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Is the incidence of motor neuron disease higher in French military personnel? 法国军人运动神经元疾病的发病率高吗?
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1675709
T. Vlaar, A. Elbaz, F. Moisan
Abstract Objective: Previous studies, mostly from the United States, showed an increased risk of motor neuron disease (MND) in military personnel. We compared MND incidence rates in French military personnel to that in the general population. Methods: Among persons covered between 2010 and 2016 by the Caisse Nationale Militaire de Sécurité Sociale (CNMSS, military personnel) and the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAMTS, general population) aged ≥50 years, we identified incident MND cases and estimated populations at risk using national health insurance databases. We estimated relative risks (RRs) and 95% confidence intervals (CIs) separately for men and women using age-adjusted Poisson regression. Analyses were also stratified by 10-year age groups. We used the E-value approach and probabilistic bias analysis to assess robustness of the results regarding unmeasured confounding by smoking. Results: On average, 25 cases/year were newly diagnosed with MND among military personnel aged ≥50 years. The incidence rate was higher for male military personnel compared to the general population (RR = 1.16; 95% CI = 1.05–1.29) but was similar for women (RR = 1.02; 95% CI = 0.79–1.31). Although there were no significant interactions with age and sex, the association was mainly explained by men aged 70–79 years. The prevalence of ever-smoking should be at least 1.1-fold higher in male CNMSS compared to male CNAMTS members to make the association in male military personnel not significant. Conclusion: MND incidence was 16% higher in French male military personnel, in agreement with studies from other countries. Smoking may contribute to this finding. Further studies are needed to identify exposures that drive this association.
摘要目的:先前的研究大多来自美国,表明军事人员患运动神经元疾病(MND)的风险增加。我们将法国军事人员的MND发病率与普通人群的MND发生率进行了比较。方法:在2010年至2016年期间,在国家安全社会军事保障中心(CNMSS,军事人员)和国家安全社会保障中心(CNAMTS,普通人群)覆盖的年龄≥50岁的人群中,我们使用国家健康保险数据库确定了MND事件病例和估计的风险人群。我们使用年龄调整后的泊松回归分别估计了男性和女性的相对风险(RR)和95%置信区间(CI)。分析还按10岁年龄组进行了分层。我们使用E值方法和概率偏差分析来评估关于吸烟引起的未测量混杂因素的结果的稳健性。结果:在年龄≥50岁的军人中,平均每年有25例新诊断为MND。男性军事人员的发病率高于普通人群(RR=1.16;95%CI=1.05-1.29),但女性的发病率相似(RR=1.02;95%CI=0.79-1.31)。尽管与年龄和性别没有显著的相互作用,但这种关联主要由70-79岁的男性解释。男性CNMSS的吸烟率应比男性CNAMTS成员高至少1.1倍,以使男性军事人员的吸烟率不显著。结论:法国男性军人MND发病率高出16%,与其他国家的研究一致。吸烟可能促成了这一发现。需要进一步的研究来确定导致这种关联的暴露。
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引用次数: 5
ALSUntangled 51: RCH4 AL缝合51:RCH4
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1675282
ALSUntangled reviews alternative and off-label therapies (AOTs) for people with ALS (PALS). Here we provide our opinion on RCH4, for which we have had more than 1700 requests (1). We were first asked to review this product 3 years ago by the family member of a person with ALS. Since then, in spite of our best efforts, we have not been able to obtain much useful disclosable information on RCH4. We define “useful” as information that helps us describe exactly what a product is and helps us complete our Table of Evidence (2). “Disclosable” means information that is in the public domain or that we have been given permission to discuss in a public forum. Since it does not appear to us that any new useful disclosable information is forthcoming, we elected to move forward with the information we have. This is the first and only ALSUntangled review on RCH4. A previous unfavorable review of this product by a person with ALS on their blog (3) has been inaccurately attributed to ALSUntangled (4,5). While this person has done valuable work with our team before, he has clearly stated that his RCH4 review is separate from any work he has done with us and was not formulated using ALSUntangled standard operating procedures (SOPs) which includes review by our international team of clinicians and scientists.
