Novel Metabolite Biomarkers of Huntington's Disease As Detected by High-Resolution Mass Spectrometry

Huntington's disease (HD) is a fatal autosomal-dominant neurodegenerative disorder that affects approximately 3-10 people per 100 000 in the Western world. The median age of onset is 40 years, with death typically following 15-20 years later. In this study, we biochemically profiled post-mortem frontal lobe and striatum from HD sufferers (n = 14) and compared their profiles with controls (n = 14). LC-LTQ-Orbitrap-MS detected a total of 5579 and 5880 features for frontal lobe and striatum, respectively. An ROC curve combining two spectral features from frontal lobe had an AUC value of 0.916 (0.794 to 1.000) and following statistical cross-validation had an 83% predictive accuracy for HD. Similarly, two striatum biomarkers gave an ROC AUC of 0.935 (0.806 to 1.000) and after statistical cross-validation predicted HD with 91.8% accuracy. A range of metabolite disturbances were evident including but-2-enoic acid and uric acid, which were altered in both frontal lobe and striatum. A total of seven biochemical pathways (three in frontal lobe and four in striatum) were significantly altered as a result of HD. This study highlights the utility of high-resolution metabolomics for the study of HD. Further characterization of the brain metabolome could lead to the identification of new biomarkers and novel treatment strategies for HD.

Does Lithium Prevent Alzheimer's Disease?

Lithium salts have a well-established role in the treatment of major affective disorders. More recently, experimental and clinical studies have provided evidence that lithium may also exert neuroprotective effects. In animal and cell culture models, lithium has been shown to increase neuronal viability through a combination of mechanisms that includes the inhibition of apoptosis, regulation of autophagy, increased mitochondrial function, and synthesis of neurotrophic factors. In humans, lithium treatment has been associated with humoral and structural evidence of neuroprotection, such as increased expression of anti-apoptotic genes, inhibition of cellular oxidative stress, synthesis of brain-derived neurotrophic factor (BDNF), cortical thickening, increased grey matter density, and hippocampal enlargement. Recent studies addressing the inhibition of glycogen synthase kinase-3 beta (GSK3B) by lithium have further suggested the modification of biological cascades that pertain to the pathophysiology of Alzheimer's disease (AD). A recent placebo-controlled clinical trial in patients with amnestic mild cognitive impairment (MCI) showed that long-term lithium treatment may actually slow the progression of cognitive and functional deficits, and also attenuate Tau hyperphosphorylation in the MCI-AD continuum. Therefore, lithium treatment may yield disease-modifying effects in AD, both by the specific modification of its pathophysiology via inhibition of overactive GSK3B, and by the unspecific provision of neurotrophic and neuroprotective support. Although the clinical evidence available so far is promising, further experimentation and replication of the evidence in large scale clinical trials is still required to assess the benefit of lithium in the treatment or prevention of cognitive decline in the elderly.

Predictive genetic test decisions for Huntington's disease: context, appraisal and new moral imperatives

Predictive testing is one of the new genetic technologies which, in conjunction with developing fields such as pharmacogenomics, promises many benefits for preventive and population health. Understanding how individuals appraise and make genetic test decisions is increasingly relevant as the technology expands. Lay understandings of genetic risk and test decision-making, located within holistic life frameworks including family or kin relationships, may vary considerably from clinical representations of these phenomena. The predictive test for Huntington's disease (HD), whilst specific to a single-gene, serious, mature-onset but currently untreatable disorder, is regarded as a model in this context. This paper reports upon a qualitative Australian study which investigated predictive test decision-making by individuals at risk for HD, the contexts of their decisions and the appraisals which underpinned them. In-depth interviews were conducted in Australia with 16 individuals at 50% risk for HD, with variation across testing decisions, gender, age and selected characteristics. Findings suggested predictive testing was regarded as a significant life decision with important implications for self and others, while the right not to know genetic status was staunchly and unanimously defended. Multiple contexts of reference were identified within which test decisions were located, including intra- and inter-personal frameworks, family history and experience of HID, and temporality. Participants used two main criteria in appraising test options: perceived value of, or need for the test information, for self and/or significant others, and degree to which such information could be tolerated and managed, short and long-term, by self and/or others. Selected moral and ethical considerations involved in decision-making are examined, as well as the clinical and socio-political contexts in which predictive testing is located. The paper argues that psychosocial vulnerabilities generated by the availability of testing technologies and exacerbated by policy imperatives towards individual responsibility and self-governance should be addressed at broader societal levels. (C) 2003 Elsevier Science Ltd. All rights reserved.

