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Lindborg SR, Goyal NA, Katz J, Burford M, Li J, Kaspi H, Abramov N, Boulanger B, Berry JD, Nicholson K, Mozaffar T, Miller R, Jenkins L, Baloh RH, Lewis R, Staff NP, Owegi MA, Dagher B, Blondheim-Shraga NR, Gothelf Y, Levy YS, Kern R, Aricha R, Windebank AJ, Bowser R, Brown RH, Cudkowicz ME. Debamestrocel multimodal effects on biomarker pathways in amyotrophic lateral sclerosis are linked to clinical outcomes. Muscle Nerve 2024; 69:719-729. [PMID: 38593477 DOI: 10.1002/mus.28093] [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: 09/01/2023] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION/AIMS Biomarkers have shown promise in amyotrophic lateral sclerosis (ALS) research, but the quest for reliable biomarkers remains active. This study evaluates the effect of debamestrocel on cerebrospinal fluid (CSF) biomarkers, an exploratory endpoint. METHODS A total of 196 participants randomly received debamestrocel or placebo. Seven CSF samples were to be collected from all participants. Forty-five biomarkers were analyzed in the overall study and by two subgroups characterized by the ALS Functional Rating Scale-Revised (ALSFRS-R). A prespecified model was employed to predict clinical outcomes leveraging biomarkers and disease characteristics. Causal inference was used to analyze relationships between neurofilament light chain (NfL) and ALSFRS-R. RESULTS We observed significant changes with debamestrocel in 64% of the biomarkers studied, spanning pathways implicated in ALS pathology (63% neuroinflammation, 50% neurodegeneration, and 89% neuroprotection). Biomarker changes with debamestrocel show biological activity in trial participants, including those with advanced ALS. CSF biomarkers were predictive of clinical outcomes in debamestrocel-treated participants (baseline NfL, baseline latency-associated peptide/transforming growth factor beta1 [LAP/TGFβ1], change galectin-1, all p < .01), with baseline NfL and LAP/TGFβ1 remaining (p < .05) when disease characteristics (p < .005) were incorporated. Change from baseline to the last measurement showed debamestrocel-driven reductions in NfL were associated with less decline in ALSFRS-R. Debamestrocel significantly reduced NfL from baseline compared with placebo (11% vs. 1.6%, p = .037). DISCUSSION Following debamestrocel treatment, many biomarkers showed increases (anti-inflammatory/neuroprotective) or decreases (inflammatory/neurodegenerative) suggesting a possible treatment effect. Neuroinflammatory and neuroprotective biomarkers were predictive of clinical response, suggesting a potential multimodal mechanism of action. These results offer preliminary insights that need to be confirmed.
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Affiliation(s)
| | - Namita A Goyal
- UCI Health ALS & Neuromuscular Center, University of California, Irvine, California, USA
| | - Jonathan Katz
- Sutter Pacific Medical Foundation, California Pacific Medical Center, San Francisco, California, USA
| | - Matthew Burford
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jenny Li
- Brainstorm Cell Therapeutics, Boston, Massachusetts, USA
| | | | | | - Bruno Boulanger
- Department of Statistics and Data Science, PharmaLex, Mont-Saint-Guibert, Belgium
| | - James D Berry
- Healey & AMG Center, Mass General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katharine Nicholson
- Healey & AMG Center, Mass General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tahseen Mozaffar
- UCI Health ALS & Neuromuscular Center, University of California, Irvine, California, USA
| | - Robert Miller
- Sutter Pacific Medical Foundation, California Pacific Medical Center, San Francisco, California, USA
| | - Liberty Jenkins
- Sutter Pacific Medical Foundation, California Pacific Medical Center, San Francisco, California, USA
| | - Robert H Baloh
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Margaret Ayo Owegi
- Neurology Department, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bob Dagher
- Brainstorm Cell Therapeutics, Boston, Massachusetts, USA
| | | | | | - Yossef S Levy
- Manufacturing, Brainstorm Cell Therapeutics, Tel Aviv, Israel
| | - Ralph Kern
- Brainstorm Cell Therapeutics, Boston, Massachusetts, USA
| | | | - Anthony J Windebank
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Robert Bowser
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Robert H Brown
- Neurology Department, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Merit E Cudkowicz
- Healey & AMG Center, Mass General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Parra-Cantu C, Martinez-Thompson JM, Linch FB, Welch TL, Chou CZ, Pattinson AK, Staff NP, Neisen M. Radiologically Inserted Gastrostomy Tube Placement Guided by the Assessment and Primary Palliative Care Provided by an Amyotrophic Lateral Sclerosis Multidisciplinary Clinic: A Single-Arm Retrospective Clinical Study. Am J Hosp Palliat Care 2024; 41:516-526. [PMID: 37266922 DOI: 10.1177/10499091231180553] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a median survival of about 3 years. An ALS multidisciplinary team can provide primary palliative care and improve outcomes and quality of life for patients. Feeding tube insertion may be considered for patients with significant weight loss, or respiratory insufficiency. While radiologically inserted gastrostomy (RIG) tube placement may be an option, further studies are required to determine its best timing and appropriateness. This study's objectives were to evaluate the feasibility and outcomes of RIG tube placement in ALS patients over a 90-day follow-up period through the assessment and primary palliative care provided by the multidisciplinary team. This retrospective study reviewed the placement of 16 or 18 French RIG-tube without intubation or endoscopy for 36 ALS patients at a single center between April 2019 and December 2021. Measures included ALS Functional Rating Scale-Revised (ALSFRS-R) scores to determine the ALS stage. Demographic, clinical, procedural, and follow-up data were reviewed. Results showed that the RIG tube placement had a low rate of minor adverse events (11%) and no major procedure-related adverse events. The mean ALSFRS-R score at the time of procedure in subjects who died within 90 days was lower than of those alive beyond 90 days (P = .04). This study found that RIG-tube placement is a safe and effective way to manage dysphagia in ALS patients and highlights the importance of educating members of the multidisciplinary clinic in palliative care principles to determine the appropriateness of RIG tube placement.
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Affiliation(s)
| | | | - Forrest B Linch
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Tasha L Welch
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Claudia Z Chou
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Adele K Pattinson
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Melissa Neisen
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
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Alberti P, Argyriou AA, Bruna J, Damaj MI, Faithfull S, Harding A, Hoke A, Knoerl R, Kolb N, Li T, Park SB, Staff NP, Tamburin S, Thomas S, Smith EL. Correction to: Considerations for establishing and maintaining international research collaboration: the example of chemotherapy‑induced peripheral neurotoxicity (CIPN)-a white paper. Support Care Cancer 2024; 32:175. [PMID: 38381222 PMCID: PMC10881766 DOI: 10.1007/s00520-024-08382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Paola Alberti
- University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Jordi Bruna
- Hospital Universitari de Bellvitge, Neuro-Oncology Unit, Institut Catala d'Oncologia (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Imad Damaj
- Department of Pharmacology and Toxicology and Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara Faithfull
- Trinity College Dublin, School of Medicine, Dublin, Ireland
- University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus, Dublin, Ireland
| | - Alice Harding
- University of Alabama at Birmingham, Office of Sponsored Programs, Birmingham, AL, USA
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT, USA
| | - Tiffany Li
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Thomas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Lavoie Smith
- Department of Acute, Chronic & Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
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Seddighi S, Qi YA, Brown AL, Wilkins OG, Bereda C, Belair C, Zhang YJ, Prudencio M, Keuss MJ, Khandeshi A, Pickles S, Kargbo-Hill SE, Hawrot J, Ramos DM, Yuan H, Roberts J, Sacramento EK, Shah SI, Nalls MA, Colón-Mercado JM, Reyes JF, Ryan VH, Nelson MP, Cook CN, Li Z, Screven L, Kwan JY, Mehta PR, Zanovello M, Hallegger M, Shantaraman A, Ping L, Koike Y, Oskarsson B, Staff NP, Duong DM, Ahmed A, Secrier M, Ule J, Jacobson S, Reich DS, Rohrer JD, Malaspina A, Dickson DW, Glass JD, Ori A, Seyfried NT, Maragkakis M, Petrucelli L, Fratta P, Ward ME. Mis-spliced transcripts generate de novo proteins in TDP-43-related ALS/FTD. Sci Transl Med 2024; 16:eadg7162. [PMID: 38277467 DOI: 10.1126/scitranslmed.adg7162] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
Functional loss of TDP-43, an RNA binding protein genetically and pathologically linked to amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), leads to the inclusion of cryptic exons in hundreds of transcripts during disease. Cryptic exons can promote the degradation of affected transcripts, deleteriously altering cellular function through loss-of-function mechanisms. Here, we show that mRNA transcripts harboring cryptic exons generated de novo proteins in TDP-43-depleted human iPSC-derived neurons in vitro, and de novo peptides were found in cerebrospinal fluid (CSF) samples from patients with ALS or FTD. Using coordinated transcriptomic and proteomic studies of TDP-43-depleted human iPSC-derived neurons, we identified 65 peptides that mapped to 12 cryptic exons. Cryptic exons identified in TDP-43-depleted human iPSC-derived neurons were predictive of cryptic exons expressed in postmortem brain tissue from patients with TDP-43 proteinopathy. These cryptic exons produced transcript variants that generated de novo proteins. We found that the inclusion of cryptic peptide sequences in proteins altered their interactions with other proteins, thereby likely altering their function. Last, we showed that 18 de novo peptides across 13 genes were present in CSF samples from patients with ALS/FTD spectrum disorders. The demonstration of cryptic exon translation suggests new mechanisms for ALS/FTD pathophysiology downstream of TDP-43 dysfunction and may provide a potential strategy to assay TDP-43 function in patient CSF.
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Affiliation(s)
- Sahba Seddighi
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yue A Qi
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Anna-Leigh Brown
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Oscar G Wilkins
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Francis Crick Institute, London, UK
| | - Colleen Bereda
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Cedric Belair
- Laboratory of Genetics and Genomics, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Yong-Jie Zhang
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Matthew J Keuss
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Aditya Khandeshi
- Laboratory of Genetics and Genomics, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Sarah Pickles
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Sarah E Kargbo-Hill
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - James Hawrot
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel M Ramos
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hebao Yuan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jessica Roberts
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Erika Kelmer Sacramento
- Leibniz Institute on Aging, Fritz Lipmann Institute (FLI), Beutenbergstrasse 11, 07745 Jena, Germany
| | - Syed I Shah
- Data Tecnica International, Washington, DC, USA
| | - Mike A Nalls
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International, Washington, DC, USA
| | - Jennifer M Colón-Mercado
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Joel F Reyes
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Veronica H Ryan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Matthew P Nelson
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Casey N Cook
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Ziyi Li
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International, Washington, DC, USA
| | - Laurel Screven
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Justin Y Kwan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Puja R Mehta
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Matteo Zanovello
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Martina Hallegger
- Francis Crick Institute, London, UK
- UK Dementia Research Institute at King's College London, London, UK
| | | | - Lingyan Ping
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuka Koike
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Björn Oskarsson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Duc M Duong
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Aisha Ahmed
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Maria Secrier
- Department of Genetics, Evolution and Environment, UCL Genetics Institute, UCL, London, UK
| | - Jernej Ule
- Francis Crick Institute, London, UK
- UK Dementia Research Institute at King's College London, London, UK
| | - Steven Jacobson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan D Rohrer
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Andrea Malaspina
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Jonathan D Glass
- Department of Neurology, Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, USA
| | - Alessandro Ori
- Leibniz Institute on Aging, Fritz Lipmann Institute (FLI), Beutenbergstrasse 11, 07745 Jena, Germany
| | - Nicholas T Seyfried
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Manolis Maragkakis
- Laboratory of Genetics and Genomics, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Pietro Fratta
- UCL Queen Square Motor Neuron Disease Centre, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Francis Crick Institute, London, UK
| | - Michael E Ward
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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5
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Alberti P, Argyriou AA, Bruna J, Damaj MI, Faithfull S, Harding A, Hoke A, Knoerl R, Kolb N, Li T, Park SB, Staff NP, Tamburin S, Thomas S, Smith EL. Considerations for establishing and maintaining international research collaboration: the example of chemotherapy-induced peripheral neurotoxicity (CIPN)-a white paper. Support Care Cancer 2024; 32:117. [PMID: 38244122 PMCID: PMC10799817 DOI: 10.1007/s00520-023-08301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE This white paper provides guidance regarding the process for establishing and maintaining international collaborations to conduct oncology/neurology-focused chemotherapy-induced peripheral neurotoxicity (CIPN) research. METHODS An international multidisciplinary group of CIPN scientists, clinicians, research administrators, and legal experts have pooled their collective knowledge regarding recommendations for establishing and maintaining international collaboration to foster advancement of CIPN science. RESULTS Experts provide recommendations in 10 categories: (1) preclinical and (2) clinical research collaboration; (3) collaborators and consortiums; (4) communication; (5) funding; (6) international regulatory standards; (7) staff training; (8) data management, quality control, and data sharing; (9) dissemination across disciplines and countries; and (10) additional recommendations about feasibility, policy, and mentorship. CONCLUSION Recommendations to establish and maintain international CIPN research collaboration will promote the inclusion of more diverse research participants, increasing consideration of cultural and genetic factors that are essential to inform innovative precision medicine interventions and propel scientific discovery to benefit cancer survivors worldwide. RELEVANCE TO INFORM RESEARCH POLICY Our suggested guidelines for establishing and maintaining international collaborations to conduct oncology/neurology-focused chemotherapy-induced peripheral neurotoxicity (CIPN) research set forth a challenge to multinational science, clinical, and policy leaders to (1) develop simple, streamlined research designs; (2) address logistical barriers; (3) simplify and standardize regulatory requirements across countries; (4) increase funding to support international collaboration; and (5) foster faculty mentorship.
