Muscle microRNAs in the cerebrospinal fluid predict clinical response to nusinersen therapy in type II and type III spinal muscular atrophy patients.

BACKGROUND AND PURPOSE: The antisense oligonucleotide nusinersen (Spinraza) regulates splicing of the survival motor neuron 2 (SMN2) messenger RNA to increase SMN protein expression. Nusinersen has improved ventilator-free survival and motor function outcomes in infantile onset forms of spinal muscular atrophy (SMA), treated early in the course of the disease. However, the response in later onset forms of SMA is highly variable and dependent on symptom severity and disease duration at treatment initiation. Therefore, we aimed to identify novel noninvasive biomarkers that could predict the response to nusinersen in type II and III SMA patients. METHODS: Thirty-four SMA patients were included. We applied next generation sequencing to identify microRNAs in the cerebrospinal fluid (CSF) as candidate biomarkers predicting response to nusinersen. Hammersmith Functional Motor Scale Expanded (HFMSE) was conducted at baseline and 6 months after initiation of nusinersen therapy to assess motor function. Patients changing by ≥3 or ≤0 points in the HFMSE total score were considered to be responders or nonresponders, respectively. RESULTS: Lower baseline levels of two muscle microRNAs (miR-206 and miR-133a-3p), alone or in combination, predicted the clinical response to nusinersen after 6 months of therapy. Moreover, miR-206 levels were inversely correlated with the HFMSE score. CONCLUSIONS: Lower miR-206 and miR-133a-3p in the CSF predict more robust clinical response to nusinersen treatment in later onset SMA patients. These novel findings have high clinical relevance for identifying early treatment response to nusinersen in later onset SMA patients and call for testing the ability of miRNAs to predict more sustained long-term benefit.

Intrathecal enzyme replacement for Hurler syndrome: biomarker association with neurocognitive outcomes.

PURPOSE: Abnormalities in cerebrospinal fluid (CSF) have been reported in Hurler syndrome, a fatal neurodegenerative lysosomal disorder. While no biomarker has predicted neurocognitive response to treatment, one of these abnormalities, glycosaminoglycan nonreducing ends (NREs), holds promise to monitor therapeutic efficacy. A trial of intrathecal enzyme replacement therapy (ERT) added to standard treatment enabled tracking of CSF abnormalities, including NREs. We evaluated safety, biomarker response, and neurocognitive correlates of change. METHODS: In addition to intravenous ERT and hematopoietic cell transplantation, patients (N = 24) received intrathecal ERT at four peritransplant time points; CSF was evaluated at each point. Neurocognitive functioning was quantified at baseline, 1 year, and 2 years posttransplant. Changes in CSF biomarkers and neurocognitive function were evaluated for an association. RESULTS: Over treatment, there were significant decreases in CSF opening pressure, biomarkers of disease activity, and markers of inflammation. Percent decrease in NRE from pretreatment to final intrathecal dose posttransplant was positively associated with percent change in neurocognitive score from pretreatment to 2 years posttransplant. CONCLUSION: Intrathecal ERT was safe and, in combination with standard treatment, was associated with reductions in CSF abnormalities. Critically, we report evidence of a link between a biomarker treatment response and neurocognitive outcome in Hurler syndrome.

The use of cerebrospinal fluid biomarkers to measure change in neurodegeneration in Alzheimer's disease clinical trials.

INTRODUCTION: All recent phase 3 trials of potentially disease-modifying therapies for Alzheimer's disease (AD) have so far failed. Potential reasons include enrolling subjects whose disease is too advanced or who do not have AD pathology, or simply incorrect drug targets. The goal of disease-modifying AD trials is to halt the progress of neuronal damage and death and this can be assessed in vivo using cerebrospinal fluid (CSF) biomarkers. Areas covered: The authors conducted a literature search of the use of CSF biomarkers in disease-modifying AD clinical trials using PubMed. The authors show that CSF biomarkers have only sparsely been used as outcome measures, and where they have, only in small subsets of patients. No clinical trials have yet showed any substantial effects on CSF biomarkers of neurodegeneration. Expert commentary: In future trials, the authors advocate that CSF biomarkers be used more extensively to optimize the chance of detecting positive drug effects. This includes the identification of potential AD patients - already in the early prodromal stage - for inclusion, for stratification, as readout i.e. proximity markers for changes in axonal/neurodegeneration between treatment and placebo groups - this also enables proof of principle verification in the discovery/dose finding phase, and for monitoring of side effects.

