1
|
Bernardini G, Braconi D, Zatkova A, Sireau N, Kujawa MJ, Introne WJ, Spiga O, Geminiani M, Gallagher JA, Ranganath LR, Santucci A. Alkaptonuria. Nat Rev Dis Primers 2024; 10:16. [PMID: 38453957 DOI: 10.1038/s41572-024-00498-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
Alkaptonuria is a rare inborn error of metabolism caused by the deficiency of homogentisate 1,2-dioxygenase activity. The consequent homogentisic acid (HGA) accumulation in body fluids and tissues leads to a multisystemic and highly debilitating disease whose main features are dark urine, ochronosis (HGA-derived pigment in collagen-rich connective tissues), and a painful and severe form of osteoarthropathy. Other clinical manifestations are extremely variable and include kidney and prostate stones, aortic stenosis, bone fractures, and tendon, ligament and/or muscle ruptures. As an autosomal recessive disorder, alkaptonuria affects men and women equally. Debilitating symptoms appear around the third decade of life, but a proper and timely diagnosis is often delayed due to their non-specific nature and a lack of knowledge among physicians. In later stages, patients' quality of life might be seriously compromised and further complicated by comorbidities. Thus, appropriate management of alkaptonuria requires a multidisciplinary approach, and periodic clinical evaluation is advised to monitor disease progression, complications and/or comorbidities, and to enable prompt intervention. Treatment options are patient-tailored and include a combination of medications, physical therapy and surgery. Current basic and clinical research focuses on improving patient management and developing innovative therapies and implementing precision medicine strategies.
Collapse
Affiliation(s)
- Giulia Bernardini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.
| | - Daniela Braconi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Andrea Zatkova
- Institute of Clinical and Translational Research, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
- Geneton Ltd, Bratislava, Slovakia
| | | | - Mariusz J Kujawa
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Wendy J Introne
- Human Biochemical Genetics Section, Medical Genetics Branch, Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ottavia Spiga
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Michela Geminiani
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - James A Gallagher
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences University of Liverpool, Liverpool, UK
| | - Lakshminarayan R Ranganath
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences University of Liverpool, Liverpool, UK
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| |
Collapse
|
2
|
Bottoms L, Prat Pons M, Fineberg NA, Pellegrini L, Fox O, Wellsted D, Drummond LM, Reid J, Baldwin DS, Hou R, Chamberlain S, Sireau N, Grohmann D, Laws KR. Effects of exercise on obsessive-compulsive disorder symptoms: a systematic review and meta-analysis. Int J Psychiatry Clin Pract 2023; 27:232-242. [PMID: 36541901 DOI: 10.1080/13651501.2022.2151474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis assessed the efficacy of exercise in reducing OCD symptoms. METHODS We searched PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus and grey literature until March 2022. The study was preregistered at Prospero (CRD42021283931). We included randomised controlled and pre-post trials assessing physical activity as an intervention for OCD. Risk of bias was assessed using the Cochrane ROBINS-I tool and the RoB2 tool. RESULTS The analysis included 6 trials (N = 92); 2 were RCTS and 4 were pre-post design studies. A random-effects meta-analysis of pre-post data identified a large reduction of OCD symptoms following exercise (g = 1.33 [95%CI 1.06-1.61]; k = 6). Exercise was also associated with significant pre-post reductions in anxiety (g = 0.71 [95%CI 0.37-1.05; k = 4) and depression (g = 0.57 [95%CI 0.26-0.89]; k = 2). Risk of bias was moderate-high in uncontrolled trials on the ROBINS-I and RCTs showed 'some concerns' on the RoB2. CONCLUSION Exercise was associated with a large pre-post reduction of OCD symptoms; however, few trials were of robust quality and all were at risk of bias. Further well-powered and better quality RCTs are required to assess the role of exercise as an intervention for OCD.KEY POINTSStudies exploring exercise as an adjunct therapy for OCD have small participant numbers, therefore a systematic review and meta-analysis is needed to estimate potential efficacy.Pre-post analysis shows that exercise was associated with a large reduction of OCD symptomsThe current systematic review and meta-analysis points to the potential for exercise to be beneficial for the treatment for OCD symptoms. However, more well-powered and better controlled RCTs are required to fully assess the benefit of exercise for the treatment of OCD symptoms.