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Affiliation(s)
- Paola Alberti
- University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Jordi Bruna
- Hospital Universitari de Bellvitge, Neuro-Oncology Unit, Institut Catala d'Oncologia (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Imad Damaj
- Department of Pharmacology and Toxicology and Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara Faithfull
- Trinity College Dublin, School of Medicine, Dublin, Ireland
- University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus, Dublin, Ireland
| | - Alice Harding
- University of Alabama at Birmingham, Office of Sponsored Programs, Birmingham, AL, USA
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT, USA
| | - Tiffany Li
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Thomas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Lavoie Smith
- Department of Acute, Chronic & Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
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Santilli AR, Martinez-Thompson JM, Speelziek SJA, Staff NP, Laughlin RS. Femoral neuropathy: A clinical and electrodiagnostic review. Muscle Nerve 2024; 69:64-71. [PMID: 37941415 DOI: 10.1002/mus.27994] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION/AIMS Femoral neuropathies can cause severe, prolonged debility, yet there have been few clinical and electrodiagnostic (EDx) studies addressing this condition. The aim of this study was to better understand the etiologies, EDx features, and clinical course of femoral neuropathy. METHODS We identified patients evaluated at Mayo Clinic Rochester between January 1, 1999 and July 31, 2019, with possible new femoral neuropathy ascertained via International Classification of Diseases-versions 9 and 10 diagnosis codes presenting within 6 months of symptom onset. RESULTS A retrospective review of 1084 records was performed and we ultimately identified 159 patients with isolated femoral neuropathy for inclusion. The most common femoral neuropathy etiologies were compressive (40%), perioperative stretch (35%), and inflammatory (6%). Presenting symptoms included weakness (96%), sensory loss (73%), and pain (53%). Presenting motor physical exam findings demonstrated moderate weakness (34%) or no activation (25%) of knee extension and mild (32%) or moderate (35%) weakness of hip flexion. Seventy-two percent of patients underwent EDx testing, including 22 with femoral motor nerve conduction studies. Treatment often involved physical therapy (89%) and was otherwise etiology-specific. In patients with follow-up data available (n = 154), 83% had subjective clinical improvement at follow-up with a mean time to initial improvement of 3.3 months and mean time to recovery at final follow-up of 14.8 months. Only 48% of patients had nearly complete or complete recovery. DISCUSSION In our cohort, the most common etiologies of femoral neuropathy were compression or perioperative stretch with high initial morbidity. Although motor recovery is common, improvement is often prolonged and incomplete.
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Affiliation(s)
| | | | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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7
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Li Z, Weller CA, Shah S, Johnson N, Hao Y, Roberts J, Bereda C, Klaisner S, Machado P, Fratta P, Petrucelli L, Prudencio M, Oskarsson B, Staff NP, Dickson DW, Cookson MR, Ward ME, Singleton AB, Nalls MA, Qi YA. ProtPipe: A Multifunctional Data Analysis Pipeline for Proteomics and Peptidomics. bioRxiv 2023:2023.12.12.571327. [PMID: 38168437 PMCID: PMC10760195 DOI: 10.1101/2023.12.12.571327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Mass spectrometry (MS) is a technique widely employed for the identification and characterization of proteins, personalized medicine, systems biology and biomedical applications. By combining MS with different proteomics approaches such as immunopurification MS, immunopeptidomics, and total protein proteomics, researchers can gain insights into protein-protein interactions, immune responses, cellular processes, and disease mechanisms. The application of MS-based proteomics in these areas continues to advance our understanding of protein function, cellular signaling, and complex biological systems. Data analysis for mass spectrometry is a critical process that includes identifying and quantifying proteins and peptides and exploring biological functions for these proteins in downstream analysis. To address the complexities associated with MS data analysis, we developed ProtPipe to streamline and automate the processing and analysis of high-throughput proteomics and peptidomics datasets. The pipeline facilitates data quality control, sample filtering, and normalization, ensuring robust and reliable downstream analysis. ProtPipe provides downstream analysis including identifying differential abundance proteins and peptides, pathway enrichment analysis, protein-protein interaction analysis, and MHC1-peptide binding affinity. ProtPipe generates annotated tables and diagnostic visualizations from statistical postprocessing and computation of fold-changes across pairwise conditions, predefined in an experimental design. ProtPipe is well-documented open-source software and is available at https://github.com/NIH-CARD/ProtPipe , accompanied by a web interface.
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Rashed HR, Niu Z, Dyck PJ, Dyck PJB, Mauermann ML, Berini SE, Dubey D, Mills JR, Staff NP, Wu Y, Spinner RE, Dasari S, Klein CJ. Nerve transcriptomes in autoimmune and genetic demyelinating neuropathies: Pathogenic pathway assessment of nerve demyelination. J Neuroimmunol 2023; 384:578220. [PMID: 37857228 DOI: 10.1016/j.jneuroim.2023.578220] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/03/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
The pathogenesis of autoimmune demyelinating neuropathies is poorly understood compared to inherited demyelinating forms. We performed whole transcriptome (RNA-Seq) using nerve biopsy tissues of patients with different autoimmune and inherited demyelinating neuropathies (CIDP n = 10, POEMS n = 18, DADS n = 3, CMT1 n = 3) versus healthy controls (n = 6). A limited number of differentially expressed genes compared to healthy controls were identified (POEMS = 125, DADS = 15, CMT = 14, CIDP = 5). Divergent pathogenic pathways including inflammatory, demyelinating and neurite regeneration such as with the triggering receptor expressed on myeloid cells (TREM1) part of the immunoglobulin superfamily and RhoGD1 are found. Shared and discordant pathogenic injury are discovered between autoimmune and inherited forms.
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Affiliation(s)
- Hebatallah R Rashed
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Rochester, MN, United States of America
| | - Peter J Dyck
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - P James B Dyck
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - Michelle L Mauermann
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - Sarah E Berini
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Rochester, MN, United States of America
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Rochester, MN, United States of America
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - Yanhong Wu
- Department of Laboratory Medicine and Pathology, Rochester, MN, United States of America
| | - Robert E Spinner
- Department of Neurosurgery, Rochester, MN, United States of America
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic Foundation, Rochester, MN, United States of America
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic Foundation, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Rochester, MN, United States of America.
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Skolka M, Shelly S, Pinto MV, Dubey D, Oishi T, Uhm JH, Santilli A, Staff NP, Spinner RJ, Dyck PJB, Robertson CE, Klein CJ. Clinical, Neurophysiologic, and Pathologic Features in Patients With Early-Onset Postradiation Neuropathy. Neurology 2023; 101:e1455-e1460. [PMID: 37400240 PMCID: PMC10573132 DOI: 10.1212/wnl.0000000000207545] [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: 01/29/2023] [Accepted: 05/05/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES The objective of this study was to study early-onset radiation-induced neuropathy reviewing neurologic course, steroid response, and available nerve biopsies. METHODS Patients coded with radiation-induced neuropathy within 6 months of radiation were reviewed from January 1,1999, to August 31, 2022. Patients had to have electrodiagnostically confirmed neuropathy localized within or distal to radiation fields. Neurologic course and nerve biopsies were reviewed. RESULTS Twenty-eight patients (16 male and 12 female patients, mean age 63.8 years) were identified. The average radiation dose was 4,659 cGy (range 1,000-7,208). Tumor infiltration was not observed on MRI and PET. Postradiation onsets averaged 2 months (range 0-5). Localizations included brachial (n = 4) plexopathies, lumbosacral (n = 12) plexopathies, radiculopathies (n = 10), and mononeuropathies (n = 2). Neuropathic pain (n = 25) and weakness (n = 25) were typical. The clinical courses were subacute monophasic (n = 14), chronic progressive (n = 8), or static (n = 1), and 5 were without follow-up. Nerve biopsies (n = 8) showed an inflammatory ischemic process with perivascular inflammatory infiltrates (n = 7) or microvasculitis (n = 2). Nine patients, 7 with monophasic courses, received steroid burst therapy with symptom improvement in 8. No patients recovered entirely back to baseline. DISCUSSION In contrast to chronic radiation-induced neuropathy, early-onset patients most commonly have painful monophasic courses with residual deficits, possibly steroid responsive. An ischemic inflammatory pathogenesis is suggested.
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Affiliation(s)
- Michael Skolka
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Shahar Shelly
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Marcus V Pinto
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Divyanshu Dubey
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Tatsuya Oishi
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Joon H Uhm
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Ashley Santilli
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Nathan P Staff
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Robert J Spinner
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - P James B Dyck
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Carrie Elizabeth Robertson
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- From the Department of Neurology (M.S., M.V.P., D.D., T.O., J.H.U., A.S., N.P.S., P.J.B.D., C.E.R., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Health Care Clinic, Haifa, Israel; Department of Neurosurgery (R.J.S.); and Department of Laboratory Medicine and Pathology (C.J.K.), Mayo Clinic, Rochester, MN.
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10
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Nair MA, Niu Z, Madigan NN, Shin AY, Brault JS, Staff NP, Klein CJ. Clinical trials in Charcot-Marie-Tooth disorders: a retrospective and preclinical assessment. Front Neurol 2023; 14:1251885. [PMID: 37808507 PMCID: PMC10556688 DOI: 10.3389/fneur.2023.1251885] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Objective This study aimed to evaluate the progression of clinical and preclinical trials in Charcot-Marie-Tooth (CMT) disorders. Background CMT has historically been managed symptomatically and with genetic counseling. The evolution of molecular and pathologic understanding holds a therapeutic promise in gene-targeted therapies. Methods ClinicalTrials.gov from December 1999 to June 2022 was data extracted for CMT with preclinical animal gene therapy trials also reviewed by PubMed search. Results The number of active trials was 1 in 1999 and 286 in 2022. Academic settings accounted for 91% and pharmaceutical companies 9%. Of the pharmaceutical and academic trials, 38% and 28%, respectively, were controlled, randomized, and double-blinded. Thirty-two countries participated: the United States accounted for 26% (75/286). In total, 86% of the trials were classified as therapeutic: 50% procedural (21% wrist/elbow surgery; 22% shock wave and hydrodissection therapy), 23% investigational drugs, 15% devices, and 11% physical therapy. Sixty-seven therapeutic trials (49%) were designated phases 1-2 and 51% phases 3-4. The remaining 14% represent non-therapeutic trials: diagnostic testing (3%), functional outcomes (4%), natural history (4%), and standard of care (3%). One-hundred and three (36%) resulted in publications. Phase I human pharmaceutical trials are focusing on the safety of small molecule therapies (n = 8) and AAV and non-viral gene therapy (n = 3). Preclinical animal gene therapy studies include 11 different CMT forms including viral, CRISPR-Cas9, and nanoparticle delivery. Conclusion Current CMT trials are exploring procedural and molecular therapeutic options with substantial participation of the pharmaceutical industry worldwide. Emerging drug therapies directed at molecular pathogenesis are being advanced in human clinical trials; however, the majority remain within animal investigations.
