title: Ceruloplasmin activity and iron chelation treatment of patients with Parkinson's disease.
abstract: BACKGROUND
  Growing body of evidence suggests that Parkinson's disease (PD) is associated with oxidative damage via iron accumulation in the substantia nigra (SN). Low ceruloplasmin (CP)-ferroxidase activity has been identified in the SN and the cerebrospinal fluid (CSF) of patients with PD. The iron chelator, deferiprone, reduces the abnormally high levels of iron in the SN. In order to determine CP's involvement in iron accumulation in SN and PD progression, we aim to compare the ability of iron chelation treatment to reducing both SN iron levels and motor handicap in PD patients according to the level of ceruloplasmin activity.
  
  
  METHODS
  We used a moderate chelation protocol with deferiprone (DFP) based on a, 6-month delayed-start paradigm, randomized placebo controlled clinical trial in 40 PD patients. CP-ferroxidase activity was determined in blood and CSF together with the D544E gene polymorphism (rs701753). Iron levels were determined by R2* MRI sequence and the motor handicap by the UPDRS motor score.
  
  
  RESULTS
  After 6 to 12 months of DFP treatment, greater reductions in SN iron levels and UPDRS motor scores were obtained in patients with higher serum and CSF levels of CP-ferroxidase activity. After 6 months of DFP treatment, the AT genotype group displayed greater reduction of iron level in the SN with greater CSF and serum levels of CP activity than the AA genotype group.
  
  
  CONCLUSIONS
  Although most of the DFP-treated patients displayed clinical and radiological improvements, those with the lower CP activity appeared to respond better to iron chelation. Larger RCTs are now needed to establish whether pharmacological modulation of CP activity could be an innovative neuroprotective strategy in PD.
  
  
  BACKGROUND
  FAIR-PARK study (ClinicalTrials.gov reference: NCT00943748 ; French national reference number: 2008-006842-25). This study was approved by the French Drug Agency (ANSM) and the local institutional review board ("Comité de Protection des Personnes of Lille").
authors.affiliation: Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. guillaume.grolez2@chru-lille.fr.|INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. guillaume.grolez2@chru-lille.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Grolez
authors.affiliation: Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. caroline.moreau@chru-lille.fr.|INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. caroline.moreau@chru-lille.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Moreau
authors.affiliation: Department of Molecular Biology and Pathology Centre, Unit 837, Team 1, INSERM Lille Faculty of Medicine, Lille University Hospital, Lille Nord de France University, Lille, France. bernard.sablonniere@inserm.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Sablonnière
authors.affiliation: Department of Toxicology, Public Health and Environment, EA 4483, Faculty of Pharmaceutic and Biological Sciences, Lille Nord de France University, Lille, France. guillaume.garcon@univ-lille2.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Garçon
authors.affiliation: Department of Medical Pharmacology, Lille Nord de France University, Lille, France. Jean-Christophe.Devedjian@univ-littoral.fr.|INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. Jean-Christophe.Devedjian@univ-littoral.fr.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Devedjian
authors.affiliation: Department of Medical Pharmacology, Lille Nord de France University, Lille, France. sayahmeguig@hotmail.fr.
authors.forename: Sayah
authors.initials: S
authors.lastname: Meguig
authors.affiliation: Biological Resources Centre, Lille University Hospital, Lille, France. patrick.gele@univ-lille2.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Gelé
authors.affiliation: INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. christine.chd@gmail.com.|Department of Neuroradiology, Lille University Hospital, Lille, France. christine.chd@gmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Delmaire
authors.affiliation: Department of Medical Pharmacology, Lille Nord de France University, Lille, France. regis.bordet@univ-lille2.fr.|INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. regis.bordet@univ-lille2.fr.
authors.forename: Regis
authors.initials: R
authors.lastname: Bordet
authors.affiliation: Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. luc.defebvre@chru-lille.fr.|INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. luc.defebvre@chru-lille.fr.
authors.forename: Luc
authors.initials: L
authors.lastname: Defebvre
authors.affiliation: Della Pergola Chair, Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel. ioav.caban@mail.huji.ac.il.
authors.forename: Ioav Z
authors.initials: IZ
authors.lastname: Cabantchik
authors.affiliation: Department of Medical Pharmacology, Lille Nord de France University, Lille, France. david.devos@chru-lille.fr.|Department of Movement Disorders and Neurology, Lille Nord de France University, Lille, France. david.devos@chru-lille.fr.|INSERM U1171, Lille Faculty of Medicine, Lille Nord de France University, Lille, France. david.devos@chru-lille.fr.|Department of Toxicology, Public Health and Environment, EA 4483, Faculty of Pharmaceutic and Biological Sciences, Lille Nord de France University, Lille, France. david.devos@chru-lille.fr.
authors.forename: David
authors.initials: D
authors.lastname: Devos
mesh_terms: D000368:Aged; D002570:Ceruloplasmin / Q000378:metabolism*; D015913:Chelation Therapy / Q000379:methods*; D002985:Clinical Protocols; D000077543:Deferiprone; D005260:Female; D006801:Humans; D007501:Iron / Q000378:metabolism*; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D011728:Pyridones / Q000627:therapeutic use*; D013378:Substantia Nigra / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D007502:Iron Chelating Agents; D011728:Pyridones; D000077543:Deferiprone; D007501:Iron; D002570:Ceruloplasmin