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Reilmann R, Anderson KE, Feigin A, Tabrizi SJ, Leavitt BR, Stout JC, Piccini P, Schubert R, Loupe P, Wickenberg A, Borowsky B, Rynkowski G, Volkinshtein R, Li T, Savola JM, Hayden M, Gordon MF. Safety and efficacy of laquinimod for Huntington's disease (LEGATO-HD): a multicentre, randomised, double-blind, placebo-controlled, phase 2 study. Lancet Neurol 2024; 23:243-255. [PMID: 38280392 DOI: 10.1016/s1474-4422(23)00454-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Laquinimod modulates CNS inflammatory pathways thought to be involved in the pathology of Huntington's disease. Studies with laquinimod in transgenic rodent models of Huntington's disease suggested improvements in motor function, reduction of brain volume loss, and prolonged survival. We aimed to evaluate the safety and efficacy of laquinimod in improving motor function and reducing caudate volume loss in patients with Huntington's disease. METHODS LEGATO-HD was a multicentre, double-blind, placebo-controlled, phase 2 study done at 48 sites across ten countries (Canada, Czech Republic, Germany, Italy, Netherlands, Portugal, Russia, Spain, UK, and USA). Patients aged 21-55 years with a cytosine-adenosine-guanine (CAG) repeat length of between 36 and 49 who had symptomatic Huntington's disease with a Unified Huntington's Disease Rating Scale-Total Motor Score (UHDRS-TMS) of higher than 5 and a Total Functional Capacity score of 8 or higher were randomly assigned (1:1:1:1) by centralised interactive response technology to laquinimod 0·5 mg, 1·0 mg, or 1·5 mg, or to matching placebo, administered orally once daily over 52 weeks; people involved in the randomisation had no other role in the study. Participants, investigators, and study personnel were masked to treatment assignment. The 1·5 mg group was discontinued before recruitment was finished because of cardiovascular safety concerns in multiple sclerosis studies. The primary endpoint was change from baseline in the UHDRS-TMS and the secondary endpoint was percent change in caudate volume, both comparing the 1·0 mg group with the placebo group at week 52. Primary and secondary endpoints were assessed in the full analysis set (ie, all randomised patients who received at least one dose of study drug and had at least one post-baseline UHDRS-TMS assessment). Safety measures included adverse event frequency and severity, and clinical and laboratory examinations, and were assessed in the safety analysis set (ie, all randomised patients who received at least one dose of study drug). This trial is registered with ClinicalTrials.gov, NCT02215616, and EudraCT, 2014-000418-75, and is now complete. FINDINGS Between Oct 28, 2014, and June 19, 2018, 352 adults with Huntington's disease (179 [51%] men and 173 [49%] women; mean age 43·9 [SD 7·6] years and 340 [97%] White) were randomly assigned: 107 to laquinimod 0·5 mg, 107 to laquinimod 1·0 mg, 30 to laquinimod 1·5 mg, and 108 to matching placebo. Least squares mean change from baseline in UHDRS-TMS at week 52 was 1·98 (SE 0·83) in the laquinimod 1·0 mg group and 1·2 (0·82) in the placebo group (least squares mean difference 0·78 [95% CI -1·42 to 2·98], p=0·4853). Least squares mean change in caudate volume was 3·10% (SE 0·38) in the 1·0 mg group and 4·86% (0·38) in the placebo group (least squares mean difference -1·76% [95% CI -2·67 to -0·85]; p=0·0002). Laquinimod was well tolerated and there were no new safety findings. Serious adverse events were reported by eight (7%) patients on placebo, seven (7%) on laquinimod 0·5 mg, five (5%) on laquinimod 1·0 mg, and one (3%) on laquinimod 1·5 mg. There was one death, which occurred in the placebo group and was unrelated to treatment. The most frequent adverse events in all laquinimod dosed groups (0·5 mg, 1·0 mg, and 1·5 mg) were headache (38 [16%]), diarrhoea (24 [10%]), fall (18 [7%]), nasopharyngitis (20 [8%]), influenza (15 [6%]), vomiting (13 [5%]), arthralgia (11 [5%]), irritability (ten [4%]), fatigue (eight [3%]), and insomnia (eight [3%]). INTERPRETATION Laquinimod did not show a significant effect on motor symptoms assessed by the UHDRS-TMS, but significantly reduced caudate volume loss compared with placebo at week 52. Huntington's disease has a chronic and slowly progressive course, and this study does not address whether a longer duration of laquinimod treatment could have produced detectable and meaningful changes in the clinical assessments. FUNDING Teva Pharmaceutical Industries.
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Affiliation(s)
- Ralf Reilmann
- George Huntington Institute, Münster, Germany; Department of Clinical Radiology, University of Münster, Münster, Germany; Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Karen E Anderson
- Department of Psychiatry and Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA
| | - Andrew Feigin
- New York University Langone Health, New York, NY, USA
| | - Sarah J Tabrizi
- University College London Queen Square Institute of Neurology, London, UK
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Julie C Stout
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Pippa Loupe
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | | | | | - Gail Rynkowski
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | - Rita Volkinshtein
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | - Thomas Li
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
| | | | - Michael Hayden
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Prilenia Therapeutics, Herzliya, Israel
| | - Mark Forrest Gordon
- Research and Development, Teva Pharmaceutical Industries, Petah Tikva, Israel
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Gonzalez-Robles C, Bartlett M, Burnell M, Clarke CS, Haar S, Hu MT, Huxford B, Jha A, Lawton M, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, van Wamelen D, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Weil RS, Schrag A. Embedding Patient Input in Outcome Measures for Long-Term Disease-Modifying Parkinson Disease Trials. Mov Disord 2024; 39:433-438. [PMID: 38140767 DOI: 10.1002/mds.29691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Clinical trials of disease-modifying therapies in PD require valid and responsive primary outcome measures that are relevant to patients. OBJECTIVES The objective is to select a patient-centered primary outcome measure for disease-modification trials over three or more years. METHODS Experts in Parkinson's disease (PD), statistics, and health economics and patient and public involvement and engagement (PPIE) representatives reviewed and discussed potential outcome measures. A larger PPIE group provided input on their key considerations for such an endpoint. Feasibility, clinimetric properties, and relevance to patients were assessed and synthesized. RESULTS Although initial considerations favored the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in Off, feasibility, PPIE input, and clinimetric properties supported the MDS-UPDRS Part II. However, PPIE input also highlighted the importance of nonmotor symptoms, especially in the longer term, leading to the selection of the MDS-UPDRS Parts I + II sum score. CONCLUSIONS The MDS-UPDRS Parts I + II sum score was chosen as the primary outcome for large 3-year disease-modification trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cristina Gonzalez-Robles
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Caroline S Clarke
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Shlomi Haar
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Brook Huxford
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Ashwani Jha
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Lynn Rochester
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
| | - Carroll Siu
- Expert by experience, Canterbury, United Kingdom
| | - Daniel van Wamelen
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, King's College London, London, United Kingdom
| | | | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Camille B Carroll
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rimona S Weil
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Dementia Research Centre, Movement Disorders Centre, University College London, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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3
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Roussakis AA, Gennaro M, Gordon MF, Reilmann R, Borowsky B, Rynkowski G, Lao-Kaim NP, Papoutsou Z, Savola JM, Hayden MR, Owen DR, Kalk N, Lingford-Hughes A, Gunn RN, Searle G, Tabrizi SJ, Piccini P. A PET-CT study on neuroinflammation in Huntington's disease patients participating in a randomized trial with laquinimod. Brain Commun 2023; 5:fcad084. [PMID: 37020532 PMCID: PMC10069663 DOI: 10.1093/braincomms/fcad084] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
Microglia activation, an indicator of central nervous system inflammation, is believed to contribute to the pathology of Huntington's disease. Laquinimod is capable of regulating microglia. By targeting the translocator protein, 11C-PBR28 PET-CT imaging can be used to assess the state of regional gliosis in vivo and explore the effects of laquinimod treatment. This study relates to the LEGATO-HD, multi-centre, double-blinded, Phase 2 clinical trial with laquinimod (US National Registration: NCT02215616). Fifteen patients of the UK LEGATO-HD cohort (mean age: 45.2 ± 7.4 years; disease duration: 5.6 ± 3.0 years) were treated with laquinimod (0.5 mg, N = 4; 1.0 mg, N = 6) or placebo (N = 5) daily. All participants had one 11C-PBR28 PET-CT and one brain MRI scan before laquinimod (or placebo) and at the end of treatment (12 months apart). PET imaging data were quantified to produce 11C-PBR28 distribution volume ratios. These ratios were calculated for the caudate and putamen using the reference Logan plot with the corpus callosum as the reference region. Partial volume effect corrections (Müller-Gartner algorithm) were applied. Differences were sought in Unified Huntington's Disease Rating Scale scores and regional distribution volume ratios between baseline and follow-up and between the two treatment groups (laquinimod versus placebo). No significant change in 11C-PBR28 distribution volume ratios was found post treatment in the caudate and putamen for both those treated with laquinimod (N = 10) and those treated with placebo (N = 5). Over time, the patients treated with laquinimod did not show a significant clinical improvement. Data from the 11C-PBR28 PET-CT study indicate that laquinimod may not have affected regional translocator protein expression and clinical performance over the studied period.
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Affiliation(s)
| | - Marta Gennaro
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | | | | | | | | | - Nicholas P Lao-Kaim
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Zoe Papoutsou
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | | | - Michael R Hayden
- Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital and Research Institute, University of British Columbia, Vancouver V5Z 4H4, Canada
| | - David R Owen
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Nicola Kalk
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Anne Lingford-Hughes
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Roger N Gunn
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
- Invicro, Hammersmith Hospital,, London W12 0NN, UK
| | | | - Sarah J Tabrizi
- Huntington’s Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Paola Piccini
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
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4
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Gonzalez-Robles C, Weil RS, van Wamelen D, Bartlett M, Burnell M, Clarke CS, Hu MT, Huxford B, Jha A, Lambert C, Lawton M, Mills G, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Schrag A. Outcome Measures for Disease-Modifying Trials in Parkinson's Disease: Consensus Paper by the EJS ACT-PD Multi-Arm Multi-Stage Trial Initiative. J Parkinsons Dis 2023; 13:1011-1033. [PMID: 37545260 PMCID: PMC10578294 DOI: 10.3233/jpd-230051] [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] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Multi-arm, multi-stage (MAMS) platform trials can accelerate the identification of disease-modifying treatments for Parkinson's disease (PD) but there is no current consensus on the optimal outcome measures (OM) for this approach. OBJECTIVE To provide an up-to-date inventory of OM for disease-modifying PD trials, and a framework for future selection of OM for such trials. METHODS As part of the Edmond J Safra Accelerating Clinical Trials in Parkinson Disease (EJS ACT-PD) initiative, an expert group with Patient and Public Involvement and Engagement (PPIE) representatives' input reviewed and evaluated available evidence on OM for potential use in trials to delay progression of PD. Each OM was ranked based on aspects such as validity, sensitivity to change, participant burden and practicality for a multi-site trial. Review of evidence and expert opinion led to the present inventory. RESULTS An extensive inventory of OM was created, divided into: general, motor and non-motor scales, diaries and fluctuation questionnaires, cognitive, disability and health-related quality of life, capability, quantitative motor, wearable and digital, combined, resource use, imaging and wet biomarkers, and milestone-based. A framework for evaluation of OM is presented to update the inventory in the future. PPIE input highlighted the need for OM which reflect their experience of disease progression and are applicable to diverse populations and disease stages. CONCLUSION We present a range of OM, classified according to a transparent framework, to aid selection of OM for disease-modifying PD trials, whilst allowing for inclusion or re-classification of relevant OM as new evidence emerges.
