USC Eye Institute researcher part of team to discover Parkinson's drug actually delays or prevents leading cause of blindness in seniors - age-related macular degeneration (AMD)

- Initial research findings confirmed through larger data set of 87 million patients

- Results support Precision Medicine research to find new interventions for older drugs and harness power of electronic medical records (EMRs) to test for drug interactions

LOS ANGELES, Dec. 3, 2015 

Researchers at six of the nation's top ophthalmology institutions, including the University of Southern California (USC) Eye Institute, have discovered that a drug intervention commonly used for Parkinson's disease may also significantly delay or prevent age-related macular degeneration – the leading cause of blindness in the U.S, according to the National Eye Institute (NEI). 

Research experts, including Andrew Moshfeghi, MD, MBA, clinical trials director at the USC Eye Institute, along with the Marshfield Clinic, University of Arizona, Medical College of Wisconsin, the University of Miami and Essentia Health found that patients who were administered the drug L-DOPA to treat Parkinson's disease, Restless Leg Syndrome (RLS) and other movement disorders, were significantly less likely to develop age-related macular degeneration or developed it years later – up to eight years later – than those patients who were not taking the drug.

"The research is significant because it points to a possible association between L-DOPA and AMD risk that may also result in L-DOPA use leading to a later onset of AMD diagnosis," said Dr. Moshfeghi. "The hope is that this discovery may mean L-DOPA may play a protective role for AMD risk—the data also gives us new insights into potential treatment targets for this complex disease." Future clinical studies will have to validate this preliminary finding.

According to the American Academy of Ophthalmology (AAO), 2.1 million Americans over age 50 have late-stage AMD and 9.1 million have early stage AMD. In addition to discovering a potential new drug therapy for AMD, researchers also illustrated the potential and power of Precision Medicine research using electronic medical records (EMRs) of large numbers of patients to test unexpected drug interactions and find new uses for old drugs.

After basic research on mice, the researchers examined the health records of 37,000 AMD patients or those taking L-DOPA for movement disorders at the Marshfield Clinic looking for racial disparities in AMD. The provocative results showed AMD patients who were also taking L-DOPA received their eye diagnosis eight years later than those who had AMD but were not on the drug. 

These results were then confirmed in a much larger data set of 87 million patients nationwide where similar results were observed.

The discovery began with basic research using albino mouse models because albinos have profound vision loss and changes in the structure of the eye, especially the retina, and specifically the macula, the area of the retina that is associated with best vision and lost in AMD. 

The pigmented retina epithelium is critical support layer in the retina that fosters macula development and keeps it healthy through DOPA signaling through its receptor. DOPA is made in pigmented tissues and it has been known for a long time that lower risk for AMD is associated with darker pigmentation with African Americans having a five-fold less risk for AMD than Caucasians. The researchers postulated that signaling through the DOPA receptor may underlie racial disparities in AMD incidence.

Researchers first examined the health records of 37,000 patients at the Marshfield Clinic for individuals with AMD, or those taking L-DOPA, or those with both AMD and taking L-DOPA.  As seen in national statistics, the average age at which individuals are given L-DOPA is 67; the average age of those diagnosed with AMD is 71.  The expectation was that for patients with both an AMD diagnosis and an L-DOPA prescription, most should have gotten L-DOPA before their AMD diagnosis. 

Instead researchers found the opposite pattern. In those few who received L-DOPA before being diagnosed with AMD, their AMD was diagnosed eight years later than those not taking L-DOPA.  These provocative results were then confirmed in a much larger data set of 87 million patients, where similar results were observed and the study expanded to include prevention and delay of "wet" AMD, the most devastating form of the disease.

About the USC Eye Institute 

The USC Eye Institute, part of the Keck Medicine of USC university-based medical enterprise, has been a leader in scientific research and innovative clinical treatments for 40 years.  Among the top three funded academic-based medical centers by the National Eye Institute (NEI) research grants and ranked in the Top 10 ophthalmology departments in U.S. News & World Report's annual "Best Hospitals" issue for the last 20 years, the USC Eye Institute is headquartered in Los Angeles with clinics in Arcadia, Beverly Hills, downtown Los Angeles and Pasadena. 