Exploratory Biomarker Study of the Triple Reuptake Inhibitor SEP-432 Compared to the Dual Reuptake Inhibitor Duloxetine in Healthy Normal Subjects.

INTRODUCTION: SEP-432 is a triple monoamine reuptake inhibitor of norepinephrine (NE), serotonin (5-HT), and dopamine (DA), based on in vitro binding studies. We sought evidence that SEP-432 engages these monoamine systems by measuring concentrations of monoamines and/or their main metabolites in cerebrospinal fluid (CSF) and plasma and comparing results to duloxetine, a dual reuptake inhibitor of NE and 5-HT. METHODS: Eighteen healthy normal subjects received either SEP-432 (300 mg/day), duloxetine (60 mg/day), or placebo for 14 days in-clinic (double blind) with CSF and plasma collections at baseline (single lumbar puncture) and Day 14 (24-h CSF and plasma collection). Concentrations of monoamines and their metabolites, as well as pharmacokinetic concentrations of SEP-432 and metabolite, were quantified by liquid chromatography-tandem mass spectrometry. RESULTS: Compared to placebo in the Day 14 area under the curve 24-h (AUC0-24 h ) analysis, SEP-432 significantly (P < 0.05) decreased the NE metabolite dihydroxyphenylglycol (DHPG) in CSF and plasma, decreased 5-HT in plasma, and did not affect DA metabolites, while duloxetine had significant effects on DHPG and 5-HT. Time-matched baseline to Day 14 biomarker comparisons confirmed these findings. CONCLUSION: CSF monoamine biomarkers confirmed central NET activity for SEP-432 and duloxetine's dual reuptake inhibition.

[The significance of expression of isoforms RARa1 and RARa2 in response to medicinal therapy and in evaluation of total survival of patients with primarily detected multiple myeloma].

Introduction: The RARa is a transcription factor playing important role in such processes as proliferation, differentiation and apoptosis of cells in norm and in tumor. At the same time, it is little known about significance of expression of two major products of transcription of gene RARa - isoforms RARa and RARa - in pathogenesis of solid and non-solid tumors, including multiple myeloma. The actual data testify ambiguity of input made by isoforms RARa and RARa into processes of tumor development and progression of malignant tumors. The results: It was established that higher level of expression of isoform RARa in combination with increased expression of isoform RARß (group 1) statistically reliable associated with lesser decreasing of concentration of Bence Jones protein in urine of patients in the result of applied treatment and, therefore, lesser effectiveness of response to standard treatment according protocol M-2 in comparison with group II which included patients with lesser levels of expression of RARa and RARß (32.8% and 62.8% for groups I and II correspondingly; p=0.037). The analysis of indices of survival of examined patients in groups I and II demonstrated that median of total survival of patients from group I was reliably lower than in patients included into group II (30 and 84 correspondingly; p=0.046). Conclusion: The results of study demonstrate that increased level of expression in the first instance of isoform RARa in combination with hyper-expression of isoform RARß but not RARa can have unfavorable significance in case of evaluation of response to medicinal therapy and prognosis of total survival in patients with multiple melanoma.

APLP1 as a cerebrospinal fluid biomarker for γ-secretase modulator treatment.