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Affiliation(s)
| | | | | | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit at University College London, London, UK
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5
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Mohamed MA, Zeng Z, Gennaro M, Lao-Kaim NP, Myers JFM, Calsolaro V, Femminella GD, Tyacke RJ, Martin-Bastida A, Gunn RN, Nutt DJ, Edison P, Piccini P, Roussakis AA. Astrogliosis in aging and Parkinson’s disease dementia: a new clinical study with 11C-BU99008 PET. Brain Commun 2022; 4:fcac199. [PMID: 36072646 PMCID: PMC9445175 DOI: 10.1093/braincomms/fcac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
The role of astrogliosis in the pathology of brain aging and neurodegenerative diseases has recently drawn great attention. Imidazoline-2 binding sites represent a possible target to map the distribution of reactive astrocytes. In this study, we use 11C-BU99008, an imidazoline-2 binding sites-specific PET radioligand, to image reactive astrocytes in vivo in healthy controls and patients with established Parkinson’s disease dementia. Eighteen healthy controls (age: 45–78 years) and six patients with Parkinson’s disease dementia (age: 64–77 years) had one 11C-BU99008 PET-CT scan with arterial input function. All subjects underwent one 3 T MRI brain scan to facilitate the analysis of the PET data and to capture individual cerebral atrophy. Regional 11C-BU99008 volumes of distribution were calculated for each subject by the two-tissue compartmental modelling. Positive correlations between 11C-BU99008 volumes of distribution values and age were found for all tested regions across the brain within healthy controls (P < 0.05); furthermore, multiple regression indicated that aging affects 11C-BU99008 volumes of distribution values in a region-specific manner. Independent samples t-test indicated that there was no significant group difference in 11C-BU99008 volumes of distribution values between Parkinson’s disease dementia (n = 6; mean age = 71.97 ± 4.66 years) and older healthy controls (n = 9; mean age = 71.90 ± 5.51 years). Our data set shows that astrogliosis is common with aging in a region-specific manner. However, in this set-up, 11C-BU99008 PET cannot differentiate patients with Parkinson’s disease dementia from healthy controls of similar age.
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Affiliation(s)
- Mohamed A Mohamed
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Zhou Zeng
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Xiangya Hospital of Central South University , Changsha, Hunan , P.R. China
| | - Marta Gennaro
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Nicholas P Lao-Kaim
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Jim F M Myers
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Valeria Calsolaro
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Grazia Daniela Femminella
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Department of Translational Medical Sciences, University of Naples Federico II , Naples , Italy
| | - Robin J Tyacke
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Antonio Martin-Bastida
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra , Pamplona-Madrid , Spain
| | - Roger N Gunn
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - David J Nutt
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Paul Edison
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
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6
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Xing Y, Sapuan AH, Martín-Bastida A, Naidu S, Tench C, Evans J, Sare G, Schwarz ST, Al-Bachari S, Parkes LM, Kanavou S, Raw J, Silverdale M, Bajaj N, Pavese N, Burn D, Piccini P, Grosset DG, Auer DP. Neuromelanin-MRI to Quantify and Track Nigral Depigmentation in Parkinson's Disease: A Multicenter Longitudinal Study Using Template-Based Standardized Analysis. Mov Disord 2022; 37:1028-1039. [PMID: 35165920 PMCID: PMC9303322 DOI: 10.1002/mds.28934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 11/24/2021] [Accepted: 01/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background Clinical diagnosis and monitoring of Parkinson's disease (PD) remain challenging because of the lack of an established biomarker. Neuromelanin‐magnetic resonance imaging (NM‐MRI) is an emerging biomarker of nigral depigmentation indexing the loss of melanized neurons but has unknown prospective diagnostic and tracking performance in multicenter settings. Objectives The aim was to investigate the diagnostic accuracy of NM‐MRI in early PD in a multiprotocol setting and to determine and compare serial NM‐MRI changes in PD and controls. Methods In this longitudinal case–control 3 T MRI study, 148 patients and 97 controls were included from six UK clinical centers, of whom 140 underwent a second scan after 1.5 to 3 years. An automated template‐based analysis was applied for subregional substantia nigra NM‐MRI contrast and volume assessment. A point estimate of the period of prediagnostic depigmentation was computed. Results All NM metrics performed well to discriminate patients from controls, with receiver operating characteristic showing 85% accuracy for ventral NM contrast and 83% for volume. Generalizability using a priori volume cutoff was good (79% accuracy). Serial MRI demonstrated accelerated NM loss in patients compared to controls. Ventral NM contrast loss was point estimated to start 5 to 6 years before clinical diagnosis. Ventral nigral depigmentation was greater in the most affected side, more severe cases, and nigral NM volume change correlated with change in motor severity. Conclusions We demonstrate that NM‐MRI provides clinically useful diagnostic information in early PD across protocols, platforms, and sites. It provides methods and estimated depigmentation rates that highlight the potential to detect preclinical PD and track progression for biomarker‐enabled clinical trials. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Yue Xing
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Abdul Halim Sapuan
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Antonio Martín-Bastida
- Division of Neurology, Imperial College London, London, United Kingdom.,Department of Neurology and Neurosciences, Clínica Universidad de Navarra, Pamplona-Madrid, Spain
| | - Saadnah Naidu
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,Neurology, Nottingham University Hospital Trust, Nottingham, United Kingdom
| | - Christopher Tench
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Jonathan Evans
- Neurology, Nottingham University Hospital Trust, Nottingham, United Kingdom
| | - Gillian Sare
- Neurology, Nottingham University Hospital Trust, Nottingham, United Kingdom
| | - Stefan T Schwarz
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,Department of Radiology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Sarah Al-Bachari
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Laura M Parkes
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sofia Kanavou
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jason Raw
- Pennine Acute Hospitals NHS Trust, Oldham, United Kingdom
| | - Monty Silverdale
- Division of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Nin Bajaj
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Spire Nottingham Hospital, Nottingham, United Kingdom
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre and Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David Burn
- Faculty of Medical Sciences, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paola Piccini
- Division of Neurology, Imperial College London, London, United Kingdom.,Department of Brain Science, Imperial College London, London, United Kingdom
| | - Donald G Grosset
- Institute for Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Dorothee P Auer
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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7
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Parkin BL, Daws RE, Das-Neves I, Violante IR, Soreq E, Faisal AA, Sandrone S, Lao-Kaim NP, Martin-Bastida A, Roussakis AA, Piccini P, Hampshire A. Dissociable effects of age and Parkinson's disease on instruction-based learning. Brain Commun 2021; 3:fcab175. [PMID: 34485905 PMCID: PMC8410985 DOI: 10.1093/braincomms/fcab175] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
The cognitive deficits associated with Parkinson's disease vary across individuals and change across time, with implications for prognosis and treatment. Key outstanding challenges are to define the distinct behavioural characteristics of this disorder and develop diagnostic paradigms that can assess these sensitively in individuals. In a previous study, we measured different aspects of attentional control in Parkinson's disease using an established fMRI switching paradigm. We observed no deficits for the aspects of attention the task was designed to examine; instead those with Parkinson's disease learnt the operational requirements of the task more slowly. We hypothesized that a subset of people with early-to-mid stage Parkinson's might be impaired when encoding rules for performing new tasks. Here, we directly test this hypothesis and investigate whether deficits in instruction-based learning represent a characteristic of Parkinson's Disease. Seventeen participants with Parkinson's disease (8 male; mean age: 61.2 years), 18 older adults (8 male; mean age: 61.3 years) and 20 younger adults (10 males; mean age: 26.7 years) undertook a simple instruction-based learning paradigm in the MRI scanner. They sorted sequences of coloured shapes according to binary discrimination rules that were updated at two-minute intervals. Unlike common reinforcement learning tasks, the rules were unambiguous, being explicitly presented; consequently, there was no requirement to monitor feedback or estimate contingencies. Despite its simplicity, a third of the Parkinson's group, but only one older adult, showed marked increases in errors, 4 SD greater than the worst performing young adult. The pattern of errors was consistent, reflecting a tendency to misbind discrimination rules. The misbinding behaviour was coupled with reduced frontal, parietal and anterior caudate activity when rules were being encoded, but not when attention was initially oriented to the instruction slides or when discrimination trials were performed. Concomitantly, Magnetic Resonance Spectroscopy showed reduced gamma-Aminobutyric acid levels within the mid-dorsolateral prefrontal cortices of individuals who made misbinding errors. These results demonstrate, for the first time, that a subset of early-to-mid stage people with Parkinson's show substantial deficits when binding new task rules in working memory. Given the ubiquity of instruction-based learning, these deficits are likely to impede daily living. They will also confound clinical assessment of other cognitive processes. Future work should determine the value of instruction-based learning as a sensitive early marker of cognitive decline and as a measure of responsiveness to therapy in Parkinson's disease.
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Affiliation(s)
- Beth L Parkin
- Department of Psychology, School of Social Science, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - Richard E Daws
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - Ines Das-Neves
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - Ines R Violante
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eyal Soreq
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - A Aldo Faisal
- Brain and Behaviour Laboratory, Department of Bioengineering, Imperial College London, London W12 0NN, UK
- Brain and Behaviour Laboratory, Department of Computing, Imperial College London, London W12 0NN, UK
- Behaviour Analytics Lab, Data Science Institute, Imperial College London, London W12 0NN, UK
- MRC London Institute of Medical Sciences, London W12 0NN, UK
| | - Stefano Sandrone
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Division of Neurology, Imperial College London, London W12 0NN, UK
| | - Antonio Martin-Bastida
- Neurology Imaging Unit, Division of Neurology, Imperial College London, London W12 0NN, UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra, Pamplona-Madrid 28027, Spain
| | | | - Paola Piccini
- Neurology Imaging Unit, Division of Neurology, Imperial College London, London W12 0NN, UK
| | - Adam Hampshire
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
- UK DRI Care Research & Technology Centre, Imperial College London, London W12 0NN, UK
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Hannaway N, Lao-Kaim NP, Martín-Bastida A, Roussakis AA, Howard J, Wall MB, Loane C, Barker RA, Piccini P. Longitudinal changes in movement-related functional MRI activity in Parkinson's disease patients. Parkinsonism Relat Disord 2021; 87:61-69. [PMID: 33975081 DOI: 10.1016/j.parkreldis.2021.04.025] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Functional brain imaging has shown alterations in the basal ganglia, cortex and cerebellum in Parkinson's disease patients. However, few functional imaging studies have tested how these changes evolve over time. Our study aimed to test the longitudinal progression of movement-related functional activity in Parkinson's disease patients. METHODS At baseline, 48 Parkinson's disease patients and 16 healthy controls underwent structural and functional magnetic resonance imaging during a joystick motor task. Patients had repeated imaging after 18-months (n = 42) and 36-months (n = 32). T-tests compared functional responses between Parkinson's disease patients and controls, and linear mixed effects models examined longitudinal differences within Parkinson's disease. Correlations of motor-activity with bradykinesia, rigidity and tremor were undertaken. All contrasts used whole-brain analyses, thresholded at Z > 3.1 with a cluster-wise P < 0.05. RESULTS Baseline activation was significantly greater in patients than controls across contralateral parietal and occipital regions, ipsilateral precentral gyrus and thalamus. Longitudinally, patients showed significant increases in cerebellar activity at successive visits following baseline. Task-related activity also increased in the contralateral motor, parietal and temporal areas at 36 months compared to baseline, however this was reduced when controlling for motor task performance. CONCLUSION We have shown that there are changes over time in the blood-activation level dependent response of patients with Parkinson's disease undertaking a simple motor task. These changes are observed primarily in the ipsilateral cerebellum and may be compensatory in nature.
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Affiliation(s)
- Naomi Hannaway
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | - Antonio Martín-Bastida
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom; Neurology Department, Clinica Universidad de Navarra, Pamplona, Navarra, 31008, Spain.
| | - Andreas-Antonios Roussakis
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | | | | | - Clare Loane
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, SE5 9RT, United Kingdom.
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, United Kingdom and WT-MRC Cambridge Stem Cell, Cambridge, United Kingdom.
| | - Paola Piccini
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
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9
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Roussakis AA, Zeng Z, Lao-Kaim NP, Martin-Bastida A, Piccini P. Parkinson's disease laterality: a 11C-PE2I PET imaging study. J Neurol 2021; 268:582-589. [PMID: 32880071 PMCID: PMC7880931 DOI: 10.1007/s00415-020-10204-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Abstract
Asymmetry of striatal dopaminergic deficits and motor symptoms is a typical characteristic of idiopathic Parkinson's disease (PD). This study aims to characterise the trend of asymmetry in moderate-stage PD. We performed a 19-month longitudinal study in 27 patients with PET-CT imaging and appropriate clinical assessments. 11C-PE2I non-displaceable binding potential (BPND) was calculated bilaterally for the striatum at baseline and follow-up to estimate the in vivo density of striatal dopamine transporters (DAT). Changes in striatal 11C-PE2I BPND over time were more prominent in the ipsilateral as compared to contralateral side. Changes in MDS-UPDRS-III (motor component of the Movement Disorders Society Unified PD Rating Scale) were not different between the clinically most and least affected body sides. Our data support that the asymmetry in striatal dopaminergic degeneration becomes less prominent in moderate-stage PD. In contrast, during the above period, the asymmetry of motor symptoms was maintained between the clinically most and least affected body sides.