Patients from across the country come to see the USC Eye Institute experts who treat a vast array of eye diseases across the life spectrum from infants to aging seniors. The USC Eye Institute is known for its scientific research and clinical innovation including: creation of the Argus implant for Retinitis pigmentosa patients (known as the "bionic eye"); stem cell research for AMD patients; discovery of the gene that is the cause of the most common eye cancer in children; treatment for eye infections for AIDS patients; inventors of the most widely used glaucoma implant in the world; pioneers of a device for long-term intraocular drug delivery; and the first to use telesurgery to train eye doctors in developing countries.  For more information visit: eye.keckmedicine.org.

http://health.einnews.com/article/300043912/Iu5k2CaKoBXNu14K

Read more at Reutershttp://www.reuters.com/article/2015/12/03/usc-eye-inst-findings-
idUSnPnbhtSFv+86+PRN20151203#hdB7GALekPJhKFJR.99

Liquorice could be used to treat Alzheimer's and Parkinson's

 1 DEC 2015  BY FIONA PARKER

Currently 850,000 people in the UK are living with Alzheimer’s, but this number is expected to soar to over one million by 2025

   

Delicious: Synthetic liquorice sweets

Liquorice root extract could be used to treat Alzheimer’s and other neurodegenerative diseases such as Parkinson’s and Huntington’s, a study revealed. 

Salicylic acid, a bitter chemical found in some plants and a critical hormone for regulating plants’ immune systems , is also a component in aspirin. 

It binds to the enzyme GAPDH, which is believed to play a role in neurodegenerative diseases stopping the enzyme moving into a cell’s nucleus where it can trigger its death.

But derivatives, such as from liquorice or synthesised versions, were even more effective than aspirin in stopping the enzyme.

Currently 850, 000 people in the UK are living with Alzheimer’s, but this number is expected to soar to over one million by 2025.

There are around 127,000 Parkinson’s sufferers and 12 in 100,000 have Huntington’s - an inherited condition that damages nerve cells in the brain. 

The anti-Parkinson’s drug deprenyl also blocks GAPDH’s entry into the nucleus but the study suggests salicylic acid can achieve the same goal.

Glyceraldehyde 3-Phosphate Dehydrogenase (GADPH) is a central enzyme in glucose metbolism, but it also plays additional roles in cells.

Under oxidative stress - an excess of free radicals and other reactive compounds -GAPDH is modified and then enters the nucleus of neurons.

It increases protein turnover, the balance between protein synthesis and protein degradation.

More synthesis than breakdown indicates an anabolic state that builds lean tissues, more breakdown than synthesis indicates a catabolic state that burns lean tissues.

The finding found GADPH led to a catabolic state and cell death which occurs in brain cells in neurodegenerative conditions.

Cruel: Man suffering from Alzheimer's (picture posed by model)

Currently 850,000 people in the UK are living with Alzheimer’s, but this 

number is expected to soar to over one million by 2025

 Solomon Snyder, from Johns Hopkins University said: “The enzyme GAPDH, 

long thought to function solely in glucose metabolism, is now known to participate in
 intracellular signalling.

“The new study establishes that GAPDH is a target for salicylate drugs related

 to aspirin, and hence may be relevant to the therapeutic actions of such drugs.”

Previous research has identified ‘targets’ that the acid binds to in plants, and

 many of these have equivalent targets in humans.

Earlier this year lead author Professor Daniel Klessig at Boyce Thompson Institute and 

Cornell University identified another novel target of salicylic acid called HMGB1 

(High Mobility Group Box 1).

HMGB1 causes inflammation and is associated with several diseases, including 

arthritis, lupus, sepsis, atherosclerosis and certain cancers.

Low levels of salicylic acid block these pro-inflammatory activities, and the 

salicylic acid derivatives were 40 to 70 times more potent than salicylic acid at 

inhibiting these pro-inflammatory activities.

Professor Klessig said: “A better understanding of how salicylic acid and its derivatives regulate the activities of GAPDH and HMGB1, coupled with the discovery of much more potent synthetic and natural derivatives of salicylic acid, provide great promise for the development of new and better salicylic acid-based treatments of a wide variety of prevalent, devastating diseases.”

Salicylic acid is used in skin care products including anti-dandruff shampoos and acne treatments.

Natural sources include blackberries, blueberries, grapes, kiwi fruits, apricots, green pepper, olives, tomatoes, radish, chicory, almonds, water chestnuts and peanuts.

The study was published in the journal PLOS ONE.

http://health.einnews.com/article/299711357/_6ROpFwFyDBQeLWk

Korean MFDS approves InSightec's Exablate Neuro system to treat movement, pain and behavioral disorders

Published on November 30, 2015

Elbit Imaging Ltd. (TASE, NASDAQ: EMITF) ("Elbit" or the "Company") announced today that it was informed by InSightec Ltd. ("InSightec"), that the Korean Ministry of Food and Drug Safety (MFDS) has approved its Exablate Neuro system to treat movement, pain and behavioral disorders.

