Parkinson’s 101 (care of Parkinson’s UK)

In December 2016, Parkinson’s UK produced a wonderful series of video explaining some of the basics of Parkinson’s disease. They are a really useful resources for folks who would like to better understand this condition, but are not really interested in the hard-core science. You can find them on Parkinson’s UK Youtube channel, but we present a couple of them here to give you a taster. Enjoy.

1. What is Parkinson’s disease?

2. How does the medication work?

3. How are future drugs developed?


We should also point out that other Parkinson’s disease group, such as the Michael J Fox Foundation also have Youtube channels as well. They too present some great videos, such as:

1. An explanation of the clinical trial process:

2. The process of getting a drug from the lab bench to the market:

 

A smartphone application for Parkinson’s disease

umotif

Here at the SoPD, we like our gadgets and new technology.

And we believe that there is enormous potential for people with Parkinson’s disease to benefit hugely even from some of the small technological advances that seem to be occurring on a day basis.

Today’s post will review a recent study that looked at tested the benefits of a smartphone application for people with Parkinson’s disease.


selfcare-infographic-english

A schematic illustrating the limited monitoring of Parkinson’s. Source: Riggare

On her great blog, Swedish engineer and ‘proud mother’ Sara Riggare posted the image above to illustrate the ridiculous current situation regarding the standard monitoring of Parkinson’s disease.

As the schematic perfectly illustrates, in 2014 Sara spent 8,765 hours conducting ‘self care’. That is, she was applying her own knowledge and experience to managing her Parkinson’s disease. For just one hour in that year was her Parkinson’s actually being monitored by a medical clinician (8,766 being the number of hours in a year).

This is actually a very serious problem – for not only the Parkinson’s community – but anyone suffering from a long-term medical condition. How are they to gage their current situation on a day to day basis when they have such infrequent visits to their medical specialist?

And this is where technology can help.

But, before we begin:

FULL DISCLOSURE NO.1: the author of this blog is an author in the study that will be discussed (#ThisIsNotShamelessSelfPromotion).

FULL DISCLOSURE NO.2: We here at the SoPD are in no way benefitting from mentioning the study here. The company behind the product, umotif, has not asked us nor been contacted by us regarding this post (in fact, they are completely unaware that we are posting this). We are writing this post simply because we thought that it would be of interest to the wider Parkinson’s community. And yes, as other technology comes to along, we will bring it to you attention by posting about it here.

With all of that out of the way, the study is AMAZING!

smart

Title: Using a smartphone based self-management platform to support medication adherence and clinical consultation in Parkinson’s disease: Results from the SMART-PD Randomised Controlled Trial v4.
Authors: Lakshminarayana R, Wang D, Burn D, Barker RA, Chaudhuri KR, Galtrey C, van Guzman N, Hellman B, Pal S, Stamford J, Steiger M, Stott SRW, Teo J, Barker RA, Wang E, Bloem BR, van der Eijk M, Rochester L, & Williams A
Journal: NPJ Parkinson’s disease (2017), 3, 2.
PMID: N/A          (This article is OPEN ACCESS if you would like to read it)

The company behind the application approached various clinical research groups around the UK and proposed to run a study of their new product. The software had many features (including information about medication, a reminder alarm for when medication should be taken, tests/games, and links to other resources online).

41531_2016_3_fig4_html

A programmable reminder system for medication. Source: Nature

The primary focus of the software, however, was a flower-petal shaped motif that the participants could manipulate to indicate how they were feeling.

umotif-app-screenshot-2

The umotif flower motif. Source: SalusDigital

Participants could drag each coloured petal in or out to indicate how they were feeling at a particular moment in time. The smaller the petal, the more lower the score. And each petal represented different aspects of daily life, for example the moon and stars (dark blue) petal allowed an indication of how one slept.

Each time the participant indicated their current status on the flower motif, the information was recorded and could be tracked over days, weeks, and months. This level of information allowed people to begin to see patterns in their own behaviour over time, with some people getting poorer sleep during the middle of the month for example. And different variables could be compared (such as sleep score with exercise score), providing users with a more dynamic idea of their situation over time.

41531_2016_3_fig5_html-1

Comparing scores between measures over time. Source: Nature

A total of 215 people with Parkinson’s disease were randomly assigned to either receive the application (106 subjects) or not (acting as a control subject; 109 subjects). Both groups were contacted by the investigators fours times during the 16 week trial and feedback was provided in addition to any changes in their treatment regimes.

72% of participants application group continued to use and engage with the application throughout the 16-week trial. By the end of the study, the application group demonstrated significantly improved adherence to their treatment regime when compared to the control group. Curiously, the application also significantly improved patients’ perception of quality of follow up consultations, demonstrating unexpected benefits.

And at the end of the study all of the control group participants in the study were allowed to begin using the application, while the application group continued to use it.

One interesting aspect of the study was the lack of interaction with technology by the target population. 180 people who were initially invited to take part in the study could not because they did not have smartphones (with iPhone/iPad or Android operating systems). So obviously there are opportunities for alternative approaches to this kind of tracking (other than a smartphone).

What does it all mean?

This smartphone application is a user friendly approach to tracking someone’s Parkinson’s over time, getting around the ‘lack of monitoring’ issue that concerns many in the community.

Umotif and Parkinson’s UK have kindly made this video about the study results so we might just sit back and let them explain what it all means and point out all of the benefits.

