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Korpela S, Sundblom J, Zetterberg H, Constantinescu R, Svenningsson P, Paucar M, Niemelä V. Cerebrospinal fluid glial fibrillary acidic protein, in contrast to amyloid beta protein, is associated with disease symptoms in Huntington's disease. J Neurol Sci 2024; 459:122979. [PMID: 38569376 DOI: 10.1016/j.jns.2024.122979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Huntington's disease (HD) is a hereditary neurodegenerative disease, currently lacking disease-modifying treatments. Biomarkers are needed for objective assessment of disease progression. Evidence supports both complex protein aggregation and astrocyte activation in HD. This study assesses the 42 amino acid long amyloid beta (Aβ42) and glial fibrillary acidic protein (GFAP) as potential biomarkers in the cerebrospinal fluid (CSF) of HD mutation carriers. METHODS CSF from participants was obtained from three sites in Sweden. Clinical symptoms were graded with the composite Unified Huntington's disease rating scale (cUHDRS). Protein concentrations were measured using ELISA. Pearson correlations were calculated to assess disease progression association. Results were adjusted for age and collection site. RESULTS The study enrolled 28 manifest HD patients (ManHD), 13 premanifest HD gene-expansion carriers (PreHD) and 20 controls. Aβ42 levels did not differ between groups and there was no correlation with measures of disease progression. GFAP concentration was higher in ManHD (424 ng/l, SD 253) compared with both PreHD (266 ng/l, SD 92.4) and controls (208 ng/l, SD 83.7). GFAP correlated with both cUHDRS (r = -0.77, p < 0.001), and 5-year risk of disease onset (r = 0.70, p = 0.008). CONCLUSION We provide evidence that indicates CSF Aβ42 has limited potential as a biomarker for HD. GFAP is a potential biomarker of progression in HD. Validation in larger cohorts measuring GFAP in blood and CSF would be of interest.
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Affiliation(s)
- Sara Korpela
- Department of Medicine, Neurology, Västerås Central Hospital, Västerås, Sweden
| | - Jimmy Sundblom
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology, Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Paucar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Valter Niemelä
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
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Fernandes Gomes B, Farris CM, Ma Y, Concha-Marambio L, Lebovitz R, Nellgård B, Dalla K, Constantinescu J, Constantinescu R, Gobom J, Andreasson U, Zetterberg H, Blennow K. α-Synuclein seed amplification assay as a diagnostic tool for parkinsonian disorders. Parkinsonism Relat Disord 2023; 117:105807. [PMID: 37591709 DOI: 10.1016/j.parkreldis.2023.105807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Synucleinopathies such as Parkinson's disease (PD) and multiple system atrophy (MSA) can be challenging to diagnose due to the symptom overlap with, for example, atypical parkinsonisms like progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Seed amplification assays (SAA), developed for the detection of α-synuclein (αSyn) aggregates in CSF, have been successful when used as a biomarker evaluation for synucleinopathies. In this study, we investigated the potential of this assay to not only detect αSyn seeds in CSF, but also discriminate between movement disorders. METHODS The αSyn-SAA was tested in a Scandinavian cohort composed of 129 CSF samples from patients with PD (n = 55), MSA (n = 27), CBD (n = 7), and PSP (n = 16), as well as healthy controls (HC, n = 24). RESULTS The αSyn seed amplification assay (αSyn-SAA) was able to correctly identify all PD samples as positive (sensitivity of 100%) while also discriminating the PD group from HC (70.8% specificity, p < 0.0001) and tauopathies [CBD (71% specificity) and PSP (75% specificity), p < 0.0001)]. The αSyn-SAA was also able to identify almost all MSA samples as positive for αSyn aggregation (sensitivity of 92.6%). In general, this assay is able to discriminate between the synucleinopathies and tauopathies analyzed herein (p < 0.0001) despite the overlapping symptoms in these diseases. CONCLUSION These findings suggest the αSyn-SAA is a useful diagnostic tool for differentiating between different parkinsonian disorders, although further optimization may be needed.
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Affiliation(s)
- Bárbara Fernandes Gomes
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
| | | | - Yihua Ma
- R&D Unit, Amprion Inc., San Diego, CA, 92121, USA
| | | | | | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Radu Constantinescu
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Gobom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ulf Andreasson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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Weiner S, Sauer M, Brinkmalm G, Constantinescu J, Constantinescu R, Gomes BF, Becker B, Nellgård B, Dalla K, Galasko D, Zetterberg H, Blennow K, Gobom J. SCRN1: A cerebrospinal fluid biomarker correlating with tau in Alzheimer's disease. Alzheimers Dement 2023; 19:4609-4618. [PMID: 36946611 DOI: 10.1002/alz.13042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/27/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Secernin-1 (SCRN1) is a neuronal protein that co-localizes with neurofibrillary tangles in Alzheimer's disease (AD), but not with tau inclusions in corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), or Pick's disease. METHODS We measured SCRN1 concentration in cerebrospinal fluid (CSF) using a novel mass spectrometric parallel reaction monitoring method in three clinical cohorts comprising patients with neurochemically characterized AD (n = 25) and controls (n = 28), clinically diagnosed Parkinson's disease (PD; n = 38), multiple system atrophy (MSA; n = 31), PSP (n = 20), CBD (n = 8), healthy controls (n = 37), and neuropathology-confirmed AD (n = 47). RESULTS CSF SCRN1 was significantly increased in AD (P < 0.01, fold change = 1.4) compared to controls (receiver operating characteristic area under the curve = 0.78) but not in CBD, PSP, PD, or MSA. CSF SCRN1 positively correlated with CSF total tau (R = 0.78, P = 1.1 × 10-13 ), phosphorylated tau181 (R = 0.64, P = 3.2 × 10-8 ), and Braak stage and negatively correlated with Mini-Mental State Examination score. DISCUSSION CSF SCRN1 is a candidate biomarker of AD, reflecting tau pathology. HIGHLIGHTS We developed a parallel reaction monitoring assay to measure secernin-1 (SCRN1) in cerebrospinal fluid (CSF). CSF SCRN1 was increased in Alzheimer's disease compared to healthy controls. CSF SCRN1 remained unchanged in Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, or corticobasal degeneration compared to controls. CSF SCRN1 correlated strongly with CSF phosphorylated tau and total tau. CSF SCRN1 increased across Braak stages and negatively correlated with Mini-Mental State Examination score.
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Affiliation(s)
- Sophia Weiner
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Mathias Sauer
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Gunnar Brinkmalm
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Julius Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Bárbara Fernandes Gomes
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Bruno Becker
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Gobom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
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Stevens-Jones O, Mojzisova H, Elisak M, Constantinescu R, Hanzalova J, Axelsson M, Krysl D. Paraneoplastic or not? Sirtuin 2 in anti-N-methyl-d-aspartate receptor encephalitis. Eur J Neurol 2023; 30:3228-3235. [PMID: 37483157 DOI: 10.1111/ene.15987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND PURPOSE N-methyl-d-aspartate receptor (NMDAR) and leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis are important types of autoimmune encephalitis (AE) with significant morbidity. In this study, we used a proteomic approach in search of novel clinically relevant biomarkers in these types of encephalitides. METHODS Swedish and Czech tertiary neuroimmunology centers collaborated in this retrospective exploratory study. Fifty-eight cerebrospinal fluid (CSF) samples of 28 patients with AE (14 definite NMDAR, 14 with definite LGI1 encephalitis) and 30 controls were included. CSF samples were analyzed using proximity extension assay technology (Olink Target 96 Inflammation panel). For each CSF sample, 92 proteins were measured. Clinical variables were retrospectively collected, and correlations with protein levels were statistically analyzed. RESULTS Patients and controls differed significantly in the following 18 biomarkers: TNFRSF9, TNFRSF12, TNFRSF14, TNFβ, TNFα, IL7, IL10, IL12B, IFNγ, CD5, CD6, CASP8, MMP1, CXCL8, CXCL10, CXCL11, IL20RA, and sirtuin 2 (SIRT2). In LGI1 encephalitis, no clinically useful association was found between biomarkers and clinical variables. In the NMDAR encephalitis group, SIRT2, TNFβ, and CD5 were significantly associated with ovarian teratoma. For SIRT2, this was true even for the first patients' CSF sample (SIRT2 without vs. with tumor, mean ± SD = 2.2 ± 0.29 vs. 2.88 ± 0.48; p = 0.007, 95% confidence interval = -1.15 to -0.22; r statistic in point-biserial correlation (rpb) = 0.66, p = 0.011). SIRT2 was positively correlated with age (rpb = 0.39, p = 0.018) and total hospital days (r = 0.55, p = <0.001). CONCLUSIONS SIRT2 should be investigated as a biomarker of paraneoplastic etiology in NMDAR encephalitis.
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Affiliation(s)
- Oskar Stevens-Jones
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden
| | - Hana Mojzisova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Elisak
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Radu Constantinescu
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden
| | - Jitka Hanzalova
- Department of Immunology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Markus Axelsson
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden
| | - David Krysl
- Institute of Neuroscience and Physiology, Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Clinical Neurophysiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Stevens-Jones O, Malmeström C, Constantinescu C, Dalla K, Nellgård B, Zelano J, Constantinescu R, Axelsson M. Presence of neural surface and onconeural autoantibodies in cerebrospinal fluid and serum in neurological diseases presents a potential risk for misdiagnosis. Eur J Neurol 2023; 30:2602-2610. [PMID: 37312655 DOI: 10.1111/ene.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Autoantibodies have been found to contribute to pathology and are used in the diagnosis of some neurological diseases. We examined the prevalence of autoantibodies in patients with various neurological diseases and whether patients who had autoantibodies differed in age, sex, or disability from those who did not. METHODS We examined the prevalence of neural surface and onconeural autoantibodies in cerebrospinal fluid (CSF) and serum from patients with multiple sclerosis (n = 64), Parkinson disease plus atypical parkinsonism (n = 150), amyotrophic lateral sclerosis (n = 43), or autoimmune encephalitis (positive control; n = 7) and a healthy control group (n = 37). A total of 12 onconeural autoantibodies and six neural surface autoantibodies were tested in all participants. RESULTS Autoantibodies were present in all cohorts. The prevalence of autoantibodies was high (>80%) in the autoimmune encephalitis cohort but low (<20%) in all other cohorts. When comparing patients within cohorts who were positive for autoantibodies to patients who were not, there was no difference in age, sex, and disability. This was apart from the multiple sclerosis and Parkinson disease plus atypical parkinsonism cohorts, where those with positivity for autoantibodies in the CSF were significantly older. CONCLUSIONS The presence of the autoantibodies examined does not appear to have a substantial clinical impact within the diseases examined in this study. The presence of autoantibodies in all cohorts presents a risk for misdiagnosis when the method is used incorrectly on patients with atypical clinical presentation.
