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Schwarzschild MA, Ascherio A, Casaceli C, Curhan GC, Fitzgerald R, Kamp C, Lungu C, Macklin EA, Marek K, Mozaffarian D, Oakes D, Rudolph A, Shoulson I, Videnovic A, Scott B, Gauger L, Aldred J, Bixby M, Ciccarello J, Gunzler SA, Henchcliffe C, Brodsky M, Keith K, Hauser RA, Goetz C, LeDoux MS, Hinson V, Kumar R, Espay AJ, Jimenez-Shahed J, Hunter C, Christine C, Daley A, Leehey M, de Marcaida JA, Friedman JH, Hung A, Bwala G, Litvan I, Simon DK, Simuni T, Poon C, Schiess MC, Chou K, Park A, Bhatti D, Peterson C, Criswell SR, Rosenthal L, Durphy J, Shill HA, Mehta SH, Ahmed A, Deik AF, Fang JY, Stover N, Zhang L, Dewey RB, Gerald A, Boyd JT, Houston E, Suski V, Mosovsky S, Cloud L, Shah BB, Saint-Hilaire M, James R, Zauber SE, Reich S, Shprecher D, Pahwa R, Langhammer A, LaFaver K, LeWitt PA, Kaminski P, Goudreau J, Russell D, Houghton DJ, Laroche A, Thomas K, McGraw M, Mari Z, Serrano C, Blindauer K, Rabin M, Kurlan R, Morgan JC, Soileau M, Ainslie M, Bodis-Wollner I, Schneider RB, Waters C, Ratel AS, Beck CA, Bolger P, Callahan KF, Crotty GF, Klements D, Kostrzebski M, McMahon GM, Pothier L, Waikar SS, Lang A, Mestre T. Effect of Urate-Elevating Inosine on Early Parkinson Disease Progression: The SURE-PD3 Randomized Clinical Trial. JAMA 2021; 326:926-939. [PMID: 34519802 PMCID: PMC8441591 DOI: 10.1001/jama.2021.10207] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/05/2021] [Indexed: 01/13/2023]
Abstract
Importance Urate elevation, despite associations with crystallopathic, cardiovascular, and metabolic disorders, has been pursued as a potential disease-modifying strategy for Parkinson disease (PD) based on convergent biological, epidemiological, and clinical data. Objective To determine whether sustained urate-elevating treatment with the urate precursor inosine slows early PD progression. Design, Participants, and Setting Randomized, double-blind, placebo-controlled, phase 3 trial of oral inosine treatment in early PD. A total of 587 individuals consented, and 298 with PD not yet requiring dopaminergic medication, striatal dopamine transporter deficiency, and serum urate below the population median concentration (<5.8 mg/dL) were randomized between August 2016 and December 2017 at 58 US sites, and were followed up through June 2019. Interventions Inosine, dosed by blinded titration to increase serum urate concentrations to 7.1-8.0 mg/dL (n = 149) or matching placebo (n = 149) for up to 2 years. Main Outcomes and Measures The primary outcome was rate of change in the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS; parts I-III) total score (range, 0-236; higher scores indicate greater disability; minimum clinically important difference of 6.3 points) prior to dopaminergic drug therapy initiation. Secondary outcomes included serum urate to measure target engagement, adverse events to measure safety, and 29 efficacy measures of disability, quality of life, cognition, mood, autonomic function, and striatal dopamine transporter binding as a biomarker of neuronal integrity. Results Based on a prespecified interim futility analysis, the study closed early, with 273 (92%) of the randomized participants (49% women; mean age, 63 years) completing the study. Clinical progression rates were not significantly different between participants randomized to inosine (MDS-UPDRS score, 11.1 [95% CI, 9.7-12.6] points per year) and placebo (MDS-UPDRS score, 9.9 [95% CI, 8.4-11.3] points per year; difference, 1.26 [95% CI, -0.59 to 3.11] points per year; P = .18). Sustained elevation of serum urate by 2.03 mg/dL (from a baseline level of 4.6 mg/dL; 44% increase) occurred in the inosine group vs a 0.01-mg/dL change in serum urate in the placebo group (difference, 2.02 mg/dL [95% CI, 1.85-2.19 mg/dL]; P<.001). There were no significant differences for secondary efficacy outcomes including dopamine transporter binding loss. Participants randomized to inosine, compared with placebo, experienced fewer serious adverse events (7.4 vs 13.1 per 100 patient-years) but more kidney stones (7.0 vs 1.4 stones per 100 patient-years). Conclusions and Relevance Among patients recently diagnosed as having PD, treatment with inosine, compared with placebo, did not result in a significant difference in the rate of clinical disease progression. The findings do not support the use of inosine as a treatment for early PD. Trial Registration ClinicalTrials.gov Identifier: NCT02642393.
