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Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration最新文献

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Verbal expressive language minimally affected in non-demented people living with amyotrophic lateral sclerosis 患有肌萎缩性脊髓侧索硬化症的非痴呆患者的口头表达能力受到的影响很小
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2024-02-02 DOI: 10.1080/21678421.2024.2307512
Elisabeth Kasper, Anna G. M. Temp, Verena Köckritz, Lisa Meier, Judith Machts, Stefan Vielhaber, Andreas Hermann, Johannes Prudlo
Objective: Language dysfunction is one of the most common cognitive impairments in amyotrophic lateral sclerosis (ALS). Although discourse capacities are essential for daily functioning, verbal exp...
目的:语言功能障碍是肌萎缩侧索硬化症(ALS)最常见的认知障碍之一:语言功能障碍是肌萎缩侧索硬化症(ALS)最常见的认知障碍之一。虽然语言表达能力对日常功能至关重要,但语言表达能力的缺失也会影响患者的生活质量。
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引用次数: 0
Time from amyotrophic lateral sclerosis symptom onset to key disease milestones: analysis of data from a multinational cross-sectional survey 从肌萎缩性脊髓侧索硬化症症状出现到主要疾病里程碑的时间:多国横断面调查数据分析
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2023-12-29 DOI: 10.1080/21678421.2023.2297795
Paulos Gebrehiwet, Johan Brekke, Stacy A. Rudnicki, Jennifer Mellor, Jack Wright, Lucy Earl, Nathan Ball, Halima Iqbal, Owen Thomas, Giorgio Castellano
To determine the average time from Amyotrophic Lateral Sclerosis (ALS) symptom onset to 11 pre-defined milestones, overall and according to ALS progression rate and geographic location.Data were dr...
目的是确定从肌萎缩侧索硬化症(ALS)症状发作到11个预定义里程碑的平均时间,包括总体时间以及根据ALS进展速度和地理位置确定的时间。
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引用次数: 0
ALS Health care provider wellness ALS 保健提供者的健康
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2023-12-09 DOI: 10.1080/21678421.2023.2291710
Gregory Hansen, Sarah Burton-MacLeod, Kerri Lynn Schellenberg
Interest in health care provider (HCP) wellness and burnout is increasing; however, minimal literature explores HCP wellness in the context of Amyotrophic Lateral Sclerosis (ALS) care.We sought to ...
人们对医疗保健提供者(HCP)的健康和职业倦怠的关注与日俱增;然而,很少有文献探讨肌萎缩性脊髓侧索硬化症(ALS)护理背景下医疗保健提供者的健康问题。
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引用次数: 0
What, how and when do families communicate about ALS? A qualitative exploration of parents’ and children’s perceptions 家庭在什么情况下、如何以及何时就 ALS 进行交流?对父母和子女看法的定性研究
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2023-12-09 DOI: 10.1080/21678421.2023.2290738
Marion Sommers-Spijkerman, Anna Stukker, Melinda S. Kavanaugh, Marjolijn Ketelaar, Johanna M. A. Visser-Meily, Anita Beelen
Objectives: In families with a parent diagnosed with amyotrophic lateral sclerosis (ALS), children’s adaptation depends among others on how their parents communicate with them about the disease and...
目的:在父母一方被诊断出患有肌萎缩性脊髓侧索硬化症(ALS)的家庭中,儿童的适应能力主要取决于父母如何与他们沟通有关疾病的信息,以及如何与他们进行交流。
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引用次数: 0
Analysis of normal C9orf72 repeat length as possible disease modifier in amyotrophic lateral sclerosis 正常C9orf72重复序列长度作为肌萎缩性侧索硬化症可能的疾病修饰因子的分析
4区 医学 Q2 Medicine Pub Date : 2023-11-01 DOI: 10.1080/21678421.2023.2273965
Silvia Peverelli, Alberto Brusati, Valeria Casiraghi, Marta Nice Sorce, Sabrina Invernizzi, Serena Santangelo, Claudia Morelli, Federico Verde, Vincenzo Silani, Nicola Ticozzi, Antonia Ratti
AbstractThe C9orf72 hexanucleotide repeat (HR) expansion is the main genetic cause of amyotrophic lateral sclerosis (ALS), with expansion size from 30 to >4000 units. Normal C9orf72 HR length is polymorphic (2–23 repeats) with alleles >8 units showing a low frequency in the general population. This study aimed to investigate if the normal C9orf72 HR length influences C9orf72 gene expression and acts as disease modifier in ALS patients negative for C9orf72 mutation (ALS-C9Neg). We found that the distribution of HR alleles was similar in 325 ALS-C9Neg and 303 healthy controls. Gene expression analysis in blood revealed a significant increase of total C9orf72 and V3 mRNA levels in ALS-C9Neg carrying two long alleles (L/L; ≥8 units) compared to patients homozygous for the 2-unit short allele (S/S). However, HR allele genotypes (L/L, S/L, S/S) correlated with no clinical parameters. Our data suggest that normal C9orf72 HR length does not act as disease modifier in ALS-C9Neg despite increasing gene expression.Keywords: amyotrophic lateral sclerosisC9orf72gene expressiondisease modifier AcknowledgementsThe Authors acknowledge the ERN Euro-NMD. AR acknowledges “Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics”, Università degli Studi di Milano. VC and SS were recipients of a fellowship from the PhD program in “Experimental Medicine”, Università degli Studi di Milano.Declaration of interestsV.S. is in the Editorial Advisory Board of Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. All the other Authors report no conflicts of interest.Additional informationFundingThis work was supported by Italian Ministry of Health—Ricerca Corrente.