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Affiliation(s)
- Oskar Stevens-Jones
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clas Malmeström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clara Constantinescu
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Keti Dalla
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Zelano
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center of Molecular and Translational Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Axelsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nilsson J, Constantinescu J, Nellgård B, Jakobsson P, Brum WS, Gobom J, Forsgren L, Dalla K, Constantinescu R, Zetterberg H, Hansson O, Blennow K, Bäckström D, Brinkmalm A. Cerebrospinal Fluid Biomarkers of Synaptic Dysfunction are Altered in Parkinson's Disease and Related Disorders. Mov Disord 2023; 38:267-277. [PMID: 36504237 DOI: 10.1002/mds.29287] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Synaptic dysfunction and degeneration are central contributors to the pathogenesis and progression of parkinsonian disorders. Therefore, identification and validation of biomarkers reflecting pathological synaptic alterations are greatly needed and could be used in prognostic assessment and to monitor treatment effects. OBJECTIVE To explore candidate biomarkers of synaptic dysfunction in Parkinson's disease (PD) and related disorders. METHODS Mass spectrometry was used to quantify 15 synaptic proteins in two clinical cerebrospinal fluid (CSF) cohorts, including PD (n1 = 51, n2 = 101), corticobasal degeneration (CBD) (n1 = 11, n2 = 3), progressive supranuclear palsy (PSP) (n1 = 22, n2 = 21), multiple system atrophy (MSA) (n1 = 31, n2 = 26), and healthy control (HC) (n1 = 48, n2 = 30) participants, as well as Alzheimer's disease (AD) (n2 = 23) patients in the second cohort. RESULTS Across both cohorts, lower levels of the neuronal pentraxins (NPTX; 1, 2, and receptor) were found in PD, MSA, and PSP, compared with HC. In MSA and PSP, lower neurogranin, AP2B1, and complexin-2 levels compared with HC were observed. In AD, levels of 14-3-3 zeta/delta, beta- and gamma-synuclein were higher compared with the parkinsonian disorders. Lower pentraxin levels in PD correlated with Mini-Mental State Exam scores and specific cognitive deficits (NPTX2; rho = 0.25-0.32, P < 0.05) and reduced dopaminergic pre-synaptic integrity as measured by DaTSCAN (NPTX2; rho = 0.29, P = 0.023). Additionally, lower levels were associated with the progression of postural imbalance and gait difficulty symptoms (All NPTX; β-estimate = -0.025 to -0.038, P < 0.05) and cognitive decline (NPTX2; β-estimate = 0.32, P = 0.021). CONCLUSIONS These novel findings show different alterations of synaptic proteins in parkinsonian disorders compared with AD and HC. The neuronal pentraxins may serve as prognostic CSF biomarkers for both cognitive and motor symptom progression in PD. © 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)
- Johanna Nilsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Julius Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Protik Jakobsson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Wagner S Brum
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Johan Gobom
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - David Bäckström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Ann Brinkmalm
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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Clim A, Toma A, Zota RD, Constantinescu R. The Need for Cybersecurity in Industrial Revolution and Smart Cities. Sensors (Basel) 2022; 23:120. [PMID: 36616718 PMCID: PMC9824218 DOI: 10.3390/s23010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Cities have grown in development and sophistication throughout human history. Smart cities are the current incarnation of this process, with increased complexity and social importance. This complexity has come to involve significant digital components and has thus come to raise the associated cybersecurity concerns. Major security relevant events can cascade into the connected systems making up a smart city, causing significant disruption of function and economic damage. The present paper aims to survey the landscape of scientific publication related to cybersecurity-related issues in relation to smart cities. Relevant papers were selected based on the number of citations and the quality of the publishing journal as a proxy indicator for scientific relevance. Cybersecurity will be shown to be reflected in the selected literature as an extremely relevant concern in the operation of smart cities. Generally, cybersecurity is implemented in actual cities through the concerted application of both mature existing technologies and emerging new approaches.
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Constantinescu R, Istrate A, Sumping JC, Dye C, Schiborra F, Mortier JR. Computed tomographic findings in dogs with suspected aspiration pneumonia: 38 cases (2014‐2019). J Small Anim Pract 2022; 64:280-287. [PMID: 36428285 DOI: 10.1111/jsap.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/26/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe computed tomographic (CT) findings in dogs diagnosed with aspiration pneumonia and to assess for any correlation with patient outcome. MATERIALS AND METHODS Retrospective analysis of 38 cases with a presumptive diagnosis of aspiration pneumonia at two UK referral centres. Medical records were reviewed for signalment, history, physical examination and clinicopathologic data. CT examinations of the thorax were reviewed by the European College of Veterinary Diagnostic Imaging board-certified radiologist for all dogs to describe the characteristics and distribution of the pulmonary lesions. RESULTS The most common CT findings were lung lobe consolidation associated with air bronchograms (100%) followed by ground-glass attenuation (89.4%), bronchial wall thickening (36.8%), bronchiolectasis (31.5%) and bronchiectasis (15.7%). Large-breed dogs were overrepresented. Duration of hospitalisation ranged between 0 and 8 days (mean 3 days). Overall, 89.4% of dogs survived the aspiration event and were discharged from the hospital. The four dogs that did not survive to discharge had five or more lobes affected on CT. CLINICAL SIGNIFICANCE CT findings in dogs with aspiration pneumonia are described. CT is a useful imaging modality to diagnose aspiration pneumonia.
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Affiliation(s)
| | - A. Istrate
- Pride Veterinary Centre, Riverside Road Derby DE24 8HX UK
| | - J. C. Sumping
- Small Animal Teaching Hospital Institute of Veterinary Science, University of Liverpool, Chester High Road Neston CH647TE UK
| | - C. Dye
- Pride Veterinary Centre, Riverside Road Derby DE24 8HX UK
| | - F. Schiborra
- Small Animal Teaching Hospital Institute of Veterinary Science, University of Liverpool, Chester High Road Neston CH647TE UK
| | - J. R. Mortier
- Centre Hospitalier Universitaire Vétérinaire d'Alfort, École Nationale Vétérinaire d'Alfort Maisons‐Alfort 94700 France
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9
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Lukkarinen H, Jeppsson A, Wikkelsö C, Blennow K, Zetterberg H, Constantinescu R, Remes AM, Herukka SK, Hiltunen M, Rauramaa T, Nägga K, Leinonen V, Tullberg M. Cerebrospinal fluid biomarkers that reflect clinical symptoms in idiopathic normal pressure hydrocephalus patients. Fluids Barriers CNS 2022; 19:11. [PMID: 35123528 PMCID: PMC8817565 DOI: 10.1186/s12987-022-00309-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background The relationship between cerebrospinal fluid (CSF) biomarkers and the clinical features of idiopathic normal pressure hydrocephalus (iNPH) has been inconclusive. We aimed to evaluate CSF biomarkers reflecting Alzheimer’s disease (AD)-related amyloid β (Aβ) aggregation, tau pathology, neuroinflammation and axonal degeneration in relation to the clinical features of pre- and post-shunt surgery in iNPH patients. Methods Mini Mental State Examination (MMSE) scores and gait velocity were evaluated pre- and postoperatively in cohorts of 65 Finnish (FIN) and 82 Swedish (SWE) iNPH patients. Lumbar CSF samples were obtained prior to shunt surgery and analysed for soluble amyloid precursor protein alpha (sAPPα) and beta (sAPPβ); amyloid-β isoforms of 42, 40 and 38 (Aβ42, Aβ40, Aβ38); total tau (T-tau); phosphorylated tau (P-tau181); neurofilament light (NfL) and monocyte chemoattractant protein 1 (MCP1). Results Preoperative patient characteristics showed no significant differences between patients in the FIN and SWE cohorts. Patients in both cohorts had significantly improved gait velocity after shunt surgery (p < 0.0001). Low CSF T-tau and absence of apolipoprotein E ε4 predicted over 20% gait improvement postoperatively (p = 0.043 and p = 0.008). Preoperative CSF T-tau, P-tau181 and NfL correlated negatively with MMSE scores both pre- (p < 0.01) and post-surgery (p < 0.01). Furthermore, T-tau, NfL and Aβ42 correlated with MMSE outcomes (p < 0.05). Low preoperative CSF P-tau181 (p = 0.001) and T-tau with NfL (p < 0.001 and p = 0.049) best predicted pre- and postoperative MMSE scores greater than or equal to 26. Conclusions CSF biomarkers of neurodegeneration appeared to correlate with pre- and postoperative cognition, providing a window into neuropathological processes. In addition, preoperative CSF neurodegeneration biomarkers may have potential in the prediction of gait and cognitive outcomes after shunt surgery.
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10
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von Euler Chelpin M, Söderberg L, Fälting J, Möller C, Giorgetti M, Constantinescu R, Blennow K, Zetterberg H, Höglund K. Alpha-Synuclein Protofibrils in Cerebrospinal Fluid: A Potential Biomarker for Parkinson's Disease. J Parkinsons Dis 2021; 10:1429-1442. [PMID: 33016895 DOI: 10.3233/jpd-202141] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Currently, there is no established biomarker for Parkinson's disease (PD) and easily accessible biomarkers are crucial for developing disease-modifying treatments. OBJECTIVE To develop a novel method to quantify cerebrospinal fluid (CSF) levels of α-synuclein protofibrils (α-syn PF) and apply it to clinical cohorts of patients with PD and atypical parkinsonian disorders. METHODS A cohort composed of 49 patients with PD, 12 with corticobasal degeneration (CBD), 22 with progressive supranuclear palsy, and 33 controls, that visited the memory clinic but had no biomarker signs of Alzheimer's disease (AD, tau<350 pg/mL, amyloid-beta 42 (Aβ42)>530 pg/mL, and phosphorylated tau (p-tau)<60 pg/mL) was used in this study. The CSF samples were analyzed with the Single molecule array (Simoa) technology. Total α-synuclein (α-syn) levels were analyzed with a commercial ELISA-kit. RESULTS The assay is specific to α-syn PF, with no cross-reactivity to monomeric α-syn, or the β- and γ-synuclein variants. CSF α-syn PF levels were increased in PD compared with controls (62.1 and 40.4 pg/mL, respectively, p = 0.03), and CBD (62.1 and 34.2 pg/mL, respectively, p = 0.02). The accuracy of predicting PD using α-syn PF is significantly different from controls (area under the curve 0.68, p = 0.0097) with a sensitivity of 62.8% and specificity of 67.7%. Levels of total α-syn were significantly different between the PD and CBD groups (p = 0.04). CONCLUSION The developed method specifically quantifies α-syn PF in human CSF with increased concentrations in PD, but with an overlap with asymptomatic elderly controls.