We are working on additional posts about wearable tech for Parkinson’s disease, which will be coming soon.

So stay tuned.


The banner for today’s post was sourced from ParkinsonsMovement

An Update from Voyager Therapeutics trials for Parkinson’s

2139

In December, we highlighted the results of a phase 1 clinical trial for Parkinson’s disease being run by a company called Voyager Therapeutics (Click here for that post). In that post we also explained that the company is attempting to take a gene therapy product (VY-AADC01) to the clinic.

VY-AADC01 is a virus that is injected into a particular part of the brain (called the putamen), where it infects cells in that area and causes them to produce a lot of a particular protein, called Aromatic L-amino acid decarboxylase (or AADC). AADC is required for turning L-dopa (one of the primary treatments for Parkinson’s disease) into dopamine – which helps to ease the motor features of the condition.

Today, while most people were focused on President Trump’s inauguration, Voyager Therapeutics provided an update on their ongoing trials. Specifically, the company reported an increase in viral infection coverage of the putamen was achieved by VY-AADC01 in their third group (‘cohort’) of subjects. They infected 42% of the putamen compared to 34% in group 2 and 21% in group 1.

In the press release, the company stated:

The five patients enrolled in Cohort 3 received similar infusion volumes of VY-AADC01 compared to Cohort 2 (up to 900 µL per putamen), but three-fold higher vector genome concentrations, representing up to a three-fold higher total dose of up to 4.5×1012 vector genomes (vg) of VY-AADC01 compared to patients in Cohort 2 (1.5 × 1012 vg).  Patients enrolled in Cohort 3 were similar in baseline characteristics to Cohort 1 and 2.  The use of real-time, intra-operative MRI-guided delivery allowed the surgical teams to visualize the delivery of VY-AADC01 and continue to achieve greater average coverage of the putamen in Cohort 3 (42%) compared to Cohort 2 (34%) with similar infusion volumes and Cohort 1 (21%) with a lower infusion volume (Figure 1).  The surgical procedure was successfully completed in all five patients.  Infusions of VY-AADC01 have been well-tolerated with no vector-related serious adverse events (SAEs) or surgical complications in Cohort 3, and all five patients were discharged from the hospital within two days following surgery.  The Phase 1b trial remains on track to deliver six-month safety, motor function, and biomarker data from Cohort 3, as well as longer-term safety and motor function data from Cohorts 1 and 2, in mid-2017.”

This update demonstrates that the company is proceeding with increased concentrations of their virus, resulting in a wider area of the putamen being infected and producing AADC. Whether this increased area of AADC producing cells results in significant improvements to motor features of Parkinson’s disease, we shall hopefully begin to find out later this year.

As always, watch this space.

Niacin rich diets for Pink flies

pink_fly-1410843

Performer Miley Cyrus says that “Pink isn’t just a colour, it’s an attitude!”

Whether that is true or not is not for us to say.

What we can tell you is that ‘Pink’ is also a gene which is associated with Parkinson’s disease. And not just any form of Parkinson’s disease – people with early onset Parkinson’s (diagnosed before 40 years of age) often have specific mutations in this gene. And recently there has been new research published which may help these particular individuals.

Today’s post will review the new research and look at what it means for people with early onset Parkinson’s disease.


MJF-by-Seliger-May-2010-for-homepage-retouched_4

The actor Michael J Fox requires no introduction.

Especially in the Parkinson’s community where his Michael J Fox Foundation has revolutionised the funding and supporting of Parkinson’s disease research (INCREDIBLE FACT: Since 2000, The Michael J. Fox Foundation has funded more than US$450 MILLION of Parkinson’s disease research) and is leading the charge in the search for a cure for this condition.

Mr Fox has become one of the foremost figures in raising awareness about the disease that he himself was diagnosed with at just 29 years of age.

Wow, so young?

It is a common mistake to consider Parkinson’s disease a condition of the aged portion of society. While the average age of diagnosis floats around 65 years of age, it is only an average. The overall range of that extends a great distance in both directions.

Being diagnosed so young, Mr Fox would be considered to have early onset Parkinson’s disease.

What is early onset Parkinson’s disease?

Broadly speaking there are three basic divisions of Parkinson’s disease across different age ranges:

  • Juvenile-onset Parkinson disease – onset before age 20 years
  • Early-onset Parkinson disease – before age 50 years
  • Late-onset Parkinson disease – after age 50 years is considered

The bulk of people with Parkinson’s disease are considered ‘late-onset’. The Juvenile-onset version of the condition, on the other hand, is extremely rare but cases do pop up regularly in the media (For example, click here). We have previously written about Juvenile-onset Parkinson disease (Click here for that post).

Early-onset Parkinson disease is more common than the juvenile form, but still only makes up a fraction of the overall Parkinsonian population. Some of those affected call themselves 1 in 20 as this is considered by some the ratio of early-onset Parkinson’s compared to late-onset.

How prevalent is early onset Parkinson’s?

In 2009, Parkinson’s UK published a report on the prevalence of Parkinson’s disease in the UK.

Using the General Practice Research Database (GPRD), which houses information about 7.2% of the UK population (or 3.4 million people in 2009), Parkinson’s UK found that the frequency of Parkinson’s disease in the general public was 27 cases in every 10,000 people (or 1 person in every 370 of the general population). The prevalence is higher in men (31 in every 10,000 compared to 24 in every 10,000 among females)

Stats

Source: ParkinsonsUK

As you can see from the table above, the number of people affected by early onset Parkinson’s disease is small when compared to the late-onset population.