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Affiliation(s)
- Andreas-Antonios Roussakis
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Zhou Zeng
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
- Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Nicholas P Lao-Kaim
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Antonio Martin-Bastida
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra, Pamplona, Madrid, Spain
| | - Paola Piccini
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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10
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Li W, Lao-Kaim NP, Roussakis AA, Martín-Bastida A, Valle-Guzman N, Paul G, Soreq E, Daws RE, Foltynie T, Barker RA, Hampshire A, Piccini P. Longitudinal functional connectivity changes related to dopaminergic decline in Parkinson's disease. Neuroimage Clin 2020; 28:102409. [PMID: 32916466 PMCID: PMC7490914 DOI: 10.1016/j.nicl.2020.102409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Resting-state functional magnetic resonance imaging (fMRI) studies have demonstrated that basal ganglia functional connectivity is altered in Parkinson's disease (PD) as compared to healthy controls. However, such functional connectivity alterations have not been related to the dopaminergic deficits that occurs in PD over time. OBJECTIVES To examine whether functional connectivity impairments are correlated with dopaminergic deficits across basal ganglia subdivisions in patients with PD both cross-sectionally and longitudinally. METHODS We assessed resting-state functional connectivity of basal ganglia subdivisions and dopamine transporter density using 11C-PE2I PET in thirty-four PD patients at baseline. Of these, twenty PD patients were rescanned after 19.9 ± 3.8 months. A seed-based approach was used to analyze resting-state fMRI data. 11C-PE2I binding potential (BPND) was calculated for each participant. PD patients were assessed for disease severity. RESULTS At baseline, PD patients with greater dopaminergic deficits, as measured with 11C-PE2I PET, showed larger decreases in posterior putamen functional connectivity with the midbrain and pallidum. Reduced functional connectivity of the posterior putamen with the thalamus, midbrain, supplementary motor area and sensorimotor cortex over time were significantly associated with changes in DAT density over the same period. Furthermore, increased motor disability was associated with lower intraregional functional connectivity of the posterior putamen. CONCLUSIONS Our findings suggest that basal ganglia functional connectivity is related to integrity of dopaminergic system in patients with PD. Application of resting-state fMRI in a large cohort and longitudinal scanning may be a powerful tool for assessing underlying PD pathology and its progression.
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Affiliation(s)
- Weihua Li
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom; Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Nick P Lao-Kaim
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom
| | - Andreas-Antonios Roussakis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom
| | - Antonio Martín-Bastida
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom; Department of Neurology and Neurosciences, Clínica universidad de Navarra, Pamplona-Madrid, Spain
| | - Natalie Valle-Guzman
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, United Kingdom
| | - Gesine Paul
- Translational Neurology Group, Department of Clinical Sciences, Wallenberg Neuroscience Centre, Lund University, Lund 221 84, Sweden; Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund 22185, Sweden
| | - Eyal Soreq
- Imperial College London, Division of Brain Sciences, Computational Cognitive & Clinical Neuroimaging Lab (C(3)NL), London W12 0NN, United Kingdom
| | - Richard E Daws
- Imperial College London, Division of Brain Sciences, Computational Cognitive & Clinical Neuroimaging Lab (C(3)NL), London W12 0NN, United Kingdom
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, United Kingdom
| | - Adam Hampshire
- Imperial College London, Division of Brain Sciences, Computational Cognitive & Clinical Neuroimaging Lab (C(3)NL), London W12 0NN, United Kingdom
| | - Paola Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, United Kingdom
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11
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Porter E, Roussakis AA, Lao-Kaim NP, Piccini P. Multimodal dopamine transporter (DAT) imaging and magnetic resonance imaging (MRI) to characterise early Parkinson's disease. Parkinsonism Relat Disord 2020; 79:26-33. [PMID: 32861103 DOI: 10.1016/j.parkreldis.2020.08.010] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 01/12/2023]
Abstract
Idiopathic Parkinson's disease (PD), the second most common neurodegenerative disorder, is characterised by the progressive loss of dopaminergic nigrostriatal terminals. Currently, in early idiopathic PD, dopamine transporter (DAT)-specific imaging assesses the extent of striatal dopaminergic deficits, and conventional magnetic resonance imaging (MRI) of the brain excludes the presence of significant ischaemic load in the basal ganglia as well as signs indicative of other forms of Parkinsonism. In this article, we discuss the use of multimodal DAT-specific and MRI protocols for insight into the early pathological features of idiopathic PD, including: structural MRI, diffusion tensor imaging, nigrosomal iron imaging and neuromelanin-sensitive MRI sequences. These measures may be acquired serially or simultaneously in a hybrid scanner. From current evidence, it appears that both nigrosomal iron imaging and neuromelanin-sensitive MRI combined with DAT-specific imaging are useful to assist clinicians in diagnosing PD, while conventional structural MRI and diffusion tensor imaging protocols are better suited to a research context focused on characterising early PD pathology. We believe that in the future multimodal imaging will be able to characterise prodromal PD and stratify the clinical stages of PD progression.
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Affiliation(s)
- Eleanor Porter
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK
| | | | - Nicholas P Lao-Kaim
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK
| | - Paola Piccini
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK.
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Zeng Z, Roussakis AA, Lao-Kaim NP, Piccini P. Astrocytes in Parkinson's disease: from preclinical assays to in vivo imaging and therapeutic probes. Neurobiol Aging 2020; 95:264-270. [PMID: 32905922 DOI: 10.1016/j.neurobiolaging.2020.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/04/2019] [Revised: 04/30/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) is increasingly thought to be associated with glial pathology. Recently, research in neurodegenerative disorders has applied a greater focus to better understanding the role of astrocytes in the disease pathophysiology. In this article, we review results from the latest preclinical and clinical work, including functional imaging studies on astrocytes in PD and highlight key molecules that may prove valuable as biomarkers. We discuss how astrocytes may contribute to the initiation and progression of PD. We additionally present trials of investigational medicinal products and the current background for the design of future clinical trials.
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Affiliation(s)
- Zhou Zeng
- Department of Brain Sciences, Imperial College London, Neurology Imaging Unit, London, UK; Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | | | - Nicholas P Lao-Kaim
- Department of Brain Sciences, Imperial College London, Neurology Imaging Unit, London, UK
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, Neurology Imaging Unit, London, UK.
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13
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Jenkins PO, Roussakis AA, De Simoni S, Bourke N, Fleminger J, Cole J, Piccini P, Sharp D. Distinct dopaminergic abnormalities in traumatic brain injury and Parkinson's disease. J Neurol Neurosurg Psychiatry 2020; 91:631-637. [PMID: 32381639 DOI: 10.1136/jnnp-2019-321759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 01/09/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) and rapid eye movement sleep behavioural disorder (RBD) are risk factors for Parkinson's disease (PD). Dopaminergic abnormalities are often seen after TBI, but patients usually lack parkinsonian features. We test whether TBI, PD and RBD have distinct striatal dopamine abnormalities using dopamine transporter (DaT) imaging. METHODS 123I-ioflupane single-photon emission CT scans were used in a cross-sectional study to measure DaT levels in moderate/severe TBI, healthy controls, patients with early PD and RBD. Caudate and putamen DaT, putamen to caudate ratios and left-right symmetry of DaT were compared. RESULTS 108 participants (43 TBI, 26 PD, 8 RBD, 31 controls) were assessed. Patients with early PD scored significantly higher on the Unified Parkinson's Disease Rating Scale motor subscale than other groups. Patients with TBI and PD had reduced DaT levels in the caudate (12.2% and 18.7%, respectively) and putamen (9.0% and 42.6%, respectively) compared with controls. Patients with RBD had reduced DaT levels in the putamen (12.8%) but not in the caudate compared with controls. Patients with PD and TBI showed distinct patterns of DaT reduction, with patients with PD showing a lower putamen to caudate ratio. DaT asymmetry was greater in the PD group than other groups. CONCLUSIONS The results show that patients with early PD and TBI have distinct patterns of striatal dopamine abnormalities. Patients with early PD and moderate/severe TBI showed similar reductions in caudate DaT binding, but patients with PD showed a greater reduction in putamen DaT and a lower putamen to caudate ratio. The results suggest that parkinsonian motor signs are absent in these patients with TBI because of relatively intact putaminal dopamine levels.
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Affiliation(s)
- Peter Owen Jenkins
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Andreas-Antonios Roussakis
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - Sara De Simoni
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Niall Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Jessica Fleminger
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College, London, United Kingdom
| | - James Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Paola Piccini
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - David Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College, London, United Kingdom .,UK Dementia Research Institute, Care Research & Technology Centre, Imperial College, London, United Kingdom
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van Eimeren T, Antonini A, Berg D, Bohnen N, Ceravolo R, Drzezga A, Höglinger GU, Higuchi M, Lehericy S, Lewis S, Monchi O, Nestor P, Ondrus M, Pavese N, Peralta MC, Piccini P, Pineda-Pardo JÁ, Rektorová I, Rodríguez-Oroz M, Rominger A, Seppi K, Stoessl AJ, Tessitore A, Thobois S, Kaasinen V, Wenning G, Siebner HR, Strafella AP, Rowe JB. Neuroimaging biomarkers for clinical trials in atypical parkinsonian disorders: Proposal for a Neuroimaging Biomarker Utility System. Alzheimers Dement (Amst) 2019; 11:301-309. [PMID: 30984816 PMCID: PMC6446052 DOI: 10.1016/j.dadm.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/18/2022]
Abstract
INTRODUCTION Therapeutic strategies targeting protein aggregations are ready for clinical trials in atypical parkinsonian disorders. Therefore, there is an urgent need for neuroimaging biomarkers to help with the early detection of neurodegenerative processes, the early differentiation of the underlying pathology, and the objective assessment of disease progression. However, there currently is not yet a consensus in the field on how to describe utility of biomarkers for clinical trials in atypical parkinsonian disorders. METHODS To promote standardized use of neuroimaging biomarkers for clinical trials, we aimed to develop a conceptual framework to characterize in more detail the kind of neuroimaging biomarkers needed in atypical parkinsonian disorders, identify the current challenges in ascribing utility of these biomarkers, and propose criteria for a system that may guide future studies. RESULTS As a consensus outcome, we describe the main challenges in ascribing utility of neuroimaging biomarkers in atypical parkinsonian disorders, and we propose a conceptual framework that includes a graded system for the description of utility of a specific neuroimaging measure. We included separate categories for the ability to accurately identify an intention-to-treat patient population early in the disease (Early), to accurately detect a specific underlying pathology (Specific), and the ability to monitor disease progression (Progression). DISCUSSION We suggest that the advancement of standardized neuroimaging in the field of atypical parkinsonian disorders will be furthered by a well-defined reference frame for the utility of biomarkers. The proposed utility system allows a detailed and graded description of the respective strengths of neuroimaging biomarkers in the currently most relevant areas of application in clinical trials.
