Spinocerebellar ataxia type 3/Machado-Joseph disease starting before adolescence.

Onset of Machado-Joseph disease (SCA3/MJD) before adolescence has been rarely reported. This study aims to describe a cohort of SCA3/MJD with onset before 12 years of age, comparing their disease progression with the progression observed in patients with usual disease onset. We identified all cases from our cohort whose onset was before adolescence. After consent, patients were examined with clinical scales Scale for the Assessment and Rating of Ataxia (SARA) and Neurological Examination Score for Spinocerebellar Ataxia (NESSCA). Gender, age, age at onset, disease duration, CAG expanded repeats, transmitting parent, and anticipation of cases with infantile and adult onset were studied. Progression of NESSCA and SARA scores was estimated through a mixed model, and was compared with a historical group with onset after adolescence. Between 2000 and 2014, 461 symptomatic individuals from our region were diagnosed as SCA3/MJD. Onset of eight cases (2.2%), all heterozygotes, was before adolescence: seven were females (p = 0.054). CAG expanded repeats--75 ± 3 versus 84 ± 4--and anticipations--7 ± 9.7 versus 14.4 ± 7.2 years--were different between early childhood and adult onset groups (p < 0.03). The median survival of early childhood onset group was 23 years of age. The annual progression of SARA--2.3 and 0.6 points/year (p = 0.001)--and NESSCA--2.04 and 0.88 points/year (p = 0.043)--was faster in childhood than in adult onset group. Onset of SCA3/MJD before adolescence was related to larger expanded CAG repeats in heterozygosis; females seemed to be at higher risk. Disease progression was faster than in SCA3/MJD starting after 12 years.

Cytokines in Machado Joseph Disease/Spinocerebellar Ataxia 3.

The aim of the present study is to describe the serum concentrations of a broad spectrum of cytokines in symptomatic and asymptomatic carriers of Machado Joseph disease (SCA3/MJD) CAG expansions. Molecularly confirmed carriers and controls were studied. Age at onset, disease duration, and clinical scales Scale for the Assessment and Rating of Ataxia (SARA), Neurological Examination Score for Spinocerebellar Ataxias (NESSCA), SCA Functional Index (SCAFI), and Composite Cerebellar Functional Score (CCFS) were obtained from the symptomatic carriers. Serum was obtained from all individuals and a cytokine panel "consisted of" eotaxin, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-α, IFN-γ, interleukin (IL)-1ß, IL-1RA, IL-2, IL-2R, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, interferon gamma-induced protein (IP)-10, monocyte chemoattractant protein (MCP)-1, monokine induced by gamma interferon (MIG), macrophage inflammatory protein (MIP)-a, MIP-b, regulated on activation, normal T cell expressed and secreted (RANTES) and tumor necrosis factor (TNF)-α was analyzed. In a subgroup of symptomatic carriers, the cytokine panel was repeated after 360 days. Cytokine distribution among groups was studied by discriminant analysis; changes in serum levels after 360 days were studied by generalized estimation equation. Sixty-six symptomatic carriers, 13 asymptomatic carriers, and 43 controls were studied. No differences in cytokine patterns were found between controls and carriers of the CAG expansions or between controls and symptomatic carriers only. In contrast, eotaxin concentrations were significantly higher in asymptomatic than in symptomatic carriers or in controls (p = 0.001, ANCOVA). Eotaxin did not correlate with age, disease duration, CAG expansion, NESSCA score, and SARA score. Among symptomatic carriers, eotaxin dropped after 360 days (p = 0.039, GEE). SCA3/MJD patients presented a benign pattern of serum cytokines. In contrast, levels of eotaxin, a peptide secreted by astrocytes, were elevated in the asymptomatic carriers, suggesting that a specific response of these cells can be related to symptom progression, in SCA3/MJD.

Progression rate of myelopathy in X-linked adrenoleukodystrophy heterozygotes.

X-linked adrenoleukodystrophy heterozygote women can present adult onset myeloneuropathy and little is known about its natural history. We aimed to describe the progression rate of the neurological impairment in the prospective follow-up of our cohort and to look for prognostic factors. The neurological scales Japanese Orthopaedic Association (JOA) and Severity Score System for Progressive Myelopathy (SSPROM) were applied at baseline in 29 symptomatic carriers and in follow-up visits. Age at onset, disease duration, X inactivation pattern, determination of the allele expressed, plasma levels of the very long chain fatty acids and of the neuron-specific enolase, and somato-sensory evoked potentials, were taken at baseline. The slope of the linear regression of both JOA and SSPROM versus disease duration since the first symptom was estimated using mixed modeling. JOA and SSPROM decreased 0.42 and 1.87 points per year, respectively (p < 0.001). None of the parameters under study influenced these rates. We estimated that the number of carriers per arm needed in a future 12 month trial with 80% power and a 50% reduction in disease progression would be 225 women for JOA and 750 for SSPROM. The progression rates of the studied neurological scales were small, did not depend on any modifier factor known, and reflected the characteristically slow worsening of symptoms in X-ALD heterozygotes. Better biomarkers are still necessary for future studies.

Identificação de padrões alimentares por regressão por redução de posto usando o programa SAS / Identification of dietary patterns with reduced rank regression using SAS software

Introdução: a regressão por redução de posto (RRR) é uma técnica que vem sendo empregada na epidemiologia nutricional desde 2004. O objetivo dela é encontrar padrões alimentares associados a algum desfecho. Assim, ela é considerada uma técnica que combina informações a priori e a posteriori. A informação a priori é um conhecimento prévio da associação entre as variáveis intermediárias (biomarcadores, nutrientes) e o desfecho (doença), e a posteriori é a combinação entre as variáveis intermediárias e o consumo alimentar (variáveis preditoras). A RRR tenta explicar o máximo possível da variação das variáveis intermediárias através das variáveis preditoras. Objetivos: fornecer uma breve revisão teórica da técnica e descrever as rotinas computacionais em SAS. Métodos: análise ilustrativa utilizando-se dados do estudo “Condições de saúde das mulheres: estudo de base populacional na região do Vale do Rio dos Sinos”. Foram utilizadas como variáveis intermediárias o consumo dos nutrientes sódio, potássio e gordura saturada; as variáveis preditoras foram a frequência de consumo de 70 tipos de alimentos. Conclusão: a RRR é uma poderosa ferramenta para detectar padrões alimentares que podem estar associados a alguma doença de interesse

Background: the reduced rank regression (RRR) is a technique that has been used in nutritional epidemiology since 2004. Its goal is to find food patterns associated with a particular outcome. Thus, it is considered a technique which combines prior and posterior information. The prior information consists of a previous knowledge on the association between intermediate variables (biomarkers, nutrients) and outcome (disease). The posterior information consists of the combination between intermediate variables and food consumption (predictor variable). Aims: to provide a brief theoretical review of the technique and to describe the computational routines in SAS software. Methods: An illustrative analysis using data from the study “Health conditions of women: a population-based study in the Vale do Rio dos Sinos” The intermediate variables were the consumption of the nutrients sodium, potassium, and saturated fat and the predictor variables were the frequencies of consumption of 70 foods. Conclusion: The RRR is a powerful technique to detect food patterns that could be associated with a particular disease of interest