Wearable sensors in Huntington disease:a pilot study

Background: The Unified Huntington’s Disease Rating Scale (UHDRS) is the principal means of assessing motor impairment in Huntington disease but is subjective and generally limited to in-clinic assessments. Objective: To evaluate the feasibility and ability of wearable sensors to measure motor impairment in individuals with Huntington disease in the clinic and at home. Methods: Participants with Huntington disease and controls were asked to wear five accelerometer-based sensors attached to the chest and each limb for standardized, in-clinic assessments and for one day at home. A secondchest sensor was worn for six additional days at home. Gait measures were compared between controls, participants with Huntington disease, and participants with Huntington disease grouped by UHDRS total motor score using Cohen’s d values. Results: Fifteen individuals with Huntington disease and five controls completed the study. Sensor data were successfully captured from 18 of the 20 participants at home. In the clinic, the standard deviation of step time (timebetween consecutive steps) was increased in Huntington disease (p<0.0001; Cohen’s d=2.61) compared to controls. At home with additional observations, significant differences were observed in seven additional gait measures. The gait of individuals with higher total motor scores (50 or more) differed significantly from those with lower total motor scores (below 50) on multiple measures at home. Conclusions: In this pilot study, the use of wearable sensors in clinic and at home was feasible and demonstrated gait differences between controls, participants with Huntington disease, and participants with Huntington diseasegrouped by motor impairment.

Health Care Delivery Practices in Huntington's Disease Specialty Clinics : An International Survey

The CHDI Foundation, Inc. funds Enroll-HD and the activities of the Enroll-HD Care Improvement Committee, including the present survey. We would like to acknowledge the Enroll-HD and REGISTRY administrative staff that assisted in the recruitment of sites and sites that completed the survey.

Metabolic signatures of Huntington's disease (HD): 1H NMR analysis of the polar metabolome in post mortem human brain

Huntington’s disease (HD) is an autosomal neurodegenerative disorder affecting approximately 5-10 persons per 100,000 worldwide. The pathophysiology of HD is not fully understood but the age of onset is known to be highly dependent on the number of CAG triplet repeats in the huntingtin gene. Using 1H NMR spectroscopy this study biochemically profiled 39 brain metabolites in post-mortem striatum (n=14) and frontal lobe (n=14) from HD sufferers and controls (n=28). Striatum metabolites were more perturbed with 15 significantly affected in HD cases, compared with only 4 in frontal lobe (P<0.05; q<0.3). The metabolite which changed most overall was urea which decreased 3.25-fold in striatum (P<0.01). Four metabolites were consistently affected in both brain regions. These included the neurotransmitter precursors tyrosine and L-phenylalanine which were significantly depleted by 1.55-1.58-fold and 1.48-1.54-fold in striatum and frontal lobe, respectively (P=0.02-0.03). They also included L-leucine which was reduced 1.54-1.69-fold (P=0.04-0.09) and myo-inositol which was increased 1.26-1.37-fold (P<0.01). Logistic regression analyses performed with MetaboAnalyst demonstrated that data obtained from striatum produced models which were profoundly more sensitive and specific than those produced from frontal lobe. The brain metabolite changes uncovered in this first 1H NMR investigation of human HD offer new insights into the disease pathophysiology. Further investigations of striatal metabolite disturbances are clearly warranted.

