Cytokines and neuro-inflammation in PSP

This is an abstract about research out of the University of Louisville. Here are the highlights from the abstract: “Although little is known about the etiology of progressive supranuclear palsy (PSP), genetic and epigenetic factors, oxidative injury and inflammation are thought to contribute to its development and/or progression. Evidence for activated glia involvement in PSP has raised the possibility that neuroinflammation may contribute to its pathogenesis. These results…[suggest] that these cytokines may contribute to the pathologic process. If so, the use of cytokine-inhibitors and/or other anti-inflammatory agents may be able to slow disease progression in PSP.”

Sorry but I couldn’t find a list of cytokine inhibitors. From spending a few minutes on the web looking into this, it seems that cytokine research is a rapidly evolving area.

Of course “anti-inflammatory agents” includes NSAIDs (nonsteroidal anti-inflammatory drugs). (Ibuprofen is an example of an NSAID.) The authors refer to a trial of NSAIDs in Alzheimer’s Disease in the final sentence of the article: “Although in the case of AD the evidence from anti-inflammatory clinical trials remains controversial, no such trials have been conducted in PSP patients.”

All of the brain tissue utilized for this study came from Mayo Jax. Tissue samples were used from both frozen brains and formalin-fixed brains. Thanks to all those who donate brain tissue of loved ones to Mayo Jax for making research like this possible.

I’ve copied the abstract below.

Robin


Parkinsonism and Related Disorders. 2011 Jul 6. [Epub ahead of print]

Cytokine expression and microglial activation in progressive supranuclear palsy.

Fernández-Botrán R, Ahmed Z, Crespo FA, Gatenbee C, Gonzalez J, Dickson DW, Litvan I.
Department of Pathology and Laboratory Medicine, School of Medicine, University of Louisville, Louisville, KY.

Abstract
Although little is known about the etiology of progressive supranuclear palsy (PSP), genetic and epigenetic factors, oxidative injury and inflammation are thought to contribute to its development and/or progression.

Evidence for activated glia involvement in PSP has raised the possibility that neuroinflammation may contribute to its pathogenesis.

To investigate the correlation between neuroinflammation and PSP, a comparative study was conducted on the patterns of cytokine expression in different regions of the brains of PSP, Alzheimer’s disease (AD) patients and normal controls.

Our results show different patterns of cytokine expression in each disease, with the expression of IL-1beta transcripts being significantly higher in the substantia nigra of PSP than in AD and controls, while AD brains had significantly higher IL-1beta expression in the parietal cortex compared to PSP and controls.

In addition, expression of TGFbeta was significantly higher in the cortical areas (particularly frontal and parietal lobes) of AD compared to PSP and controls.

These results show a disease-specific topographical relationship among the expression of certain cytokines (IL-1beta and TGFbeta), microglial activation and neurodegenerative changes, suggesting that these cytokines may contribute to the pathologic process. If so, the use of cytokine-inhibitors and/or other anti-inflammatory agents may be able to slow disease progression in PSP.

Copyright © 2011 Elsevier Ltd. All rights reserved.

PubMed ID#: 21741294 (see pubmed.gov for this abstract only)

Simulating Alzheimer’s (UK newspaper article)

This post may only be of interest to those dealing with dementia though certainly a similar “simulation” could be created for the non-dementing types of PSP.

In a British newspaper article from last Sunday, there’s a description of a simulation called the “Alzheimer’s Experience.” The company Care UK runs care facilities in Britain. It requires all of its staff to go through the simulation. The one-day simulation “gives staff direct experience of the dramatic effect that dementia and frailty can have on the senses.” The tasks in the simulated experience include:

* “The training starts with a communication task. [The participant] must read words on a piece of white paper written in a fluorescent yellow highlighter pen, which makes them hard to see.”

“Dementia makes it difficult to read whole words…patients cannot make out what they are seeing.”

* “Next, [the participant] is given a newspaper to read. A machine is switched on that emits a din of ‘white noise’ – a fuzzy hum that permeates the atmosphere among sounds of clattering, scraping chairs and doors opening and closing. [The instructor] constantly walks up to [the participant] and asks her endless, random questions.”

“This task simulates what it is like for someone with dementia who may suffer from a constant noise in their head that they cannot shut out, which is a common symptom… Talking, shouting and asking questions further confuses a sufferer – their brain finds it difficult to differentiate between all the different stimuli.”

* “A third task is called Questions And Answers. [The participant] sits in a chair trying to count from one to ten while [the instructor] bombards her with questions as she tries to keep counting.”

“This helps the carer understand-that it takes people with dementia-longer to process information.”

* “The final task, entitled Physical And Sensory Impairment, involves [the participant] wearing headphones emitting white noise, to emulate loss of hearing, and putting on goggles that blur her vision.”