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Affiliation(s)
- Michael A Schwarzschild
- Mass General Institute for Neurodegenerative Disease, Boston, Massachusetts
- Massachusetts General Hospital, Boston
| | | | | | | | - Rebecca Fitzgerald
- Parkinson's Foundation Research Advocates, Parkinson's Foundation, New York, New York
| | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Eric A Macklin
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Dariush Mozaffarian
- Tufts School of Medicine and Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
- Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - David Oakes
- University of Rochester, Rochester, New York
| | | | - Ira Shoulson
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Jason Aldred
- Inland Northwest Research, Spokane, Washington
- Selkirk Neurology, Spokane, Washington
| | | | | | | | - Claire Henchcliffe
- University of California, Irvine
- Weill Cornell Medical College, New York, New York
| | | | | | | | | | | | | | - Rajeev Kumar
- Rocky Mountain Movement Disorders Center, Englewood, Colorado
| | | | | | | | | | | | | | | | | | | | | | | | - David K Simon
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia Poon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mya C Schiess
- The University of Texas Health Science Center, Houston McGovern Medical School, Houston
| | | | - Ariane Park
- The Ohio State University Wexner Medical Center, Columbus
| | | | | | - Susan R Criswell
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | | | - Holly A Shill
- Banner Sun Health Research Institute, Sun City, Arizona
- University of Arizona School of Medicine-Phoenix
| | | | | | | | - John Y Fang
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Ashley Gerald
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | - Leslie Cloud
- VCU Parkinson's & Movement Disorders Center, Richmond, Virginia
| | | | | | | | | | - Stephen Reich
- University of Maryland School of Medicine, Baltimore
| | - David Shprecher
- Banner Sun Health Research Institute, Sun City, Arizona
- University of Arizona School of Medicine-Phoenix
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City
| | | | - Kathrin LaFaver
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Peter A LeWitt
- Henry Ford Hospital-West Bloomfield, West Bloomfield Township, Michigan
| | - Patricia Kaminski
- Henry Ford Hospital-West Bloomfield, West Bloomfield Township, Michigan
| | | | | | | | | | - Karen Thomas
- Sentara Neurology Specialists, Norfolk, Virginia
| | - Martha McGraw
- Center for Movement Disorders and Neurodegenerative Disease, Northwestern Medicine/Central DuPage Hospital, Winfield, Illinois
| | - Zoltan Mari
- Cleveland Clinic-Las Vegas, Las Vegas, Nevada
| | | | | | - Marcie Rabin
- Atlantic Neuroscience Institute, Summit, New Jersey
| | - Roger Kurlan
- Atlantic Neuroscience Institute, Summit, New Jersey
| | | | - Michael Soileau
- Texas Movement Disorder Specialists, Georgetown
- Scott & White Healthcare/Texas A&M University, Temple
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sushrut S Waikar
- Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
| | - Anthony Lang
- University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada
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Li M, Yang D, Mei L, Yuan L, Xie A, Yuan J. Screening and characterization of purine nucleoside degrading lactic acid bacteria isolated from Chinese sauerkraut and evaluation of the serum uric acid lowering effect in hyperuricemic rats. PLoS One 2014; 9:e105577. [PMID: 25184445 PMCID: PMC4153548 DOI: 10.1371/journal.pone.0105577] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/16/2014] [Indexed: 02/07/2023] Open
Abstract
Hyperuricemia is well known as the cause of gout. In recent years, it has also been recognized as a risk factor for arteriosclerosis, cerebrovascular and cardiovascular diseases, and nephropathy in diabetic patients. Foods high in purine compounds are more potent in exacerbating hyperuricemia. Therefore, the development of probiotics that efficiently degrade purine compounds is a promising potential therapy for the prevention of hyperuricemia. In this study, fifty-five lactic acid bacteria isolated from Chinese sauerkraut were evaluated for the ability to degrade inosine and guanosine, the two key intermediates in purine metabolism. After a preliminary screening based on HPLC, three candidate strains with the highest nucleoside degrading rates were selected for further characterization. The tested biological characteristics of candidate strains included acid tolerance, bile tolerance, anti-pathogenic bacteria activity, cell adhesion ability, resistance to antibiotics and the ability to produce hydrogen peroxide. Among the selected strains, DM9218 showed the best probiotic potential compared with other strains despite its poor bile resistance. Analysis of 16S rRNA sequences showed that DM9218 has the highest similarity (99%) to Lactobacillus plantarum WCFS1. The acclimated strain DM9218-A showed better resistance to 0.3% bile salt, and its survival in gastrointestinal tract of rats was proven by PCR-DGGE. Furthermore, the effects of DM9218-A in a hyperuricemia rat model were evaluated. The level of serum uric acid in hyperuricemic rat can be efficiently reduced by the intragastric administration of DM9218-A (P<0.05). The preventive treatment of DM9218-A caused a greater reduction in serum uric acid concentration in hyperuricemic rats than the later treatment (P<0.05). Our results suggest that DM9218-A may be a promising candidate as an adjunctive treatment in patients with hyperuricemia during the onset period of disease. DM9218-A also has potential as a probiotic in the prevention of hyperuricemia in the normal population.