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Affiliation(s)
- Marianne von Euler Chelpin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | | | | | | | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kina Höglund
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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11
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Constantinescu C, Novakova L, Brandt AF, Malmeström C, Constantinescu R, Axelsson M, Lycke J. Persons with suspicious onset of multiple sclerosis but with undetermined diagnosis had persistent lower cognition and reduced quality of life. Mult Scler Relat Disord 2021; 52:102977. [PMID: 33964570 DOI: 10.1016/j.msard.2021.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGOUND Differential diagnosis of multiple sclerosis (MS) includes a variety of disorders and misdiagnosis is common. OBJECTIVE To follow-up persons with suspected onset of MS but in whom the diagnostic investigation was negative. METHODS In a prospective study including 271 persons with clinical features of suspected MS onset, 136 persons were diagnosed with MS or clinically isolated syndrome (PwMS), 46 had other disorders, and 89 persons had a negative diagnostic work-up, i.e. persons with undetermined diagnosis (PwUD). They underwent diagnostic reassessment, and those who remained without a diagnosis were investigated for signs of pathology including cognitive tests and assessments of quality of life (QoL). Results were compared with those of PwMS and 24 age and sex matched healthy controls (HC). RESULTS After reassement 55 (20%) persons still had undetermined diagnosis (PwUD). They had similar age and gender distribution as PwMS. In 76% of PwUD, the suspected clinical onset included sensory symptoms. PwUD and PwMS scored similarly in cognitive tests and QoL but significantly lower than HC. At 3 years follow-up, PwMS and PwUD improved in most test parameters, but PwUD scored lower than PwMS in cognition. CONCLUSION PwUD constituted the dominating differential diagnosis in persons with suspected clinical onset of MS. QoL and cognition were comparable with those of PwMS but significantly lower than in HC.
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Affiliation(s)
- Clara Constantinescu
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gotheburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gotheburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | - Clas Malmeström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gotheburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gotheburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gotheburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gotheburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Niemela V, Landtblom AM, Nyholm D, Kneider M, Constantinescu R, Paucar M, Svenningsson P, Abujrais S, Burman J, Shevchenko G, Bergquist J, Sundblom J. Proenkephalin Decreases in Cerebrospinal Fluid with Symptom Progression of Huntington's Disease. Mov Disord 2020; 36:481-491. [PMID: 33247616 PMCID: PMC7984171 DOI: 10.1002/mds.28391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Identifying molecular changes that contribute to the onset and progression of Huntington's disease (HD) is of importance for the development and evaluation of potential therapies. METHODS We conducted an unbiased mass-spectrometry proteomic analysis on the cerebrospinal fluid of 12 manifest HD patients (ManHD), 13 pre-manifest (preHD), and 38 controls. A biologically plausible and significant possible biomarker was validated in samples from a separate cohort of patients and controls consisting of 23 ManHD patients and 23 controls. RESULTS In ManHD compared to preHD, 10 proteins were downregulated and 43 upregulated. Decreased levels of proenkephalin (PENK) and transthyretin were closely linked to HD symptom severity, whereas levels of 15 upregulated proteins were associated with symptom severity. The decreased PENK levels were replicated in the separate cohort where absolute quantitation was performed. CONCLUSIONS We hypothesize that declining PENK levels reflect the degeneration of medium spiny neurons (MSNs) that produce PENK and that assays for PENK may serve as a surrogate marker for the state of MSNs in HD. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Valter Niemela
- Department of Neuroscience; Neurology, Uppsala University, Uppsala, Sweden
| | | | - Dag Nyholm
- Department of Neuroscience; Neurology, Uppsala University, Uppsala, Sweden
| | - Maria Kneider
- Institute of Neuroscience and Physiology; Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology; Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Paucar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sandy Abujrais
- Analytical Chemistry, Department of Chemistry - BMC, Uppsala University, Uppsala, Sweden
| | - Joachim Burman
- Department of Neuroscience; Neurology, Uppsala University, Uppsala, Sweden
| | - Ganna Shevchenko
- Analytical Chemistry, Department of Chemistry - BMC, Uppsala University, Uppsala, Sweden
| | - Jonas Bergquist
- Analytical Chemistry, Department of Chemistry - BMC, Uppsala University, Uppsala, Sweden
| | - Jimmy Sundblom
- Department of Neuroscience; Neurosurgery, Uppsala University, Uppsala, Sweden
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13
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Aghanavesi S, Westin J, Bergquist F, Nyholm D, Askmark H, Aquilonius SM, Constantinescu R, Medvedev A, Spira J, Ohlsson F, Thomas I, Ericsson A, Buvarp DJ, Memedi M. A multiple motion sensors index for motor state quantification in Parkinson's disease. Comput Methods Programs Biomed 2020; 189:105309. [PMID: 31982667 DOI: 10.1016/j.cmpb.2019.105309] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 06/10/2023]
Abstract
AIM To construct a Treatment Response Index from Multiple Sensors (TRIMS) for quantification of motor state in patients with Parkinson's disease (PD) during a single levodopa dose. Another aim was to compare TRIMS to sensor indexes derived from individual motor tasks. METHOD Nineteen PD patients performed three motor tests including leg agility, pronation-supination movement of hands, and walking in a clinic while wearing inertial measurement unit sensors on their wrists and ankles. They performed the tests repeatedly before and after taking 150% of their individual oral levodopa-carbidopa equivalent morning dose.Three neurologists blinded to treatment status, viewed patients' videos and rated their motor symptoms, dyskinesia, overall motor state based on selected items of Unified PD Rating Scale (UPDRS) part III, Dyskinesia scale, and Treatment Response Scale (TRS). To build TRIMS, out of initially 178 extracted features from upper- and lower-limbs data, 39 features were selected by stepwise regression method and were used as input to support vector machines to be mapped to mean reference TRS scores using 10-fold cross-validation method. Test-retest reliability, responsiveness to medication, and correlation to TRS as well as other UPDRS items were evaluated for TRIMS. RESULTS The correlation of TRIMS with TRS was 0.93. TRIMS had good test-retest reliability (ICC = 0.83). Responsiveness of the TRIMS to medication was good compared to TRS indicating its power in capturing the treatment effects. TRIMS was highly correlated to dyskinesia (R = 0.85), bradykinesia (R = 0.84) and gait (R = 0.79) UPDRS items. Correlation of sensor index from the upper-limb to TRS was 0.89. CONCLUSION Using the fusion of upper- and lower-limbs sensor data to construct TRIMS provided accurate PD motor states estimation and responsive to treatment. In addition, quantification of upper-limb sensor data during walking test provided strong results.
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Affiliation(s)
| | - Jerker Westin
- Department of Computer Engineering, Dalarna University, Falun, Sweden.
| | - Filip Bergquist
- Department of Pharmacology at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Dag Nyholm
- Department of Neuroscience, Neurology at Uppsala University, Uppsala, Sweden.
| | - Håkan Askmark
- Department of Neuroscience, Neurology at Uppsala University, Uppsala, Sweden.
| | | | - Radu Constantinescu
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden.
| | - Alexander Medvedev
- Department of Information Technology, at Uppsala University, Uppsala, Sweden.
| | | | | | - Ilias Thomas
- Department of Statistics, Dalarna University, Falun, Sweden.
| | | | - Dongni Johansson Buvarp
- Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
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14
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Cocan D, Miresan V, Popescu F, Constantinescu R, Coroian A, Latiu C, Turcu RVF, Farcasanu AS, Martonos C. MRI Investigations on Venomous Glands of Brown Bullhead, Ameiurus nebulosus (Lesueur, 1819) (Actinopterygii: Ictaluridae). PAK J ZOOL 2020. [DOI: 10.17582/journal.pjz/20180717090711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Coroian CO, Miresan V, Raducu C, Costea C, Constantinescu R, Coroian A, Bentea MI, Simeanu D, Radu-Rusu CG, Latiu C, Cocan D. Oxidative Stress and Haematological Response in Rainbow Trout (Oncorhynchus Mykiss) Fed With Brewer Yeast (Saccharomyces Cerevisiae) as Nutritional Supplement. Rev Chim 2019. [DOI: 10.37358/rc.19.10.7634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Production of freshwater fish evolved constantly over the past decades in parallel with increasing the amount of ingredients conventionally used to feed these fish. From the main ingredients, those protein based are the most expensive and increasingly difficult to obtain. Fishmeal demands valuable alternative ingredients to replace it and yeasts seem to offer new protein sources, but not only, acting as probiotics in fish feed. We tested productive and physiological benefits of brewer yeast (Saccharomyces cerevisiae) added 1.5% in standard rainbow trout (Oncorhynchus mykiss) nutrition with Coppens fodder (2 mm granulation) with 45% crude protein (CP) over a period of 45 days, starting at an average live weight of 56.86 gramsin a classical system of breeding. Production parameters as average daily gain (ADG), total live gain (TLG) and feed conversion rate (FCR) but also hematologic and biochemical blood parameters have been evaluated. Yeast fed batch presented higher productive indices but not statistically represented. Significant differences were observed in hematological parameters for hemoglobin, very significant response of yeast fed batch regarding gamma globulins (GGL) level and significant changes were also recorded for total proteins (TP). Significantly lower values for amylase were revealed, while enzymatic profile shown significant differences in alkaline phosphatase (PAL) and creatinine phosphokinase (CPK). Overall, 1.5% of dried brewer yeast added to standard fodder in rainbow trout das led to a better use of feed and a strengthening of immunity.