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Affiliation(s)
- Thilo van Eimeren
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Berg
- Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - Nico Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, and VAMC, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- VAMC, Ann Arbor, MI, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alexander Drzezga
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Forschungszentrum Jülich, INM-2, Jülich, Germany
| | - Günter U. Höglinger
- German Centre for Neurodegenerative Diseases (DZNE), and Technical University Munich, Department of Neurology, Munich, Germany
| | - Makoto Higuchi
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Stephane Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, ICM Team “Movement Investigations and Therapeutics”, Sorbonne Universités, Inserm U1127, CNRS UMR, Paris, France
| | - Simon Lewis
- Brain & Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
- Mater Hospital, South Brisbane, QLD, Australia
| | - Matej Ondrus
- AXON Neuroscience CRM Services SE, Bratislava, Slovak Republic
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - María Cecilia Peralta
- Center for Medical Education and Clinical Research, Section of Neurology, Buenos Aires, Argentina
| | - Paola Piccini
- Department of Medicine, Imperial College London, London, United Kingdom
| | - José Ángel Pineda-Pardo
- hmCINAC, University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Irena Rektorová
- First Department of Neurology – Faculty of Medicine and CEITEC MU, Masaryk University, Brno, Czech Republic
| | | | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Alessandro Tessitore
- Department of Medical, Surgery, Neurological, Metabolic and Aging Sciences, University of Campania, “L. Vanvitelli”, Caserta CE, Italy
| | - Stephane Thobois
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Medecine Lyon Sud Charles Merieux, Lyon, France
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C, Lyon, France
- CNRS, Institut des Sciences Cognitives, Bron, France
| | - Valtteri Kaasinen
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Gregor Wenning
- Division of Clinical Neurology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hartwig R. Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN, Toronto, Ontario, Canada
- Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Bassi A, Piccini P, Bianchi L, Montagnani C, de Martino M, Venturini E, Galli L. Diffuse hyperkeratotic lesions in a 4-year-old HIV-infected girl. Arch Dis Child 2019; 104:1228. [PMID: 30181128 DOI: 10.1136/archdischild-2018-315536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Andrea Bassi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paola Piccini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elisbetta Venturini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Abstract
Purpose of Review Parkinson’s disease (PD) has a wide spectrum of symptoms including the presence of psychiatric disease. At present, most treatment plans, comprised of dopaminergic drugs, are chronic and complex. Though dopaminergic agents are quite efficient in managing the motor aspects of the disease, chronic pharmacotherapy specifically with dopamine receptor agonists has been highly linked to the occurrence of Impulse Compulsive disorder (ICD), which can be problematic for individual patients. Recent Findings Much of what is known today about PD-related ICD stems from brain imaging studies, however, evidence is not quite conclusive. Research in the field has been focused on identifying the underlying mechanisms of PD-related ICD and understanding the functions of the structures involved in the reward network. Summary This article presents an update of recent findings from key neuroimaging studies in PD-related ICD, discusses results from controversial studies, and identifies areas for future research in the field.
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Affiliation(s)
- Andreas-Antonios Roussakis
- Neurology Imaging Unit, Imperial College London - Hammersmith Hospital, 1st Floor, B-Block, Du Cane Road, London, W12 0NN, UK
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Imperial College London - Hammersmith Hospital, 1st Floor, B-Block, Du Cane Road, London, W12 0NN, UK
| | - Paola Piccini
- Neurology Imaging Unit, Imperial College London - Hammersmith Hospital, 1st Floor, B-Block, Du Cane Road, London, W12 0NN, UK.
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Martín-Bastida A, Lao-Kaim NP, Roussakis AA, Searle GE, Xing Y, Gunn RN, Schwarz ST, Barker RA, Auer DP, Piccini P. Relationship between neuromelanin and dopamine terminals within the Parkinson's nigrostriatal system. Brain 2019; 142:2023-2036. [PMID: 31056699 PMCID: PMC6664390 DOI: 10.1093/brain/awz120] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 12/03/2018] [Revised: 02/13/2019] [Accepted: 03/05/2019] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease is characterized by the progressive loss of pigmented dopaminergic neurons in the substantia nigra and associated striatal deafferentation. Neuromelanin content is thought to reflect the loss of pigmented neurons, but available data characterizing its relationship with striatal dopaminergic integrity are not comprehensive or consistent, and predominantly involve heterogeneous samples. In this cross-sectional study, we used neuromelanin-sensitive MRI and the highly specific dopamine transporter PET radioligand, 11C-PE2I, to assess the association between neuromelanin-containing cell levels in the substantia nigra pars compacta and nigrostriatal terminal density in vivo, in 30 patients with bilateral Parkinson's disease. Fifteen healthy control subjects also underwent neuromelanin-sensitive imaging. We used a novel approach taking into account the anatomical and functional subdivision of substantia nigra into dorsal and ventral tiers and striatal nuclei into pre- and post-commissural subregions, in accordance with previous animal and post-mortem studies, and consider the clinically asymmetric disease presentation. In vivo, Parkinson's disease subjects displayed reduced neuromelanin levels in the ventral (-30 ± 28%) and dorsal tiers (-21 ± 24%) as compared to the control group [F(1,43) = 11.95, P = 0.001]. Within the Parkinson's disease group, nigral pigmentation was lower in the ventral tier as compared to the dorsal tier [F(1,29) = 36.19, P < 0.001] and lower in the clinically-defined most affected side [F(1,29) = 4.85, P = 0.036]. Similarly, lower dopamine transporter density was observed in the ventral tier [F(1,29) = 76.39, P < 0.001] and clinically-defined most affected side [F(1,29) = 4.21, P = 0.049]. Despite similar patterns, regression analysis showed no significant association between nigral pigmentation and nigral dopamine transporter density. However, for the clinically-defined most affected side, significant relationships were observed between pigmentation of the ventral nigral tier with striatal dopamine transporter binding in pre-commissural and post-commissural striatal subregions known to receive nigrostriatal projections from this tier, while the dorsal tier correlated with striatal projection sites in the pre-commissural striatum (P < 0.05, Benjamini-Hochberg corrected). In contrast, there were no statistically significant relationships between these two measures in the clinically-defined least affected side. These findings provide important insights into the topography of nigrostriatal neurodegeneration in Parkinson's disease, indicating that the characteristics of disease progression may fundamentally differ across hemispheres and support post-mortem data showing asynchrony in the loss of neuromelanin-containing versus tyrosine hydroxylase positive nigral cells.
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Affiliation(s)
- Antonio Martín-Bastida
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
- Neurology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nicholas P Lao-Kaim
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - Andreas Antonios Roussakis
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Yue Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Roger N Gunn
- Invicro LLC, London, UK
- Centre for Restorative Neuroscience, Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - Stefan T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Paola Piccini
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
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18
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Pagano G, Niccolini F, Wilson H, Yousaf T, Khan NL, Martino D, Plisson C, Gunn RN, Rabiner EA, Piccini P, Foltynie T, Politis M. Comparison of phosphodiesterase 10A and dopamine transporter levels as markers of disease burden in early Parkinson's disease. Mov Disord 2019; 34:1505-1515. [PMID: 31158314 DOI: 10.1002/mds.27733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Recent work has shown loss of phosphodiesterase 10A levels in middle-stage and advanced treated patients with PD, which was associated with motor symptom severity. OBJECTIVES To assess phosphodiesterase 10A levels in early PD and compare with loss of dopamine transporter as markers of disease burden. METHODS Seventy-eight subjects were included in this study (17 early de novo, 15 early l-dopa-treated, 24 moderate-advanced l-dopa-treated patients with PD, and 22 healthy controls). All participants underwent [11 C]IMA107 PET, [11 C]PE2I PET, and 3-Tesla MRI scan. RESULTS Early de novo PD patients showed loss of [11 C]IMA107 and of [11 C]PE2I binding in caudate and putamen (P < 0.001); early l-dopa-treated PD patients showed additional loss of [11 C]IMA107 in the caudate (P < 0.001; annual decline 3.6%) and putamen (P < 0.001; annual decline 2.8%), but loss of [11 C]PE2I only in the putamen (P < 0.001; annual decline 6.8%). Lower [11 C]IMA107 correlated with lower [11 C]PE2I in the caudate (rho = 0.51; P < 0.01) and putamen (rho = 0.53; P < 0.01). Longer disease duration correlated with lower [11 C]IMA107 in the caudate (rho = -0.72; P < 0.001) and putamen (rho = -0.48; P < 0.01), and with lower [11 C]PE2I only in the putamen (rho = -0.65; P < 0.001). Higher burden of motor symptoms correlated with lower [11 C]IMA107 in the caudate (rho = -0.42; P < 0.05) and putamen (rho = -0.41; P < 0.05), and with lower [11 C]PE2I only in the putamen (rho = -0.69; P < 0.001). CONCLUSION Our findings demonstrate loss of phosphodiesterase 10A levels very early in the course of PD and is associated with the gradual and progressive increase of motor symptoms. Phosphodiesterase 10A imaging shows similar potential with dopamine transporter imaging to follow disease progression. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gennaro Pagano
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Flavia Niccolini
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Naheed L Khan
- Department of Neurology, Maidstone Hospital, Kent, United Kingdom
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christophe Plisson
- Imanova Ltd, Centre for Imaging Sciences, Hammersmith Hospital, London, United Kingdom
| | - Roger N Gunn
- Imanova Ltd, Centre for Imaging Sciences, Hammersmith Hospital, London, United Kingdom
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Eugenii A Rabiner
- Imanova Ltd, Centre for Imaging Sciences, Hammersmith Hospital, London, United Kingdom
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, United Kingdom
| | - Paola Piccini
- Neurology Imaging Unit, Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus, Imperial College London, London, United Kingdom
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
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19
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Della Bella C, Venturini E, Devente S, Piccini P, Tapinassi S, Bianchi L, Grassi A, Benagiano M, Alnwaisri HFM, Montagnani C, Chiappini E, Bitter W, D’Elios MM, de Martino M, Galli L. Role of Mycobacterium avium lysate INF-γ, IL-17, and IL-2 ELISPOT assays in diagnosing nontuberculous mycobacteria lymphadenitis in children. Eur J Clin Microbiol Infect Dis 2019; 38:1113-1122. [DOI: 10.1007/s10096-019-03506-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
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20
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Venturini E, Piccini P, Tersigni C, Chiappini E, Galli L. Systematic review shows that immunising internationally adopted children is a major challenge for primary health care. Acta Paediatr 2019; 108:411-418. [PMID: 30368909 DOI: 10.1111/apa.14625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
Abstract
AIM This systematic review aimed to provide an overview of the immunisation of internationally adopted children and to discuss possible vaccination strategies. METHODS A literature search was performed covering papers published in English from 1988 to 15 June 2018 using the Ovid MEDLINE, EMBASE and Cochrane Library databases. This identified 749 studies and 41 full texts were evaluated. RESULTS Overall, 19 studies conducted between 1988 and 2016 fulfilled our inclusion criteria. These covered 7663 children aged 1.1-5.7 years adopted from Asia, Eastern Europe, Africa and South and Central America. Tetanus protective antibody levels ranged from 35 to 95%, and similar data were reported for diphtheria. A higher percentage of adoptees had protective antibody levels for polio (50-93%) and measles (62-95%). More than a third (35%) did not have protective antibody titres for hepatitis B. Only one study investigated adoptees with protective antibodies against haemophilus influenza, and it reported that this was around 66%. CONCLUSION The appropriate immunisation of internationally adopted children is a major challenge for primary health care and a number of different approaches have been suggested, with no clear conclusions. Further studies on the cost-effectiveness of different approaches should be performed to optimise screening strategies and develop recommendations.
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Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Paola Piccini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Chiara Tersigni
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Elena Chiappini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
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21
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Bassi A, Piccini P, Filippeschi C, Oranges T, Giani T, Neri I, Cimaz R, Martino MD. Inflammatory morphea presenting as a hemifacial acquired port-wine stain. Arch Dis Child 2019; 104:296. [PMID: 29449213 DOI: 10.1136/archdischild-2017-314721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Andrea Bassi
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paola Piccini
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Teresa Oranges
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Teresa Giani
- Department of Rheumatology, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Iria Neri
- Department of Dermatology, University of Bologna, Bologna, Italy
| | - Rolando Cimaz
- Department of Rheumatology, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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22
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Roussakis AA, Gennaro M, Lao-Kaim NP, Towey D, Piccini P. Dopamine Transporter Density in de novo Parkinson's Disease Does Not Relate to the Development of Levodopa-Induced Dyskinesias. J Neuroinflamm Neurodegener Dis 2019; 3:10000. [PMID: 31819926 PMCID: PMC6901354] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), the onset of levodopa-induced dyskinesias (LIDs) is difficult to predict. This study examines whether dopamine transporter (DAT)-specific SPECT imaging in de novo PD relates to later development of LIDs. METHODS 42 de novo unilateral PD participants received DAT-specific SPECT imaging with 123I-FP-CIT at time of diagnosis. At five years post-diagnosis, all PD patients were clinically evaluated and divided into two groups based on whether they had or had not developed LIDs. Fourteen gender- and age-matched healthy volunteers undertook 123I-FP-CIT SPECT imaging and were included as controls. A semi-quantification approach was used for the 123I-FP-CIT data using the occipital cortex as the reference region. We calculated specific binding ratios (SBR) for the caudate and putamen (posterior and anterior putaminal subregions). In parallel, we analysed our 123I-FP-CIT dataset with a voxel-based analysis approach. RESULTS PD patients had significantly lower striatal 123I-FP-CIT SBR values in comparison to controls (p<0.001). After five years, dyskinetic patients (N=10) were taking higher daily doses of dopaminergic medication (p<0.001) and had more severe disease (difference in Hoehn & Yahr staging scores p<0.05) as compared to the non-dyskinetic group (N=32). At the time of diagnosis, 123I-FP-CIT SBR values were not statistically different between the two groups for all striatal regions (p>0.05). SPM voxel-based analysis did not show a statistically significant difference between the two groups (p>0.05). CONCLUSION 123I-FP-CIT SPECT imaging, performed at diagnosis in de novo early-stage PD could not differentiate patients who will develop LIDs within five years from those who will not.