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Affiliation(s)
- Ming Li
- Department of Microecology, School of Basic Medical Science, Dalian Medical University, Dalian, Liaoning, China
| | - Dianbin Yang
- Department of Microecology, School of Basic Medical Science, Dalian Medical University, Dalian, Liaoning, China
| | - Lu Mei
- Department of Microecology, School of Basic Medical Science, Dalian Medical University, Dalian, Liaoning, China
- Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lin Yuan
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ao Xie
- Department of Microecology, School of Basic Medical Science, Dalian Medical University, Dalian, Liaoning, China
| | - Jieli Yuan
- Department of Microecology, School of Basic Medical Science, Dalian Medical University, Dalian, Liaoning, China
- * E-mail:
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Li H, Zheng YH, Shen Z, Liu M, Liu C, He Y, Chen J, Ou QY, Huang ZL. [Evaluation for two-year highly active antiretroviral therapy in Chinese HIV-1 infection patients]. Zhonghua Yi Xue Za Zhi 2007; 87:2973-2976. [PMID: 18261327] [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: 05/25/2023]
Abstract
OBJECTIVE To observe that antiretroviral efficacy, immune reconstitution of two-year HAART, and evaluate its side effect in Chinese HIV-1-infected patients. METHODS Three drug regimen composed of didanosine (ddI), stavudine (d4T), and nevirapine (NVP) was used on 27 HIV-1 infected patients, Within 2 weeks before treatment, and 3, 6, 12, 18, and 24 months after the beginning of treatment peripheral blood samples were collected to measure the HIV-RNA viral load (VL) by fluorescent quantitative polymerase chain reactions (FQ-PCR), and the counts of CD3+CD4+ cells, CD3+CD8+ cells, CD4+CD45RA+CD62L+ cells, CD4+CD45RO+ cells, CD8+CD38+ cells, and CD8+CD38+/CD3+CD8+ percentage. The side effects, blood routine, main biochemical parameters, and other disadvantageous accidents were monitored during the 24-mouth treatment period. 17 males and 10 females, aged 33 +/- 11. Thirty-one sex- and age-matched healthy persons were used as controls. RESULTS FQ-PCR showed that the plasma HIV-1 RNA levels 2 weeks before treatment, and 3, 6, 12, 18, and 24 months after the beginning of treatment were 5.15 logs (copies/ml), 3.37 logs, 2.24 logs, 2.02 logs, 1.97 logs, and 2.15 logs respectively. 24 months after the treatment. In 56.6% (13/24) of the patients the HIV-1 VL was < 50 copies/ml 24 months after treatment, and the counts of CD3+CD4+ cells, CD4+CD45RA+62L+ cells (nave cells), and CD4+CD45RO+ cells (memory cells) 24 months after treatment were (317 +/- 175) cells/microl, (133 +/- 65) cells/microl, and (207 +/- 85) cells/microl respectively, all significantly hoi/higher than the baseline levels [(185 +/- 73) cells/microl, (51 +/- 21) cells/microl, and (115 +/- 57) cells/microl respectively]. And the CD3+CD8+ cell count, CD8+CD38+ cell count, and CD8+CD38+/CD3+CD8+ percentage decreased from (907 +/- 435) cells/microl, (614 +/- 299) cells/microl, and 67.7% to (775 +/- 303) cells/microl, (385 +/- 131) cells/microl, and 49.7% respectively, with the lowest values in the months 3 and 6. But by the month 24, all of the parameters failed to reach the normal level. 19 of the 27 patients had side effects, such as peripheral polyneuropathy, various rashes, central nervous system disorders, abdominal pain, fullness or bloating, fever, and baldness, 21 showed abnormalities in blood routine, liver function, renal function, or lipid tests and increased gamma glutamyl transferase (GGT) and amylase. The regimen had to be changed for 3 of these patients because of paresthesia and suspected lactic acidosis. CONCLUSION The regimen with ddI, d4T and NVP foe 24 months showed a good antiretroviral effect and immune reconstitution on the HIV-1 infected persons. However, there are side effects, especially in the respect of gastrointestinal disorder and peripheral neuritis, decrease of WBC and increase of GGT and amylase.
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Affiliation(s)
- Hui Li
- AIDS Research Laboratory, Second Xiangya Hospital, Central South University, Changsha, China
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