INTRODUCTION: Alzheimer's disease brains are characterized by extracellular plaques containing the aggregated amyloid ß42 (Aß42) peptide and intraneuronal tangles containing hyperphosphorylated tau. Aß42 is produced by sequential processing of the amyloid precursor protein (APP) by ß-secretase followed by γ-secretase. Substantial efforts have been put into developing pharmaceuticals preventing the production or increasing the clearance of Aß42. However, treatments inhibiting γ-secretase have proven disappointing due to off-target effects. To circumvent these effects, γ-secretase modulators (GSMs) have been developed, which rather than inhibiting γ-secretase shift its preference into producing less aggregation-prone shorter Aß peptides. Belonging to the same family of proteins as APP, amyloid-like protein 1 (APLP1) is also a substrate for γ-secretase. Herein we investigated whether the GSM E2012 affects APLP1 processing in the central nervous system by measuring APLP1 peptide levels in cerebrospinal fluid (CSF) before and after E2012 treatment in dogs. METHODS: An in-house monoclonal APLP1 antibody, AP1, was produced and utilized for immunopurification of APLP1 from human and dog CSF in a hybrid immuno-affinity mass spectrometric method. Seven dogs received a single dose of 20 or 80 mg/kg of E2012 in a randomized cross-over design and CSF was collected prior to and 4, 8 and 24 hours after dosing. RESULTS: We have identified 14 CSF APLP1 peptides in humans and 12 CSF APLP1 peptides in dogs. Of these, seven were reproducibly detectable in dogs who received E2012. We found a dose-dependent relative increase of the CSF peptides APLP1ß17, 1ß18 and 1ß28 accompanied with a decrease of 1ß25 and 1ß27 in response to E2012 treatment. All peptides reverted to baseline over the time of sample collection. CONCLUSION: We show an in vivo effect of the GSM E2012 on the processing of APLP1 which is measurable in CSF. These data suggest that APLP1 peptides may be used as biomarkers to monitor drug effects of GSMs on γ-secretase processing in clinical trials. However, this requires further investigation in larger cohorts, including studies in man.

Biomarkers of interferon Beta therapy in multiple sclerosis.

Multiple sclerosis (MS) is characterized by episodes of inflammatory damage to myelin and oligodendrocytes in the central nervous system mediated by T, B, and Natural killer lymphocytes of various types, antibody and complement, dendritic cells, macrophages, microglia, and secreted cytokines and chemokines. These relapses cause significant neurologic dysfunction, which is only partially reversible, and eventual secondary progressive neurologic decline frequently occurs. Interferon-beta (IFNß) has been a mainstay of MS treatment for more than 20 years after being proven to reduce relapse frequency and development of new lesions on magnetic resonance imaging. However, patient response is highly variable and the exact mechanisms of action are not fully understood. Breakthrough relapses and secondary progressive neurologic decline remain significant concerns in long-term MS treatment. Biomarkers may help elucidate the beneficial effects of IFNß in MS and possibly guide therapeutic decision making given the variety of different therapies now available with varying mechanisms of action and risks. Various serum and cerebrospinal fluid candidate biomarkers have been described, but none have yet been proven to carry sufficient predictive reliability for routine clinical use.

Biomarkers in amyloid-ß immunotherapy trials in Alzheimer's disease.