Mesenchymal stem cells

Cell based therapies as they apply to tissue engineering and regenerative medicine, require cells capable of self renewal and differentiation, and a prerequisite is to be able to prepare an effective dose of ex vivo expanded cells for autologous transplants. The in vivo identification of a source of physiologically relevant cell types suitable for cell therapies therefore figures as an integral part of tissue engineering. Stem cells serve as a reserve for biological repair, having the potential to differentiate into a number of specialised cell types within the body; they therefore represent the most useful candidates for cell based therapies. The primary goal of stem cell research is to produce cells that are both patient specific, as well as having properties suitable for the specific conditions for which they are intended to remedy. From a purely scientific perspective, stem cells allow scientists to gain a deeper understanding of developmental biology and regenerative therapies. Stem cells have acquired a number of uses for applications in regenerative medicine, immunotherapy, gene therapy, but it is in the area of tissue engineering that they generate most excitement, primarily as a result of their capacity for self-renewal and pluripotency. A unique feature of stem cells is their ability to maintain an uncommitted quiescent state in vivo and then, once triggered by conditions such as disease, injury or natural wear or tear, serve as a reservoir and natural support system to replenish lost cells. Although these cells retain the plasticity to differentiate into various tissues, being able to control this differentiation process is still one of the biggest challenges facing stem cell research. In an effort to harness the potential of these cells a number of studies have been conducted using both embryonic/foetal and adult stem cells. The use of embryonic stem cells (ESC) have been hampered by strong ethical and political concerns, this despite their perceived versatility due to their pluripotency. Ethical issues aside, other concerns raised with ESCs relates to the possibility of tumorigenesis, immune rejection and complications with immunosuppressive therapies, all of which adds layers of complications to the application ESC in research and which has led to the search for alternative sources for stem cells. The adult tissues in higher organisms harbours cells, termed adult stem cells, and these cells are reminiscent of unprogrammed stem cells. A number of sources of adult stem cells have been described. Bone marrow is by far the most accessible source of two potent populations of adult stem cells, namely haematopoietic stem cells (HSCs) and bone marrow mesenchymal stem cells (BMSCs). Autologously harvested adult stem cells can, in contrast to embryonic stem cells, readily be used in autografts, since immune rejection is not an issue; and their use in scientific research has not attracted the ethical concerns which have been the case with embryonic stem cells. The major limitation to their use, however, is the fact that adult stem cells are exceedingly rare in most tissues. This fact makes identifying and isolating these cells problematic; bone marrow being perhaps the only notable exception. Unlike the case of HSCs, there are as yet no rigorous criteria for characterizing MSCs. Changing acuity about the pluripotency of MSCs in recent studies has expanded their potential application; however, the underlying molecular pathways which impart the features distinctive to MSCs remain elusive. Furthermore, the sparse in vivo distribution of these cells imposes a clear limitation to their study in vitro. Also, when MSCs are cultured in vitro, there is a loss of the in vivo microenvironment, resulting in a progressive decline in proliferation potential and multipotentiality. This is further exacerbated with increased passage numbers in culture, characterized by the onset of senescence related changes. As a consequence, it is necessary to establish protocols for generating large numbers of MSCs but without affecting their differentiation potential. MSCs are capable of differentiating into mesenchymal tissue lineages, including bone, cartilage, fat, tendon, muscle, and marrow stroma. Recent findings indicate that adult bone marrow may also contain cells that can differentiate into the mature, nonhematopoietic cells of a number of tissues, including cells of the liver, kidney, lung, skin, gastrointestinal tract, and myocytes of heart and skeletal muscle. MSCs can readily be expanded in vitro and can be genetically modified by viral vectors and be induced to differentiate into specific cell lineages by changing the microenvironment–properties which makes these cells ideal vehicles for cellular gene therapy. MSCs can also exert profound immunosuppressive effects via modulation of both cellular and innate immune pathways, and this property allows them to overcome the issue of immune rejection. Despite the many attractive features associated with MSCs, there are still many hurdles to overcome before these cells are readily available for use in clinical applications. The main concern relates to in vivo characterization and identification of MSCs. The lack of a universal biomarker, sparse in vivo distribution, and a steady age related decline in their numbers, makes it an obvious need to decipher the reprogramming pathways and critical molecular players which govern the characteristics unique to MSCs. This book presents a comprehensive insight into the biology of adult stem cells and their utility in current regeneration therapies. The adult stem cell populations reviewed in this book include bone marrow derived MSCs, adipose derived stem cells (ASCs), umbilical cord blood stem cells, and placental stem cells. The features such as MSC circulation and trafficking, neuroprotective properties, and the nurturing roles and differentiation potential of multiple lineages have been discussed in details. In terms of therapeutic applications, the strengths of MSCs have been presented and their roles in disease treatments such as osteoarthritis, Huntington’s disease, periodontal regeneration, and pancreatic islet transplantation have been discussed. An analysis comparing osteoblast differentiation of umbilical cord blood stem cells and MSCs has been reviewed, as has a comparison of human placental stem cells and ASCs, in terms of isolation, identification and therapeutic applications of ASC in bone, cartilage regeneration, as well as myocardial regeneration. It is my sincere hope that this book will update the reader as to the research progress of MSC biology and potential use of these cells in clinical applications. It will be the best reward to all contributors of this book, if their efforts herein may in some way help the readers in any part of their study, research, and career development.