Insightec's Exablate Neuro platform is transforming medicine by presenting a non-invasive treatment alternative that combines two technologies: Focused Ultrasound, which is used to lesion the targeted tissue deep in the brain, and Magnetic Resonance Imaging (MRI), which is used to guide the ultrasound waves to the specific target tissue and provide real-time feedback on treatment progress and outcome. The result of the above integration is a breakthrough therapy platform that enables outpatient procedures.

This regulatory approval allows Korean patients suffering from neurological disorders which cause significant disability access to a new, non-invasive treatment option that does not require open surgery. Previous treatment options for patients who do not respond to drugs include deep brain stimulation, radiofrequency ablation and radiosurgery which are highly invasive and/or involve risks such as ionizing radiation, infection, bleeding and collateral brain tissue damage.

The Company holds approximately 89.9% of the share capital of Elbit Medical Technologies Ltd. (TASE: EMTC-M) (on a fully diluted basis) which, in turn, holds approximately 29.6% of the share capital in InSightec (on a fully diluted basis).

http://www.news-medical.net/news/20151130/Korean-MFDS-approves-InSightecs-Exablate-Neuro-system-to-treat-movement-pain-and-behavioral-disorders.aspx

Engineering the Brain: Ethical Issues and the Introduction of Neural Devices

Dec. 1, 2015

Eran Klein, Tim Brown, Matthew Sample, Anjali R. Truitt, and Sara Goering

Neural engineering technologies such as implanted deep brain stimulators for Parkinson's disease and brain-computer interfaces represent exciting and potentially transformative tools for improving human health and well-being. But they raise ethical and philosophical concerns about identity, normality, authority, responsibility, privacy, and justice. 

If a device is stimulating my brain while I decide upon an action, am I still the author of the action? Does a device make my personal experience accessible to others? Will the device change the way I think of myself and others think of me? Devices currently under development--such as the BrainGate System of implanted brain sensors coupled to robotics in persons with paralysis and brain-to-brain interfacing--promise to extend and deepen these debates. 

The authors are part of a National Science Foundation-funded engineering research center tasked with investigating philosophical and social implications of neural engineering research and technologies. 

In the "Another Voice" column, Ronald M. Green, professor emeritus for the study of ethics and human values at Dartmouth College, examines the "ethical novelty" of deep brain stimulation compared with potent psychiatric drugs. He concludes, "It is not simply the fact that neural technologies pose questions of identity, privacy, and the like but that they do so with a degree of intensity that creates qualitatively new challenges."

http://www.medicalnewstoday.com/releases/303381.php?tw

Progression of Parkinson's disease hard to predict

Posted: Monday, November 30, 2015 7:28 am

DEAR MAYO CLINIC: My father is 64 and was diagnosed with Parkinson's last year. So far his symptoms are very mild, but I'm wondering what the typical progression of the disease is like. I have read that deep brain stimulation is sometimes recommended. When is this type of treatment usually considered? Is it safe?

The symptoms of Parkinson's disease, or PD, tend to begin very gradually and then become progressively more severe. The rate of progression is hard to predict and is different from one person to another. Treatment for PD includes a variety of options, such as exercise, medication and surgery. Deep brain stimulation is one surgical possibility for treating PD, but it's usually only considered in advanced cases when other treatments don't effectively control symptoms.Parkinson's disease is a syndrome which typically has no known cause. The diagnosis is based on symptoms. Neurologists who specialize in movement disorders typically have the most experience with PD diagnosis and treatment. There are many symptoms of parkinsonism. The most common include excessive slowness and lack of movement, as well as shaking or tremor.As in your father's situation, symptoms are often mild at the outset. How quickly they get worse varies substantially, perhaps because there may be multiple underlying causes of the disease. In most cases, symptoms change slowly, with substantive progression taking place over the space of many months or years.

Many people with PD have symptoms for at least a year or two before a diagnosis is actually made. The longer symptoms are present, the easier it is to predict how a person with PD will do over time. In those who have tremor and symptoms on one side of the body only, the disease typically advances more slowly than in those without tremor who have symptoms that affect both sides of the body, as well as walking.

While life expectancy is marginally reduced, people with PD usually function quite well for many years. They are, however, at an increased risk to develop instability that could lead to falls. They also have a higher risk for dementia. These two possibilities represent the greatest potential difficulties for those with PD.

