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Review
. 2013 May;14 Suppl 1(0 1):19-32.
doi: 10.3109/21678421.2013.778554.

Mechanisms, models and biomarkers in amyotrophic lateral sclerosis

Martin R Turner  1 , Robert Bowser, Lucie Bruijn, Luc Dupuis, Albert Ludolph, Michael McGrath, Giovanni Manfredi, Nicholas Maragakis, Robert G Miller, Seth L Pullman, Seward B Rutkove, Pamela J Shaw, Jeremy Shefner, Kenneth H Fischbeck
Affiliations
Review

Mechanisms, models and biomarkers in amyotrophic lateral sclerosis

Martin R Turner et al. Amyotroph Lateral Scler Frontotemporal Degener. 2013 May.

Abstract

The last 30 years have seen a major advance in the understanding of the clinical and pathological heterogeneity of amyotrophic lateral sclerosis (ALS), and its overlap with frontotemporal dementia. Multiple, seemingly disparate biochemical pathways converge on a common clinical syndrome characterized by progressive loss of upper and lower motor neurons. Pathogenic themes in ALS include excitotoxicity, oxidative stress, mitochondrial dysfunction, neuroinflammation, altered energy metabolism, and most recently RNA mis-processing. The transgenic rodent, overexpressing mutant superoxide dismutase-1, is now only one of several models of ALS pathogenesis. The nematode, fruit fly and zebrafish all offer fresh insight, and the development of induced pluripotent stem cell-derived motor neurons holds promise for the screening of candidate therapeutics. The lack of useful biomarkers in ALS contributes to diagnostic delay, and the inability to stratify patients by prognosis may be an important factor in the failure of therapeutic trials. Biomarkers sensitive to disease activity might lessen reliance on clinical measures and survival as trial endpoints and reduce study length. Emerging proteomic markers of neuronal loss and glial activity in cerebrospinal fluid, a cortical signature derived from advanced structural and functional MRI, and the development of more sensitive measurements of lower motor neuron physiology are leading a new phase of biomarker-driven therapeutic discovery.

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Conflict of interest statement

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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