Biochemical and Biophysical Characterization of Huntingtin

Huntington’s disease (HD) is a fatal autosomal dominant neurodegenerative disease. HD has no cure, and patients pass away 10-20 years after the onset of symptoms. The causal mutation for HD is a trinucleotide repeat expansion in exon 1 of the huntingtin gene that leads to a polyglutamine (polyQ) repeat expansion in the N-terminal region of the huntingtin protein. Interestingly, there is a threshold of 37 polyQ repeats under which little or no disease exists; and above which, patients invariably show symptoms of HD. The huntingtin protein is a 350 kDa protein with unclear function. As the polyQ stretch expands, its propensity to aggregate increases with polyQ length. Models for polyQ toxicity include formation of aggregates that recruit and sequester essential cellular proteins, or altered function producing improper interactions between mutant huntingtin and other proteins. In both models, soluble expanded polyQ may be an intermediate state that can be targeted by potential therapeutics.

In the first study described herein, the conformation of soluble, expanded polyQ was determined to be linear and extended using equilibrium gel filtration and small-angle X-ray scattering. While attempts to purify and crystallize domains of the huntingtin protein were unsuccessful, the aggregation of huntingtin exon 1 was investigated using other biochemical techniques including dynamic light scattering, turbidity analysis, Congo red staining, and thioflavin T fluorescence. Chapter 4 describes crystallization experiments sent to the International Space Station and determination of the X-ray crystal structure of the anti-polyQ Fab MW1. In the final study, multimeric fibronectin type III (FN3) domain proteins were engineered to bind with high avidity to expanded polyQ tracts in mutant huntingtin exon 1. Surface plasmon resonance was used to observe binding of monomeric and multimeric FN3 proteins with huntingtin.

Contrôle postural et intégration sensorielle chez l’enfant en santé, chez l’adolescent atteint du syndrome Gilles de la Tourette ainsi que chez l’adulte atteint de la maladie de Huntington

Le contrôle postural et la perception des limites de la stabilité sont des processus complexes qui nécessitent le traitement et l’intégration d’informations sensorielles multimodales. Pendant l’enfance, le développement de la stabilité posturale s’effectue de façon non-monotonique. Plusieurs auteurs ont suggéré que ce profil non linéaire serait provoqué par une période de recalibration des systèmes sensoriels. Cette phase, nommée période de transition, est observée vers l’âge de 6-7 ans. Nous disposons toutefois de très peu d’information sur le rôle spécifique des afférences et des mécanismes d’intégration sensorielle au cours du développement postural. Les dysfonctions dans les noyaux gris centraux, telles que ceux observés dans la maladie de Parkinson, ont été associées à divers déficits dans le contrôle de la posture, dans le traitement et l’intégration sensoriel plus particulièrement, au niveau des informations proprioceptives. De plus, les limites fonctionnelles de la stabilité posturale des personnes atteintes de la maladie de Parkinson sont significativement réduites. Cependant, les connaissances concernant comment certaines pathologies des noyaux gris centraux, telles que le syndrome Gilles de la Tourette (SGT) et la maladie de Huntington (MH) affectent la capacité d’utiliser les informations sensorielles pour contrôler la posture demeurent à ce jour, incomplètes. Cette thèse porte sur le rôle des noyaux gris centraux dans les processus de traitements et d’intégration sensorielle, particulièrement les afférences proprioceptives dans le contrôle de la posture au cours du développement de l’enfant en santé, atteint du SGT et chez l’adulte atteint de la MH avec et sans symptôme clinique. Notre protocole expérimental a été testé chez ces trois populations (enfants en santé, SGT et MH). Nous avons utilisé des mesures quantitatives à partir de données issues d’une plateforme de force afin d’évaluer les ajustements posturaux dans les limites de la stabilité posturale. Les participants devaient s’incliner le plus loin possible dans quatre différentes directions (avant, arrière, droite et gauche) et maintenir l’inclinaison posturale maximale pendant 10 secondes. Afin de tester la capacité à traiter et à intégrer les informations sensorielles, la tâche expérimentale a été exécutée dans trois conditions sensorielles : 1) yeux ouverts, 2) yeux fermés et 3) yeux fermés, debout sur une mousse. Ainsi, la contribution relative de la proprioception pour le contrôle postural augmente à travers les conditions sensorielles. Dans la première étude, nous avons évalué la capacité à traiter et à intégrer les informations sensorielles avant (4 ans) et après (8-10 ans) la période de transition comparativement aux adultes. Dans la deuxième et la troisième étude, nous avons également évalué le traitement et l’intégration des informations sensorielles chez les patients atteints de désordres des noyaux gris centraux. La deuxième étude portera spécifiquement sur les adolescents atteints du SGT et la troisième, sur la MH avant et après l’apparition des symptômes cliniques. En somme, les résultats de la première étude ont démontré que la performance des enfants est affectée de façon similaire par les différentes conditions sensorielles avant et après la période de transition. Toutefois, le profil de développement des mécanismes responsables des ajustements posturaux de l’axe antéropostérieur est plus précoce comparativement à ceux de l’axe médiolatéral. Ainsi, nos résultats ne supportent pas l’hypothèse de la période de recalibration des systèmes sensoriels pendant cette période ontogénétique mais suggèrent que la période de transition peut être expliquée par la maturation précoce des mécanismes d’ajustements posturaux dans l’axe antéropostérieur. Dans l’ensemble, les résultats de nos études chez les populations atteintes de désordres des noyaux gris centraux (MH et SGT) démontrent non seulement qu’ils ont des déficits posturaux mais également que les ajustements posturaux dans les deux axes sont affectés par les conditions sensorielles. Pour la première fois, nos études démontrent des déficits globaux de traitements et d’intégration sensorielle accentués pour les signaux proprioceptifs. Ces résultats sont similaires à ceux observés dans la maladie de Parkinson. De plus, les adolescents atteints du SGT éprouvent également des troubles posturaux marqués dans la condition visuelle ce qui suggère des déficits d’intégrations visuelles et/ou multimodaux.