“This simulates a combination of eye-ageing and dementia.”

http://www.dailymail.co.uk/health/artic … ather.html

Now I know how alzheimer’s trapped dad in its cruel grip: Bucks Fizz’s Jay Aston on how dementia devastated her father
By Bonnie Estridge
Daily Mail (UK)
Last updated at 1:41 AM on 26th June 2011

Alzheimer’s accounts for about 60 per cent of the 750,000 British adults affected by dementia.

The disease attacks nerves, brain cells and neurotransmitters – chemicals that carry messages to and from the brain. It is a progressive condition usually associated with old age, but the cause remains unknown. It is estimated that more than a million people will suffer from it by 2021.

As Jay Aston walked down the aisle on her wedding day, she struggled to hold back tears. Her pleasure at seeing her soon-to-be husband, musician Dave Colquhoun, waiting for her at the altar was tinged with a deep sadness for the man who was about to give her away.

Jay’s father, Ted, looked dignified and handsome but he was lost to the grip of Alzheimer’s disease – the most common form of dementia.

‘Not long before my wedding in August 1999, Dad had swallowed disinfectant, tried to stab my mother and told her, my brother Lance and me that he would shoot us and then shoot himself,’ says Jay, 50, who found fame in the now reformed Eighties pop band Bucks Fizz.

‘When he walked me down the aisle, he had no idea what he was doing or why he was there at all. The disease had made him the opposite of the man he had once been, and to see what he had become was my worst nightmare.

I know it was his, too. He always had a horror of mental illness and, because he was so physically fit when he eventually went into a care home, it took years for his body to decline and he suffered a hideous, drawn-out death.’

Ted had been one half of Fifties husband-and-wife variety act Ted and Hilda Durante and was renowned for his quick wit. But in 1995 he started to display behaviour that was unlike his normal self.

‘He kept forgetting his gags on stage – he’d had the sharpest wit of anyone I’d met so it was really quite worrying,’ says Jay, who has a daughter, Josie, seven.

Jay’s mother put these lapses down to age – he was 70 at the time – but Jay disagreed and she and her mother fell out over Ted’s health. As time went on, Ted forgot that he loved opera and stopped listening to records, and he could not recall which band Jay was once a member of. It reached a point where he became a danger to himself and other members of the family. He started to drink heavily and would then forget that he shouldn’t be driving, so Jay reported him to the police.

‘I felt like a Judas,’ she admits. ‘But I had to do something. We tried to keep Dad at home (in Tatsfield, Surrey) with Mum but he would let himself out in the middle of the night and wander down the road. He’d lost all sense of direction and it soon got to the point when it became impossible to keep him at home.’

On Boxing Day 2004, not long after Ted and Hilda’s 52nd wedding anniversary-Ted was admitted to a care home. Jay says: ‘We were all devastated. I used to visit him and as time went by he got angrier and angrier – frustrated that his life involved just sitting in a room all day. Because he was so fit, it took a long time for him to deteriorate physically. Over five years, he went from being a strapping 13st man to a 7st shadow of his former self.’

Ted died of pneumonia in 2009. Today, Jay remains passionate about learning to understand the disease that tore her father’s life apart – and has agreed to take part in a unique training programme run by residential care specialists Care UK, which has 57 homes across Britain. Dubbed The Alzheimer’s Experience, it involves a series of tasks that simulate the sensory experiences of those suffering from dementia.

Everyone from senior executives to cleaning staff is required to take the innovative course, which aims to improve services by giving them a better understanding of what residents go through.

‘With the help of doctors and other dementia specialists, we have developed a practical, hands-on, oneday course that gives staff direct experience of the dramatic effect that dementia and frailty can have on the senses,’ says Maizie Mears-Owen, service design manager at Care UK.

‘When one’s cognitive ability is impaired, everyday activities such as following instructions can be confusing – and even terrifying. As well as memory loss, dementia can affect motor skills, which means walking and dressing become increasingly difficult. Jay is going to get an idea of what her father went through.’ The training starts with a communication task. Jay must read words on a piece of white paper written in a fluorescent yellow highlighter pen, which makes them hard to see.

Jay spends several minutes trying to decipher the words. ‘This is incredibly demanding,’ she says. ‘I could make out only 25 per cent of the words.’

Maizie explains: ‘Dementia makes it difficult to read whole words – because of deterioration in certain parts of the brain, patients cannot make out what they are seeing.’

Next, Jay is given a newspaper to read. A machine is switched on that emits a din of ‘white noise’ – a fuzzy hum that permeates the atmosphere among sounds of clattering, scraping chairs and doors opening and closing. Maizie constantly walks up to Jay and asks her endless, random questions.