摘要C9orf72六核苷酸重复扩增(hexanucleotide repeat, HR)是肌萎缩性侧索硬化症(ALS)的主要遗传原因,扩增量从30 ~ >4000个单位不等。正常C9orf72 HR长度具有多态性(2-23个重复),等位基因>8个单位,在普通人群中出现频率较低。本研究旨在探讨正常的C9orf72 HR长度是否会影响C9orf72基因的表达,并在C9orf72突变(ALS- c9neg)阴性的ALS患者中发挥疾病修饰因子的作用。我们发现325例ALS-C9Neg和303例健康对照的HR等位基因分布相似。血液基因表达分析显示,携带两个长等位基因的ALS-C9Neg患者C9orf72和V3 mRNA总水平显著升高(L/L;≥8个单位)与2个单位短等位基因(S/S)纯合的患者相比。然而,HR等位基因型(L/L、S/L、S/S)与临床参数无相关性。我们的数据表明,正常的C9orf72 HR长度并不作为ALS-C9Neg的疾病调节剂,尽管基因表达增加。关键词:肌萎缩性侧索硬化症isc9orf72基因表达疾病修饰因子致谢作者认可ERN - nmd。AR承认“Aldo Ravelli神经技术和实验脑治疗中心”,米兰大学。VC和SS是米兰大学“实验医学”博士项目的奖学金获得者。利益申报表是肌萎缩性侧索硬化症和额颞叶变性的编辑顾问委员会成员。所有其他作者报告无利益冲突。这项工作得到了意大利卫生部ricerca Corrente的支持。
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引用次数: 0
Theme 03 - In Vitro Experimental Models 主题03-体外实验模型
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2022-11-01 DOI: 10.1080/21678421.2022.2120679
S. Baver, V. Smith, A. Robertson, L. Lenkiu, H. Cannon, D. Martinez, J. Hickman, D. Eyerman, G. Edozie, S. Pigeyre, A. Gosselin, M. Brenes, C. Sephton, S. Pozzi
The aggregation of amyloidogenic proteins/peptides is asso- ciated with the onset and progression of several amyloidoses, including neurodegenerative disorders, such as Alzheimer ‘ s or Parkinson ‘ s diseases. In recent years, it has been observed that the cross-interaction between these protein molecules may be one of the main influences for amyloid aggregate formation. This was first suggested by the presence of different proteins in amyloid plaques found in the nervous tissue of patients. While the cross-interaction between Alzheimer ‘ s disease-related amyloid-beta and tau protein is documented in numerous cases (1,2), there is a lack of information on other protein coaggregation. One such paring, which was examined in this work, was superoxide dismutase-1 (SOD1, related to amyotrophic lateral sclerosis) and prion protein (PrP, relation to prionopathies). Both of them share a localisation in vivo and there was only a single report regarding the influence that SOD1 had on the aggregation of PrP (3), which prompted this investigation. In order to investigate the influence of non-aggregated SOD1 on prion protein fibril formation, conditions were chosen which did not facilitate the aggregation SOD1, while actively promoting the fibrilization of PrP. A large number of samples was analyzed using different SOD1 concentrations to determine if there was a notable effect induced by the pro- tein cross-interaction. The resulting fibrils were examined using Fourier-transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM). Parameters obtained from each assay were compared between each condition to determine the significance of SOD1 influence on PrP aggregation. It was discovered that the presence of SOD1 increased the lag time of PrP fibril formation and reduced their apparent rate of replication. There was also Background: The complement cascade is a critical compo-nent of the immune system, and its activation has been implicated in ALS (1). Furthermore, complement cascade components (e.g. C3 breakdown products) are reported to be deposited on the neuromuscular junction (NMJ) in people living with restored NMJ numbers to 76.1% of the ND control and fatigue index by 30.1% from hCS. In TDP-43 NMJs, hCS reduced NMJ numbers by 82.9% of the ND control and increased fatigue index by 22.8% (stimulation frequency of 2Hz), while the addition of pegcetacoplan restored NMJ numbers to 60.5% of the ND control and fatigue index by 9% from hCS. Furthermore, fidelity was increased in SOD-1 NMJs following treatment of pegcetacoplan and remained stable in TDP-43 NMJs. Conclusions: These data demonstrate that inhibiting C3 with pegcetacoplan in an inflammatory environment may improve overall NMJ survival and function. Background: Neuroinflammation plays a significant role in the onset and progression of amyotrophic lateral sclerosis (ALS), which presently has no effective treatment. Peptidylprolyl cis-/trans-isomerase A (PPIA), also as Background: RNA-bindi