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16
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Zelano J, Axelsson M, Constantinescu R, Malmeström C, Kumlien E. Neuronal antibodies in adult patients with new-onset seizures: A prospective study. Brain Behav 2019; 9:e01442. [PMID: 31588654 PMCID: PMC6851805 DOI: 10.1002/brb3.1442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/14/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Immunotherapy in addition to antiepileptic drugs can improve seizure freedom rates in autoimmune epilepsy, highlighting the importance of early diagnosis. A diagnosis of autoimmune epilepsy can be supported by presence of serum antibodies to neuronal antigens. We asked how often neuronal antibodies are found in the serum of unselected adult patients with new-onset seizures and whether such testing could improve detection of autoimmune epilepsy. MATERIAL AND METHODS We included 44 patients over the age of 25 presenting after at least one unprovoked seizure to the Neurology Clinic at Sahlgrenska University Hospital, Gothenburg, Sweden. The median time between the first-ever seizure in life and the serum sampling was 50 days (range 22-11,000). Antibody testing in serum was performed according to the manufacturer's instructions. The patients were followed for at least 1 year. RESULTS Epilepsy could be diagnosed already at the first visit in 21/44 patients (47.7%). Two patients (4.5%) were positive for neuronal antibodies: one against contactin-associated protein 2 (CASPR-2) and one against glutamate acid decarboxylase (GAD). Three patients (6.7%) displayed very weak immunoreactivity that was deemed clinically insignificant. One of the antibody-positive patients had only a single seizure. The other had a focal cortical dysplasia and was seizure-free on levetiracetam. None of the five patients with antibodies or immunoreactivity displayed any feature of autoimmune epilepsy. CONCLUSIONS We conclude that indiscriminate testing in patients presenting to a first seizure clinic with new-onset seizures or epilepsy is unlikely to improve detection of autoimmune epilepsy.
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Affiliation(s)
- Johan Zelano
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clas Malmeström
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Laboratory for Clinical immunology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Kumlien
- Department of Neurology, Uppsala University, Uppsala, Sweden
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17
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Jeppsson A, Wikkelsö C, Blennow K, Zetterberg H, Constantinescu R, Remes AM, Herukka SK, Rauramaa T, Nagga K, Leinonen V, Tullberg M. CSF biomarkers distinguish idiopathic normal pressure hydrocephalus from its mimics. J Neurol Neurosurg Psychiatry 2019; 90:1117-1123. [PMID: 31167811 PMCID: PMC6817981 DOI: 10.1136/jnnp-2019-320826] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 03/18/2019] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the differential diagnostic significance of cerebrospinal fluid (CSF) biomarkers reflecting Alzheimer's disease-related amyloid β (Aβ) production and aggregation, cortical neuronal damage, tau pathology, damage to long myelinated axons and astrocyte activation, which hypothetically separates patients with idiopathic normal pressure hydrocephalus (iNPH) from patients with other neurodegenerative disorders. METHODS The study included lumbar CSF samples from 82 patients with iNPH, 75 with vascular dementia, 70 with Parkinson's disease, 34 with multiple system atrophy, 34 with progressive supranuclear palsy, 15 with corticobasal degeneration, 50 with Alzheimer's disease, 19 with frontotemporal lobar degeneration and 54 healthy individuals (HIs). We analysed soluble amyloid precursor protein alpha (sAPPα) and beta (sAPPβ), Aβ species (Aβ38, Aβ40 and Aβ42), total tau (T-tau), phosphorylated tau, neurofilament light and monocyte chemoattractant protein 1 (MCP-1). RESULTS Patients with iNPH had lower concentrations of tau and APP-derived proteins in combination with elevated MCP-1 compared with HI and the non-iNPH disorders. T-tau, Aβ40 and MCP-1 together yielded an area under the curve of 0.86, differentiating iNPH from the other disorders. A prediction algorithm consisting of T-tau, Aβ40 and MCP-1 was designed as a diagnostic tool using CSF biomarkers. CONCLUSIONS The combination of the CSF biomarkers T-tau, Aβ40 and MCP-1 separates iNPH from cognitive and movement disorders with good diagnostic sensitivity and specificity. This may have important implications for diagnosis and clinical research on disease mechanisms for iNPH.
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Affiliation(s)
- Anna Jeppsson
- Hydrocephalus Research Unit, Department of clinical neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carsten Wikkelsö
- Hydrocephalus Research Unit, Department of clinical neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Radu Constantinescu
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Sanna-Kaisa Herukka
- Department of Neurology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Katarina Nagga
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Ville Leinonen
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland.,Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mats Tullberg
- Hydrocephalus Research Unit, Department of clinical neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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18
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Constantinescu R, Mahamud U, Constantinescu C, Eriksson B, Novakova L, Olsson B, Rosengren L, Blennow K, Axelsson M. Cerebrospinal fluid biomarkers in patients with neurological symptoms but without neurological diseases. Acta Neurol Scand 2019; 140:177-183. [PMID: 31087810 DOI: 10.1111/ane.13118] [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] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Elevated levels of the cerebrospinal fluid (CSF) neuronal injury markers (neurofilament light chain [NF-L] and total tau protein [t-tau]) and of the astroglial marker glial fibrillary acidic protein (GFAP) are found in etiologically different neurological disorders affecting the peripheral and the central nervous system. AIMS To explore the role of CSF biomarkers in the clinical management of patients admitted for alarming neurological symptoms, but in whom neurological disorders could be excluded. METHODS Study participants were patients seeking medical attention for neurological symptoms primarily considered to be caused by a neurological diagnosis and investigated according to clinical routine. Demographic, clinical, and CSF data were extracted retrospectively from medical records. Patients with a final neurological diagnosis were excluded. RESULTS Out of 990 patients, 900 with a neurological diagnosis were excluded leaving 90 patients without a final neurological diagnosis. Sixty-eight (75.6%) were females. Median (range) age at lumbar puncture was 34.7 (16.9-65.1) years. Age-adjusted CSF-NF-L, CSF-t-tau, and CSF-GFAP concentrations were normal in 89 (98.9%), 86 (95.6%), and 87 (96.7%) patients, respectively. CONCLUSION In patients with significant neurological symptoms but in whom a neurological diagnosis could not be made, the CSF markers NF-L, t-tau, and GFAP did not indicate signs of neuronal or astroglial cell damage close to symptom onset. Consequently, increased levels of CSF markers are not expected in this patient group and, if present, should raise suspicion of underlying neurological disorders and motivate further investigations.
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Affiliation(s)
- Radu Constantinescu
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ubah Mahamud
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Clara Constantinescu
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Barbro Eriksson
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Lenka Novakova
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Bob Olsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Lars Rosengren
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Markus Axelsson
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Neuroscience and Physiology at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Clim A, Zota R, Constantinescu R, Ilie-Nemedi I. Health services in smart cities: Choosing the big data mining based decision support. International Journal of Healthcare Management 2019. [DOI: 10.1080/20479700.2019.1650478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Antonio Clim
- The Department of Economic Informatics and Cybernetics, The Bucharest University of Economic Studies, Bucharest, Romania
| | - Răzvan Zota
- The Department of Economic Informatics and Cybernetics, The Bucharest University of Economic Studies, Bucharest, Romania
| | - Radu Constantinescu
- The Department of Economic Informatics and Cybernetics, The Bucharest University of Economic Studies, Bucharest, Romania
| | - Iulian Ilie-Nemedi
- The Department of Economic Informatics and Cybernetics, The Bucharest University of Economic Studies, Bucharest, Romania
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Constantinescu R, Rosengren L, Eriksson B, Blennow K, Axelsson M. Cerebrospinal fluid neurofilament light and tau protein as mortality biomarkers in parkinsonism. Acta Neurol Scand 2019; 140:147-156. [PMID: 31070772 DOI: 10.1111/ane.13116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mortality is increased in parkinsonian disorders, moderately in Parkinson's disease (PD) but markedly in atypical parkinsonian disorders (APD), including multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). Still, there are no reliable quantitative biomarkers for mortality. The cerebrospinal fluid (CSF) neurodegeneration biomarkers such as neurofilament light chain (NF-L), total tau (t-tau), and the tau pathology marker phosphorylated tau (p-tau) are related to mortality in other neurological disorders (eg, amyotrophic lateral sclerosis, Alzheimer's disease), but have not been investigated in this respect in parkinsonian disorders. AIMS To investigate the CSF biomarkers' (NF-L, t-tau, and p-tau) relationship to mortality in parkinsonian disorders. METHODS Demographic, mortality, and CSF data were collected from 68 PD and 83 APD patients. Survival analysis was conducted using Cox regression, with age at lumbar puncture, gender, diagnosis, and levels of CSF biomarkers as predictors. RESULTS NF-L in CSF was associated with increased mortality in synucleinopathies (PD, MSA; HR 3.698 [2.196-6.228, 95% confidence interval (CI)], P < 0.001), in PSP (HR 2.767 [1.126-6.802 95% CI], P = 0.027), and in the entire cohort (HR 1.661 [1.082-2.55, 95% CI], P = 0.02). t-Tau in CSF was associated with increased mortality in PSP (HR 9.587 [1.143-80.418], P = 0.037). p-Tau in CSF was associated with decreased mortality in synucleinopathies (HR 0.196 [0.041-0.929, 95% CI], P = 0.040). Atypical parkinsonian disorders and tauopathies were associated with higher mortality (HR 8.798 [4.516-17.14, 95% CI] and HR 3.040 [1.904-4.854], respectively, P < 0.001). CONCLUSION NF-L and tau protein in CSF might be useful for mortality prognosis in patients with parkinsonian disorders and should be investigated in larger studies.
