Kennedy’s Disease: focus on muscle damage reveals key biomarker

Findings from the largest biomarker study of people with Kennedy’s Disease, published in the journal Neurology, found a predictive biomarker to help in differential diagnosis and tracking clinical progression. Led by Dr Pietro Fratta from University College London, the research team highlighted the importance of markers of muscle mass rather than neuronal damage in Kennedy’s Disease, differentiating it from the slightly more common motor neurone disease (MND).

Kennedy’s Disease, also known as Spinal and Bulbar Muscular Atrophy (SBMA), is a rare genetic condition that leads to progressive weakening and wasting of muscles, particularly affecting the limbs and bulbar region. Caused by a mistake on the AR (androgen receptor) gene (positioned on the X chromosome), this condition mainly affects males, with a 50% chance of receiving the affected gene from their mothers (women can only be carriers of the genetic mistake without developing the disease).

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Clinical trials: Highlights from Glasgow

This blog is part of the ‘Highlights from Glasgow’ collection of articles, where you can read about the content of some of the talks and posters presented at the 29th International Symposium on ALS/MND.

In the Clinical trials and trial design (4B) session we heard from two speakers looking at ways to improve current design of clinical trials. In his plenary talk, Mahesh Parmar (C20) provided his perspective on the necessity of changes from his experience working on cancer trials, highlighting that any efforts to improve clinical trials should be focused on Phase 3 where the most money and time is spent. One solution that stuck with a lot of clinicians attending Prof Parmar’s talk was the design used in the STAMPEDE trial, a large clinical trial assessing effectiveness of new treatments for people affected by prostate cancer, which has been running since 2005. The innovation of this approach is the ongoing protocol that allows to test multiple treatments within the same established clinical trial, allowing new drug candidates to be tested (relatively) straight away, avoiding the creation of a brand new clinical trial. This design improves efficacy of testing new treatments, systematic approach to testing, and access to a large pool of participants who could take part in multiple treatment trials over time.

Brian Dickie, the Director of Research Development at the MND Association said: “Prof Parmar’s presentation generated a lot of interest amongst clinicians who are regularly involved in MND trials and there was a strong feeling that this is the direction that we need to be taking with MND as it could increase the efficiency and reduce the cost. That said, it will take a while to put the building blocks in place and we certainly wouldn’t want to hold up trials that are already in advances stages of planning, so I would expect to see a gradual introduction of changes to trials design over the coming years.”

You can learn more about the multi-arm multi-stage trial design from Prof Parmar here.

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Lifestyle & environment: Highlights from Glasgow

This blog is part of the ‘Highlights from Glasgow’ collection of articles, where you can read about the content of some of the talks and posters presented at the 29th International Symposium on ALS/MND.

In the Epidemiology session (5C), several talks focused on the risk associated with various lifetime events, and the demographics of people who develop MND categorised by onset at various body regions. Susan Peters (C37) and her colleagues studied a group of 1,500 people with MND and 3,000 control participants, and found that people who had suffered head trauma after the age of 55 had an increased risk of developing the disease compared to those without this type trauma. They further found reduced risk in people currently/recently taking antihypertensive and cholesterol-lowering medication, but this risk was significantly increased in people who were taking these medications earlier in life. These findings now need to be explored further to investigate the underlying mechanisms that would explain these differences.Read More »

MND and the mind – who is affected?

Motor Neurone Disease (MND), as the name suggests, is known as a disease of motor neurons, a specific type of neurons that co-ordinate our voluntary movement, leading to loss of the ability to move, speak and breathe. And perhaps because the main focus often falls on the rapidly-progressing physical symptoms and their management, the way MND affects the mind has often be overlooked.

brain networkMost literature on MND states that certain behavioural and cognitive (thinking) problems affect up to 50% people with MND, out of which 15% have a co-occurring diagnosis of frontotemporal dementia (FTD). Adding to this, a recent paper by Dr Christopher Crockford and colleagues, published in the journal Neurology, found that up to 80% of people living with MND will have some form of cognitive or behavioural impairment by the final stage of their disease (or in other words, only 20% will have an intact cognitive and behavioural processing).Read More »

Physical activity and the odds of developing MND

Physical activity has always been at the forefront of factors associated with MND, but studies investigating its effect have often been conflicting. The reason why we might see contrasting results is often due to different cohorts and numbers of people included in the study, the method by which the data was collected, or the types of questions asked and the way they were presented. Increased number of studies on the same topic might then improve the way these are conducted in the future and provide more reliable conclusions.