‘This task simulates what it is like for someone with dementia who may suffer from a constant noise in their head that they cannot shut out, which is a common symptom,’ says Maizie. ‘Talking, shouting and asking questions further confuses a sufferer – their brain finds it difficult to differentiate between all the different stimuli.’

Jay remarks: ‘Towards the end, Dad was very frustrated at not being able to read a newspaper easily. He found it impossible, complaining about all the distractions. He would become angry and often started shouting.’

A third task is called Questions And Answers. Jay sits in a chair trying to count from one to ten while Maizie bombards her with questions as she tries to keep counting.

This helps the carer understand-that it takes people with dementia-longer to process information. Jay could also relate to this task.

‘Dad would respond to questions but then lose his train of thought,’ she says. ‘This, again, was frustrating for him so he would shout, get a headache or simply shut down and go to sleep.’

The final task, entitled Physical And Sensory Impairment, involves Jay wearing headphones emitting white noise, to emulate loss of hearing, and putting on goggles that blur her vision. This simulates a combination of eye-ageing and dementia.

She also wears thick gloves to take sensation away from her fingers, which have been taped together to simulate the difficulty sufferers have controlling their limbs and digits.

Dried beans are put in Jay’s shoes, making it difficult and painful for her to walk, similar to the difficulties faced by Alzheimer’s patients who have suffered nerve damage.

When asked to stack plastic cups on the table in front of her, Jay knocks them over and finds the task of pouring water from a jug into one of them virtually impossible, as are tasks such as doing up a button on her dress or brushing her hair.

Jay tearfully removes the goggles, gloves and headphones. Composing herself, she says: ‘It’s so upsetting to know what it was like for Dad living so long in this muffled, confusing world. I remember once he was trying to pour a drink and knocked the cup over. His clothes were wet but he couldn’t understand what had happened or why. It was heartbreaking, as he had been so strong.’

But despite the raw emotions that surfaced during the experience, Jay was pleased she had taken part.

‘It seems to me that this is a very good form of basic training, and any project that would help dementia sufferers be better understood has to be a positive, valuable one.

‘I wish I’d had this experience when Dad was still alive because it would have unlocked the secret of why he – and so many other dementia sufferers – undergo a change of personality. I’m also reassured to know that those caring for dementia patients now have such an insight.’

PSP: “what’s new?” – 5 types

PSP folks –
A review article was recently published on what’s new in PSP.  I don’t have access to this full article.  It largely seems to be a summary of research published in 2009 by Williams and Lees regarding the five clinical types of PSP.  The most common type is Richardson’s syndrome.  In the abstract, the first paragraph describes the symptoms of Richardson’s syndrome but doesn’t use that term.
Robin

————————-

Geriatrie et Psychologie Neuropsychiatrie du Vieillissement. 2011 May 1;9(2):191-201.

Progressive supranuclear palsy: what’s new?

Levy R.

Abstract
Progressive supranuclear palsy (PSP) has been described as a clinical syndrome characterized by an impairment of voluntary control of gaze (supranuclear palsy), postural and gait instability, and behavioral and cognitive deficits including a frontal syndrome and psychic retardation.

However, in the recent years, at least four other clinical forms of PSP have been recognized: PSP-Parkinsonism, “pure akinesia with gait freezing”, PSP with cortico-basal syndrome, and PSP with speech apraxia.

PSP-Parkinsonism mimics the signs and symptoms of idiopathic Parkinson’s disease, including a significant reactivity to levodopa.

“Pure akinesia with gait freezing” is characterized by a difficulty of self-initiation of motor programs, usually walking program.

PSP with cortico-basal syndrome mimics cortico-basal degeneration (CBD) in that unilateral or asymmetric limb dystonia and apraxia are prominent signs.

PSP with speech apraxia is an isolated syndrome of progressive anarthria.

All these clinical syndromes are due to brain accumulation of phosphorylated tau protein. The differences in clinical expression within the framework of PSP can be explained by the differences in the topographical distribution of the lesions. PSP is considered as a primary tau disease (“tauopathy”) such as CBD and some forms of fronto-temporal lobar degeneration. At the level of neuropathology, the pattern of tau abnormal inclusions differentiates PSP from other tau diseases, but some overlaps are reported. Moreover, several of the clinical forms of PSP partially or fully overlap with the other tauopathies. As a whole, the emergence of new clinical forms of PSP challenges the nosology of tauopathies and our understanding of these diseases.