淀粉样蛋白/肽的聚集与几种淀粉样疾病的发生和发展有关,包括神经退行性疾病,如阿尔茨海默病或帕金森病。近年来,人们观察到这些蛋白质分子之间的交叉相互作用可能是淀粉样蛋白聚集体形成的主要影响因素之一。这首先是由患者神经组织中淀粉样蛋白斑块中存在的不同蛋白质提出的。虽然阿尔茨海默病相关的淀粉样蛋白β和tau蛋白之间的交叉相互作用在许多病例中都有记录(1,2),但缺乏关于其他蛋白质聚集的信息。这项工作中检测到的一种配对是超氧化物歧化酶-1(SOD1,与肌萎缩侧索硬化症有关)和朊病毒蛋白(PrP,与朊病毒病有关)。它们都有一个体内定位,只有一份关于SOD1对PrP(3)聚集的影响的报告,这促使了这项研究。为了研究非聚集的SOD1对朊病毒蛋白原纤维形成的影响,选择了不促进聚集SOD1,同时积极促进PrP原纤维化的条件。使用不同的SOD1浓度对大量样品进行分析,以确定蛋白质交叉相互作用是否引起显著影响。使用傅里叶变换红外光谱(FTIR)和原子力显微镜(AFM)对所得原纤维进行检查。在每种条件之间比较从每种测定获得的参数,以确定SOD1对PrP聚集的影响的显著性。发现SOD1的存在增加了PrP原纤维形成的滞后时间并降低了它们的表观复制速率。还有背景:补体级联是免疫系统的关键组成部分,其激活与ALS有关(1)。此外,据报道,补体级联成分(如C3分解产物)沉积在神经肌肉接头(NMJ)上,NMJ数量恢复到ND对照的76.1%,疲劳指数从hCS恢复到30.1%。在TDP-43 NMJ中,hCS使NMJ数量减少了ND对照的82.9%,疲劳指数增加了22.8%(刺激频率为2Hz),而添加培西酞普兰使NMJ数恢复到ND对照的60.5%,疲劳指数从hCS恢复到9%。此外,在聚乙二醇乙酮普兰处理后,SOD-1 NMJ的保真度增加,在TDP-43 NMJ中保持稳定。结论:这些数据表明,在炎症环境中用培西他普兰抑制C3可以提高NMJ的整体存活率和功能。背景:神经炎症在肌萎缩侧索硬化症(ALS)的发生和发展中起着重要作用,目前尚无有效的治疗方法。肽基丙基顺式/反式异构酶A(PPIA),也称为背景:RNA结合蛋白(RBPs)与mRNA组装成细胞质复合物,以控制mRNA的局部翻译和轴突运输。这些过程对维持神经元存活至关重要,它们的损伤与许多神经退行性疾病的发展有关,如ALS(1)。我们发现,与ALS相关的TDP-43耗竭驱动异质性核核糖核酸蛋白A1(hnRNP A1)的另一种天然剪接变体的积累,(2)。这种亚型被称为hnRNP A1B,具有细长的朊病毒样结构域(PrLD),存在于神经元过程中,而hnRNP A1不存在(3)。这一发现支持了一种假设,即hnRNP A1B可能在神经元中具有与hnRNP A1不共享的胞浆功能。此外,hnRNP A1和hnRNP A1B在家族性ALS的罕见病例中发生突变,其中一些突变是hnRNP AlB特有的。到目前为止,文献主要集中在hnRNPA1异构体上,而对hnRNP A1B功能知之甚少。由于RNA结合蛋白在信使核糖核酸过程中的关键作用,需要更深入地了解它们的功能,以阐明它们对生理学和病理学的贡献。目的:鉴定和表征运动神经元中hnRNP A1B的细胞质功能及其在ALS中的潜在损伤。方法:神经元变性被认为是中枢神经系统疾病(如硬化症)致残和进展的主要驱动因素,这些RNA结合的成功标志着这些疾病的病理学,即蛋白质病。融合肉瘤(FUS)是一种细胞核RBP,是指将病理内含物转化为生理颗粒,使细胞稳态至神经元细胞死亡。FUS的突变——其C末端核定位——在模型细胞系中的常染色体显性遗传及其细胞质信号传导涉及过表达。方法:我们使用BioID2近端标记技术利用生物素连接酶对近端内源性蛋白质进行生物素化的能力。 我们证明了TBK1激酶功能的丧失导致小胶质细胞以细胞自主方式失调,并揭示了新的失调途径
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引用次数: 0
Theme 09 - Clinical Trials and Trial Design 主题09 -临床试验和试验设计
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2022-11-01 DOI: 10.1080/21678421.2022.2120685
S. Badri, J. Mason, S. Paganoni, J. Timmons, P. Yeramian, M. Cudkowicz, S. Appel, S. Ladha, N. Maragakis, M. Rivner, J. Katz, A. Genge, N. Olney, D. Lange, D. Heitzman, C. Bodkin, O., Jawdat, N. Goyal, J. Bornstein, C. Mak, S. Perrin
Background: The safety and efficacy of sodium phenylbutyrate (PB) and taurursodiol (TURSO, also known as ursodoxicol- taurine) coformulation in ALS were evaluated in a phase 2 US multicenter trial (CENTAUR) encompassing both randomized (NCT03127514) and open-label extension (OLE; NCT03488524) phases. While overall treatment-emergent adverse event (TEAE) incidence was similar in the PB&TURSO versus placebo groups in the randomized phase and between those continuing versus switching to PB&TURSO in the OLE phase, treatment-emergent cardiac adverse events (TECAEs) and centrally read electrocardiographic abnormalities were reported more frequently among those receiving PB&TURSO in both phases. Objective: Describe the findings of independent expert reviews of reported TECAEs and electrocardiographic abnor- malities and of recorded electrocardiographic parameters in CENTAUR. Methods: Occurrence of TEAEs was assessed at each visit during both phases. Standard 12-lead electrocardiograms were performed at baseline in both phases and at a total of 2 visits in the randomized phase and up to 10 visits in the OLE phase, blinded and centrally read. Unblinded independent expert reviews assessed reported TECAEs and electrocar- diographic abnormalities for diagnostic accuracy and treatment emergence based on absence at baseline or lack Background: CD40L/CD40 costimulatory pathway mediates both humoral and adaptive immune responses in the pathophysiology of autoimmunity and transplant rejection. Studies have implicated CD40L (CD154) signaling and adaptive and innate immune cell activation in induction of neuroinflammation in neurodegenerative diseases. Methods: In this multicenter dose escalating phase 2 study 54 participants with a definite or probable diagnosis of ALS by El Escorial Criteria-revised received an anti CD154 antibody, tegoprubart, via intravenous infusion every two weeks for twelve weeks. Enrollment consisted of 9 participants in cohorts 1 and 2 (1 and 2mg/kg) and 18 participants in cohorts 3 and 4 (4 and 8mg/kg). The primary endpoint of the study was safety and tolerability. Secondary endpoints assessed the pharmacokinetics of tegoprubart as well as anti-drug antibody responses. Exploratory endpoints evaluated changes in disease progression utilizing the ALS Functional Rating Scale-Revised (ALSFRS-R), assessment of CD154 target engagement specifically looking at change in circulating CD40L and CXCL13, and changes in the levels of pro-inflam-matory biomarkers in circulation, by looking at change from baseline in circulating levels of a panel of inflammatory che-mokines and cytokines. Results: Seventy participants were screened, and fifty-four were enrolled in the study. Forty-nine completed the study (90.7%) receiving all six infusions of tegoprubart and com- pleting their final follow up visit. The most common TEAEs overall ( 10%) were fatigue (25.9%), falls (22.2%), headaches and muscle spasms (11.1%). Mean tegoprubart plasma concentrations increa