Officially, the prevalence of early onset Parkinson’s in Europe is estimated to be 1 in every 8,000 people in the general population (Source: Orphanet). This makes the population of affected individuals approximately 5-10 % of all people with Parkinson’s. Hence the 1 in 20 label mentioned above.

Like older onset Parkinson’s, males are more affected than females (1.7 males to every 1 female case). In addition, women generally develop the disease two years later than men.

So what does ‘Pink’ have to do with early onset Parkinson’s?

First, let’s have a look at ‘Pink’ the gene.

PTEN-induced putative kinase 1 (or PINK1; also known as PARK6) is a gene that is thought to protect cells. Specifically, Pink1 is believed to interact with another Parkinson’s disease-associated protein called Parkin (also known as PARK2). Pink1 grabs Parkin and causes it to bind to dysfunctional mitochondria. Parkin then signals to the rest of the cell for that particular mitochondria to be disposed of. This is an essential part of the cell’s garbage disposal system.

Hang on a second. Remind me again: what are mitochondria?

Mitochondria are the power house of each cell. They keep the lights on. Without them, the lights go out and the cell dies.

Mitochondria

Mitochondria and their location in the cell. Source: NCBI

You may remember from high school biology class that mitochondria are bean-shaped objects within the cell. They convert energy from food into Adenosine Triphosphate (or ATP). ATP is the fuel which cells run on. Given their critical role in energy supply, mitochondria are plentiful and highly organised within the cell, being moved around to wherever they are needed.

When a cell is stressed by a toxic chemical, the organisation of mitochondria breaks down (as is shown in the image below, where everything except mitochondria (in green) and the nucleus (blue) has been made invisible:

ampkmito-945x466

Mitochondria (green) in health cells (left) and in unhealthy cells (right).
The nucleus of the cell is in blue. Source: Salk Institute

In normal, healthy cells, PINK1 is absorbed by mitochondria and eventually degraded. In unhealthy cells, however, this process is inhibited and PINK1 starts to accumulate on the outer surface of the mitochondria. There, it starts grabbing the PARKIN protein. This pairing is a signal to the cell that this particular mitochondria is not healthy and needs to be removed.

601587-fig-003

Pink1 and Parkin in normal (right) and unhealthy (left) situations. Source: Hindawi

The process by which mitochondria are removed is called autophagy. Autophagy is an absolutely essential function in a cell. Without it, old proteins will pile up making the cell sick and eventually it dies. Through the process of autophagy, the cell can break down the old protein, clearing the way for fresh new proteins to do their job.

Think of autophagy as the waste disposal process of the cell.

So why is Pink1 important to Parkinson’s disease?

In 2004 this research article was published:

pink

Title: Hereditary early-onset Parkinson’s disease caused by mutations in PINK1
Authors: Valente EM, Abou-Sleiman PM, Caputo V, Muqit MM, Harvey K, Gispert S, Ali Z, Del Turco D, Bentivoglio AR, Healy DG, Albanese A, Nussbaum R, González-Maldonado R, Deller T, Salvi S, Cortelli P, Gilks WP, Latchman DS, Harvey RJ, Dallapiccola B, Auburger G, Wood NW.
Journal: Science. 2004 May 21;304(5674):1158-60.
PMID: 15087508

The researchers in this study were the first to report that mutations in the Pink1 gene were associated with increased risk of Parkinson’s disease. They found three families in Europe that exhibited a very similar kind of Parkinson’s disease and by analysing their DNA they determined that mutations in the Pink1 gene were directly linked to the condition.

They also looked at where in the cell Pink1 protein was located, noting the close contact with the mitochondria. In addition, they noted that the normal Pink1 protein provided the cell with protection against a toxic chemical, while the mutated version of Pink1 did not. These findings led the researchers to conclude that Pink1 and mitochondria may be involved in the underlying mechanisms of Parkinson’s disease.

And this initial study was quickly followed up 7 months later by this report:

dec-2004

Title: Analysis of the PINK1 gene in a large cohort of cases with Parkinson disease.
Authors: Rogaeva E, Johnson J, Lang AE, Gulick C, Gwinn-Hardy K, Kawarai T, Sato C, Morgan A, Werner J, Nussbaum R, Petit A, Okun MS, McInerney A, Mandel R, Groen JL, Fernandez HH, Postuma R, Foote KD, Salehi-Rad S, Liang Y, Reimsnider S, Tandon A, Hardy J, St George-Hyslop P, Singleton AB.
Journal: Arch Neurol. 2004 Dec;61(12):1898-904.
PMID: 15596610

In this study, the researchers analysed the Pink1 gene in 289 people with Parkinson’s disease and 80 neurologically normal control subjects. They identified 27 genetic variations, including a mutation in 2 unrelated early-onset Parkinson disease patients. They concluded that autosomal recessive mutations in PINK1 result in a rare form of early-onset Parkinson’s disease.

What does autosomal recessive mean?

Autosomal recessive means two copies of an abnormal gene must be present in order for the disease or trait to develop. That is to say, both parents will be carrying one copy of the mutation.

Mutations in the Pink1 gene have now been thoroughly analysed, with many mutations identified (the red and blue arrows in the image below). It is important, however, to understand that not all of those mutations are associated with Parkinson’s disease.

f4-large

Looks complicated. Genetic variations in the Pink1 gene. Source: APS

So how do mutations in the Pink1 gene cause Parkinson’s disease?

