title: Mechanisms, models and biomarkers in amyotrophic lateral sclerosis.
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.
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, UK. martin.turner@ndcn.ox.ac.uk
authors.forename: Martin R
authors.initials: MR
authors.lastname: Turner
authors.forename: Robert
authors.initials: R
authors.lastname: Bowser
authors.forename: Lucie
authors.initials: L
authors.lastname: Bruijn
authors.forename: Luc
authors.initials: L
authors.lastname: Dupuis
authors.forename: Albert
authors.initials: A
authors.lastname: Ludolph
authors.forename: Michael
authors.initials: M
authors.lastname: McGrath
authors.forename: Giovanni
authors.initials: G
authors.lastname: Manfredi
authors.forename: Nicholas
authors.initials: N
authors.lastname: Maragakis
authors.forename: Robert G
authors.initials: RG
authors.lastname: Miller
authors.forename: Seth L
authors.initials: SL
authors.lastname: Pullman
authors.forename: Seward B
authors.initials: SB
authors.lastname: Rutkove
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shefner
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Fischbeck
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000235:genetics / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology*; D000818:Animals; D015415:Biomarkers / Q000378:metabolism*; D004195:Disease Models, Animal; D006801:Humans; D028361:Mitochondrial Diseases / Q000503:physiopathology; D059906:Neuroimaging; D018384:Oxidative Stress / Q000502:physiology
chemical_list: D015415:Biomarkers