背景:美国一项2期多中心试验(CENTAUR)评估了苯丁酸钠(PB)和牛磺酸二醇(TURSO,也称为牛磺酸多醇-牛磺酸)联合配方治疗ALS的安全性和有效性,该试验包括随机(NCT03127514)和开放标签扩展(OLE;NCT03488524)阶段。虽然随机期PB&TURSO组与安慰剂组的总体治疗不良事件(TEAE)发生率相似,OLE期继续使用PB&TURSO组与改用PB&TURSO组之间的总体治疗不良事件(TEAE)发生率相似,但在两个阶段接受PB&TURSO的患者中,治疗出现的心脏不良事件(tecae)和中心阅读心电图异常的报告频率更高。目的:描述独立专家对CENTAUR报告的tecae和心电图异常以及记录的心电图参数的审查结果。方法:在两个阶段的每次访问中评估teae的发生情况。标准12导联心电图在两个阶段的基线上进行,随机阶段共2次访问,OLE阶段最多10次访问,盲法和中央读取。背景:CD40L/CD40共刺激通路在自身免疫和移植排斥的病理生理过程中介导体液和适应性免疫反应。研究表明,CD40L (CD154)信号和适应性和先天免疫细胞激活在神经退行性疾病中诱导神经炎症。方法:在这项多中心剂量递增的2期研究中,54名根据El Escorial标准修订的明确或可能诊断为ALS的参与者每两周静脉输注一次抗CD154抗体tegopruart,持续12周。入组1和2组9名受试者(1和2mg/kg), 3和4组18名受试者(4和8mg/kg)。研究的主要终点是安全性和耐受性。次要终点评估了地戈鲁巴的药代动力学以及抗药物抗体反应。探索性终点评估疾病进展的变化,使用ALS功能评定量表-修订版(ALSFRS-R),评估CD154靶点参与,特别是观察循环CD40L和CXCL13的变化,以及循环中促炎生物标志物水平的变化,通过观察一组炎症因子和细胞因子的循环水平从基线的变化。结果:70名参与者被筛选,54人被纳入研究。49例(90.7%)完成了研究,接受了全部六次输注地甲肽并完成了最后的随访。最常见的teae(10%)是疲劳(25.9%)、跌倒(22.2%)、头痛和肌肉痉挛(11.1%)。平均地鲁巴血药浓度随剂量增加成比例增加,半衰期约为24天。抗药物抗体(ADA)滴度较低,所有队列的tego- prubart循环水平与预测一致。Tegopurbart通过降低循环CD40L和CXCL13水平证明了剂量依赖性靶标作用。虽然该研究的目的不是检测临床疗效,但靶标接触与ALSFRS-R基线变化导致功能丧失减慢的趋势有关。tegopruart还以剂量依赖性的方式降低循环中的多种促炎生物标志物,包括TNF a、en -rage、IL-16、IL-18、CXCL9和CXCL10等。靶接触和炎症生物标志物显示,从1mg/ kg剂量组到2mg/kg剂量组,降低水平不断增加,然后在4mg/kg剂量组达到峰值。这种变化在第一次给药后出现,并在整个治疗期间持续存在。结论:替戈鲁巴在成人ALS患者中是安全且耐受性良好的,显示出剂量依赖性的功能活性,可以参与靶标并减少与ALS相关的促炎切因子和细胞因子。这些结果为进一步的临床研究提供了足够的力量和持续时间来评估作为成人ALS潜在治疗方法的临床结果。背景:平台试验方法允许通过杠杆化共享临床试验基础设施来同时评估多种研究产品,以减少启动新研究所需的时间和资源。平台试验的启动需要大量的临床试验专业知识、资源和基础设施才能成功。 背景:WVE-004是一种正在研究的体纯反义寡核苷酸,旨在选择性地降低来自C9orf72基因中六核苷酸重复扩增突变(G4C2)的转录本,这是ALS和FTD最常见的遗传原因。重复扩增降低了C9orf72基因的表达;重复序列的转录导致异常的RNA聚焦,最终产生二肽重复序列(DPR)蛋白,如聚甘氨酸-脯氨酸(聚(GP))。在临床前小鼠研究中,WVE-004在不降低C9orf72蛋白表达的情况下,显著且持久地降低了含有重复序列的C9orf72转录因子和致病性多聚(GP)(1)。FOCUS-C9 (NCT04931862)是一项全球性、多中心、安慰剂对照的1b/2a期临床试验,采用自适应设计,可快速评估C9-ALS或C9-FTD患者鞘内单次和多次递增剂量WVE-004的安全性、耐受性、药代动力学和药效学效应。初步结果(直至第85天)显示单剂量(10mg, n / 2;30mg, n¼4;60mg, n¼3),聚(GP)浓度在第85天没有明显达到稳态最大还原。不良事件(ae)在治疗组之间是平衡的,包括安慰剂组(n¼3),并且大多数是轻度到中度的强度。4名患者(包括1名安慰剂组患者)经历了严重和/或严重不良反应;据报道,其中一个与研究药物有关。这些数据表明,单次上升剂量的WVE-004通常是安全的,脑脊液聚(GP)的减少证实了单次剂量的目标接触。基于这些初始数据,FOCUS-C9被用于评估额外的和扩大的低单剂量队列。讨论:治疗正在进行中,预计将于2022年获得单剂量和多剂量队列的额外数据。研究中出现的新数据也将被介绍。FOCUS-C9是首个在同一项研究中解决由C9orf72基因变异引起的ALS和FTD的临床试验。此外,FOCUS-C9的自适应设计使数据驱动的研究修改成为可能,以支持WVE-004的剂量水平和频率的更快优化。前言目的:改善肌萎缩性侧索硬化症的功能结果测量将有助于肌萎缩性侧索硬化症的试验设计,并有助于加速药物的发现。我们评估了rasch构建的肌萎缩侧索硬化症总体残疾量表(ROADS)与肌萎缩侧索硬化症自我进入功能评定量表(ALSFRS-RSE)作为ALS患者报告的功能状态结果的纵向表现。方法:ALS患者在基线、3个月、6个月和12个月时使用基于网络的平台完成ROADS和ALSFRS-RSE问卷,研究电子数据采集作为2020年9月至2021年12月ALS患者疲劳的前瞻性、纵向、远程、在线调查研究的一部分。对量表进行横断面(基线)和纵向比较。评估相关系数、变异系数和描述性统计。随访约12个月时记录生命状况。结果:182名成年ALS患者同意这项研究。这个志愿者样本主要由白人、非西班牙裔、不吸烟的参与者组成。基线时同意参与者的调查完成率约为90%,12个月时超过40%。ALSFRS-RSE与ROADS在第3个月和第6个月具有高度显著的一致性,Cohen ' s kappa bb0.71 (p < 0.001);各尺度上功能增加或停滞的次数无显著性差异;功能衰退的变异系数在6个月时相似,但在3个月时更高,在12个月时更低。背景:肌萎缩性侧索硬化症(ALS)的治疗发展在很大程度上依赖于工作人员管理的功能评定量表来确定治疗效果。移动应用程序和可穿戴设备为生物识别数据收集提供了多种机会。假设:可穿戴和智能手机设备可以收集患者报告的结果,并被动收集传感器数据,为ALS疾病进展提供定量测量。方法:参与者远程同意,登记并随访6个月。ALSFRS-R在基线、3和6个月时通过电话给药。研究应用程序(Beiwe)在基线时安装在参与者的个人智能手机上,并每2 - 4周提供ALSFRS-R自我输入(ALSFRS-RSE)和Rasch整体ALS残疾量表(RO
{"title":"Theme 09 - Clinical Trials and Trial Design","authors":"S. Badri, J. Mason, S. Paganoni, J. Timmons, P. Yeramian, M. Cudkowicz, S. Appel, S. Ladha, N. Maragakis, M. Rivner, J. Katz, A. Genge, N. Olney, D. Lange, D. Heitzman, C. Bodkin, O., Jawdat, N. Goyal, J. Bornstein, C. Mak, S. Perrin","doi":"10.1080/21678421.2022.2120685","DOIUrl":"https://doi.org/10.1080/21678421.2022.2120685","url":null,"abstract":"Background: The safety and efficacy of sodium phenylbutyrate (PB) and taurursodiol (TURSO, also known as ursodoxicol- taurine) coformulation in ALS were evaluated in a phase 2 US multicenter trial (CENTAUR) encompassing both randomized (NCT03127514) and open-label extension (OLE; NCT03488524) phases. While overall treatment-emergent adverse event (TEAE) incidence was similar in the PB&TURSO versus placebo groups in the randomized phase and between those continuing versus switching to PB&TURSO in the OLE phase, treatment-emergent cardiac adverse events (TECAEs) and centrally read electrocardiographic abnormalities were reported more frequently among those receiving PB&TURSO in both phases. Objective: Describe the findings of independent expert reviews of reported TECAEs and electrocardiographic abnor- malities and of recorded electrocardiographic parameters in CENTAUR. Methods: Occurrence of TEAEs was assessed at each visit during both phases. Standard 12-lead electrocardiograms were performed at baseline in both phases and at a total of 2 visits in the randomized phase and up to 10 visits in the OLE phase, blinded and centrally read. Unblinded independent expert reviews assessed reported TECAEs and electrocar- diographic abnormalities for diagnostic accuracy and treatment emergence based on absence at baseline or lack Background: CD40L/CD40 costimulatory pathway mediates both humoral and adaptive immune responses in the pathophysiology of autoimmunity and transplant rejection. Studies have implicated CD40L (CD154) signaling and adaptive