Multicenter ALS Cohort Study of Oxidative Stress and Disease Progression

描述（由首席研究员提供）：肌萎缩性侧索硬化症（ALS）是一种毁灭性的、迅速致命的神经退行性疾病，主要原因未知。临床特征为进行性骨骼肌麻痹和最终呼吸衰竭，症状发作后平均生存期约为40个月。没有前瞻性调查试图确定什么因素加速或减缓疾病进展。最近的临床和流行病学研究表明，多种环境和生活方式因素与ALS有关，并产生氧化应激（OS）。我们假设这些外在因素在整个病程中起作用，产生不同程度的OS，从而影响疾病进展。我们建议在美国11个ALS中心的420名新诊断的ALS患者中验证这一假设。我们的具体目标是：1；通过问卷调查或生物标志物测量，确定OS暴露增加的标志物是否与ALS的进展有关。ALS的进展将通过广泛使用且经过验证的ALS功能量表（ALSFRS-R）来确定，每3至6个月进行一次，持续24个月。在基线和随访时，我们将获得OS生物标志物（尿15- f2t -异前列腺素和8-氧脱氧鸟苷、血浆对氧磷酶I [PON1]水平和PON1功能状态）的测量，并通过结构化访谈测量当前与OS相关的环境、心理、饮食和生活方式因素。2. 研究生存期生物标志物、生存期指数与ALS患者生存期之间的关系。将根据外部因素的总和制定OS指数（Goodman et al. 2007）。在拨款期间，ALS中心将使用国家死亡指数数据跟踪患者的生存情况。我们将测试由指数和生物标志物测量的增加和持续的OS是否影响生存；3. 确定各种环境、生活方式和心理因素是否与基线时OS生物标志物水平升高有关；4. 通过ALSFRS-R和生存来评估脂质谱与ALS进展之间的关系。血脂将在几个时间点进行分析，以确定高胆固醇和低密度脂蛋白是否与更长的生存期有关，正如最近报道的那样（Dupuis et al 2008）；和5。在探索性分析中，确定OS标记物和暴露是否与ALS的不同亚型相关，如球型或脊柱型ALS， ALS伴或不伴额颞叶痴呆（FTD）。据我们所知，这是首次前瞻性、跨学科、深入的多中心ALS OS流行病学调查。我们的项目将增加对疾病预后的疾病机制的理解，并可能是新的治疗和预防方法的第一步，例如针对ALS的氧化应激位点的多种抗氧化治疗。

DESCRIPTION (provided by principal investigator): Amyotrophic lateral sclerosis (ALS) is a devastating, rapidly fatal neurodegenerative disease of largely unknown cause. It is clinically characterized by progressive skeletal muscle paralysis and eventual respiratory failure, with a mean survival of about 40 months after symptom onset. No prospective investigations have attempted to determine what factors accelerate or slow disease progression. Recent clinical and epidemiological studies suggest that diverse environmental and lifestyle factors are associated with ALS and that these generate oxidative stress (OS). We hypothesize that these extrinsic factors act throughout the disease course, generating varying levels of OS, and thus influence disease progression. We propose to test this hypothesis in 420 newly diagnosed ALS patients from 11 ALS centers across the US. We specifically aim: 1. To determine whether markers of increased exposure to OS, measured via questionnaire or biomarkers, are associated with the progression of ALS. ALS progression will be determined with a widely used and well-validated ALS functional scale (the ALSFRS-R) every 3 to 6 months for 24 months. At baseline and follow-up, we will obtain measures of OS biomarkers (urinary 15-F2t-isoprostane and 8- oxodeoxyguanosine, plasma paraoxonase I [PON1] levels, and PON1 functional status) and, through structured interviews, measures of current environmental, psychological, dietary, and lifestyle factors associated with OS. 2. To examine the associations between OS biomarkers, an OS index, and survival of patients with ALS. An OS index will be developed based on a sum of the external factors (Goodman et al. 2007). Survival will be followed at the ALS Centers during the grant period and thereafter by using National Death Index data. We will test whether increased and continuing OS as measured by the index and biomarkers affect survival; 3. To determine whether a variety of environmental, lifestyle, and psychological factors are associated with increased levels of OS biomarkers at baseline; 4. To evaluate associations between lipid profile and ALS progression, as measured by ALSFRS-R and survival. Lipids will be analyzed at several time points to determine whether high cholesterol and LDL are associated with longer survival, as recently reported (Dupuis et al 2008); and 5. In exploratory analyses, to determine whether OS markers and exposures are associated with distinct subtypes of ALS, such as bulbar- or spinal-onset ALS, and ALS with or without fronto-temporal dementia (FTD). To our knowledge, this is the first prospective, interdisciplinary, in-depth multicenter epidemiological investigation of OS in ALS. Our project will increase the understanding of the disease mechanisms involved in disease prognosis and may be the first step toward new treatment and prevention approaches, such as multiple anti- oxidant therapy, to target oxidative stress sites in ALS.