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Affiliation(s)
- Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden
| | - Lars Rosengren
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden
| | - Barbro Eriksson
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Markus Axelsson
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden
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21
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Cicognola C, Brinkmalm G, Wahlgren J, Portelius E, Gobom J, Cullen NC, Hansson O, Parnetti L, Constantinescu R, Wildsmith K, Chen HH, Beach TG, Lashley T, Zetterberg H, Blennow K, Höglund K. Novel tau fragments in cerebrospinal fluid: relation to tangle pathology and cognitive decline in Alzheimer's disease. Acta Neuropathol 2019; 137:279-296. [PMID: 30547227 PMCID: PMC6514201 DOI: 10.1007/s00401-018-1948-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [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: 10/22/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/02/2023]
Abstract
Tau is an axonal microtubule-binding protein. Tau pathology in brain and increased tau concentration in the cerebrospinal fluid (CSF) are hallmarks of Alzheimer's disease (AD). Most of tau in CSF is present as fragments. We immunoprecipitated tau from CSF and identified several endogenous peptides ending at amino acid (aa) 123 or 224 using high-resolution mass spectrometry. We raised neo-epitope-specific antibodies against tau fragments specifically ending at aa 123 and 224, respectively. With these antibodies, we performed immunohistochemistry on brain tissue and designed immunoassays measuring N-123, N-224, and x-224 tau. Immunoassays were applied to soluble brain fractions from pathologically confirmed subjects (81 AD patients, 33 controls), CSF from three cross-sectional and two longitudinal cohorts (a total of 133 AD, 38 MCI, 20 MCI-AD, 31 PSP, 15 CBS patients, and 91 controls), and neuronally- and peripherally-derived extracellular vesicles (NDEVs and PDEVs, respectively) in serum from four AD patients and four controls. Anti-tau 224 antibody stained neurofibrillary tangles and neuropil threads, while anti-tau 123 only showed weak cytoplasmic staining in AD. N-224 tau was lower in the AD soluble brain fraction compared to controls, while N-123 tau showed similar levels. N-224 tau was higher in AD compared to controls in all CSF cohorts (p < 0.001), but not N-123 tau. Decrease in cognitive performance and conversion from MCI to AD were associated with increased baseline CSF levels of N-224 tau (p < 0.0001). N-224 tau concentrations in PSP and CBS were significantly lower than in AD (p < 0.0001) and did not correlate to t-tau and p-tau. In a longitudinal cohort, CSF N-224 tau levels were stable over 6 months, with no significant effect of treatment with AChE inhibitors. N-224 tau was present in NDEVs, while N-123 tau showed comparable concentrations in both vesicle types. We suggest that N-123 tau is produced both in CNS and PNS and represents a general marker of tau metabolism, while N-224 tau is neuron-specific, present in the tangles, secreted in CSF, and upregulated in AD, suggesting a link between tau cleavage and propagation, tangle pathology, and cognitive decline.
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Affiliation(s)
- Claudia Cicognola
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden.
| | - Gunnar Brinkmalm
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
| | - Jessica Wahlgren
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
| | - Erik Portelius
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Gobom
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nicholas C Cullen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Lucilla Parnetti
- Department of Medicine, Center for Memory Disturbances, Laboratory of Clinical Neurochemistry, Neurology Clinic, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology, Department of Neurology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kristin Wildsmith
- Biomarker Development Department, Genentech, South San Francisco, CA, USA
| | - Hsu-Hsin Chen
- Biomarker Discovery Department, Genentech, South San Francisco, CA, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders, Department of Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kina Höglund
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Göteborgsvägen 31, House V3/SU, 43180, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Novum, Huddinge, Stockholm, Sweden
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Constantinescu R, Blennow K, Rosengren L, Eriksson B, Gudmundsdottir T, Jansson Y, Johnels B, Renck A, Bergquist F. Cerebrospinal fluid protein markers in PD patients after DBS-STN surgery-A retrospective analysis of patients that underwent surgery between 1993 and 2001. Clin Neurol Neurosurg 2018; 174:174-179. [PMID: 30248592 DOI: 10.1016/j.clineuro.2018.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/11/2018] [Accepted: 09/15/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Cerebrospinal fluid (CSF) markers of neurodegeneration [neurofilament light chain (NFL), total Tau (T-Tau)], tau pathology [phosphorylated tau (p-Tau)], glial cell damage or activation [glial fibrillary acidic protein (GFAP)], and brain amyloidosis [β-amyloid 1-42 (Aβ42)] are useful for diagnosis and prognosis in several neurodegenerative disorders. In this paper we investigate these markers and their relationship to key clinical milestones in patients with advanced Parkinson´s disease (PD) operated at our center with subthalamic nucleus deep brain stimulation (STN-DBS) for at least 15 years ago. PATIENTS AND METHODS Retrospective analysis of available cerebrospinal fluid and clinical data in PD-patients, 15 years or more after they underwent STN-DBS surgery. All PD-patients implanted with STN-DBS at Sahlgrenska University Hospital before January 1, 2001, were regularly assessed until January 10, 2018, or until death, or until lost to follow-up. RESULTS Twenty three PD patients were operated with STN-DBS. Sixteen of these (six females and ten males) underwent at least one lumbar puncture (LP) immediately prior to or after STN-DBS. Their age at the latest available LP was 64 (55-75) years [median (range)], PD duration 20 (11-33) years, and Hoehn & Yahr (H&Y) stage 3 (2-4). Time between DBS operation and the last LP was 4.5 (0.3-10.8) years. Time from the last LP to the last follow up was 6 (0.1-18) years, and for the entire cohort 115 person-years. On January 10, 2018, four PD-patients (25%) were still alive. All preoperative CSF marker levels were normal. Between two days and six months after DBS, NFL and GFAP levels increased sharply but they normalized thereafter in most patients, and were normal up to almost 11 years after neurosurgery. Over time, all patients deteriorated slowly. At the last follow up, H&Y was 5 (3-5) and 12/16 were demented. There was no significant correlation between postoperative (> 6 months) CSF NFL, GFAP, T-Tau, p-Tau, β-amyloid levels and the presence of dementia, psychosis, inability to walk or need for nursing home at the time for LP, nor for presence of dementia at the last follow up or for death as of January 10, 2018. CONCLUSION CSF protein biomarkers remain normal despite long PD duration, severe disability, and chronic STN-DBS. They cannot be used for PD staging or prognostication but may indicate brain damage caused by other pathological factors.
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Affiliation(s)
- Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lars Rosengren
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Barbro Eriksson
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Thordis Gudmundsdottir
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Yvonne Jansson
- Department of Neurology, Norra Älvsborgs Länssjukhus, Sjukhuskansliet, 461 85, Trollhättan, Sweden
| | - Bo Johnels
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Annika Renck
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Filip Bergquist
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
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Dumitrescu SI, Boingiu R, Hantulie I, Popescu R, Savoiu D, Gurzun M, Stanciu S, Chiriac L, Bolohan R, Botezatu S, Constantinescu R. P1553PROCAM vs. SCORE: 10 years after. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S I Dumitrescu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - R Boingiu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - I Hantulie
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - R Popescu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - D Savoiu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - M Gurzun
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - S Stanciu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - L Chiriac
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - R Bolohan
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - S Botezatu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
| | - R Constantinescu
- 'Carol Davila' Emergency Clinical Military Hospital, Bucharest, Romania
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Constantinescu R, Eriksson B, Jansson Y, Johnels B, Holmberg B, Gudmundsdottir T, Renck A, Berglund P, Bergquist F. Key clinical milestones 15 years and onwards after DBS-STN surgery—A retrospective analysis of patients that underwent surgery between 1993 and 2001. Clin Neurol Neurosurg 2017; 154:43-48. [DOI: 10.1016/j.clineuro.2017.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/02/2017] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
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25
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Constantinescu R, Krýsl D, Andrén K, Asztély F, Bergquist F, Zetterberg H, Andreasson U, Axelsson M, Menachem EB, Jons D, Mahamud U, Malmeström C, Rosengren L, Blennow K. Cerebrospinal fluid markers of neuronal and glial cell damage in patients with autoimmune neurologic syndromes with and without underlying malignancies. J Neuroimmunol 2017; 306:25-30. [PMID: 28385184 DOI: 10.1016/j.jneuroim.2017.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/21/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 12/19/2022]
Abstract
Autoimmune neurologic syndromes can be paraneoplastic (associated with malignancies and/or onconeural antibodies), or non-paraneoplastic. Their clinical presentation is often similar. As prognosis is related to malignancy treatment, better biomarkers are needed to identify patients with malignancy. We investigated cerebrospinal fluid (CSF) markers of neuronal (neurofilament light chain, NFL and total tau protein, T-tau) and glial (glial fibrillary acidic protein) damage. CSF-NFL and T-tau were increased in both paraneoplastic and non-paraneoplastic autoimmune syndromes. Patients with manifest malignancies were older, had less epilepsy, more focal central and peripheral neurological signs and symptoms, and worse long-term outcome, than those without malignancy. CSF-NFL-levels predicted long-term outcome but were not diagnostic for malignancy, after age adjustment.
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Affiliation(s)
- Radu Constantinescu
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
| | - David Krýsl
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Kerstin Andrén
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Fredrik Asztély
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Neurology Department, Waikato Clinical Campus, Auckland University, New Zealand
| | - Filip Bergquist
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Ulf Andreasson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Markus Axelsson
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Elinor Ben Menachem
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Daniel Jons
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Ubah Mahamud
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Clas Malmeström
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Laboratory for Clinical immunology, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Lars Rosengren
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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26
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Hansson O, Janelidze S, Hall S, Magdalinou N, Lees AJ, Andreasson U, Norgren N, Linder J, Forsgren L, Constantinescu R, Zetterberg H, Blennow K. Blood-based NfL: A biomarker for differential diagnosis of parkinsonian disorder. Neurology 2017; 88:930-937. [PMID: 28179466 PMCID: PMC5333515 DOI: 10.1212/wnl.0000000000003680] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [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: 04/22/2016] [Accepted: 11/15/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine if blood neurofilament light chain (NfL) protein can discriminate between Parkinson disease (PD) and atypical parkinsonian disorders (APD) with equally high diagnostic accuracy as CSF NfL, and can therefore improve the diagnostic workup of parkinsonian disorders. METHODS The study included 3 independent prospective cohorts: the Lund (n = 278) and London (n = 117) cohorts, comprising healthy controls and patients with PD, progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA), as well as an early disease cohort (n = 109) of patients with PD, PSP, MSA, or CBS with disease duration ≤3 years. Blood NfL concentration was measured using an ultrasensitive single molecule array (Simoa) method, and the diagnostic accuracy to distinguish PD from APD was investigated. RESULTS We found strong correlations between blood and CSF concentrations of NfL (ρ ≥ 0.73-0.84, p ≤ 0.001). Blood NfL was increased in patients with MSA, PSP, and CBS (i.e., all APD groups) when compared to patients with PD as well as healthy controls in all cohorts (p < 0.001). Furthermore, in the Lund cohort, blood NfL could accurately distinguish PD from APD (area under the curve [AUC] 0.91) with similar results in both the London cohort (AUC 0.85) and the early disease cohort (AUC 0.81). CONCLUSIONS Quantification of blood NfL concentration can be used to distinguish PD from APD. Blood-based NfL might consequently be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that blood NfL levels discriminate between PD and APD.