and innate immune cell activation in induction of neuroinflammation in neurodegenerative diseases. Methods: In this multicenter dose escalating phase 2 study 54 participants with a definite or probable diagnosis of ALS by El Escorial Criteria-revised received an anti CD154 antibody, tegoprubart, via intravenous infusion every two weeks for twelve weeks. Enrollment consisted of 9 participants in cohorts 1 and 2 (1 and 2mg/kg) and 18 participants in cohorts 3 and 4 (4 and 8mg/kg). The primary endpoint of the study was safety and tolerability. Secondary endpoints assessed the pharmacokinetics of tegoprubart as well as anti-drug antibody responses. Exploratory endpoints evaluated changes in disease progression utilizing the ALS Functional Rating Scale-Revised (ALSFRS-R), assessment of CD154 target engagement specifically looking at change in circulating CD40L and CXCL13, and changes in the levels of pro-inflam-matory biomarkers in circulation, by looking at change from baseline in circulating levels of a panel of inflammatory che-mokines and cytokines. Results: Seventy participants were screened, and fifty-four were enrolled in the study. Forty-nine completed the study (90.7%) receiving all six infusions of tegoprubart and com- pleting their final follow up visit. The most common TEAEs overall ( 10%) were fatigue (25.9%), falls (22.2%), headaches and muscle spasms (11.1%). Mean tegoprubart plasma concentrations increa","PeriodicalId":7740,"journal":{"name":"Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48272049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Theme 10 - Disease Stratification and Phenotyping of Patients 主题10 -患者的疾病分层和表型
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2022-11-01 DOI: 10.1080/21678421.2022.2120686
E. Young, D. Wang, J. Meyer, B. Narapureddy, D. Manta, B. Sah, U. Desai, B. Brooks
Background: COVID-19 pandemic presents new opportunities to augment respiratory monitoring complementary to remote telehealth services. Stratification of vital capacity may allow for characterization of FVC and disease trajectory clusters (1). Objective(s): In this implementation science study, we assessed the feasibility of measuring FVC in seated upright and supine positions obtained with in-clinic-conventional (Viaire and Vyasis, USA), in-clinic-portable and at-home-portable (MIR Spirobank Smart, Italy) spirometers with respiratory therapist coaching. Method(s): Electronic health records of 22/95 ALS clinic patients (23%) from single-center in Central New York that launched AHT between July 2020 and June 2021 was reviewed in this IRB-approved retrospective study. Mean age of patients was 65 years old and 9 were males. Patients were stratified according to baseline seated FVC % predicted by conventional method: Group A, FVC >80%, Group B, 60-80%, Group C <60% predicted. Patients unable to come to clinic received spirometers by mail followed with remote training with respiratory therapists without conventional spirometry. Result(s): Pearson correlation coefficient was used to evaluate the correlation between FVC measurement using conventional and portable spirometry by position. Bland-Altman analysis was performed to evaluate the mean difference (conventional - portable) with 95% limits of agreement. Measurement of seated FVC acquired during the same clinic visit (N=13) were highly correlated in liters (R2=0.95, p<0.0001) and % predicted (R2=0.952, p<0.0001). Bland- Altman analysis showed good agreement with a mean difference of 0.147L, 0.345 to 0.639L);4.154% predicted, (8.004 to 16.311%). In-clinic supine FVC (N=4) were highly correlated in liters (R2=0.987, p=0.007) and % predicted (R2=0.987, p=0.007) with a mean difference of =0.33L, (0.101 to 0.761L);8.5% predicted, (0.043-17.043%). Supine vital capacity measurements were more frequently obtained with AHT 35/52 (67.31%) vs. 9/21(42.86%) with Conventional spirometry. Safety concerns associated with patient transfers were the most frequently encountered barrier in performing supine testing in clinic. Reason for drop out for 2/22 patients with no remote AHT was attributed to perceived aggravation of anxiety from readily viewing FVC results on smartphone and low baseline FVC (<50% predicted). AHT led to prompt initiation of NIV in 5/22 patients, of which 3 were homebound, had low FVC at initial AHT (12-48% predicted), low ALS FRSR (14-28 out of 48) and received remote AHT training without conventional spirometry. An ongoing slow vital capacity (NCT05106569) prospective clinical study in ALS will determine if frequent respiratory surveillance from home using AHT leads to better outcomes in relation to use of NIV.