Drug candidates directed against amyloid-ß (Aß) are mainstream in Alzheimer's disease (AD) drug development. Active and passive Aß immunotherapy is the principle that has come furthest, both in number and in stage of clinical trials. However, an increasing number of reports on major difficulties in identifying any clinical benefit in phase II-III clinical trials on this type of anti-Aß drug candidates have caused concern among researchers, pharmaceutical companies, and other stakeholders. This has provided critics of the amyloid cascade hypothesis with fire for their arguments that Aß deposition may merely be a bystander, and not the cause, of the disease or that the amyloid hypothesis may only be valid for the familial form of AD. On the other hand, most researchers argue that it is the trial design that will need refinement to allow for identifying a positive clinical effect of anti-Aß drugs. A consensus in the field is that future trials need to be performed in an earlier stage of the disease and that biomarkers are essential to guide and facilitate drug development. In this context, it is reassuring that, in contrast to most brain disorders, research advances in the AD field have led to both imaging (magnetic resonance imaging (MRI) and PET) and cerebrospinal fluid (CSF) biomarkers for the central pathogenic processes of the disease. AD biomarkers will have a central role in future clinical trials to enable early diagnosis, and Aß biomarkers (CSF Aß42 and amyloid PET) may be essential to allow for testing a drug on patients with evidence of brain Aß pathology. Pharmacodynamic Aß and amyloid precursor protein biomarkers will be of use to verify target engagement of a drug candidate in humans, thereby bridging the gap between mechanistic data from transgenic AD models (that may not be relevant to the neuropathology of human AD) and large and expensive phase III trials. Last, downstream biomarker evidence (CSF tau proteins and MRI volumetry) that the drug ameliorates neurodegeneration will, together with beneficial clinical effects on cognition and functioning, be essential for labeling an anti-Aß drug as disease modifying.

Fluid biomarkers in Alzheimer disease.

Research progress has provided detailed understanding of the molecular pathogenesis of Alzheimer disease (AD). This knowledge has been translated into new drug candidates with putative disease-modifying effects, which are now being tested in clinical trials. The promise of effective therapy has created a great need for biomarkers able to detect AD in the predementia phase, because drugs will probably be effective only if neurodegeneration is not too advanced. In this chapter, cerebrospinal fluid (CSF) and plasma biomarkers are reviewed. The core CSF biomarkers total tau (T-tau), phosphorylated tau (P-tau) and the 42 amino acid form of ß-amyloid (Aß42) reflect AD pathology, and have high diagnostic accuracy to diagnose AD with dementia and prodromal AD in mild cognitive impairment cases. The rationale for the use of CSF biomarkers to identify and monitor the mechanism of action of new drug candidates is also outlined in this chapter.

Evaluación de marcadores moleculares asociados con resistencia a gota (Phytophthora infestans L) en papas diploides y tetraploides / Evaluation of molecular markers associated with resistance to late blight (Phytophthora infestans L) in diploid and tetraploid potatoes

La papa, cultivo de importancia a nivel mundial es gravemente afectado por gota, enfermedad ocasionada por el oomycete Phytophthora infestans. Actualmente la forma más efectiva para combatir la enfermedad es mediante el desarrollo de cultivares resistentes al patógeno. Para esto, una estrategia es identificar genes que confieran resistencia al patógeno, para lo cual se buscan marcadores asociados con el carácter de resistencia. En este estudio se evaluaron marcadores moleculares tipo SCAR (Sequence Characterized Amplified Region): CosA, GP179, BA47f2 y Prp1 asociados con resistencia a P. infestans y el gen de resistencia R1, en 22 cultivares tetraploides pertenecientes a la subespecie andigena y cinco especies silvestres. Se evaluó el polimorfismo y se determinó si los alelos polimórficos permitían diferenciar genotipos resistentes de susceptibles. Se comparó el tamaño de los fragmentos obtenidos con los fragmentos esperados asociados con resistencia de acuerdo a reportes. El análisis se realizó considerando presencia/ausencia de los fragmentos: CosA210, CosA250, R11400, R11800, BA47f2500, GP179570, Prp1300, Prp1600, y Prp1900. Los resultados indicaron que en los cultivares tetraploides y silvestres, se presentaron polimorfismos en todos los marcadores evaluados, con excepción del marcador GP179. No se encontró correlación entre el rasgo de resistencia y los alelos. Los resultados de este estudio muestran que hay repuesta diferencial a los marcadores entre las subsp. tuberosum y subsp. Andigena.