The most recent multi-centre study that included over 1,500 people with MND and nearly 3,000 control participants was conducted by the Euro-MOTOR consortium under the leadership of Prof Leonard van den Berg. Today (24 April), the group published a paper on their findings in the Journal of Neurology, Neurosurgery and Psychiatry . The study collected data using thorough questionnaires, presented to Dutch, Irish and Italian participants either face-to-face or on paper, asking about their exposure to smoking, alcohol, and the type and amount of physical activity throughout their lifetime – both occupational and leisure. A score was then assigned to each person based on the amount of energy expenditure each activity requires – this is called metabolic equivalent of task (MET).Read More »

Stuck in FUS – the story of arginines, MND and FTD

In recent news, a number of press releases highlighted a paper published in the journal Cell, in which scientists, under the leadership of the University of Toronto’s Professor Peter St George-Hyslop, and in collaboration with University of Cambridge, described the process of how the FUS protein leads to the development of motor neurone disease (MND) and frontotemporal dementia (FTD).

MND and FTD – what is the connection?

We know that there is a link between MND and FTD, which in most part is caused by a mutation in the C9ORF72 gene, causing familial MND in around 35% cases and FTD in 25% of cases. Mistakes in the gene disrupt normal processes leading to toxic accumulation of TDP-43 protein in the neurons, and their subsequent death. There is however another protein toxic to neurons which results in the development of MND and FTD – the one that makes it slightly easier for us science writers to come up with witty titles: FUS (see one of our previous articles ‘What’s the FUS all about’).Read More »

Lessons learnt in the past year…update on clinical trials

Looking for a treatment for MND is the ultimate goal of the whole MND community. Unfortunately, as MND is a very complicated disease, it is not as easy as it may sound. Setting aside the sheer cost of running trials, researchers have to look at all the possible causes of MND (the genes, lifestyle and environment) and then target these with specific compounds and hoping that this strategy won’t be halted by a different biological process. This is made even harder by the large number of possible combinations of these causative factors and the many different ways these can interact.

Thankfully, lots of research groups across the world are doing their best to tackle the adverse disease mechanisms, which is why we heard lots of results of early as well as late stage clinical trials, new strategies to design better treatments in the future, and lessons learnt from previous studies.

While there was much more to hear and read at the Symposium, here we summarise the Clinical trials session (4B), where five presenters reported results and analyses of the treatments they have been investigating.Read More »

‘There is an app for that’ – the wonders of technology in ALS

At the end of a very busy Day 2 of the Symposium, I sat down with my colleagues for a quick chat. After a while, one of them, who has been with the Association since 1995 told us how someone once asked him: ‘So if you look at the last 20 years, how has the world progressed to know more about MND, since there is still no cure to halt it?’. ‘Technology!’, he replied without hesitation. (Alright, he is a tech guy by occupation, so his opinion might be a bit biased, but he still proves the point I am trying to make).

Technology in the world of research has progressed incredibly far. From the ability to sequence the whole genome of a person in a fraction of the time (and price) that we were able to do a decade ago, to using delicate electrodes and sensors to explore what is happening inside our bodies.Read More »

It’s that time of the year again… #alssymp

It was only one week after the 27th International Symposium on ALS/MND in Dublin had ended when we started the next stage of planning for Boston 2017. Now a year has passed and we are here again, waiting to learn about the exciting research that is happening throughout the world. But before we start talking science to you, I thought I would give you a whistle-stop tour of what it takes to organise the Symposium.

It all starts with a selection of a venue at least three years prior the event. This has to tick a number of boxes, including appropriate number and size of rooms for platform and poster presentations, a place for exhibitors, lunch, ease of access both inside the venue as well as outside with respect to the location from transport facilities and so on. A number of site visits are organised to ensure that we are familiar with the venue so that we can plan the location of the platform sessions, locations for exhibitors, lunch, meetings, and networking. And then the year of the event comes…Read More »

Tirasemtiv not found effective for treatment of MND

In their official press release published on 21 November 2017, Cytokinetics Inc. announced that they will not be continuing work on tirasemtiv after disappointing results in the latest Phase 3 clinical trial. The trial, known under the acronym ‘VITALITY-ALS’, tested whether the drug has a beneficial effect on the breathing function and muscle strength of people with MND. This is very unfortunate news for everyone affected by the disease, however, Cytokinetics are already testing another compound with the hope that this will be more effective and better tolerated than tirasemtiv.

Tirasemtiv is a drug that aims to improve quality of life of people living with MND by increasing strength of their skeletal muscles (controlling body motion and posture) and therefore postponing muscle fatigue. It compensates for the missing nerve signal from a motor neurone to a muscle that instructs it to contract. Tirasemtiv activates a protein called troponin by increasing its sensitivity to calcium, which is crucial for muscle contraction.Read More »