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Affiliation(s)
- Malavika A. Nair
- Department of Graduate Education, Alix School of Medicine, Rochester, MN, United States
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Rochester, MN, United States
- Department of Clinical Genomics, Rochester, MN, United States
| | | | - Alexander Y. Shin
- Division of Hand Surgery, Department of Orthopaedic, Rochester, MN, United States
| | - Jeffrey S. Brault
- Department of Physical Medicine and Rehabilitation Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Christopher J. Klein
- Department of Laboratory Medicine and Pathology, Rochester, MN, United States
- Department of Neurology, Rochester, MN, United States
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11
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Wilkins JM, Gakh O, Guo Y, Popescu B, Staff NP, Lucchinetti CF. Biomolecular alterations detected in multiple sclerosis skin fibroblasts using Fourier transform infrared spectroscopy. Front Cell Neurosci 2023; 17:1223912. [PMID: 37744877 PMCID: PMC10512183 DOI: 10.3389/fncel.2023.1223912] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Multiple sclerosis (MS) is the leading cause of non-traumatic disability in young adults. New avenues are needed to help predict individuals at risk for developing MS and aid in diagnosis, prognosis, and outcome of therapeutic treatments. Previously, we showed that skin fibroblasts derived from patients with MS have altered signatures of cell stress and bioenergetics, which likely reflects changes in their protein, lipid, and biochemical profiles. Here, we used Fourier transform infrared (FTIR) spectroscopy to determine if the biochemical landscape of MS skin fibroblasts were altered when compared to age- and sex-matched controls (CTRL). More so, we sought to determine if FTIR spectroscopic signatures detected in MS skin fibroblasts are disease specific by comparing them to amyotrophic lateral sclerosis (ALS) skin fibroblasts. Spectral profiling of skin fibroblasts from MS individuals suggests significant alterations in lipid and protein organization and homeostasis, which may be affecting metabolic processes, cellular organization, and oxidation status. Sparse partial least squares-discriminant analysis of spectral profiles show that CTRL skin fibroblasts segregate well from diseased cells and that changes in MS and ALS may be unique. Differential changes in the spectral profile of CTRL, MS, and ALS cells support the development of FTIR spectroscopy to detect biomolecular modifications in patient-derived skin fibroblasts, which may eventually help establish novel peripheral biomarkers.
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Affiliation(s)
| | - Oleksandr Gakh
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Bogdan Popescu
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada
- Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathan P. Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Claudia F. Lucchinetti
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
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12
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Staff NP, Hrstka SC, Dasari S, Capobianco E, Rieger S. Skin Extracellular Matrix Breakdown Following Paclitaxel Therapy in Patients with Chemotherapy-Induced Peripheral Neuropathy. Cancers (Basel) 2023; 15:4191. [PMID: 37627219 PMCID: PMC10453667 DOI: 10.3390/cancers15164191] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The chemotherapeutic agent paclitaxel causes peripheral neuropathy, a dose-limiting side effect, in up to 68% of cancer patients. In this study, we investigated the impact of paclitaxel therapy on the skin of breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN), building upon previous findings in zebrafish and rodents. Comprehensive assessments, including neurological examinations and quality of life questionnaires, were conducted, followed by intraepidermal nerve fiber (IENF) density evaluations using skin punch biopsies. Additionally, RNA sequencing, immunostaining for Matrix-Metalloproteinase 13 (MMP-13), and transmission electron microscopy provided insights into molecular and ultrastructural changes in this skin. The results showed no significant difference in IENF density between the control and CIPN patients despite the presence of patient-reported CIPN symptoms. Nevertheless, the RNA sequencing and immunostaining on the skin revealed significantly upregulated MMP-13, which is known to play a key role in CIPN caused by paclitaxel therapy. Additionally, various genes involved in the regulation of the extracellular matrix, microtubules, cell cycle, and nervous system were significantly and differentially expressed. An ultrastructural examination of the skin showed changes in collagen and basement membrane structures. These findings highlight the presence of CIPN in the absence of IENF density changes and support the role of skin remodeling as a major contributor to CIPN.
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Affiliation(s)
- Nathan P. Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (N.P.S.)
| | - Sybil C. Hrstka
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (N.P.S.)
| | - Surendra Dasari
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (N.P.S.)
| | | | - Sandra Rieger
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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13
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Huber RG, Pandey S, Chhangani D, Rincon-Limas DE, Staff NP, Yeo CJJ. Identification of potential pathways and biomarkers linked to progression in ALS. Ann Clin Transl Neurol 2023; 10:150-165. [PMID: 36533811 PMCID: PMC9930436 DOI: 10.1002/acn3.51697] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify potential diagnostic and prognostic biomarkers for clinical management and clinical trials in amyotrophic lateral sclerosis. METHODS We analysed proteomics data of ALS patient-induced pluripotent stem cell-derived motor neurons available through the AnswerALS consortium. After stratifying patients using clinical ALSFRS-R and ALS-CBS scales, we identified differentially expressed proteins indicative of ALS disease severity and progression rate as candidate ALS-related and prognostic biomarkers. Pathway analysis for identified proteins was performed using STITCH. Protein sets were correlated with the effects of drugs using the Connectivity Map tool to identify compounds likely to affect similar pathways. RNAi screening was performed in a Drosophila TDP-43 ALS model to validate pathological relevance. A statistical classification machine learning model was constructed using ridge regression that uses proteomics data to differentiate ALS patients from controls. RESULTS We identified 76, 21, 71 and 1 candidate ALS-related biomarkers and 22, 41, 27 and 64 candidate prognostic biomarkers from patients stratified by ALSFRS-R baseline, ALSFRS-R progression slope, ALS-CBS baseline and ALS-CBS progression slope, respectively. Nineteen proteins enhanced or suppressed pathogenic eye phenotypes in the ALS fly model. Nutraceuticals, dopamine pathway modulators, statins, anti-inflammatories and antimicrobials were predicted starting points for drug repurposing using the connectivity map tool. Ten diagnostic biomarker proteins were predicted by machine learning to identify ALS patients with high accuracy and sensitivity. INTERPRETATION This study showcases the powerful approach of iPSC-motor neuron proteomics combined with machine learning and biological confirmation in the prediction of novel mechanisms and diagnostic and predictive biomarkers in ALS.
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Affiliation(s)
- Roland G Huber
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Matrix #07-01, 30 Biopolis Street, Singapore, 138671, Singapore
| | - Swapnil Pandey
- Department of Neurology, McKnight Brain Institute, and Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, 32611, USA
| | - Deepak Chhangani
- Department of Neurology, McKnight Brain Institute, and Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, 32611, USA
| | - Diego E Rincon-Limas
- Department of Neurology, McKnight Brain Institute, and Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, 32611, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Crystal Jing Jing Yeo
- Agency for Science, Technology and Research (A*STAR), IMCB, 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
- Lee Kong Chian School of Medicine, Imperial College London and NTU Singapore, Singapore, 308232, Singapore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, AB243FX, Scotland, UK
- National Neuroscience Institute, TTSH Campus, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore
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14
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Sista SRS, Shelly S, Oskarsson B, Rubin DI, Martinez-Thompson JM, Parra-Cantu C, Staff NP, Laughlin RS. Clinical and electrophysiological findings in C9ORF72 ALS. Muscle Nerve 2022; 66:270-275. [PMID: 35727129 DOI: 10.1002/mus.27665] [Citation(s) in RCA: 2] [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: 01/30/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS Amyotrophic lateral sclerosis (ALS) is a progressive, fatal, neurodegenerative disorder of motor neurons in which the cause is mostly unknown. Early identification of genetic ALS cases, of which C9ORF72 (C9ALS) is the most frequent, can have important implications for evaluation, prognosis, and therapeutics. Here, we aimed to characterize the clinical and electrophysiological hallmarks of C9ALS and investigate differences from C9ORF72 negative ALS (non-C9ALS). METHODS We retrospectively reviewed clinical and electrodiagnostic (EDX) data for all genetically confirmed C9ALS cases seen between 1/1/2012 and 10/1/2020 who met Gold Coast criteria and compared them 1:1 with non-C9ALS patients within the same time frame. RESULTS A total of 99 C9ALS and 99 non-C9ALS cases were identified. Compared to non-C9ALS, C9ALS demonstrated higher prevalence in women, lesser racial variability, stronger family history of ALS, and higher frequency of upper motor neuron signs. EDX testing of C9ALS showed higher median sensory nerve and lower fibular compound muscle action potential amplitudes. DISCUSSION Although the differences between C9ALS and non-C9ALS reached statistical significance in certain nerve conduction parameters, they were not sufficient to discriminate between groups on a case-by-case basis. Genetic testing is required to identify C9ALS patients.
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Affiliation(s)
| | - Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Sheba Medical Center, Tel HaShomer, Sackler Faculty of Medicine, Tel Aviv University, Middle East, Israel
| | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Kelly CR, Parra-Cantu C, Thapa P, Boynton B, Selim BJ, Sorenson EJ, Martinez-Thompson JM, Mandrekar J, Staff NP. Comparative Performance of Different Respiratory Test Parameters for Detection of Early Respiratory Insufficiency in Patients With ALS. Neurology 2022; 99:e743-e750. [PMID: 35584920 DOI: 10.1212/wnl.0000000000200758] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/06/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the performance of different respiratory function testing in a multidisciplinary ALS clinic. METHODS Demographics, clinical data, and respiratory testing parameters were abstracted from the medical records of patients who attended a multidisciplinary ALS clinic from 2008-2016. We compared the performance of the three primary respiratory test parameters used by Medicare for the initiation of non-invasive ventilation (NIV), (forced vital capacity (FVC) < 50% predicted, maximum inspiratory pressure (MIP) < 60 cm H20, and abnormal overnight pulse oximetry (OvOx)) on how they related to several clinically relevant attributes. RESULTS 476 subjects were identified who underwent at least one respiratory test. Abnormalities of OvOx, MIP, and FVC occurred at a median of 1.6, 1.5, and 3.8 years from disease onset, respectively (p < 0.00001). Subjects with bulbar-onset ALS exhibited earlier abnormalities in MIP and FVC than in spinal-onset ALS (p <0.005). The median survival after an abnormal OvOx, MIP, or FVC test was 1.4, 1.4, and 0.9 years, respectively (p < 0.0001). Utilizing the ALS Functional Rating Score respiratory subscales, at the time of reported respiratory symptoms there were abnormalities in OvOx (60%), MIP (69%), and FVC (19%). Conversely, when respiratory parameter abnormalities preceded reported respiratory symptoms, this occurred with frequencies in OvOx (79%), MIP (42%) or FVC (24%). Four hundred forty-three subjects (93.1%) developed at least one abnormal respiratory measure meeting Medicare criteria for NIV consideration, but fewer than 50% in our cohort demonstrated NIV use. Improved survival in subjects using NIV was statistically significant in patients with bulbar-onset ALS. CONCLUSIONS Abnormalities in OvOx and MIP perform better than FVC at early detection of neuromuscular respiratory weakness in ALS. Initiation of NIV in patients with respiratory insufficiency may improve overall survival in ALS. In the setting of the COVID-19 pandemic, FVC and MIP have not been routinely performed due to infectious aerosol generation. OvOx, which we now routinely mail to patients' homes, has been utilized exclusively during the COVID-19 pandemic, and allows for continued remote monitoring of respiratory status of patients with ALS.
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Affiliation(s)
| | | | - Prabin Thapa
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Bradley Boynton
- Division of Pulmonary Care and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Bernardo J Selim
- Division of Pulmonary Care and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Jaywant Mandrekar
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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16
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Peters J, Staff NP. Update on Toxic Neuropathies. Curr Treat Options Neurol 2022; 24:203-216. [PMID: 36186669 PMCID: PMC9518699 DOI: 10.1007/s11940-022-00716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review Toxic neuropathies are an important preventable and treatable form of peripheral neuropathy. While many forms of toxic neuropathies have been recognized for decades, an updated review is provided to increase vigilant in this area of neurology. A literature review was conducted to gather recent information about toxic neuropathies, which included the causes, clinical findings, and treatment options in these conditions. Recent Findings Toxic neuropathies continue to cause significant morbidity throughout the world and the causative agents, particularly with regards to medications, do not appear to be diminishing. A wide variety of causes of toxic neuropathies exist, which include alcohol, industrial chemicals, biotoxins, and medications. Unfortunately, no breakthrough treatments have been developed and prevention and symptom management remain the standard of care. Summary A detailed medication, occupational and hobby exposure history is critical to identifying toxic neuropathies. Increased research is warranted to identify mechanisms of neurotoxic susceptibility and potential common pathomechanistic pathways for treatment across diverse toxic neuropathies.
