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [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: 08/22/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 11/09/2022] Open
Abstract
Objective: The objective of this study was to assess longitudinal change in clinical and dopamine transporter imaging outcomes in early, untreated PD. Methods: We describe 5‐year longitudinal change of the MDS‐UPDRS and other clinical measures using results from the Parkinson's Progression Markers Initiative, a longitudinal cohort study of early Parkinson's disease (PD) participants untreated at baseline. We also provide data on the longitudinal change in dopamine transporter 123‐I Ioflupane striatal binding and correlation between the 2 measures. Results: A total of 423 PD participants were recruited, and 358 remain in the study at year 5. Baseline MDS‐UPDRS total score was 32.4 (standard deviation 13.1), and the average annual change (assessed medications OFF for the treated participants) was 7.45 (11.6), 3.11 (11.7), 4(11.9), 4.7 (11.1), and 1.74(11.9) for years 1, 2, 3, 4, and 5, respectively (P < .0001 for the change over time), with a steeper change in year 1. Dopaminergic therapy had a significant effect on the change of MDS‐UPDRS. There was a significant longitudinal change in dopamine transporter binding in all striatal regions (P < .001). There was a significant but weak correlation between MDS‐UPDRS and dopamine transporter binding at baseline and years 1, 2, and 4, but no correlation between the rate of change of the 2 variables. Conclusions: We present 5‐year longitudinal data on the change of the MDS‐UPDRS and other clinical and dopamine transporter imaging outcome measures in early PD. These data can be used for sample size estimates for interventional studies in the de novo PD population. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | - Shirley Lasch
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | | | | | | | | | | | - Leslie M Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Norbert Schuff
- University of California, San Francisco, California, USA
| | - Andrew Singleton
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Karl Kieburtz
- Clinical Trials Coordination Center, University of Rochester, Rochester, New York, USA
| | - Arthur W Toga
- University of Southern California, Los Angeles, California, USA
| | | | - Doug Galasko
- University of California, San Diego, California, USA
| | - Lana M Chahine
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Duygu Tosun
- University of California, San Francisco, California, USA
| | - Kathleen Poston
- Stanford University Medical Center, Stanford, California, USA
| | | | | | | | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
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