We believe that the mutations in the Pink1 DNA result in malformed Pink1 protein. This results in Pink1 not being able to do what it is supposed to do. You will remember what we wrote above: Pink1 grabs Parkin when mitochondria get sick and Parkin signals for that mitochondria is be disposed of. Well, in the absence a properly functioning Pink1, we believe that there is a build up of sick mitochondria and this is what kills off the cell. All Parkinson’s disease-associated mutations in the Pink1 gene inhibit the ability of Pink1 grab parkin (Click here for more on this).

And we see this in flies.

kk8g8b9t-1367209604

Flies. Source: TheConservation

Flies (or drosophila) are a regular feature in biological research. Given their short life cycle, they can be used to quickly determine the necessity and function of particular genes. Yes, they are slightly different to us, but quite often the same biological principles apply.

Take Pink1 for example.

When scientists mutate the Pink1 gene in flies, it leads to the loss of flight muscles and male sterility. These effects both appear to be due to the kind of mitochondrial issues we were discussing above. One really amazing fact is that the human version of Pink1 can actually rescue the flies that have their Pink1 gene mutated. This is remarkable because across evolution genes begin to differ slightly resulting in some major differences by the time you get to humans. The fact that Pink1 is similar between both flies and humans shows that it has been relatively well conserved (functionally at least).

And given that we see similarities in the Pink1 gene and function between flies and humans, then perhaps we can apply what we see in flies to humans with regards to treatments.

Which brings us (finally!) to the research paper we wanted to look at today:

pink1-et

Title: Enhancing NAD+ salvage metabolism is neuroprotective in a PINK1 model of Parkinson’s disease<
Authors: Lehmann S, Loh SH, Martins LM.
Journal: Biol Open. 2016 Dec 23. pii: bio.022186.
PMID: 28011627              (this article is OPEN ACCESS if you would like to read it)

In this study, the researchers analysed Pink1 flies and found alterations in the activity of an enzyme called nicotinamide adenine dinucleotide (or NAD+). NAD+ is one of the major targets for the anti-aging crowd and there is some very interesting research being done on it (Click here for a good review on this). NAD+ is a coenzyme found in all living cells. A coenzyme functions by carrying electrons from one molecule to another (Click here for a nice animation that will explain this better). The researchers found that Pink1 mutant flies have decreased levels of NAD+.

The researchers were curious if a diet supplemented with the NAD+ would rescue the mitochondrial defects seen in the Pink1 mutant fly. Specifically, they fed the flies a diet high in the NAD+ precursor nicotinamide (being a precursor means that nicotinamide can be made into NAD+ once inside a cell). They found that not only did nicotinamide rescue the mitochondrial problems in the flies, but it also protected neurons from degeneration.

So why is the title of this post talking about Niacin and not nicotinamide?

Niacin (also known as vitamin B3 or nicotinic acid) – like nicotinamide – is also a precursor of NAD+. And in their discussion of the study, the researchers noted that a high level of dietary niacin has been associated with a reduced risk of developing Parkinson’s disease (Click here and here for more on this).

The researchers were quick to point out that while a high Niacin diet may be beneficial, it could not be considered a cure in anyway for people with Parkinson’s disease because although it may be able to slow the cell death it would not be able to replace the cells that have already been lost.

So what does it all mean?

Hang on a second. We’re not finished yet.

Numerous media outlets have made a big fuss about the Niacin diet angle to this research, and they have ignored another really interesting finding:

In their study the researchers mutated another gene in the Pink1 flies which also resulted in improved mitochondrial function and neuroprotection. That gene was Poly (ADP-ribose) polymerase (or PARP). Parp is an enzyme involved in DNA repair and cell division. It is produced in very high levels in many types of cancer and medication that inhibit or block Parp are being tested in the clinic as therapies in those cancers.

Interestingly, blocking Parp has been previously shown to be beneficial for cell survival in models of Parkinson’s disease (Click here and here for more information on this). So in addition to changing to a high niacin diet, it would be interesting to follow up this results as well.

Particularly for people with the Pink1 mutation.

And this is where the results of this study are particularly interesting: they may relate specifically to a small population within the Parkinson’s community – those with Pink1 mutations. It would be interesting to begin discussing and designing clinical studies that focus particularly on people in this population (similar to the Ambroxol study – click here for our post on this).

So what does it all mean? (again)

The results of the present study demonstrate two means by which people with a particular genetic mutation could be treated for Parkinson’s disease. Obviously further research is required, but the idea that we are approaching an age in Parkinson’s disease research where treatments could be personalised is very appealing. It will be interesting to see where all of this goes.


EDITOR’S NOTE:  If nothing we have written here makes any sense, then maybe this video will help:


The banner for today’s post was sourced from Wallpapersinhq

The Dogfish solution for Parkinson’s

Spiny dogfish 096

This week an interesting study was published in the scientific journal, Proceedings of the National Academy of SciencesIt involved our old friend, alpha synuclein – the aggregating protein that is associated with Parkinson’s disease – and the dogfish shark.

Not natural dance partners, I agree. But the findings of the study are very interesting.

In today’s post we will review the study and explain the connection between the protein and the shark.


spiny-dogfish-shark-622x363

Source: Discovery

Some people call them spiny dogfish.