While no treatment is currently available to slow the natural progression of PD, this condition is by far the most treatable of all neurodegenerative disorders. The vast majority of patients see major improvements in their symptoms with treatment that includes exercise and medication. For example, most people who have PD are able to function better in their daily lives five years after they start medication treatment than they were before they started treatment.

Surgery is only rarely required to treat PD, and usually is in the form of deep brain stimulation. This procedure involves placing an electrode into the brain that is connected to a battery. It delivers a small electric discharge into the brain, which influences the brain circuitry and improves symptoms.

Most people who undergo surgery for PD have had symptoms for at least five years. Surgery can be helpful when medications don't consistently control symptoms or when tremor persists despite medication. Serious complication rates for deep brain stimulation surgery are low, with most institutions reporting a 1 to 2 percent risk for serious side effects.

Several other disorders similar to PD, known as atypical parkinsonism, have a less favorable long-term outlook than PD. In some cases, it can be hard to distinguish these conditions from PD. After several years of symptoms, however, determining the correct diagnosis is relatively straightforward.

Working closely with his neurologist, it is likely that your father will be able to achieve acceptable PD symptom control. It's important that he contact his physician if he notices changes in symptoms, so treatment can be adjusted as needed over time. — Ryan Uitti, M.D., Neurology, Mayo Clinic, Jacksonville, Fla.

http://www.postbulletin.com/life/lifestyles/progression-of-parkinson-s-disease-hard-to-predict/article_9016e77a-08e0-5575-a1f5-80adbabb20ff.html

Nobody ever thought I had Parkinson’s disease – I was just 10 years old”

On National Day of Parkinson’s in Italy we hear one Italian girl’s extraordinary story of how she’s coped with Parkinson’s from the tender age of 10 

PERSPECTIVES 

Author: Elisa RovelliPublished: 28 November 2015

The average age for the onset of Parkinson’s disease is 60. So, imagine first experiencing the symptoms at 10 years old. That’s what happened to Elisa Rovelli, from Bologna in Italy, who is now 29. After being misdiagnosed with dopamine-responsive dystonia, she was eventually told she had Parkinson’s at 19. Here, she recalls a childhood blighted by the condition, blaming herself for being different, and the time she was mistaken for a heroin user by a nun while at convent school.

I was still at primary school in a village of the region called Brianza, in the north of Italy, when I first started feeling weak. I soon lost my balance as my centre of gravity was beginning to shift ahead. When the left side of my body stiffened I started dragging my left leg, which meant I always wore down my shoes.

I went to see many doctors: physiotherapists, neurologists, orthopedists. Nobody ever thought I had Parkinson’s disease because I was too young – I was just 10 years old.

I got worse year after year. Then other symptoms appeared, such as tremor and postural instability. Walking also became hard. At 17, I was almost paralysed by pain and tiredness.

The mornings were the only time I could make a few steps without becoming exhausted. The only symptom I’ve never had is speech impairment as I’ve always tried to train my speaking skills – a trained brain means a lot while the body struggles.

Before I turned 18, I was diagnosed with dopamine-responsive dystonia (DRD). Doctors prescribed me the drug, levodopa. Everything was better with half a tablet of levodopa a day. But the diagnosis of 2004 was wrong. I was diagnosed with PARK2 – a form of genetic Parkinson’s – in 2006 thanks to a more specific genetic test. I was 19.

Too young to understand

I understood the deficiency that made me different was outside of my control. I was living between my family who couldn’t help me and the pain of being different and not accepted by society.

My parents couldn’t be my role models because I was different to them – I’ve never had any guidance, anyone I could look up to. I felt like I was alone with the condition. This was particularly painful during the seven years of my life when I didn’t have a diagnosis.

Unfortunately, it forced me to grow up very quickly and I was no longer a ‘child’ when I was diagnosed. I didn’t know anything of my illness. I thought I was the problem.

“I didn’t know anything of my illness. I thought I was the problem”

Parkinson’s is destabilising and its treatment is nothing but a temporary fix. Living with Parkinson’s is like living with a bleeding cut in your throat. I’ve had this for 20 years. It bleeds the whole day, except when you are under levodopa and ropinirole. But these drugs don’t cure you. The wound stops bleeding for a while, but you know it will open again.

The awareness of the condition being there all the time preys on my mind and prevents me from expressing my ideas in the way someone at 29 with all her cognitive capabilities should do. I fight everyday but I don’t blame people who don’t. Anyway, this is the only life I have. And it’s one that’s worth living.