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Affiliation(s)
- Jannik Peters
- Department of Neurology, Mayo Clinic Rochester, MN USA
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Schalk G, Worrell S, Mivalt F, Belsten A, Kim I, Morris JM, Hermes D, Klassen BT, Staff NP, Messina S, Kaufmann T, Rickert J, Brunner P, Worrell GA, Miller KJ. Toward a fully implantable ecosystem for adaptive neuromodulation in humans: Preliminary experience with the CorTec BrainInterchange device in a canine model. Front Neurosci 2022; 16:932782. [PMID: 36601593 PMCID: PMC9806357 DOI: 10.3389/fnins.2022.932782] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
This article describes initial work toward an ecosystem for adaptive neuromodulation in humans by documenting the experience of implanting CorTec's BrainInterchange (BIC) device in a beagle canine and using the BCI2000 environment to interact with the BIC device. It begins with laying out the substantial opportunity presented by a useful, easy-to-use, and widely available hardware/software ecosystem in the current landscape of the field of adaptive neuromodulation, and then describes experience with implantation, software integration, and post-surgical validation of recording of brain signals and implant parameters. Initial experience suggests that the hardware capabilities of the BIC device are fully supported by BCI2000, and that the BIC/BCI2000 device can record and process brain signals during free behavior. With further development and validation, the BIC/BCI2000 ecosystem could become an important tool for research into new adaptive neuromodulation protocols in humans.
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Affiliation(s)
- Gerwin Schalk
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, China
- *Correspondence: Gerwin Schalk
| | - Samuel Worrell
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Filip Mivalt
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | - Alexander Belsten
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, United States
- National Center for Adaptive Neurotechnologies, Albany, NY, United States
| | - Inyong Kim
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Bryan T. Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Nathan P. Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Steven Messina
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States
| | - Timothy Kaufmann
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States
| | | | - Peter Brunner
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, United States
- National Center for Adaptive Neurotechnologies, Albany, NY, United States
| | - Gregory A. Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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18
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Forkner KA, Wissman AW, Jimison RC, Nelson KB, Wuertz RE, Silvano CJ, Barreto EF, Eckel Passow JE, Enders FT, Staff NP. Lessons Learned from Clinical and Translational Science Faculty and Student Survey as COVID-19 Pandemic Continues to Shift Education Online. J Med Educ Curric Dev 2022; 9:23821205211073253. [PMID: 35036569 PMCID: PMC8755924 DOI: 10.1177/23821205211073253] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION As the pandemic continues with new variants emerging, faculty and students require support with education's rapid shift to the virtual space. The Mayo Clinic Center for Clinical and Translational Science curriculum team works closely with faculty to support a smooth transition to offering graduate courses in a virtual learning environment. The aim of the present project was to explore faculty and student perceptions of these remote learning strategies to gain an understanding of the innovations required to improve future educational offerings. METHODS All faculty and learners involved in nine Clinical and Translational Science courses in spring 2020 were invited to participate in a web-based questionnaire. Quantitative analysis was performed on closed-ended items, including 5-point Likert-scale questions used to assess the range of views. Qualitative free-text responses were independently analyzed for repetitive themes and summarized. Additionally, comparisons of faculty and course evaluations and student grade point averages (GPAs) from the in-person courses and their subsequent virtual course offerings were considered. RESULTS Survey results indicated several positive impacts with moving courses into the virtual environment, including increased accessibility as well as more student-centered education. Learners joining from sites outside of the originating campus were especially grateful for the virtual classroom because they felt newly integrated within classes. Faculty and course evaluations, as well as student GPAs, remained consistent. CONCLUSION New COVID-19 variants continue to shift education online, and innovative ideas are required to further improve future virtual course offerings. Increased engagement is warranted, both from faculty to incorporate activities designed specifically for a virtual classroom, and from students to increase participation by activating their microphones and webcams. Greater opportunities for global involvement and connectedness arise. Finally, this project advocates for adequate eLearning staffing to support quality online education as the need for pedagogical and technical provision continues.
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Affiliation(s)
| | - Adam W. Wissman
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Ryan C. Jimison
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | | | - Ryan E. Wuertz
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Carmen J. Silvano
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
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19
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Smith C, Crowley A, Munsie M, Behfar A, DeMartino ES, Staff NP, Shapiro SA, Master Z. Academic Physician Specialists' Approaches to Counseling Patients Interested in Unproven Stem Cell and Regenerative Therapies-A Qualitative Analysis. Mayo Clin Proc 2021; 96:3086-3096. [PMID: 34454715 DOI: 10.1016/j.mayocp.2021.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the experiences, approaches, and challenges of physicians consulting patients about experimental stem cell and regenerative medicine interventions (SCRIs). PARTICIPANTS AND METHODS From August 21, 2018, through July 30, 2019, semistructured interviews of 25 specialists in cardiology, ophthalmology, orthopedics, pulmonology, and neurology were conducted and qualitatively analyzed using modified grounded theory. RESULTS All specialists used informational approaches to counsel patients, especially orthopedists. Informational approaches included explaining stem cell science, sharing risks, and providing principles. Several specialists also used relational counseling approaches including emphasizing that physicians want what is best for patients, acknowledging suffering, reassuring continued care, empathizing with patients and families, and underscoring that patients have the final decision. Many specialists reported being comfortable with the conversation, although some were less comfortable and several noted challenges in the consultation including wanting to support a patient's decision but worrying about harms from unproven SCRIs, navigating family pressure, and addressing stem cell hype and unrealistic expectations. Specialists also desired that additional resources be available for them and patients. CONCLUSION Physicians relied more heavily on providing patients with information about SCRIs than using relational counseling approaches. Efforts should be directed at helping physicians address the informational and relational needs of patients, including providing tools and resources that inform physicians about the unproven SCRI industry, building skills in empathic communication, and the creation and dissemination of evidence-based resources to offer patients.
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Affiliation(s)
- Cambray Smith
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Aidan Crowley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Megan Munsie
- School of Biomedical Sciences and Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Regenerative Medicine, Mayo Clinic, Rochester, MN
| | - Erin S DeMartino
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | | | - Shane A Shapiro
- Department of Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic, Jacksonville, FL
| | - Zubin Master
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.
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20
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Johnson SA, Shouman K, Shelly S, Sandroni P, Berini SE, Dyck PJB, Hoffman EM, Mandrekar J, Niu Z, Lamb CJ, Low PA, Singer W, Mauermann ML, Mills J, Dubey D, Staff NP, Klein CJ. Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability. Neurology 2021; 97:e2236-e2247. [PMID: 34706972 DOI: 10.1212/wnl.0000000000012894] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are limited population-based data on small fiber neuropathy (SFN). We wished to determine SFN incidence, prevalence, comorbid conditions, longitudinal impairments, and disabilities. METHODS Test-confirmed patients with SFN in Olmsted, Minnesota, and adjacent counties were compared 3:1 to matched controls (January 1, 1998-December 31, 2017). RESULTS Ninety-four patients with SFN were identified, with an incidence of 1.3/100,000/y that increased over the study period and a prevalence of 13.3 per 100,000. Average follow-up was 6.1 years (0.7-43 years), and mean onset age was 54 years (range 14-83 years). Female sex (67%), obesity (body mass index mean 30.4 vs 28.5 kg/m2), insomnia (86% vs 54%), analgesic-opioid prescriptions (72% vs 46%), hypertriglyceridemia (180 mg/dL mean vs 147 mg/dL), and diabetes (51% vs 22%, p < 0.001) were more common (odds ratio 3.8-9.0, all p < 0.03). Patients with SFN did not self-identify as disabled with a median modified Rankin Scale score of 1.0 (range 0-6) vs 0.0 (0-6) for controls (p = 0.04). Higher Charlson comorbid conditions (median 6, range 3-9) occurred vs controls (median 3, range 1-9, p < 0.001). Myocardial infarctions occurred in 46% vs 27% of controls (p < 0.0001). Classifications included idiopathic (70%); diabetes (15%); Sjögren disease (2%); AL-amyloid (1%); transthyretin-amyloid (1%); Fabry disease (1%); lupus (1%); postviral (1%); Lewy body (1%), and multifactorial (5%). Foot ulcers occurred in 17, with 71% having diabetes. Large fiber neuropathy developed in 36%, on average 5.3 years (range 0.2-14.3 years) from SFN onset. Median onset Composite Autonomic Severity Score (CASS) was 3 (change per year 0.08, range 0-2.0). Median Neuropathy Impairment Scale (NIS) score was 2 at onset (range 0-8, change per year 1.0, range -7.9 to +23.3). NIS score and CASS change >1 point per year occurred in only AL-amyloid, hereditary transthyretin-amyloid, Fabry, uncontrolled diabetes, and Lewy body. Death after symptom onset was higher in patients with SFN (19%) vs controls (12%, p < 0.001), 50% secondary to diabetes complications. DISCUSSION Isolated SFN is uncommon but increasing in incidence. Most patients do not develop major neurologic impairments and disability but have multiple comorbid conditions, including cardiovascular ischemic events, and increased mortality from SFN onsets. Development of large fiber involvements and diabetes are common over time. Targeted testing facilitates interventional therapies for diabetes but also rheumatologic and rare genetic forms.
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21
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Miller KJ, Hermes D, Staff NP. The current state of electrocorticography-based brain-computer interfaces. Neurosurg Focus 2021; 49:E2. [PMID: 32610290 DOI: 10.3171/2020.4.focus20185] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
Brain-computer interfaces (BCIs) provide a way for the brain to interface directly with a computer. Many different brain signals can be used to control a device, varying in ease of recording, reliability, stability, temporal and spatial resolution, and noise. Electrocorticography (ECoG) electrodes provide a highly reliable signal from the human brain surface, and these signals have been used to decode movements, vision, and speech. ECoG-based BCIs are being developed to provide increased options for treatment and assistive devices for patients who have functional limitations. Decoding ECoG signals in real time provides direct feedback to the patient and can be used to control a cursor on a computer or an exoskeleton. In this review, the authors describe the current state of ECoG-based BCIs that are approaching clinical viability for restoring lost communication and motor function in patients with amyotrophic lateral sclerosis or tetraplegia. These studies provide a proof of principle and the possibility that ECoG-based BCI technology may also be useful in the future for assisting in the cortical rehabilitation of patients who have suffered a stroke.
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Affiliation(s)
- Kai J Miller
- Departments of1Neurosurgery.,2Physiology & Biomedical Engineering, and
| | - Dora Hermes
- 2Physiology & Biomedical Engineering, and.,3Neurology, Mayo Clinic, Rochester, Minnesota
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22
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Prudencio M, Garcia-Moreno H, Jansen-West KR, Al-Shaikh RH, Gendron TF, Heckman MG, Spiegel MR, Carlomagno Y, Daughrity LM, Song Y, Dunmore JA, Byron N, Oskarsson B, Nicholson KA, Staff NP, Gorcenco S, Puschmann A, Lemos J, Januário C, LeDoux MS, Friedman JH, Polke J, Labrum R, Shakkottai V, McLoughlin HS, Paulson HL, Konno T, Onodera O, Ikeuchi T, Tada M, Kakita A, Fryer JD, Karremo C, Gomes I, Caviness JN, Pittelkow MR, Aasly J, Pfeiffer RF, Veerappan V, Eggenberger ER, Freeman WD, Huang JF, Uitti RJ, Wierenga KJ, Marin Collazo IV, Tipton PW, van Gerpen JA, van Blitterswijk M, Bu G, Wszolek ZK, Giunti P, Petrucelli L. Toward allele-specific targeting therapy and pharmacodynamic marker for spinocerebellar ataxia type 3. Sci Transl Med 2021; 12:12/566/eabb7086. [PMID: 33087504 DOI: 10.1126/scitranslmed.abb7086] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Spinocerebellar ataxia type 3 (SCA3), caused by a CAG repeat expansion in the ataxin-3 gene (ATXN3), is characterized by neuronal polyglutamine (polyQ) ATXN3 protein aggregates. Although there is no cure for SCA3, gene-silencing approaches to reduce toxic polyQ ATXN3 showed promise in preclinical models. However, a major limitation in translating putative treatments for this rare disease to the clinic is the lack of pharmacodynamic markers for use in clinical trials. Here, we developed an immunoassay that readily detects polyQ ATXN3 proteins in human biological fluids and discriminates patients with SCA3 from healthy controls and individuals with other ataxias. We show that polyQ ATXN3 serves as a marker of target engagement in human fibroblasts, which may bode well for its use in clinical trials. Last, we identified a single-nucleotide polymorphism that strongly associates with the expanded allele, thus providing an exciting drug target to abrogate detrimental events initiated by mutant ATXN3. Gene-silencing strategies for several repeat diseases are well under way, and our results are expected to improve clinical trial preparedness for SCA3 therapies.