Collapse
Affiliation(s)
- Lindsay Bottoms
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Montserrat Prat Pons
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Oliver Fox
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lynne M Drummond
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- South West London and St George's NHS Trust and School of Life and Medical Science, London, UK
| | - Jemma Reid
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Cornwall Partnership NHS Foundation Trust, Cornwall, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Samuel Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Dominique Grohmann
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
3
|
Ooi N, Cooper IR, Norman B, Gallagher JA, Sireau N, Bou-Gharios G, Ranganath LR, Savage VJ. Evaluation of Homogentisic Acid, a Prospective Antibacterial Agent Highlighted by the Suitability of Nitisinone in Alkaptonuria 2 (SONIA 2) Clinical Trial. Cells 2023; 12:1683. [PMID: 37443717 PMCID: PMC10341174 DOI: 10.3390/cells12131683] [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: 05/02/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Despite urgent warnings about the spread of multidrug-resistant bacteria, the antibiotic development pipeline has remained sparsely populated. Naturally occurring antibacterial compounds may provide novel chemical starting points for antibiotic development programs and should be actively sought out. Evaluation of homogentisic acid (HGA), an intermediate in the tyrosine degradation pathway, showed that the compound had innate activity against Gram-positive and Gram-negative bacteria, which was lost following conversion into the degradation product benzoquinone acetic acid (BQA). Anti-staphylococcal activity of HGA can be attributed to effects on bacterial membranes. Despite an absence of haemolytic activity, the compound was cytotoxic to human HepG2 cells. We conclude that the antibacterial activity and in vitro safety profile of HGA render it more suitable for use as a topical agent or for inclusion in a small-molecule medicinal chemistry program.
Collapse
Affiliation(s)
- Nicola Ooi
- Infex Therapeutics, Alderley Park, Macclesfield SK10 4TG, UK
| | - Ian R. Cooper
- Infex Therapeutics, Alderley Park, Macclesfield SK10 4TG, UK
| | - Brendan Norman
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool L7 8TX, UK
| | - James A. Gallagher
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool L7 8TX, UK
| | | | - George Bou-Gharios
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool L7 8TX, UK
| | - Lakshminarayan R. Ranganath
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool L7 8TX, UK
- Departments of Clinical Biochemistry and Metabolic Medicine, Liverpool University Hospitals NHS Foundation Trusts, Liverpool L7 8XP, UK
| | | |
Collapse
|
4
|
Khedr M, Sireau N, Bou‐Gharios G, Gallagher JA, Ranganath LR. First decade anniversary of the United Kingdom National Alkaptonuria Centre. JIMD Rep 2023; 64:212-213. [PMID: 36873083 PMCID: PMC9981412 DOI: 10.1002/jmd2.12340] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Milad Khedr
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool University Hospitals NHS Foundation TrustsLiverpoolUK
| | | | | | | | - Lakshminarayan R. Ranganath
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool University Hospitals NHS Foundation TrustsLiverpoolUK
| |
Collapse
|
5
|
Ranganath LR, Sireau N. Clinical development innovation in rare diseases: overcoming barriers to successful delivery of a randomised clinical trial in alkaptonuria-a mini-review. Orphanet J Rare Dis 2023; 18:1. [PMID: 36600285 PMCID: PMC9811731 DOI: 10.1186/s13023-022-02606-0] [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: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023] Open
Abstract
Alkaptonuria is a rare inherited disorder for which there was no disease-modifying treatment. In order to develop a successful approved therapy of AKU multiple barriers had to be overcome. These included activities before the conduct of the study including deciding on the drug therapy, the dose of the drug to be used, clarify the nature of the disease, develop outcome measures likely to yield a positive outcome, have a strategy to ensure appropriate patient participation through identification, build a consortium of investigators, obtain regulatory approval for proposed investigation plan and secure funding. Significant barriers were overcome during the conduct of the multicentre study to ensure harmonisation. Mechanisms were put in place to recruit and retain patients in the study. Barriers to patient access following completion of the study and regulatory approval were resolved.
