Clifford W. Shults

Neuropsychological evidence for multiple implicit memory systems: a comparison of Alzheimer's, Huntington's, and Parkinson's disease patients

The performances of patients with dementia of the Alzheimer type (DAT), patients with Huntingtons disease (HD), and demented and nondemented patients with Parkinsons disease (PD) were compared on 2 tests of implicit memory that do not require the conscious recollection of prior study episodes: (1) a pursuit-rotor motor learning task and (2) a lexical priming test. The HD patients were found to be impaired on the motor learning but not the lexical priming task, whereas the DAT patients evidenced the opposite relationship on these tasks. The demented, but not the nondemented, PD patients were found to be impaired on both tests of implicit memory. For both the HD and PD patients, deficits on the motor learning task correlated significantly with severity of dementia but not with level of primary motor dysfunction. The noted double dissociation between HD and DAT patients indicates that different forms of implicit memory, all of which are intact in amnesia, are dependent upon distinct neuroanatomic systems. Motor skill learning may be mediated by a corticostriatal system, whereas verbal priming may depend upon the integrity of the neocortical association areas involved in the storage of semantic knowledge. The results for the PD patients suggest that the demented PD patients have endured damage to the neurologic systems subserving both motor learning and lexical priming.

Genetic screening for a single common LRRK2 mutation in familial Parkinson's disease

Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene cause some forms of autosomal dominant Parkinsons disease. We measured the frequency of a novel mutation (Gly2019 ser) in familial Parkinsons disease by screening genomic DNA of patients and controls. Of 767 affected individuals from 358 multiplex families, 35 (5%) individuals were either heterozygous (34) or homozygous (one) for the mutation, and had typical clinical findings of idiopathic Parkinsons disease. Thus, our results suggest that a single LRRK2 mutation causes Parkinsons disease in 5% of individuals with familial disease. Screening for this mutation should be a component of genetic testing for Parkinsons disease.

Differential neuropathological alterations in transgenic mice expressing α-synuclein from the platelet-derived growth factor and Thy-1 promoters

Accumulation of α‐synuclein has been associated with neurodegenerative disorders, such as Lewy body disease and multiple system atrophy. We previously showed that expression of wild‐type human α‐synuclein in transgenic mice results in motor and dopaminergic deficits associated with inclusion formation. To determine whether different levels of human α‐synuclein expression from distinct promoters might result in neuropathology mimicking other synucleopathies, we compared patterns of human α‐synuclein accumulation in the brains of transgenic mice expressing this molecule from the murine Thy‐1 and platelet‐derived growth factor (PDGF) promoters. In murine Thy‐1‐human α‐synuclein transgenic mice, this protein accumulated in synapses and neurons throughout the brain, including the thalamus, basal ganglia, substantia nigra, and brainstem. Expression of human α‐synuclein from the PDGF promoter resulted in accumulation in synapses of the neocortex, limbic system, and olfactory regions as well as formation of inclusion bodies in neurons in deeper layers of the neocortex. Furthermore, one of the intermediate expresser lines (line M) displayed human α‐synuclein expression in glial cells mimicking some features of multiple system atrophy. These results show a more widespread accumulation of human α‐synuclein in transgenic mouse brains. Taken together, these studies support the contention that human α‐synuclein expression in transgenic mice might mimic some neuropathological alterations observed in Lewy body disease and other synucleopathies, such as multiple system atrophy.

The role of radiotracer imaging in Parkinson disease

Radiotracer imaging (RTI) of the nigrostriatal dopaminergic system is a widely used but controversial biomarker in Parkinson disease (PD). Here the authors review the concepts of biomarker development and the evidence to support the use of four radiotracers as biomarkers in PD: [18F]fluorodopa PET, (+)-[11C]dihydrotetrabenazine PET, [123I]β-CIT SPECT, and [18F]fluorodeoxyglucose PET. Biomarkers used to study disease biology and facilitate drug discovery and early human trials rely on evidence that they are measuring relevant biologic processes. The four tracers fulfill this criterion, although they do not measure the number or density of dopaminergic neurons. Biomarkers used as diagnostic tests, prognostic tools, or surrogate endpoints must not only have biologic relevance but also a strong linkage to the clinical outcome of interest. No radiotracers fulfill these criteria, and current evidence does not support the use of imaging as a diagnostic tool in clinical practice or as a surrogate endpoint in clinical trials. Mechanistic information added by RTI to clinical trials may be difficult to interpret because of uncertainty about the interaction between the interventions and the tracer.