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Affiliation(s)
| | | | | | - David Towey
- Radiological Sciences Unit, Imperial Healthcare NHS Trust, UK
| | - Paola Piccini
- Neurology Imaging Unit, Imperial College London, UK,Corresponding author: Professor Paola Piccini, Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, Du Cane Road, London, W12 0NN, United Kingdom, Tel.: +442033133172, Fax: +442033131783;
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23
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Piccini P, Venturini E, Romano F, Di Maurizio M, De Filippi C, Azzari C, de Martino M, Galli L. Osteomyelitis and arthritis caused by Mycobacterium intracellulare: an underestimated diagnosis. Int J Tuberc Lung Dis 2018; 21:1184-1185. [PMID: 28911365 DOI: 10.5588/ijtld.17.0393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - Francesca Romano
- Department of Pediatric Immunology, Jeffrey Modell Center for Primary Immunodeficiencies
| | - Marco Di Maurizio
- Pediatric Radiology, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy ,
| | - Claudio De Filippi
- Pediatric Radiology, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy ,
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24
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Maxan A, Mason S, Saint-Pierre M, Smith E, Ho A, Harrower T, Watts C, Tai Y, Pavese N, Savage JC, Tremblay MÈ, Gould P, Rosser AE, Dunnett SB, Piccini P, Barker RA, Cicchetti F. Outcome of cell suspension allografts in a patient with Huntington's disease. Ann Neurol 2018; 84:950-956. [PMID: 30286516 PMCID: PMC6587549 DOI: 10.1002/ana.25354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
Abstract
For patients with incurable neurodegenerative disorders such as Huntington's (HD) and Parkinson's disease, cell transplantation has been explored as a potential treatment option. Here, we present the first clinicopathological study of a patient with HD in receipt of cell-suspension striatal allografts who took part in the NEST-UK multicenter clinical transplantation trial. Using various immunohistochemical techniques, we found a discrepancy in the survival of grafted projection neurons with respect to grafted interneurons as well as major ongoing inflammatory and immune responses to the grafted tissue with evidence of mutant huntingtin aggregates within the transplant area. Our results indicate that grafts can survive more than a decade post-transplantation, but show compromised survival with inflammation and mutant protein being observed within the transplant site. Ann Neurol 2018;84:950-956.
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Affiliation(s)
- Alexander Maxan
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Sarah Mason
- John van Geest Centre for Brain Repair and Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Martine Saint-Pierre
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Emma Smith
- John van Geest Centre for Brain Repair and Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Aileen Ho
- John van Geest Centre for Brain Repair and Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Harrower
- Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, United Kingdom
| | - Colin Watts
- John van Geest Centre for Brain Repair and Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Yen Tai
- John van Geest Centre for Brain Repair and Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Nicola Pavese
- Department of Medicine, Neurology Imaging Unit, Imperial College London, London, United Kingdom
| | - Julie C Savage
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada.,Département de médecine moléculaire, Université Laval, Québec, QC, Canada
| | - Marie-Ève Tremblay
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada.,Département de médecine moléculaire, Université Laval, Québec, QC, Canada
| | - Peter Gould
- Laboratoire de neuropathology, Hôpital de l'Enfant-Jésus-CHU de Québec, Québec, QC, United Kingdom
| | - Anne E Rosser
- Brain Repair Group and BRAIN unit, Neuroscience and Mental Health Research Institute and School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Stephen B Dunnett
- Brain Repair Group and BRAIN unit, Neuroscience and Mental Health Research Institute and School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Paola Piccini
- Department of Medicine, Neurology Imaging Unit, Imperial College London, London, United Kingdom
| | - Roger A Barker
- John van Geest Centre for Brain Repair and Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada.,Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada
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25
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Piccini P, Venturini E, Bianchi L, Galli L, de Martino M, Bassi A. Bilateral Painful Erythematous Nodules on the Sole. J Pediatr 2018; 199:278. [PMID: 29730146 DOI: 10.1016/j.jpeds.2018.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Paola Piccini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence, Italy
| | - Elisabetta Venturini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence, Italy
| | - Leila Bianchi
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence, Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence, Italy
| | - Andrea Bassi
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence, Italy
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26
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Lee JY, Lao-Kaim NP, Pasquini J, Deuschl G, Pavese N, Piccini P. Pallidal dopaminergic denervation and rest tremor in early Parkinson's disease: PPMI cohort analysis. Parkinsonism Relat Disord 2018; 51:101-104. [PMID: 29503156 DOI: 10.1016/j.parkreldis.2018.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/30/2018] [Accepted: 02/20/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND s: Over recent years there have been some conflicting reports upon the role of pallidal dopaminergic denervation in rest tremor in Parkinson's disease. OBJECTIVES To clarify this issue we analyzed the clinical and 123I-FP-CIT SPECT data of a large cohort of early Parkinson's disease patients enrolled in the PPMI study. METHODS Pallidal and striatal dopamine transporter uptake ratios were calculated in 382 patients (120 no-tremor, 60 tremor-dominant, and 202 indeterminate) and 150 controls. A region of interest (ROI) approach was used to estimate DAT uptake ratios from 123I-FP-CIT SPECT scans in the caudate nucleus, putamen, and globus pallidus after normalization to a DAT template. DAT uptake ratios for each region were compared between subgroups using ANCOVA and linear regression analyses were performed to evaluate the relationship between severity of rest tremor and regional DAT uptake ratios. RESULTS PD patients had significantly lower DAT uptake ratios in the pallidum, putamen and caudate as compared to healthy controls (p < 0.001). ANCOVA showed inter-PD subgroup differences in DAT uptake ratios in the putamen and pallidum (p < 0.05) after adjustment for age and disease duration, with post-hoc comparisons revealing significantly higher DAT uptake ratios for the tremor-dominant subgroup as compared to non-tremor and indeterminate subgroups (p < 0.016). There was no significant relationship between rest tremor severity and pallidal DAT either in the tremor-dominant subgroup or in the total PD population. CONCLUSIONS Pallidal dopaminergic denervation appears unrelated to rest tremor severity in early Parkinson's disease.
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Affiliation(s)
- Jee-Young Lee
- Division of Brain Sciences, Neurology Imaging Unit, Imperial College London, Hammersmith Campus, UK; Department of Neurology, Seoul National University Boramae Hospital, South Korea.
| | - Nicholas P Lao-Kaim
- Division of Brain Sciences, Neurology Imaging Unit, Imperial College London, Hammersmith Campus, UK
| | - Jacopo Pasquini
- Dipartimento di medicina clinica e sperimentale, Pisa University, Italy
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Germany
| | - Nicola Pavese
- Institute of Neuroscience, Newcastle University, UK; Department of Nuclear Medicine & PET Centre, Aarhus University, Denmark
| | - Paola Piccini
- Division of Brain Sciences, Neurology Imaging Unit, Imperial College London, Hammersmith Campus, UK
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27
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Tersigni C, Venturini E, Cordola C, Piccini P, Bianchi L, Montagnani C, Sollai S, Chiappini E, de Martino M, Galli L. Latent tuberculosis in childhood: tolerability of two different therapeutic approaches. Expert Rev Anti Infect Ther 2018; 16:359-365. [PMID: 29465259 DOI: 10.1080/14787210.2018.1441025] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND Isoniazid monotherapy for six or nine months and the combination of isoniazid and rifampicin for three or four months are the most used regimens for treating latent tuberculosis. The main aim of this retrospective study is to evaluate the safety of latent tuberculosis treatment by analysing side effects in both regimens. RESEARCH DESIGN AND METHODS Children with latent tuberculosis and treated with isoniazid or isoniazid and rifampicin were included. Periodic evaluations with clinical assessment and blood exams were carried out to detect any adverse reaction, including elevated serum transaminases. RESULTS 441 children were included, 14.5% treated with isoniazid and 85.5% with isoniazid and rifampicin. Five patients under combined treatment developed hepatotoxicity within the first month. None of the patients under isoniazid monotherapy presented hepatotoxicity. A slight increase of transaminases level was found in both groups (18.7% in isoniazid and 10.3% in isoniazid/rifampicin groups, respectively) without causing discontinuation of treatment, with values normalization at the subsequent checks. CONCLUSIONS Both regimens resulted safe. Hepatotoxicity occurred rarely and within the first month. For this reason, it may be appropriate to perform liver function tests after about one month from the beginning of therapy to avoid diagnostic delays.
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Affiliation(s)
- Chiara Tersigni
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Elisabetta Venturini
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Chiara Cordola
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Paola Piccini
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Leila Bianchi
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Carlotta Montagnani
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Sara Sollai
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Elena Chiappini
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Maurizio de Martino
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Luisa Galli
- a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
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28
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Abstract
BACKGROUND Gender-based medicine is an innovative branch of biomedical research and represents a new perspective for the future of health research. Many studies have been published on gender medicine in adults but very few data regarding children are available. LITERATURE SEARCH AND RESULTS A literature search covering articles published between 1stJuly, 2006 and 1st February, 2017 and concerning children only was conducted using multiple keywords and standardized terminology in Pubmed database. The search was limited to English-language publications. All relevant articles on endocrines, neurological, psychiatric, gastrointestinal, immunological, oncological, rheumatic, pneumological disorders, infectious diseases and analgesia were evaluated and pertinent articles were included in this review. Most of the available studies on gender disparity in childhood are about endocrine and neuro-psychiatric disorders, while there are few data in other areas of medicine. CONCLUSIONS Even if several studies on pediatric gender differences can be found on literature, few of them move forwards to analyze the reasons of the observed diversity. No data on pharmacokinetic and pharmacodynamic differences between boys and girls can be found. Hence, more efforts should be directed to investigate these topics in childhood.
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Affiliation(s)
- Paola Piccini
- Post Graduate Pediatric School, University of Florence, Anna Meyer Children’s University Hospital, viale Gaetano Pieraccini 24, I-50139 Florence, Italy
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Anna Meyer Children’s University Hospital, viale Gaetano Pieraccini 24, I-50139 Florence, Italy
| | - Maurizio de Martino
- Director Post Graduate Pediatric Scool University of Florence, Director Anna Meyer University Campus, viale Gaetano Pieraccini 24, I-50139 Florence, Italy
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Schwarz ST, Xing Y, Naidu S, Birchall J, Skelly R, Perkins A, Evans J, Sare G, Martin-Bastida A, Bajaj N, Gowland P, Piccini P, Auer DP. Protocol of a single group prospective observational study on the diagnostic value of 3T susceptibility weighted MRI of nigrosome-1 in patients with parkinsonian symptoms: the N3 iPD study (nigrosomal iron imaging in Parkinson's disease). BMJ Open 2017; 7:e016904. [PMID: 29247084 PMCID: PMC5736049 DOI: 10.1136/bmjopen-2017-016904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is the most common movement disorder in the elderly and is characterised clinically by bradykinesia, tremor and rigidity. Diagnosing Parkinson's can be difficult especially in the early stages. High-resolution nigrosome MRI offers promising diagnostic accuracy of patients with established clinical symptoms; however, it is unclear whether this may help to establish the diagnosis in the early stages of PD, when there is diagnostic uncertainty. In this scenario, a single photon emission CT scan using a radioactive dopamine transporter ligand can help to establish the diagnosis, or clinical follow-up may eventually clarify the diagnosis. A non-invasive, cost-effective diagnostic test that could replace this would be desirable. We therefore aim to prospectively test whether nigrosome MRI is as useful as DaTSCAN to establish the correct diagnosis in people with minor or unclear symptoms suspicious for PD. METHODS AND ANALYSIS In a prospective study we will recruit 145 patients with unclear symptoms possibly caused by Parkinson's from three movement disorder centres in the UK to take part in the study. We will record the Movement Disorder Society - Unified Parkinson's Disease Rating Scale, and participants will undergo DaTSCAN and high-resolution susceptibility weighted MRI at a field strength of 3T. DaTSCANs will be assessed visually and semiquantitatively; MRI scans will be visually assessed for signal loss in nigrosome-1 by blinded investigators. We will compare how the diagnosis suggested by MRI compares with the diagnosis based on DaTSCAN and will also validate the diagnosis based on the two tests with a clinical examination performed at least 1 year after the initial presentation as a surrogate gold standard diagnostic test. ETHICS AND DISSEMINATION The local ethics commission (Health Research Authority East Midlands - Derby Research Ethics Committee) has approved this study (REC ref.: 16/EM/0229). The study is being carried out under the principles of the Declaration of Helsinki (64th, 2013) and Good Clinical Practice standards. We have included a number of 15 research-funded DaTSCAN in the research protocol. This is to compensate for study site-specific National Health Service funding for this investigation in affected patients. We therefore have also obtained approval from the Administration of Radioactive Substances Administration Committee (ARSAC Ref 253/3629/35864). All findings will be presented at relevant scientific meetings and published in peer-reviewed journals, on the study website, and disseminated in lay and social media where appropriate. TRIAL REGISTRATION NUMBER NCT03022357; Pre-results.