Collapse
Affiliation(s)
- L. R. Ranganath
- grid.415970.e0000 0004 0417 2395Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP UK ,grid.10025.360000 0004 1936 8470Department of Musculoskeletal Biology, University of Liverpool, Liverpool, L7 8TX UK
| | - Nick Sireau
- The Alkaptonuria Society, 66 Devonshire Road, Cambridge, CB1 2BL, UK.
| |
Collapse
|
6
|
Cinosi E, Adam D, Aslan I, Baldwin D, Chillingsworth K, Enara A, Gale T, Garg K, Garner M, Gordon R, Hall N, Huneke NTM, Kucukterzi-Ali S, McCarthy J, Meron D, Monji-Patel D, Mooney R, Robbins T, Smith M, Sireau N, Wellsted D, Wyatt S, Fineberg NA. Feasibility and acceptability of transcranial stimulation in obsessive-compulsive symptoms (FEATSOCS): study protocol for a randomised controlled trial of transcranial direct current stimulation (tDCS) in obsessive-compulsive disorder (OCD). Pilot Feasibility Stud 2021; 7:213. [PMID: 34872621 PMCID: PMC8646008 DOI: 10.1186/s40814-021-00945-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). Methods The aim of this feasibility study is to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment effect. To this end, we will deliver a double-blind, sham-controlled, crossover randomised multicentre study in 25 adults with OCD. Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprises four 20-min stimulations, delivered over two consecutive days, separated by at least 4 weeks’ washout period. We will collect information about recruitment, study conduct and tDCS delivery. Blinded raters will assess clinical outcomes before, during and up to 4 weeks after stimulation using validated scales. We will include relevant objective neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning. Discussion We will analyse the magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure, to estimate effect size and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Additionally, qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, as well as the impact on their overall quality of life. These clinical outcomes will enable the project team to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the treatment in a full-scale trial. Trial registration ISRCTN17937049. (date applied 08/07/2019). Recruitment (ongoing) began 23rd July 2019 and is anticipated to complete 30th April 2021.
Collapse
Affiliation(s)
- Eduardo Cinosi
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK. .,University of Hertfordshire, Hertfordshire, UK.
| | - David Adam
- ORCHARD-Advancing Global OCD Research Charity, Cambridge, UK
| | - Ibrahim Aslan
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - David Baldwin
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Kieran Chillingsworth
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Arun Enara
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
| | - Tim Gale
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK.,University of Hertfordshire, Hertfordshire, UK
| | - Kabir Garg
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
| | - Matthew Garner
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Robert Gordon
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Nathan T M Huneke
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK.,Southern Health NHS Foundation Trust, Southampton, UK
| | - Sonay Kucukterzi-Ali
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK.,University of Hertfordshire, Hertfordshire, UK
| | | | - Daniel Meron
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK.,Somerset NHS Foundation Trust, Taunton, UK
| | - Deela Monji-Patel
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK.,University of Hertfordshire, Hertfordshire, UK
| | | | - Trevor Robbins
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Megan Smith
- University of Hertfordshire, Hertfordshire, UK
| | - Nick Sireau
- ORCHARD-Advancing Global OCD Research Charity, Cambridge, UK
| | | | | | - Naomi A Fineberg
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK.,University of Hertfordshire, Hertfordshire, UK.,Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
7
|
Fineberg NA, Pellegrini L, Wellsted D, Hall N, Corazza O, Giorgetti V, Cicconcelli D, Theofanous E, Sireau N, Adam D, Chamberlain SR, Laws KR. Facing the "new normal": How adjusting to the easing of COVID-19 lockdown restrictions exposes mental health inequalities. J Psychiatr Res 2021; 141:276-286. [PMID: 34271458 PMCID: PMC7611491 DOI: 10.1016/j.jpsychires.2021.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Re-establishing societal norms in the wake of the COVID-19 pandemic will be important for restoring public mental health and psychosocial wellbeing as well as economic recovery. We investigated the impact on post-pandemic adjustment of a history of mental disorder, with particular reference to obsessive-compulsive (OC) symptoms or traits. METHODS The study was pre-registered (Open Science Framework; https://osf.io/gs8j2/). Adult members of the public (n = 514) were surveyed between July and November 2020, to identify the extent to which they reported difficulties re-adjusting as lockdown conditions eased. All were assessed using validated scales to determine which demographic and mental health-related factors impacted adjustment. An exploratory analysis of a subgroup on an objective online test of cognitive inflexibility was also performed. RESULTS Adjustment was related to a history of mental disorder and the presence of OC symptoms and traits, all acting indirectly and statistically-mediated via depression, anxiety and stress; and in the case of OC symptoms, also via COVID-related anxiety (all p < 0.001). One hundred and twenty-eight (25%) participants reported significant adjustment difficulties and were compared with those self-identifying as "good adjusters" (n = 231). This comparison revealed over-representation of those with a history or family history of mental disorder in the poor adjustment category (all p < 0.05). 'Poor-adjusters' additionally reported higher COVID-related anxiety, depression, anxiety and stress and OC symptoms and traits (all p < 0.05). Furthermore, history of mental disorder directly statistically mediated adjustment status (p < 0.01), whereas OC symptoms (not OC traits) acted indirectly via COVID-related anxiety (p < 0.001). Poor-adjusters also showed evidence of greater cognitive inflexibility on the intra-extra-dimensional set-shift task. CONCLUSION Individuals with a history of mental disorder, OC symptoms and OC traits experienced greater difficulties adjusting after lockdown-release, largely statistically mediated by increased depression, anxiety, including COVID-related anxiety, and stress. The implications for clinical and public health policies and interventions are discussed.