Friends for life

At the age of 11 my friends and I were not kids anymore. We were already very independent: we cooked by ourselves, we took our bikes and went out on our own.

My friends didn’t care if I was crippled, if I lost my balance or if had to stop in the middle of the street. They wanted to stay with me because I was Elisa, not the girl with a weird illness. I was happy.

There has always been two categories of people: the ones who see Elisa and the ones who see my illness. I’ve always preferred the first category.

I remember when my schoolmates went to Paris, but I couldn’t go. They sent me a postcard, a letter and a souvenir but I was stuck at home. I couldn’t do what they were doing, which upset me.

“My friends didn’t care if I was crippled. They wanted to stay with me because I was Elisa, not the girl with a weird illness”

Although it was hard to live without a clear diagnosis for seven years, without the ‘shield’ of Parkinson’s that could have justified me being different, now I feel nostalgic about that time of my youth when I was happy.

At school, my teachers understood I had a problem and were very patient. They always tried to value me for what I was able to do in terms of intellectual work.

It was actually my chemistry teacher, in 2003, when I was 16, who told me I had to do something to feel better and convinced my mother to withdraw me from school.

Lack of parental guidance

My mum didn’t understand what was going on. She kept sending me to school and when she brought me to the doctor we had to walk or go by train. She didn’t understand I was always weak and tired because of an illness. But at least she was trying to help me. My dad was never around but he was financially supporting me.

I’ve always made do with what I had. But I can’t say my family environment helped me to make me feel a hero. Actually, my parents realise only now, after 20 years, that I have a problem!

Also I left home when I was 20, as I wanted to try to live a normal life, without any external help. I went to university but I left when I found a job in a big bookshop, where I love what I do. I love what I’ve learnt but now everything is becoming hard.

Dealing with skepticism

It’s even harder to deal with when you’re not only ill, but people also don’t believe that you have an illness – or they suspect it might be something else.

For example, I remember I was at the convent school and a nun sent me a harsh letter, which said she was very worried about me consuming heroin – she mistook my tremors for the withdrawal symptoms that drug addicts experience.

“A nun sent me a harsh letter, which said she was very worried about me consuming heroin”

She also called in my mother to tell her I was using drugs. I left that school after this happened. When there’s pressure to prove you’re ill, you are not pretending.

Without proper diagnosis, people believe you even less. And it’s even worse when you’re too young to understand what is wrong with you. Sometimes people thought I was attention seeking, they didn’t take a child in pain seriously. Someone even talked about behavioural troubles linked to my age.

Children on the inside

People should remain children on the inside. It’s when people lose their innocent and spontaneous side that things go wrong. Also educational sessions at school would be useful, for both children and parents.

My main problem has always been the feeling of being wrong without being responsible – or even knowing what was wrong with me – before and after the diagnosis.

I can’t complain too much, I have my ‘breath hours’ thanks to levodopa. However, when it’s too hot in the summer and events of life make me feel depressed, I often stay at home and nobody visits me. This is the heaviest burden: the isolation of minorities, defined by people’s fear of what they perceive to be different.

Live without fear

Children have a special instinct, something similar to animals. They just follow their nature. For me it was natural to seek refuge at my granddad’s house. He was already very old and had a bad heart.

I was his caregiver and he was mine. Despite his difficulty moving, he always cooked risotto for me and bought me Nutella, things that my mother forbade me at home…

What I’ve understood is that when people are at the extremities of life’s spectrum – the young and the old – they are not trapped in social roles.

With my granddad, I was sure about the affection we had for each other. We didn’t see each other very often, as we usually stayed in our rooms, but sometimes we went out and had a chat. That’s the way we helped each other.

“On National Day of Parkinson’s in Italy, I would like people to go beyond their limits”

I also lived near the house of a lady called Luciana. She was like my second mum because I could just go and talk to her. She allowed me to attach my drawings to her kitchen wall and to watch her cooking. I loved doing these things. That’s what I did from the age of 6 until I was 13.

This was a friendship where age didn’t matter, like the one with granddad. Then unfortunately Luciana died. They were two free people who gave me the strength to go on. I’ve found the rest in myself.

On National Day of Parkinson’s in Italy, I would like people to be themselves. To be able to tell the world “that’s the way I feel”. Without fear. Without compassion from anybody. I would like people to go beyond their limits. And live.

http://parkinsonslife.eu/nobody-ever-thought-i-had-parkinsons-disease-i-was-just-10-years-old/#.VluIO1XehFs.facebook