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Affiliation(s)
- Stefan T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Radiology, Cardiff and Vale University Health Board, Cardiff University Hospitals, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), University of Cardiff, Cardiff, UK
| | - Yue Xing
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals, Department of Nuclear Medicine, Queen's Medical Centre, Nottingham, UK
| | - Saadnah Naidu
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jim Birchall
- Department of Nuclear Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Rob Skelly
- Department of Elderly Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Alan Perkins
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals, Department of Nuclear Medicine, Queen's Medical Centre, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Jonathan Evans
- Department of Neurology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Gill Sare
- Department of Neurology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Antonio Martin-Bastida
- Centre for Neuroinflammation and Neurodegeneration, Imperial College London, London, W12 0NN, UK
| | - Nin Bajaj
- Department of Neurology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Paola Piccini
- Centre for Neuroinflammation and Neurodegeneration, Imperial College London, London, W12 0NN, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham University Hospital Trusts and University of Nottingham, Nottingham, UK
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Roussakis AA, Towey D, Piccini P. PO105 Levodopa-induced dyskinesias in parkinson’s: imaging of striatal dat density over time. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Martin-Bastida A, Lao-Kaim NP, Xing Y, Loane C, Roussakis AA, Schwarz ST, Foltynie T, Barker RA, Auer DP, Piccini P. PO088 Nigral iron susceptibility in parkinson’s disease: a longitudinal study. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Li X, Xing Y, Martin-Bastida A, Piccini P, Auer DP. Patterns of grey matter loss associated with motor subscores in early Parkinson's disease. Neuroimage Clin 2017; 17:498-504. [PMID: 29201638 PMCID: PMC5700824 DOI: 10.1016/j.nicl.2017.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/13/2017] [Accepted: 11/08/2017] [Indexed: 12/22/2022]
Abstract
Classical motor symptoms of Parkinson's disease (PD) such as tremor, rigidity, bradykinesia, and axial symptoms are graded in the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III. It is yet to be ascertained whether parkinsonian motor symptoms are associated with different anatomical patterns of neurodegeneration as reflected by brain grey matter (GM) alteration. This study aimed to investigate associations between motor subscores and brain GM at voxel level. High resolution structural MRI T1 scans from the Parkinson's Progression Markers Initiative (PPMI) repository were employed to estimate brain GM intensity of PD subjects. Correlations between GM intensity and total MDS-UPDRS III and its four subscores were computed. The total MDS-UPDRS III score was significantly negatively correlated bilaterally with putamen and caudate GM density. Lower anterior striatal GM intensity was significantly associated with higher rigidity subscores, whereas left-sided anterior striatal and precentral cortical GM reduction were correlated with severity of axial symptoms. No significant morphometric associations were demonstrated for tremor subscores. In conclusion, we provide evidence for neuroanatomical patterns underpinning motor symptoms in early PD.
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Affiliation(s)
- Xingfeng Li
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
| | - Yue Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Antonio Martin-Bastida
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Paola Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
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Li W, Lao-Kaim NP, Roussakis AA, Martín-Bastida A, Valle-Guzman N, Paul G, Loane C, Widner H, Politis M, Foltynie T, Barker RA, Piccini P. 11 C-PE2I and 18 F-Dopa PET for assessing progression rate in Parkinson's: A longitudinal study. Mov Disord 2017; 33:117-127. [PMID: 29082547 DOI: 10.1002/mds.27183] [Citation(s) in RCA: 33] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND 18 F-dopa PET measuring aromatic l-amino acid decarboxylase activity is regarded as the gold standard for evaluating dopaminergic function in Parkinson's disease. Radioligands for dopamine transporters are also used in clinical trials and for confirming PD diagnosis. Currently, it is not clear which imaging marker is more reliable for assessing clinical severity and rate of progression. The objective of this study was to directly compare 18 F-dopa with the highly selective dopamine transporter radioligand 11 C-PE2I for the assessment of motor severity and rate of progression in PD. METHODS Thirty-three mild-moderate PD patients underwent 18 F-dopa and 11 C-PE2I PET at baseline. Twenty-three were followed up for 18.8 ± 3.4 months. RESULTS Standard multiple regression at baseline indicated that 11 C-PE2I BPND predicted UPDRS-III and bradykinesia-rigidity scores (P < 0.05), whereas 18 F-dopa Ki did not make significant unique explanatory contributions. Voxel-wise analysis showed negative correlations between 11 C-PE2I BPND and motor severity across the whole striatum bilaterally. 18 F-Dopa Ki clusters were restricted to the most affected putamen and caudate. Longitudinally, negative correlations were found between striatal Δ11 C-PE2I BPND , ΔUPDRS-III, and Δbradykinesia-rigidity, whereas no significant associations were found for Δ18 F-dopa Ki . One cluster in the most affected putamen was identified in the longitudinal voxel-wise analysis showing a negative relationship between Δ11 C-PE2I BPND and Δbradykinesia-rigidity. CONCLUSIONS Striatal 11 C-PE2I appears to show greater sensitivity for detecting differences in motor severity than 18 F-dopa. Furthermore, dopamine transporter decline is closely associated with motor progression over time, whereas no such relationship was found with aromatic l-amino acid decarboxylase. 11 C-PE2I may be more effective for evaluating the efficacy of neuroprotective treatments in PD. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Weihua Li
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - Nick P Lao-Kaim
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - Andreas A Roussakis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - Antonio Martín-Bastida
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Gesine Paul
- Translational Neurology Group, Department of Clinical Sciences, Wallenberg Neuroscience Centre, Lund University, Lund, Sweden.,Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Clare Loane
- Memory Research Group, Nuffield Department of Clinical Neurosciences, Medical Science Division. University of Oxford, Oxford, UK
| | - Håkan Widner
- Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Paola Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
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Li W, Lao-Kaim N, Roussakis A, Martin-Bastida A, Loane C, Valle-Guzman N, Kefalopoulou Z, Politis M, Foltynie T, Barker R, Piccini P. Longitudinal comparison of 11C-PE2I and 18F-DOPA pet for assessing severity and rate of disease progression in patients with Parkinson’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Roussakis A, Towey D, Piccini P. Longitudinal single-photon emitted computed tomography (SPECT) study of striatal dopamine transporter (DAT) density: Relevance to levodopa-induced dyskinesias in Parkinson’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pietracupa S, Martin-Bastida A, Piccini P. Iron metabolism and its detection through MRI in parkinsonian disorders: a systematic review. Neurol Sci 2017; 38:2095-2101. [DOI: 10.1007/s10072-017-3099-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023]
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37
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Politis M, Wilson H, Wu K, Brooks DJ, Piccini P. Chronic exposure to dopamine agonists affects the integrity of striatal D 2 receptors in Parkinson's patients. Neuroimage Clin 2017; 16:455-460. [PMID: 28879087 PMCID: PMC5577411 DOI: 10.1016/j.nicl.2017.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/06/2017] [Accepted: 08/12/2017] [Indexed: 01/27/2023]
Abstract
We aimed to investigate the integrity and clinical relevance of striatal dopamine receptor type-2 (D2R) availability in Parkinson's disease (PD) patients. We studied 68 PD patients, spanning from early to advanced disease stages, and 12 healthy controls. All participants received one [11C]raclopride PET scan in an OFF medication condition for quantification of striatal D2R availability in vivo. Parametric images of [11C]raclopride non-displaceable binding potential were generated from the dynamic [11C]raclopride scans using implementation of the simplified reference tissue model with cerebellum as the reference tissue. PET data were interrogated for correlations with clinical data related to disease burden and dopaminergic treatment. PD patients showed a mean 16.7% decrease in caudate D2R and a mean 3.5% increase in putaminal D2R availability compared to healthy controls. Lower caudate [11C]raclopride BPND correlated with longer PD duration. PD patients on dopamine agonist treatment had 9.2% reduced D2R availability in the caudate and 12.8% in the putamen compared to PD patients who never received treatment with dopamine agonists. Higher amounts of lifetime dopamine agonist therapy correlated with reduced D2Rs availability in both caudate and putamen. No associations between striatal D2R availability and levodopa treatment and dyskinesias were found. In advancing PD the caudate and putamen D2R availability are differentially affected. Chronic exposure to treatment with dopamine agonists, but no levodopa, suppresses striatal D2R availability, which may have relevance to output signaling to frontal lobes and the occurrence of executive deficits, but not dyskinesias. D2R in caudate and putamen are differentially affected in PD. Loss of D2R in caudate correlates with longer disease duration. Dopamine agonists treatment, but not levodopa, suppresses caudate and putamen D2Rs. No association between striatal D2R availability, levodopa treatment and dyskinesia.
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Key Words
- AIMS, Abnormal Involuntary Movement Scale
- BDI-II, Beck Depression Inventory
- BPND, non-displaceable binding potential
- Basal ganglia
- D2R, dopamine receptor type-2
- Dopamine D2 receptors
- Dopamine agonists
- H&Y, Hoehn and Yahr staging
- LED, levodopa-equivalent-dose
- MMSE, Mini-Mental State Examination
- MRI, magnetic resonance imaging
- PD, Parkinson's disease
- PET
- PET, position emission tomography
- Parkinson's disease
- ROI, region of interest
- UPDRS, Unified Parkinson's Disease Rating Scale
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Affiliation(s)
- Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Heather Wilson
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Kit Wu
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - David J Brooks
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Positron Emission Tomography Center, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Paola Piccini
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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Abstract
Neuromelanin (NM) is a dark pigment that accumulates linearly with aging in substantia nigra (SN) and locus coeruleus (LC). The dual protective and toxic role of NM has been hypothesized according to its intraneuronal or extraneuronal deposition. The melanized dopaminergic neurons in SN and LC seem to have special vulnerability to neurodegeneration in Parkinson's disease (PD). The paramagnetic properties of NM due to its association to metals like iron induce T1 prolongation; hence the measurement of SN-sensitive contrast could be a useful diagnostic biomarker in neurodegenerative disease like PD and other atypical parkinsonisms. This paper will review NM histopathology and neurochemistry studies in health and diseases and the role of imaging targeting NM load in parkinsonian disorders.
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Affiliation(s)
- Antonio Martin-Bastida
- a Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences , Imperial College London , London , United Kingdom
| | - Sara Pietracupa
- b Department of Neurology , IRCCS Neuromed , Pozzilli , Italy
| | - Paola Piccini
- a Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences , Imperial College London , London , United Kingdom
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Martin-Bastida A, Ward RJ, Newbould R, Piccini P, Sharp D, Kabba C, Patel MC, Spino M, Connelly J, Tricta F, Crichton RR, Dexter DT. Brain iron chelation by deferiprone in a phase 2 randomised double-blinded placebo controlled clinical trial in Parkinson's disease. Sci Rep 2017; 7:1398. [PMID: 28469157 PMCID: PMC5431100 DOI: 10.1038/s41598-017-01402-2] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [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: 01/22/2016] [Accepted: 03/27/2017] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is associated with increased iron levels in the substantia nigra (SNc). This study evaluated whether the iron chelator, deferiprone, is well tolerated, able to chelate iron from various brain regions and improve PD symptomology. In a randomised double-blind, placebo controlled trial, 22 early onset PD patients, were administered deferiprone, 10 or 15 mg/kg BID or placebo, for 6 months. Patients were evaluated for PD severity, cognitive function, depression rating and quality of life. Iron concentrations were assessed in the substantia nigra (SNc), dentate and caudate nucleus, red nucleus, putamen and globus pallidus by T2* MRI at baseline and after 3 and 6 months of treatment. Deferiprone therapy was well tolerated and was associated with a reduced dentate and caudate nucleus iron content compared to placebo. Reductions in iron content of the SNc occurred in only 3 patients, with no changes being detected in the putamen or globus pallidus. Although 30 mg/kg deferiprone treated patients showed a trend for improvement in motor-UPDRS scores and quality of life, this did not reach significance. Cognitive function and mood were not adversely affected by deferiprone therapy. Such data supports more extensive clinical trials into the potential benefits of iron chelation in PD.