Rôle du métabolisme énergétique dans un contexte de vieillissement chez C. elegans

L’incidence constante des maladies liées à l’âge reflète un réel enjeu dans nos sociétés actuelles, principalement lorsqu’il est question des cas de cancers, d’accidents cérébraux et de maladies neurodégénératives. Ces désordres sont liés à l’augmentation de l’espérance de vie et à un vieillissement de la population. Les coûts, estimés en milliards de dollars, représentent des sommes de plus en plus importantes. Bien que les efforts déployés soient importants, aucun traitement n’a encore été trouvé. Les maladies neurodégénératives, telles que la maladie d’Alzheimer, de Parkinson, d’Huntington ou la sclérose latérale amyotrophique (SLA), caractérisées par la dégénérescence d’un type neuronal spécifique à chaque pathologie, représentent un défi important. Les mécanismes de déclenchement de la pathologie sont encore nébuleux, de plus il est maintenant clair que certains de ces désordres impliquent de nombreux gènes impliqués dans diverses voies de signalisation induisant le dysfonctionnement de processus biologiques importants, tel que le métabolisme. Dans nos sociétés occidentales, une problématique, directement lié à notre style de vie s’ajoute. L’augmentation des quantités de sucre et de gras dans nos diètes a amené à un accroissement des cas de diabètes de type II, d’obésité et de maladies coronariennes. Néanmoins, le métabolisme du glucose, principale source énergétique du cerveau, est primordial à la survie de n’importe quel organisme. Lors de ces travaux, deux études effectuées à l’aide de l’organisme Caenorhabditis elegans ont porté sur un rôle protecteur du glucose dans un contexte de vieillissement pathologique et dans des conditions de stress cellulaire. Le vieillissement semble accéléré dans un environnement enrichi en glucose. Cependant, les sujets traités ont démontré une résistance importante à différents stress et aussi à la présence de protéines toxiques impliquées dans la SLA et la maladie de Huntington. Dans un deuxième temps, nous avons démontré que ces effets peuvent aussi être transmis à la génération suivante. Un environnement enrichi en glucose a pour bénéfice de permettre une meilleure résistance de la progéniture, sans pour autant transmettre les effets néfastes dû au vieillissement accéléré.