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Affiliation(s)
- Oskar Hansson
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden.
| | - Shorena Janelidze
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Sara Hall
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Nadia Magdalinou
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Andrew J Lees
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Ulf Andreasson
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Niklas Norgren
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Jan Linder
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Lars Forsgren
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Radu Constantinescu
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Henrik Zetterberg
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
| | - Kaj Blennow
- From the Clinical Memory Research Unit (O.H., S.J., S.H.), Department of Clinical Sciences, Lund University; Memory Clinic (O.H., S.J., S.H.), Skåne University Hospital, Sweden; UCL Institute of Neurology (N.M., A.J.L., H.Z.), Queen Square, London, UK; Clinical Neurochemistry Laboratory (R.C., H.Z., K.B.), Institute of Neuroscience and Physiology (U.A.), The Sahlgrenska Academy at University of Gothenburg, Mölndal; UmanDiagnostics (N.N.), Umeå; and Department of Pharmacology and Clinical Neuroscience (J.L., L.F.), Umeå University, Sweden
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Senek M, Aquilonius SM, Askmark H, Bergquist F, Constantinescu R, Ericsson A, Lycke S, Medvedev A, Memedi M, Ohlsson F, Spira J, Westin J, Nyholm D. Levodopa/carbidopa microtablets in Parkinson's disease: a study of pharmacokinetics and blinded motor assessment. Eur J Clin Pharmacol 2017; 73:563-571. [PMID: 28101657 PMCID: PMC5384948 DOI: 10.1007/s00228-017-2196-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/05/2017] [Indexed: 11/12/2022]
Abstract
Background Motor function assessments with rating scales in relation to the pharmacokinetics of levodopa may increase the understanding of how to individualize and fine-tune treatments. Objectives This study aimed to investigate the pharmacokinetic profiles of levodopa-carbidopa and the motor function following a single-dose microtablet administration in Parkinson’s disease. Methods This was a single-center, open-label, single-dose study in 19 patients experiencing motor fluctuations. Patients received 150% of their individual levodopa equivalent morning dose in levodopa-carbidopa microtablets. Blood samples were collected at pre-specified time points. Patients were video recorded and motor function was assessed with six UPDRS part III motor items, dyskinesia score, and the treatment response scale (TRS), rated by three blinded movement disorder specialists. Results AUC0–4/dose and Cmax/dose for levodopa was found to be higher in Parkinson’s disease patients compared with healthy subjects from a previous study, (p = 0.0008 and p = 0.026, respectively). The mean time to maximum improvement in sum of six UPDRS items score was 78 min (±59) (n = 16), and the mean time to TRS score maximum effect was 54 min (±51) (n = 15). Mean time to onset of dyskinesia was 41 min (±38) (n = 13). Conclusions In the PD population, following levodopa/carbidopa microtablet administration in fasting state, the Cmax and AUC0–4/dose were found to be higher compared with results from a previous study in young, healthy subjects. A large between subject variability in response and duration of effect was observed, highlighting the importance of a continuous and individual assessment of motor function in order to optimize treatment effect.
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Affiliation(s)
- Marina Senek
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.
| | | | - Håkan Askmark
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Filip Bergquist
- Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Alexander Medvedev
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Mevludin Memedi
- Computer Engineering, Dalarna University, Falun, Sweden.,Informatics, School of Business, Örebro University, Örebro, Sweden
| | | | | | - Jerker Westin
- Computer Engineering, Dalarna University, Falun, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
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Constantinescu R, Codreanu MD, Codreanu I. Correlation between renal resistive index and histological changes in dogs with chronic kidney disease. J Biotechnol 2016. [DOI: 10.1016/j.jbiotec.2016.05.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Constantinescu R, Krýsl D, Bergquist F, Andrén K, Malmeström C, Asztély F, Axelsson M, Menachem EB, Blennow K, Rosengren L, Zetterberg H. Cerebrospinal fluid markers of neuronal and glial cell damage to monitor disease activity and predict long-term outcome in patients with autoimmune encephalitis. Eur J Neurol 2016; 23:796-806. [PMID: 26822123 DOI: 10.1111/ene.12942] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 09/09/2015] [Accepted: 11/13/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Clinical symptoms and long-term outcome of autoimmune encephalitis are variable. Diagnosis requires multiple investigations, and treatment strategies must be individually tailored. Better biomarkers are needed for diagnosis, to monitor disease activity and to predict long-term outcome. The value of cerebrospinal fluid (CSF) markers of neuronal [neurofilament light chain protein (NFL), and total tau protein (T-tau)] and glial cell [glial fibrillary acidic protein (GFAP)] damage in patients with autoimmune encephalitis was investigated. METHODS Demographic, clinical, magnetic resonance imaging, CSF and antibody-related data of 25 patients hospitalized for autoimmune encephalitis and followed for 1 year were retrospectively collected. Correlations between these data and consecutive CSF levels of NFL, T-tau and GFAP were investigated. Disability, assessed by the modified Rankin scale, was used for evaluation of disease activity and long-term outcome. RESULTS The acute stage of autoimmune encephalitis was accompanied by high CSF levels of NFL and T-tau, whereas normal or significantly lower levels were observed after clinical improvement 1 year later. NFL and T-tau reacted in a similar way but at different speeds, with T-tau reacting faster. CSF levels of GFAP were initially moderately increased but did not change significantly later on. Final outcome (disability at 1 year) directly correlated with CSF-NFL and CSF-GFAP levels at all time-points and with CSF-T-tau at 3 ± 1 months. This correlation remained significant after age adjustment for CSF-NFL and T-tau but not for GFAP. CONCLUSION In autoimmune encephalitis, CSF levels of neuronal and glial cell damage markers appear to reflect disease activity and long-term disability.
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Affiliation(s)
- R Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - D Krýsl
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - F Bergquist
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - K Andrén
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - C Malmeström
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - F Asztély
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - M Axelsson
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - E B Menachem
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - K Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Clinical Neurochemistry Laboratory, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - L Rosengren
- Department of Neurology, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
| | - H Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Clinical Neurochemistry Laboratory, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Queen Square, UCL Institute of Neurology, London, UK
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Ihuţ A, Mireşan V, Răducu C, Constantinescu R, Andronie L, Laţiu C. Conformation Features of Three-Year Old Rainbow Trout (Oncorhynchus mykiss) Breeding Stock from a Trout Farm. BUASVMCN-ASB 2015. [DOI: 10.15835/buasvmcn-asb:11534] [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: 11/09/2022] Open
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Daniel C, Rotar I, Andronie L, Negrea O, Laţiu C, Constantinescu R, Răducu C, Vioara M. Danube Crayfish Astacus leptodactylus (Eschscholtz, 1823) from Ţaga Mare Lake – Size and Population Structure. BUASVMCN-ASB 2015. [DOI: 10.15835/buasvmcn-asb:11455] [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: 11/09/2022] Open
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Coşier V, Comşa E, Constantinescu R. The Use of Direct Genetic Markers K-Casein and DGAT1, Involved in Milk Production Characteristics. BUASVMCN-ASB 2015. [DOI: 10.15835/buasvmcn-asb:11551] [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: 11/09/2022] Open
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Constantinescu R, Cucos CA, Goran GV, Codreanu MD. Renal vascular Doppler ultrasonographic indices evaluation in dehydrated dogs. J Biotechnol 2015. [DOI: 10.1016/j.jbiotec.2015.06.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cucos CA, Ionaşcu I, Mocanu J, Constantinescu R, Militaru M. Ocular and central nervous system involvement in non-effusive form of feline infectious peritonitis. J Biotechnol 2015. [PMCID: PMC7133807 DOI: 10.1016/j.jbiotec.2015.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laurens B, Constantinescu R, Freeman R, Gerhard A, Jellinger K, Jeromin A, Krismer F, Mollenhauer B, Schlossmacher MG, Shaw LM, Verbeek MM, Wenning GK, Winge K, Zhang J, Meissner WG. Fluid biomarkers in multiple system atrophy: A review of the MSA Biomarker Initiative. Neurobiol Dis 2015; 80:29-41. [PMID: 25982836 DOI: 10.1016/j.nbd.2015.05.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 04/02/2015] [Revised: 04/29/2015] [Accepted: 05/08/2015] [Indexed: 01/10/2023] Open
Abstract
Despite growing research efforts, no reliable biomarker currently exists for the diagnosis and prognosis of multiple system atrophy (MSA). Such biomarkers are urgently needed to improve diagnostic accuracy, prognostic guidance and also to serve as efficacy measures or surrogates of target engagement for future clinical trials. We here review candidate fluid biomarkers for MSA and provide considerations for further developments and harmonization of standard operating procedures. A PubMed search was performed until April 24, 2015 to review the literature with regard to candidate blood and cerebrospinal fluid (CSF) biomarkers for MSA. Abstracts of 1760 studies were retrieved and screened for eligibility. The final list included 60 studies assessing fluid biomarkers in patients with MSA. Most studies have focused on alpha-synuclein, markers of axonal degeneration or catecholamines. Their results suggest that combining several CSF fluid biomarkers may be more successful than using single markers, at least for the diagnosis. Currently, the clinically most useful markers may comprise a combination of the light chain of neurofilament (which is consistently elevated in MSA compared to controls and Parkinson's disease), metabolites of the catecholamine pathway and proteins such as α-synuclein, DJ-1 and total-tau. Beyond future efforts in biomarker discovery, the harmonization of standard operating procedures will be crucial for future success.
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Affiliation(s)
- Brice Laurens
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France
| | - Radu Constantinescu
- Department of Neurology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Alexander Gerhard
- Institute of Brain Behaviour and Mental Heath, University of Manchester, UK
| | - Kurt Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, A-1070 Vienna, Austria
| | | | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany and Department of Neuropathology, University Medical Center Goettingen, Germany
| | - Michael G Schlossmacher
- Program in Neuroscience, The Ottawa Hospital, University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Leslie M Shaw
- Perelman School of Medicine, University of Pennsylvania
| | - Marcel M Verbeek
- Department of Neurology, Parkinson Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Laboratory Medicine, Parkinson Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kristian Winge
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jing Zhang
- Department of Pathology, University of WA, Seattle, USA
| | - Wassilios G Meissner
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, F-33076 Bordeaux, France; Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33076 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33076 Bordeaux, France.