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Affiliation(s)
- Antonio Martin-Bastida
- Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Roberta J Ward
- Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.,Universite Catholique de Louvain, 1348, Louvain-la-Neuve, Belgium
| | - Rexford Newbould
- Imanova Ltd, Burlington Danes Building, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Paola Piccini
- Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - David Sharp
- Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Christina Kabba
- Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Maneesh C Patel
- Imaging Department, Charing Cross Hospital, Imperial College NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Michael Spino
- ApoPharma Inc. 200 Barmac Drive, Toronto, Ontario, M9L 2Z7, Canada
| | - John Connelly
- ApoPharma Inc. 200 Barmac Drive, Toronto, Ontario, M9L 2Z7, Canada
| | - Fernando Tricta
- ApoPharma Inc. 200 Barmac Drive, Toronto, Ontario, M9L 2Z7, Canada
| | | | - David T Dexter
- Centre for Neuroinflammation & Neurodegeneration, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.
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Strafella AP, Bohnen NI, Perlmutter JS, Eidelberg D, Pavese N, Van Eimeren T, Piccini P, Politis M, Thobois S, Ceravolo R, Higuchi M, Kaasinen V, Masellis M, Peralta MC, Obeso I, Pineda-Pardo JÁ, Cilia R, Ballanger B, Niethammer M, Stoessl JA. Molecular imaging to track Parkinson's disease and atypical parkinsonisms: New imaging frontiers. Mov Disord 2017; 32:181-192. [DOI: 10.1002/mds.26907] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 12/23/2022] Open
Affiliation(s)
- Antonio P. Strafella
- Morton and Gloria Shulman Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Neurology Div/Dept. Medicine, Toronto Western Hospital, UHN; Krembil Research Institute, UHN; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH; University of Toronto; Ontario Canada
| | - Nicolaas I. Bohnen
- University of Michigan & Veterans Administration Medical Center; Ann Arbor Michigan USA
| | - Joel S. Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy & Occupational Therapy; Washington University in St. Louis; St. Louis Missouri USA
| | - David Eidelberg
- Center for Neurosciences; The Feinstein Institute for Medical Research; Manhasset New York USA
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre; Newcastle University; Campus for Ageing & Vitality Newcastle upon Tyne United Kingdom
| | - Thilo Van Eimeren
- Multimodal Neuroimaging Group-Department of Nuclear Medicine Department of Neurology-University of Cologne; Institute of Neuroscience and Medicine, Jülich Research Center, German Center for Neurodegenerative Diseases (DZNE); Germany
| | - Paola Piccini
- Neurology Imaging Unit, Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus; Imperial College London; United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry; Psychology and Neuroscience, King's College London; London United Kingdom
| | - Stephane Thobois
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer; Université Lyon 1; CNRS, Centre de Neurosciences Cognitives; UMR 5229 Lyon France
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Movement Disorders and Parkinson Center; University of Pisa; Italy
| | - Makoto Higuchi
- National Institute of Radiological Sciences; National Institutes for Quantum and Radiological Science and Technology; Chiba Japan
| | - Valtteri Kaasinen
- Division of Clinical Neurosciences, Turku University Hospital; Department of Neurology; University of Turku; Turku PET Centre, University of Turku; Turku Finland
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; University of Toronto; Toronto Ontario Canada
| | - M. Cecilia Peralta
- Movement Disorder and Parkinson's Disease Program; CEMIC University Hospital; Buenos Aires Argentina
| | - Ignacio Obeso
- Centro Integral de Neurociencias (CINAC), Hospitales Madrid Puerta del Sur & Centro de Investigación Biomédica en Red; Enfermedades Neurodegenerativas (CIBERNED); Madrid Spain
| | - Jose Ángel Pineda-Pardo
- Centro Integral de Neurociencias (CINAC), Hospitales Madrid Puerta del Sur & Centro de Investigación Biomédica en Red; Enfermedades Neurodegenerativas (CIBERNED); Madrid Spain
| | - Roberto Cilia
- Parkinson Institute; ASST Gaetano Pini-CTO; Milan Italy
| | - Benedicte Ballanger
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Neuroplasticity & Neuropathology of Olfactory Perception Team; University Lyon; France
| | - Martin Niethammer
- Center for Neurosciences; The Feinstein Institute for Medical Research; Manhasset New York USA
| | - Jon A. Stoessl
- Pacific Parkinson's Research Centre & National Parkinson Foundation Centre of Excellence; University of British Columbia & Vancouver Coastal Health; Vancouver British Columbia Canada
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Martin-Bastida A, Lao-Kaim NP, Loane C, Politis M, Roussakis AA, Valle-Guzman N, Kefalopoulou Z, Paul-Visse G, Widner H, Xing Y, Schwarz ST, Auer DP, Foltynie T, Barker RA, Piccini P. Motor associations of iron accumulation in deep grey matter nuclei in Parkinson's disease: a cross-sectional study of iron-related magnetic resonance imaging susceptibility. Eur J Neurol 2016; 24:357-365. [PMID: 27982501 DOI: 10.1111/ene.13208] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE To determine whether iron deposition in deep brain nuclei assessed using high-pass filtered phase imaging plays a role in motor disease severity in Parkinson's disease (PD). METHODS Seventy patients with mild to moderate PD and 20 age- and gender-matched healthy volunteers (HVs) underwent susceptibility-weighted imaging on a 3 T magnetic resonance imaging scanner. Phase shifts (radians) in deep brain nuclei were derived from high-pass filtered phase images and compared between groups. Analysis of clinical laterality and correlations with motor severity (Unified Parkinson's Disease Rating Scale, Part III, UPDRS-III) were performed. Phase shifts (in radians) were compared between HVs and three PD subgroups divided according to UPDRS-III scores using analysis of covariance, adjusting for age and regional area. RESULTS Parkinson's disease patients had significantly (P < 0.001) higher radians than HVs bilaterally in the putamen, globus pallidus and substantia nigra (SN). The SN contralateral to the most affected side showed higher radians (P < 0.001) compared to the less affected side. SN radians positively correlated with UPDRS-III and bradykinesia-rigidity subscores, but not with tremor subscores. ancova followed by post hoc Bonferroni-adjusted pairwise comparisons revealed that SN radians were significantly greater in the PD subgroup with higher UPDRS-III scores compared to both lowest UPDRS-III PD and HV groups (P < 0.001). CONCLUSIONS Increased nigral iron accumulation in PD appears to be stratified according to disease motor severity and correlates with symptoms related to dopaminergic neurodegeneration. This semi-quantitative in vivo iron assessment could prove useful for objectively monitoring PD progression, especially in clinical trials concerning iron chelation therapies.
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Affiliation(s)
- A Martin-Bastida
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - N P Lao-Kaim
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - C Loane
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK.,Memory Research Group, Nuffield Department of Clinical Neurosciences, Medical Science Division, University of Oxford, Oxford, UK
| | - M Politis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK.,Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A A Roussakis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - N Valle-Guzman
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Z Kefalopoulou
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - G Paul-Visse
- Translational Neurology Group, Department of Clinical Sciences, Wallenberg Neuroscience Centre, Lund University, Lund, Sweden
| | - H Widner
- Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Y Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - S T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - D P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - T Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - R A Barker
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - P Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
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42
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Politis M, Lahiri N, Niccolini F, Su P, Wu K, Giannetti P, Scahill RI, Turkheimer FE, Tabrizi SJ, Piccini P. Corrigendum to "Increased central microglial activation associated with peripheral cytokine levels in premanifest Huntington's disease gene carriers" [Neurobiol. Dis. 83 (2015) 115-121]. Neurobiol Dis 2016; 98:162. [PMID: 27939917 DOI: 10.1016/j.nbd.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Nayana Lahiri
- Huntington's Disease Research Group, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Flavia Niccolini
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Paul Su
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Kit Wu
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Paolo Giannetti
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Rachael I Scahill
- Huntington's Disease Research Group, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Federico E Turkheimer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Research Group, Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Paola Piccini
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.
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Politis M, Sauerbier A, Loane C, Pavese N, Martin A, Corcoran B, Brooks DJ, Ray-Chaudhuri K, Piccini P. Sustained striatal dopamine levels following intestinal levodopa infusions in Parkinson's disease patients. Mov Disord 2016; 32:235-240. [PMID: 27859651 DOI: 10.1002/mds.26848] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 04/10/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate in vivo the ability of levodopa/carbidopa intestinal gel infusions to produce sustained striatal dopamine levels and to improve clinical outcomes in Parkinson's disease patients. METHODS Six advanced Parkinson's disease patients had serial [11 C]raclopride PET to assess levodopa/carbidopa intestinal gel infusion-induced rises in striatal dopamine as reflected by a fall in dopamine-D2/3 receptor availability. Parkinson's disease patients had baseline scan OFF-dopaminergic stimulation and 2 scans following initiation of levodopa/carbidopa intestinal gel infusions. Striatal D2/3 binding was measured in striatal subregions corresponding to sensorimotor, limbic, and cognitive/associative function. RESULTS Mean striatal [11 C]raclopride nondisplaceable binding potential decreased by 14.0% to 16.7% in sensorimotor, 12.0%-14.4% in limbic, and 8.7%-11.6% in cognitive/associative function subregions at 1- to 10-hour points (P < 0.01). Sensorimotor subregion [11 C]raclopride nondisplaceable binding potential reductions correlated with reductions in Unified Parkinson's Disease Rating Scale Part III scores over the course of the infusion (r = 0.81; P < 0.05). CONCLUSIONS Levodopa/carbidopa intestinal gel infusions generate a stable rise in striatal dopamine levels and are associated with improvements in motor manifestations. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Anna Sauerbier
- Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Clare Loane
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Memory Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU
| | - Nicola Pavese
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Department of Nuclear Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Martin
- Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK
| | - Benjamin Corcoran
- Department of Nuclear Medicine, King's College Hospital Foundation Trust, London, UK
| | - David J Brooks
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Department of Nuclear Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Division of Neurology, Newcastle University, Newcastle upon Tyne, UK
| | - K Ray-Chaudhuri
- Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Paola Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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44
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Roussakis AA, Lao-Kaim N, Martin-Bastida A, Valle-Guzman N, Kefalopoulou Z, Paul-Visse G, Widner H, Politis M, Foltynie T, Barker R, Piccini P. LEVODOPA-INDUCED DYSKINESIA IN PARKINSON'S: A LONGITUDINAL PET STUDY. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.113] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
To date, little is known about how neurodegeneration and neuroinflammation propagate in Huntington's disease (HD). Unfortunately, no treatment is available to cure or reverse the progressive decline of function caused by the disease, thus considering HD a fatal disease. Mutation gene carriers typically remain asymptomatic for many years although alterations in the basal ganglia and cortex occur early on in mutant HD gene-carriers. Positron Emission Tomography (PET) is a functional imaging technique of nuclear medicine which enables in vivo visualization of numerous biological molecules expressed in several human tissues. Brain PET is most powerful to study in vivo neuronal and glial cells function as well as cerebral blood flow in a plethora of neurodegenerative disorders including Parkinson's disease, Alzheimer's and HD. In absence of HD-specific biomarkers for monitoring disease progression, previous PET studies in HD were merely focused on the study of dopaminergic terminals, cerebral blood flow and glucose metabolism in manifest and premanifest HD-gene carriers. More recently, research interest has been exploring novel PET targets in HD including the state of phosphodiesterse expression and the role of activated microglia. Hence, a better understanding of the HD pathogenesis mechanisms may lead to the development of targeted therapies. PET imaging follow-up studies with novel selective PET radiotracers such as 11C-IMA-107 and 11C-PBR28 may provide insight on disease progression and identify prognostic biomarkers, elucidate the underlying HD pathology and assess novel pharmaceutical agents and over time.