Biology and characterisation of polyalanine as an emerging pathological marker

Dix-huit maladies humaines graves ont jusqu'ici été associées avec des expansions de trinucléotides répétés (TNR) codant soit pour des polyalanines (codées par des codons GCN répétés) soit pour des polyglutamines (codées par des codons CAG répétés) dans des protéines spécifiques. Parmi eux, la dystrophie musculaire oculopharyngée (DMOP), l’Ataxie spinocérébelleuse de type 3 (SCA3) et la maladie de Huntington (MH) sont des troubles à transmission autosomale dominante et à apparition tardive, caractérisés par la présence d'inclusions intranucléaires (IIN). Nous avons déjà identifié la mutation responsable de la DMOP comme étant une petite expansion (2 à 7 répétitions supplémentaires) du codon GCG répété du gène PABPN1. En outre, nous-mêmes ainsi que d’autres chercheurs avons identifié la présence d’événements de décalage du cadre de lecture ribosomique de -1 au niveau des codons répétés CAG des gènes ATXN3 (SCA3) et HTT (MH), entraînant ainsi la traduction de codons répétés hybrides CAG/GCA et la production d'un peptide contenant des polyalanines. Or, les données observées dans la DMOP suggèrent que la toxicité induite par les polyalanines est très sensible à leur quantité et leur longueur. Pour valider notre hypothèse de décalage du cadre de lecture dans le gène ATXN3 dans des modèles animaux, nous avons essayé de reproduire nos constatations chez la drosophile et dans des neurones de mammifères. Nos résultats montrent que l'expression transgénique de codons répétés CAG élargis dans l’ADNc de ATXN3 conduit aux événements de décalage du cadre de lecture -1, et que ces événements sont néfastes. À l'inverse, l'expression transgénique de codons répétés CAA (codant pour les polyglutamines) élargis dans l’ADNc de ATXN3 ne conduit pas aux événements de décalage du cadre de lecture -1, et n’est pas toxique. Par ailleurs, l’ARNm des codons répétés CAG élargis dans ATXN3 ne contribue pas à la toxicité observée dans nos modèles. Ces observations indiquent que l’expansion de polyglutamines dans nos modèles drosophile et de neurones de mammifères pour SCA3 ne suffit pas au développement d'un phénotype. Par conséquent, nous proposons que le décalage du cadre de lecture ribosomique -1 contribue à la toxicité associée aux répétitions CAG dans le gène ATXN3. Pour étudier le décalage du cadre de lecture -1 dans les maladies à expansion de trinucléotides CAG en général, nous avons voulu créer un anticorps capable de détecter le produit présentant ce décalage. Nous rapportons ici la caractérisation d’un anticorps polyclonal qui reconnaît sélectivement les expansions pathologiques de polyalanines dans la protéine PABPN1 impliquée dans la DMOP. En outre, notre anticorps détecte également la présence de protéines contenant des alanines dans les inclusions intranucléaires (IIN) des échantillons de patients SCA3 et MD.

Chorea in primary antiphospholipid syndrome is associated with rheumatic fever

The aim of the study is to evaluate the frequency of chorea in a cohort of primary antiphospholipid syndrome (PAPS) patients and their possible clinical and laboratory associations. The records of 88 PAPS patients, fulfilling Sapporo criteria, followed up at the rheumatology outpatient clinic, were analyzed in order to determine the frequency of chorea. Risk factors for chorea, clinical manifestations, associated comorbidities, serologic features and treatment strategies were analyzed. Eighty-eight PAPS patients were evaluated. Mean age was 40.6 +/- A 11.1 years, and 91% of them were Caucasian and 91% women. Four (4.5%) patients with chorea were identified: 2 of them (50%) had only one chorea episode and 2 (50%) had recurrent chorea. All patients had chorea onset before PAPS diagnosis. Mean age, gender and ethnical distribution were comparable in groups with or without seizures (P > 0.05). Interestingly, the comparison of the 4 PAPS patients with chorea with those without this abnormality (n = 84) demonstrated a lower BMI [21.1 (18-24.2) vs. 27.5 (17.5-40.9) kg/m(2), P = 0.049] and frequency of venous events (0 vs. 63.1%, P = 0.023) in the first group. A higher frequency of rheumatic fever (75% vs. 0, P < 0.001) and thrombocytopenia (75 vs. 21.4%, P = 0.041) was observed in PAPS individuals with chorea. Both groups were alike regarding the other clinical APS manifestations, disease duration, risk factors for cerebrovascular diseases, use of drugs and antiphospholipid antibodies (P > 0.05). This study demonstrated that 4.5% of PAPS patients had chorea, predominately before PAPS diagnosis, and this neurological abnormality was associated with rheumatic fever and thrombocytopenia. These data reinforce the need for RF diagnosis in those PAPS patients with chorea.

