Multifaceted superoxide dismutase 1 expression in amyotrophic lateral sclerosis patients:a rare occurrence?

Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.

Safety of intrathecal injection of Wharton's jellyderived mesenchymal stem cells in amyotrophic lateral sclerosis therapy

Animal experiments have confirmed that mesenchymal stem cells can inhibit motor neuron apoptosis and inflammatory factor expression and increase neurotrophic factor expression. Therefore, mesenchymal stem cells have been shown to exhibit prospects in the treatment of amyotrophic lateral sclerosis. However, the safety of their clinical application needs to be validated. To investigate the safety of intrathecal injection of Wharton's jelly-derived mesenchymal stem cells in amyotrophic lateral sclerosis therapy, 43 patients(16 females and 27 males, mean age of 57.3 years) received an average dose of 0.42 × 106 cells/kg through intrathecal administration at the cervical, thoracic or lumbar region depending on the clinical symptoms. There was a 2 month interval between two injections. The adverse events occurring during a 6-month treatment period were evaluated. No adverse events occurred. Headache occurred in one case only after first injection of stem cells. This suggests that intrathecal injection of Wharton's Jelly-derived mesenchymal stem cells is well tolerated in patients with amyotrophic lateral sclerosis. This study was approved by the Bioethical Committee of School of Medicine, University of Warmia and Mazury in Olsztyn, Poland(approval No. 36/2014 and approval No. 8/2016). This study was registered with the ClinicalTrials.gov(identifier: NCT02881476)on August 29, 2016.

Prospects for bone marrow cell therapy in amyotrophic lateral sclerosis：how far are we from a clinical treatment？

Amyotrophic lateral sclerosis（ALS） is a fatal neurodegenerative disease that causes progressive muscular atrophy and death within 3–5 years after its onset.Despite the significant advances in knowledge of ALS pathology,no effective treatment is available.Therefore,it is imperative to search for new alternatives to treat ALS.Cell therapy,especially using bone-marrow cells,has showed to be very useful to protect the neural tissue in different brain disease or traumatic lesions.In ALS,most published results show beneficial effects of the use bone marrow cells,especially mesenchymal stromal cells.However,until now,the best outcome extends animal＇s lifespan by only a few weeks.It is essential to continue the search for a really effective therapy,testing different cells,routes and time-windows of administration.Studying the mechanisms that initiate and spread the degenerative process is also important to find out an effective therapy.Therefore,we discussed here some progresses that have been made using bone-marrow cell therapy as a therapeutic tool for ALS.

Transplantation of stem cell-derived astrocytes for the treatment of amyotrophic lateral sclerosis and spinal cord injury

Neglected for years, astrocytes are now recognized to fulfill and support many, if not all, homeostatic functionsof the healthy central nervous system(CNS). During neurodegenerative diseases such as amyotrophic lateral sclerosis(ALS) and spinal cord injury(SCI), astrocytes in the vicinity of degenerating areas undergo both morphological and functional changes that might compromise their intrinsic properties. Evidence from human and animal studies show that deficient astrocyte functions or loss-of-astrocytes largely contribute to increased susceptibility to cell death for neurons, oligodendrocytes and axons during ALS and SCI disease progression. Despite exciting advances in experimental CNS repair, most of current approaches that are translated into clinical trials focus on the replacement or support of spinal neurons through stem cell transplantation, while none focus on the specific replacement of astroglial populations. Knowing the important functions carried out by astrocytes in the CNS, astrocyte replacement-based therapies might be a promising approach to alleviate overall astrocyte dysfunction, deliver neurotrophic support to degenerating spinal tissue and stimulate endogenous CNS repair abilities. Enclosed in this review, we gathered experimental evidence that argue in favor of astrocyte transplantation during ALS and SCI. Based on their intrinsic properties and according to the cell type transplanted, astrocyte precursors or stem cell-derived astrocytes promote axonal growth, support mechanisms and cells involved in myelination, are able to modulate the host immune response, deliver neurotrophic factors and provide protective molecules against oxidative or excitotoxic insults, amongst many possible benefits. Embryonic or adult stem cells can even be genetically engineered in order to deliver missing gene products and therefore maximize the chance of neuroprotection and functional recovery. However, before broad clinical translation, further preclinical data on safety, reliability and therapeutic efficiency should be collected. Although several technical challenges need to be overcome, we discuss the major hurdles that have already been met or solved by targeting the astrocyte populationin experimental ALS and SCI models and we discuss avenues for future directions based on latest molecular findings regarding astrocyte biology.