Collapse
Affiliation(s)
- Naomi A. Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom,University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Valentina Giorgetti
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Dorotea Cicconcelli
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Elena Theofanous
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Nick Sireau
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - David Adam
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Samuel R. Chamberlain
- University of Southampton, Department of Psychiatry, Faculty of Medicine, Southampton, United Kingdom,Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Keith R. Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| |
Collapse
|
8
|
Fineberg N, Van Ameringen M, Drummond L, Hollander E, Stein D, Geller D, Walitza S, Pallanti S, Pellegrini L, Zohar J, Rodriguez C, Menchon J, Morgado P, Mpavaenda D, Fontenelle L, Feusner J, Grassi G, Lochner C, Veltman D, Sireau N, Carmi L, Adam D, Nicolini H, Dell'Osso B. How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology. Compr Psychiatry 2020; 100:152174. [PMID: 32388123 PMCID: PMC7152877 DOI: 10.1016/j.comppsych.2020.152174] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- N.A. Fineberg
- University of Hertfordshire, Hatfield, UK,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UK,University of Cambridge School of Clinical Medicine, Cambridge, UK,Corresponding author at: University of Hertfordshire, Hatfield, UK.
| | - M. Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - L. Drummond
- SW London and St George's NHS Trust and St George's, University of London, UK
| | - E. Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - D.J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - D. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - S. Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland,Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - S. Pallanti
- Istituto di Neuroscienze, University of Florence, Italy,Albert Einstein College of Medicine, New York, USA
| | - L. Pellegrini
- University of Hertfordshire, Hatfield, UK,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UK,Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - J. Zohar
- The Post Trauma Center, Chaim Sheba Medical Center, Israel,Tel Aviv University, Israel
| | - C.I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - J.M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - P. Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS-3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal,Clinical Academic Center – Braga, Hospital de Braga, Braga, Portugal
| | - D. Mpavaenda
- University of Hertfordshire, Hatfield, UK,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UK
| | - L.F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia,D'Or Institute for Research and Education and Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J.D. Feusner
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - G. Grassi
- Brain Center Firenze, Florence, Italy
| | - C. Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, South Africa
| | - D.J. Veltman
- Department of Psychiatry, Amsterdam UMC location VUMC, Amsterdam, the Netherlands
| | - N. Sireau
- Orchard, 66 Devonshire Road, Cambridge CB1 2BL, UK
| | - L. Carmi
- The Post Trauma Center, Chaim Sheba Medical Center, Israel
| | | | - H. Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico,Clinical Research, Carracci Medical Group, Mexico City, Mexico
| | - B. Dell'Osso
- University of Milan, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy,“Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| |
Collapse
|
9
|
Davison AS, Hughes AT, Milan AM, Sireau N, Gallagher JA, Ranganath LR. Alkaptonuria – Many questions answered, further challenges beckon. Ann Clin Biochem 2019; 57:106-120. [DOI: 10.1177/0004563219879957] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Alkaptonuria is an iconic rare inherited inborn error of metabolism affecting the tyrosine metabolic pathway, resulting in the accumulation of homogentisic acid in the circulation, and significant excretion in urine. Dating as far back as 1500 BC in the Egyptian mummy Harwa, homogentisic acid was shown to be central to the pathophysiology of alkaptonuria through its deposition in collagenous tissues in a process termed ochronosis. Clinical manifestations occurring as a consequence of this are typically observed from the third decade of life, are lifelong and significantly affect the quality of life. In large supportive and palliative treatment measures are available to patients, including analgesia, physiotherapy and joint replacement. Studying the natural history of alkaptonuria, in a murine model and human subjects, has provided key insights into the biochemical and molecular mechanisms underlying the pathophysiology associated with the disease, and has enabled a better understanding of the common disease osteoarthritis. In the last decade, a major focus has been on an unlicensed disease-modifying therapy called nitisinone. This has been shown to be highly efficacious in reducing homogentisic acid, and it is hoped this will halt ochronosis, thus limiting the clinical complications associated with the disease. A well-documented metabolic consequence of nitisinone therapy is hypertyrosinaemia, the clinical implications of which are uncertain. Recent metabolomic studies have helped understand the wider metabolic consequences of nitisinone therapy.