Others call them Spurdogs. Or Mud shark. Or even Piked dogfish.

Call them what you will – in the scientific realm they are referred to as Squalus acanthias. They are one of the most common members of the Squalide (dogfish) family of sharks. In the wild, Squalus acanthias are found in shallow waters, but can be seen further offshore in more temperate latitudes. They are relatively harmless to humans, but they do have venom in their rear fin – when under attack, the dogfish shark will arch its back and pierce/poison its attacker (so beware!).

Interesting, but what is the connection with Parkinson’s disease?

Good question.

So here’s the thing about dogfish sharks: they are extremely hardy when it comes to infection.

They don’t really get sick all that often. And this is despite having a relatively “primitive” immune system (Click here to read more on this). A team led by Prof Michael Zasloff (of Georgetown University) discovered that a chemical called ‘Squalamine’ may be one of the reasons for this robustness.

What is Squalamine?

Squalamine is steroid with a wide range of antimicrobial activity. Steroids are used as a treatment for certain inflammatory conditions, but the research published this week suggests another property for Squalamine.

This is the research article that was published:

pnas-dobson

Title: A natural product inhibits the initiation of α-synuclein aggregation and suppresses its toxicity
Authors: Perni M, Galvagnion C, Maltsev A, Meisl G, Müller MB, Challa PK, Kirkegaard JB, Flagmeier P, Cohen SI, Cascella R, Chen SW, Limboker R, Sormanni P, Heller GT, Aprile FA, Cremades N, Cecchi C, Chiti F, Nollen EA, Knowles TP, Vendruscolo M, Bax A, Zasloff M, Dobson CM.
Journal: PNAS 2017; doi:10.1073/pnas.1610586114
PMID: 28096355             (this article is OPEN ACCESS if you would like to read it)

In this study, the researchers discovered that squalamine can actually block alpha synuclein from aggregating (that is clumping together). They treated human cells (that produce too much alpha synuclein, which ultimately kills them) in culture with squalamine and they observed an almost complete suppression of the toxic effect of alpha synuclein.

c_elegans

Caenorhabditis elegans – cute huh? Source: Nematode

The researchers next looked at the effects of squalamine in a microscopic worm called Caenorhabditis elegans . These tiny creatures are widely used in biology because they can be easily genetically manipulated and their nervous system is very simple and well mapped out (they have just 302 neurons and 56 glial cells!). The particular strain of Caenorhabditis elegans used in this current study produced enormous amounts of alpha synuclein, which results in muscle paralysis.

By treating the worms with squalamine, the researchers observed a dramatic reduction of alpha synuclein protein aggregating and an almost complete elimination of the muscle paralysis. In addition, they noted a reduction in the cellular damage caused by the aggregation of alpha synuclein. All in all, a pretty impression result! The researchers suggested that their findings indicate that “squalamine could be a means of therapeutic intervention in Parkinson’s disease”.

So is squalamine being tested in the clinic?

The answer is: Yes, but not for Parkinson’s disease.

There is currently a clinical trial for squalamine in people with neovascular age-related macular degeneration – a condition of the eye (click here for more information about that trial). This work is being carried out by a company called Ohr Pharmaceuticals and as far as we are aware all of their work is focused on eye treatments. Squalamine has also been tested in clinical studies of fungal infection of the scalp – tinea capitis – and appeared to be well tolerated (Click here for more information).

Regarding Parkinson’s disease, there is just one small problem:

Squalamine doesn’t cross the blood-brain barrier
(click here to read more on this)

The blood brain barrier is a membrane that covers and protects the brain. It limits what chemicals can enter (or leave) the brain. Squalamine is one chemical that the blood brain barrier won’t let into the brain.

But this is not the end of the world!

Prof Zasloff and colleagues have designed a drug very similar to Squalamine, which they have called MSI-1436 which is currently being tested. And the good news is that it can cross the blood brain barrier (Click here to read more on this). MSI-1436 appears to exhibit potent appetite suppression and anti-diabetic properties when injected in animals. MSI-1436 has been clinically tested (phase 1) for tolerance in diabetes with obesity (Click here to see the details of that trial), but that clinical trial was conducted in 2008-9 and the results are still not available. The company behind the trial, ‘Genaera Corp’, has since been shut down (Click here for more on this), and we are unaware of any follow up clinical work on this drug.

What does it all mean?

Well, the researchers in this study have found a chemical (squalamine) which is able to prevent alpha synuclein from aggregating – which is believed to be one the underlying processes in Parkinson’s disease. This means that we have another experimental therapy to add to the growing arsenal of potential future Parkinson’s disease treatments.

It is important to appreciate, however, that this is the first time this result has been shown and what we need to see now is independent replication of these results. This follow-up work will also need to involve squalamine being tested in a more advanced animal model of Parkinson’s disease (worms are cute and all, but there is only so much data we can get from them!). In addition, if squalamine (or MSI-1436) has a future in treating Parkinson’s disease, we will need to better investigate the weight-loss properties of this chemical as this would not be an ideal side effect for people with Parkinson’s disease.

As this research progresses on squalamine, we’ll report it here.

Watch this space.


UPDATE – 16th May, 2016

Wow! So this is all happening very fast.

Today, Enterin Inc. has just enrolled their first patient in the RASMET study: a Phase 1/2a randomised, controlled, multi-center clinical study evaluating synthetic squalamine in people with PD. The study will enrol 50 patients over a 9-to-12-month period (Click here for the press release).

