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Oxidative Stress and Environmental Exposures are Associated with Multiple System Atrophy in Chinese Patients

  • Linli Zhou (a1), Ying Jiang (a1), Cansheng Zhu (a1), Lili Ma (a1), Qiling Huang (a1) and Xiaohong Chen (a1) (a2)...
Abstract

Objective: Oxidative stress is involved in the pathogenesis of multiple system atrophy (MSA). The aim of this study is to examine oxidant biomarkers including homocysteine (Hcys), bilirubin, uric acid, lipids, and potential environmental risk factors and to ascertain whether these data correlate with MSA in a Chinese population. Methods: In this study, serum levels of Hcys, bilirubin, uric acid, and lipids were studied in 55 MSA patients and 76 healthy controls (HCs). Education, anti-parkinsonian agent usage, smoking, drinking, farming, and living area of the subjects also were analyzed. The Unified MSA Rating Scale (UMSARS), Hoehn & Yahr stage, International Cooperative Ataxia Rating Scale, and Mini-Mental State Examination were used to assess the disease severity, the parkinsonism, ataxia, and the cognitive ability of MSA, respectively. Results: The levels of Hcys were higher (p<0.001) and those of total bilirubin (p=0.007), indirect bilirubin (p=0.011), and total cholesterol (p=0.046) were lower in MSA patients than in healthy controls, whereas uric acid levels did not differ significantly between MSA and healthy controls. Moreover, Hcys levels in MSA patients had positive correlations with illness duration (r s =0.422, p=0.001) and UMSARS-I (r s =0.555, p<0.001), respectively. High-density lipoprotein cholesterol levels were negatively correlated with UMSARS-I (r s =−0.325, p=0.015). Farming was more frequent in MSA patients (1-20 years: odds ratio, 6.36; p<0.001; >20 years: odds ratio, 10.26; p=0.001), whereas current smoking was less frequent (odds ratio, 0.13, p=0.002). Conclusions: Elevated Hcys and decreased high-density lipoprotein cholesterol may be associated with the disease severity of MSA. Environmental exposures such as farming and smoking may contribute to the occurrence but not the progression of MSA.

Le stress oxydatif et l’exposition ambiante associés à l’atrophie multi-systématisée chez des patients chinois. Objectif: On le sait, le stress oxydatif est impliqué dans la pathogénèse de l’atrophie multi-systématisée (AMS). Le but de cette étude est donc de passer en revue des marqueurs biologiques, notamment l’homocystéine, la bilirubine, l’acide urique, et des facteurs de risque potentiels d’origine environnementale pour ensuite déterminer dans quelle mesure il existe un lien entre ces données et l’AMS dans un groupe de la population chinoise. Méthodes: Dans cette étude, nous avons analysé les lipides et les taux sériques d’homocystéine, de bilirubine et d’acide urique de 55 patients atteints d’AMS et de 76 sujets témoins en bonne santé (healthy controls). Nous avons aussi analysé les niveaux d’instruction, la prise de médicaments antiparkinsoniens, le tabagisme, la consommation d’alcool, la pratique de l’agriculture et les lieux de vie de ces individus. À cet effet, nous avons utilisé l’UMSARS-I (Unified MSA Rating Scale), l’échelle de Hoehn et Yahr, l’échelle ICARS (International Cooperative Ataxia Rating Scale) et le test de Folstein (Mini-Mental State Examination) pour évaluer respectivement la gravité de leur maladie, leur syndrome parkinsonien, leur ataxie et leurs capacités cognitives. Résultats: D’emblée, les niveaux d’homocystéine se sont révélés plus élevés (p<0.001). Les niveaux de bilirubine totale (p=0.007) et de bilirubine indirecte (p=0.011), de même que le taux de cholestérol total (p=0.046), se sont ensuite révélés moins élevés chez les patients atteint d’AMS que chez les sujets témoins en bonne santé alors que les niveaux d’acide urique de ces patients et de ces sujets témoins n’ont pas différé grandement. Qui plus est, nous avons observé une corrélation positive entre les niveaux d’homocystéine des patients atteints d’AMS et, respectivement, la durée de la maladie (rs=0.422, p=0.001) et l’UMSARS-I (rs=0.555, p<0.001). Les taux de lipoprotéines de haute densité ont été aussi négativement corrélés avec l’UMSARS-I (rs=-0.325, p=0.015). Fait à noter, la pratique de l’agriculture était plus répandue chez les patients atteints d’AMS (1-20 ans: risque relatif rapproché, 6,36 ; p<0.001; > 20 ans: risque relatif rapproché, 10,26 ; p=0.001), tandis que le tabagisme l’était moins (risque relatif rapproché, 0,13 ; p=0.002). Conclusions: Il se peut que les niveaux élevés d’homocystéine et que les taux réduits de lipoprotéines de haute densité soient associés à la gravité de l’AMS. Il se peut aussi que des facteurs environnementaux tels que la pratique de l’agriculture et le tabagisme contribuent à l’apparition de l’AMS et non à sa progression.

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Copyright
Corresponding author
Correspondence to: Xiaohong Chen, Department of Neurology (LZ, YJ, CZ, LM, QH, XC), The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, Guangdong 510630, China. Email: xiaohongchenzssy@aliyun.com
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