This RDCRC on Rare Autonomic Diseases encompasses 5 major centers: Vanderbilt University, Mayo/Rochester, New York University, Beth Israel Deaconess/Harvard, and the NINDS/Clinical Center. Major support groups for autonomic disorders are engaged and participate. During the renewal period, our research efforts will focus on the rare autonomic diseases of multiple system atrophy (MSA), pure autonomic failure (PAF), and hyperadrenergic postural tachycardia syndrome (POTS), as well as dementia with Lewy bodies and other synucleinopathies. The overall objectives of our Consortium are to improve our understanding of the pathophysiology of these diseases to develop novel therapies to not only alleviate patients' symptoms but also to intervene in disease progression, and hopefully when possible to find a cure. Over the past four years, we met virtually all specific goals of our initial funding cycle. We developed a website that educates patients, researchers and clinicians, and assists with recruitment for the various consortium studies. We enrolled 469 patients in the ongoing natural history study of neurogenic orthostatic hypotension (and a total of 656 in all projects). We met target enrollment ahead of schedule in a randomized, double-blind, placebo-controlled trial of rifampicin in patients with MSA. While rifampicin did not improve MSA, this study taught us much, providing valuable insights and strategies that have been incorporated into the design of the clinical projects in our renewal. We also completed enrollment in a proof-of-concept study to examine the role of norepinephrine reuptake blockade as both a diagnostic and therapeutic tool in patients with neurogenic orthostatic hypotension. For this renewal, in addition to continuing with an expanded phenotyping and natural history study, we propose three new clinical projects and three new pilot projects. A trial of mesenchymal stem cells is directed at combating the growth factor deficiency recently identified in MSA. Our studies suggest that atomoxetine can improve orthostatic tolerance. We are proposing similar studies with reducing splanchnic capacitance in neurogenic orthostatic hypotension, harnessing residual sympathetic tone with 3,4- diaminopyridine in MSA and a novel vagal stimulation strategy in hyperadrenergic POTS. These studies will be linked with efforts to expand our development of autonomic biomarkers. Continuation of the Autonomic RDCRC will enable us to build on our recent new knowledge to understand and hopefully alter the course of these diseases. We will work collaboratively with patient advocacy groups. We will address informative biomarkers and elucidate mechanisms to find genuinely effective agents for the rare autonomic diseases.

Public Health Relevance

Autonomic disorders cause loss of regulation of the heart, blood vessels, stomach, bowel and bladder. Affected patients frequently have palpitations or lose consciousness, and some have a rapidly fatal course. The Autonomic Consortium proposes to join with patient support groups to harness the knowledge and energies of physicians and investigators in the major centers where these patients are cared for, so that they can discover ways to treat and to cure these diseases.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
6U54NS065736-08
Application #
9146407
Study Section
Special Emphasis Panel (ZNS1-SRB-S (62))
Program Officer
Sieber, Beth-Anne
Project Start
2009-08-15
Project End
2019-06-30
Budget Start
2016-07-01
Budget End
2017-06-30
Support Year
8
Fiscal Year
2016
Total Cost
$1,250,001
Indirect Cost
$189,137
Name
Vanderbilt University Medical Center
Department
Type
DUNS #
079917897
City
Nashville
State
TN
Country
United States
Zip Code
37232
Singer, Wolfgang; Berini, Sarah E; Sandroni, Paola et al. (2017) Pure autonomic failure: Predictors of conversion to clinical CNS involvement. Neurology 88:1129-1136
Palma, Jose-Alberto; Spalink, Christy; Barnes, Erin P et al. (2017) Neurogenic dysphagia with undigested macaroni and megaesophagus in familial dysautonomia. Clin Auton Res :
Wallach, Asya I; Park, Hannah; Rucker, Janet C et al. (2017) Supranuclear gaze palsy and horizontal ocular oscillations in Creutzfeldt-Jakob disease. Neurology 89:749
Palma, Jose-Alberto; Norcliffe-Kaufmann, Lucy; Perez, Miguel A et al. (2017) Sudden Unexpected Death During Sleep in Familial Dysautonomia: A Case-Control Study. Sleep 40:
Coon, Elizabeth A; Low, Phillip A (2017) Pure autonomic failure without alpha-synuclein pathology: an evolving understanding of a heterogeneous disease. Clin Auton Res 27:67-68
Mendoza-Santiesteban, Carlos E; Palma, Jose-Alberto; Hedges 3rd, Thomas R et al. (2017) Pathological Confirmation of Optic Neuropathy in Familial Dysautonomia. J Neuropathol Exp Neurol 76:238-244
Kaufmann, Horacio; Jordan, Jens (2017) The Clinical Autonomic Research journal 2017 and onward. Clin Auton Res 27:1-2
Spalink, Christy L; Barnes, Erin; Palma, Jose-Alberto et al. (2017) Intranasal dexmedetomidine for adrenergic crisis in familial dysautonomia. Clin Auton Res 27:279-282
Bajaj, Sweta; Krismer, Florian; Palma, Jose-Alberto et al. (2017) Diffusion-weighted MRI distinguishes Parkinson disease from the parkinsonian variant of multiple system atrophy: A systematic review and meta-analysis. PLoS One 12:e0189897
Mendoza-Santiesteban, Carlos E; Palma, Jose-Alberto; Norcliffe-Kaufmann, Lucy et al. (2017) Familial dysautonomia: a disease with hidden tears. J Neurol 264:1290-1291

Showing the most recent 10 out of 133 publications