ALSUntangled回顾了ALS (PALS)患者的替代疗法和标签外疗法(aot)。在这里,我们提供我们对RCH4的意见,我们已经有超过1700个请求(1)。3年前,一位ALS患者的家庭成员第一次要求我们审查该产品。从那时起,尽管我们尽了最大的努力,但我们未能获得关于RCH4的许多有用的可披露信息。我们将“有用”定义为帮助我们准确描述产品并帮助我们完成证据表(2)的信息。“可披露”是指处于公共领域或我们已获准在公共论坛上讨论的信息。由于在我们看来没有任何新的有用的可披露信息即将到来,我们决定继续使用我们所拥有的信息。这是第一个也是唯一一个关于RCH4的ALSUntangled综述。此前一位ALS患者在其博客上对该产品的负面评论(3)被错误地归因于ALSUntangled(4,5)。虽然此人之前在我们团队中做过有价值的工作,但他明确表示,他的RCH4审查与他在我们团队中所做的任何工作都是分开的,并且没有按照ALSUntangled标准操作程序(sop)制定,其中包括我们的国际临床医生和科学家团队的审查。
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引用次数: 1
Twelve-month duration as an appropriate criterion for flail arm syndrome 12个月持续时间作为连枷臂综合征的适当标准
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1663872
Lu Chen, Lu Tang, D. Fan
Abstract Objectives: To analyze the clinical features of flail arm syndrome (FAS) in a large Chinese clinic-based cohort, and to discuss whether it is proper to use a course of 12 months from symptoms onset as the criterion for FAS. Methods: This cohort study included patients with FAS or upper-limb-onset amyotrophic lateral sclerosis (UL-ALS) who visited Peking University Third Hospital between 2003 and 2013. Patients with FAS were diagnosed according to Wijesekera’s definition, and patients fulfilling all the diagnostic criteria of FAS except that the course of disease was less than 12 months were defined as “FAS-type ALS”. Group differences were analyzed using parametric and nonparametric tests as appropriate. Survival was analyzed using the Kaplan–Meier method and a Cox regression model. Results: One thousand nine hundred and thirty-five patients with ALS were recruited in the database, including 131 patients with FAS or FAS-type ALS and 767 with UL-ALS. The prognosis of FAS was significantly better than that of UL-ALS (p = 0.024) and FAS-type ALS (p < 0.0005), and the survival of patients with FAS-type ALS was worse than that of UL-ALS (p = 0.002). The difference in survival between those with proximal FAS (pFAS) and distal FAS (dFAS) (p = 0.188) was not significant. Conclusion: Since the prognosis of FAS-type ALS was significantly worse than that of FAS, our data suggest that a FAS subphenotype can be established after 12 months from first symptoms. It is important to note that FAS-type ALS phenotype may carry a worse prognosis than that of patients with UL-ALS.
目的:分析连枷臂综合征(flail - arm syndrome, FAS)的临床特征,探讨以症状出现后12个月的病程作为FAS的诊断标准是否合适。方法:本队列研究纳入2003 - 2013年在北京大学第三医院就诊的FAS或上肢肌萎缩性侧索硬化症(UL-ALS)患者。FAS患者按照Wijesekera的定义进行诊断,除病程少于12个月外,满足FAS所有诊断标准的患者定义为“FAS型ALS”。采用参数检验和非参数检验分析组间差异。生存率分析采用Kaplan-Meier法和Cox回归模型。结果:数据库中招募了1335例ALS患者,其中FAS或FAS型ALS患者131例,UL-ALS患者767例。FAS的预后明显优于UL-ALS (p = 0.024)和FAS型ALS (p < 0.0005), FAS型ALS患者的生存期较UL-ALS患者差(p = 0.002)。近端FAS (pFAS)与远端FAS (dFAS)患者的生存率差异无统计学意义(p = 0.188)。结论:由于FAS型ALS的预后明显差于FAS,我们的数据表明,FAS亚表型可以在首次出现症状后12个月建立。值得注意的是,fas型ALS表型可能比UL-ALS患者预后更差。
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引用次数: 5
Selection design phase II trial of high dosages of tamoxifen and creatine in amyotrophic lateral sclerosis 高剂量他莫昔芬和肌酸治疗肌萎缩侧索硬化症的选择设计II期试验
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1672750
Suma Babu, E. Macklin, K. Jackson, Elizabeth Simpson, K. Mahoney, Hong Yu, Jason Walker, Z. Simmons, W. David, P. Barkhaus, L. Simionescu, M. Dimachkie, A. Pestronk, J. Salameh, M. Weiss, B. Brooks, D. Schoenfeld, J. Shefner, Swati Aggarwal, M. Cudkowicz, N. Atassi
