Disease mechanisms: 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.

Several sessions at the Symposium focused on how impairments in key neuronal structures in MND contribute to the development and progression of the disease, and how these could be targeted with therapeutics.

Prof Spires-Jones (C16) opened session 4A with a discussion of the role of synapses in neurodegeneration. Synapse dysfunction and loss is seen in many neurological diseases, including MND, Alzheimer’s disease and Dementia with Lewy bodies. The commonality of synapse loss across these diseases makes it a key therapeutic target, and in addition, most neurological drugs work at the level of synapses, making them a very ‘druggable’ target. Prof Spires-Jones summarised data from her team and others that showed that in MND, synapse degeneration in the frontal cortex is associated with cognitive decline, and damaging TDP-43 protein is found in synapses. Targeting these pathways could be beneficial to prevent or treat MND.

We also heard an interesting talk from Prof Schiavo in session 5A (C29) on the use of axonal transport as a therapeutic target. Deficits in axonal transport are found in many neurological diseases, including MND.  These deficits appear before/at disease onset and are likely to be important in the development of MND. Schiavo talked us through data that showed that the p38 MAPK signalling cascade, which is important for axonal transport, is increased in the SOD1 mouse model of MND, and that long-term treatment with a p38 MAPK inhibitor partially restores physiological function in MND neurones in vitro and in vivo. Another example showed that inhibition of the insulin-like growth factor-1 receptor (IGF1R) (which is overexpressed in MND patients) restores axonal retrograde transport in a SOD1 mouse in vivo, providing further evidence of the possible beneficial effects of targeting key pathways linked to axonal transport. The take-home message was that axonal impairments are reversible and can be modulated by small molecule inhibitors.


Find out more about the topics discussed in Glasgow on our Periodic table of Symposium at www.mndassociation.org/symplive.

Cognition and FTD: Highlights from Glasgow

Written by Rachel Boothman and Kaye Stevens

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.

Exploration into cognition and frontotemporal dementia with MND/ALS continues to attract attention. At the Symposium in Glasgow 2018, we heard of several studies adding to the growing knowledge bank in this field.

A history of other mental health conditions or psychiatric disorders within the family, or for the individual, indicates a correlation with MND/FTD. There seems to be a link between this increased history and a risk of apathy. Early screening is recommended where these histories exist. This can help prepare families and enable early discussions with the person diagnosed with MND, so they can make decisions that may be important to them in the future (C41) C McHutchison.

We are all subject to apathy at times, where we lack motivation to accomplish our goals. However, where cognitive change is involved this can be more marked. Using a five minute questionnaire based on the Dimensional Apathy Scale (DAS), with patients and their care givers, research has found that up to 50% of people with MND/ALS experience apathy throughout the progression of the disease (C53) R Radakovic. Initiation apathy is most typical which makes it hard to accept new things, such as support from an external care worker. This can impact on burden for care givers and quality of life for both patient and care giver. External stimulation can help, so finding out what motivates the person enables activity and therapy to be customised to individual need. This is consistent with sessions at the Allied Professionals Forum which highlighted the use of music therapy and art therapy (Alisa Apreleva, Vivianna Faierman). Also, volunteers working with people who have cognitive change to stimulate interest (Marjolein Cleaver).

With cognitive change there is a greater burden on care givers than with physical demands of care support alone. Early screening and recognition of signs may help to prepare and improve the support given to carers, for example, metabolic changes and overeating indicate the potential for cognitive change. Also, making unexpected decisions about finance, wills or end of life planning that conflict greatly with previous views. Those with the gene C9orf72 may be more predisposed towards frontotemporal dementia and the MND/FTD combination is more likely to have a genetic cause (C64) J Hodges.

People with cognitive change are more likely to drop out of studies and trials. When looking at why this attrition occurs, factors common to cognitive or behavioural change became apparent, such as advancing disease stage, age of onset, fewer years of education and the presence of the genetic mutation C9orf72 (C65) C Crockford. There was a recommendation that cognitive assessment should take place during diagnosis, be monitored throughout the disease course and featured as standard in any further work on defining the stages of MND.

Typically, there isn’t a great deal of emphasis on memory decline in MND. However, a study has shown that clinicians should pay attention to memory function in older patients with cognitive impairment where episodic memory deficits may be a notable feature (C66) J Machts. Those intact at the start are unlikely to show deficits, whereas those already impaired at the start are more likely to develop deficits in, as yet unaffected areas.

If there is a past family or personal history of mental disorder or alcohol abuse, men with MND/FTD are more likely to develop psychosis. This psychosis should possibly be considered as a distinct behavioural subtype, which appears to be made up predominantly of males with the genetic mutation C9orf72 and FTD. Surprisingly, survival in this subtype seems to be prolonged. There needs to be prompt referral to psychiatric services and this form can be very difficult for carers to manage (C67) R Ahmed.

All presentations in this section indicate the need for early screening to prepare families, relieve care giver burden through better support and enable opportunities for decision making before impairment progresses.