We’ll continue to watch this space… things appear to be moving very quick here!


The banner for today’s post was sourced from X-ray Mag

An interesting commentary on the interpretation of the Nilotinib trial results

DSK_4634s

“The devil is in the detail”

A frequently used quote and sage words when analysing scientific data, especially clinical trial data.

Nilotinib is a cancer drug from Novartis that has the Parkinson’s community very excited. In October 2015, researchers at Georgetown University announced that a phase 1 open-label clinical study involving 12 people with Parkinson’s had demonstrated some pretty impressive results (click here to read more about this). The results of that first clinical trial have been published (click here to read more on this), but follow up studies have been hampered by study design issues (click here for more on this).

Today a letter to the editor of the Journal of Parkinson’s disease (published in this months issue) was brought to our attention (click here to read the letter). It queries one important aspect of the results from that first Nilotinib clinical trial for Parkinson’s disease.

In the letter, Prof Michael Schwarzschild of Massachusetts General Hospital (Boston) notes that 8 of the 11 subjects in the study had their monoamine oxidase-B (MAO-B) inhibitor treatment withdrawn less than a month after starting the trial. The change of treatment regime was made due to “increased psychosis in the first 2–4 weeks after Nilotinib administration”.


For reasons which we will outline below, a small change like this in a clinical trial could have major implications for the end results.

What are MAO-B inhibitors?

After the chemical dopamine is used by a neuron, it is reabsorbed by the dopamine cell and broken down for disposal. MAO-B is the enzyme that breaks down dopamine.

maoi-inhibitor
Selegiline is an example of a MAO-B inhibitor. Source: KnowMental

As the schematic above illustrates, dopamine is released by dopamine neurons and then binds to a receptor on a neighbouring cell. After this process has occurred, the dopamine detaches and it is reabsorbed by the dopamine neuron via a particular pathway called the dopamine transporter. Back inside the dopamine cell, dopamine is quickly broken down by the enzyme MAO-B into 3,4-Dihydroxyphenylacetic acid (or DOPAC).

Now, by blocking MAO-B, more dopamine is left hanging around inside the cell where it can be recycled and used again. Thus, this blockade increases the level of dopamine in the brain, which helps with alleviating the motor features of Parkinson’s disease. This simple concept has lead to the development of MAO-B inhibitors which are used in the treatment of the condition.

Why is this important to the Nilotinib results?

Dopamine is broken down by MAO-B into DOPAC. DOPAC can be further broken down into Homovanillic acid (HVA), and both DOPAC and HVA are often used in research studies to indicate levels of dopamine activity. Higher levels of both (in theory) should indicate higher levels of dopamine. It is a means of inferring greater dopamine production.

In the published results of the Nilotinib clinical trial, the researchers used increased HVA levels as an indication of greater dopamine production as a result of taking Nilotinib. But Prof Schwarzschild is correct in providing a cautionary warning of over-interpreting this result. You see, by discontinuing the treatment of MAO-B inhibitors shortly after starting the study, one would expect to see a rise in HVA levels regardless of any effect Nilotinib may be having. Without the MAO-B inhibitors, more dopamine will be broken down thus resulting in increased levels of HVA (compared to the baseline measurements at the start of the study).

And this issue is particularly important since HVA measurements taken at the start of the study (before the MAO-B inhibitors were removed) were compared with HVA measurement taken at the end of the study.

Another commentary discussing the Nilotinib results published in July of last year (in the same journal) actually questioned the value of measuring HVA levels, saying that prior studies have suggested that HVA levels can vary greatly between subjects at similar disease stages, and in general do not correlate well with disease progression.

Whether the removal of MAO-B inhibitors alters the overall interpretation of the first clinical study results is a subject for debate. Something interesting did appear to be happening in the participants involved in the first trial (whether this could have been a placebo effect could also be debated). Obviously, as Prof Schwarzschild’s letter indicates, what we really require now is a carefully designed, placebo-controlled, randomised clinical trial to determine if the initial results can be replicated.

And we are still awaiting news regarding a start date for that delayed trial.

NRF2 and Parkinson’s disease

nrf2-effects-on-cells

Over the Christmas festive period an interesting study was published in the journal Proceedings of the National Academy of Sciences (PNAS). It was about a protein called Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) that has some impressive properties that could be good for Parkinson’s disease.

In today’s post we will review the results of the study and discuss what they mean for Parkinson’s disease.


free-radical-n0864buocgw24nkj0fwain64rsquzlav3pxwjiibho

We are going to be talking about free radicals. Source: PRIMOH2

Antioxidants are one of those subjects that is often discussed, but not well understood. So before we review the study that was published last week, let’s first have a look at what we mean when we talk about antioxidants.

What is an antioxidant?

An antioxidant is simply a molecule that prevents the oxidation of other molecules.

OK, but what does that mean?

Well, the cells in your body are made of molecules. Molecules are combinations atoms of one or more elements joined by chemical bonds. Atoms consist of a nucleus, neutrons, protons and electrons.

Oxidation is simply the loss of electrons from a molecule, which in turn destabilises the molecule.

Think of iron rusting. Rust is the oxidation of iron – in the presence of oxygen and water, iron molecules will lose electrons over time. Given enough time, this results in the complete break down of objects made of iron.