Amyotrophic lateral sclerosis: a complex syndrome that needs an integrated research approach

Amyotrophic lateral sclerosis, the most common neurodegenerative disease affecting motor neurons, lacks an effective treatment. A small fraction of amyotrophic lateral sclerosis cases have a familial origin, related to mutations in causative genes, while the vast majority of amyotrophic lateral sclerosis cases are considered to be sporadic, resulting from the interaction between genes and environmental factors in predisposed individuals. During the past few years, dozens of drugs have been postulated as promising strategies for the disease after showing some beneficial effects in preclinical cellular and murine models. However, the translation into clinical practice has been largely unsuccessful and the compounds failed when were tested in clinical trials. This might be explained, at least partially, by the enormous complexity of the disease both from clinico-epidemiological and a pathogenic points of view. In this review, we will briefly comment on the complexity of the disease focusing on some recent findings, and we will suggest how amyotrophic lateral sclerosis research might be reoriented to foster the advance in the diagnostic and therapeutic questions.

Fungal-contaminated grass and well water and sporadic amyotrophic lateral sclerosis

Fungi are important infectious disease-causing agents,but are often overlooked as environmental factors in disease.We review several lines of evidence that point to a potential fungal origin of sporadic amyotrophic lateral sclerosis(ALS),the most common form of motor neurone disease.Approximately 90%cases of ALS are sporadic,and the aetiology of sporadic ALS is still unknown.We have previously postulated that grass or soil-associated fungal infections may be a leading cause of sporadic ALS.Herein we extend this proposal to water-associated fungi.A wide variety of fungi have been reported in drinking water including Acremonium,Alternaria,Aspergillus,Cladosporium,Fusarium,Penicillium and Trichoderma.Some of these are known to produce neurotoxic mycotoxins.Despite this,drinking water is not routinely monitored for fungal contamination.Fungal contamination could explain the close correlation between distribution of well water and cases of sporadic ALS in the United States.We propose several mechanisms by which an opportunistic fungal infection from environmental exposure(to water,soil or plants)can lead to long term neuronal degradation resulting in the hallmarks of ALS.If confirmed,the association between fungal infection and sporadic ALS could lead to novel treatment strategies for this progressive and fatal disease.

Cultivating stem cells for treating amyotrophic lateral sclerosis

This editorial addresses the current challenges and future directions in the use of stem cells as an approach for treating amyotrophic lateral sclerosis.A wide variety of literature has been reviewed to enlighten the reader on the many facets of stem cell research that are important to consider before using them for a cell based therapy.

Diffusion tensor imaging as a tool to detect presymptomatic axonal degeneration in a preclinical spinal cord model of amyotrophic lateral sclerosis

The G93A-SOD1 mice model and MRI diffusion as a preclinical tool to study amyotrophic lateral sclerosis （ALS）： ALS is a progressive neurological disease characterized primarily by the development of limb paralysis, which eventually leads to lack of control on muscles under voluntary control and death within 3–5 years. Genetic heterogeneity and environmental factors play a critical role in the rate of disease progression and patients display faster declines once the symptoms have manifested. Since its original discovery, ALS has been associated with pathological alterations in motor neurons located in the spinal cord （SC）, where neuronal loss by a mutation in the protein superoxide dismutase in parenthesis （mSOD1） and impairment in axonal connectivity, have been linked to early functional impairments. In addition,mechanisms of neuroinflammation, apoptosis, necroptosis and autophagy have been also implicated in the development of this disease. Among different animal models developed to study ALS, the transgenic G93A-SOD1 mouse has become recognized as a benchmark model for preclinical screening of ALS therapies. Furthermore, the progressive alterations in the locomotor phenotype expressed in this model closely resemble the progressive lower limb dysfunction of ALS patients. Among other imaging tools, MR diffusion tensor imaging （DTI） has emerged as a crucial, noninvasive and real time neuroimaging tool to gather information in ALS. One of the current concerns with the use of DTI is the lack of biological validation of the microstructural information given by this technique. Although clinical studies using DTI can provide a remarkable insight on the targets of neurodegeneration and disease course,they lack histological correlations. To address these shortcomings, preclinical models can be designed to validate the microstructural information unveiled by this particular MRI technique. Thus, the scope of this review is to describe how MRI diffusion and optical microscopy evaluate axonal structural changes at early stages of the disease in a preclinical model of ALS.

Amyotrophic lateral sclerosis disease modifying therapeutics:a cell biological perspective

Amyotrophic lateral sclerosis（ALS）is a progressively fatal neuromuscular disorder classically characterized by loss of upper and lower motor neurons from the cortex to the spinal cord Diagnosed patients have a median survival of about 3 years and death usually results from eventual respiratory failure.