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Affiliation(s)
- Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | | | | | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew R Spiegel
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yari Carlomagno
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | | | - Yuping Song
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Judith A Dunmore
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Natalie Byron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Katharine A Nicholson
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital (MGH), Boston, MA 02114, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sorina Gorcenco
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund 22185, Sweden
| | - Andreas Puschmann
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund 22185, Sweden
| | - João Lemos
- Coimbra University Hospital Centre, Coimbra University, Coimbra 3000-075, Portugal
| | - Cristina Januário
- Coimbra University Hospital Centre, Coimbra University, Coimbra 3000-075, Portugal
| | - Mark S LeDoux
- University of Memphis and Veracity Neuroscience LLC, Memphis, TN 38152, USA
| | - Joseph H Friedman
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - James Polke
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | - Robin Labrum
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | - Vikram Shakkottai
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Takuya Konno
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Mari Tada
- Department of Pathology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - John D Fryer
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA.,Department of Neuroscience, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Christin Karremo
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund 22185, Sweden
| | - Inês Gomes
- Coimbra University Hospital Centre, Coimbra University, Coimbra 3000-075, Portugal
| | - John N Caviness
- Department of Neurology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Jan Aasly
- Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Ronald F Pfeiffer
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Venka Veerappan
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | | | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Klaas J Wierenga
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Philip W Tipton
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Marka van Blitterswijk
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | | | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK. .,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA. .,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
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23
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Krull AA, Setter DO, Gendron TF, Hrstka SCL, Polzin MJ, Hart J, Dudakovic A, Madigan NN, Dietz AB, Windebank AJ, van Wijnen AJ, Staff NP. Alterations of mesenchymal stromal cells in cerebrospinal fluid: insights from transcriptomics and an ALS clinical trial. Stem Cell Res Ther 2021; 12:187. [PMID: 33736701 PMCID: PMC7977179 DOI: 10.1186/s13287-021-02241-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/21/2020] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Mesenchymal stromal cells (MSCs) have been studied with increasing intensity as clinicians and researchers strive to understand the ability of MSCs to modulate disease progression and promote tissue regeneration. As MSCs are used for diverse applications, it is important to appreciate how specific physiological environments may stimulate changes that alter the phenotype of the cells. One need for neuroregenerative applications is to characterize the spectrum of MSC responses to the cerebrospinal fluid (CSF) environment after their injection into the intrathecal space. Mechanistic understanding of cellular biology in response to the CSF environment may predict the ability of MSCs to promote injury repair or provide neuroprotection in neurodegenerative diseases. Methods In this study, we characterized changes in morphology, metabolism, and gene expression occurring in human adipose-derived MSCs cultured in human (hCSF) or artificial CSF (aCSF) as well as examined relevant protein levels in the CSF of subjects treated with MSCs for amyotrophic lateral sclerosis (ALS). Results Our results demonstrated that, under intrathecal-like conditions, MSCs retained their morphology, though they became quiescent. Large-scale transcriptomic analysis of MSCs revealed a distinct gene expression profile for cells cultured in aCSF. The aCSF culture environment induced expression of genes related to angiogenesis and immunomodulation. In addition, MSCs in aCSF expressed genes encoding nutritional growth factors to expression levels at or above those of control cells. Furthermore, we observed a dose-dependent increase in growth factors and immunomodulatory cytokines in CSF from subjects with ALS treated intrathecally with autologous MSCs. Conclusions Overall, our results suggest that MSCs injected into the intrathecal space in ongoing clinical trials remain viable and may provide a therapeutic benefit to patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02241-9.
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Affiliation(s)
- Ashley A Krull
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Deborah O Setter
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Sybil C L Hrstka
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Michael J Polzin
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Joseph Hart
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nicolas N Madigan
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Anthony J Windebank
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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24
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Smith C, Crowley A, Munsie M, DeMartino ES, Staff NP, Shapiro S, Master Z. Academic physician specialists' views toward the unproven stem cell intervention industry: areas of common ground and divergence. Cytotherapy 2021; 23:348-356. [PMID: 33563545 DOI: 10.1016/j.jcyt.2020.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Premature commercialization of unproven stem cell interventions (SCIs) has received significant attention within the regenerative medicine community. Patients considering SCIs may encounter misinformation and seek out guidance from their physicians who are trusted brokers of health information. However, little is known about the perspectives of academic physician specialists toward the SCI industry. The purpose of this study was to capture the attitudes of physician specialists with experience addressing patient questions about unproven SCIs. METHODS The authors undertook 25 semi-structured interviews with academic physicians in cardiology, ophthalmology, orthopedics, pulmonology and neurology primarily from one academic center. RESULTS The authors identified two major themes: concerns and mediators of appropriateness of offering SCIs as therapies to patients. Specialists were generally aware of the industry and reported scientific and commercial concerns, including the scientific uncertainty of SCIs, medical harms to patients, misleading marketing and its impact on patient informed consent and economic harms due to large out-of-pocket costs for patients. All specialists outside of orthopedics voiced that it was inappropriate to be offering SCIs to patients today. These views were informed by previously expressed concerns surrounding safety and properly informing patients, levels of evidence needed prior to offering SCIs therapeutically and desired qualifications for clinicians. Among the specialties, orthopedists reported that under certain conditions, SCIs may be appropriate for patients with limited clinical options but only when safety is adequate, expectations are managed and patients are well informed about the risks and chances of benefit. Most participants expressed a desire for phase 3 studies and Food and Drug Administration approval prior to marketing SCIs, but some also shared the challenges associated with upholding these thresholds of evidence, especially when caring for out-of-option patients. CONCLUSIONS The authors' results suggest that medical specialists are aware of the industry and express several concerns surrounding SCIs but differ in their views on the appropriateness and clinical evidence necessary for offering SCIs currently to patients. Additional educational tools may help physicians with patient engagement and expectation management surrounding SCIs.
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Affiliation(s)
- Cambray Smith
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aidan Crowley
- Department of Biological Sciences, College of Science, University of Notre Dame, Notre Dame, Indiana, USA
| | - Megan Munsie
- Department of Anatomy and Neuroscience, Centre for Stem Cell Systems, University of Melbourne, Parkville, Australia
| | - Erin S DeMartino
- Division of Pulmonary and Critical Care Medicine and Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shane Shapiro
- Department of Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
| | - Zubin Master
- Biomedical Ethics Research Program and Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Hrstka SCL, Ankam S, Agac B, Klein JP, Moore RA, Narapureddy B, Schneider I, Hrstka RF, Dasari S, Staff NP. Proteomic analysis of human iPSC-derived sensory neurons implicates cell stress and microtubule dynamics dysfunction in bortezomib-induced peripheral neurotoxicity. Exp Neurol 2021; 335:113520. [PMID: 33129842 PMCID: PMC7750199 DOI: 10.1016/j.expneurol.2020.113520] [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] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/26/2022]
Abstract
The neurotoxic effects of the chemotherapeutic agent bortezomib on dorsal root ganglia sensory neurons are well documented, yet the mechanistic underpinnings that govern these cellular processes remain incompletely understood. In this study, system-wide proteomic changes were identified in human induced pluripotent stem cell-derived sensory neurons (iSNs) exposed to a clinically relevant dose of bortezomib. Label-free mass spectrometry facilitated the identification of approximately 2800 iSN proteins that exhibited differential levels in the setting of bortezomib. A significant proportion of these proteins affect the cellular processes of microtubule dynamics, cytoskeletal and cytoplasmic organization, and molecular transport, and pathway analysis revealed an enrichment of proteins in signaling pathways attributable to the unfolded protein response and the integrated stress response. Alterations in microtubule-associated proteins suggest a multifaceted relationship exists between bortezomib-induced proteotoxicity and microtubule cytoskeletal architecture, and MAP2 was prioritized as a topmost influential candidate. We observed a significant reduction in the overall levels of MAP2c in somata without discernable changes in neurites. As MAP2 is known to affect cellular processes including axonogenesis, neurite extension and branching, and neurite morphology, its altered levels are suggestive of a prominent role in bortezomib-induced neurotoxicity.
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Affiliation(s)
- Sybil C L Hrstka
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Soneela Ankam
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Busranur Agac
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Jon P Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Raymond A Moore
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Bhavya Narapureddy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Isabella Schneider
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Ronald F Hrstka
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America.
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Affiliation(s)
- Ajay A Madhavan
- From the Departments of Radiology (A.A.M., C.M.C.), Hematology and Oncology (H.A.), and Neurology (N.P.S., E.N.), Mayo Clinic, Rochester, MN
| | - Carrie M Carr
- From the Departments of Radiology (A.A.M., C.M.C.), Hematology and Oncology (H.A.), and Neurology (N.P.S., E.N.), Mayo Clinic, Rochester, MN
| | - Hassan Alkhateeb
- From the Departments of Radiology (A.A.M., C.M.C.), Hematology and Oncology (H.A.), and Neurology (N.P.S., E.N.), Mayo Clinic, Rochester, MN
| | - Nathan P Staff
- From the Departments of Radiology (A.A.M., C.M.C.), Hematology and Oncology (H.A.), and Neurology (N.P.S., E.N.), Mayo Clinic, Rochester, MN
| | - Elie Naddaf
- From the Departments of Radiology (A.A.M., C.M.C.), Hematology and Oncology (H.A.), and Neurology (N.P.S., E.N.), Mayo Clinic, Rochester, MN.
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Abstract
PURPOSE OF REVIEW Vitamin and mineral deficiencies, neurotoxins, and, particularly, prescription medications, are some of the most common causes of peripheral neuropathy. Recognition and prompt treatment of these neuropathies require a high index of suspicion and an accompanied detailed history. This article provides a comprehensive approach and list of items that must be considered in the setting of new-onset neuropathy. RECENT FINDINGS Although many of the neuropathies described in this article have decreased in prevalence in developed countries because of public health interventions and occupational/environmental regulations, new causes for this class of neuropathy continue to be uncovered. SUMMARY The peripheral nervous system is susceptible to a broad array of metabolic and toxic abnormalities, which most often lead to a length-dependent sensory-predominant axonal peripheral neuropathy. A careful history accompanied by recognition of multisystem clues can increase recognition of these neuropathies, which is important as many have specific treatments that may either improve the neuropathy or halt its progression.
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Paganoni S, De Marchi F, Chan J, Thrower SK, Staff NP, Datta N, Kisanuki YY, Drory V, Fournier C, Pioro EP, Goutman SA, Atassi N, Jeon M, Caldwell S, Mcdonough T, Gentile C, Liu J, Turner M, Denny C, Felice K, Green M, Scarberry S, Abu-Saleh S, Nefussy B, Hastings D, Kim S, Swihart B, Arcila-Londono X, Newman DS, Silverman M, Genge A, Salmon K, Elman L, Mccluskey L, Almasy K, Gotkine M, Goslin K, Cummings A, Edwards EK, Rivner M, Bouchard K, Quarles B, Kwan J, Jaffa M, Baloh R, Allred P, Walk D, Maiser S, Manousakis G, Ferment V, Fernandes JAM, Thaisetthawatkul P, Heimes D, Phillips M, Sams L, Kahler M, Corcoran A, Larriviere DG, Chotto S, Juba G. The NEALS primary lateral sclerosis registry. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:74-81. [PMID: 32915077 DOI: 10.1080/21678421.2020.1804591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Primary lateral sclerosis (PLS) is a neurodegenerative disease characterized by progressive upper motor neuron dysfunction. Because PLS patients represent only 1 to 4% of patients with adult motor neuron diseases, there is limited information about the disease's natural history. The objective of this study was to establish a large multicenter retrospective longitudinal registry of PLS patients seen at Northeast ALS Consortium (NEALS) sites to better characterize the natural progression of PLS. Methods: Clinical characteristics, electrophysiological findings, laboratory values, disease-related symptoms, and medications for symptom management were collected from PLS patients seen between 2000 and 2015. Results: The NEALS registry included data from 250 PLS patients. Median follow-up time was 3 years. The mean rate of functional decline measured by ALSFRS-R total score was -1.6 points/year (SE:0.24, n = 124); the mean annual decline in vital capacity was -3%/year (SE:0.55, n = 126). During the observational period, 18 patients died, 17 patients had a feeding tube placed and 7 required permanent assistive ventilation. Conclusions: The NEALS PLS Registry represents the largest available aggregation of longitudinal clinical data from PLS patients and provides a description of expected natural disease progression. Data from the registry will be available to the PLS community and can be leveraged to plan future clinical trials in this rare disease.