Find out more about the topics discussed in Glasgow on our Periodic table of Symposium at www.mndassociation.org/symplive.

What’s the story with CuATSM

There has recently been a flood of news stories on the outcomes of the Australian Phase 1 clinical trial investigating Copper ATSM (CuATSM) which is a small man-made compound that can selectively deliver copper to cells. The results were first presented at our International Symposium in Glasgow back in December.

MND is a terrible disease and anyone affected by it is looking for good news. We really hope that CuATSM will provide a new treatment for MND that is going to have a positive effect on people’s disease progression.

However, CuATSM is not yet at a stage where a clinician can prescribe it as a treatment. Drug development is a long journey, where any drug has to pass important rigorous checks before approval as a medicine. This trial is an important ‘first’ in the drug development process.

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Tissue biomarkers: 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.

Around the globe, teams are working to find tissue biomarkers for MND and there some promising candidates coming through, some of which were explored at session 8C of the Symposium: Tissue Biomarkers.

We first heard from Rebekah Ahmed (C83), who presented her data on possible neuroendocrine and metabolic biomarkers. Ahmed and her team analysed several proteins related to these systems in the blood of 127 people with either MND or MND with FTD and compared them to controls. The Neuropeptide Y protein (NPY), which is related to eating habits and food intake, was found to be higher in people with MND and MND-FTD, and lower in people with FTD, shining the light on a possible biomarker. All patients also had an increase in leptin and insulin levels, highlighting the need to examine how these neuroendocrine changes affect underlying disease pathology.Read More »

Psychological and emotional wellbeing: 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.

Written by Kaye Stevens and Rachel Boothman

At the 2018 International Symposium on MND in Glasgow, it was positive to see an increase in the number of studies about the psychological and emotional impact of MND/ALS. Read about our highlights below.

From the expected to the unexpected, such as studies which considered the effect of gut health on brain and mood.  (C2) J Cryan – As stress and other factors such as medications can affect gut bacteria, there is a need to maintain a healthy microbiome. This led to a recommendation for sharing refined human poo. Coming your way soon could be ‘Crapsules’ and supplements such as ‘Poopulate’.

(C40) Jane Parkin Kullmann – In other work on stress, researchers in Australia found that stress is not necessarily a risk factor in the development of MND/ALS, indeed it appears that people with the disease may actually be more resilient. Further study is ongoing to determine whether this might indicate a genetic difference.Read More »

Technology and MND: 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.

Where to start on a subject as wide and varied as technology and MND?

Indeed, this problem is not just limited to a simple blog post, it is a challenge for us as an MND charity faced with a proliferation of potentially beneficial technological developments in smartphones, wheelchairs, and exoskeletons to name but a few.

Fortunately, there is a fundamental question that can help us make sense of it all and it is a question that stems from our Association values – What does this mean for people with MND? I’ll be trying to answer this question as part of my summary of technology talks from our 29th International Symposium.

Much of the content that was presented related to the use of technology in clinical trials, so let’s start by considering clinical trials and what we want from them:

  • We want them to be efficient and report results quickly – this means they will be cheaper, so we can do more of them and secure a cure or effective treatment for MND more quickly.
  • We also want the trials to be reliable and give accurate results whilst allowing as much patient participation as possible.
  • Above all, we want trials to translate into tangible change such as clinical developments that improve quality of life or the introduction of an effective treatment for MND.

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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 »

It’s not just about the neurones

Long before the latest wave of cellular and molecular biology advances started to give us new information on what was going on at the cellular level in MND, some doctors had observed that if the disease started in one particular part of the body, it would be neighbouring parts that became affected next.  This suggested that the disease usually starts in a single part of the brain or spinal cord before spreading further, like ripples in a pond.

How this happens is not well understood. It is likely that there are a number of processes going on, but they can broadly be divided into two theories. One of these is that damaged proteins can leak out of sick neurons and ‘infect’ their neighbours – a subject we have discussed at previous international Symposia.Read More »

Catch up on Symposium…focus on causes and treatments

Following on from our previous catch-up blog on clinical management talks presented at the Symposium, here is a continuation that looks at talks focusing on treatment therapies and causes of MND.

RNA Binding & Transport

RNA is the lesser-known ‘cousin’ of DNA – it contains copies of genetic instructions sent out from the nucleus – the ‘control hub’ of every cell. This RNA is carried out of the nucleus by lots of different proteins, including the RNA-binding proteins TDP-43 and FUS, which act as ‘couriers’ dropping off their RNA at the right part of the cell and then returning to the nucleus for the next package.

These binding proteins both play an important role in motor neurone health. In motor neurones affected by MND, the TDP-43 and FUS seem unable to make their way back to the nucleus so they form clumps in other parts of the neurone. How and why this happens is not really understood and several presentations on the first day of the Symposium provided insight into what might be going wrong.  Dr Brian Dickie, Director of Research Development at the MND Association, summarises these presentations in his blog Libraries, Doormen and Harry Potter. You can also hear Brian talk about RNA proteins on the Symposium website.Read More »