Enhanced substantia nigra mitochondrial pathology in human alpha-synuclein transgenic mice after treatment with MPTP.

Recent studies have implicated alpha-synuclein (alpha-S) in the pathogenesis of Parkinsons disease (PD). The mechanisms underlying PD are not completely understood; however, mitochondrial complex I inhibition and oxidative injury may be involved. Because the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is a potent complex I inhibitor that can cause oxidative injury and mimic many aspects of PD in treated animals, we sought to determine whether the overexpression of alpha-S in transgenic (tg) mice (alpha-S-tg) would enhance the substantia nigra (SN) pathology resulting from treatment with MPTP. For this purpose, alpha-S-tg mice were produced expressing high levels of wild-type (wt) human alpha-S under the control of the neuron-specific Thy-1 promoter. Alpha-S-tg mice and non-tg controls were treated with MPTP (15 mg/kg ip, twice a week for 2 weeks) or saline (Sal) and then examined 2 weeks after completion of treatment by transmission electron microscopy (EM). We found that alpha-S-tg mice treated with MPTP had extensive mitochondrial alterations, increases in mitochondrial size, filamentous neuritic aggregations, axonal degeneration, and formation of electron dense perinuclear cytoplasmic inclusions in the SN that did not occur in the hippocampus or neocortex, nor in MPTP-treated non-tg mice or Sal-treated alpha-S-tg mice. These findings support the potential involvement of alpha-S expression in the vulnerability of SN neurons to toxicity from mitochondrial complex I inhibitors and the subsequent development of neurodegenerative pathology.

Coenzyme Q10 attenuates the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced loss of striatal dopamine and dopaminergic axons in aged mice

We investigated whether oral administration of coenzyme Q10 (CoQ10) could attenuate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) neurotoxicity in one-year-old mice. Four groups of one-year-old, male C57BL/6 mice received a either standard diet or a diet supplemented with CoQ10 (200 mg/kg/day) for five weeks. After four weeks, one group that had received the standard diet and one group that had received the CoQ10 supplemented diet were treated with MPTP. The four groups continued on their assigned diets for an additional week prior to sacrifice. Striatal dopamine concentrations were reduced in both groups treated with MPTP, but they were significantly higher (37%) in the group treated with CoQ10 and MPTP than in the group treated with MPTP alone. The density of tyrosine hydroxylase immunoreactive (TH-IR) fibers in the caudal striatum was reduced in both MPTP-treated groups, but the density of TH-IR fibers was significantly (62%) greater in the group treated with CoQ10 and MPTP than in the group treated with MPTP alone. Our results indicate that CoQ10 can attenuate the MPTP-induced loss of striatal dopamine and dopaminergic axons in aged mice and suggest that CoQ10 may be useful in the treatment of Parkinsons disease.

Partial lesion of the substantia nigra : relation between extent of lesion and rotational behavior