1112dp_01rust_bustingrusty_bottom_of_door

Rust, the oxidation of metal. Source: TravelwithKevinandRuth

The exact same thing happens in biology. Molecules in your body go through a similar process of oxidation – losing electrons and becoming unstable. This chemical reaction leads to the production of what we call free radicals, which can then go on to damage cells.

What is a free radical?

A free radical is an unstable molecule – unstable because it is missing electrons. They react quickly with other molecules, trying to capture the needed electron to re-gain stability. Free radicals will literally attack the nearest stable molecule, stealing an electron. This leads to the “attacked” molecule becoming a free radical itself, and thus a chain reaction is started. Inside a living cell this can cause terrible damage, ultimately killing the cell.

Antioxidants are thus the good guys in this situation. They are molecules that neutralize free radicals by donating one of their own electrons. The antioxidant don’t become free radicals by donating an electron because by their very nature they are stable with or without that extra electron.

imgres

How free radicals and antioxidants work. Source: h2miraclewater

Interesting, but what does all this have to do with this new gene Nrf2?

Well, Nrf2 is a ‘transcription factor’ with some interesting properties.

What is a transcription factor?

So you remember your high school science class when some adult at the front of the class was talking about biology 101 – DNA gives rise to RNA, RNA gives rise to protein.

maxresdefault

The basic of biology. Source: Youtube

Ultimately this is a circular cycle, because the protein that is produced using RNA is required at all levels of this process. Some of the protein is required for making RNA from DNA, while other proteins are required for making protein from the RNA instructions.

A transcription factor is a protein that is involved in the process of converting (or transcribing) DNA into RNA.

Now, a transcription factor can be an ‘activator’ of transcription – that is initiating or helping the process of generating RNA from DNA.

6567f50d30ad3ac65aff1e815caf202b3abd7111

An example of a transciptional activator. Source: Khan Academy

Or it can be a repressor of transcription – blocking the machinery (required for generating RNA) from doing it’s work.

6286f2dbd5e353145bef785aecb273d25176ff23

An example of a transciptional repressor. Source: Khan Academy

Nrf2 is an activator of transcription. When it binds to DNA to aids in the production of RNA, which then results in specific proteins being produced.

And this is where Nrf2 gets interesting.

You see, Nrf2 binds to antioxidant response elements (ARE).

What are ARE?

Antioxidant response elements (ARE) are regions of DNA is commonly found in the regulatory region of genes encoding various antioxidant and cytoprotective enzymes.

The regulatory region of genes is the section of DNA where transcription is initiated for each gene. They are pieces of DNA that a transcription factor like Nrf2 binds to and activates the production of RNA.

ARE are particularly interesting because these regions reside in the regulatory regions of genes that encode naturally occurring antioxidant and protective proteins. And given that antioxidants and protective proteins are generally considered a good thing for sick/dying cells, you can see why Nrf2 is an interesting protein to investigate.

By binding to ARE, Nrf2 is directly encouraging the production of naturally occurring antioxidant and protective proteins. And this is why a lot of people are excited by Nrf2 and call it the ‘next big thing’.

So what did the new research study report?

Well, this is where the story gets really interesting.

The researchers in the new study found that Nrf2 has some additional features that may be completely unrelated to the antioxidant properties:

nrf2

Title: Nrf2 mitigates LRRK2- and α-synuclein-induced neurodegeneration by modulating proteostasis.
Authors: Skibinski G, Hwang V, Ando DM, Daub A, Lee AK, Ravisankar A, Modan S, Finucane MM, Shaby BA, Finkbeiner S.
Journal: Proc Natl Acad Sci U S A. 2016 Dec 27. pii: 201522872.
PMID: 28028237

The researchers wanted to determine what effect introducing exaggerated amounts of Nrf2 into cell culture models of Parkinson’s disease would have on the behaviour and survival of the cells. There were two types of cell culture models of Parkinson’s disease used in the study: one produced a lot of the Parkinson’s associated protein alpha synuclein (normal un-mutated) and the other cell culture model involved two mutations in the Lrrk2 gene (we have previously discussed Lrrk2 – click here to read that post).

The researchers had previously demonstrated that both of these cell culture models of Parkinson’s disease exhibited increased levels of cell death when compared with normal cells. In the current study, when the researchers artificially exaggerated the amounts of  Nrf2 in both sets of cell cultures, they found that not only did Nrf2 reduce Lrrk2 and alpha-synuclein toxicity in cell culture, but it also influenced alpha-synuclein protein regulation, by increasing the degradation of the protein. This means that Nrf2 increased the disposal of the unnecessary excess of alpha synuclein.

In addition, Nrf2 also promoted the collection of free-floating mutant Lrrk2 and bundling it up into dense ‘inclusion bodies’ – dense clusters which are similar to the Lewy bodies of Parkinson’s disease but inclusion bodies are not associated with cell death. The scientists concluded that excessive levels of Nrf2 help to make the cells healthier and that this could represent a new target for future therapies of Parkinson’s disease. The researchers acknowledge that the ARE-related features of Nrf2 may be also playing a beneficial role in the cells, but this is the first time the alpha synuclein and Lrrk2 features have been identified.

Sounds great. Are there any catches?

Yes, a very interesting one.

The response of Nrf2 is time-dependent. The researchers found that over stimulation with Nrf2 leads to natural compensation from cells that eventually limits the activity of Nrf2. In other words, too much of a good thing loses it’s affect over time. Biology is one giant balancing act and sometimes when one factor is artificially introduced, cells will compensate regardless of whether it’s a good thing or not.