Abstract Objective: To conduct a phase-II trial using a ranking and selection paradigm where multiple treatments are compared with limited sample size and the best is chosen for a subsequent efficacy trial versus placebo. This strategy can find an effective treatment faster than traditional strategy of conducting larger trials against placebo. Methods: Sixty amyotrophic lateral sclerosis (ALS) participants were randomized 1:1:1 to creatine 30 g/day (CRE), tamoxifen 40 mg/day (T40), or tamoxifen 80 mg/day (T80), with matching placebo. The primary outcome was 38-week change in ALS Functional Rating Scale-Revised (ALSFRS-R), analyzed in a repeated-measures ANOVA. Secondary outcomes included slow vital capacity (SVC), quantitative muscle strength, early drug discontinuation (EDD), adverse events (AEs), and survival. Results: CRE participants experienced higher rates of drug-related AEs (82% vs. 43% T40, 47% T80) and EDD (50% vs. 24% T40, 29% T80). T80 participants experienced slower adjusted mean decline in ALSFRS-R in points/month (–0.80 vs. –0.84 T40, –0.85 CRE) and quantitative muscle strength but not in SVC and higher rates of mortality. Conclusion: Efficacy of T80 ranked numerically superior to CRE and T40 with respect to ALSFRS-R decline. Following the selection paradigm, T80 would be chosen to test against placebo. The approach was not designed to distinguish among treatments that are nearly equally effective or ineffective. If treatments are equivalent, then under the paradigm, it does not matter which treatment is selected. Newer approaches for increasing trial efficiency, including an adaptive platform trial design, may mitigate limitations of the selection design.
摘要目的:使用排名和选择范式进行II期试验,在有限的样本量下比较多种治疗方法,并在随后的疗效试验中选择最佳治疗方法与安慰剂进行比较。这种策略可以比传统的针对安慰剂进行大规模试验的策略更快地找到有效的治疗方法。方法:60名肌萎缩侧索硬化症(ALS)参与者以1:1:1的比例随机接受肌酸30 g/天(CRE),他莫昔芬40 mg/天(T40)或他莫昔芬80 mg/天(T80),与匹配的安慰剂。主要结果是ALS功能评定量表修订版(ALSFRS-R)38周的变化,通过重复测量方差分析进行分析。次要结果包括缓慢肺活量(SVC)、定量肌肉力量、早期停药(EDD)、不良事件(AE)和生存率。结果:CRE参与者经历了更高的药物相关AE发生率(82%对43%的T40,47%的T80)和EDD发生率(50%对24%的T40和29%的T90)。T80参与者的ALSFRS-R的调整后平均下降速度较慢,以点/月为单位(-0.80 vs.-0.84 T40,-0.85 CRE),肌肉力量定量下降,但SVC和死亡率较高。结论:在ALSFRS-R下降方面,T80的疗效在数量上优于CRE和T40。按照选择范式,T80将被选择与安慰剂进行测试。该方法并不是为了区分几乎同等有效或无效的治疗方法。如果治疗是等效的,那么在范式下,选择哪种治疗并不重要。提高试验效率的新方法,包括自适应平台试验设计,可以减轻选择设计的局限性。
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引用次数: 10
Stage-specific riluzole effect in amyotrophic lateral sclerosis: a retrospective study 利鲁唑治疗肌萎缩性侧索硬化症的阶段性疗效:一项回顾性研究
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1655060
Nimish J. Thakore, B. Lapin, E. Pioro
Abstract Objectives: To estimate the effect of riluzole on the stage-specific risk of progression of ALS. Methods: Patients from the PRO-ACT dataset were staged employing two methods (King's and FT9). Hazard ratios associated with riluzole treatment were estimated for forward transition between stages, using unadjusted and adjusted Markov multistate models. Results: Of 1903 patients, 1587 had received riluzole. Riluzole-treated patients survived non-significantly longer than those who did not (median 22.9 months vs. 18.3 months from time of initial observation, log rank p = 0.16). After adjusting for age and ALSFRS-R slope at first visit, riluzole significantly reduced risk of the following transitions: (1) King's stages: 1->2 (hazard ratio (HR) = 0.81), and 2->3 (HR = 0.82), 4->death (HR = 0.57), and (2) FT9 stages: 1->2 (HR = 0.84), 3->4 (HR = 0.71), and 4->death (HR = 0.67). In contrast, the beneficial effect of riluzole in bulbar-onset patients was in early rather than late King’s stages. Conclusions: This examination of cohorts closely followed in clinical trials finds a beneficial effect of riluzole that is predominantly but not exclusively in later stages of ALS. This analytic framework has utility to discern stage-specific treatment effects, and for refined health economic analyses.