Potato is an important worldwide crop seriously affected by late blight disease caused by the oomycete Phytophthora infestans. Currently, the most effective way to control the disease is developing resistant cultivars to the pathogen by identifying genes that confer resistance to the pathogen. For this purpose it is important to find molecular markers associated with the trait. In this study, the SCAR (Sequence Characterized Amplified Region) markers: CosA, GP179, BA47f2 y Prp1, associated with late blight and the resistant gen R1 were evaluated in 22 tetraploid cultivars from subspecie andigena and five wild potato species. Polymorphism was evaluated and it was evaluated if polymorphic alleles allow differentiating resistant from susceptible genotypes. The fragment length for each marker was compared to the allele size reported associated to resistance. The analysis considered the presence/absence of the fragments: CosA210, CosA250, R11400, R11800, BA47f2500, GP179570, Prp1300, Prp1600 and Prp1900. The results indicated that both, tetraploid cultivars and wild potatoes, showed polymorphisms with all these markers, except with the GP179 marker. It was not found correlation between resistance and the presence of specific alleles. Evidence found in this study indicates that results obtained with molecular markers differed between subsp. tuberosum and subsp. andigena.

Biomarkers of disease activity in multiple sclerosis.

As therapeutic options for multiple sclerosis widen, validated biomarkers of clinical disease activity are urgently needed. Reliable biomarkers would assist in choosing initial therapy, monitoring response to therapy, detecting subclinical disease activity, predicting and possibly preventing therapeutic failure, and hopefully improving both short (relapses) and long-term (disability) outcomes. The presence of oligoclonal bands in the cerebrospinal fluid is a well-validated biomarker that is useful in initial diagnosis. Neutralizing antibodies to interferon-beta are also useful in identifying treatment failure and possibly guiding changes in therapy. The discovery of antibodies to aquaporin-4 in patients with neuromyelitis optica delineates patients with a fundamentally different underlying pathophysiology and clinical course who may require alternate therapeutic approaches. While numerous other candidate biomarkers in serum and cerebrospinal fluid have been described, none so far have the validated reliability necessary for widespread clinical use. The availability of multiple genetic and protein microarray technology may assist in identifying more reliable candidate biomarkers or patterns of multiple biomarkers and improve specificity. The heterogeneity of multiple sclerosis may necessitate individualized biomarkers and therapeutic decisions within distinct subsets of patients.

Identification of non-small-cell lung cancer with activating EGFR mutations in malignant effusion and cerebrospinal fluid: rapid and sensitive detection of exon 19 deletion E746-A750 and exon 21 L858R mutation by immunocytochemistry.

BACKGROUND: Recently, we have reported that EGFR mutation-specific antibodies performed well in immunohistochemical analysis, with good sensitivity. We investigated whether this method could detect non-small-cell lung cancer (NSCLC) carrying EGFR mutations in malignant effusions and cerebrospinal fluid (CSF), comparable to the peptide nucleic acid-locked nucleic acid (PNA-LNA) PCR clamp assay. Furthermore, we compared activating EGFR mutations between primary and recurrent NSCLC. PATIENTS AND METHODS: Twenty-four patients with NSCLC effusions and CSF were examined by immunocytochemistry using antibodies specific for the E746-A750 deletion mutation in exon 19 and the L858R point mutation in exon 21. The PNA-LNA PCR clamp assay was used to detect the E746-A750 deletion at exon 19, L858R mutation at exon 21, and T790M mutation at exon 20. RESULTS: We were able to identify EGFR mutations in NSCLC effusion and CSF with a sensitivity of 100% (5/5) using the anti-delE746-A750 antibody and 100% (8/8) using the anti-L858R antibody. Furthermore, in samples without these EGFR mutations, immunocytochemistry with the two specific antibodies identified 91% (10/11) as negative for both the deletion and the point mutations in EGFR. Activating EGFR mutations decreased in recurrent NSCLC compared with primary NSCLC, and the T790M mutation was detected in recurrent NSCLC of patients receiving gefitinib treatment. CONCLUSIONS: Identification of EGFR mutations is important for patients with primary and recurrent NSCLC. Rapid and sensitive immunocytochemistry using mutation-specific antibodies to detect EGFR mutations will be useful for diagnosing responsiveness to EGFR-targeted drugs.