背景:COVID-19大流行为加强呼吸监测提供了新的机会,以补充远程医疗服务。肺活量的分层可能允许表征FVC和疾病轨迹群(1)。目的:在这项实施科学研究中,我们评估了在呼吸治疗师指导下使用临床常规(Viaire和Vyasis,美国)、临床便携式和家庭便携式(MIR Spirobank Smart,意大利)肺活量计测量直立和仰卧位FVC的可行性。方法:在这项经irb批准的回顾性研究中,对2020年7月至2021年6月期间在纽约中部开展AHT的单中心22/95名ALS临床患者(23%)的电子健康记录进行了审查。患者平均年龄65岁,男性9例。根据常规方法预测的基线坐位FVC %对患者进行分层:A组FVC >80%, B组60-80%,C组<60%。无法来诊所的患者通过邮件接收肺活量计,随后由呼吸治疗师进行远程培训,无需常规肺活量计。结果:采用Pearson相关系数评价常规肺活量法与便携式体位肺活量法测定肺活量的相关性。采用Bland-Altman分析评估平均差异(常规-便携式),一致性限为95%。同一次就诊期间(N=13)获得的坐式FVC测量与升(R2=0.95, p<0.0001)和%预测(R2=0.952, p<0.0001)高度相关。Bland- Altman分析结果吻合良好,平均差值为0.147L (0.345 ~ 0.639L);预测值为4.154%(8.004 ~ 16.311%)。临床仰卧FVC (N=4)与升(R2=0.987, p=0.007)和预测% (R2=0.987, p=0.007)高度相关,平均差异为0.33L (0.101 ~ 0.761L);预测8.5%(0.043 ~ 17.043%)。AHT 35/52(67.31%)比传统肺活量计9/21(42.86%)更频繁地测量仰卧肺活量。与病人转移相关的安全问题是临床上进行仰卧位试验时最常遇到的障碍。2/22没有远程AHT的患者退出的原因是由于在智能手机上随时查看FVC结果和低基线FVC(预测<50%)而感知到焦虑加重。5/22例患者(其中3例为居家患者)在初始AHT时FVC较低(预测为12-48%),ALS FRSR较低(48例中有14-28例),并且在没有常规肺活量测定的情况下接受了远程AHT训练。一项正在进行的ALS慢肺活量(NCT05106569)前瞻性临床研究将确定在家中使用AHT进行频繁的呼吸监测是否会导致与使用NIV相关的更好结果。
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引用次数: 1
Theme 04 - In Vivo Experimetal Models 主题04-体内Experimetal模型
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2022-11-01 DOI: 10.1080/21678421.2022.2120680
C. Germeys, T. Vandoorne, K. Davie, S. Poovathingal, M. Moisse, A. Quaegebeur, A. Sierksma, P. Carmeliet, P. Van, Damme, K. Bock, L. Bosch, A. Mazzaro, I. Casola, V. Vita, A. Klein, G. Gobbo, G. Dobrowolny, G. Sorar, A. Musar, M. Mongillo, T. Zaglia
Background: A growing body of evidence shows disturbances in energy metabolism in amyotrophic lateral sclerosis (ALS) (1). The oxygen-sensing prolyl hydroxylase domain proteins (PHDs) regulate cellular metabolism and play a role in oxidative stress response. Interestingly, selective inhibition of the PHD isoen- zyme 1 (PHD1) protects cortical neurons via metabolic rewiring in a model for stroke (2). As the major source of oxidative stress, which is known to be elevated in ALS, energy metabol- ism forms a promising target for ALS research. Objectives: This project aims to investigate the effect of target- ing cellular metabolism, via selective PHD1 ablation, in ALS. Methods: To investigate the role and therapeutic potential of PHD1 in ALS, we intercrossed PHD1 knock-out mice with SOD1- G93A mice and monitored disease progression, evaluating weight, neuromuscular junction innervation and total motor neuron count. Single-nuclei RNA-sequencing (snRNAseq) was performed on the lumbar spinal cord of early symptomatic mice to investigate the molecular mechanisms underlying the observed beneficial effect of PHD1 deletion in SOD1-G93A mice. Results and discussion: We demonstrated that genetic dele- tion of PHD1 improves muscle innervation and motor neuron integrity and extends the lifespan of SOD1-G93A mice, increasing the disease duration with 40%. Using snRNAseq, we were able to identify the different cell types present in the spinal cord of SOD1-G93A mice with and without PHD1. Gene ontology analysis of the differentially expressed genes showed that pathways related to oxidative metabolism are downregulated upon PHD1 deletion in motor neurons. Moreover, we also found a downregulation of interferon-stimulated genes in astrocytes. Strikingly some of these genes have recently been shown to be upregulated in ALS patients and models. A downregulation of these genes in astrocytes, which may be dependent or independent from the downregulation of reactive oxygen species (ROS) produc- ing metabolic pathways in motor neurons, could contribute to the PHD1-mediated neuroprotection. In conclusion, our data identify PHD1 inhibition as a novel ALS therapeutic strategy that targets both the metabolic dysregulation and interferon-driven hyperinflammatory response linked to ALS pathology. Rationale: Amyotrophic Lateral Sclerosis (ALS) is a fatal neuromuscular disorder characterized by motor neuron (MN) degeneration, muscle weakness, paralysis and respiratory fail- ure, leading to death within 2 – 5 years after diagnosis. ALS sprouting, process fragmentation and irregular distribution of varicosities. Notably, similar alterations in neuronal morphology and topology have been observed in muscle biopsies from ALS patients, indicating that the alteration of sympathetic innervation is a common aspect in ALS muscles. Consistently, alterations of Heart Rate Variability and a greater incidence of arrhythmic events were observed in ALS patients, indicating that SN morphological a