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Affiliation(s)
- Sabrina Paganoni
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Fabiola De Marchi
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - James Chan
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Sara K Thrower
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | - Neil Datta
- Hospital for Special Care, New Britain, CT/University of Connecticut School of Medicine, Farmington, CT, USA
| | - Yaz Y Kisanuki
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivian Drory
- Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | | | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nazem Atassi
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | - Maryangel Jeon
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Caldwell
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Timothy Mcdonough
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Gentile
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Jianing Liu
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kevin Felice
- Hospital for Special Care, New Britain, CT/University of Connecticut School of Medicine, Farmington, CT, USA
| | - Misty Green
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Scarberry
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Debbie Hastings
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sangri Kim
- Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Blake Swihart
- Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Angela Genge
- Montreal Neurological Institute & Hospital, Montreal, Canada
| | | | - Lauren Elman
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Leo Mccluskey
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Kelly Almasy
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Marc Gotkine
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | - Michael Rivner
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Kristy Bouchard
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Brandy Quarles
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Justin Kwan
- University of Maryland Medical Center, College Park, MD, USA
| | - Matthew Jaffa
- University of Maryland Medical Center, College Park, MD, USA
| | - Robert Baloh
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peggy Allred
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Walk
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Samuel Maiser
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Valerie Ferment
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - J Americo M Fernandes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Deborah Heimes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Laura Sams
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Kahler
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Alecia Corcoran
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Gracy Juba
- Ochsner Health System, New Orleans, LA, USA
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Affiliation(s)
- Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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30
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Oishi T, Kogelschatz CJ, Young NP, Hoffmann EM, Staff NP, Visscher SL, Borah BJ, Krauss WE, Arumaithurai K, Shelly S, Ansell SM, Klein CJ. Expanded neuromuscular morbidity in Hodgkin lymphoma after radiotherapy. Brain Commun 2020; 2:fcaa050. [PMID: 32954302 PMCID: PMC7425393 DOI: 10.1093/braincomms/fcaa050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/30/2022] Open
Abstract
Our study aims to quantitate neuromuscular morbidity from radiotherapy in Hodgkin lymphoma including: (i) frequency and (ii) time of onsets for neurological localizations; (iii) degree of disabilities and (iv) number of clinical visits compared to cardiopulmonary Hodgkin lymphoma-radiation complications. Medical records from Mayo Health systems were retrieved; identifying neuromuscular radiation treated Hodgkin lymphoma-complications from 1 January 1994 to 31 December 2016. Of an estimated 4100 post-radiotherapy Hodgkin lymphoma patients, 4.6% (189) were identified with complications. Mean latency to physician visit for symptoms was 23.7 years (range: 1-50). Most commonly identified complications included: head drop 10% (19) with or without myopathy, myopathy 39% (73), plexopathy 29% (54), myelopathy 27% (51) and polyradiculopathy 13% (24). Other findings included benign and malignant nerve sheath tumours 5% (9), phrenic and long thoracic mononeuropathies 7% (14) and compressive spinal meningioma 2% (4). Patients frequently had multiple coexisting complications (single = 76% [144], double = 17% [33], triple = 4% [8], quadruple = 2% [4]). Cardiac 28% (53) and pulmonary 15% (29) complications were also seen in these patients. History of Hodgkin lymphoma was initially overlooked by neurologists (14.3%, 48/336 clinical notes). Hospital and outpatient visits for complications were frequent: neuromuscular 19% (77/411) versus cardiopulmonary 30% (125/411). Testing was largely exclusionary, except when imaging identified secondary malignancy. Modified Rankin score at diagnosis varied: 0-1 (55.8%), 2-3 (5.8%) and 4-5 (38.3%). Neuromuscular complications among post-radiation Hodgkin lymphoma are diverse, occurring in ∼1 of 20 having markedly delayed onsets often eluding diagnosis. Frequent care visits and major morbidity are common. Survivorship recommendations should recognize the diverse neurological complications.
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Affiliation(s)
- Tatsuya Oishi
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Cory J Kogelschatz
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Intermountain Neurosciences Institute, Murray, UT 84107, USA
| | - Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sue L Visscher
- Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bijan J Borah
- Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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31
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Staff NP, Cavaletti G, Islam B, Lustberg M, Psimaras D, Tamburin S. Platinum-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2020; 24 Suppl 2:S26-S39. [PMID: 31647151 DOI: 10.1111/jns.12335] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
Platinum-induced peripheral neurotoxicity (PIPN) is a common side effect of platinum-based chemotherapy that may cause dose reduction and discontinuation, with oxaliplatin being more neurotoxic. PIPN includes acute neurotoxicity restricted to oxaliplatin, and chronic non-length-dependent sensory neuronopathy with positive and negative sensory symptoms and neuropathic pain in both upper and lower limbs. Chronic sensory axonal neuropathy manifesting as stocking-and-glove distribution is also frequent. Worsening of neuropathic symptoms after completing the last chemotherapy course may occur. Motor and autonomic involvement is uncommon. Ototoxicity is frequent in children and more commonly to cisplatin. Platinum-based compounds result in more prolonged neuropathic symptoms in comparison to other chemotherapy agents. Patient reported outcomes questionnaires, clinical evaluation and instrumental tools offer complementary information in PIPN. Electrodiagnostic features include diffusely reduced/abolished sensory action potentials, in keeping with a sensory neuronopathy. PIPN is dependent on cumulative dose but there is a large variability in its occurrence. The search for additional risk factors for PIPN has thus far yielded no consistent findings. There are currently no neuroprotective strategies to reduce the risk of PIPN, and symptomatic treatment is limited to duloxetine that was found effective in a single phase III intervention study. This review critically examines the pathogenesis, incidence, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of PIPN.
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Affiliation(s)
- Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Badrul Islam
- Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Dimitri Psimaras
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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32
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Lehmann HC, Staff NP, Hoke A. Modeling chemotherapy induced peripheral neuropathy (CIPN) in vitro: Prospects and limitations. Exp Neurol 2020; 326:113140. [DOI: 10.1016/j.expneurol.2019.113140] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
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Staff NP, Fehrenbacher JC, Caillaud M, Damaj MI, Segal RA, Rieger S. Pathogenesis of paclitaxel-induced peripheral neuropathy: A current review of in vitro and in vivo findings using rodent and human model systems. Exp Neurol 2020; 324:113121. [PMID: 31758983 PMCID: PMC6993945 DOI: 10.1016/j.expneurol.2019.113121] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [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: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022]
Abstract
Paclitaxel (Brand name Taxol) is widely used in the treatment of common cancers like breast, ovarian and lung cancer. Although highly effective in blocking tumor progression, paclitaxel also causes peripheral neuropathy as a side effect in 60-70% of chemotherapy patients. Recent efforts by numerous labs have aimed at defining the underlying mechanisms of paclitaxel-induced peripheral neuropathy (PIPN). In vitro models using rodent dorsal root ganglion neurons, human induced pluripotent stem cells, and rodent in vivo models have revealed a number of molecular pathways affected by paclitaxel within axons of sensory neurons and within other cell types, such as the immune system and peripheral glia, as well skin. These studies revealed that paclitaxel induces altered calcium signaling, neuropeptide and growth factor release, mitochondrial damage and reactive oxygen species formation, and can activate ion channels that mediate responses to extracellular cues. Recent studies also suggest a role for the matrix-metalloproteinase 13 (MMP-13) in mediating neuropathy. These diverse changes may be secondary to paclitaxel-induced microtubule transport impairment. Human genetic studies, although still limited, also highlight the involvement of cytoskeletal changes in PIPN. Newly identified molecular targets resulting from these studies could provide the basis for the development of therapies with which to either prevent or reverse paclitaxel-induced peripheral neuropathy in chemotherapy patients.
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Affiliation(s)
- Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jill C Fehrenbacher
- Department of Pharmacology and Toxicology, University School of Medicine, Indianapolis, IN 46202, USA
| | - Martial Caillaud
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, USA
| | - M Imad Damaj
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, USA
| | - Rosalind A Segal
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Sandra Rieger
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA.
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Abstract
Postsurgical neuropathies represent an infrequent but potentially devastating complication of surgery that may result in significant morbidity with medicolegal implications. Elucidation of this phenomenon has evolved over the past few decades, with emerging evidence for not only iatrogenic factors contributing to this process but also inflammatory causes. This distinction can be important; for instance, cases in which inflammatory etiologies are suspected may benefit from further investigations including nerve biopsy and may benefit from treatment in the form of immunotherapy. In contrast, postsurgical neuropathies due to perioperative causes including anesthesia, traction, compression, and transection will not benefit in the same manner. This article summarizes early and current literature surrounding the frequency of new neurologic deficits after various surgical types, potential causes including anatomical and inflammatory considerations, and roles for treatment. To capture the scope of the issue, a literature review was conducted for human studies in English via MEDLINE and EMBASE from January 1, 1988 to March 31, 2018. Search terms included anesthesia and/or surgical procedures, operative, peripheral nervous system diseases, trauma, mononeuropathy, polyneuropathy, peripheral nervous system, nerve compression, neuropathy, plexopathy, postoperative, postsurgical, perioperative, complication. We excluded case series with less than 10 patients and review papers. We then narrowed the studies to those presented highlighting key concepts in postsurgical neuropathy.
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Goyal NA, Berry JD, Windebank A, Staff NP, Maragakis NJ, van den Berg LH, Genge A, Miller R, Baloh RH, Kern R, Gothelf Y, Lebovits C, Cudkowicz M. Addressing heterogeneity in amyotrophic lateral sclerosis CLINICAL TRIALS. Muscle Nerve 2020; 62:156-166. [PMID: 31899540 PMCID: PMC7496557 DOI: 10.1002/mus.26801] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 08/19/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a debilitating neurodegenerative disorder with complex biology and significant clinical heterogeneity. Many preclinical and early phase ALS clinical trials have yielded promising results that could not be replicated in larger phase 3 confirmatory trials. One reason for the lack of reproducibility may be ALS biological and clinical heterogeneity. Therefore, in this review, we explore sources of ALS heterogeneity that may reduce statistical power to evaluate efficacy in ALS trials. We also review efforts to manage clinical heterogeneity, including use of validated disease outcome measures, predictive biomarkers of disease progression, and individual clinical risk stratification. We propose that personalized prognostic models with use of predictive biomarkers may identify patients with ALS for whom a specific therapeutic strategy may be expected to be more successful. Finally, the rapid application of emerging clinical and biomarker strategies may reduce heterogeneity, increase trial efficiency, and, in turn, accelerate ALS drug development.
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Affiliation(s)
| | - James D Berry
- Healey Center at Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Angela Genge
- Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Robert Miller
- California Pacific Medical Center, San Francisco, California
| | - Robert H Baloh
- Robert H. Baloh, Cedars-Sinai Medical Center, California, Los Angeles
| | - Ralph Kern
- Brainstorm Cell Therapeutics, New York, New York
| | - Yael Gothelf
- Brainstorm Cell Therapeutics, New York, New York
| | | | - Merit Cudkowicz
- Healey Center at Massachusetts General Hospital, Boston, Massachusetts
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36
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Berry JD, Cudkowicz ME, Windebank AJ, Staff NP, Owegi M, Nicholson K, McKenna-Yasek D, Levy YS, Abramov N, Kaspi H, Mehra M, Aricha R, Gothelf Y, Brown RH. NurOwn, phase 2, randomized, clinical trial in patients with ALS: Safety, clinical, and biomarker results. Neurology 2019; 93:e2294-e2305. [PMID: 31740545 PMCID: PMC6937497 DOI: 10.1212/wnl.0000000000008620] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
Objective To determine the safety and efficacy of mesenchymal stem cell (MSC)-neurotrophic factor (NTF) cells (NurOwn®, autologous bone marrow-derived MSCs, induced to secrete NTFs) delivered by combined intrathecal and intramuscular administration to participants with amyotrophic lateral sclerosis (ALS) in a phase 2 randomized controlled trial. Methods The study enrolled 48 participants randomized 3:1 (treatment: placebo). After a 3-month pretransplant period, participants received 1 dose of MSC-NTF cells (n = 36) or placebo (n = 12) and were followed for 6 months. CSF was collected before and 2 weeks after transplantation. Results The study met its primary safety endpoint. The rate of disease progression (Revised ALS Functional Rating Scale [ALSFRS-R] slope change) in the overall study population was similar in treated and placebo participants. In a prespecified rapid progressor subgroup (n = 21), rate of disease progression was improved at early time points (p < 0.05). To address heterogeneity, a responder analysis showed that a higher proportion of treated participants experienced ≥1.5 points/month ALSFRS-R slope improvement compared to placebo at all time points, and was significant in rapid progressors at 4 and 12 weeks (p = 0.004 and 0.046, respectively). CSF neurotrophic factors increased and CSF inflammatory biomarkers decreased in treated participants (p < 0.05) post-transplantation. CSF monocyte chemoattractant protein-1 levels correlated with ALSFRS-R slope improvement up to 24 weeks (p < 0.05). Conclusion A single-dose transplantation of MSC-NTF cells is safe and demonstrated early promising signs of efficacy. This establishes a clear path forward for a multidose randomized clinical trial of intrathecal autologous MSC-NTF cell transplantation in ALS. Classification of evidence This phase II study provides Class I evidence.
