TTS in ALS and Synucleinopathies

Takotsubo syndrome (TTS) is an acute cardiac syndrome characterized by regional left ventricular dysfunction with a peculiar circumferential pattern, which typically results in apical ballooning. Evidence indicates a pivotal role of catecholamines in TTS, and researchers have discussed multiple hypotheses on the etiology, including multivessel coronary spasm, myocardial stunning, excessive transient ventricular afterload, and cardiac sympathetic overactivity with local noradrenaline spillover. Although central nervous system disorders, such as stroke and epilepsy, are known to trigger TTS, the incidence and clinical features of TTS in neurodegenerative disorders are poorly understood. Here, we retrospectively examined TTS cases in a single-center cohort composed of 250 patients with amyotrophic lateral sclerosis (ALS) and 870 patients with synucleinopathies [582 patients with Parkinson’s disease (PD), 125 patients with dementia with Lewy bodies (DLB), and 163 patients with multiple system atrophy (MSA)] and identified 4 (1.6%, including 2 women) cases with ALS and no cases with synucleinopathies. Two ALS patients underwent autopsy and the pathological findings were compatible with the chronological changes identified in catecholamine-induced cardiomyopathy. A literature review identified 16 TTS cases with ALS, 1 case each with PD and DLB, and no cases with MSA. When current and previous TTS cases with ALS were concatenated: 55% (11/20) were female; 35% (7/20) had a bulbar-onset and 45% (9/20) had a limb-onset; the mean age of TTS onset was 63.3 ± 9.0 years and the mean interval time from ALS onset to TTS development was 4.9 ± 3.0 years; no (0/16) patients developed TTS within 12 months after ALS onset; 50% (10/20) underwent artificial ventilations; the mortality was 17% (3/18); and most cases had precipitating factors, and TTS development was associated with gastrostomy, tracheostomy, or infections in 45% (9/20) of the patients. This study demonstrated that ALS is a considerable predisposing factor of TTS and that synucleinopathies rarely cause TTS. The distinct TTS incidence between ALS and synucleinopathies may be due to cardiac sympathetic overactivity in ALS and may also be affected by cardiac sympathetic denervation in synucleinopathies. Moreover, the etiology of TTS in ALS may be reasonably explained by the two-hit theory

Distinct Incidence of Takotsubo Syndrome Between Amyotrophic Lateral Sclerosis and Synucleinopathies: A Cohort Study

Takotsubo syndrome (TTS) is an acute cardiac syndrome characterized by regional left ventricular dysfunction with a peculiar circumferential pattern, which typically results in apical ballooning. Evidence indicates a pivotal role of catecholamines in TTS, and researchers have discussed multiple hypotheses on the etiology, including multivessel coronary spasm, myocardial stunning, excessive transient ventricular afterload, and cardiac sympathetic overactivity with local noradrenaline spillover. Although central nervous system disorders, such as stroke and epilepsy, are known to trigger TTS, the incidence and clinical features of TTS in neurodegenerative disorders are poorly understood. Here, we retrospectively examined TTS cases in a single-center cohort composed of 250 patients with amyotrophic lateral sclerosis (ALS) and 870 patients with synucleinopathies [582 patients with Parkinson's disease (PD), 125 patients with dementia with Lewy bodies (DLB), and 163 patients with multiple system atrophy (MSA)] and identified 4 (1.6%, including 2 women) cases with ALS and no cases with synucleinopathies. Two ALS patients underwent autopsy and the pathological findings were compatible with the chronological changes identified in catecholamine-induced cardiomyopathy. A literature review identified 16 TTS cases with ALS, 1 case each with PD and DLB, and no cases with MSA. When current and previous TTS cases with ALS were concatenated: 55% (11/20) were female; 35% (7/20) had a bulbar-onset and 45% (9/20) had a limb-onset; the mean age of TTS onset was 63.3 ± 9.0 years and the mean interval time from ALS onset to TTS development was 4.9 ± 3.0 years; no (0/16) patients developed TTS within 12 months after ALS onset; 50% (10/20) underwent artificial ventilations; the mortality was 17% (3/18); and most cases had precipitating factors, and TTS development was associated with gastrostomy, tracheostomy, or infections in 45% (9/20) of the patients. This study demonstrated that ALS is a considerable predisposing factor of TTS and that synucleinopathies rarely cause TTS. The distinct TTS incidence between ALS and synucleinopathies may be due to cardiac sympathetic overactivity in ALS and may also be affected by cardiac sympathetic denervation in synucleinopathies. Moreover, the etiology of TTS in ALS may be reasonably explained by the two-hit theory

POPULATION DENSITIES OF DIURNAL MAMMALS SYMPATRIC WITH THE CHIMPANZEES OF THE MAHALE MOUNTAINS, TANZANIA: COMPARISON BETWEEN THE CENSUS DATA OF 1996 AND 2000

A route census was carried out by one observer using the same methods along the same survey routes during the same seasons in 1996 and 2000 to estimate the abundance of medium- and large-sized diurnal mammals within the home range of the chimpanzees of M Group in the Mahale Mountains, western Tanzania. All eight mammalian species censused were known to have been consumed by chimpanzees, and there are other resident predators such as leopards and crowned hawk eagles. No statistically signifi cant differences were found in group densities of gregarious species or individual densities of non-gregarious species between the two data sets. However, frequencies of encounter with and estimates of group size of some species suggested possible decrease (bushbucks) or increase/non-decrease (red-tailed monkeys, yellow baboons, red colobus, warthogs, blue duikers and forest squirrels) from 1996 to 2000, although such an assumption could not be made for blue monkeys due to their low densities in both years. No quantitative predation data for the relevant period exist, but the results show that predation pressure as a whole including hunts by chimpanzees did not seem to exceed population growth rates of the prey mammals, with the exclusion of blue monkeys and the possible exception of bushbucks, during the 1996-2000 period at Mahale

Seed Dispersal by Chimpanzees: Supplementary Note 1

Six species of fruit (Saba florida/Ladolphia owariensis, Garcinia huillensis, Azanza garckeana, Parkia filicoidea, Zanha golungensis, and Strychnos innocua) seeds collected from chimpanzee feces were tested for germinability in the Mahale Mts., western Tanzania. Among the seeds tested, there were viable ones from all 6 species. This indicates, together with the previous study, that virtually all fruit species whose seeds are commonly seen in chimpanzee feces between September and November in Mahale are effectively disseminated by chimpanzees

Drosophilid Flies (Diptera) in the Mahale Mountains National Park, Tanzania: A Preliminary Report

Eight species of drosophilids were collected at Kasoje in the Mahale Mountains National Park, western Tanzania, during the wet season of 1983-1984; one circumtropical species and seven Afrotropical species, all of which are all new records from Tanzania. The distributions of respective species known so far suggest some affinities in the drosophilid fauna between the Mahale Mountains and central and western Africa