背景:越来越多的证据表明肌萎缩侧索硬化症(ALS)的能量代谢紊乱(1)。氧感应脯氨酰羟化酶结构域蛋白(PHDs)调节细胞代谢并在氧化应激反应中发挥作用。有趣的是,在中风模型中,PHD同工酶1(PHD1)的选择性抑制通过代谢重组保护皮层神经元(2)。作为氧化应激的主要来源,众所周知,氧化应激在ALS中升高,能量代谢是ALS研究的一个很有前途的靶点。目的:本项目旨在研究通过选择性PHD1消融靶向细胞代谢对ALS的影响。方法:为了研究PHD1在ALS中的作用和治疗潜力,我们将敲除PHD1的小鼠与SOD1-G93A小鼠杂交,监测疾病进展,评估体重、神经肌肉接头神经支配和总运动神经元计数。对早期症状小鼠的腰椎进行单核RNA测序(snRNAseq),以研究在SOD1-G93A小鼠中观察到的PHD1缺失有益作用的分子机制。结果和讨论:我们证明PHD1的基因缺失改善了肌肉神经支配和运动神经元的完整性,并延长了SOD1-G93A小鼠的寿命,使疾病持续时间增加了40%。使用snRNAseq,我们能够鉴定存在于具有和不具有PHD1的SOD1-G93A小鼠脊髓中的不同细胞类型。对差异表达基因的基因本体论分析表明,运动神经元中PHD1缺失后,与氧化代谢相关的途径下调。此外,我们还发现星形胶质细胞中干扰素刺激的基因下调。引人注目的是,这些基因中的一些最近被证明在ALS患者和模型中上调。星形胶质细胞中这些基因的下调可能依赖于或独立于运动神经元中活性氧(ROS)产生代谢途径的下调,可能有助于PHD1介导的神经保护。总之,我们的数据表明,PHD1抑制是一种新的ALS治疗策略,其靶向与ALS病理相关的代谢失调和干扰素驱动的高炎症反应。理由:肌萎缩侧索硬化症(ALS)是一种致命的神经肌肉疾病,其特征是运动神经元(MN)变性、肌肉无力、瘫痪和呼吸衰竭,可在诊断后2-5年内死亡。肌萎缩侧索硬化(ALS)的萌芽、突起碎裂和静脉曲张的不规则分布。值得注意的是,在ALS患者的肌肉活检中观察到神经元形态和拓扑结构的类似变化,这表明交感神经支配的改变是ALS肌肉的一个常见方面。一致地,在ALS患者中观察到心率变异性的改变和更高的心律失常事件发生率,表明SN形态的改变伴随着细胞功能障碍。结论:总之,我们的研究结果表明,SN是ALS中受损的额外细胞类型,为这种无法治愈的疾病的复杂谜题增添了新的一块。了解SN与ALS的关系可能会发现其他但未被充分重视的治疗靶点。背景:最近,脑脊液(CSF)中源自Gpnmb的肽水平升高与肌萎缩侧索硬化症(ALS)患者的不良预后有关。另一方面,其他研究强调,Gpnmb的上调可能发挥神经保护和免疫调节作用。目的:在本研究中,我们对SOD1.G93A转基因ALS大鼠模型和患者的Gpnmb变化进行了深入的表征,以阐明Gpnmb作为预后生物标志物的价值,并确定疾病过程中适合成功治疗干预的精确时间窗。方法:应用原位杂交(ISH)和免疫组织化学(IHC)在中枢和外周神经系统中进行检测,并结合TG大鼠CSF和血液中Gpnmb外结构域(sGpnmb)的检测。同时,在一小部分ALS患者中对sGpnmb进行了评估。结果与讨论:Gpnmb主要在健康条件下的MNs中表达。然而,在TG动物中,MNs中的Gpnmb mRNA和蛋白水平早期降低,症状发作后反应性小胶质细胞上调。ISH和IHC强调了神经胶质细胞在sGpnmb合成和释放中的关键作用。同时,我们发现TG大鼠的CSF和血液中sGpnmb显著增加,当病理更严重时,ALS患者的sGpnmb也显著增加。我们目前正在进行一项临床前概念验证研究,以验证早期给予重组Gpnmb的治疗潜力,同时监测GpnmbE作为靶点参与的生物标志物。 通过使用CRISPR/Cas9系统,我们在斑马鱼模型和敲除模型中产生了类似的FUS[R521H]变体(FUS[R536H]敲除(KI)突变(FUS[(cid:1)/(cid:1)])。我们提供了表征成年纯合[R536H]变体斑马鱼退行性表型的数据。通过自由游泳和强迫游泳实验比较运动表型,我们发现在3岁时,与野生型(WT)和敲除型相比,我们的纯合fus[R536H]斑马鱼表现出显著的运动缺陷。通过免疫印迹实验发现,在我们的纯合变体中发现了与年龄相关的自调节缺陷,该缺陷显示与WT相比,Fus蛋白增加。对1岁的WT、Fus[R536H/R536H]和Fus[(cid:1)/(cid:1)]脊髓进行了RNA测序,发现突变脊髓中存在突触因子的mRNA失调。我们的研究结果得到了ALS-FUS文献中数据的支持,使我们相信,在我们的动物中敲低突变体FUS将使我们突变体中的表型减弱到与敲除相同的水平。我们已经产生了潜在的靶向ASOs的fus,并通过逆转录聚合酶链式反应分析在幼虫中显示出显著的敲除作用。这些ASO将通过新型脑间-脑室注射进入成年“有症状”突变鱼的中枢神经系统,并分析表型回归。这些结果表明,我们的[R536H]变体中存在一种退行性表型,这与我们的野生型和敲除系中的行为、表达和分析不同,这为该模型在不同的实验疗法中进行测试和进一步了解FUS相关ALS的生物学性质留下了希望。的参与了这两个突变体中的。在我们的参与传播和散发性ALS中,结构和功能性神经肌肉接头缺陷的未来方向,测试使用新的基因编辑技术修复这些突变。在ALS和FTLD中,正常核反式反应DNA结合蛋白43(TDP-43)的错误定位和异常磷酸化和泛素化内含物进入患病神经元的细胞质是该疾病的标志。TDP-蛋白病。TDP-43蛋白病在开放阅读(C9orf72)G4C2中也占多数结果:运动皮层、内嗅皮层、视觉皮层、初级体感区、梨状区、杏仁核和嗅球神经元中存在大量胞质EGFP-TDP-25内含物。EGFP-TDP-25内含物与磷酸化TDP-43、p62和泛素共同标记,概括了TDP-43蛋白病的关键特征。EGFP-TDP-25-C9KO小鼠形成数量减少的EGFP-TDP-25内含物,与EGFP-TDP-25-WT小鼠相比,这些内含物的大小也更小。此外,我们发现,与两种基因型的EGFP-TDP-25-WT小鼠和EGFP小鼠相比,EGFP-TDP-25-C9KO小鼠表现出神经元损失和轻度运动表型。通过p62免疫反应性和ULK1的蛋白表达来评估自噬缺陷。EGFP-TDP-25的表达导致细胞质p62点增加,C9orf72的缺失加剧了这种情况。我们发现,与WT小鼠相比,对照C9KO小鼠的ULK1水平更高。然而,这种ULK1水平的增加在EGFP-TDP-25-C9KO小鼠中并不存在,表明自噬反应改变或受损。结论:我们的研究结果表明,EGFP-TDP-25的表达与C9orf72缺陷具有协同作用,导致神经元损失和运动行为缺陷,有助于形成导致ALS/FTLD神经退行性变的双稳态模型。背景:尽管进行了协调一致的研究,并且分子工具不断扩展,但ALS的遗传病因仍知之甚少,已知的遗传基础不到所有病例的20%(1)。发掘与ALS相关的新基因对于推进我们对疾病机制的理解和新疗法的开发至关重要。为此,大型多机构合作联盟一直致力于对ALS患者的基因组和转录组进行表征。另外,翻译稳态领域的研究表明,核糖体质量控制(RQC)被破坏会导致神经发育、神经退行性和运动表型(
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引用次数: 0
Theme 02 - Genetics and Genomics 主题02 -遗传学和基因组学
IF 2.8 4区 医学 Q2 Medicine Pub Date : 2022-11-01 DOI: 10.1080/21678421.2022.2120678
L. Becattini, F. Bianchi, L. Fontanelli, A. Fogli, G. Siciliano, A. Bombaci, U. Manera, A. Canosa, M. Grassano, F. Palumbo, G. Marco, F. Casale, P. Salamone, G. Fuda, G. Marchese, C. Moglia, A. Chi, S. Gallone, A. Calvo