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Affiliation(s)
| | - Paola Piccini
- Correspondence to: Professor Paola Piccini, Imperial CollegeLondon, Hammersmith Hospital, Neurology Imaging Unit, 1stfloor, B-Block, Du Cane Road, London, W12 0NN, UK. Tel.: +44 2083833773; Fax: +44 2033131783; E-mail:
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46
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Affiliation(s)
| | - A. Paoletti
- Istituto dì Clinica Ostetrica e Ginecologica, Università di Pisa, Italy
| | - P. Piccini
- Muratorio A. Istituto di Clinica Neurologica
| | - A. Colzi
- Muratorio A. Istituto di Clinica Neurologica
| | - A. Nuti
- Istituto dì Clinica Ostetrica e Ginecologica, Università di Pisa, Italy
| | - G.B. Melis
- Istituto dì Clinica Ostetrica e Ginecologica, Università di Pisa, Italy
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47
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Colasanti A, Guo Q, Giannetti P, Wall MB, Newbould RD, Bishop C, Onega M, Nicholas R, Ciccarelli O, Muraro PA, Malik O, Owen DR, Young AH, Gunn RN, Piccini P, Matthews PM, Rabiner EA. Hippocampal Neuroinflammation, Functional Connectivity, and Depressive Symptoms in Multiple Sclerosis. Biol Psychiatry 2016; 80:62-72. [PMID: 26809249 PMCID: PMC4918731 DOI: 10.1016/j.biopsych.2015.11.022] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/04/2015] [Accepted: 11/25/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Depression, a condition commonly comorbid with multiple sclerosis (MS), is associated more generally with elevated inflammatory markers and hippocampal pathology. We hypothesized that neuroinflammation in the hippocampus is responsible for depression associated with MS. We characterized the relationship between depressive symptoms and hippocampal microglial activation in patients with MS using the 18-kDa translocator protein radioligand [(18)F]PBR111. To evaluate pathophysiologic mechanisms, we explored the relationships between hippocampal neuroinflammation, depressive symptoms, and hippocampal functional connectivities defined by resting-state functional magnetic resonance imaging. METHODS The Beck Depression Inventory (BDI) was administered to 11 patients with MS and 22 healthy control subjects before scanning with positron emission tomography and functional magnetic resonance imaging. We tested for higher [(18)F]PBR111 uptake in the hippocampus of patients with MS relative to healthy control subjects and examined the correlations between [(18)F]PBR111 uptake, BDI scores, and hippocampal functional connectivities in the patients with MS. RESULTS Patients with MS had an increased hippocampal [(18)F]PBR111 distribution volume ratio relative to healthy control subjects (p = .024), and the hippocampal distribution volume ratio was strongly correlated with the BDI score in patients with MS (r = .86, p = .006). Hippocampal functional connectivities to the subgenual cingulate and prefrontal and parietal regions correlated with BDI scores and [(18)F]PBR111 distribution volume ratio. CONCLUSIONS Our results provide evidence that hippocampal microglial activation in MS impairs the brain functional connectivities in regions contributing to maintenance of a normal affective state. Our results suggest a rationale for the responsiveness of depression in some patients with MS to effective control of brain neuroinflammation. Our findings also lend support to further investigation of the role of inflammatory processes in the pathogenesis of depression more generally.
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Affiliation(s)
- Alessandro Colasanti
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Imanova Centre for Imaging Sciences, London, United Kingdom.
| | - Qi Guo
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Paolo Giannetti
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | | | | | - Mayca Onega
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Richard Nicholas
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Olga Ciccarelli
- Department of Neuroinflammation, University College London Institute of Neurology, London, United Kingdom,National Institute of Health Research Biomedical Research Centre at University College London Hospitals, London, United Kingdom
| | - Paolo A. Muraro
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Omar Malik
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - David R. Owen
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Allan H. Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Roger N. Gunn
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom,Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Paola Piccini
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Paul M. Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Eugenii A. Rabiner
- Psychological Medicine, and Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,Imanova Centre for Imaging Sciences, London, United Kingdom
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48
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Rolinski M, Griffanti L, Piccini P, Roussakis AA, Szewczyk-Krolikowski K, Menke RA, Quinnell T, Zaiwalla Z, Klein JC, Mackay CE, Hu MTM. Basal ganglia dysfunction in idiopathic REM sleep behaviour disorder parallels that in early Parkinson's disease. Brain 2016; 139:2224-34. [PMID: 27297241 PMCID: PMC4958897 DOI: 10.1093/brain/aww124] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 12/02/2022] Open
Abstract
See Postuma (doi:10.1093/aww131) for a scientific commentary on this article. Resting state functional magnetic resonance imaging dysfunction within the basal ganglia network is a feature of early Parkinson’s disease and may be a diagnostic biomarker of basal ganglia dysfunction. Currently, it is unclear whether these changes are present in so-called idiopathic rapid eye movement sleep behaviour disorder, a condition associated with a high rate of future conversion to Parkinson’s disease. In this study, we explore the utility of resting state functional magnetic resonance imaging to detect basal ganglia network dysfunction in rapid eye movement sleep behaviour disorder. We compare these data to a set of healthy control subjects, and to a set of patients with established early Parkinson’s disease. Furthermore, we explore the relationship between resting state functional magnetic resonance imaging basal ganglia network dysfunction and loss of dopaminergic neurons assessed with dopamine transporter single photon emission computerized tomography, and perform morphometric analyses to assess grey matter loss. Twenty-six patients with polysomnographically-established rapid eye movement sleep behaviour disorder, 48 patients with Parkinson’s disease and 23 healthy control subjects were included in this study. Resting state networks were isolated from task-free functional magnetic resonance imaging data using dual regression with a template derived from a separate cohort of 80 elderly healthy control participants. Resting state functional magnetic resonance imaging parameter estimates were extracted from the study subjects in the basal ganglia network. In addition, eight patients with rapid eye movement sleep behaviour disorder, 10 with Parkinson’s disease and 10 control subjects received 123I-ioflupane single photon emission computerized tomography. We tested for reduction of basal ganglia network connectivity, and for loss of tracer uptake in rapid eye movement sleep behaviour disorder and Parkinson’s disease relative to each other and to controls. Connectivity measures of basal ganglia network dysfunction differentiated both rapid eye movement sleep behaviour disorder and Parkinson’s disease from controls with high sensitivity (96%) and specificity (74% for rapid eye movement sleep behaviour disorder, 78% for Parkinson’s disease), indicating its potential as an indicator of early basal ganglia dysfunction. Rapid eye movement sleep behaviour disorder was indistinguishable from Parkinson’s disease on resting state functional magnetic resonance imaging despite obvious differences on dopamine transported single photon emission computerized tomography. Basal ganglia connectivity is a promising biomarker for the detection of early basal ganglia network dysfunction, and may help to identify patients at risk of developing Parkinson’s disease in the future. Future risk stratification using a polymodal approach could combine basal ganglia network connectivity with clinical and other imaging measures, with important implications for future neuroprotective trials in rapid eye movement sleep behaviour disorder.
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Affiliation(s)
- Michal Rolinski
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Paola Piccini
- 4 Division of Clinical Neurosciences and MRC Clinical Sciences Centre, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Andreas A Roussakis
- 4 Division of Clinical Neurosciences and MRC Clinical Sciences Centre, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Konrad Szewczyk-Krolikowski
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ricarda A Menke
- 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Timothy Quinnell
- 5 Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
| | - Zenobia Zaiwalla
- 6 Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford, UK
| | - Johannes C Klein
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Clare E Mackay
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 3 Centre for the functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK 7 Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michele T M Hu
- 1 Oxford Parkinson's Disease Centre (OPDC), Oxford, UK 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Loane C, Politis M, Kefalopoulou Z, Valle-Guzman N, Paul G, Widner H, Foltynie T, Barker RA, Piccini P. Aberrant nigral diffusion in Parkinson's disease: A longitudinal diffusion tensor imaging study. Mov Disord 2016; 31:1020-6. [DOI: 10.1002/mds.26606] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Clare Loane
- Neurology Imaging Unit, Hammersmith Hospital, Imperial College London; London UK
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London; London UK
- Memory Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford; Oxford UK
| | - Marios Politis
- Neurology Imaging Unit, Hammersmith Hospital, Imperial College London; London UK
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London; London UK
| | - Zinovia Kefalopoulou
- Sobell Department of Motor Neuroscience, University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square; London England
| | - Natalie Valle-Guzman
- John Van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge; Cambridge UK
| | - Gesine Paul
- Translational Neurology Group, Department of Clinical Sciences, Wallenberg Neuroscience Center, Lund University; Lund Sweden
| | - Hakan Widner
- Division of Neurology; Department of Clinical Sciences; Lund University, Skane University Hospital; Sweden
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square; London England
| | - Roger A. Barker
- Department of Clinical Neuroscience; University of Cambridge; Cambridge UK
- MRC Cognition and Brian Sciences Unit; University of Cambridge; Cambridge UK
| | - Paola Piccini
- Neurology Imaging Unit, Hammersmith Hospital, Imperial College London; London UK
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50
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Roussakis AA, Politis M, Towey D, Piccini P. Serotonin-to-dopamine transporter ratios in Parkinson disease: Relevance for dyskinesias. Neurology 2016; 86:1152-8. [PMID: 26920358 DOI: 10.1212/wnl.0000000000002494] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether a serotonin-to-dopamine terminal ratio is related to the appearance of dyskinesias in patients with Parkinson disease (PD). METHODS Twenty-eight patients with idiopathic PD (17 with levodopa-induced dyskinesias [LIDs], 11 without dyskinesias) and 12 age-matched healthy controls were studied with PET and 5[(11)C]-3-amino-4-(2-dimethylaminomethylphenyl-sulfanyl)-benzonitrile ((11)C-DASB) and with SPECT and [(123)I]N-w-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane ((123)I-ioflupane), which are in vivo specific markers of the serotonin and dopamine transporters' availability, respectively. We have employed a simplified reference tissue model for the quantification of (11)C-DASB, whereas a semiquantification approach was used for (123)I-ioflupane data. We calculated (11)C-DASB binding to (123)I-ioflupane uptake ratios for the caudate and the putamen. RESULTS Patients with PD showed striatal decreases in (11)C-DASB binding potential (p < 0.01) and in (123)I-ioflupane mean uptake (p < 0.001) compared to controls. The mean (11)C-DASB binding to (123)I-ioflupane uptake ratio in the putamen was 0.779 (increased by 75.8% of the controls' mean) for the nondyskinetic group and 0.901 (increased by 103.4% of the controls' mean) for the patients with dyskinesias. There was a statistically significant difference (p < 0.001) in (11)C-DASB binding to (123)I-ioflupane uptake ratio in the putamen between the group of patients with and without dyskinesias. Higher (11)C-DASB to (123)I-ioflupane binding ratios correlated with longer disease duration for the 28 patients with PD (r = 0.52; p < 0.01). CONCLUSIONS Serotonin-to-dopamine transporter binding ratio increases as PD progresses and patients experience LIDs. Our findings suggest that, when the dopaminergic innervation in the striatum is critically low, the serotonergic system plays an important role in development of LIDs.
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Affiliation(s)
- Andreas-Antonios Roussakis
- From the Neurology Imaging Unit (A.-A.R., P.P.), Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus, Imperial College London; Neurodegeneration Imaging Group (M.P.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Radiological Sciences Unit (D.T.), Imperial College Healthcare NHS Trust, London, UK
| | - Marios Politis
- From the Neurology Imaging Unit (A.-A.R., P.P.), Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus, Imperial College London; Neurodegeneration Imaging Group (M.P.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Radiological Sciences Unit (D.T.), Imperial College Healthcare NHS Trust, London, UK
| | - David Towey
- From the Neurology Imaging Unit (A.-A.R., P.P.), Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus, Imperial College London; Neurodegeneration Imaging Group (M.P.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Radiological Sciences Unit (D.T.), Imperial College Healthcare NHS Trust, London, UK
| | - Paola Piccini
- From the Neurology Imaging Unit (A.-A.R., P.P.), Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus, Imperial College London; Neurodegeneration Imaging Group (M.P.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Radiological Sciences Unit (D.T.), Imperial College Healthcare NHS Trust, London, UK.
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