Recent work, largely carried out in primate models of Parkinsons disease (PD), indicates that residual dopaminergic neurons in the midbrain and their axons to the nucleus accumbens and striatum can be stimulated to sprout collateral axons, reinnervate the striatum, and cause a behavioral recovery. We sought to create a partial lesion model of PD in the rat that would (i) mimic the pattern of cell loss in human patients in early stages of PD, and (ii) permit examination of experimental manipulations that promote sprouting of axons of the surviving dopaminergic cells in the midbrain. Rats with unilateral 6-hydroxydopamine (6-OHDA) lesions of the substantia nigra pars compacta (SNpc) were tested weekly for rotational asymmetry following administration of apomorphine or amphetamine. After completion of behavioral testing, the animals were sacrificed and the brains immunolabeled for tyrosine hydroxylase (TH). Analysis of anatomical and behavioral data revealed a strong correlation between number of remaining TH-immunoreactive cells in the SNpc and the number of rotations induced by apomorphine. There was no significant correlation between number of remaining TH-immunoreactive nigral neurons and number of rotations induced by amphetamine. We also examined the relation between area in the denervated striatum with remaining TH-immunoreactive axons, number of TH-immunoreactive cells in the lesioned SNpc, and rotational behavior. As expected, there was a strong correlation between area innervated by TH-immunoreactive axons and number of remaining TH-immunoreactive neurons in the lesioned SNpc. Total extent of innervation was also correlated with number of apomorphine-induced rotations but not with number of amphetamine-induced rotations.(ABSTRACT TRUNCATED AT 250 WORDS)

Grafting genetically modified cells to the brain: possibilities for the future.

Diagnostic and therapeutic approaches to disorders of the central nervous system (CNS) are particularly difficult to develop because of the relative inaccessibility of the mammalian brain to study and chemical treatment, the complexity and interconnectedness of CNS subsystems, and the profound and continued lack of fundamental understanding of the relationship between structure and function in the CNS. Neural grafting in the CNS has recently suggested a potential approach to CNS therapy through the selective replacement of cells lost as a result of disease or damage. Independently, studies aimed at direct genetic therapy in model systems have recently begun to suggest conceptually new approaches to the treatment of several kinds of human genetic disease, especially those caused by single-gene enzyme deficiencies. We suggest that a combination of these two approaches, namely the grafting into the CNS of genetically modified cells, may provide a new approach toward the restoration of some functions in the damaged or diseased CNS. We present evidence for the feasibility of this approach, including a description of some current techniques for mammalian cell gene transfer and CNS grafting, and several possible approaches to clinical applications.

Heterozygosity for a mutation in the parkin gene leads to later onset Parkinson disease

Background: The vast majority of the parkin mutations previously identified have been found in individuals with juvenile or early onset PD. Previous screening of later onset PD cohorts has not identified substantial numbers of parkin mutations. Methods: Families with at least two siblings with PD were ascertained to identify genes contributing to PD susceptibility. Screening of the parkin gene, by both quantitative PCR and exon sequencing, was performed in those families with either early onset PD (age onset ≤50 years) or positive lod score with a marker in intron 7 of the parkin gene. Results: A total of 25 different mutations in the parkin gene were identified in 103 individuals from 47 families. Mutations were found in both parkin alleles in 41 of the individuals, whereas a single mutation in only one of the two parkin alleles was observed in 62 individuals. Thirty-five of the subjects (34%) with a parkin mutation had an age at onset of 60 years or above with 30 of these 35 (86%) having a detectable mutation on only one parkin allele. Few significant clinical differences were observed among the individuals with two, one, or no mutated copies of the parkin gene. Conclusion: Mutations in the parkin gene occur among individuals with PD with an older age at onset (≥60 years) who have a positive family history of the disease. In addition, the clinical findings of parkin-positive individuals are remarkably similar to those without mutations.

Pilot trial of high dosages of coenzyme Q10 in patients with Parkinson's disease

The safety and tolerability of high dosages of coenzyme Q10 were studied in 17 patients with Parkinsons disease (PD) in an open label study. The subjects received an escalating dosage of coenzyme Q10--1200, 1800, 2400, and 3000 mg/day with a stable dosage of vitamin E (alpha-tocopherol) 1200 IU/day. The plasma level of coenzyme Q10 was measured at each dosage. Thirteen of the subjects achieved the maximal dosage, and adverse events were typically considered to be unrelated to coenzyme Q10. The plasma level reached a plateau at the 2400 mg/day dosage and did not increase further at the 3000 mg/day dosage. Our data suggest that in future studies of coenzyme Q10 in PD, a dosage of 2400 mg/day (with vitamin E/alpha-tocopherol 1200 IU/day) is an appropriate highest dosage to be studied.