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Affiliation(s)
- James D Berry
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Merit E Cudkowicz
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Anthony J Windebank
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Nathan P Staff
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Margaret Owegi
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Katherine Nicholson
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Diane McKenna-Yasek
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Yossef S Levy
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Natalie Abramov
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Haggai Kaspi
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Munish Mehra
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Revital Aricha
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Yael Gothelf
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ
| | - Robert H Brown
- From Massachusetts General Hospital Neurological Clinical Research Institute and Harvard Medical School (J.D.B., M.E.C., K.N.), Boston; Mayo Clinic (A.J.W., N.P.S.), Rochester, MN; University of Massachusetts (M.O., D.M.-Y., R.H.B.), Worcester; Brainstorm Cell Therapeutics (Y.S.L., N.A., H.K., R.A., Y.G.), Petach Tikva, Israel; and Tigermed USA (M.M.), Somerset, NJ.
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Islam B, Lustberg M, Staff NP, Kolb N, Alberti P, Argyriou AA. Vinca alkaloids, thalidomide and eribulin-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2019; 24 Suppl 2:S63-S73. [PMID: 31647152 DOI: 10.1111/jns.12334] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023]
Abstract
Vinca alkaloids, thalidomide, and eribulin are widely used to treat patients with childhood acute lymphoblastic leukemia (ALL), adults affected by multiple myeloma and locally invasive or metastatic breast cancer, respectively. However, soon after their introduction into clinical practice, chemotherapy-induced peripheral neurotoxicity (CIPN) emerged as their main non-hematological and among dose-limiting adverse events. It is generally perceived that vinca alkaloids and the antiangiogenic agent thalidomide are more neurotoxic, compared to eribulin. The exposure to these chemotherapeutic agents is associated with an axonal, length-dependent, sensory polyneuropathy of mild to moderate severity, whereas it is considered that the peripheral nerve damage, unless severe, usually resolves soon after treatment discontinuation. Advanced age, high initial and prolonged dosing, coadministration of other neurotoxic chemotherapeutic agents and pre-existing neuropathy are the common risk factors. Pharmacogenetic biomarkers might be used to define patients at increased susceptibility of CIPN. Currently, there is no established therapy for CIPN prevention or treatment; symptomatic treatment for neuropathic pain and dose reduction or withdrawal in severe cases is considered, at the cost of reduced cancer therapeutic efficacy. This review critically examines the pathogenesis, epidemiology, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of CIPN as a result of exposure to vinca alkaloids, thalidomide and its analogue lenalidomide as also eribulin.
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Affiliation(s)
- Badrul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer, Columbus, Ohio
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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Cavaletti G, Alberti P, Argyriou AA, Lustberg M, Staff NP, Tamburin S. Chemotherapy-induced peripheral neurotoxicity: A multifaceted, still unsolved issue. J Peripher Nerv Syst 2019; 24 Suppl 2:S6-S12. [PMID: 31647155 DOI: 10.1111/jns.12337] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 05/17/2019] [Accepted: 07/15/2019] [Indexed: 12/30/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a potentially dose-limiting side effect of several commonly used cytotoxic chemotherapy agents. The main pharmacological classes that may cause CIPN include classical anticancer drugs, as well as the recently introduced immune checkpoint inhibitors and antibody drug conjugates. The absence of a complete knowledge of CIPN pathophysiology is only one of the several unsolved issues related to CIPN. Among some of the most relevant aspects of CIPN deserving further attention include the real number of patients exposed to the risk of CIPN, the long-term impact on cancer survivors' quality of life due to incomplete recovery from CIPN, the economic burden related to acute and chronic CIPN, and the different perspective and education of the healthcare specialists in charge of managing patients with CIPN. Overall, CIPN remains a very challenging area of research as there are still several unresolved issues to be addressed in the future. In this special issue, the multifaceted profile of CIPN will be presented, with particular emphasis on bolstering the need to develop more optimized outcome measures than the existing ones to accurately evaluate the extent of CIPN, but also to ascertain the differences in the incidence, risk factors, clinical phenotype, and management of CIPN, according to the most commonly used neurotoxic chemotherapy classes. Perspectives for future research to pursue in order to cover the gaps in knowledge in the CIPN field will also be discussed.
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Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Medical Center, Columbus, Ohio
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Mohassel P, Liewluck T, Hu Y, Ezzo D, Ogata T, Saade D, Neuhaus S, Bolduc V, Zou Y, Donkervoort S, Medne L, Sumner CJ, Dyck PJB, Wierenga KJ, Tennekoon G, Finkel RS, Chen J, Winder TL, Staff NP, Foley AR, Koch M, Bönnemann CG. Dominant collagen XII mutations cause a distal myopathy. Ann Clin Transl Neurol 2019; 6:1980-1988. [PMID: 31509352 PMCID: PMC6801183 DOI: 10.1002/acn3.50882] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 01/20/2023] Open
Abstract
Objective To characterize the natural history and clinical features of myopathies caused by mono‐allelic, dominantly acting pathogenic variants in COL12A1. Methods Patients with dominant COL12A1‐related myopathies were characterized by history and clinical examination, muscle imaging, and genetic analysis. Pathogenicity of the variants was assessed by immunostaining patient‐derived dermal fibroblast cultures for collagen XII. Results Four independent families with childhood‐onset weakness due to novel, dominantly acting pathogenic variants in COL12A1 were identified. Adult patients exhibited distal‐predominant weakness. Three families carried dominantly acting glycine missense variants, and one family had a heterozygous, intragenic, in‐frame deletion of exon 52 of COL12A1. All pathogenic variants resulted in increased intracellular retention of collagen XII in patient‐derived fibroblasts as well as loss of extracellular, fibrillar collagen XII deposition. Since haploinsufficiency for COL12A1 is largely clinically asymptomatic, we designed and evaluated small interfering RNAs (siRNAs) that specifically target the mutant allele containing the exon 52 deletion. Immunostaining of the patient fibroblasts treated with the siRNA showed a near complete correction of collagen XII staining patterns. Interpretation This study characterizes a distal myopathy phenotype in adults with dominant COL12A1 pathogenic variants, further defining the phenotypic spectrum and natural history of COL12A1‐related myopathies. This work also provides proof of concept of a precision medicine treatment approach by proposing and validating allele‐specific knockdown using siRNAs specifically designed to target a patient’s dominant COL12A1 disease allele.
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Affiliation(s)
- Payam Mohassel
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | | | - Ying Hu
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | - Daniel Ezzo
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | - Tracy Ogata
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | - Dimah Saade
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | - Sarah Neuhaus
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | | | - Yaqun Zou
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | | | - Livija Medne
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charlotte J Sumner
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Klaas J Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, Florida
| | - Gihan Tennekoon
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Richard S Finkel
- Department of Pediatrics, Nemours Children' Health System, Orlando, Florida
| | - Jiani Chen
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - A Reghan Foley
- National Institutes of Health, NINDS, NNDCS, Bethesda, Maryland
| | - Manuel Koch
- Institute for Dental Research and Oral Musculoskeletal Biology, Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
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Ankam S, Rovini A, Baheti S, Hrstka R, Wu Y, Schmidt K, Wang H, Madigan N, Koenig LS, Stelzig K, Resch Z, Klein CJ, Sun Z, Staff NP. DNA methylation patterns in human iPSC-derived sensory neuronal differentiation. Epigenetics 2019; 14:927-937. [PMID: 31148524 PMCID: PMC6691994 DOI: 10.1080/15592294.2019.1625672] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 12/18/2022] Open
Abstract
Sensory neurons of the peripheral nervous system are critical in health and disease. Sensory neurons derived from induced pluripotent stem (iPS) cells are now being used increasingly for in vitro models of neuropathy, pain, and neurotoxicity. DNA methylation is critical for neurodevelopment and has been implicated in many neuronal diseases, but has not been examined in iPS-derived sensory neurons. In order to better characterize the iPS-derived sensory neuron model, we have undertaken a genome-wide DNA methylation study on the cells from human iPS to iPS-derived sensory neurons during differentiation through reduced representation and bisulfite sequencing. We report decreasing DNA methylation with iPS-derived sensory neuronal differentiation that is reflected in increasing numbers and proportions of hypomethylated individual CpGs and regions, as well as lowered DNMT3b expression. Furthermore, genes with changes in DNA methylation near their TSS suggest key pathways that may be involved in iPS-derived sensory neuronal differentiation. These findings provide insights into sensory neuronal differentiation and can be used for further in vitro modelling of disease states.
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Affiliation(s)
- Soneela Ankam
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Saurabh Baheti
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ron Hrstka
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yanhong Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kiley Schmidt
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Hailong Wang
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Kimberly Stelzig
- Center for Regenerative Medicine Biotrust, Mayo Clinic, Rochester, MN, USA
| | - Zachary Resch
- Center for Regenerative Medicine Biotrust, Mayo Clinic, Rochester, MN, USA
| | | | - Zhifu Sun
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Chan A, Hertz DL, Morales M, Adams EJ, Gordon S, Tan CJ, Staff NP, Kamath J, Oh J, Shinde S, Pon D, Dixit N, D'Olimpio J, Dumitrescu C, Gobbo M, Kober K, Mayo S, Pang L, Subbiah I, Beutler AS, Peters KB, Loprinzi C, Lustberg MB. Biological predictors of chemotherapy-induced peripheral neuropathy (CIPN): MASCC neurological complications working group overview. Support Care Cancer 2019; 27:3729-3737. [PMID: 31363906 DOI: 10.1007/s00520-019-04987-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating condition associated with a number of chemotherapeutic agents. Drugs commonly implicated in the development of CIPN include platinum agents, taxanes, vinca alkaloids, bortezomib, and thalidomide analogues. As a drug response can vary between individuals, it is hypothesized that an individual's specific genetic variants could impact the regulation of genes involved in drug pharmacokinetics, ion channel functioning, neurotoxicity, and DNA repair, which in turn affect CIPN development and severity. Variations of other molecular markers may also affect the incidence and severity of CIPN. Hence, the objective of this review was to summarize the known biological (molecular and genomic) predictors of CIPN and discuss the means to facilitate progress in this field.
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Affiliation(s)
- Alexandre Chan
- National University of Singapore, Singapore, Singapore
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Manuel Morales
- University Hospital Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Elizabeth J Adams
- The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - Sharon Gordon
- University of Connecticut, Storrs, USA
- East Carolina University, Greenville, USA
| | - Chia Jie Tan
- National University of Singapore, Singapore, Singapore
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Jayesh Kamath
- University of Connecticut Health Center, Storrs, USA
| | - Jeong Oh
- MD Anderson Cancer Center, Houston, USA
| | - Shivani Shinde
- University of Colorado, Colorado, USA
- VA Eastern Colorado Health Care Systems, Aurora, MS, USA
| | - Doreen Pon
- Western University of Health Sciences, Pomona, USA
| | - Niharkia Dixit
- University of California San Francisco, San Francisco, USA
- Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - James D'Olimpio
- Northwell Cancer Institute, New Hyde Park, USA
- Zucker School of Medicine at Hofstra, 500 Hofstra Blvd, Hempstead, USA
| | | | | | - Kord Kober
- University of California San Francisco, San Francisco, USA
- Helen Diller Comprehensive Cancer Centre, San Francisco, USA
| | | | | | | | | | | | | | - Maryam B Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, USA.