摘要目的:评估利鲁唑对ALS分期风险的影响。方法:采用两种方法(King’s和FT9)对来自PRO-ACT数据集的患者进行分期。使用未经调整和调整的马尔可夫多状态模型,估计了与利鲁唑治疗相关的阶段间正向转换的风险比。结果:1903例患者中,1587例接受了利鲁唑治疗。接受利鲁唑治疗的患者存活时间与未接受利鲁佐治疗的患者相比无显著性差异(自首次观察时起,中位22.9个月vs.18.3个月,log秩p = 0.16)。在第一次就诊时调整了年龄和ALSFRS-R斜率后,利鲁唑显著降低了以下转变的风险:(1)King’s分期:1->2(危险比(HR)=0.81),2->3(HR=0.82),4->死亡(HR=0.57),和(2)FT9分期:1->2(HR=0.84),3->4(HR=0.71),4->死亡(HR0.67)。相反,利鲁唑对延髓发病患者的有益作用是在King’s早期而不是晚期。结论:这项对临床试验中密切关注的队列的检查发现,利鲁唑的有益作用主要但不限于ALS的晚期。该分析框架有助于识别特定阶段的治疗效果,并进行精细的健康经济分析。
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引用次数: 16
The rise of innovative clinical trial designs: what’s in it for amyotrophic lateral sclerosis? 创新临床试验设计的兴起:肌萎缩性侧索硬化症有什么好处?
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1681455
R. V. van Eijk, A. Genge
The randomized, placebo-controlled trial (RCT) has long been recognized as the gold standard for assessing therapeutic benefit. The randomization ensures that both the observed and unobserved prognostic variables are balanced across treatment arms. Many regulatory agencies require, therefore, RCTs to obtain an unbiased estimate of a drug’s risk–benefit ratio. The conduct of a RCT demands, however, a considerable amount of resources and time. The median costs of phase II and III clinical trials are $8.6 million and $21.4 million, respectively (1); costs that are likely to further increase in the near future (2). These excessive expenditures are especially problematic for rare diseases such as amyotrophic lateral sclerosis (ALS), where funding, awareness and resources could be limited. Therefore, there is a need to improve the efficiency of clinical trial design while maintaining scientific rigor. In this issue of the Journal, Babu et al. (3) deviate from the classical two-armed RCT by applying a ranking and selection paradigm in order to determine which of three treatment strategies (i.e., creatine, tamoxifen 40mg or tamoxifen 80mg) is the most promising for a future pivotal trial. Notwithstanding the recent advancements in preclinical and early clinical models, phase II clinical trials are often the first opportunity for investigators to obtain a hint of therapeutic benefit. Improving the phase II selection process of promising ALS drugs is, therefore, essential, especially when one considers the expanding pipeline of ALS compounds (4). The selection paradigm as proposed by Babu et al. may give preliminary insights in the efficacy and safety of new drugs. As patients can only be allocated to active arms, enrollment rates could be positively affected. The lack of a concurrent placebo arm is, however, also its major drawback. This diminishes the interpretation of the safety data and may provide insufficient insight in the therapeutic benefit. In the end, this could lead to the