Control of protein degradation pathways by BAG proteins and changes during aging

Many age-related neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis and polyglutamine disorders, including Huntington’s disease, are associated with the aberrant formation of protein aggregates. These protein aggregates and/or their precursors are believed to be causally linked to the pathogenesis of such protein conformation disorders, also referred to as proteinopathies. The accumulation of protein aggregates, frequently under conditions of an age-related increase in oxidative stress, implies the failure of protein quality control and the resulting proteome instability as an upstream event of proteinopathies. As aging is a main risk factor of many proteinopathies, potential alterations of protein quality control pathways that accompany the biological aging process could be a crucial factor for the onset of these disorders.rnrnThe focus of this dissertation lies on age-related alterations of protein quality control mechanisms that are regulated by the co-chaperones of the BAG (Bcl-2-associated athanogene) family. BAG proteins are thought to promote nucleotide exchange on Hsc/Hsp70 and to couple the release of chaperone-bound substrates to distinct down-stream cellular processes. The present study demonstrates that BAG1 and BAG3 are reciprocally regulated during aging leading to an increased BAG3 to BAG1 ratio in cellular models of replicative senescence as well as in neurons of the aging rodent brain. Furthermore, BAG1 and BAG3 were identified as key regulators of protein degradation pathways. BAG1 was found to be essential for effective degradation of polyubiquitinated proteins by the ubiquitin/proteasome system, possibly by promoting Hsc/Hsp70 substrate transfer to the 26S proteasome. In contrast, BAG3 was identified to stimulate the turnover of polyubiquitinated proteins by macroautophagy, a catabolic process mediated by lysosomal hydrolases. BAG3-regulated protein degradation was found to depend on the function of the ubiquitin-receptor protein SQSTM1 which is known to sequester polyubiquitinated proteins for macroautophagic degradation. It could be further demonstrated that SQSTM1 expression is tightly coupled to BAG3 expression and that BAG3 can physically interact with SQSTM1. Moreover, immunofluorescence-based microscopic analyses revealed that BAG3 co-localizes with SQSTM1 in protein sequestration structures suggesting a direct role of BAG3 in substrate delivery to SQSTM1 for macroautophagic degradation. Consistent with these findings, the age-related switch from BAG1 to BAG3 was found to determine that aged cells use the macroautophagic system more intensely for the turnover of polyubiquitinated proteins, in particular of insoluble, aggregated quality control substrates. Finally, in vivo expression analysis of macroautophagy markers in young and old mice as well as analysis of the lysosomal enzymatic activity strongly indicated that the macroautophagy pathway is also recruited in the nervous system during the organismal aging process.rnrnTogether these findings suggest that protein turnover by macroautophagy is gaining importance during the aging process as insoluble quality control substrates are increasingly produced that cannot be degraded by the proteasomal system. For this reason, a switch from the proteasome regulator BAG1 to the macroautophagy stimulator BAG3 occurs during cell aging. Hence, it can be concluded that the BAG3-mediated recruitment of the macroauto-phagy pathway is an important adaptation of the protein quality control system to maintain protein homeostasis in the presence of an enhanced pro-oxidant and aggregation-prone milieu characteristic of aging. Future studies will explore whether an impairment of this adaptation process may contribute to age-related proteinopathies.

Untersuchungen zur Wirkung des Ginkgo-biloba-Extraktes EGb 761 auf die Proteinaggregation in der Huntington-Krankheit