Collapse
Affiliation(s)
- AS Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical Laboratories, Royal Liverpool University Hospitals Trust, Liverpool, UK
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - AT Hughes
- Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical Laboratories, Royal Liverpool University Hospitals Trust, Liverpool, UK
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - AM Milan
- Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical Laboratories, Royal Liverpool University Hospitals Trust, Liverpool, UK
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | | | - JA Gallagher
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - LR Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical Laboratories, Royal Liverpool University Hospitals Trust, Liverpool, UK
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| |
Collapse
|
10
|
Griffin R, Psarelli EE, Cox TF, Khedr M, Milan AM, Davison AS, Hughes AT, Usher JL, Taylor S, Loftus N, Daroszewska A, West E, Jones A, Briggs M, Fisher M, McCormick M, Judd S, Vinjamuri S, Sireau N, Dillon JP, Devine JM, Hughes G, Harrold J, Barton GJ, Jarvis JC, Gallagher JA, Ranganath LR. Data on items of AKUSSI in Alkaptonuria collected over three years from the United Kingdom National Alkaptonuria Centre and the impact of nitisinone. Data Brief 2018; 20:1620-1628. [PMID: 30263914 PMCID: PMC6157456 DOI: 10.1016/j.dib.2018.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/02/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Abstract
Alkaptonuria is a rare genetic disorder characterized by a high level of circulating (and urine) homogentisic acid (HGA), which contributes to ochronosis when it is deposited in connective tissue as a pigmented polymer. In an observational study carried out by National AKU Centre (NAC) in Liverpool, a total of thirty-nine AKU patients attended yearly visits in varying numbers. At each visit a mixture of clinical, joint and spinal assessments were carried out and the results calculated to yield an AKUSSI (Alkaptonuria Severity Score Index), see "Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre" (Ranganath at el., 2018). The aim of this data article is to produce visual representation of the change in the components of AKUSSI over 3 years, through radar charts. The metabolic effect of nitisinone is shown through box plots.
Collapse
Affiliation(s)
- R Griffin
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - E E Psarelli
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - T F Cox
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - M Khedr
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A M Milan
- AKU Society, 66 Devonshire Road, Cambridge, UK
| | - A S Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A T Hughes
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - J L Usher
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Taylor
- Department of Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N Loftus
- Department of Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Daroszewska
- Department of Rheumatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.,Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - E West
- Department of Dermatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Jones
- Department of Anaesthesia, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Briggs
- Department of Ophthalmology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Fisher
- Department of Cardiology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M McCormick
- Department of ENT, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Judd
- Department of Dietetics, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N Sireau
- AKU Society, 66 Devonshire Road, Cambridge, UK
| | - J P Dillon
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - J M Devine
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - G Hughes
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - J Harrold
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - G J Barton
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J C Jarvis
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J A Gallagher
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - L R Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| |
Collapse
|
11
|
Ranganath LR, Khedr M, Milan AM, Davison AS, Hughes AT, Usher JL, Taylor S, Loftus N, Daroszewska A, West E, Jones A, Briggs M, Fisher M, McCormick M, Judd S, Vinjamuri S, Griffin R, Psarelli EE, Cox TF, Sireau N, Dillon JP, Devine JM, Hughes G, Harrold J, Barton GJ, Jarvis JC, Gallagher JA. Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: Evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre. Mol Genet Metab 2018; 125:127-134. [PMID: 30055994 DOI: 10.1016/j.ymgme.2018.07.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