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Andronie L, Mireşan V, Pop I, Raducu C, Coroian A, Coroian C, Cocan D, Constantinescu R. Adsorption of Orotic Acid on Ag Colloidal Nanoparticles. BUASVMCN-ASB 2015. [DOI: 10.15835/buasvmcn-asb:10794] [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: 11/09/2022] Open
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Silajdžić E, Constantinescu R, Holmberg B, Björkqvist M, Hansson O. Flt3 ligand does not differentiate between Parkinsonian disorders. Mov Disord 2014; 29:1319-22. [DOI: 10.1002/mds.25948] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Edina Silajdžić
- Brain Disease Biomarker UnitDepartment of Experimental Medical ScienceWallenberg Neuroscience CenterLund UniversityLund Sweden
| | | | - Björn Holmberg
- Neurology ClinicSahlgrenska University HospitalGothenburg Sweden
| | - Maria Björkqvist
- Brain Disease Biomarker UnitDepartment of Experimental Medical ScienceWallenberg Neuroscience CenterLund UniversityLund Sweden
| | - Oskar Hansson
- Clinical Memory Research UnitDepartment of Clinical Sciences MalmöLund UniversityMalmö Sweden
- Memory ClinicSkåne University Hospital Sweden
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Schwarzschild MA, Ascherio A, Beal MF, Cudkowicz ME, Curhan GC, Hare JM, Hooper DC, Kieburtz KD, Macklin EA, Oakes D, Rudolph A, Shoulson I, Tennis MK, Espay AJ, Gartner M, Hung A, Bwala G, Lenehan R, Encarnacion E, Ainslie M, Castillo R, Togasaki D, Barles G, Friedman JH, Niles L, Carter JH, Murray M, Goetz CG, Jaglin J, Ahmed A, Russell DS, Cotto C, Goudreau JL, Russell D, Parashos SA, Ede P, Saint-Hilaire MH, Thomas CA, James R, Stacy MA, Johnson J, Gauger L, Antonelle de Marcaida J, Thurlow S, Isaacson SH, Carvajal L, Rao J, Cook M, Hope-Porche C, McClurg L, Grasso DL, Logan R, Orme C, Ross T, Brocht AFD, Constantinescu R, Sharma S, Venuto C, Weber J, Eaton K. Inosine to increase serum and cerebrospinal fluid urate in Parkinson disease: a randomized clinical trial. JAMA Neurol 2014; 71:141-50. [PMID: 24366103 DOI: 10.1001/jamaneurol.2013.5528] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Convergent biological, epidemiological, and clinical data identified urate elevation as a candidate strategy for slowing disability progression in Parkinson disease (PD). OBJECTIVE To determine the safety, tolerability, and urate-elevating capability of the urate precursor inosine in early PD and to assess its suitability and potential design features for a disease-modification trial. DESIGN, SETTING, AND PARTICIPANTS The Safety of Urate Elevation in PD (SURE-PD) study, a randomized, double-blind, placebo-controlled, dose-ranging trial of inosine, enrolled participants from 2009 to 2011 and followed them for up to 25 months at outpatient visits to 17 credentialed clinical study sites of the Parkinson Study Group across the United States. Seventy-five consenting adults (mean age, 62 years; 55% women) with early PD not yet requiring symptomatic treatment and a serum urate concentration less than 6 mg/dL (the approximate population median) were enrolled. INTERVENTIONS Participants were randomized to 1 of 3 treatment arms: placebo or inosine titrated to produce mild (6.1-7.0 mg/dL) or moderate (7.1-8.0 mg/dL) serum urate elevation using 500-mg capsules taken orally up to 2 capsules 3 times per day. They were followed for up to 24 months (median, 18 months) while receiving the study drug plus 1 washout month. MAIN OUTCOMES AND MEASURES The prespecified primary outcomes were absence of unacceptable serious adverse events (safety), continued treatment without adverse event requiring dose reduction (tolerability), and elevation of urate assessed serially in serum and once (at 3 months) in cerebrospinal fluid. RESULTS Serious adverse events (17), including infrequent cardiovascular events, occurred at the same or lower rates in the inosine groups relative to placebo. No participant developed gout and 3 receiving inosine developed symptomatic urolithiasis. Treatment was tolerated by 95% of participants at 6 months, and no participant withdrew because of an adverse event. Serum urate rose by 2.3 and 3.0 mg/dL in the 2 inosine groups (P < .001 for each) vs placebo, and cerebrospinal fluid urate level was greater in both inosine groups (P = .006 and <.001, respectively). Secondary analyses demonstrated nonfutility of inosine treatment for slowing disability. CONCLUSIONS AND RELEVANCE Inosine was generally safe, tolerable, and effective in raising serum and cerebrospinal fluid urate levels in early PD. The findings support advancing to more definitive development of inosine as a potential disease-modifying therapy for PD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00833690.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Oakes
- University of Rochester, Rochester, New York
| | | | | | | | | | | | - Albert Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | - Grace Bwala
- Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Lenehan
- Scott & White Memorial Hospital/Texas A&M University, Temple
| | | | - Melissa Ainslie
- Scott & White Memorial Hospital/Texas A&M University, Temple
| | | | | | - Gina Barles
- University of Southern California, Los Angeles
| | | | - Lisa Niles
- Butler Hospital, Providence, Rhode Island
| | | | | | | | - Jeana Jaglin
- Rush University Medical Center, Chicago, Illinois
| | | | - David S Russell
- Institute of Neurodegenerative Disorders, New Haven, Connecticut
| | - Candace Cotto
- Institute of Neurodegenerative Disorders, New Haven, Connecticut
| | | | | | | | - Patricia Ede
- Struthers Parkinson's Center, Golden Valley, Minnesota
| | | | | | | | | | | | | | | | | | - Stuart H Isaacson
- Parkinson's Disease & Movement Disorder Center of Boca Raton, Boca Raton, Florida
| | - Lisbeth Carvajal
- Parkinson's Disease & Movement Disorder Center of Boca Raton, Boca Raton, Florida
| | | | - Maureen Cook
- Ochsner Clinic Foundation, New Orleans, Louisiana
| | | | - Lauren McClurg
- Administrative Coordination Center, Massachusetts General Hospital, Boston
| | - Daniela L Grasso
- Administrative Coordination Center, Massachusetts General Hospital, Boston
| | - Robert Logan
- Administrative Coordination Center, Massachusetts General Hospital, Boston
| | - Constance Orme
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Tori Ross
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Alicia F D Brocht
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | | | - Saloni Sharma
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Charles Venuto
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Joseph Weber
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Ken Eaton
- Clinical Coordination Center, University of Rochester, Rochester, New York
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Constantinescu R, Elm J, Auinger P, Sharma S, Augustine EF, Khadim L, Kieburtz K. Malignant melanoma in early-treated Parkinson's disease: the NET-PD trial. Mov Disord 2013; 29:263-5. [PMID: 24323565 DOI: 10.1002/mds.25734] [Citation(s) in RCA: 23] [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: 08/19/2013] [Revised: 09/19/2013] [Accepted: 10/01/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The risk for malignant melanoma is higher than expected in Parkinson's disease (PD). The National Institutes of Health (NIH) Exploratory Trials in PD (NET-PD) Long-term Study 1 (LS-1) trial is a contemporary phase 3 study of subjects with early, treated PD. The objective of this work was to assess the incidence of malignant melanoma in a PD cohort. METHODS Incident melanoma cases were identified from the adverse events log. The expected number of cases was calculated, using the expected incidence rates and the number of person-years. RESULTS A total of 618 females and 1119 males were followed for 6452 person-years; 19 new melanoma cases were observed. The expected number was 5.29. The standardized event ratio compared to the general population was 3.6 (95% confidence interval, 2.2-5.6). CONCLUSIONS The risk for developing melanoma was higher than expected in the NET-PD LS-1 cohort and was similar to the risk reported in earlier comparable clinical trial cohorts. Dermatologic screening may be useful in Parkinson's disease to identify melanoma at an early stage.
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Affiliation(s)
- Radu Constantinescu
- Center for Human Experimental Therapeutics, University of Rochester Medical Center, Rochester, New York, USA
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Olsson B, Constantinescu R, Holmberg B, Andreasen N, Blennow K, Zetterberg H. The glial marker YKL-40 is decreased in synucleinopathies. Mov Disord 2013; 28:1882-5. [DOI: 10.1002/mds.25589] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/03/2013] [Accepted: 05/29/2013] [Indexed: 01/09/2023] Open
Affiliation(s)
- Bob Olsson
- Department of Psychiatry and Neurochemistry; the Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
| | - Radu Constantinescu
- Department of Neurology; the Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - Björn Holmberg
- Department of Neurology; the Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - Niels Andreasen
- Alzheimer Disease Research Center; Karolinska Institute; Stockhom Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry; the Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry; the Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
- University College London Institute of Neurology; London United Kingdom
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Constantinescu R, Andreasson U, Holmberg B, Zetterberg H. Serum and cerebrospinal fluid urate levels in synucleinopathies versus tauopathies. Acta Neurol Scand 2013; 127:e8-12. [PMID: 22998191 DOI: 10.1111/ane.12012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low levels of serum urate are associated with a higher risk of Parkinson's disease (PD). Higher serum and cerebrospinal fluid (CSF) urate levels are associated with slower rates of clinical decline in PD and in multiple system atrophy (MSA). AIMS To compare CSF and blood urate levels in healthy controls, patients with synucleinopathies and with tauopathies. METHODS We investigated urate levels in serum and CSF from 18 healthy controls, 19 patients with synucleinopathies (six patients with PD and 13 with MSA), and 24 patients with tauopathies (18 with progressive supranuclear palsy and six with corticobasal degeneration). None of the patients were treated with dopaminergic medications. RESULTS No significant differences were seen when comparing serum and CSF urate levels from controls across the parkinsonian diagnostic groups. However, in men, serum urate levels were significantly lower in the synucleinopathy group compared with the tauopathy group (P = 0.046), although with a broad overlap. CONCLUSION Our study suggests that urate levels might provide new insights into the potential pathophysiological mechanisms underlying Parkinsonism and thereby contribute to the future management of these disorders.