erroneous selection of a treatment. Further refinement of the proposed methodology may help to ameliorate these limitations. In the last decades, there has been a steady increase in the use of innovative or adaptive design elements in RCTs (5), deviating from the fixed sample size, fixed eligibility criteria and fixed allocation ratios as seen in classical trial design. Adaptive designs use the accruing information during a RCT to make interim decisions regarding, for example, the continuation of subgroups, the re-estimation of sample sizes or to stop a trial early. These design adaptation may help to improve the efficiency of clinical trials when there is sufficient evidence for either superiority or futility. Especially the futility adaptations could prove value for ALS clinical trials (6). The probability that a compound will successfully pass the different phases of drug development, including regulatory approval, is less than 10% for rare diseases (7). In case of ALS, th
长期以来,随机、安慰剂对照试验(RCT)一直被认为是评估治疗效果的金标准。随机化确保观察到的和未观察到的预后变量在治疗组之间是平衡的。因此,许多监管机构要求随机对照试验获得对药物风险收益比的无偏估计。然而,进行随机对照试验需要大量的资源和时间。II期和III期临床试验的中位成本分别为860万美元和2140万美元(1);在不久的将来,这些费用可能会进一步增加(2)。这些过度的支出对于像肌萎缩侧索硬化症(ALS)这样的罕见疾病来说尤其有问题,因为资金、意识和资源都可能有限。因此,在保持科学严谨性的同时,需要提高临床试验设计的效率。在这一期的Journal中,Babu等人(3)偏离了经典的双臂随机对照试验,采用了排序和选择范式,以确定三种治疗策略(即肌酸、他莫昔芬40mg或他莫昔芬80mg)中哪一种最有希望用于未来的关键试验。尽管最近在临床前和早期临床模型方面取得了进展,但II期临床试验通常是研究人员获得治疗益处的第一个机会。因此,改善有希望的ALS药物的II期选择过程是至关重要的,特别是当人们考虑到ALS化合物管道的扩大时(4)。Babu等人提出的选择范式可能会对新药的有效性和安全性提供初步的见解。由于患者只能被分配到现役,因此入学率可能会受到积极影响。然而,缺乏同步安慰剂组也是其主要缺点。这削弱了对安全性数据的解释,并可能对治疗益处提供不足的见解。最后,这可能会导致错误的治疗选择。进一步完善所建议的方法可能有助于改善这些限制。在过去的几十年里,在随机对照试验中,创新或适应性设计元素的使用稳步增加(5),偏离了经典试验设计中固定的样本量、固定的资格标准和固定的分配比例。适应性设计利用随机对照试验中累积的信息来做出临时决定,例如,继续进行亚组、重新估计样本量或提前停止试验。当有足够的证据证明其优势或无效时,这些设计调整可能有助于提高临床试验的效率。特别是无效的适应性可以证明ALS临床试验的价值(6)。对于罕见疾病,化合物成功通过药物开发不同阶段(包括监管批准)的概率不到10%(7)。对于ALS,成功概率甚至不到5%:在60多种测试化合物中,FDA批准了两种(即利鲁唑和依达拉曲)。因此,为了优化ALS中资源的使用和分配,第一个选择问题可能不是“哪种化合物最有希望?”,而应该是“哪个化合物没有希望?”后一个问题是适应性多臂、多阶段(MAMS)临床试验的主要目标。
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引用次数: 1
Adult onset Sandhoff disease: a rare mimicker of amyotrophic lateral sclerosis 成人发病山德霍夫病:一种罕见的肌萎缩性侧索硬化症
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1663214
Maria Khoueiry, Elia G. Malek, J. Salameh
Abstract Sandhoff disease is an under-recognized disease that may present as a lower motor neuron disorder in adulthood. We report the case of siblings presenting in their late 40s with a motor neuron disease phenotype and were misdiagnosed as amyotrophic lateral sclerosis and later found to have Sandhoff disease. Sandhoff disease should be considered in patients presenting with a slowly progressive predominately lower motor neuron disorder. A simple low-cost blood test can confirm the diagnosis.