Can cannabinoids be a potential therapeutic tool in amyotrophic lateral sclerosis？

Amyotrophic lateral sclerosis（ALS） is the most common degenerative disease of the motor neuron system. Over the last years, a growing interest was aimed to discovery new innovative and safer therapeutic approaches in the ALS treatment. In this context, the bioactive compounds of Cannabis sativa have shown antioxidant, anti-inflammatory and neuroprotective effects in preclinical models of central nervous system disease. However, most of the studies proving the ability of cannabinoids in delay disease progression and prolong survival in ALS were performed in animal model, whereas the few clinical trials that investigated cannabinoids-based medicines were focused only on the alleviation of ALS-related symptoms, not on the control of disease progression. The aim of this report was to provide a short but important overview of evidences that are useful to better characterize the efficacy as well as the molecular pathways modulated by cannabinoids.

The 5’-Untranslated Region of the C9orf72 mRNA Exhibits a Phylogenetic Alignment to the Cis-Aconitase Iron-Responsive Element;Novel Therapies for Amytrophic Lateral Sclerosis

The hexanucleotide repeat mutation in the intron-1 of the chromosome 9 open reading frame (C9orf72) is a frequent cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Altered RNA folding plays a role in ALS pathogenesis in two ways: non-ATG translation of the repeat can lead to aggregates of the known C9orf72 specific dipeptide polymer, whereas the repeat also can form neurotoxic RNA inclusions that dose-responsively kill motor neurons. We report the presence of a homology in the 5’untranslated region (UTR) of the messenger RNA encoding C9orf72 with the iron responsive elements (IRE) that control expression of iron-associated transcripts and predict that this RNA structure may iron-dependently regulate C9orf72 translation. We previously report altered serum ferritin levels track with severity of ALS in patients. Here, we conduct bioinformatics analyses to determine the secondary structure of the 5’UTR in C9orf72 mRNA and find it aligned with IREs in the human mitochondrial cis-aconitase and L and H-ferritin transcripts. Comparison of the role of RNA repeats in Friedriech’s ataxia and fragile X mental retardation suggests the utility of RNA based therapies for treatment of ALS. Antisense oligonucleotides (ASO) have been reported to therapeutically target these GGGGCC repeats. At the same time, because the function of C9orf72 is unknown, knockdown strategies carry some risk of inducing or compounding haploinsufficiency. We propose, for consideration, an approach that may enhance its therapeutic dynamic range by increasing the 5’UTR driven translation of C9orf72 protein to compensate for any potential ALS-specific or ASO-induced haploinsufficieny.

Spastin and alsin protein interactome analyses begin to reveal key canonical pathways and suggest novel druggable targets

Developing effective and long-term treatment strategies for rare and complex neurodegenerative diseases is challenging. One of the major roadblocks is the extensive heterogeneity among patients. This hinders understanding the underlying disease-causing mechanisms and building solutions that have implications for a broad spectrum of patients. One potential solution is to develop personalized medicine approaches based on strategies that target the most prevalent cellular events that are perturbed in patients. Especially in patients with a known genetic mutation, it may be possible to understand how these mutations contribute to problems that lead to neurodegeneration. Protein–protein interaction analyses offer great advantages for revealing how proteins interact, which cellular events are primarily involved in these interactions, and how they become affected when key genes are mutated in patients. This line of investigation also suggests novel druggable targets for patients with different mutations. Here, we focus on alsin and spastin, two proteins that are identified as “causative” for amyotrophic lateral sclerosis and hereditary spastic paraplegia, respectively, when mutated. Our review analyzes the protein interactome for alsin and spastin, the canonical pathways that are primarily important for each protein domain, as well as compounds that are either Food and Drug Administration–approved or are in active clinical trials concerning the affected cellular pathways. This line of research begins to pave the way for personalized medicine approaches that are desperately needed for rare neurodegenerative diseases that are complex and heterogeneous.