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Abstract
Mesenchymal stromal cells are multipotent cells that are being used to treat a variety of medical conditions. Over the past decade, there has been considerable excitement about using MSCs to treat neurodegenerative diseases, which are diseases that are typically fatal and without other robust therapies. In this review, we discuss the proposed MSC mechanisms of action in neurodegenerative diseases, which include growth factor secretion, exosome secretion, and attenuation of neuroinflammation. We then provide a summary of preclinical and early clinical work on MSC therapies in amyotrophic lateral sclerosis, multiple system atrophy, Parkinson disease, and Alzheimer disease. Continued rigorous and controlled studies of MSC therapies will be critical in order to establish efficacy and protect patients from possible untoward effects.
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Speelziek SJA, Staff NP, Johnson RL, Sierra RJ, Laughlin RS. Clinical spectrum of neuropathy after primary total knee arthroplasty: A series of 54 cases. Muscle Nerve 2019; 59:679-682. [PMID: 30897216 DOI: 10.1002/mus.26473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Neuropathy after total knee arthroplasty (TKA) can cause significant morbidity but is inconsistently reported. METHODS We reviewed the clinical, electrodiagnostic and perioperative features of all patients who underwent primary TKA at our institution and developed a new neuropathy within 8 weeks postoperatively. RESULTS Fifty-four cases were identified (incidence 0.37% [95% confidence interval, 0.28-0.49]) affecting the following nerve(s): peroneal (37), sciatic (11), ulnar (2), tibial (2), sural (1), and lumbosacral plexus (1). In all cases with follow-up data, motor recovery typically occurred within 1 year and was complete or near-complete. CONCLUSIONS Post-TKA neuropathy is uncommon, typically does not require intervention and usually resolves within 1 year. Post-TKA neuropathy most often affects the nerves surgically at risk. Anesthesia type does not correlate with post-TKA neuropathy. An inflammatory etiology for post-TKA neuropathy is rare but should be considered in specific cases. Muscle Nerve 59:679-682, 2019.
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Affiliation(s)
- Scott J A Speelziek
- Department of Neurology, Mayo Clinic, E8A. 200 1st Street SW, Rochester, Minnesota, 55905, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, E8A. 200 1st Street SW, Rochester, Minnesota, 55905, USA
| | - Rebecca L Johnson
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruple S Laughlin
- Department of Neurology, Mayo Clinic, E8A. 200 1st Street SW, Rochester, Minnesota, 55905, USA
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Greenberg-Worisek AJ, Campbell KA, Klee EW, Staff NP, Schimmenti LA, Weavers KM, Ekker SC, Windebank AJ. Case-Based Learning in Translational Biomedical Research Education: Providing Realistic and Adaptive Skills for Early-Career Scientists. Acad Med 2019; 94:213-216. [PMID: 30256254 PMCID: PMC6351155 DOI: 10.1097/acm.0000000000002470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PROBLEM Case-based learning is an established means of educating students in law, business, and medicine; however, this methodology is not often applied to educating translational biomedical researchers. The application of case-based learning to translational biomedical research education allows scholars to actively engage with real-world material and apply their newfound knowledge as it is acquired. APPROACH Through the Mayo Clinic Center for Clinical and Translational Science (CCaTS), three courses were delivered in 2009-2017 which emphasized case-based learning in clinical and translational science, entrepreneurship, and individualized medicine. Quantitative measures collected in student course reviews upon course completion were analyzed. Additionally, products arising from each course were identified, including publications and startups pitched. OUTCOMES Analyses demonstrate that case-based learning techniques are well suited to graduate biomedical research education. Furthermore, case studies can be employed throughout the entire clinical and translational spectrum, from basic and preclinical work through to clinical and population-based learning. NEXT STEPS Within CCaTS, next steps include creating case-based courses in regulatory and team science to continue to allow scholars to learn and apply these critical skills to real-world material. The goal is to continue to provide immersive training opportunities in areas of clinical and translational science that cannot be readily learned in a traditional lecture-based class setting.
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Affiliation(s)
- Alexandra J Greenberg-Worisek
- A.J. Greenberg-Worisek is assistant professor of epidemiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. K.A. Campbell is assistant professor of molecular pharmacology and experimental therapeutics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. E.W. Klee is assistant professor of biomedical informatics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. N.P. Staff is associate professor of neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. L.A. Schimmenti is professor of pediatrics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. K.M. Weavers is manager of research operations, Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota. S.C. Ekker is professor of biochemistry and molecular biology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. A.J. Windebank is professor of neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting motor neurons and other neuronal cells, leading to severe disability and eventually death from ventilatory failure. It has a prevalence of 5 in 100,000, with an incidence of 1.7 per 100,000, reflecting short average survival. The pathogenesis is incompletely understood, but defects of RNA processing and protein clearance may be fundamental. Repeat expansions in the chromosome 9 open reading frame 72 gene (C9orf72) are the most common known genetic cause of ALS and are seen in approximately 40% of patients with a family history and approximately 10% of those without. No environmental risk factors are proved to be causative, but many have been proposed, including military service. The diagnosis of ALS rests on a history of painless progressive weakness coupled with examination findings of upper and lower motor dysfunction. No diagnostic test is yet available, but electromyography and genetic tests can support the diagnosis. Care for patients is best provided by a multidisciplinary team, and most interventions are directed at managing symptoms. Two medications with modest benefits have Food and Drug Administration approval for the treatment of ALS: riluzole, a glutamate receptor antagonist, and, new in 2017, edaravone, a free radical scavenger. Many other encouraging treatment strategies are being explored in clinical trials for ALS; herein we review stem cell and antisense oligonucleotide gene therapies.
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Shah A, Hoffman EM, Mauermann ML, Loprinzi CL, Windebank AJ, Klein CJ, Staff NP. Incidence and disease burden of chemotherapy-induced peripheral neuropathy in a population-based cohort. J Neurol Neurosurg Psychiatry 2018; 89:636-641. [PMID: 29439162 PMCID: PMC5970026 DOI: 10.1136/jnnp-2017-317215] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess disease burden of chemotherapy-induced peripheral neuropathy (CIPN), which is a common dose-limiting side effect of neurotoxic chemotherapy. Late effects of CIPN may increase with improved cancer survival. METHODS Olmsted County, Minnesota residents receiving neurotoxic chemotherapy were identified and CIPN was ascertained via text searches of polyneuropathy symptoms in the medical record. Clinical records were queried to collect data on baseline characteristics, risk factors, signs and symptoms of CIPN, medications, impairments and International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes for all subjects. RESULTS A total of 509 individuals with incident exposure to an inclusive list of neurotoxic chemotherapy agents between 2006 and 2008 were identified. 268 (52.7%) of these individuals were determined to have CIPN. The median time from incident exposure to first documented symptoms was 71 days. Patients with CIPN received a neuropathy ICD-9 diagnosis in only 37 instances (13.8%). Pain symptoms and use of pain medications were observed more often in patients with CIPN. Five-year survival was greater in those with CIPN (55.2%) versus those without (36.1%). Those with CIPN surviving greater than 5 years (n=145) continued to have substantial impairments and were more likely to be prescribed opioids than those without CIPN (OR 2.0, 1.06-3.69). CONCLUSIONS Results from our population-based study are consistent with previous reports of high incidence of CIPN in the first 2 years following incident exposure to neurotoxic chemotherapeutic agents, and its association with significant pain symptomatology and accompanied long-term opioid use. Increased survival following exposure to neurotoxic chemotherapy and its long-term disease burden necessitates further study among survivors.
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Affiliation(s)
- Arya Shah
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Davies JL, Engelstad JK, E Gove L, Linbo LK, Carter RE, Lynch C, Staff NP, Klein CJ, Dyck PJB, Herrmann DN, Dyck PJ. Somatotopic heat pain thresholds and intraepidermal nerve fibers in health. Muscle Nerve 2018; 58:509-516. [PMID: 29543981 DOI: 10.1002/mus.26128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION For sequential and somatotopic assessment of small fiber neuropathy, heat pain (HP) tests of hypoalgesia might be used instead of decreased counts of epidermal nerve fibers (ENFs), but then healthy subject reference values of HP thresholds are needed. METHODS Using the Computer Assisted Sensation Evaluator IVc system, HP thresholds of hypoalgesia were estimated for 10 unilateral sites and counts of ENFs for 4 of them in healthy subjects. RESULTS In healthy subjects, small but statistically significant differences of both HP thresholds of hypoalgesia and counts of ENFs were observed among tested sites. Significant correlations between HP thresholds and counts of ENFs were not found. DISCUSSION For the studied somatotopic sites, we provide ≥95th and ≥99th percentile reference limits for HP 0.5 and 5 of 1-10 HP thresholds of hypoalgesia and decreased counts of ENFs at ≤5th and ≤1st percentile levels. Muscle Nerve 58: 509-516, 2018.
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Affiliation(s)
- Jenny L Davies
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | - Janean K Engelstad
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | - Linde E Gove
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | - Linda K Linbo
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | - Rickey E Carter
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
| | | | - Peter J Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, USA, 55905
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Kao JC, Liao B, Markovic SN, Klein CJ, Naddaf E, Staff NP, Liewluck T, Hammack JE, Sandroni P, Finnes H, Mauermann ML. Neurological Complications Associated With Anti-Programmed Death 1 (PD-1) Antibodies. JAMA Neurol 2017; 74:1216-1222. [PMID: 28873125 DOI: 10.1001/jamaneurol.2017.1912] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Neurological complications are an increasingly recognized consequence of the use of anti-programmed death 1 (PD-1) antibodies in the treatment of solid-organ tumors, with an estimated frequency of 4.2%. To date, the clinical spectrum and optimum treatment approach are not established. Objective To investigate the frequency, clinical spectrum, and optimum treatment approach to neurological complications associated with anti-PD-1 therapy. Design, Setting, and Participants This single-center, retrospective cohort study was conducted from either September or December 2014 (the approval dates of the study drugs by the US Food and Drug Administration) to May 19, 2016. All patients receiving anti-PD-1 monoclonal antibodies were identified using the Mayo Cancer Pharmacy Database. Patients with development of neurological symptoms within 12 months of anti-PD-1 therapy were included. Patients with neurological complications directly attributable to metastatic disease or other concurrent cancer-related treatments were excluded. Main Outcomes and Measures Clinical and pathological characteristics, time to development of neurological symptoms, and modified Rankin Scale (mRS) score. Results Among 347 patients treated with anti-PD1 monoclonal antibodies (pembrolizumab or nivolumab), 10 (2.9%) developed subacute onset of neurological complications. Seven patients were receiving pembrolizumab, and 3 patients were receiving nivolumab. The patients included 8 men and 2 women. Their median age was 71 years (age range, 31-78 years). Neurological complications occurred after a median of 5.5 (range, 1-20) cycles of anti-PD-1 inhibitors. Complications included myopathy (n = 2), varied neuropathies (n = 4), cerebellar ataxia (n = 1), autoimmune retinopathy (n = 1), bilateral internuclear ophthalmoplegia (n = 1), and headache (n = 1). Peripheral neuropathies included axonal and demyelinating polyradiculoneuropathies (n = 2), length-dependent neuropathies (n = 1), and asymmetric vasculitic neuropathy (n = 1). The time to maximum symptom severity varied from 1 day to more than 3 months. The median mRS score was 2.5 (range, 1-5), indicating mild to moderate disability. Five patients experienced other systemic immune-mediated complications, including hypothyroidism (n = 3), colitis (n = 2), and hepatitis (n = 1). Treatment with anti-PD-1 antibodies was discontinued in 7 patients. Treatment included corticosteroids (n = 7), intravenous immunoglobulin (n = 3), and plasma exchange (n = 1). Nine patients improved, with a median mRS score of 2 (range, 0-6). One patient with severe necrotizing myopathy died. Conclusions and Relevance Neurological adverse events associated with anti-PD-1 therapy have a diverse phenotype, with more frequent neuromuscular complications. Although rare, they will likely be encountered with increasing frequency as anti-PD-1 therapy expands to other cancers. The time of onset is unpredictable, and evolution may be rapid and life-threatening. Prompt recognition and discontinuation of anti-PD-1 therapy is recommended. In some cases, immune rescue treatment may be required.
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Affiliation(s)
- Justin C Kao
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Bing Liao
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Heidi Finnes
- Pharmacy Services, Mayo Clinic, Rochester, Minnesota
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Affiliation(s)
| | - Nathan P Staff
- From the Department of Neurology, Mayo Clinic, Rochester, MN
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