The researchers suggested that this issue could potentially be over come by periodic use of Nrf2, rather than simply chronic (or continuous) use of the protein. This still needs to be determined, however, in follow up experiments.

What does it all mean?

This new study provides us with new data relating to a protein that has been seen as holding great promise in the treatment of neurodegenerative conditions (not just Parkinson’s disease). The new research, however, demonstrates some interesting characteristic of Nrf2 specific to two Parkinson’s disease related genes.

Nrf2 has been considered a drug target for some time and agents targeting this protein have been patented and are under investigation (Click here to read more on this). We will be keeping an eye out for these compounds and we’ll report here the results of any research being conducted on them.


Interesting side note here:

We have previously discussed the treatments for Parkinson’s disease that were prescribed in India over 2000 years ago (Click here for that post). Outlined in the ancient texts, called the ‘Ayurveda’ (/aɪ.ərˈveɪdə/; Sanskrit for “the science of life” or “Life-knowledge”) was the use of the seeds of Mucuna pruriens in treating conditions of tremor. The seeds of this tropical legume we now know have extremely high levels of L-dopa in them (L-dopa being the standard therapy for Parkinson’s disease in modern medicine).

Here’s the interesting bit:

A second popular Ayurvedic treatment that is popular for Parkinson’s disease is Curcumin.

turmeric

Tumeric. Source: Cerebrum

Curcumin is an active component of turmeric (Curcuma longa), a dietary spice used in Indian cuisine and medicine. Curcumin exhibits antioxidant, anti-inflammatory and anti-cancer properties, crosses the blood-brain barrier and there are numerous studies that indicate neuroprotective properties in various models of neurological disorders.

Curcumin has also been shown to activate Nrf2 (Click here , here and here for more on this).

It has also been shown to prevent the aggregation of alpha synuclein (click here for more on this).

We are always amazed at the curious little connection with ancient remedies that can be found in modern research and medical practice, and we thought we’d share this one here.


EDITORIAL NOTE: The content provided by the Science of Parkinson’s website is for information purposes only. It is provided by research scientists, not medical practitioners. Any actions taken – based on what has been read on the website – are the sole responsibility of the reader. The information provided on this website should under no circumstances be considered medical advice, and any actions taken by readers should firstly be discussed with a qualified healthcare professional.


The banner for today’s post was sourced from NRF2 science

Improving the SoPD blog – any thoughts?

improve-yourself1

It has been a week since we posted our discussion regarding where we think things are going in 2017 in the world of Parkinson’s disease research. Today’s short post is a follow up piece on how we can improve the SoPD blog.

Specifically, we would like to ask for your thoughts as to what particular improvements you would like to this on this blog.


cwk7va-xgaa-vip

PPI in action. Source: Parkinson’s UK

Patient and public involvement (PPI)

PPI is a big deal in the world of Parkinson’s research.

It involves researchers and people affected by Parkinson’s disease (both sufferers and carers/family/friends) work in partnership to plan, design, implement, manage, evaluate and disseminate research. It is a win-win situation for everyone involved as it seeks to achieve a more patient-centric approach to the research.

Parkinson’s UK provides lots of very useful information on PPI (Click here to read more).

Here at SoPD, we see great value in PPI and we would like to embrace it by asking for your feedback on what we are doing here.

It is very easy in science to get very exciting about the details and fail to see the big picture (a ‘not seeing the forest for the trees’ scenario). This situation can make us blind to what the reader of this blog may be looking for. Similarly, we have certain ideas about how this blog is developing and where it could be going which may not be the best way to serve the Parkinson’s community.

So in this post, we will review where things at the SoPD currently stand, and then what future plans are being developed, before we then invite your feedback.

sotu201211

The State of the Union address. Source: Tngop

So lets begin with where we are at present.

The state of the blog:

The blog has been running since the 9th Sept, 2015. We currently have 90 posts dealing with all manner of Parkinson’s disease research-related content. If you are interested in a particular topic, you can use our site map page to search for key words across all of those post.

In addition, we have a menu bar of key topics related to Parkinson’s disease, such as dopamine and tremor. We also have a page of lectures that we would like to expand in the new year.

The post are usually focused around a particular topic, recent research publication, or clinical trial. We try to provide an easy to understand background on the topic before delving into what new discovery or result has been announced. At the end of each post, we try to sum up what it all means for the Parkinson’s community.

For shorter and more regular updates, we also have a twitter account that you can follow.

Future directions:

In this new year, we are planning to:

  • add more pages to our menu bar dealing with key aspects of Parkinson’s disease (such as “what is a Lewy body?”)
  • encourage great involvement and participation in Parkinson’s research
  • put some videos on the site which will explain some of the more commonly asked questions regarding Parkinson’s disease.

There are some other ideas, but these are the ones we are prepared to put on paper and be held to.

And this brings us to your feedback.

maxresdefault

Source: Youtube

What improvements can we make?

We are seeking feedback here – either in the comments section below or by contacting us directly by email – regarding what features or changes you would like to see on this blog.

Specifically:

  • what could we improve or do better that we currently do on the blog?
  • what new features could we add?
  • are there alternative ways of bringing the same information to you that would be better/easier for you to consume?

Any and all thoughts would be greatly appreciated. Please help us to improve the service we are providing.

We look forward to hearing from you.

The team at SoPD


The banner for today’s post was sourced from OnthecontraryKelly