专项康复训练对ALS患者日常生活能力及吞咽功能的临床疗效分析

目的观察专项康复训练对肌萎缩侧索硬化(ALS)患者日常生活能力及吞咽功能的临床效果,以期提高患者的生活质量。方法50例ALS患者,随机分为对照组和观察组,每组25例,两组均给予常规基础治疗及护理,观察组在此基础上给予专项康复训练。对比两组患者治疗前后改良巴氏指数评定量表(MBI)评分及洼田饮水试验分级。结果治疗后,观察组MBI评分65.00(60.00,72.50)分较治疗前的60.00(45.00,65.00)分升高,且高于对照组的55.00(50.00,60.00)分,差异具有统计学意义(P<0.05)。治疗后,观察组洼田饮水试验分级较治疗前改善,差异具有统计学意义(Z=2.225,P=0.026<0.05);治疗后,对照组洼田饮水试验分级与治疗前对比差异无统计学意义(Z=1.552,P=0.121>0.05);治疗后,观察组洼田饮水试验分级优于对照组,差异具有统计学意义(Z=3.512,P=0.000<0.05)。结论专项康复训练可提高ALS患者日常生活能力和吞咽功能,从而改善ALS患者生活质量,减轻疾病带来的影响,具有临床应用价值。

Sleep-based therapy:A new treatment for amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis(ALS)is a worldwide problem with no effective treatment.Patients usually die of respiratory failure.The basic pathological process of ALS is the degeneration and necrosis of motor neurons.Neuroglial cell dysfunction is considered closely related to the development of ALS.Sleep plays an important role in repairing the nervous system,and sleep disorders can worsen ALS.Herein,we review the pathogenesis of ALS and the neuroprotective mechanism of sleep-based therapy.Sleep-based therapy could be a potential strategy to treat ALS.

Genotype-phenotype relationship in hereditary amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis(ALS)is the most common adult-onset motor neuron disease.It is characterized by neuronal loss and degeneration of the upper motor neurons(UMNs)and lower motor neurons(LMNs),and is usually fatal due to respiratory failure within 3–5 years of onset.Although approximately 5–10%of patients with ALS have an inherited form of the disease,the distinction between hereditary and apparently sporadic ALS(SALS)seems to be artificial.Thus,genetic factors play a role in all types of ALS,to a greater or lesser extent.During the decade of upheaval,the evolution of molecular genetics technology has rapidly advanced our genetic knowledge about the causes of ALS,and the relationship between the genetic subtypes and clinical phenotype.In this review,we will focus on the possible genotype-phenotype correlation in hereditary ALS.Uncovering the identity of the genetic factors in ALS will not only improve the accuracy of ALS diagnosis,but may also provide new approaches for preventing and treating the disease.

Genotype-phenotype correlations of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis(ALS)is a devastating neurodegenerative disease characterized by progressive neuronal loss and degeneration of upper motor neuron(UMN)and lower motor neuron(LMN).The clinical presentations of ALS are heterogeneous and there is no single test or procedure to establish the diagnosis of ALS.Most cases are diagnosed based on symptoms,physical signs,progression,EMG,and tests to exclude the overlapping conditions.Familial ALS represents about 5~10% of ALS cases,whereas the vast majority of patients are sporadic.To date,more than 20 causative genes have been identified in hereditary ALS.Detecting the pathogenic mutations or risk variants for each ALS individual is challenging.However,ALS patients carrying some specific mutations or variant may exhibit subtly distinct clinical features.Unraveling the respective genotype-phenotype correlation has important implications for the genetic explanations.In this review,we will delineate the clinical features of ALS,outline the major ALS-related genes,and summarize the possible genotype-phenotype correlations of ALS.

Diets for Patients with Amyotrophic Lateral Sclerosis： Pay Attention to Nutritional Intervention

INTRODUCTIONAmyotrophic lateral sclerosis （ALS） is characterized by the progressive degeneration of upper and lower motor neurons. Typical clinical features orALS are limb paralysis, muscle atrophy, dysphagia, dysarthria, shortness of breath＋ and respiratory failure.