Der Ginkgo biloba-Extrakt EGb 761 besteht aus einer Reihe pharmakologisch wirksamer Substanzen, welche gut beschriebene Wirkungen auf verschiedene potentiell zytoprotektive Signalwege ausüben und u.a. antioxidative Wirksamkeit haben. Folglich wurde EGb 761 bisher als eine natürliche Behandlung bei neurodegenerativen Erkrankungen mit zellulärem oxidativen Stress angewendet, einschließlich der Alzheimer-Krankheit (AD). Aufgrund von vielen gemeinsamen Merkmalen zwischen der AD und der Huntington-Krankheit (HD) wurde vermutet, dass EGb 761 eventuell auch positive Wirksamkeit bei der HD aufweisen könnte. rnDie Neuropathologie der HD wird durch pathologische Verlängerung an Glutamin-Wiederholungen im Huntingtin-Protein (polyQ-Protein) verursacht, wodurch es zu Fehlfaltungen im Protein kommt und hierdurch der proteasomale Abbau aberranter Proteine erschwert wird. Somit sollten in der vorliegenden Arbeit die EGb 761-Wirkungen auf die Proteasom-Aktivität und die Proteinaggregation in zellulären Modellen der HD untersucht werden. rnWie die ersten Untersuchungen in nativen HEK293-Zellen ergaben, bewirkte die Behandlung der Zellen mit EGb 761 eine Steigerung der basalen Proteasom-Aktivität sowie des proteasomalen Proteinabbaus und erhöhte die Transkription proteasomaler Gene. Hieraus ergaben sich Untersuchungen in Zellen mit Expressionen pathologischer Varianten von polyQ-Proteinen als zelluläre Modelle der HD. Hierbei konnte festgestellt werden, dass die Expression aberranter polyQ-Proteine eine verminderte zelluläre Proteasom-Aktivität bewirkte. Interessanterweise verursachte EGb 761 eine Abmilderung der pathologisch-induzierten verminderten Proteasom-Aktivität, in dem die EGb 761-Behandlung der Zellen zu einer erhöhten Proteasom-Aktivität, einem verbesserten proteasomalen Proteinabbau, sowie zu einer erhöhten Transkription proteasomaler Gene führte. Da diese EGb 761-Effekte unabhängig von der Expression aberranter polyQ-Proteine waren, demonstrierten diese Ergebnisse eine allgemeine EGb 761-Wirkungen auf die Proteasom-Aktivität. Anhand dieser Ergebnisse sollten anschließend weitere Untersuchungen mit zellulären Modellen der HD die genau Wirkung von EGb 761 auf die Degradation von abnormal verlängerten polyQ-Proteinen sowie auf die Bildung von polyQ-Aggregaten klären. rnHier konnte gezeigt werden, dass die Expression aberranter polyQ-Proteinen zu einer Akkumulation von SDS-resistenten bzw. SDS-unlöslichen, aggregierten polyQ-Proteinen führte, sowie die Bildung von sichtbaren polyQ-Aggregaten in Zellen bewirkte. Hierbei verursachte eine EGb 761-Behandlung der Zellen eine signifikante Verminderung im Gehalt an SDS-resistenten polyQ-Proteinen sowie eine Reduzierung von Aggregat-tragenden Zellen. Zudem konnte gezeigt werden, dass eine pharmakologische Inhibition des Proteasoms in EGb 761-behandelten Zellen, den Gehalt an SDS-unlöslichen polyQ-Proteinaggregate wieder erhöhte und somit den Effekt von EGb 761 aufhob. Folglich zeigten diese Ergebnisse, dass die EGb 761-induzierte Reduzierung der polyQ-Proteinaggregate durch einen effizienteren proteasomalen Abbau von fehlgefalteten, aberranten polyQ-Proteinen bewirkte wurde. rnAufbauend auf diesen Ergebnissen wurde eine experimentell-therapeutische Anwendung von EGb 761 in Modellen der HD in vitro und in vivo überprüft und hierzu primäre humane Fibroblasten sowie transgene C. elegans Würmer mit Expressionen aberranter polyQ-Proteine untersucht. Interessanterweise konnte in vitro und in vivo gezeigt werden, dass die EGb 761-Behandlung auch hier eine Reduzierung von SDS-unlöslichen polyQ-Proteinen bewirkte und zudem eine Reduzierung des pathologisch erhöhten Gehalts an Polyubiquitin-Proteinen bewirkte. Folglich wurde auch hier vermutet, dass EGb 761 einen verbesserten proteasomalen Abbau von polyQ-Proteinen induzierte und dies eine Verminderung der polyQ-Proteinaggregate verursachte. Darüber hinaus führte die EGb 761-Behandlung von seneszenten Fibroblasten zur Reduzierung von altersabhängig erhöhten Mengen von polyQ-Aggregaten, wodurch ein therapeutischer Effekt auf den proteasomalen Abbau der polyQ-Proteine verdeutlicht wurde. Zusätzlich konnte in polyQ-transgenen C. elegans demonstriert werden, dass eine EGb 761-Behandlung die Abmilderung eines typischen pathologischen Phänotyps bewirkte, indem eine polyQ-induzierte verminderte Motilität der Nematoden verbessert wurde und hierdurch eine positive EGb 761-Wirkung auf die Pathologie der HD in vivo dargestellt wurde. rnZusammenfassend konnten in dieser Arbeit neue Wirkungen von EGb 761 in der HD demonstriert werden. Hierbei wurde gezeigt, dass EGb 761 die Aggregation von pathogenen aberranten polyQ-Proteinen in vitro und in vivo reduziert, indem eine effizientere Degradation von polyQ-Proteinen erfolgt. Somit könnte diese Wirkungen von EGb 761 eine potentiell therapeutische Anwendung in der HD und ähnliche neurodegenerativen Erkrankungen darstellen.