Sandhoff病是一种未被充分认识的疾病,可能在成年期表现为较低的运动神经元障碍。我们报告一例兄弟姐妹在40多岁时出现运动神经元疾病表型,并被误诊为肌萎缩侧索硬化症,后来发现有桑德霍夫病。以缓慢进展为主的下运动神经元紊乱患者应考虑桑德霍夫病。一种简单的低成本血液检查就能确诊。
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引用次数: 4
The revised El Escorial criteria “clinically probable laboratory supported ALS”—once a promising now a superfluous category? 修订后的El Escorial标准“临床上可能的实验室支持的ALS”——曾经是一个有希望的类别,现在是多余的类别?
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1666875
Nathalie Braun, E. Macklin, E. Sinani, A. Sherman, Markus Weber
Abstract Over the past two decades, the El Escorial criteria (EEC) have been used as eligibility criteria in major randomized controlled trials. One of the goals of the revised EEC was to allow earlier diagnosis and, thus earlier trial inclusion by introducing a new category, namely “clinically probable laboratory supported” ALS. This category allowed EMG findings to be taken into account assuming that EMG is more sensitive than the clinical examination in detecting lower motor neuron signs. Recently, Edaravone has been licensed in several countries for the treatment of ALS based on a randomized controlled trial in a selected group of ALS patients excluding the EEC category “clinically probable laboratory supported”. The major reason was that in a post hoc analysis of the first Edaravone trial this group comprised many slow progressors. As it is unclear whether this bias towardslow progressors was a study-specific problem or related to the category itself, we performed an analysis in the PRO-ACT dataset. In the PRO-ACT dataset, progression in ALS patients included at baseline into the “clinically probable laboratory supported” category was significantly slower (–0.53 in ALSFRS/month) compared to the other EEC categories (–0.68 in ALSFRS/month; p < 0.001) and exhibited a significantly longer diagnostic delay (13.5 months vs. 11.7 months, p < 0.001). This suggests that the bias toward slow progressors in the “clinically probable laboratory supported” category is an inherent problem of the category and thus does not fulfill the previous goal of earlier diagnosis, raising several questions concerning the application of this category.
摘要在过去的二十年里,El Escorial标准(EEC)一直被用作主要随机对照试验的合格标准。修订后的EEC的目标之一是通过引入一个新的类别,即“临床上可能的实验室支持”ALS,允许更早的诊断,从而更早地纳入试验。假设EMG在检测下运动神经元体征方面比临床检查更敏感,则可以将EMG的发现纳入考虑范围。最近,依达拉奉在几个国家获得了治疗ALS的许可,这是基于一项在选定的ALS患者组中进行的随机对照试验,不包括EEC类别的“临床可能实验室支持”。主要原因是在对第一次依达拉奉试验的事后分析中,该组包括许多进展缓慢的患者。由于尚不清楚这种对缓慢进展者的偏见是研究特定的问题还是与类别本身有关,我们在PRO-ACT数据集中进行了分析。在PRO-ACT数据集中,与其他EEC类别(ALSFRS/月-0.68;p < 0.001),并表现出明显更长的诊断延迟(13.5个月vs.11.7个月,p < 0.001)。这表明,在“临床上可能的实验室支持”类别中,对缓慢进展者的偏见是该类别的一个固有问题,因此不能实现早期诊断的先前目标,这引发了关于该类别应用的几个问题。
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引用次数: 9
HSC70 expression is reduced in lymphomonocytes of sporadic ALS patients and contributes to TDP-43 accumulation 散发性ALS患者的淋巴细胞中HSC70表达降低,并有助于TDP-43的积累
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2020-01-02 DOI: 10.1080/21678421.2019.1672749
A. Arosio, R. Cristofani, O. Pansarasa, V. Crippa, C. Riva, R. Sirtori, V. Menendez, N. Riva, F. Gerardi, C. Lunetta, Cristina Cereda, A. Poletti, C. Ferrarese, L. Tremolizzo, G. Sala
Abstract Aim: The demonstration that chaperone-mediated autophagy (CMA) contributes to the degradation of TDP-43, the main constituent of cytoplasmic inclusions typically found in motor neurons of patients with sporadic amyotrophic lateral sclerosis (sALS), has pointed out a possible involvement of CMA in aggregate formation. To explore this possibility, in this study, we verified the presence of a possible systemic CMA alteration in sALS patients and its effect on TDP-43 expression. Materials and methods: Gene and protein expression of the cytosolic chaperone HSC70 and the lysosome receptor LAMP2A, the two pivotal mediators of CMA, was assessed in peripheral blood mononuclear cells (PBMCs) derived from 30 sALS patients and 30 healthy controls. The expression of TDP-43 and co-chaperones BAG1 and BAG3 was also analyzed. Results: We found reduced HSC70 expression in patient cells, with no change in LAMP2A, and increased insoluble TDP-43 protein levels, with an aberrant intracellular localization. We also observed an unbalanced expression of co-chaperones BAG1 and BAG3. HSC70 down-regulation was confirmed in immortalized lymphoblastoid cell lines derived from sporadic and TARDBP mutant ALS patients. Lastly, we demonstrated that HSC70 silencing directly increases TDP-43 protein levels in human neuroblastoma cells. Discussion: Our results do not support the existence of a systemic CMA alteration in sALS patients but indicate a direct involvement of HSC70 alterations in ALS pathogenesis.