肌萎缩侧索硬化症CMAP波幅与ALSFRS-r评分的相关性分析

目的分析肌萎缩侧索硬化症(ALS)患者运动神经传导复合肌肉动作电位(compound muscle action potential,CMAP)波幅下降与改良肌萎缩侧索硬化功能评分(revised amyotrophic lateral sclerosis functional rating scale,ALSFRS-r)的相关性。方法 258例ALS患者进行常规运动神经传导测定,对上、下肢不同神经CMAP波幅下降进行分析,并探讨其与ALSFRS-r评分及各亚项评分的关系。结果大多数患者出现运动神经传导异常,其中正中神经、尺神经、腓总神经和胫神经传导异常均以CMAP波幅减低最为常见(14.80%~59.90%),然后依次为末端运动潜伏期(distal motor latency,DML)延长(1.83%~25.00%)、CMAP未引出(2.23%~10.55%)和运动传导速度(motor conduction velocity,MCV)减慢(0~14.36%)。相关分析显示,正中神经、尺神经、腓总神经和胫神经的CMAP波幅与ALSFRS-r呈正相关(r=0.333,P<0.001;r=0.284,P<0.001;r=0.189,P=0.002;r=0.253,P<0.001)。Logistic回归分析显示,正中神经和胫神经的CMAP波幅与ALSFRS-r呈正相关,ALSFRS-r颈膨大亚项得分与正中神经CMAP波幅明显相关,而与尺神经CMAP波幅无相关性;ALSFRS-r腰膨大评分与胫神经和腓总神经CMAP波幅均有相关性。结论ALS患者运动神经传导异常以CMAP波幅下降最多见。它是一种有效的不可忽视的客观判断ALS病情严重程度的电生理指标,不同神经的CMAP波幅下降对判断颈膨大和腰膨大支配肌肉功能损害程度与ALSFRS-r评分中各个亚项评分具有同等评估效能。

夹脊电针对ALS-SOD1^(G93A)小鼠腰髓中p38 MAPK/NF-κB信号通路的影响研究

目的探究p38 MAPK/NF-κB信号通路在夹脊电针治疗肌萎缩侧索硬化-超氧化物歧化酶1^(G93A)(ALS—SOD1^(G93A))转基因小鼠的作用机制。方法选取45只ALS-SOD1^(G93A)转基因阳性雌性小鼠为研究对象,随机分为模型组、手针组、电针组,每组各15只,另取15只同窝野生型雌性小鼠为对照组,小鼠60 d龄时开始实验:对照组、模型组每周给予捆绑固定20 min 2次,手针组给与普通针、电针组采用全能脉冲电疗仪给与电针治疗,每周2次刺激双侧L_(1～2)、L_(5～6)夹脊穴,共治疗4周。120 d取小鼠腰膨大L_(1～6)腰髓,采用尼氏染色、透射电镜观察进行形态学检测,采用免疫组织化学法检测p38、p-p38表达,免疫荧光检测p65核移位,蛋白免疫印迹法检测全称肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-1β(IL-1β)、核因子-κB抑制因子(IκB-α)、p38、p65、p-IκB-α、p-p38、p-p65的表达,实时定量PCR(qPCR)检测TNF-α、IL-6、IL-1βmRNA的表达。结果模型组神经元数目明显减少(P<0.05),手针组与电针组形态学均有较大改善、电针组改善更佳。模型组炎症因子TNF-α、IL-6、IL-1β蛋白及mRNA水平上升,与模型组及手针组比较,电针组TNF-α、IL-6、IL-1β蛋白及mRNA明显降低(P<0.05)。模型组检出大量p38、p-p38阳性细胞分布于脊髓灰质前角,与模型组比较,手针组与电针组p-p38表达减弱,电针组减弱程度更大;与对照组比较,模型组p-IκB-α、p-p65含量升高(P<0.05);与模型组相比,手针组与电针组p-IκB-α、p-p65含量下降(P<0.05)。手针组与电针组均抑制p65入核过程,其中电针组抑制更加明显。结论夹脊电针通过抑制p38 MAPK/NF-κB信号通路,对腰髓前角运动神经元产生保护作用,缓解ALS病情的进展,为夹脊电针临床推广提供了理论依据。

肌萎缩侧索硬化患者肌电图与ALS-FRS-R的研究

目的研究肌萎缩侧索硬化(ALS)患者肌电图(EMG)相关肌肉小力收缩时运动单位动作电位(MUAP)的波幅(Amp)和时限(Lat)与肌萎缩侧索硬化功能评分(ALS-FRS-R)之间的相关性。方法 25例ALS患者分别进行ALS-FRS-R和EMG检查,分别记录并分析左右胫骨前肌、左右伸指总肌、腹直肌及胸锁乳突肌小力收缩时MUAP的Amp和Lat与ALS-FRS-R的相关性。结果 23例ALS患者右胫骨前肌小力收缩时Amp与ALS-FRS-R存在相关性,R2=0.173,P=0.043。左胫骨前肌、左右伸指总肌、腹直肌及胸锁乳突肌小力收缩时的Amp及左右胫骨前肌、左右伸指总肌、腹直肌及胸锁乳突肌小力收缩时的Lat与ALS-FRS-R不存在相关性(P>0.05)。结论 EMG中仅个别相关肌肉小力收缩时MUAP的Amp与ALS-FRS-R相关,因此EMG相关肌肉小力收缩时的Amp和Lat对ALS仅具有定性意义,不能反映ALS患者病情的严重程度。