PubMed ID#:  21690028  (see pubmed.gov for this abstract only)

Nature Genetics – June 2011 Landmark Study PSP Genetics

Here’s the wonderful abstract from the PSP Genetics Study Group letter in the journal Nature Genetics:

Letter
Identification of common variants influencing risk of the tauopathy progressive supranuclear palsy

Günter U Höglinger, Nadine M Melhem, Dennis W Dickson, Patrick M A Sleiman, Li-San Wang, Lambertus Klei, Rosa Rademakers, Rohan de Silva, Irene Litvan, David E Riley, John C van Swieten, Peter Heutink, Zbigniew K Wszolek, Ryan J Uitti,    Jana Vandrovcova, Howard I Hurtig, Rachel G Gross, Walter Maetzler, Stefano Goldwurm, Eduardo Tolosa, Barbara Borroni, Pau Pastor, PSP Genetics Study Group, Laura B Cantwell, Mi Ryung Han, Allissa Dillman, Marcel P van der Brug, J Raphael Gibbs, Mark R Cookson, Dena G Hernandez, Andrew B Singleton, Matthew J Farrer, Chang-En Yu, Lawrence I Golbe, Tamas Revesz, John Hardy, Andrew J Lees, Bernie Devlin, Hakon Hakonarson, Ulrich Müller & Gerard D Schellenberg

Nature Genetics (2011):10.1038/ng.859
Received 29 November 2010
Accepted 16 May 2011
Published online 19 June 2011

Abstract
Progressive supranuclear palsy (PSP) is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer’s disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP (cases) and 3,247 controls (stage 1) followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the stage 1 SNPs that yielded P <= 10(-3). We found significant previously unidentified signals (P < 5 × 10(-eight)) associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression.  The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component.

The full article is available online at no charge here:

www.ncbi.nlm.nih.gov/pmc/articles/PMC3125476/

Fantastic!

Robin

 

Constant groaning in PSP (case report)

This recently-published letter to the editor in a medical journal article describes “characteristic constant groaning” in late-stage PSP. The authors, members of a top PSP researcher team in the UK, believe that the constant groaning is “often misinterpreted as due to pain.”

They state:

“We have seen this phenomenon in at least 4 patients in the last two years. All of them presented with constant groaning only when they were in the advanced stages having lost ambulation and being confined to a wheelchair (equal to stage V). This phenomenon is very distressing for their caregivers…”

Indeed, over the last 7 years that I’ve been learning about PSP, many, many caregivers report this symptom of constant groaning on the PSP Forum and elsewhere. Sometimes it’s described as growling, moaning, or humming. I have read many guesses over the years as to why those with PSP do this including clearing the throat, warming up the throat before trying to speak, wanting to stay involved in the conversation, expressing a complaint about something, and comforting oneself.

My father (autopsy-confirmed PSP) had what we called the “moanin’ and groanin” symptom but it was NOT limited to late-stage PSP for him. He groaned for the last 18 months or so of his life. Sometimes it was very loud, and I’d ask him to keep it down a bit; he was able to adjust the volume. Or I’d put my hand back and forth over his mouth so that the sound alternated from loud to muffled; that would make Dad laugh and that stopped the moaning for a short while. Sometimes I’d moan along with him, and found it physically very hard to do for as long as he could do it for. For him, it started as a means of expressing a complaint. Later, it turned into something he did seemingly without a purpose. I’d call him the “ole groaner”; that would get a laugh (when he could laugh).

The authors state:

“[The] groaning in PSP can be seen as analogous to other ‘noise-making’ phenomena which have been described in patients with Alzheimer’s disease, vascular dementia and frontotemporal dementia, such as persistent screaming, perseverative vocalization, continuous chattering, muttering, etc., all together characterized as ‘inappropriate vocalization, due to frontal lobe damage or interruption of subcortical circuits’. What makes this groaning so characteristic of PSP is the combination of the characteristic spastic-hypokinetic dysarthria with perseverative vocalization due to frontal disinhibition…”

I’ve only seen it briefly mentioned in one medical journal article a few years ago (also authored by members of the UK team). Now, this is quite a bit of attention given to one little-discussed symptom.

When I posted this case report on the PSP Forum, the moderator Ed Plowman replied as follows with his experience about his late wife Rose:

Groaning and moaning is common in mid- to late-stage PSP. Rarely does it mean the patient is in pain (but go ahead and ask). It MAY be related to the same kind of progressive nerve damage that results in unintended and uncontrollable-by-the-patient laughter or crying in an earlier stage. Often, my late Rose was unaware of the moaning until I called attention to it; that would seem to get her mind focused elsewhere, and it would stop. I stopped making an issue of it except periodically when I would ask if she was in pain or feeling bad, and in time, that phase of the symptoms went away.

Here’s the citation for the case report, if you’d like to look it up:

Parkinsonism and Related Disorders. 2011 May 13. [Epub ahead of print]

Characteristic constant groaning in late stage progressive supranuclear palsy: A case report.

Stamelou M, Rubio-Agusti I, Quinn N, Bhatia K.
Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, United Kingdom; Department of Neurology, Philipps University, Marburg, Germany.

PubMed ID#: 21571571 (see pubmed.gov for this citation only)

Robin