摘要目的:伴侣介导的自噬(CMA)有助于TDP-43的降解,TDP-43是散发性肌萎缩侧索硬化症(sALS)患者运动神经元中常见的细胞质内含物的主要成分,这表明CMA可能参与聚集体的形成。为了探索这种可能性,在本研究中,我们验证了sALS患者可能存在的系统性CMA改变及其对TDP-43表达的影响。材料和方法:在来自30名sALS患者和30名健康对照的外周血单核细胞(PBMC)中,评估了CMA的两种关键介质胞质伴侣HSC70和溶酶体受体LAMP2A的基因和蛋白质表达。还分析了TDP-43和共伴侣BAG1和BAG3的表达。结果:我们发现患者细胞中HSC70的表达减少,LAMP2A没有变化,不溶性TDP-43蛋白水平增加,细胞内定位异常。我们还观察到共伴侣BAG1和BAG3的不平衡表达。HSC70下调在来源于散发性和TARDBP突变ALS患者的永生淋巴母细胞系中得到证实。最后,我们证明HSC70沉默直接增加了人类神经母细胞瘤细胞中TDP-43蛋白水平。讨论:我们的研究结果不支持sALS患者存在系统性CMA改变,但表明HSC70改变直接参与了ALS的发病机制。
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引用次数: 23
ALSUntangled No. 52: Glutathione ALSU咨询编号52:谷胱甘肽
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2019-11-29 DOI: 10.1080/21678421.2019.1697029
Glutathione is a naturally occurring antioxidant which helps cells eliminate damaging free radicals (2). It is part of the “glutathione system” which includes chemicals that help synthesize glutathione as well as chemicals that use glutathione to fight oxidative stress (3). Glutathione exists in different forms including the active (reduced) form referred to as GSH, and the spent (oxidized) form referred to as glutathione disulfide (GSSG); GSH protects cells while rising GSSG indicates worsening oxidative stress (2). GSH itself is available as an oral, intranasal, inhaled or injectable supplement. These formulations are advertised on websites as a treatment for ALS (4,5). Some cysteine-containing supplements such as Immunocal and N-acetylcysteine (NAC) are used to increase intracellular GSH (3,6,7) and so their potential role in treating ALS will also be reviewed here.
谷胱甘肽是一种天然存在的抗氧化剂,可帮助细胞清除有害的自由基(2)。它是“谷胱甘肽系统”的一部分,其中包括有助于合成谷胱甘肽的化学物质以及利用谷胱甘肽对抗氧化应激的化学物质(3)。谷胱甘肽以不同的形式存在,包括称为GSH的活性(还原)形式和称为谷胱甘肽二硫化物(GSSG)的废(氧化)形式;GSH保护细胞,而GSSG升高表明氧化应激恶化(2)。GSH本身可作为口服、鼻内、吸入或注射补充剂。这些配方在网站上被宣传为ALS的治疗方法(4,5)。一些含有半胱氨酸的补充剂,如免疫和N-乙酰半胱氨酸(NAC),用于增加细胞内GSH(3,6,7),因此它们在治疗ALS中的潜在作用也将在这里进行综述。
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引用次数: 1
期刊
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
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