Multiple system atrophy (MSA) is a progressive, neurodegenerative disorder characterized clinically by the combination of varying degrees of Parkinsonism and/or cerebellar ataxia, autonomic dysfunction and an inexorable progression to death in a few years, whereas Parkinson's disease (PD) and PD with autonomic failure (PD_AF) have a more benign prognosis. This project is part of a highly integrated PPG focused on defining the diagnosis, course and pathogenesis of MSA. This project is based on the central hypothesis that clinical and laboratory indices, especially autonomic indices, will differentiate MSA, PD, and PD_AF and will predict outcome. We will prospectively test the hypothesis within three specific aims.
Specific aim #1 will differentiate MSA from PD and PD_AF using selected clinical features, a standardized autonomic symptom profile evaluating seven domains of autonomic dysfunction, and standardized autonomic function tests. These evaluate cardiovagal, adrenergic, and sudomotor functions.
Specific aim #2 will be achieved in a series of mechanistic studies undertaken to identify pathophysiologic autonomic differences between MSA, PD, and PDAF. These studies will be focused on autonomic regulation at the levels of autonomic neurons, arteriole, and vein. The autonomic lesion in MSA is preganglionic, that of PD postganglionic (at least in the heart), while that of PD_AF is uncertain (but likely to be postganglionic sympathetic). Within this specific aim, we will undertake direct microneurographic recordings of sympathetic discharges of the peroneal nerve to differentiate the three conditions. We will undertake pharmacologic dissection studies to differentiate preganglionic from postganglionic disorders. We will also be able to undertake direct studies on vasoreactivity of veins in vivo to provide the same information in a different effector (vein instead of arteriole).
Specific aim #3 is a prospective study of patients with MSA, PD, and PD_AF where we evaluate predictors of more rapid rate of progression. Specifically, we predict that certain indices (autonomic and clinical) predict outcome, defined as the time in months from (a) first clinical feature and (b) diagnosis, to Hoehn and Yahr stage IV. Specifically, we posit that a higher deficit score on autonomic reflex screen, on the symptom profile, and certain clinical features (dopa unresponsiveness, absence of dyskinesias) are predictive of a bad outcome. As part of a PPG, these patients will also be evaluated in Project 1 (for risk factors) via the Data and Administrative and Clinical Cores, DNA from these patients will, via the DNA core, be provided to Projects 2 and 3 for molecular studies on synuclein and patients will be earmarked for eventual pathologic confirmation and segregation into the appropriate diagnostic groups.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Program Projects (P01)
Project #
Application #
Study Section
National Institute of Neurological Disorders and Stroke Initial Review Group (NSD)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Diego
La Jolla
United States
Zip Code
Coon, Elizabeth A; Ahlskog, J Eric; Silber, Michael H et al. (2018) Do selective serotonin reuptake inhibitors improve survival in multiple system atrophy? Parkinsonism Relat Disord 48:51-53
Ogaki, Kotaro; Martens, Yuka A; Heckman, Michael G et al. (2018) Multiple system atrophy and apolipoprotein E. Mov Disord 33:647-650
Wenning, Gregor; Trojanowski, John Q; Kaufmann, Horacio et al. (2018) Is multiple system atrophy an infectious disease? Ann Neurol 83:10-12
Cutsforth-Gregory, Jeremy K; McKeon, Andrew; Coon, Elizabeth A et al. (2018) Ganglionic Antibody Level as a Predictor of Severity of Autonomic Failure. Mayo Clin Proc 93:1440-1447
Rockenstein, Edward; Ostroff, Gary; Dikengil, Fusun et al. (2018) Combined Active Humoral and Cellular Immunization Approaches for the Treatment of Synucleinopathies. J Neurosci 38:1000-1014
Singer, Wolfgang; Berini, Sarah E; Sandroni, Paola et al. (2017) Pure autonomic failure: Predictors of conversion to clinical CNS involvement. Neurology 88:1129-1136
Valera, Elvira; Spencer, Brian; Mott, Jennifer et al. (2017) MicroRNA-101 Modulates Autophagy and Oligodendroglial Alpha-Synuclein Accumulation in Multiple System Atrophy. Front Mol Neurosci 10:329
Valera, Elvira; Spencer, Brian; Fields, Jerel A et al. (2017) Combination of alpha-synuclein immunotherapy with anti-inflammatory treatment in a transgenic mouse model of multiple system atrophy. Acta Neuropathol Commun 5:2
Coon, Elizabeth A; Fealey, Robert D; Sletten, David M et al. (2017) Anhidrosis in multiple system atrophy involves pre- and postganglionic sudomotor dysfunction. Mov Disord 32:397-404
El-Agnaf, Omar; Overk, Cassia; Rockenstein, Edward et al. (2017) Differential effects of immunotherapy with antibodies targeting ?-synuclein oligomers and fibrils in a transgenic model of synucleinopathy. Neurobiol Dis 104:85-96

Showing the most recent 10 out of 159 publications