QUESTION Does Nitisinone prevent the clinical progression of the Alkaptonuria? FINDINGS In this observational study on 39 patients, 2 mg of daily nitisinone inhibited ochronosis and significantly slowed the progression of AKU over a three-year period. MEANING Nitisinone is a beneficial therapy in Alkaptonuria. BACKGROUND Nitisinone decreases homogentisic acid (HGA), but has not been shown to modify progression of Alkaptonuria (AKU). METHODS Thirty-nine AKU patients attended the National AKU Centre (NAC) in Liverpool for assessments and treatment. Nitisinone was commenced at V1 or baseline. Thirty nine, 34 and 22 AKU patients completed 1, 2 and 3 years of monitoring respectively (V2, V3 and V4) in the VAR group. Seventeen patients also attended a pre-baseline visit (V0) in the VAR group. Within the 39 patients, a subgroup of the same ten patients attended V0, V1, V2, V3 and V4 visits constituting the SAME Group. Severity of AKU was assessed by calculation of the AKU Severity Score Index (AKUSSI) allowing comparison between the pre-nitisinone and the nitisinone treatment phases. RESULTS The ALL (sum of clinical, joint and spine AKUSSI features) AKUSSI rate of change of scores/patient/month, in the SAME group, was significantly lower at two (0.32 ± 0.19) and three (0.15 ± 0.13) years post-nitisinone when compared to pre-nitisinone (0.65 ± 0.15) (p < .01 for both comparisons). Similarly, the ALL AKUSSI rate of change of scores/patient/month, in the VAR group, was significantly lower at one (0.16 ± 0.08) and three (0.19 ± 0.06) years post-nitisinone when compared to pre-nitisinone (0.59 ± 0.13) (p < .01 for both comparisons). Combined ear and ocular ochronosis rate of change of scores/patient/month was significantly lower at one, two and three year's post-nitisinone in both VAR and SAME groups compared with pre-nitisinone (p < .05). CONCLUSION This is the first indication that a 2 mg dose of nitisinone slows down the clinical progression of AKU. Combined ocular and ear ochronosis progression was arrested by nitisinone.
Collapse
Affiliation(s)
- L R Ranganath
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - M Khedr
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A M Milan
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A S Davison
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A T Hughes
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - J L Usher
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - S Taylor
- Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N Loftus
- Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Daroszewska
- Rheumatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK; Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - E West
- Dermatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Jones
- Anaesthesia, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Briggs
- Ophthalmology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Fisher
- Cardiology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M McCormick
- ENT, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Judd
- Dietetics, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Vinjamuri
- Nuclear Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - R Griffin
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - E E Psarelli
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - T F Cox
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - N Sireau
- AKU Society, 66 Devonshire Road, Cambridge, UK
| | - J P Dillon
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - J M Devine
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - G Hughes
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - J Harrold
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - G J Barton
- Liverpool John Moores University, Liverpool, UK
| | - J C Jarvis
- Liverpool John Moores University, Liverpool, UK
| | - J A Gallagher
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| |
Collapse
|
12
|
Ranganath L, Taylor AM, Shenkin A, Fraser WD, Jarvis J, Gallagher JA, Sireau N. Identification of alkaptonuria in the general population: a United Kingdom experience describing the challenges, possible solutions and persistent barriers. J Inherit Metab Dis 2011; 34:723-30. [PMID: 21311977 DOI: 10.1007/s10545-011-9282-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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: 11/02/2010] [Revised: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 12/19/2022]
Abstract
Progress in research into rare diseases is challenging. This paper discusses strategies to identify individuals with the rare genetic disease alkaptonuria (AKU) within the general population. Strategies used included a questionnaire survey of general practitioners, a dedicated website and patient network contact, targeted family screening and medical conference targeting. Primary care physicians of the UK were targeted by a postal survey that involved mailing 11,151 UK GPs; the response rate was 18.2%. We have identified 75 patients in the UK with AKU by the following means: postal survey (23), targeted family screening (11), patient networks and the website (41). Targeting medical conferences (AKU, rare diseases, rheumatology, clinical biochemistry, orthopaedics, general practitioners) did not lead to new identification in the UK but helped identify overseas cases. We are now aware of 626 patients worldwide including newly identified non-UK people with AKU in the following areas: Slovakia (208), the rest of Europe (including Turkey) (79), North America (including USA and Canada) (110), and the rest of the world (154). A mechanism for identifying individuals with AKU in the general population-not just in the UK but worldwide-has been established. Knowledge of patients with AKU, both in the UK and outside, is often confined to establishing their location in a particular GP practice or association with a particular medical professional. Mere identification, however, does not always lead to full engagement for epidemiological research purposes or targeting treatment since further barriers exist.
Collapse
Affiliation(s)
- L Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
| | | | | | | | | | | | | |
Collapse
|