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Affiliation(s)
- R. Constantinescu
- Department of Neurology; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - U. Andreasson
- Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - B. Holmberg
- Department of Neurology; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - H. Zetterberg
- Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
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Abstract
The Parkinsonian disorders are a large group of neurodegenerative diseases including idiopathic Parkinson’s disease (PD) and atypical Parkinsonian disorders (APD), such as multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies. The etiology of these disorders is not known although it is considered to be a combination of genetic and environmental factors. One of the greatest obstacles for developing efficacious disease-modifying treatment strategies is the lack of biomarkers. Reliable biomarkers are needed for early and accurate diagnosis, to measure disease progression, and response to therapy. In this review several of the most promising cerebrospinal biomarker candidates are discussed. Alpha-synuclein seems to be intimately involved in the pathogenesis of synucleinopathies and its levels can be measured in the cerebrospinal fluid and in plasma. In a similar way, tau protein accumulation seems to be involved in the pathogenesis of tauopathies. Urate, a potent antioxidant, seems to be associated to the risk of developing PD and with its progression. Neurofilament light chain levels are increased in APD compared with PD and healthy controls. The new “omics” techniques are potent tools offering new insights in the patho-etiology of these disorders. Some of the difficulties encountered in developing biomarkers are discussed together with future perspectives.
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Affiliation(s)
- Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg, Sweden
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Nutu M, Bourgeois P, Zetterberg H, Portelius E, Andreasson U, Parent S, Lipari F, Hall S, Constantinescu R, Hansson O, Blennow K. Aβ1-15/16 as a Potential Diagnostic Marker in Neurodegenerative Diseases. Neuromolecular Med 2012; 15:169-79. [DOI: 10.1007/s12017-012-8208-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
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Hall S, Öhrfelt A, Constantinescu R, Andreasson U, Surova Y, Bostrom F, Nilsson C, Widner H, Decraemer H, Nägga K, Minthon L, Londos E, Vanmechelen E, Holmberg B, Zetterberg H, Blennow K, Hansson O. Accuracy of a Panel of 5 Cerebrospinal Fluid Biomarkers in the Differential Diagnosis of Patients With Dementia and/or Parkinsonian Disorders. ACTA ACUST UNITED AC 2012; 69:1445-52. [DOI: 10.1001/archneurol.2012.1654] [Citation(s) in RCA: 343] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Thordstein M, Constantinescu R. Possibly lifesaving, noninvasive, EEG-guided neuromodulation in anesthesia-refractory partial status epilepticus. Epilepsy Behav 2012; 25:468-72. [PMID: 22981238 DOI: 10.1016/j.yebeh.2012.07.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/21/2012] [Accepted: 07/27/2012] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) guided as to localization and effect by continuous EEG on a super-refractory status epilepticus unresponsive to conventional treatment for 44 days including repeated deep sedation. Repetitive transcranial magnetic stimulation was delivered for one-hour sessions to the most active of two EEG foci for 8 days. From the third day of stimulation, the EEG pathology markedly decreased in parallel to clinical improvement. The patient could be weaned off the respirator, transferred to an ordinary ward then to a rehabilitation clinic. This is the first report of a positive outcome of rTMS treatment in super-refractory status epilepticus. In the context of refractory partial status epilepticus, neuromodulation through rTMS is a safe treatment option. If performed along the lines herein described, it may also be more efficient than conventional treatment. Repetitive transcranial magnetic stimulation may be an underused treatment option for status epilepticus.
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Affiliation(s)
- Magnus Thordstein
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Luk C, Compta Y, Magdalinou N, Martí MJ, Hondhamuni G, Zetterberg H, Blennow K, Constantinescu R, Pijnenburg Y, Mollenhauer B, Trenkwalder C, Van Swieten J, Chiu WZ, Borroni B, Cámara A, Cheshire P, Williams DR, Lees AJ, de Silva R. Development and assessment of sensitive immuno-PCR assays for the quantification of cerebrospinal fluid three- and four-repeat tau isoforms in tauopathies. J Neurochem 2012; 123:396-405. [PMID: 22862741 DOI: 10.1111/j.1471-4159.2012.07911.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 11/29/2022]
Abstract
Characteristic tau isoform composition of the insoluble fibrillar tau inclusions define tauopathies, including Alzheimer's disease (AD), progressive supranuclear palsy (PSP) and frontotemporal dementia with parkinsonism linked to chromosome 17/frontotemporal lobar degeneration-tau (FTDP-17/FTLD-tau). Exon 10 splicing mutations in the tau gene, MAPT, in familial FTDP-17 cause elevation of tau isoforms with four microtubule-binding repeat domains (4R-tau) compared to those with three repeats (3R-tau). On the basis of two well-characterised monoclonal antibodies against 3R- and 4R-tau, we developed novel, sensitive immuno-PCR assays for measuring the trace amounts of these isoforms in CSF. This was with the aim of assessing if CSF tau isoform changes reflect the pathological changes in tau isoform homeostasis in the degenerative brain and if these would be relevant for differential clinical diagnosis. Initial analysis of clinical CSF samples of PSP (n = 46), corticobasal syndrome (CBS; n = 22), AD (n = 11), Parkinson's disease with dementia (PDD; n = 16) and 35 controls revealed selective decreases of immunoreactive 4R-tau in CSF of PSP and AD patients compared with controls, and lower 4R-tau levels in AD compared with PDD. These decreases could be related to the disease-specific conformational masking of the RD4-binding epitope because of abnormal folding and/or aggregation of the 4R-tau isoforms in tauopathies or increased sequestration of the 4R-tau isoforms in brain tau pathology.
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Affiliation(s)
- Connie Luk
- Reta Lila Weston Institute, UCL Institute of Neurology, London, UK
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Abstract
Urate, a natural antioxidant and iron chelator, has emerged as a potentially promising compound that might prevent neurodegenerative disorders. However, hyperuricemia may cause gout and is associated with increased cardiovascular morbidity. This paper summarizes the impact of urate in the context of Parkinson's disease (PD). It reviews the association of serum urate with the risk of PD, the clinical progression in PD, cognitive, dietary and gender aspects, the relationship between gout and PD, and potential therapeutic implications for the future.
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Affiliation(s)
- R Constantinescu
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Constantinescu R, Romer M, Zetterberg H, Rosengren L, Kieburtz K. Increased levels of total tau protein in the cerebrospinal fluid in Huntington’s disease. Parkinsonism Relat Disord 2011; 17:714-5. [DOI: 10.1016/j.parkreldis.2011.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/29/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022]
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Constantinescu R, Holmberg B, Rosengren L, Corneliusson O, Johnels B, Zetterberg H. Light subunit of neurofilament triplet protein in the cerebrospinal fluid after subthalamic nucleus stimulation for Parkinson's disease. Acta Neurol Scand 2011; 124:206-10. [PMID: 21039366 DOI: 10.1111/j.1600-0404.2010.01451.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Cerebrospinal fluid (CSF) levels of neurofilament triplet protein (NFL), a non-specific marker of neuronal damage, are normal in Parkinson's disease (PD) but increased after brain trauma and in several neurological disorders. Using longitudinal CSF-NFL measurements as an indicator of neuronal damage, this study investigated the impact of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on the brain, directly following the surgical intervention and in chronically treated patients with PD. MATERIALS AND METHODS CSF-NFL levels were measured consecutively in eight patients with PD before and after STN-DBS treatment. RESULTS CSF-NFL levels were normal prior to STN-DBS and increased sharply during the first 2 weeks post-operatively, but normalized after 12 months or more. CONCLUSION The STN-DBS procedure leads to an acute but limited neuronal damage, as expected. However, normal CSF-NFL levels at 12 months post-operatively and beyond suggest the absence of any long-term neuronal damage caused by long-term STN-DBS stimulation.
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Affiliation(s)
- R Constantinescu
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Mitrică D, Pleşa A, Constantinescu R, Drug V, Stanciu C. Efficacy of Helicobacter pylori eradication therapy in cirrhotic patients with peptic ulcer disease. Rev Med Chir Soc Med Nat Iasi 2011; 115:367-374. [PMID: 21870725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Few studies have been focused on the role of Helicobacter pylori eradication in cirrhotic patients with peptic ulcer and the reported results are conflicting. AIM To evaluate the efficacy of proton pump inhibitor (PPI)-based triple therapy on peptic ulcer course in patients with liver cirrhosis. MATERIAL AND METHODS This prospective study was carried out in a tertiary-care hospital. Of the 63 consecutive cirrhotic patients with peptic ulcer identified by endoscopy 39 (22 males, 14 females, aged 53 to 62 years) entered the study. The patients with peptic ulcer and H. pylori infection received eradication therapy, while H. pylori negative patients received PPI treatment. H. pylori eradication was confirmed by rapid urease test and histological examination. Follow-up endoscopies were performed at 6 and 12 months. The patients with peptic ulcer recurrence were treated with PPI. RESULTS Of the 39 selected patients 22 (56.4%) were H. pylori positive, and 17 (43.6%) were H. pylori negative. H. pylori was eradicated in 63.6% (14/22) of the patients. During the follow-up period 2 H. pylori negative patients died from variceal bleeding and hepatic encephalopathy, respectively, and one H. pylori positive patient did not return for further assessment). Ulcers recurring within 1 year were found in 14 of 36 (38.8%) patients. Peptic ulcer recurred in 4 of 21 (19.0%) H. pylori positive patients and in 10 of 15 (47.6%) H. pylori negative patients at study entry. Patients' age (p = 0.018), Child-Pugh stage (p = 0.019), peptic ulcer site (p = 0.008), and H. pylori negative status (p = 0.004) were significantly related to ulcer recurrence. CONCLUSIONS Eradication of H. pylori infection in patients with liver cirrhosis and peptic ulcer disease could be helpful, but does not protect all cirrhotic patients from peptic ulcer recurrence. Most relapsed ulcers were gastric ulcers in H. pylori negative patients.
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Affiliation(s)
- Dana Mitrică
- Universităţii de Medicină şi Farmacie Gr. T. Popa Iaşi, Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi, Facultatea de Medicină
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