Background: Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disorder involving upper and lower motor neurons. It is mostly sporadic, tough pathogenic mutations are sometime detectable, mainly in those patients with a positive familiar track record for neurodegenerative disorders. More than 50 genes have been put in relation with ALS so far, among which SOD1, C9Orf72, FUS, ATXN2 and TARDBP are the most frequent. SOD1, encoding for the antioxidant enzyme Cu/ Zn superoxide dismutase and described for the first time in 1993, is the first gene that had been put in rela- tion with ALS. To date, over 180 different SOD1 mutations have been described throughout the five exons of the SOD1 gene. However, the exact pathogenic effect of this gene mutations are still unclear. Recently, a gene therapy targeting SOD1 has been approved for ALS patients carrying any SOD1 mutation. This new therapeutic approach has boosted the number of genetic tests performed, sometimes revealing unexpected positivity and sometimes underlying new genes ’ mutations. Here we describe a case of a woman with a new SOD1 mutation, not described in literature before and con- sidered as pathogenetic in VarSome. Case report: diseases, gait complete neurological dis-closing severe bulbar with anarthria, tongue hyposthenia and oral apraxia. presented mild upper hyposthenia, limbs Hereditary spastic paraplegia (HSP) is a heterogeneous group of genetic neurodegenerative disorders characterized by progressive weakness and spasticity of lower limbs. SPG15 is a rare form of autosomal recessive HSP due to mutations in ZFYVE26 gene, which encodes for spastizin, involved in autophagy and endocytosis (1). Here we describe the case of a 56 years old man who presented to our clinic in November 2020 referring a progressive motor clumsiness of both legs and walking instability during the last five years. No motor impairment at upper limb, no bulbar nor respiratory symptoms. These symptoms had a progressive evolution. In anamnesis only high blood pressure. No familiar history of neurodegenerative diseases. Neurological examination showed a spastic gait, a light hypo-trophy and hyposthenia of the left leg, brisk reflexes at lower limb, no Hoffmann nor Babinski signs, no urinary nor intes- tinal problems. He underwent: blood examination (resulted normal, no HIV, HTLV infections), electroneurography/electro- myography study (signs of chronic neurogenic muscle with apparently sporadic disease have a lower than expected testing yield. Increasing availability of wider genetic panels may confound our results and yield of testing with contemporary approaches may increase. Our data supports testing of individuals with early-onset disease but does not provide strong evidence for testing those without a family history. Interval re-evaluation of this cohort may be of benefit to appreciate the utility of an extended panel (26 genes plus C9orf72 established in 2021). Systematic questioning regarding fa
背景:肌萎缩侧索硬化症(ALS)是一种涉及上下运动神经元的致命神经退行性疾病。它大多是散发性的,有时可以检测到强硬的致病性突变,主要发生在那些熟悉的神经退行性疾病阳性记录的患者身上。迄今为止,已有50多个基因与ALS有关,其中SOD1、C9Orf72、FUS、ATXN2和TARDBP是最常见的。SOD1编码抗氧化酶Cu/Zn超氧化物歧化酶,于1993年首次被描述,是第一个与ALS相关的基因。到目前为止,已经在SOD1基因的五个外显子中描述了180多种不同的SOD1突变。然而,这种基因突变的确切致病作用尚不清楚。最近,针对SOD1的基因疗法已被批准用于携带任何SOD1突变的ALS患者。这种新的治疗方法增加了基因检测的数量,有时会显示出意想不到的阳性,有时还会潜在的新基因突变。在这里,我们描述了一例女性携带新的SOD1突变的病例,这在以前的文献中没有描述过,并且被认为是VarSome的病因。病例报告:疾病、步态完全性神经系统疾病、闭合性严重延髓伴关节炎、舌功能减退和口腔失用症。遗传性痉挛性截瘫(HSP)是一组异质性遗传性神经退行性疾病,其特征是下肢进行性无力和痉挛。SPG15是一种罕见的常染色体隐性HSP,由于ZFYVE26基因突变,该基因编码spastizin,参与自噬和内吞作用(1)。在这里,我们描述了一名56岁的男子的病例,他于2020年11月来到我们的诊所,指的是在过去五年中,双腿出现渐进性运动笨拙和行走不稳定。上肢无运动障碍,无延髓或呼吸道症状。这些症状有一个渐进的演变过程。在记忆中只有高血压。没有熟悉的神经退行性疾病史。神经系统检查显示步态痉挛,左腿轻度营养不良和肌肉无力,下肢反应敏捷,没有Hoffmann或Babinski体征,没有泌尿或视网膜问题。他接受了:血液检查(结果正常,无HIV、HTLV感染),神经电图/肌电图研究(患有明显散发性疾病的慢性神经源性肌肉的症状的检测结果低于预期。更广泛的基因组的可用性的增加可能会混淆我们的结果,而采用现代方法进行检测的结果可能会增加。我们的数据支持对早发性疾病患者进行检测,但没有为检测那些没有家族史的患者提供有力的证据对该队列的rval重新评估可能有助于评估扩展小组的效用(2021年建立的26个基因加C9orf72)。关于痴呆症、其他神经和精神疾病家族史的系统性询问也可能有助于识别早发性疾病的高危人群。背景:神经元烟碱乙酰胆碱受体(nAChRs)是由不同的烟碱胆碱能受体(CHRN)基因编码的配体门控离子通道,在延髓和脊髓运动神经元中均有表达。它们参与神经保护和控制包括谷氨酸在内的许多神经递质的释放。先前有人假设,nAChRs亚基中的罕见变体可能代表肌萎缩侧索硬化症(ALS)的几种遗传风险因素之一(1)。目的:本研究旨在阐明CHRN基因的遗传变异对ALS疾病风险的影响。方法:我们分析了来自皮埃蒙特和奥斯塔ALS登记处的935名意大利裔散发性ALS患者和775名种族和地理匹配的对照组。我们使用常见变异的线性回归和罕见(次要等位基因频率,MAF,<1%)变异的负荷分析来测试CHRN基因簇中变异的相关性。结果:经过多次测试的适当校正后,CHRN基因突变与ALS之间没有发现显著关联。我们没有观察到罕见的非同义变体的显著过量,也没有观察到稀有和常见编码变体对ALS风险的总体贡献。在基因簇水平上应用联合测试时未检测到任何影响。结论:我们的研究结果表明,CHRN基因簇中常见和罕见的遗传变异与ALS的发病机制无关。然而,还需要进一步的研究来了解nAChRs的遗传变异对运动神经元变性的可能影响。ERLIN1和UNC13A基因在两个不同的PLS患者中的表达。我们还研究了致病性扩增在PLS中的作用。在我们的PLS队列中,在ATXN2和C9orf72中未发现致病性扩增。
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Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
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